CARIN Digital Insurance Card
1.0.0 - STU 1 US

This page is part of the CARIN Digital Insurance Card (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example Coverage: Example-Coverage-FSH

Generated Narrative

Resource "Example-Coverage-FSH" Version "1" Updated "2021-04-06 10:49:02+0000"

Profile: C4DIC Coverage

Plan Beneficiaries

value: 102345672-01

value: John Doe

Plan Beneficiaries

value: 102345672-02

value: jane Doe

Plan Beneficiaries

value: 102345672-03

value: Jimmy Doe

Plan Beneficiaries

value: 102345672-04

value: Ginny Doe

Additional Insurance Card Information: If you use a TTY, call 711. You may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law. We encourage you to use a primary care physician as a valuable resource and personal health advocate.

Card Issue Date: 2020-12-15

Background Color: #00bfff (IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB##00bfff)

Highlight Color: #ceebf5 (IEC 61966-2-1: Colour measurement and management - Part 2-1: Colour management - Default RGB colour space - sRGB##ceebf5)

Logo

value: ACME Inc.

value: Company logo

value:

QR Code

value: Some label for this QR code

value: Usage text for this QR code for the end user

value:

Barcode

value: Some label for this Barcode

value: Usage text for this Barcode for the end user

value:

Supporting image

value: Some label text

value: Some text for the end user about the usage/meaning of this image

value:

identifier: Member Number: 102345672-02

status: active

type: health insurance plan policy (ActCode#HIP)

subscriber: Patient/Example-Patient1: John Doe " DOE"

subscriberId: 102345672-01

beneficiary: Patient/Example-Patient2: Jane Doe " DOE"

dependent: 02

relationship: Spouse (SubscriberPolicyholder Relationship Codes#spouse)

period: 2021-01-01 --> (ongoing)

payor: Organization/Example-PayerOrganization1: Acme Insurance Co "Acme Insurance Co"

class

type: Group (Coverage Class Codes#group)

value: 993355

name: Stars Inc

class

type: Plan (Coverage Class Codes#plan)

value: 11461128

name: Acme Gold Plus

class

type: Division (C4DIC Extended Coverage Class#division)

value: 11

class

type: Network (C4DIC Extended Coverage Class#network)

value: 561490

name: Acme Gold Plus South

class

type: RX BIN (Coverage Class Codes#rxbin)

value: 100045

class

type: RX PCN (Coverage Class Codes#rxpcn)

value: 1234000

costToBeneficiary

type: Family Out of Network Deductible (C4DIC Extended Copay Type#FamOutDed)

value: $10,000.00 (USD)

costToBeneficiary

type: Family In Network Deductible (C4DIC Extended Copay Type#FamInDed)

value: $8,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Deductible (C4DIC Extended Copay Type#FamRxOutDed)

value: $2,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Deductible (C4DIC Extended Copay Type#FamRxInDed)

value: $1,500.00 (USD)

costToBeneficiary

type: Family Out of Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamOutMax)

value: $12,000.00 (USD)

costToBeneficiary

type: Family In Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamInMax)

value: $10,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamRxOutMax)

value: $3,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Out of Pocket Maximum (C4DIC Extended Copay Type#FamRxInMax)

value: $2,000.00 (USD)

costToBeneficiary

type: GP Office Visit (Coverage Copay Type Codes#gpvisit)

value:

Exception generating Narrative: null