<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 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."/> <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="6"/> <concept> <code value="coinsurance-maximum"/> <display value="Most you pay in coinsurance per visit"/> <definition value="The most the member pays in coinsurance for one visit."/> </concept> <concept> <code value="not-covered"/> <display value="Not covered"/> <definition value="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."/> </concept> <concept> <code value="not-filed"/> <display value="Not in the public files"/> <definition value="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."/> </concept> <concept> <code value="not-stated"/> <display value="Not stated"/> <definition value="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."/> </concept> <concept> <code value="not-part-of-plan"/> <display value="Not part of this plan"/> <definition value="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."/> </concept> <concept> <code value="no-cost-data"/> <display value="No cost data in the public files"/> <definition value="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."/> </concept> </CodeSystem>

Generated Narrative: CodeSystem plan-benefits-cost-type

This case-sensitive code system https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type defines the following codes:

Code	Display	Definition
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.