haau3 FHIR Implementation Guide (HFIG)
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CodeSystem: Plan Benefits Cost Type

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

The kinds of Plan Benefits cost entry HL7's benefit-type has no code for: the per-visit cap on coinsurance, and, for an entry with no amount, why it has none. A copay, a coinsurance and a per-service deductible use HL7's benefit-type. haau3 publishes these until the SBC guide codes cost types.

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-type defines the following codes:

CodeDisplayDefinition
coinsurance-maximum Most you pay in coinsurance per visit The most the member pays in coinsurance for one visit.
not-covered Not covered The plan's own filing says it does not cover this service in this network: an ACA Marketplace plan's filing for the service, or a Medicare Advantage plan's filing that it covers no care out of network at all. Emergency and urgent care are priced once for both networks and never carry it for that reason. The entry has no amount.
not-filed Not in the public files The plan filed no cost for this service in this network in CMS's public files. This does not show that the plan excludes the service: an exclusion that appears only in the plan's own documents is not in these files. Used for Medicare Advantage plans. The entry has no amount.
not-stated Not stated CMS's file has an entry for this service in this network but states no cost, for example "Not Applicable" in both the copay and the coinsurance. The entry has no amount.
not-part-of-plan Not part of this plan The service is not part of this plan's benefits, as hospital care is not for a Medicare Advantage plan that covers Part B services only. The entry has no amount.
no-cost-data No cost data in the public files The plan files no cost data for any service in CMS's public files, as PACE, medical savings account and cost plans do. The entry has no amount.