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 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

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• XML
• JSON
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: SBC Plan Type Code System - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "sbc-plan-type",
  "text" : {
    "status" : "generated",
    "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>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "claims"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "informative",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type",
  "version" : "2.0.0",
  "name" : "SBCPlanTypeCS",
  "title" : "SBC Plan Type Code System",
  "status" : "draft",
  "experimental" : true,
  "date" : "2026-02-03T01:43:53+00:00",
  "publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact" : [
    {
      "name" : "HL7 International / Payer/Provider Information Exchange Work Group",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/claims"
        },
        {
          "system" : "email",
          "value" : "pie@lists.HL7.org"
        }
      ]
    }
  ],
  "description" : "Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 6,
  "concept" : [
    {
      "code" : "HMO",
      "display" : "Health Maintenance Organization (HMO)",
      "definition" : "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"
    },
    {
      "code" : "PPO",
      "display" : "Preferred Provider Organization (PPO)",
      "definition" : "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"
    },
    {
      "code" : "POS",
      "display" : "Point of Service (POS)",
      "definition" : "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"
    },
    {
      "code" : "EPO",
      "display" : "Exclusive Provider Organization (EPO)",
      "definition" : "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"
    },
    {
      "code" : "HDHP",
      "display" : "High Deductible Health Plan (HDHP)",
      "definition" : "A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account"
    },
    {
      "code" : "INDEMNITY",
      "display" : "Indemnity Plan",
      "definition" : "A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill"
    }
  ]
}