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

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: Plan Benefits Cost Scope: Network - JSON Representation

Active as of 2026-10-14

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{
  "resourceType" : "ValueSet",
  "id" : "plan-benefits-cost-scope-network",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet plan-benefits-cost-scope-network</b></p><a name=\"plan-benefits-cost-scope-network\"> </a><a name=\"hcplan-benefits-cost-scope-network\"> </a><p>This value set includes codes based on the following rules:</p><ul><li>Include these codes as defined in <a href=\"http://terminology.hl7.org/7.4.0/CodeSystem-benefit-network.html\"><code>http://terminology.hl7.org/CodeSystem/benefit-network</code></a><span title=\"Version is explicitly stated to be 2.0.0\"> version &#x1F4CD;2.0.0</span><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"http://terminology.hl7.org/7.4.0/CodeSystem-benefit-network.html#benefit-network-in\">in</a></td><td style=\"color: #cccccc\">In Network</td><td>Services rendered by a Network provider</td></tr><tr><td><a href=\"http://terminology.hl7.org/7.4.0/CodeSystem-benefit-network.html#benefit-network-out\">out</a></td><td style=\"color: #cccccc\">Out of Network</td><td>Services rendered by a provider who is not in the Network</td></tr></table></li><li>Include these codes as defined in <a href=\"CodeSystem-plan-benefits-cost-scope.html\"><code>https://haau3.com/fhir/CodeSystem/plan-benefits-cost-scope</code></a><span title=\"Version is not explicitly stated, which means it is fixed to the version provided in this specification\"> version &#x1F4E6;1.0.0</span><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-plan-benefits-cost-scope.html#plan-benefits-cost-scope-tier-2\">tier-2</a></td><td style=\"color: #cccccc\">In network, tier 2</td><td>The plan's second in-network tier.</td></tr><tr><td><a href=\"CodeSystem-plan-benefits-cost-scope.html#plan-benefits-cost-scope-point-of-service\">point-of-service</a></td><td style=\"color: #cccccc\">Point of service</td><td>Care outside an HMO's network under the plan's point-of-service option.</td></tr><tr><td><a href=\"CodeSystem-plan-benefits-cost-scope.html#plan-benefits-cost-scope-combined\">combined</a></td><td style=\"color: #cccccc\">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><a href=\"CodeSystem-plan-benefits-cost-scope.html#plan-benefits-cost-scope-in-and-out\">in-and-out</a></td><td style=\"color: #cccccc\">In and out of network</td><td>An amount that applies to services both in and out of network.</td></tr><tr><td><a href=\"CodeSystem-plan-benefits-cost-scope.html#plan-benefits-cost-scope-unstated\">unstated</a></td><td style=\"color: #cccccc\">Network not stated</td><td>The plan's filing does not say which network the amount applies to.</td></tr></table></li></ul></div>"
  },
  "url" : "https://haau3.com/fhir/ValueSet/plan-benefits-cost-scope-network",
  "version" : "1.0.0",
  "name" : "PlanBenefitsCostScopeNetworkVS",
  "title" : "Plan Benefits Cost Scope: Network",
  "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" : "Which network a deductible or out-of-pocket maximum belongs to: HL7's in and out (in is the first tier for a plan with two in-network tiers), and haau3's codes for the rest.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "compose" : {
    "include" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/benefit-network",
        "version" : "2.0.0",
        "concept" : [
          {
            "code" : "in"
          },
          {
            "code" : "out"
          }
        ]
      },
      {
        "system" : "https://haau3.com/fhir/CodeSystem/plan-benefits-cost-scope",
        "concept" : [
          {
            "code" : "tier-2"
          },
          {
            "code" : "point-of-service"
          },
          {
            "code" : "combined"
          },
          {
            "code" : "in-and-out"
          },
          {
            "code" : "unstated"
          }
        ]
      }
    ]
  }
}