CARIN Digital Insurance Card
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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

Example Coverage: Example-Coverage-FSH

Page standards status: Informative

version: 1; Last updated: 2021-04-06 10:49:02+0000

Profile: C4DIC Coverage

Plan Beneficiaries

  • memberId: 102345672-01
  • name: John Doe

Plan Beneficiaries

  • memberId: 102345672-02
  • name: jane Doe

Plan Beneficiaries

  • memberId: 102345672-03
  • name: Jimmy Doe

Plan Beneficiaries

  • memberId: 102345672-04
  • name: 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.

Additional Insurance Card Information: Summary of Benefits and Coverage - Acme Gold Plus HMO

Card Issue Date: 2020-12-15

Color Palette

  • http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension: #00bfff
  • http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-ForegroundColor-extension: #000000
  • http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension: #ceebf5

Logo

  • description: Company logo
  • image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...
  • label: ACME Inc.

QR Code

  • description: Usage text for this QR code for the end user
  • image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...
  • label: Some label for this QR code

Barcode

  • description: Usage text for this Barcode for the end user
  • image: image/png: iVBORw0KGgoAAAANSUhEUgAAABAAAAAk...
  • label: Some label for this Barcode

Supporting image

  • description: Image of the front of the member's physical insurance card showing plan name, member ID, and group number
  • image: image/jpeg: /9j/4AAQSkZJRgABAQEAYABgAAD/4QBo...
  • label: Front of insurance card

Supporting image

  • description: Image of the back of the member's physical insurance card showing claims address, customer service numbers, and pharmacy information
  • image: image/jpeg: /9j/4AAQSkZJRgABAQEAYABgAAD/4QBo...
  • label: Back of insurance card

identifier: Member Number/102345672-02

status: Active

type: health insurance plan policy

subscriber: John Doe

subscriberId: 102345672-01

beneficiary: Jane Doe

dependent: 02

relationship: Spouse

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

payor: Acme Insurance Co

class

type: Group

value: 993355

name: Stars Inc

class

type: Plan

value: 11461128

name: Acme Gold Plus

class

type: Division

value: 11

class

type: Network

value: 561490

name: Acme Gold Plus South

class

type: RX BIN

value: 100045

class

type: RX PCN

value: 1234000

costToBeneficiary

type: Family Out of Network Deductible

value: $10,000.00 (USD)

costToBeneficiary

type: Family In Network Deductible

value: $8,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Deductible

value: $2,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Deductible

value: $1,500.00 (USD)

costToBeneficiary

type: Family Out of Network Out of Pocket Maximum

value: $12,000.00 (USD)

costToBeneficiary

type: Family In Network Out of Pocket Maximum

value: $10,000.00 (USD)

costToBeneficiary

type: Family Pharmacy Out of Network Out of Pocket Maximum

value: $3,000.00 (USD)

costToBeneficiary

type: Family Pharmacy In Network Out of Pocket Maximum

value: $2,000.00 (USD)