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

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: 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
  • label: ACME Inc.

QR Code

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

Barcode

  • description: Usage text for this Barcode for the end user
  • image: image/png: 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
  • 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: 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
  • 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: 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
  • 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)