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 |
{
"resourceType" : "CodeSystem",
"id" : "plan-benefits-cost-scope",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem plan-benefits-cost-scope</b></p><a name=\"plan-benefits-cost-scope\"> </a><a name=\"hcplan-benefits-cost-scope\"> </a><p>This case-sensitive code system <code>https://haau3.com/fhir/CodeSystem/plan-benefits-cost-scope</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-2<a name=\"plan-benefits-cost-scope-tier-2\"> </a></td><td>In network, tier 2</td><td>The plan's second in-network tier.</td></tr><tr><td style=\"white-space:nowrap\">point-of-service<a name=\"plan-benefits-cost-scope-point-of-service\"> </a></td><td>Point of service</td><td>Care outside an HMO's network under the plan's point-of-service option.</td></tr><tr><td style=\"white-space:nowrap\">combined<a name=\"plan-benefits-cost-scope-combined\"> </a></td><td>In and out of network combined</td><td>One amount that counts what the member pays in and out of network together.</td></tr><tr><td style=\"white-space:nowrap\">in-and-out<a name=\"plan-benefits-cost-scope-in-and-out\"> </a></td><td>In and out of network</td><td>An amount that applies to services both in and out of network.</td></tr><tr><td style=\"white-space:nowrap\">unstated<a name=\"plan-benefits-cost-scope-unstated\"> </a></td><td>Network not stated</td><td>The plan's filing does not say which network the amount applies to.</td></tr><tr><td style=\"white-space:nowrap\">family-per-person<a name=\"plan-benefits-cost-scope-family-per-person\"> </a></td><td>Family, per person</td><td>The amount for each person in a family.</td></tr><tr><td style=\"white-space:nowrap\">medical-and-drug<a name=\"plan-benefits-cost-scope-medical-and-drug\"> </a></td><td>Medical and drugs</td><td>One amount for medical care and prescription drugs together.</td></tr><tr><td style=\"white-space:nowrap\">medical<a name=\"plan-benefits-cost-scope-medical\"> </a></td><td>Medical</td><td>Medical care only.</td></tr><tr><td style=\"white-space:nowrap\">drug<a name=\"plan-benefits-cost-scope-drug\"> </a></td><td>Drugs</td><td>Prescription drugs only.</td></tr></table></div>"
},
"url" : "https://haau3.com/fhir/CodeSystem/plan-benefits-cost-scope",
"version" : "1.0.0",
"name" : "PlanBenefitsCostScopeCS",
"title" : "Plan Benefits Cost Scope",
"status" : "active",
"experimental" : false,
"date" : "2026-10-14T18:01:46+00:00",
"publisher" : "haau3",
"contact" : [
{
"name" : "haau3",
"telecom" : [
{
"system" : "url",
"value" : "https://haau3.com"
},
{
"system" : "email",
"value" : "hello@haau3.com"
}
]
}
],
"description" : "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.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}
]
}
],
"caseSensitive" : true,
"content" : "complete",
"count" : 9,
"concept" : [
{
"code" : "tier-2",
"display" : "In network, tier 2",
"definition" : "The plan's second in-network tier."
},
{
"code" : "point-of-service",
"display" : "Point of service",
"definition" : "Care outside an HMO's network under the plan's point-of-service option."
},
{
"code" : "combined",
"display" : "In and out of network combined",
"definition" : "One amount that counts what the member pays in and out of network together."
},
{
"code" : "in-and-out",
"display" : "In and out of network",
"definition" : "An amount that applies to services both in and out of network."
},
{
"code" : "unstated",
"display" : "Network not stated",
"definition" : "The plan's filing does not say which network the amount applies to."
},
{
"code" : "family-per-person",
"display" : "Family, per person",
"definition" : "The amount for each person in a family."
},
{
"code" : "medical-and-drug",
"display" : "Medical and drugs",
"definition" : "One amount for medical care and prescription drugs together."
},
{
"code" : "medical",
"display" : "Medical",
"definition" : "Medical care only."
},
{
"code" : "drug",
"display" : "Drugs",
"definition" : "Prescription drugs only."
}
]
}