haau3 FHIR Implementation Guide (HFIG)
1.0.0 - ci-build
haau3 FHIR Implementation Guide (HFIG)
1.0.0 - ci-build
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
| Active as of 2026-10-14 |
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/plan-benefits-cost-qualifier> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "plan-benefits-cost-qualifier"] ;
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ] ;
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem plan-benefits-cost-qualifier</b></p><a name=\"plan-benefits-cost-qualifier\"> </a><a name=\"hcplan-benefits-cost-qualifier\"> </a><p>This case-sensitive code system <code>https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier</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\">tier-1<a name=\"plan-benefits-cost-qualifier-tier-1\"> </a></td><td>In network, tier 1</td><td>The plan's first in-network tier. Used only for a plan with two in-network tiers.</td></tr><tr><td style=\"white-space:nowrap\">tier-2<a name=\"plan-benefits-cost-qualifier-tier-2\"> </a></td><td>In network, tier 2</td><td>The plan's second in-network tier, which has its own costs, deductible and out-of-pocket maximum.</td></tr><tr><td style=\"white-space:nowrap\">point-of-service<a name=\"plan-benefits-cost-qualifier-point-of-service\"> </a></td><td>Point of service</td><td>Care from providers outside an HMO's network under the plan's point-of-service option. Written with applicability out-of-network.</td></tr><tr><td style=\"white-space:nowrap\">per-visit<a name=\"plan-benefits-cost-qualifier-per-visit\"> </a></td><td>Per visit</td><td>The cost is charged for each visit.</td></tr><tr><td style=\"white-space:nowrap\">per-day<a name=\"plan-benefits-cost-qualifier-per-day\"> </a></td><td>Per day</td><td>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.</td></tr><tr><td style=\"white-space:nowrap\">per-stay<a name=\"plan-benefits-cost-qualifier-per-stay\"> </a></td><td>Per stay</td><td>The cost is charged once for each stay.</td></tr><tr><td style=\"white-space:nowrap\">one-price-both-networks<a name=\"plan-benefits-cost-qualifier-one-price-both-networks\"> </a></td><td>One price in and out of network</td><td>The plan files one price for this service for both in network and out of network, so the same price appears under both.</td></tr><tr><td style=\"white-space:nowrap\">after-deductible<a name=\"plan-benefits-cost-qualifier-after-deductible\"> </a></td><td>After deductible</td><td>CMS's file says the cost applies after deductible.</td></tr><tr><td style=\"white-space:nowrap\">with-deductible<a name=\"plan-benefits-cost-qualifier-with-deductible\"> </a></td><td>With deductible</td><td>CMS's file says the cost applies with deductible. CMS lists this apart from \"after deductible\", and haau3 does not interpret either.</td></tr><tr><td style=\"white-space:nowrap\">counts-toward-maximum<a name=\"plan-benefits-cost-qualifier-counts-toward-maximum\"> </a></td><td>Counts toward the out-of-pocket maximum</td><td>The plan files that this service counts toward the out-of-pocket maximum for this network.</td></tr><tr><td style=\"white-space:nowrap\">excluded-from-maximum<a name=\"plan-benefits-cost-qualifier-excluded-from-maximum\"> </a></td><td>Does not count toward the out-of-pocket maximum</td><td>The plan files that this service does not count toward the out-of-pocket maximum for this network.</td></tr><tr><td style=\"white-space:nowrap\">no-copay-or-coinsurance-filed<a name=\"plan-benefits-cost-qualifier-no-copay-or-coinsurance-filed\"> </a></td><td>No copay or coinsurance</td><td>The plan answered No both to a copay and to a coinsurance for this service, which means the member pays $0.</td></tr><tr><td style=\"white-space:nowrap\">varies-by-hospital-tier<a name=\"plan-benefits-cost-qualifier-varies-by-hospital-tier\"> </a></td><td>Varies by hospital tier</td><td>The plan charges different amounts at different tiers of hospitals. The cost given is the plan's tier 1.</td></tr></table></div>"
] ;
fhir:CodeSystem.url [ fhir:value "https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier"] ;
fhir:CodeSystem.version [ fhir:value "1.0.0"] ;
fhir:CodeSystem.name [ fhir:value "PlanBenefitsCostQualifierCS"] ;
fhir:CodeSystem.title [ fhir:value "Plan Benefits Cost Qualifier"] ;
fhir:CodeSystem.status [ fhir:value "active"] ;
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean] ;
fhir:CodeSystem.date [ fhir:value "2026-10-14T18:01:46+00:00"^^xsd:dateTime] ;
fhir:CodeSystem.publisher [ fhir:value "haau3"] ;
fhir:CodeSystem.contact [
fhir:index 0 ;
fhir:ContactDetail.name [ fhir:value "haau3" ] ;
fhir:ContactDetail.telecom [
fhir:index 0 ;
fhir:ContactPoint.system [ fhir:value "url" ] ;
fhir:ContactPoint.value [ fhir:value "https://haau3.com" ]
], [
fhir:index 1 ;
fhir:ContactPoint.system [ fhir:value "email" ] ;
fhir:ContactPoint.value [ fhir:value "hello@haau3.com" ]
]
] ;
fhir:CodeSystem.description [ fhir:value "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."] ;
fhir:CodeSystem.jurisdiction [
fhir:index 0 ;
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ] ;
fhir:Coding.code [ fhir:value "US" ] ;
fhir:Coding.display [ fhir:value "United States of America" ]
]
] ;
fhir:CodeSystem.caseSensitive [ fhir:value "true"^^xsd:boolean] ;
fhir:CodeSystem.content [ fhir:value "complete"] ;
fhir:CodeSystem.count [ fhir:value "13"^^xsd:nonNegativeInteger] ;
fhir:CodeSystem.concept [
fhir:index 0 ;
fhir:CodeSystem.concept.code [ fhir:value "tier-1" ] ;
fhir:CodeSystem.concept.display [ fhir:value "In network, tier 1" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan's first in-network tier. Used only for a plan with two in-network tiers." ]
], [
fhir:index 1 ;
fhir:CodeSystem.concept.code [ fhir:value "tier-2" ] ;
fhir:CodeSystem.concept.display [ fhir:value "In network, tier 2" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan's second in-network tier, which has its own costs, deductible and out-of-pocket maximum." ]
], [
fhir:index 2 ;
fhir:CodeSystem.concept.code [ fhir:value "point-of-service" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Point of service" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "Care from providers outside an HMO's network under the plan's point-of-service option. Written with applicability out-of-network." ]
], [
fhir:index 3 ;
fhir:CodeSystem.concept.code [ fhir:value "per-visit" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Per visit" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The cost is charged for each visit." ]
], [
fhir:index 4 ;
fhir:CodeSystem.concept.code [ fhir:value "per-day" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Per day" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "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." ]
], [
fhir:index 5 ;
fhir:CodeSystem.concept.code [ fhir:value "per-stay" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Per stay" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The cost is charged once for each stay." ]
], [
fhir:index 6 ;
fhir:CodeSystem.concept.code [ fhir:value "one-price-both-networks" ] ;
fhir:CodeSystem.concept.display [ fhir:value "One price in and out of network" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan files one price for this service for both in network and out of network, so the same price appears under both." ]
], [
fhir:index 7 ;
fhir:CodeSystem.concept.code [ fhir:value "after-deductible" ] ;
fhir:CodeSystem.concept.display [ fhir:value "After deductible" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "CMS's file says the cost applies after deductible." ]
], [
fhir:index 8 ;
fhir:CodeSystem.concept.code [ fhir:value "with-deductible" ] ;
fhir:CodeSystem.concept.display [ fhir:value "With deductible" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "CMS's file says the cost applies with deductible. CMS lists this apart from \"after deductible\", and haau3 does not interpret either." ]
], [
fhir:index 9 ;
fhir:CodeSystem.concept.code [ fhir:value "counts-toward-maximum" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Counts toward the out-of-pocket maximum" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan files that this service counts toward the out-of-pocket maximum for this network." ]
], [
fhir:index 10 ;
fhir:CodeSystem.concept.code [ fhir:value "excluded-from-maximum" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Does not count toward the out-of-pocket maximum" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan files that this service does not count toward the out-of-pocket maximum for this network." ]
], [
fhir:index 11 ;
fhir:CodeSystem.concept.code [ fhir:value "no-copay-or-coinsurance-filed" ] ;
fhir:CodeSystem.concept.display [ fhir:value "No copay or coinsurance" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan answered No both to a copay and to a coinsurance for this service, which means the member pays $0." ]
], [
fhir:index 12 ;
fhir:CodeSystem.concept.code [ fhir:value "varies-by-hospital-tier" ] ;
fhir:CodeSystem.concept.display [ fhir:value "Varies by hospital tier" ] ;
fhir:CodeSystem.concept.definition [ fhir:value "The plan charges different amounts at different tiers of hospitals. The cost given is the plan's tier 1." ]
] .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/CodeSystem/plan-benefits-cost-qualifier.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/CodeSystem/plan-benefits-cost-qualifier.ttl> .
IG © 2026+ haau3. Package haau3.fhir#1.0.0 based on FHIR 4.0.1. Generated 2026-10-14
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