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

## Extension: SBC Metadata Extension (Experimental)

Official URL: http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-metadata | Version: 2.0.0
Standards status: Informative | Computable Name: SBCMetadata

Extension containing regulatory metadata required for Summary of Benefits and Coverage documents

Context of Use

This extension may be used on the following element(s):

- Element ID InsurancePlan

Usage info

Usages:

- Use this Extension: SBC Insurance Plan Profile
- Examples for this Extension: Sample Health HMO Gold Plan

You can also check for usages in the FHIR IG Statistics

### Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

- Text Summary
- Differential Table
- Snapshot Table
- All

This structure is derived from Extension

Summary

Complex Extension: Extension containing regulatory metadata required for Summary of Benefits and Coverage documents

- sbcVersionDate: date: The effective date of the SBC template version used
- minimumEssentialCoverage: boolean: Indicates whether the plan provides minimum essential coverage under section 5000A(f) of the Internal Revenue Code
- minimumValue: boolean: Indicates whether the plan's share of the total allowed costs of benefits meets the minimum value requirement
- abortionCoverage: CodeableConcept: For qualified health plans, indicates coverage, exclusion, or limitation to excepted abortion services per 45 CFR 156.280

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | SBC Metadata Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:sbcVersionDate |  | 0..1 | Extension | SBC Template Version Date
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "sbcVersionDate"
value[x] |  | 0..1 | date | Value of extension
extension:minimumEssentialCoverage |  | 0..1 | Extension | Minimum Essential Coverage Indicator
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "minimumEssentialCoverage"
value[x] |  | 0..1 | boolean | Value of extension
extension:minimumValue |  | 0..1 | Extension | Minimum Value Indicator
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "minimumValue"
value[x] |  | 0..1 | boolean | Value of extension
extension:abortionCoverage |  | 0..1 | Extension | Abortion Coverage Disclosure
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "abortionCoverage"
value[x] |  | 0..1 | CodeableConcept | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-metadata"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | SBC Metadata Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:sbcVersionDate |  | 0..1 | Extension | SBC Template Version Date
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "sbcVersionDate"
value[x] |  | 0..1 | date | Value of extension
extension:minimumEssentialCoverage |  | 0..1 | Extension | Minimum Essential Coverage Indicator
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "minimumEssentialCoverage"
value[x] |  | 0..1 | boolean | Value of extension
extension:minimumValue |  | 0..1 | Extension | Minimum Value Indicator
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "minimumValue"
value[x] |  | 0..1 | boolean | Value of extension
extension:abortionCoverage |  | 0..1 | Extension | Abortion Coverage Disclosure
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "abortionCoverage"
value[x] |  | 0..1 | CodeableConcept | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-metadata"
Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: Extension containing regulatory metadata required for Summary of Benefits and Coverage documents

- sbcVersionDate: date: The effective date of the SBC template version used
- minimumEssentialCoverage: boolean: Indicates whether the plan provides minimum essential coverage under section 5000A(f) of the Internal Revenue Code
- minimumValue: boolean: Indicates whether the plan's share of the total allowed costs of benefits meets the minimum value requirement
- abortionCoverage: CodeableConcept: For qualified health plans, indicates coverage, exclusion, or limitation to excepted abortion services per 45 CFR 156.280

Differential View

This structure is derived from Extension

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | SBC Metadata Extension
Slices for extension |  |  |  | Content/Rules for all slices
extension:sbcVersionDate |  | 0..1 | Extension | SBC Template Version Date
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "sbcVersionDate"
value[x] |  | 0..1 | date | Value of extension
extension:minimumEssentialCoverage |  | 0..1 | Extension | Minimum Essential Coverage Indicator
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "minimumEssentialCoverage"
value[x] |  | 0..1 | boolean | Value of extension
extension:minimumValue |  | 0..1 | Extension | Minimum Value Indicator
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "minimumValue"
value[x] |  | 0..1 | boolean | Value of extension
extension:abortionCoverage |  | 0..1 | Extension | Abortion Coverage Disclosure
extension |  | 0..0 |  | Extension
url |  | 1..1 | uri | "abortionCoverage"
value[x] |  | 0..1 | CodeableConcept | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-metadata"
value[x] |  | 0..0 |  | Value of extension
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Extension |  | 0..* | Extension | SBC Metadata Extension
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
extension:sbcVersionDate |  | 0..1 | Extension | SBC Template Version Date
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "sbcVersionDate"
value[x] |  | 0..1 | date | Value of extension
extension:minimumEssentialCoverage |  | 0..1 | Extension | Minimum Essential Coverage Indicator
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "minimumEssentialCoverage"
value[x] |  | 0..1 | boolean | Value of extension
extension:minimumValue |  | 0..1 | Extension | Minimum Value Indicator
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "minimumValue"
value[x] |  | 0..1 | boolean | Value of extension
extension:abortionCoverage |  | 0..1 | Extension | Abortion Coverage Disclosure
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  | Extension Slice: Unordered, Open by value:url
url |  | 1..1 | uri | "abortionCoverage"
value[x] |  | 0..1 | CodeableConcept | Value of extension
url |  | 1..1 | uri | "http://hl7.org/fhir/us/insurance-card/StructureDefinition/sbc-metadata"
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Constraints

Id | Grade | Path(s) | Description | Expression
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`