# SBC Benefit Category Code System - CARIN Digital Insurance Card v2.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **SBC Benefit Category Code System**

## 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](http://hl7.org/fhir/R4/versions.html#std-process) | *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](ValueSet-sbc-benefit-category.md)



## Resource Content

```json
{
  "resourceType" : "CodeSystem",
  "id" : "sbc-benefit-category",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "claims"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "informative",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-benefit-category",
  "version" : "2.0.0",
  "name" : "SBCBenefitCategoryCS",
  "title" : "SBC Benefit Category Code System",
  "status" : "draft",
  "experimental" : true,
  "date" : "2026-03-20T01:21:28+00:00",
  "publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact" : [{
    "name" : "HL7 International / Payer/Provider Information Exchange Work Group",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/claims"
    },
    {
      "system" : "email",
      "value" : "pie@lists.HL7.org"
    }]
  }],
  "description" : "Code system for the 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents per ACA Section 2715 regulations",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 29,
  "concept" : [{
    "code" : "preventive-care",
    "display" : "Preventive Care/Screening/Immunization",
    "definition" : "Preventive care services, health screenings, and immunizations"
  },
  {
    "code" : "primary-care-visit",
    "display" : "Primary Care Visit",
    "definition" : "Visits to primary care physicians to treat illness or injury"
  },
  {
    "code" : "specialist-visit",
    "display" : "Specialist Visit",
    "definition" : "Visits to specialist physicians"
  },
  {
    "code" : "diagnostic-test",
    "display" : "Diagnostic Test",
    "definition" : "X-rays and diagnostic imaging other than CT/PET/MRI"
  },
  {
    "code" : "imaging",
    "display" : "Imaging (CT/PET/MRI)",
    "definition" : "Advanced imaging services including CT scans, PET scans, and MRIs"
  },
  {
    "code" : "generic-drugs",
    "display" : "Generic Drugs",
    "definition" : "Generic prescription medications"
  },
  {
    "code" : "preferred-brand-drugs",
    "display" : "Preferred Brand Drugs",
    "definition" : "Brand-name prescription medications on the preferred drug list"
  },
  {
    "code" : "non-preferred-brand-drugs",
    "display" : "Non-Preferred Brand Drugs",
    "definition" : "Brand-name prescription medications not on the preferred drug list"
  },
  {
    "code" : "specialty-drugs",
    "display" : "Specialty Drugs",
    "definition" : "High-cost or specialty prescription medications"
  },
  {
    "code" : "facility-fee",
    "display" : "Facility Fee",
    "definition" : "Hospital or facility charges for services"
  },
  {
    "code" : "physician-surgeon-fee",
    "display" : "Physician/Surgeon Fees",
    "definition" : "Professional fees for physicians and surgeons"
  },
  {
    "code" : "emergency-room-care",
    "display" : "Emergency Room Care",
    "definition" : "Emergency department services"
  },
  {
    "code" : "emergency-medical-transport",
    "display" : "Emergency Medical Transportation",
    "definition" : "Ambulance and emergency medical transport services"
  },
  {
    "code" : "urgent-care",
    "display" : "Urgent Care",
    "definition" : "Urgent care facility services"
  },
  {
    "code" : "hospital-outpatient",
    "display" : "Hospital Outpatient Care",
    "definition" : "Outpatient hospital services and surgeries"
  },
  {
    "code" : "hospital-inpatient",
    "display" : "Hospital Inpatient Care",
    "definition" : "Inpatient hospital stays and services"
  },
  {
    "code" : "mental-health-outpatient",
    "display" : "Mental/Behavioral Health Outpatient Services",
    "definition" : "Outpatient mental health and substance abuse services"
  },
  {
    "code" : "mental-health-inpatient",
    "display" : "Mental/Behavioral Health Inpatient Services",
    "definition" : "Inpatient mental health and substance abuse services"
  },
  {
    "code" : "pregnancy",
    "display" : "Pregnancy Services",
    "definition" : "Prenatal and postnatal office visits"
  },
  {
    "code" : "pregnancy-delivery",
    "display" : "Childbirth/Delivery Professional Services",
    "definition" : "Professional services for childbirth and delivery"
  },
  {
    "code" : "pregnancy-home-health",
    "display" : "Pregnancy Home Health Care",
    "definition" : "Home health care services related to pregnancy"
  },
  {
    "code" : "rehabilitation",
    "display" : "Rehabilitation Services",
    "definition" : "Outpatient physical, occupational, and speech therapy"
  },
  {
    "code" : "habilitation",
    "display" : "Habilitation Services",
    "definition" : "Health care services that help develop or maintain daily living skills"
  },
  {
    "code" : "skilled-nursing",
    "display" : "Skilled Nursing Care",
    "definition" : "Skilled nursing facility services"
  },
  {
    "code" : "durable-medical-equipment",
    "display" : "Durable Medical Equipment",
    "definition" : "Medical equipment for home use such as wheelchairs, oxygen equipment"
  },
  {
    "code" : "hospice",
    "display" : "Hospice Services",
    "definition" : "End-of-life care services"
  },
  {
    "code" : "children-eye-exam",
    "display" : "Children's Eye Exam",
    "definition" : "Eye examinations for children"
  },
  {
    "code" : "children-glasses",
    "display" : "Children's Glasses",
    "definition" : "Eyeglasses for children"
  },
  {
    "code" : "children-dental",
    "display" : "Children's Dental Check-up",
    "definition" : "Routine dental care for children"
  }]
}

```
