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 
: Insurance Plan Type Code System - JSON Representation
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{
"resourceType" : "CodeSystem",
"id" : "InsurancePlanTypeCS",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system <code>http://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCS</code> 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\tA 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\tA 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\tA 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\tA 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>"
},
"url" : "http://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCS",
"version" : "1.0.0-ballot",
"name" : "InsurancePlanTypeCS",
"title" : "Insurance Plan Type Code System",
"status" : "active",
"experimental" : false,
"date" : "2023-07-30T14:53:07+00:00",
"publisher" : "HL7 International - Patient Administration Work Group",
"contact" : [
{
"name" : "HL7 International - Patient Administration Work Group",
"telecom" : [
{
"system" : "url",
"value" : "http://hl7.org/Special/committees/pafm"
},
{
"system" : "email",
"value" : "pafm@lists.hl7.org"
}
]
}
],
"description" : "Categories of cost-sharing used by plans",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}
]
}
],
"caseSensitive" : true,
"content" : "complete",
"count" : 8,
"concept" : [
{
"code" : "platinum",
"display" : "Platinum-QHP",
"definition" : "Plan with highest monthly premium and lowest costs when you need care\tA Qualified Health Plan with the highest monthly premiums and smallest out-of-pocket costs for the member in comparison to other metal-category plans"
},
{
"code" : "gold",
"display" : "Gold-QHP",
"definition" : "Plan with high monthly premium and low costs when you need care\tA Qualified Health Plan with the higher monthly premiums and smaller out-of-pocket costs for the member in comparison to other metal-category plans"
},
{
"code" : "silver",
"display" : "Silver-QHP",
"definition" : "Plan with moderate monthly premium and moderate costs when you need care\tA Qualified Health Plan with the lower monthly premiums and larger out-of-pocket costs for the member in comparison to other metal-category plans"
},
{
"code" : "bronze",
"display" : "Bronze-QHP",
"definition" : "Plan with lowest monthly premium and highest costs when you need care\tA Qualified Health Plan with the lowest monthly premiums and largest out-of-pocket costs for the member in comparison to other metal-category plans"
},
{
"code" : "catastrophic",
"display" : "Catastrophic-QHP",
"definition" : "A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions."
},
{
"code" : "lowdeductible",
"display" : "Low Deductible",
"definition" : "A plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan."
},
{
"code" : "highdeductible",
"display" : "High Deductible",
"definition" : "A plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan."
},
{
"code" : "catastrophicplan",
"display" : "Catastrophic Plan",
"definition" : "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."
}
]
}
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