haau3 FHIR Implementation Guide (HFIG)
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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 Scope

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

The parts of a deductible's or out-of-pocket maximum's scope HL7's benefit-network and benefit-unit have no code for: the networks other than in and out, each person in a family, and what the amount applies to. 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-scope defines the following codes:

CodeDisplayDefinition
tier-2 In network, tier 2 The plan's second in-network tier.
point-of-service Point of service Care outside an HMO's network under the plan's point-of-service option.
combined In and out of network combined One amount that counts what the member pays in and out of network together.
in-and-out In and out of network An amount that applies to services both in and out of network.
unstated Network not stated The plan's filing does not say which network the amount applies to.
family-per-person Family, per person The amount for each person in a family.
medical-and-drug Medical and drugs One amount for medical care and prescription drugs together.
medical Medical Medical care only.
drug Drugs Prescription drugs only.