DaVinci Payer Data Exchange (PDex) US Drug Formulary
1.1.0 - STU 1.1

This page is part of the US Drug Formulary (v1.1.0: STU 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

CodeSystem: Code for qualifier for coinsurance rate

Summary

Defining URL:http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS
Version:1.1.0
Name:CoInsuranceOptionCS
Title:Code for qualifier for coinsurance rate
Status:Active as of 2021-10-15T15:46:55+00:00
Definition:

Code for qualifier for coinsurance rate

Publisher:HL7 Pharmacy Working Group
Content:Complete: All the concepts defined by the code system are included in the code system resource
Source Resource:XML / JSON / Turtle

This Code system is referenced in the content logical definition of the following value sets:

This code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS defines the following codes:

CodeDisplayDefinition
after-deductible After 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-charge No ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductible No Charge After DeductibleThe consumer first pays the deductible, and after thedeductible is met, no coinsurance is charged (this indicates that this benefit is subject to the deductible).
charge ChargeThe 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-applicable Not 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).