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

ValueSet: Insurance Plan Type Value Set

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

Categories of cost-sharing used by plans

References

Logical Definition (CLD)

 

Expansion

This value set contains 8 concepts

Expansion based on Insurance Plan Type Code System v1.0.0-ballot (CodeSystem)

CodeSystemDisplayDefinition
  platinumhttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSPlatinum-QHP

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

  goldhttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSGold-QHP

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

  silverhttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSSilver-QHP

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

  bronzehttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSBronze-QHP

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

  catastrophichttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSCatastrophic-QHP

A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions.

  lowdeductiblehttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSLow Deductible

A plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan.

  highdeductiblehttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSHigh Deductible

A plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan.

  catastrophicplanhttp://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCSCatastrophic Plan

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.

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