CARIN Digital Insurance Card
2.0.0-ballot - STU 2 Ballot

CARIN Digital Insurance Card - Downloaded Version 2.0.0-ballot See the Directory of published versions

## ValueSet: C4DIC Copay Type

Official URL: http://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVS | Version: 2.0.0-ballot
Standards status: Trial-use | Maturity Level: 2 | Computable Name: C4DICCopayTypeVS
Other Identifiers: OID:2.16.840.1.113883.4.642.40.9.48.2
Copyright/Legal: This Valueset is not copyrighted.

This value set includes an extended set of copay type codes.

References

- C4DIC Coverage

### Logical Definition (CLD)

This value set includes codes based on the following rules:

- Import all the codes that are contained in Coverage Copay Type Codes
- Include all codes defined in `http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` version 📦2.0.0-ballot
- Include all codes defined in `http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` version 📦2.1.0

### Expansion

Expansion performed internally based on:

- codesystem Codes for medication drug tiers in health plans v2.1.0 (CodeSystem)
- codesystem C4DIC Extended Copay Type v2.0.0-ballot (CodeSystem)
- codesystem Coverage Copay Type Codes v1.0.1 (CodeSystem)
- valueset Coverage Copay Type Codes v4.0.1 (ValueSet)

This value set contains 38 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | gpvisit | GP Office Visit | An office visit for a general practitioner of a discipline. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | spvisit | Specialist Office Visit | An office visit for a specialist practitioner of a discipline |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | emergency | Emergency | An episode in an emergency department. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | inpthosp | Inpatient Hospital | An episode of an Inpatient hospital stay. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | televisit | Tele-visit | A visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | urgentcare | Urgent Care | A visit to an urgent care facility - typically a community care clinic. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | copaypct | Copay Percentage | A standard percentage applied to all classes or service or product not otherwise specified. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | copay | Copay Amount | A standard fixed currency amount applied to all classes or service or product not otherwise specified. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | deductible | Deductible | The accumulated amount of patient payment before the coverage begins to pay for services. |  |
`http://terminology.hl7.org/CodeSystem/coverage-copay-type` | maxoutofpocket | Maximum out of pocket | The maximum amout of payment for services which a patient, or family, is expected to incur - typically annually. |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamOutDed | Family Out of Network Deductible | Family Out of Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamInDed | Family In Network Deductible | Family In Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamRxOutDed | Family Pharmacy Out of Network Deductible | Family Pharmacy Out of Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamRxInDed | Family Pharmacy In Network Deductible | Family Pharmacy In Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamOutMax | Family Out of Network Out of Pocket Maximum | Family Out of Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamInMax | Family In Network Out of Pocket Maximum | Family In Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamRxOutMax | Family Pharmacy Out of Network Out of Pocket Maximum | Family Pharmacy Out of Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | FamRxInMax | Family Pharmacy In Network Out of Pocket Maximum | Family Pharmacy In Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndOutDed | Invidual Out of Network Deductible | Individual Out of Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndInDed | Individual In Network Deductible | Individual In Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndRxOutDed | Individual Pharmacy Out of Network Deductible | Individual Pharmacy Out of Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndRxInDed | Individual Pharmacy In Network Deductible | Individual Pharmacy In Network Deductible |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndOutMax | Individual Out of Network Out of Pocket Maximum | Individual Out of Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndInMax | Individual In Network Out of Pocket Maximum | Individual In Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndRxOutMax | Individual Pharmacy Out of Network Out of Pocket Maximum | Individual Pharmacy Out of Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | IndRxInMax | Individual Pharmacy In Network Out of Pocket Maximum | Individual Pharmacy In Network Out of Pocket Maximum |  |
`http://terminology.hl7.org/CodeSystem/C4DICExtendedCopayTypeCS` | rx | Prescription | Prescription |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | generic | Generic | Commonly prescribed generic drugs that cost more than drugs in the 'preferred generic' tier. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | preferred | Preferred | Commonly prescribed drugs that are preferred by the plan. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | non-preferred | Non-preferred | Commonly prescribed drugs that cost more than drugs in the 'preferred' tier. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | preferred-generic | Preferred Generic | Commonly prescribed generic drugs. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | non-preferred-generic | Non-preferred Generic | Generic drugs that cost more than drugs in ‘generic’ tier. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | specialty | Specialty | Drugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | brand | Brand | Brand name drugs that cost more than ‘preferred brand’ drugs. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | preferred-brand | Preferred Brand | Brand name drugs |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | non-preferred-brand | Non-preferred Brand | Brand name drugs that cost more than ‘brand’ drugs. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | zero-cost-share-preventative | Zero cost-share preventative | Preventive medications and products available at no cost. |  |
`http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE` | medical-service | Medical Service | Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit. |  |

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