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

• Narrative Content
• XML
• JSON
• TTL

: Plan Benefits Cost Scope: Network - XML Representation

Active as of 2026-10-14

Raw xml | Download

<ValueSet xmlns="http://hl7.org/fhir">
  <id value="plan-benefits-cost-scope-network"/>
  <text>
    <status value="extensions"/>
    <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>
  </text>
  <url
       value="https://haau3.com/fhir/ValueSet/plan-benefits-cost-scope-network"/>
  <version value="1.0.0"/>
  <name value="PlanBenefitsCostScopeNetworkVS"/>
  <title value="Plan Benefits Cost Scope: Network"/>
  <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="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 value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system value="http://terminology.hl7.org/CodeSystem/benefit-network"/>
      <version value="2.0.0"/>
      <concept>
        <code value="in"/>
      </concept>
      <concept>
        <code value="out"/>
      </concept>
    </include>
    <include>
      <system
              value="https://haau3.com/fhir/CodeSystem/plan-benefits-cost-scope"/>
      <concept>
        <code value="tier-2"/>
      </concept>
      <concept>
        <code value="point-of-service"/>
      </concept>
      <concept>
        <code value="combined"/>
      </concept>
      <concept>
        <code value="in-and-out"/>
      </concept>
      <concept>
        <code value="unstated"/>
      </concept>
    </include>
  </compose>
</ValueSet>