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

Representing Multiple Types of Coverage for the Same Payer

Use Case - Representing Multiple Types of Coverage for the Same Payer

In instances where a Health Plan API actor is the Payer for multiple types of coverage for a member, the payer SHOULD represent each type of Coverage as a distinct Coverage resource.

Examples:

• A government agency offers separate plans (or “Parts”) that each cover distinct types of services, such as inpatient, outpatient, and prescription fills. The Health Plan API Actor SHOULD represent these using three different Coverage resources, with different values in Coverage.type.
• A private insurance plan offers both medical and dental insurance using the same group ID and member number. The insurance plan SHOULD represent medical and dental insurance using separate Coverage resources, with different values in Coverage.type.