CARIN Digital Insurance Card, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-digital-insurance-card/ and changes regularly. See the Directory of published versions
: SBC Plan Type 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-plan-type> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "sbc-plan-type"] ;
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-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>"
] ;
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-plan-type"] ;
fhir:CodeSystem.identifier [
fhir:index 0 ;
fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ] ;
fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.4.642.40.9.16.6" ]
] ;
fhir:CodeSystem.version [ fhir:value "2.0.0-ballot"] ;
fhir:CodeSystem.name [ fhir:value "SBCPlanTypeCS"] ;
fhir:CodeSystem.title [ fhir:value "SBC Plan Type Code System"] ;
fhir:CodeSystem.status [ fhir:value "draft"] ;
fhir:CodeSystem.experimental [ fhir:value "true"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2026-08-12T14:42:03+00:00"^^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 health insurance plan types displayed in Summary of Benefits and Coverage documents"] ;
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 "6"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index 0 ;
fhir:CodeSystem.concept.code [ fhir:value "HMO" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Health Maintenance Organization (HMO)" ] ;
fhir:CodeSystem.concept.definition [ fhir: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" ]
], [
fhir:index 1 ;
fhir:CodeSystem.concept.code [ fhir:value "PPO" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Preferred Provider Organization (PPO)" ] ;
fhir:CodeSystem.concept.definition [ fhir: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" ]
], [
fhir:index 2 ;
fhir:CodeSystem.concept.code [ fhir:value "POS" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Point of Service (POS)" ] ;
fhir:CodeSystem.concept.definition [ fhir: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" ]
], [
fhir:index 3 ;
fhir:CodeSystem.concept.code [ fhir:value "EPO" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Exclusive Provider Organization (EPO)" ] ;
fhir:CodeSystem.concept.definition [ fhir: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" ]
], [
fhir:index 4 ;
fhir:CodeSystem.concept.code [ fhir:value "HDHP" ] ;
fhir:CodeSystem.concept.display [ fhir:value "High Deductible Health Plan (HDHP)" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account" ]
], [
fhir:index 5 ;
fhir:CodeSystem.concept.code [ fhir:value "INDEMNITY" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Indemnity Plan" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill" ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/sbc-plan-type.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/sbc-plan-type.ttl> .
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