National Directory of Healthcare Providers & Services (NDH) Implementation Guide
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National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. 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 2024-06-17 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 case-sensitive code system http://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCS defines the following codes:

CodeDisplayDefinition
platinum Platinum-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
gold Gold-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
silver Silver-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
bronze Bronze-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
catastrophic Catastrophic-QHP A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions.
lowdeductible Low 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.
highdeductible High 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.
catastrophicplan Catastrophic 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.