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

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: SBC Plan Type Code System - XML Representation

Draft as of 2025-11-10

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="sbc-plan-type"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url value="http://flexpa.com/fhir/sbc/CodeSystem/sbc-plan-type"/>
  <version value="0.1.0"/>
  <name value="SBCPlanType"/>
  <title value="SBC Plan Type Code System"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2025-11-10T22:33:16+00:00"/>
  <publisher value="SBC FHIR Project"/>
  <contact>
    <name value="SBC FHIR Project"/>
    <telecom>
      <system value="url"/>
      <value value="http://flexpa.com"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="contact@flexpa.com"/>
    </telecom>
  </contact>
  <description
               value="Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="6"/>
  <concept>
    <code value="HMO"/>
    <display value="Health Maintenance Organization (HMO)"/>
    <definition
                value="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"/>
  </concept>
  <concept>
    <code value="PPO"/>
    <display value="Preferred Provider Organization (PPO)"/>
    <definition
                value="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"/>
  </concept>
  <concept>
    <code value="POS"/>
    <display value="Point of Service (POS)"/>
    <definition
                value="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"/>
  </concept>
  <concept>
    <code value="EPO"/>
    <display value="Exclusive Provider Organization (EPO)"/>
    <definition
                value="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"/>
  </concept>
  <concept>
    <code value="HDHP"/>
    <display value="High Deductible Health Plan (HDHP)"/>
    <definition
                value="A health insurance plan with a higher deductible than traditional plans, often paired with a Health Savings Account"/>
  </concept>
  <concept>
    <code value="INDEMNITY"/>
    <display value="Indemnity Plan"/>
    <definition
                value="A type of health insurance that allows members to see any doctor or hospital and pays a portion of the bill"/>
  </concept>
</CodeSystem>