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-type | Version: 1.0.0 | |||
| Active as of 2026-10-14 | Computable Name: PlanBenefitsCostTypeVS | |||
Every Plan Benefits cost type: HL7's benefit-type codes for a copay, a coinsurance (copay-percent) and a per-service deductible, and haau3's for the rest.
References
This value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/benefit-type version 📍1.0.1| Code | Display | Definition |
| copay | Copayment per service | Copayment per service |
| copay-percent | Copayment Percent per service | Copayment percentage per service |
| deductible | Deductible | Cost to be incurred before benefits are applied |
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type version 📦1.0.0
Expansion performed internally based on:
This value set contains 9 concepts
| System | Code | Display (en) | Definition | JSON | XML |
http://terminology.hl7.org/CodeSystem/benefit-type | copay | Copayment per service | Copayment per service | ||
http://terminology.hl7.org/CodeSystem/benefit-type | copay-percent | Copayment Percent per service | Copayment percentage per service | ||
http://terminology.hl7.org/CodeSystem/benefit-type | deductible | Deductible | Cost to be incurred before benefits are applied | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type | coinsurance-maximum | Most you pay in coinsurance per visit | The most the member pays in coinsurance for one visit. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type | 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. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type | 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. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type | 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. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type | 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. | ||
https://haau3.com/fhir/CodeSystem/plan-benefits-cost-type | 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. |
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 |