Summary of Benefits and Coverage (SBC) FHIR Implementation Guide
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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

ValueSet: SBC Benefit Category Value Set

Official URL: http://flexpa.com/fhir/sbc/ValueSet/sbc-benefit-category Version: 0.1.0
Draft as of 2025-11-10 Computable Name: SBCBenefitCategory

Value set containing all 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents

References

Logical Definition (CLD)

 

Expansion

Expansion performed internally based on codesystem SBC Benefit Category Code System v0.1.0 (CodeSystem)

This value set contains 29 concepts

SystemCodeDisplay (en)JSONXML
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  preventive-carePreventive Care/Screening/Immunization
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  primary-care-visitPrimary Care Visit
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  specialist-visitSpecialist Visit
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  diagnostic-testDiagnostic Test
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  imagingImaging (CT/PET/MRI)
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  generic-drugsGeneric Drugs
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  preferred-brand-drugsPreferred Brand Drugs
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  non-preferred-brand-drugsNon-Preferred Brand Drugs
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  specialty-drugsSpecialty Drugs
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  facility-feeFacility Fee
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  physician-surgeon-feePhysician/Surgeon Fees
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  emergency-room-careEmergency Room Care
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  emergency-medical-transportEmergency Medical Transportation
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  urgent-careUrgent Care
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  hospital-outpatientHospital Outpatient Care
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  hospital-inpatientHospital Inpatient Care
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  mental-health-outpatientMental/Behavioral Health Outpatient Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  mental-health-inpatientMental/Behavioral Health Inpatient Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  pregnancyPregnancy Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  pregnancy-deliveryChildbirth/Delivery Professional Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  pregnancy-home-healthPregnancy Home Health Care
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  rehabilitationRehabilitation Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  habilitationHabilitation Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  skilled-nursingSkilled Nursing Care
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  durable-medical-equipmentDurable Medical Equipment
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  hospiceHospice Services
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  children-eye-examChildren's Eye Exam
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  children-glassesChildren's Glasses
http://flexpa.com/fhir/sbc/CodeSystem/sbc-benefit-category  children-dentalChildren's Dental Check-up

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code