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 - TTL Representation

Active as of 2024-06-17

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "InsurancePlanTypeCS"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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	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</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	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</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	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</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	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</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>"
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "pa" ]
  ] ) ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/us/ndh/CodeSystem/InsurancePlanTypeCS"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "1.0.0-ballot"] ; # 
  fhir:name [ fhir:v "InsurancePlanTypeCS"] ; # 
  fhir:title [ fhir:v "Insurance Plan Type Code System"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v "false"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2024-06-17T18:03:52+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International / Patient Administration"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HL7 International / Patient Administration" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/pafm" ]     ] [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "pafm@lists.hl7.org" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "Categories of cost-sharing used by plans"] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ] ;
fhir:display [ fhir:v "United States of America" ]     ] )
  ] ) ; # 
  fhir:caseSensitive [ fhir:v "true"^^xsd:boolean] ; # 
  fhir:content [ fhir:v "complete"] ; # 
  fhir:count [ fhir:v "8"^^xsd:nonNegativeInteger] ; # 
  fhir:concept ( [
fhir:code [ fhir:v "platinum" ] ;
fhir:display [ fhir:v "Platinum-QHP" ] ;
fhir:definition [ fhir:v "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" ]
  ] [
fhir:code [ fhir:v "gold" ] ;
fhir:display [ fhir:v "Gold-QHP" ] ;
fhir:definition [ fhir:v "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" ]
  ] [
fhir:code [ fhir:v "silver" ] ;
fhir:display [ fhir:v "Silver-QHP" ] ;
fhir:definition [ fhir:v "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" ]
  ] [
fhir:code [ fhir:v "bronze" ] ;
fhir:display [ fhir:v "Bronze-QHP" ] ;
fhir:definition [ fhir:v "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" ]
  ] [
fhir:code [ fhir:v "catastrophic" ] ;
fhir:display [ fhir:v "Catastrophic-QHP" ] ;
fhir:definition [ fhir:v "A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions." ]
  ] [
fhir:code [ fhir:v "lowdeductible" ] ;
fhir:display [ fhir:v "Low Deductible" ] ;
fhir:definition [ fhir:v "A plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan." ]
  ] [
fhir:code [ fhir:v "highdeductible" ] ;
fhir:display [ fhir:v "High Deductible" ] ;
fhir:definition [ fhir:v "A plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan." ]
  ] [
fhir:code [ fhir:v "catastrophicplan" ] ;
fhir:display [ fhir:v "Catastrophic Plan" ] ;
fhir:definition [ fhir:v "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." ]
  ] ) . #