CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot

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## : SBC Plan Type Code System - XML Representation

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    <CodeSystem xmlns="http://hl7.org/fhir">
      <id value="sbc-plan-type"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem sbc-plan-type</b></p><a name="sbc-plan-type"> </a><a name="hcsbc-plan-type"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type</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">HMO<a name="sbc-plan-type-HMO"> </a></td><td>Health Maintenance Organization (HMO)</td><td>A type of health insurance plan that requires members to get health care services from doctors and hospitals in the plan's network, except in an emergency</td></tr><tr><td style="white-space:nowrap">PPO<a name="sbc-plan-type-PPO"> </a></td><td>Preferred Provider Organization (PPO)</td><td>A type of health insurance plan where members pay less if they use providers in the plan's network, but can use out-of-network providers at higher cost</td></tr><tr><td style="white-space:nowrap">POS<a name="sbc-plan-type-POS"> </a></td><td>Point of Service (POS)</td><td>A type of health insurance plan where members pay less if they use doctors and hospitals in the plan's network and choose a primary care doctor to coordinate care</td></tr><tr><td style="white-space:nowrap">EPO<a name="sbc-plan-type-EPO"> </a></td><td>Exclusive Provider Organization (EPO)</td><td>A type of health insurance plan where services are covered only if members use doctors and providers in the plan's network, except in an emergency</td></tr><tr><td style="white-space:nowrap">HDHP<a name="sbc-plan-type-HDHP"> </a></td><td>High Deductible Health Plan (HDHP)</td><td>A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account</td></tr><tr><td style="white-space:nowrap">INDEMNITY<a name="sbc-plan-type-INDEMNITY"> </a></td><td>Indemnity Plan</td><td>A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill</td></tr></table></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="claims"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="informative">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
            <valueCanonical
                            value="http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"/>
          </extension>
        </valueCode>
      </extension>
      <url
           value="http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.9.16.6"/>
      </identifier>
      <version value="2.0.0-ballot"/>
      <name value="SBCPlanTypeCS"/>
      <title value="SBC Plan Type Code System"/>
      <status value="draft"/>
      <experimental value="true"/>
      <date value="2026-08-13T02:29:19+10:00"/>
      <publisher
                 value="HL7 International / Payer/Provider Information Exchange Work Group"/>
      <contact>
        <name
              value="HL7 International / Payer/Provider Information Exchange Work Group"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/claims"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="pie@lists.HL7.org"/>
        </telecom>
      </contact>
      <description
                   value="Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents"/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
        </coding>
      </jurisdiction>
      <caseSensitive value="true"/>
      <content value="complete"/>
      <count value="6"/>
      <concept>
        <code value="HMO"/>
        <display value="Health Maintenance Organization (HMO)"/>
        <definition
                    value="A type of health insurance plan that requires members to get health care services from doctors and hospitals in the plan's network, except in an emergency"/>
      </concept>
      <concept>
        <code value="PPO"/>
        <display value="Preferred Provider Organization (PPO)"/>
        <definition
                    value="A type of health insurance plan where members pay less if they use providers in the plan's network, but can use out-of-network providers at higher cost"/>
      </concept>
      <concept>
        <code value="POS"/>
        <display value="Point of Service (POS)"/>
        <definition
                    value="A type of health insurance plan where members pay less if they use doctors and hospitals in the plan's network and choose a primary care doctor to coordinate care"/>
      </concept>
      <concept>
        <code value="EPO"/>
        <display value="Exclusive Provider Organization (EPO)"/>
        <definition
                    value="A type of health insurance plan where services are covered only if members use doctors and providers in the plan's network, except in an emergency"/>
      </concept>
      <concept>
        <code value="HDHP"/>
        <display value="High Deductible Health Plan (HDHP)"/>
        <definition
                    value="A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account"/>
      </concept>
      <concept>
        <code value="INDEMNITY"/>
        <display value="Indemnity Plan"/>
        <definition
                    value="A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill"/>
      </concept>
    </CodeSystem>