<status value="active"/> <experimental value="false"/> <date value="2026-10-14T18:01:46+00:00"/> <publisher value="haau3"/> <contact> <name value="haau3"/> <telecom> <system value="url"/> <value value="https://haau3.com"/> </telecom> <telecom> <system value="email"/> <value value="hello@haau3.com"/> </telecom> </contact> <description 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."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <caseSensitive value="true"/> <content value="complete"/> <count value="13"/> <concept> <code value="tier-1"/> <display value="In network, tier 1"/> <definition value="The plan's first in-network tier. Used only for a plan with two in-network tiers."/> </concept> <concept> <code value="tier-2"/> <display value="In network, tier 2"/> <definition value="The plan's second in-network tier, which has its own costs, deductible and out-of-pocket maximum."/> </concept> <concept> <code value="point-of-service"/> <display value="Point of service"/> <definition value="Care from providers outside an HMO's network under the plan's point-of-service option. Written with applicability out-of-network."/> </concept> <concept> <code value="per-visit"/> <display value="Per visit"/> <definition value="The cost is charged for each visit."/> </concept> <concept> <code value="per-day"/> <display value="Per day"/> <definition 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."/> </concept> <concept> <code value="per-stay"/> <display value="Per stay"/> <definition value="The cost is charged once for each stay."/> </concept> <concept> <code value="one-price-both-networks"/> <display value="One price in and out of network"/> <definition value="The plan files one price for this service for both in network and out of network, so the same price appears under both."/> </concept> <concept> <code value="after-deductible"/> <display value="After deductible"/> <definition value="CMS's file says the cost applies after deductible."/> </concept> <concept> <code value="with-deductible"/> <display value="With deductible"/> <definition value="CMS's file says the cost applies with deductible. CMS lists this apart from "after deductible", and haau3 does not interpret either."/> </concept> <concept> <code value="counts-toward-maximum"/> <display value="Counts toward the out-of-pocket maximum"/> <definition value="The plan files that this service counts toward the out-of-pocket maximum for this network."/> </concept> <concept> <code value="excluded-from-maximum"/> <display value="Does not count toward the out-of-pocket maximum"/> <definition value="The plan files that this service does not count toward the out-of-pocket maximum for this network."/> </concept> <concept> <code value="no-copay-or-coinsurance-filed"/> <display value="No copay or coinsurance"/> <definition value="The plan answered No both to a copay and to a coinsurance for this service, which means the member pays $0."/> </concept> <concept> <code value="varies-by-hospital-tier"/> <display value="Varies by hospital tier"/> <definition value="The plan charges different amounts at different tiers of hospitals. The cost given is the plan's tier 1."/> </concept> </CodeSystem>

Generated Narrative: CodeSystem plan-benefits-cost-qualifier

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

Code	Display	Definition
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.