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-scope"/>
<text>
<status value="generated"/>
<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>
</text>
<url value="https://haau3.com/fhir/CodeSystem/plan-benefits-cost-scope"/>
<version value="1.0.0"/>
<name value="PlanBenefitsCostScopeCS"/>
<title value="Plan Benefits Cost Scope"/>
<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="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 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="9"/>
<concept>
<code value="tier-2"/>
<display value="In network, tier 2"/>
<definition value="The plan's second in-network tier."/>
</concept>
<concept>
<code value="point-of-service"/>
<display value="Point of service"/>
<definition
value="Care outside an HMO's network under the plan's point-of-service option."/>
</concept>
<concept>
<code value="combined"/>
<display value="In and out of network combined"/>
<definition
value="One amount that counts what the member pays in and out of network together."/>
</concept>
<concept>
<code value="in-and-out"/>
<display value="In and out of network"/>
<definition
value="An amount that applies to services both in and out of network."/>
</concept>
<concept>
<code value="unstated"/>
<display value="Network not stated"/>
<definition
value="The plan's filing does not say which network the amount applies to."/>
</concept>
<concept>
<code value="family-per-person"/>
<display value="Family, per person"/>
<definition value="The amount for each person in a family."/>
</concept>
<concept>
<code value="medical-and-drug"/>
<display value="Medical and drugs"/>
<definition
value="One amount for medical care and prescription drugs together."/>
</concept>
<concept>
<code value="medical"/>
<display value="Medical"/>
<definition value="Medical care only."/>
</concept>
<concept>
<code value="drug"/>
<display value="Drugs"/>
<definition value="Prescription drugs only."/>
</concept>
</CodeSystem>