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
| Official URL: https://haau3.com/fhir/ValueSet/plan-benefits-cost-qualifier | Version: 1.0.0 | |||
| Active as of 2026-10-14 | Computable Name: PlanBenefitsCostQualifierVS | |||
Every Plan Benefits cost qualifier.
References
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier version 📦1.0.0
Expansion performed internally based on codesystem Plan Benefits Cost Qualifier v1.0.0 (CodeSystem)
This value set contains 13 concepts
| System | Code | Display (en) | Definition | JSON | XML |
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | tier-1 | In network, tier 1 | The plan's first in-network tier. Used only for a plan with two in-network tiers. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | tier-2 | In network, tier 2 | The plan's second in-network tier, which has its own costs, deductible and out-of-pocket maximum. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | point-of-service | Point of service | Care from providers outside an HMO's network under the plan's point-of-service option. Written with applicability out-of-network. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | per-visit | Per visit | The cost is charged for each visit. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | per-day | Per day | The cost is charged for each day of a stay. Where a day range is given, the cost applies to those days of the stay. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | per-stay | Per stay | The cost is charged once for each stay. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | one-price-both-networks | One price in and out of network | The plan files one price for this service for both in network and out of network, so the same price appears under both. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | after-deductible | After deductible | CMS's file says the cost applies after deductible. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | with-deductible | With deductible | CMS's file says the cost applies with deductible. CMS lists this apart from "after deductible", and haau3 does not interpret either. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | counts-toward-maximum | Counts toward the out-of-pocket maximum | The plan files that this service counts toward the out-of-pocket maximum for this network. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | excluded-from-maximum | Does not count toward the out-of-pocket maximum | The plan files that this service does not count toward the out-of-pocket maximum for this network. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | no-copay-or-coinsurance-filed | No copay or coinsurance | The plan answered No both to a copay and to a coinsurance for this service, which means the member pays $0. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-qualifier | varies-by-hospital-tier | Varies by hospital tier | The plan charges different amounts at different tiers of hospitals. The cost given is the plan's tier 1. |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |