CARIN Digital Insurance Card
0.1.0 - STU 1 Ballot

This page is part of the CARIN Digital Insurance Card (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

Physical Insurance Card Data Elements

Physical Insurance Card Data Elements

This table outlines the necessary data elements found on physicial insurance cards. This list of data elements was compiled through collaboration with numerous subject-matter experts across major insurance companies in the US. The authors of this IG also consulted the following resources for additional guidance:

  • WEDI Health Identification Card Implementation Guide
  • WEDI Virtual Clipboard
  • NYS DFS Title 11, section 52.69
  • CCA/No Surprises Act, section 107
  • SMART Health Card IG (related to QR codes)
Data Element Description FHIR Mapping
Member Name Member's first and last name and may include middle name or initial coverage.extension C4DIC-PlanBeneficiaries-extension (enables represenation of all members), coverage.beneficiary (reflecting the patient for whom this resource is being pulled), patient.name (reflecting the patient for whom this resource is being pulled)
Member ID The unique identifier for the organization's membership coverage.extension C4DIC-PlanBeneficiaries-extension (enables represenation of all members), coverage.identifier (reflecting the patient for whom this resource is being pulled), coverage.subscriberId (representing the subscriber of the plan)
Dependent code Identifies the unique dependent under the plan coverage.dependent
Subscriber The person covered by the health insurance plan coverage.subscriber
Patient Relationship to Subscriber Describes how the beneficiary and how the plan subscriber are related coverage.relationship
Plan Type Refers to how plans provide coverage and from which network. Also may be called Product Type. Exampe HMO, PPO coverage.type
Payer ID This is the Unique ID assigned to each insurance provider organization.identifier
Payer Name The name of the insurance provider coverage.payor.display, organization.name
Group ID The unique ID for the group you get insurance coverage from. Typically refers to an employer group. coverage.class where type = group
Group Name The group from which your insurance coverage is from. Typically your employer. coverage.class where type = group
Division ID This is a sub-group from the group that identifed which cohort an individaul is assigned. coverage.class where type = division
Primary Network ID Identifes a group of providers in one network. coverage.class where type = network
Primary Network Name The name of the group that identifies a group of providers in a network. coverage.class where type = network
Secondary Network ID Identifes a group of providers in one network. coverage.class where type = network
Secondary Network Name Is the name of the gropu that identifies a group of providers in a network. coverage.class where type = network
Payer Contact Details: Contacts details often found on the back of the physical insurance card.
--Claims Address Address to send provider claims to for adjudication. organization.contact.address
--Phone Phone numbers. Need to support multiple types of phone numbers for different purposes (physician, member, pharmacist, etc.) organization.contact.telecom
--Web Address The public internet address of the payer organization.contact.telecom
--Customer Service This is the customer-facing number for member service questions organization.contact.telecom
RxBin/BIN Bank identification number used to locate your pharmacy member profile under the PBM system coverage.class where type = rxbin
RxPCN Processor control number tells the pharmacy which group you're in so they can process your prescription payment correctly coverage.class where type = rxpcn
RxGRP RX group number coverage.class where type = rxgroup
RxID A Pharmacy Benefit Manager specified Member ID. coverage.class where type = rxid
Free text fields Additional contextual information often found on the back of physical insurance cards. Could include TTY, disclaimers about eligibility, and/or limits to coverage. Could include notice of dental/vision coverage. coverage.extension C4DIC-AdditionalCardInformation-extension
Copay Designation & Amounts: What type of payment required for various types of medical services
--PCP office visits Copay for PCP office visits coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
--Specialist office visits Copay for specialist office visits coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
--Urgent care Copay for urgent care visits coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
--ER visits Copay for ER visits coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
--Prescription drugs, retail pharmacy, 30-day supply Copay for prescription drugs coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family Out of Network Deductible The amount you must pay before your insurance plan's benefits begin. Out of Network amount coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family In Network Deductible The amount you must pay before your insurance plan's benefits begin. In network amount coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family Pharmacy Out of Network Deductible The amount you must pay before your insurance plan's benefits begin. Pharmacy Out of Network amount. coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family Pharmacy In Network Deductible The amount you must pay before your insurance plan's benefits begin. Pharmacy In Network amount. coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family Out of Network Out of Pocket Max The limit on the amount of money you have to pay for covered health services. Out of Network amount. coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family In Network Out of Pocket Max The limit on the amount of money you have to pay for covered health services. In Network amount. coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family Pharmacy Out of Network Out of Pocket Max The limit on the amount of money you have to pay for covered health services. Pharmacy Out of Network amount. coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Individual or Family Pharmacy In Network Out of Pocket Max The limit on the amount of money you have to pay for covered health services. Pharmacy In Network amount. coverage.costToBeneficiary (where value can be represented as valueMoney), coverage.extension C4DIC-AdditionalCardInformation-extension (where string is required)
Images Images often found on the front or back of the physical insurance card
--Logo A company logo or image to represent the company coverage.extension C4DIC-Logo-extension
--Barcode Machine readable code in the form of numbers or patterns or special charaters. coverage.extension C4DIC-Barcode-extension
--QR code Scannable code in the form of patterns. coverage.extension C4DIC-QRCode-extension
--Other supporting images Partner logos, images indicating the type of coverage provided, etc. coverage.extension C4DIC-SupportingImage-extension
Card issuance date Date when the insurance company issued the insurance card coverage.extension C4DIC-CardIssueDate-extension
Date of Birth Date of Birth of the beneficiary patient.birthDate