haau3 FHIR Implementation Guide (HFIG)
1.0.0 - ci-build United States of America flag

haau3 FHIR Implementation Guide (HFIG) - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

CodeSystem: Plan Benefits Cost Qualifier

Official URL: https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier Version: 1.0.0
Active as of 2026-10-14 Computable Name: PlanBenefitsCostQualifierCS

Facts that describe a Plan Benefits cost entry: which in-network tier it is, how it is charged, and how it relates to the deductible and the out-of-pocket maximum. haau3 publishes these until the SBC guide codes them.

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier defines the following codes:

CodeDisplayDefinition
tier-1 In network, tier 1 The plan's first in-network tier. Used only for a plan with two in-network tiers.
tier-2 In network, tier 2 The plan's second in-network tier, which has its own costs, deductible and out-of-pocket maximum.
point-of-service Point of service Care from providers outside an HMO's network under the plan's point-of-service option. Written with applicability out-of-network.
per-visit Per visit The cost is charged for each visit.
per-day Per day The cost is charged for each day of a stay. Where a day range is given, the cost applies to those days of the stay.
per-stay Per stay The cost is charged once for each stay.
one-price-both-networks One price in and out of network The plan files one price for this service for both in network and out of network, so the same price appears under both.
after-deductible After deductible CMS's file says the cost applies after deductible.
with-deductible With deductible CMS's file says the cost applies with deductible. CMS lists this apart from "after deductible", and haau3 does not interpret either.
counts-toward-maximum Counts toward the out-of-pocket maximum The plan files that this service counts toward the out-of-pocket maximum for this network.
excluded-from-maximum Does not count toward the out-of-pocket maximum The plan files that this service does not count toward the out-of-pocket maximum for this network.
no-copay-or-coinsurance-filed No copay or coinsurance The plan answered No both to a copay and to a coinsurance for this service, which means the member pays $0.
varies-by-hospital-tier Varies by hospital tier The plan charges different amounts at different tiers of hospitals. The cost given is the plan's tier 1.