CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot

CARIN Digital Insurance Card - Downloaded Version 2.0.0-ballot See the Directory of published versions

## Use Cases

Page standards status: Informative

> This section has been restructured into a multi-page section to support the addition of a significant number of new use cases for the use of Digital Insurance Card.

## Terms and Concepts

Term | Definition
--- | ---
Subscriber | An individual or entity that selects benefits offered by an entity, such as an employer, government, or insurance company
Dependent | An individual, other than the subscriber, who has insurance coverage under the benefits selected by a subscriber
Member | Any individual covered by the benefits offered by an entity, such as an employer or insurance company. In the US, some government programs refer to Members as Beneficiaries.
Patient | An individual who has received, is receiving or intends to receive health care services. (Health care services as defined by federal and state regulations.)
Personal Representative | Per the HIPAA privacy regulations at 45 CFR 164.502(g), a personal-representative is someone authorized under state or other applicable law to act on behalf of the individual in making health care related decisions (such as a parent, guardian, or person with a medical power of attorney)
Payer | Public or private party which offers and/or administers health insurance plan(s) or coverage and/or pays claims directly or indirectly. Examples include: - Insurance Company - Health Maintenance Organization - Medicare - Third-party Administrator - Repricer

## Use Cases

This Implementation Guide provides both foundational and specific use cases for a Digital Insurance Card. The Foundational use case describe basic capabilities, such as initiating a Digital Insurance enabled transaction. Other use case are specific examples of exchanges, such as utilizing a Digital Insurance Card to enable a Real-Time Pharmacy Benefit Check.

### Foundational Use Cases

- Authorization
- Distribution
- Patient Access API
- Representing Multiple Coverages for the Same Payer
- Support for Multiple Digital Insurance cards

### Insurance Card Transaction Examples

- Consumer Access to their Insurance Card Data
- Consumer Access and Exchange
- Real-Time Pharmacy Benefit Check
- Comparison with International Patient Summary IG
- Summary of Benefits and Coverage