National Healthcare Directory Attestation and Verification
1.0.0-ballot - ballot US

This page is part of the National Healthcare Directory Attestation (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

: Insurance Plan Type Code System - XML Representation

Active as of 2022-08-09

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="InsurancePlanTypeCS"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This code system http://hl7.org/fhir/us/directory-attestation/CodeSystem/InsurancePlanTypeCS 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">platinum<a name="InsurancePlanTypeCS-platinum"> </a></td><td>Platinum-QHP</td><td>Plan with highest monthly premium and lowest costs when you need care	A Qualified Health Plan with the highest monthly premiums and smallest out-of-pocket costs for the member in comparison to other metal-category plans</td></tr><tr><td style="white-space:nowrap">gold<a name="InsurancePlanTypeCS-gold"> </a></td><td>Gold-QHP</td><td>Plan with high monthly premium and low costs when you need care	A Qualified Health Plan with the higher monthly premiums and smaller out-of-pocket costs for the member in comparison to other metal-category plans</td></tr><tr><td style="white-space:nowrap">silver<a name="InsurancePlanTypeCS-silver"> </a></td><td>Silver-QHP</td><td>Plan with moderate monthly premium and moderate costs when you need care	A Qualified Health Plan with the lower monthly premiums and larger out-of-pocket costs for the member in comparison to other metal-category plans</td></tr><tr><td style="white-space:nowrap">bronze<a name="InsurancePlanTypeCS-bronze"> </a></td><td>Bronze-QHP</td><td>Plan with lowest monthly premium and highest costs when you need care	A Qualified Health Plan with the lowest monthly premiums and largest out-of-pocket costs for the member in comparison to other metal-category plans</td></tr><tr><td style="white-space:nowrap">catastrophic<a name="InsurancePlanTypeCS-catastrophic"> </a></td><td>Catastrophic-QHP</td><td>A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions.</td></tr><tr><td style="white-space:nowrap">lowdeductible<a name="InsurancePlanTypeCS-lowdeductible"> </a></td><td>Low Deductible</td><td>A plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan.</td></tr><tr><td style="white-space:nowrap">highdeductible<a name="InsurancePlanTypeCS-highdeductible"> </a></td><td>High Deductible</td><td>A plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan.</td></tr><tr><td style="white-space:nowrap">catastrophicplan<a name="InsurancePlanTypeCS-catastrophicplan"> </a></td><td>Catastrophic Plan</td><td>A plan that requires the insured to pay out of pocket a much larger proportion of incurred health care costs than a traditional insurance plan.</td></tr></table></div>
  </text>
  <url
       value="http://hl7.org/fhir/us/directory-attestation/CodeSystem/InsurancePlanTypeCS"/>
  <version value="1.0.0-ballot"/>
  <name value="InsurancePlanTypeCS"/>
  <title value="Insurance Plan Type Code System"/>
  <status value="active"/>
  <date value="2022-08-09T12:52:38+00:00"/>
  <publisher value="HL7 Patient Administration Working Group"/>
  <contact>
    <name value="HL7 Patient Administration Working Group"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.hl7.org/Special/committees/pafm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pafm@lists.HL7.org"/>
    </telecom>
  </contact>
  <description value="Categories of cost-sharing used by plans"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="false"/>
  <content value="complete"/>
  <count value="8"/>
  <concept>
    <code value="platinum"/>
    <display value="Platinum-QHP"/>
    <definition
                value="Plan with highest monthly premium and lowest costs when you need care	A Qualified Health Plan with the highest monthly premiums and smallest out-of-pocket costs for the member in comparison to other metal-category plans"/>
  </concept>
  <concept>
    <code value="gold"/>
    <display value="Gold-QHP"/>
    <definition
                value="Plan with high monthly premium and low costs when you need care	A Qualified Health Plan with the higher monthly premiums and smaller out-of-pocket costs for the member in comparison to other metal-category plans"/>
  </concept>
  <concept>
    <code value="silver"/>
    <display value="Silver-QHP"/>
    <definition
                value="Plan with moderate monthly premium and moderate costs when you need care	A Qualified Health Plan with the lower monthly premiums and larger out-of-pocket costs for the member in comparison to other metal-category plans"/>
  </concept>
  <concept>
    <code value="bronze"/>
    <display value="Bronze-QHP"/>
    <definition
                value="Plan with lowest monthly premium and highest costs when you need care	A Qualified Health Plan with the lowest monthly premiums and largest out-of-pocket costs for the member in comparison to other metal-category plans"/>
  </concept>
  <concept>
    <code value="catastrophic"/>
    <display value="Catastrophic-QHP"/>
    <definition
                value="A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions."/>
  </concept>
  <concept>
    <code value="lowdeductible"/>
    <display value="Low Deductible"/>
    <definition
                value="A plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan."/>
  </concept>
  <concept>
    <code value="highdeductible"/>
    <display value="High Deductible"/>
    <definition
                value="A plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan."/>
  </concept>
  <concept>
    <code value="catastrophicplan"/>
    <display value="Catastrophic Plan"/>
    <definition
                value="A plan that requires the insured to pay out of pocket a much larger proportion of incurred health care costs than a traditional insurance plan."/>
  </concept>
</CodeSystem>