CARIN Digital Insurance Card
2.0.0 - STU 2.0 United States of America flag

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

Use Cases

This section has been restructured into a multi-page section to support the addition of a significant number of new use cases for the use of Digital Insurance Card.

Terms and Concepts

Term Definition
Subscriber An individual or entity that selects benefits offered by an entity, such as an employer, government, or insurance company
Dependent An individual, other than the subscriber, who has insurance coverage under the benefits selected by a subscriber
Member Any individual covered by the benefits offered by an entity, such as an employer or insurance company. In the US, some government programs refer to Members as Beneficiaries.
Patient An individual who has received, is receiving or intends to receive health care services. (Health care services as defined by federal and state regulations.)
Personal Representative Per the HIPAA privacy regulations at 45 CFR 164.502(g), a personal-representative is someone authorized under state or other applicable law to act on behalf of the individual in making health care related decisions (such as a parent, guardian, or person with a medical power of attorney)
Payer Public or private party which offers and/or administers health insurance plan(s) or coverage and/or pays claims directly or indirectly. Examples include:
- Insurance Company
- Health Maintenance Organization
- Medicare
- Third-party Administrator
- Repricer

Use Cases

This Implementation Guide provides both foundational and specific use cases for a Digital Insurance Card. The Foundational use case describe basic capabilities, such as initiating a Digital Insurance enabled transaction. Other use case are specific examples of exchanges, such as utilizing a Digital Insurance Card to enable a Real-Time Pharmacy Benefit Check.

Foundational Use Cases

Insurance Card Transaction Examples