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## : SBC Benefit Category Code System - TTL Representation

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

    <http://hl7.org/fhir/CodeSystem/sbc-benefit-category> a fhir:CodeSystem ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:Resource.id [ fhir:value "sbc-benefit-category"] ;
      fhir:DomainResource.text [
         fhir:Narrative.status [ fhir:value "generated" ] ;
         fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem sbc-benefit-category</b></p><a name=\"sbc-benefit-category\"> </a><a name=\"hcsbc-benefit-category\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">preventive-care<a name=\"sbc-benefit-category-preventive-care\"> </a></td><td>Preventive Care/Screening/Immunization</td><td>Preventive care services, health screenings, and immunizations</td></tr><tr><td style=\"white-space:nowrap\">primary-care-visit<a name=\"sbc-benefit-category-primary-care-visit\"> </a></td><td>Primary Care Visit</td><td>Visits to primary care physicians to treat illness or injury</td></tr><tr><td style=\"white-space:nowrap\">specialist-visit<a name=\"sbc-benefit-category-specialist-visit\"> </a></td><td>Specialist Visit</td><td>Visits to specialist physicians</td></tr><tr><td style=\"white-space:nowrap\">diagnostic-test<a name=\"sbc-benefit-category-diagnostic-test\"> </a></td><td>Diagnostic Test</td><td>X-rays and diagnostic imaging other than CT/PET/MRI</td></tr><tr><td style=\"white-space:nowrap\">imaging<a name=\"sbc-benefit-category-imaging\"> </a></td><td>Imaging (CT/PET/MRI)</td><td>Advanced imaging services including CT scans, PET scans, and MRIs</td></tr><tr><td style=\"white-space:nowrap\">generic-drugs<a name=\"sbc-benefit-category-generic-drugs\"> </a></td><td>Generic Drugs</td><td>Generic prescription medications</td></tr><tr><td style=\"white-space:nowrap\">preferred-brand-drugs<a name=\"sbc-benefit-category-preferred-brand-drugs\"> </a></td><td>Preferred Brand Drugs</td><td>Brand-name prescription medications on the preferred drug list</td></tr><tr><td style=\"white-space:nowrap\">non-preferred-brand-drugs<a name=\"sbc-benefit-category-non-preferred-brand-drugs\"> </a></td><td>Non-Preferred Brand Drugs</td><td>Brand-name prescription medications not on the preferred drug list</td></tr><tr><td style=\"white-space:nowrap\">specialty-drugs<a name=\"sbc-benefit-category-specialty-drugs\"> </a></td><td>Specialty Drugs</td><td>High-cost or specialty prescription medications</td></tr><tr><td style=\"white-space:nowrap\">facility-fee<a name=\"sbc-benefit-category-facility-fee\"> </a></td><td>Facility Fee</td><td>Hospital or facility charges for services</td></tr><tr><td style=\"white-space:nowrap\">physician-surgeon-fee<a name=\"sbc-benefit-category-physician-surgeon-fee\"> </a></td><td>Physician/Surgeon Fees</td><td>Professional fees for physicians and surgeons</td></tr><tr><td style=\"white-space:nowrap\">emergency-room-care<a name=\"sbc-benefit-category-emergency-room-care\"> </a></td><td>Emergency Room Care</td><td>Emergency department services</td></tr><tr><td style=\"white-space:nowrap\">emergency-medical-transport<a name=\"sbc-benefit-category-emergency-medical-transport\"> </a></td><td>Emergency Medical Transportation</td><td>Ambulance and emergency medical transport services</td></tr><tr><td style=\"white-space:nowrap\">urgent-care<a name=\"sbc-benefit-category-urgent-care\"> </a></td><td>Urgent Care</td><td>Urgent care facility services</td></tr><tr><td style=\"white-space:nowrap\">hospital-outpatient<a name=\"sbc-benefit-category-hospital-outpatient\"> </a></td><td>Hospital Outpatient Care</td><td>Outpatient hospital services and surgeries</td></tr><tr><td style=\"white-space:nowrap\">hospital-inpatient<a name=\"sbc-benefit-category-hospital-inpatient\"> </a></td><td>Hospital Inpatient Care</td><td>Inpatient hospital stays and services</td></tr><tr><td style=\"white-space:nowrap\">mental-health-outpatient<a name=\"sbc-benefit-category-mental-health-outpatient\"> </a></td><td>Mental/Behavioral Health Outpatient Services</td><td>Outpatient mental health and substance abuse services</td></tr><tr><td style=\"white-space:nowrap\">mental-health-inpatient<a name=\"sbc-benefit-category-mental-health-inpatient\"> </a></td><td>Mental/Behavioral Health Inpatient Services</td><td>Inpatient mental health and substance abuse services</td></tr><tr><td style=\"white-space:nowrap\">pregnancy<a name=\"sbc-benefit-category-pregnancy\"> </a></td><td>Pregnancy Services</td><td>Prenatal and postnatal office visits</td></tr><tr><td style=\"white-space:nowrap\">pregnancy-delivery<a name=\"sbc-benefit-category-pregnancy-delivery\"> </a></td><td>Childbirth/Delivery Professional Services</td><td>Professional services for childbirth and delivery</td></tr><tr><td style=\"white-space:nowrap\">pregnancy-home-health<a name=\"sbc-benefit-category-pregnancy-home-health\"> </a></td><td>Pregnancy Home Health Care</td><td>Home health care services related to pregnancy</td></tr><tr><td style=\"white-space:nowrap\">rehabilitation<a name=\"sbc-benefit-category-rehabilitation\"> </a></td><td>Rehabilitation Services</td><td>Outpatient physical, occupational, and speech therapy</td></tr><tr><td style=\"white-space:nowrap\">habilitation<a name=\"sbc-benefit-category-habilitation\"> </a></td><td>Habilitation Services</td><td>Health care services that help develop or maintain daily living skills</td></tr><tr><td style=\"white-space:nowrap\">skilled-nursing<a name=\"sbc-benefit-category-skilled-nursing\"> </a></td><td>Skilled Nursing Care</td><td>Skilled nursing facility services</td></tr><tr><td style=\"white-space:nowrap\">durable-medical-equipment<a name=\"sbc-benefit-category-durable-medical-equipment\"> </a></td><td>Durable Medical Equipment</td><td>Medical equipment for home use such as wheelchairs, oxygen equipment</td></tr><tr><td style=\"white-space:nowrap\">hospice<a name=\"sbc-benefit-category-hospice\"> </a></td><td>Hospice Services</td><td>End-of-life care services</td></tr><tr><td style=\"white-space:nowrap\">children-eye-exam<a name=\"sbc-benefit-category-children-eye-exam\"> </a></td><td>Children's Eye Exam</td><td>Eye examinations for children</td></tr><tr><td style=\"white-space:nowrap\">children-glasses<a name=\"sbc-benefit-category-children-glasses\"> </a></td><td>Children's Glasses</td><td>Eyeglasses for children</td></tr><tr><td style=\"white-space:nowrap\">children-dental<a name=\"sbc-benefit-category-children-dental\"> </a></td><td>Children's Dental Check-up</td><td>Routine dental care for children</td></tr></table></div>"
      ] ;
      fhir:DomainResource.extension [
         fhir:index 0 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
         fhir:Extension.valueCode [ fhir:value "claims" ]
      ], [
         fhir:index 1 ;
         fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status" ] ;
         fhir:Extension.valueCode [
           fhir:value "informative" ;
           fhir:Element.extension [
             fhir:index 0 ;
             fhir:Extension.url [ fhir:value "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom" ] ;
             fhir:Extension.valueCanonical [
               fhir:value "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card" ;
               fhir:link <http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card>
             ]
           ]
         ]
      ] ;
      fhir:CodeSystem.url [ fhir:value "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category"] ;
      fhir:CodeSystem.identifier [
         fhir:index 0 ;
         fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ] ;
         fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.4.642.40.9.16.5" ]
      ] ;
      fhir:CodeSystem.version [ fhir:value "2.0.0-ballot"] ;
      fhir:CodeSystem.name [ fhir:value "SBCBenefitCategoryCS"] ;
      fhir:CodeSystem.title [ fhir:value "SBC Benefit Category Code System"] ;
      fhir:CodeSystem.status [ fhir:value "draft"] ;
      fhir:CodeSystem.experimental [ fhir:value "true"^^xsd:boolean] ;
      fhir:CodeSystem.date [ fhir:value "2026-08-13T02:29:19+10:00"^^xsd:dateTime] ;
      fhir:CodeSystem.publisher [ fhir:value "HL7 International / Payer/Provider Information Exchange Work Group"] ;
      fhir:CodeSystem.contact [
         fhir:index 0 ;
         fhir:ContactDetail.name [ fhir:value "HL7 International / Payer/Provider Information Exchange Work Group" ] ;
         fhir:ContactDetail.telecom [
           fhir:index 0 ;
           fhir:ContactPoint.system [ fhir:value "url" ] ;
           fhir:ContactPoint.value [ fhir:value "http://www.hl7.org/Special/committees/claims" ]
         ], [
           fhir:index 1 ;
           fhir:ContactPoint.system [ fhir:value "email" ] ;
           fhir:ContactPoint.value [ fhir:value "pie@lists.HL7.org" ]
         ]
      ] ;
      fhir:CodeSystem.description [ fhir:value "Code system for the 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents per ACA Section 2715 regulations"] ;
      fhir:CodeSystem.jurisdiction [
         fhir:index 0 ;
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
           fhir:Coding.code [ fhir:value "US" ]
         ]
      ] ;
      fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ;
      fhir:CodeSystem.content [ fhir:value "complete"] ;
      fhir:CodeSystem.count [ fhir:value "29"^^xsd:nonNegativeInteger] ;
      fhir:CodeSystem.concept [
         fhir:index 0 ;
         fhir:CodeSystem.concept.code [ fhir:value "preventive-care" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Preventive Care/Screening/Immunization" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Preventive care services, health screenings, and immunizations" ]
      ], [
         fhir:index 1 ;
         fhir:CodeSystem.concept.code [ fhir:value "primary-care-visit" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Primary Care Visit" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Visits to primary care physicians to treat illness or injury" ]
      ], [
         fhir:index 2 ;
         fhir:CodeSystem.concept.code [ fhir:value "specialist-visit" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Specialist Visit" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Visits to specialist physicians" ]
      ], [
         fhir:index 3 ;
         fhir:CodeSystem.concept.code [ fhir:value "diagnostic-test" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Diagnostic Test" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "X-rays and diagnostic imaging other than CT/PET/MRI" ]
      ], [
         fhir:index 4 ;
         fhir:CodeSystem.concept.code [ fhir:value "imaging" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Imaging (CT/PET/MRI)" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Advanced imaging services including CT scans, PET scans, and MRIs" ]
      ], [
         fhir:index 5 ;
         fhir:CodeSystem.concept.code [ fhir:value "generic-drugs" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Generic Drugs" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Generic prescription medications" ]
      ], [
         fhir:index 6 ;
         fhir:CodeSystem.concept.code [ fhir:value "preferred-brand-drugs" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Preferred Brand Drugs" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Brand-name prescription medications on the preferred drug list" ]
      ], [
         fhir:index 7 ;
         fhir:CodeSystem.concept.code [ fhir:value "non-preferred-brand-drugs" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Non-Preferred Brand Drugs" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Brand-name prescription medications not on the preferred drug list" ]
      ], [
         fhir:index 8 ;
         fhir:CodeSystem.concept.code [ fhir:value "specialty-drugs" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Specialty Drugs" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "High-cost or specialty prescription medications" ]
      ], [
         fhir:index 9 ;
         fhir:CodeSystem.concept.code [ fhir:value "facility-fee" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Facility Fee" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Hospital or facility charges for services" ]
      ], [
         fhir:index 10 ;
         fhir:CodeSystem.concept.code [ fhir:value "physician-surgeon-fee" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Physician/Surgeon Fees" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Professional fees for physicians and surgeons" ]
      ], [
         fhir:index 11 ;
         fhir:CodeSystem.concept.code [ fhir:value "emergency-room-care" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Emergency Room Care" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Emergency department services" ]
      ], [
         fhir:index 12 ;
         fhir:CodeSystem.concept.code [ fhir:value "emergency-medical-transport" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Emergency Medical Transportation" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Ambulance and emergency medical transport services" ]
      ], [
         fhir:index 13 ;
         fhir:CodeSystem.concept.code [ fhir:value "urgent-care" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Urgent Care" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Urgent care facility services" ]
      ], [
         fhir:index 14 ;
         fhir:CodeSystem.concept.code [ fhir:value "hospital-outpatient" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Hospital Outpatient Care" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Outpatient hospital services and surgeries" ]
      ], [
         fhir:index 15 ;
         fhir:CodeSystem.concept.code [ fhir:value "hospital-inpatient" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Hospital Inpatient Care" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Inpatient hospital stays and services" ]
      ], [
         fhir:index 16 ;
         fhir:CodeSystem.concept.code [ fhir:value "mental-health-outpatient" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Mental/Behavioral Health Outpatient Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Outpatient mental health and substance abuse services" ]
      ], [
         fhir:index 17 ;
         fhir:CodeSystem.concept.code [ fhir:value "mental-health-inpatient" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Mental/Behavioral Health Inpatient Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Inpatient mental health and substance abuse services" ]
      ], [
         fhir:index 18 ;
         fhir:CodeSystem.concept.code [ fhir:value "pregnancy" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Pregnancy Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Prenatal and postnatal office visits" ]
      ], [
         fhir:index 19 ;
         fhir:CodeSystem.concept.code [ fhir:value "pregnancy-delivery" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Childbirth/Delivery Professional Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Professional services for childbirth and delivery" ]
      ], [
         fhir:index 20 ;
         fhir:CodeSystem.concept.code [ fhir:value "pregnancy-home-health" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Pregnancy Home Health Care" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Home health care services related to pregnancy" ]
      ], [
         fhir:index 21 ;
         fhir:CodeSystem.concept.code [ fhir:value "rehabilitation" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Rehabilitation Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Outpatient physical, occupational, and speech therapy" ]
      ], [
         fhir:index 22 ;
         fhir:CodeSystem.concept.code [ fhir:value "habilitation" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Habilitation Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Health care services that help develop or maintain daily living skills" ]
      ], [
         fhir:index 23 ;
         fhir:CodeSystem.concept.code [ fhir:value "skilled-nursing" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Skilled Nursing Care" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Skilled nursing facility services" ]
      ], [
         fhir:index 24 ;
         fhir:CodeSystem.concept.code [ fhir:value "durable-medical-equipment" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Durable Medical Equipment" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Medical equipment for home use such as wheelchairs, oxygen equipment" ]
      ], [
         fhir:index 25 ;
         fhir:CodeSystem.concept.code [ fhir:value "hospice" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Hospice Services" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "End-of-life care services" ]
      ], [
         fhir:index 26 ;
         fhir:CodeSystem.concept.code [ fhir:value "children-eye-exam" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Children's Eye Exam" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Eye examinations for children" ]
      ], [
         fhir:index 27 ;
         fhir:CodeSystem.concept.code [ fhir:value "children-glasses" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Children's Glasses" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Eyeglasses for children" ]
      ], [
         fhir:index 28 ;
         fhir:CodeSystem.concept.code [ fhir:value "children-dental" ] ;
         fhir:CodeSystem.concept.display [ fhir:value "Children's Dental Check-up" ] ;
         fhir:CodeSystem.concept.definition [ fhir:value "Routine dental care for children" ]
      ] .

    # - ontology header ------------------------------------------------------------

    <http://hl7.org/fhir/CodeSystem/sbc-benefit-category.ttl> a owl:Ontology ;
      owl:imports fhir:fhir.ttl ;
      owl:versionIRI <http://build.fhir.org/CodeSystem/sbc-benefit-category.ttl> .