DaVinci Payer Data Exchange (PDex) US Drug Formulary | STU2 Ballot
1.2.0 - STU2 Ballot

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

ValueSet: Qualifier for coinsurance rate

Summary

Defining URL:http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/CoinsuranceOptionVS
Version:1.2.0
Name:CoinsuranceOptionVS
Title:Qualifier for coinsurance rate
Status:Active as of 12/3/21 6:37 PM
Definition:

Qualifier for coinsurance rate

Publisher:HL7 Pharmacy Working Group
Source Resource:XML / JSON / Turtle

References

Logical Definition (CLD)

 

Expansion

This value set contains 6 concepts

Expansion based on Code for qualifier for coinsurance rate codes v1.2.0 (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS

CodeDisplayDefinition
after-deductibleAfter DeductibleThe 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).
no-chargeNo ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductibleNo Charge After DeductibleThe 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).
chargeChargeThe 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).
not-applicableNot ApplicableThe 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).
deductible-waivedDeductible WaivedThe consumer pays the coinsurance with deductible requirement waived.

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
Source 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