CARIN Digital Insurance Card
2.0.0 - STU 2.0

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

## CodeSystem: SBC Benefit Category Code System (Experimental)

Official URL: http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category | Version: 2.0.0
Standards status: Informative | Computable Name: SBCBenefitCategoryCS

Code system for the 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents per ACA Section 2715 regulations

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

- SBCBenefitCategoryVS

This case-sensitive code system `http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category` defines the following codes:

Code | Display | Definition
preventive-care | Preventive Care/Screening/Immunization | Preventive care services, health screenings, and immunizations
primary-care-visit | Primary Care Visit | Visits to primary care physicians to treat illness or injury
specialist-visit | Specialist Visit | Visits to specialist physicians
diagnostic-test | Diagnostic Test | X-rays and diagnostic imaging other than CT/PET/MRI
imaging | Imaging (CT/PET/MRI) | Advanced imaging services including CT scans, PET scans, and MRIs
generic-drugs | Generic Drugs | Generic prescription medications
preferred-brand-drugs | Preferred Brand Drugs | Brand-name prescription medications on the preferred drug list
non-preferred-brand-drugs | Non-Preferred Brand Drugs | Brand-name prescription medications not on the preferred drug list
specialty-drugs | Specialty Drugs | High-cost or specialty prescription medications
facility-fee | Facility Fee | Hospital or facility charges for services
physician-surgeon-fee | Physician/Surgeon Fees | Professional fees for physicians and surgeons
emergency-room-care | Emergency Room Care | Emergency department services
emergency-medical-transport | Emergency Medical Transportation | Ambulance and emergency medical transport services
urgent-care | Urgent Care | Urgent care facility services
hospital-outpatient | Hospital Outpatient Care | Outpatient hospital services and surgeries
hospital-inpatient | Hospital Inpatient Care | Inpatient hospital stays and services
mental-health-outpatient | Mental/Behavioral Health Outpatient Services | Outpatient mental health and substance abuse services
mental-health-inpatient | Mental/Behavioral Health Inpatient Services | Inpatient mental health and substance abuse services
pregnancy | Pregnancy Services | Prenatal and postnatal office visits
pregnancy-delivery | Childbirth/Delivery Professional Services | Professional services for childbirth and delivery
pregnancy-home-health | Pregnancy Home Health Care | Home health care services related to pregnancy
rehabilitation | Rehabilitation Services | Outpatient physical, occupational, and speech therapy
habilitation | Habilitation Services | Health care services that help develop or maintain daily living skills
skilled-nursing | Skilled Nursing Care | Skilled nursing facility services
durable-medical-equipment | Durable Medical Equipment | Medical equipment for home use such as wheelchairs, oxygen equipment
hospice | Hospice Services | End-of-life care services
children-eye-exam | Children's Eye Exam | Eye examinations for children
children-glasses | Children's Glasses | Eyeglasses for children
children-dental | Children's Dental Check-up | Routine dental care for children