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
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
These define constraints on FHIR resources for systems conforming to this implementation guide.
| SBC Insurance Plan Profile |
Profile of InsurancePlan resource for representing Summary of Benefits and Coverage (SBC) documents as required under ACA Section 2715 and implementing regulations at 45 CFR 147.200, 29 CFR 2590.715-2715, and 26 CFR 54.9815-2715 |
These define constraints on FHIR data types for systems conforming to this implementation guide.
| Benefit Limitation Extension |
Extension for documenting limitations and exceptions that apply to specific benefits in the SBC |
| Excluded Services Extension |
Extension for documenting services that are not covered by the health insurance plan, as required in SBC 'Excluded Services & Other Covered Services' section |
| SBC Metadata Extension |
Extension containing regulatory metadata required for Summary of Benefits and Coverage documents |
These define sets of codes used by systems conforming to this implementation guide.
| SBC Benefit Category Value Set |
Value set containing all 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents |
| SBC Plan Type Value Set |
Value set containing health insurance plan types for Summary of Benefits and Coverage documents |
These define new code systems used by systems conforming to this implementation guide.
| SBC Benefit Category Code System |
Code system for the 27 benefit categories required in Summary of Benefits and Coverage (SBC) documents per ACA Section 2715 regulations |
| SBC Plan Type Code System |
Code system for health insurance plan types displayed in Summary of Benefits and Coverage documents |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
| Example Health Insurance Issuer |
Example organization representing a health insurance issuer |
| Example SBC - Sample HMO Health Plan |
Example Summary of Benefits and Coverage document represented as a FHIR InsurancePlan resource, demonstrating an HMO plan with multiple benefit categories and cost-sharing information |