Summary of Benefits and Coverage (SBC) FHIR Implementation Guide
0.1.0 - ci-build United States of America

Summary of Benefits and Coverage (SBC) FHIR Implementation Guide, published by SBC FHIR Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/jdjkelly/fhir-sbc/ and changes regularly. See the Directory of published versions

CodeSystem: SBC Plan Type Code System

Official URL: http://flexpa.com/fhir/sbc/CodeSystem/sbc-plan-type Version: 0.1.0
Draft as of 2026-02-16 Computable Name: SBCPlanTypeCS

Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://flexpa.com/fhir/sbc/CodeSystem/sbc-plan-type defines the following codes:

CodeDisplayDefinition
HMO Health Maintenance Organization (HMO) 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
PPO Preferred Provider Organization (PPO) 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
POS Point of Service (POS) 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
EPO Exclusive Provider Organization (EPO) 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
HDHP High Deductible Health Plan (HDHP) A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account
INDEMNITY Indemnity Plan A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill