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 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="plan-benefits-cost-qualifier"/>
<text>
<status value="generated"/>
<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>
</text>
<url
value="https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier"/>
<version value="1.0.0"/>
<name value="PlanBenefitsCostQualifierCS"/>
<title value="Plan Benefits Cost Qualifier"/>
<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>