Summary of Benefits and Coverage (SBC) FHIR Implementation Guide
0.1.0 - ci-build
Summary of Benefits and Coverage (SBC) FHIR Implementation Guide
0.1.0 - ci-build
Summary of Benefits and Coverage (SBC) FHIR Implementation Guide, published by SBC FHIR Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/jdjkelly/fhir-sbc/ and changes regularly. See the Directory of published versions
| Draft as of 2025-11-10 |
{
"resourceType" : "CodeSystem",
"id" : "sbc-plan-type",
"text" : {
"status" : "generated",
"div" : "<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://flexpa.com/fhir/sbc/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>"
},
"url" : "http://flexpa.com/fhir/sbc/CodeSystem/sbc-plan-type",
"version" : "0.1.0",
"name" : "SBCPlanType",
"title" : "SBC Plan Type Code System",
"status" : "draft",
"experimental" : false,
"date" : "2025-11-10T22:33:16+00:00",
"publisher" : "SBC FHIR Project",
"contact" : [
{
"name" : "SBC FHIR Project",
"telecom" : [
{
"system" : "url",
"value" : "http://flexpa.com"
},
{
"system" : "email",
"value" : "contact@flexpa.com"
}
]
}
],
"description" : "Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"caseSensitive" : true,
"content" : "complete",
"count" : 6,
"concept" : [
{
"code" : "HMO",
"display" : "Health Maintenance Organization (HMO)",
"definition" : "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"
},
{
"code" : "PPO",
"display" : "Preferred Provider Organization (PPO)",
"definition" : "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"
},
{
"code" : "POS",
"display" : "Point of Service (POS)",
"definition" : "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"
},
{
"code" : "EPO",
"display" : "Exclusive Provider Organization (EPO)",
"definition" : "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"
},
{
"code" : "HDHP",
"display" : "High Deductible Health Plan (HDHP)",
"definition" : "A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account"
},
{
"code" : "INDEMNITY",
"display" : "Indemnity Plan",
"definition" : "A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill"
}
]
}