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

## : SBC Plan Type Code System - TTL Representation

Page standards status: Informative

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:CodeSystem ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "sbc-plan-type"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<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>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "claims"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "informative" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type>
      ] ; #
      fhir:version [ fhir:v "2.0.0"] ; #
      fhir:name [ fhir:v "SBCPlanTypeCS"] ; #
      fhir:title [ fhir:v "SBC Plan Type Code System"] ; #
      fhir:status [ fhir:v "draft"] ; #
      fhir:experimental [ fhir:v true] ; #
      fhir:date [ fhir:v "2026-03-20T01:21:28+00:00"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Payer/Provider Information Exchange Work Group"] ; #
      fhir:contact ( [
    fhir:name [ fhir:v "HL7 International / Payer/Provider Information Exchange Work Group" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/claims" ]     ] [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "pie@lists.HL7.org" ]     ] )
      ] ) ; #
      fhir:description [ fhir:v "Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents"] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ]     ] )
      ] ) ; #
      fhir:caseSensitive [ fhir:v true] ; #
      fhir:content [ fhir:v "complete"] ; #
      fhir:count [ fhir:v "6"^^xsd:nonNegativeInteger] ; #
      fhir:concept ( [
    fhir:code [ fhir:v "HMO" ] ;
    fhir:display [ fhir:v "Health Maintenance Organization (HMO)" ] ;
    fhir:definition [ fhir:v "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" ]
      ] [
    fhir:code [ fhir:v "PPO" ] ;
    fhir:display [ fhir:v "Preferred Provider Organization (PPO)" ] ;
    fhir:definition [ fhir:v "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" ]
      ] [
    fhir:code [ fhir:v "POS" ] ;
    fhir:display [ fhir:v "Point of Service (POS)" ] ;
    fhir:definition [ fhir:v "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" ]
      ] [
    fhir:code [ fhir:v "EPO" ] ;
    fhir:display [ fhir:v "Exclusive Provider Organization (EPO)" ] ;
    fhir:definition [ fhir:v "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" ]
      ] [
    fhir:code [ fhir:v "HDHP" ] ;
    fhir:display [ fhir:v "High Deductible Health Plan (HDHP)" ] ;
    fhir:definition [ fhir:v "A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account" ]
      ] [
    fhir:code [ fhir:v "INDEMNITY" ] ;
    fhir:display [ fhir:v "Indemnity Plan" ] ;
    fhir:definition [ fhir:v "A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill" ]
      ] ) . #