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

: Insurance Plan Type Code System - JSON Representation

Active as of 2024-06-17

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{
  "resourceType" : "CodeSystem",
  "id" : "InsurancePlanTypeCS",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This case-sensitive 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>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "pa"
    }
  ],
  "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" : "2024-06-17T18:03:52+00:00",
  "publisher" : "HL7 International / Patient Administration",
  "contact" : [
    {
      "name" : "HL7 International / Patient Administration",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.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."
    }
  ]
}