This page is part of the US Drug Formulary (v1.2.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

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: Code for qualifier for coinsurance rate codes - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="usdf-CoinsuranceOptionCS"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">after-deductible<a name="usdf-CoinsuranceOptionCS-after-deductible"> </a></td><td>After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style="white-space:nowrap">no-charge<a name="usdf-CoinsuranceOptionCS-no-charge"> </a></td><td>No Charge</td><td>No cost sharing is charged (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style="white-space:nowrap">no-charge-after-deductible<a name="usdf-CoinsuranceOptionCS-no-charge-after-deductible"> </a></td><td>No Charge After Deductible</td><td>The consumer first pays the deductible, and after the deductible is met, no coinsurance is charged (this indicates that this benefit is subject to the deductible).</td></tr><tr><td style="white-space:nowrap">charge<a name="usdf-CoinsuranceOptionCS-charge"> </a></td><td>Charge</td><td>The consumer always pays just the coinsurance and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).</td></tr><tr><td style="white-space:nowrap">not-applicable<a name="usdf-CoinsuranceOptionCS-not-applicable"> </a></td><td>Not Applicable</td><td>The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs).</td></tr><tr><td style="white-space:nowrap">deductible-waived<a name="usdf-CoinsuranceOptionCS-deductible-waived"> </a></td><td>Deductible Waived</td><td>The consumer pays the coinsurance with deductible requirement waived.</td></tr></table></div>
  </text>
  <url
       value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS"/>
  <version value="1.2.0"/>
  <name value="CoInsuranceOptionCS"/>
  <title value="Code for qualifier for coinsurance rate codes"/>
  <status value="active"/>
  <date value="2021-12-03T18:37:11+00:00"/>
  <publisher value="HL7 Pharmacy Working Group"/>
  <contact>
    <name value="HL7 Pharmacy Working Group"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/medication"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pharmacy@lists.HL7.org"/>
    </telecom>
  </contact>
  <description value="Code for qualifier for coinsurance rate"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="6"/>
  <concept>
    <code value="after-deductible"/>
    <display value="After Deductible"/>
    <definition
                value="The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible)."/>
  </concept>
  <concept>
    <code value="no-charge"/>
    <display value="No Charge"/>
    <definition
                value="No cost sharing is charged (this indicates that this benefit is not subject to the deductible)."/>
  </concept>
  <concept>
    <code value="no-charge-after-deductible"/>
    <display value="No Charge After Deductible"/>
    <definition
                value="The consumer first pays the deductible, and after the deductible is met, no coinsurance is charged (this indicates that this benefit is subject to the deductible)."/>
  </concept>
  <concept>
    <code value="charge"/>
    <display value="Charge"/>
    <definition
                value="The consumer always pays just the coinsurance and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible)."/>
  </concept>
  <concept>
    <code value="not-applicable"/>
    <display value="Not Applicable"/>
    <definition
                value="The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs)."/>
  </concept>
  <concept>
    <code value="deductible-waived"/>
    <display value="Deductible Waived"/>
    <definition
                value="The consumer pays the coinsurance with deductible requirement waived."/>
  </concept>
</CodeSystem>