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Source1

{
  "resourceType": "CodeSystem",
  "id": "sbc-plan-type",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "claims"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "informative",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/insurance-card/ImplementationGuide/hl7.fhir.us.insurance-card"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/insurance-card/CodeSystem/sbc-plan-type",
  "version": "2.0.0",
  "name": "SBCPlanTypeCS",
  "title": "SBC Plan Type Code System",
  "status": "draft",
  "experimental": true,
  "date": "2026-02-03T01:43:53+00:00",
  "publisher": "HL7 International / Payer/Provider Information Exchange Work Group",
  "contact": [
    {
      "name": "HL7 International / Payer/Provider Information Exchange Work Group",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/claims"
        },
        {
          "system": "email",
          "value": "pie@lists.HL7.org"
        }
      ]
    }
  ],
  "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"
    }
  ]
}