National Directory of Healthcare Providers & Services (NDH) Implementation Guide
1.0.0-ballot - ballot United States of America flag

This page is part of the National Directory of Healthcare Providers and Services (NDH) Implementation Guide (v1.0.0-ballot: STU1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

CodeSystem: Insurance Plan Type Code System

Official URL: http://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCS Version: 1.0.0-ballot
Active as of 2023-07-30 Computable Name: InsurancePlanTypeCS

Categories of cost-sharing used by plans

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

This code system http://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCS defines the following codes:

CodeDisplayDefinition
platinum Platinum-QHPPlan 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
gold Gold-QHPPlan 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
silver Silver-QHPPlan 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
bronze Bronze-QHPPlan 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
catastrophic Catastrophic-QHPA plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions.
lowdeductible Low DeductibleA plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan.
highdeductible High DeductibleA plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan.
catastrophicplan Catastrophic PlanA plan that requires the insured to pay out of pocket a much larger proportion of incurred health care costs than a traditional insurance plan.