CARIN Digital Insurance Card
2.0.0 - STU 2.0 United States of America flag

CARIN Digital Insurance Card, published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-digital-insurance-card/ and changes regularly. See the Directory of published versions

ValueSet: C4DIC Copay Type (Experimental)

Official URL: http://hl7.org/fhir/us/insurance-card/ValueSet/C4DICCopayTypeVS Version: 2.0.0
Active as of 2025-10-01 Computable Name: C4DICCopayTypeVS

Copyright/Legal: This Valueset is not copyrighted.

This value set includes an extended set of copay type codes.

References

Logical Definition (CLD)

This value set includes codes based on the following rules:

 

Expansion

This value set contains 38 concepts

CodeSystemDisplayDefinition
  gpvisithttp://terminology.hl7.org/CodeSystem/coverage-copay-typeGP Office VisitAn office visit for a general practitioner of a discipline.
  spvisithttp://terminology.hl7.org/CodeSystem/coverage-copay-typeSpecialist Office VisitAn office visit for a specialist practitioner of a discipline
  emergencyhttp://terminology.hl7.org/CodeSystem/coverage-copay-typeEmergencyAn episode in an emergency department.
  inpthosphttp://terminology.hl7.org/CodeSystem/coverage-copay-typeInpatient HospitalAn episode of an Inpatient hospital stay.
  televisithttp://terminology.hl7.org/CodeSystem/coverage-copay-typeTele-visitA visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.
  urgentcarehttp://terminology.hl7.org/CodeSystem/coverage-copay-typeUrgent CareA visit to an urgent care facility - typically a community care clinic.
  copaypcthttp://terminology.hl7.org/CodeSystem/coverage-copay-typeCopay PercentageA standard percentage applied to all classes or service or product not otherwise specified.
  copayhttp://terminology.hl7.org/CodeSystem/coverage-copay-typeCopay AmountA standard fixed currency amount applied to all classes or service or product not otherwise specified.
  deductiblehttp://terminology.hl7.org/CodeSystem/coverage-copay-typeDeductibleThe accumulated amount of patient payment before the coverage begins to pay for services.
  maxoutofpockethttp://terminology.hl7.org/CodeSystem/coverage-copay-typeMaximum out of pocketThe maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.
  FamOutDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily Out of Network Deductible
  FamInDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily In Network Deductible
  FamRxOutDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily Pharmacy Out of Network Deductible
  FamRxInDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily Pharmacy In Network Deductible
  FamOutMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily Out of Network Out of Pocket Maximum
  FamInMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily In Network Out of Pocket Maximum
  FamRxOutMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily Pharmacy Out of Network Out of Pocket Maximum
  FamRxInMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSFamily Pharmacy In Network Out of Pocket Maximum
  IndOutDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSInvidual Out of Network Deductible
  IndInDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual In Network Deductible
  IndRxOutDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual Pharmacy Out of Network Deductible
  IndRxInDedhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual Pharmacy In Network Deductible
  IndOutMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual Out of Network Out of Pocket Maximum
  IndInMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual In Network Out of Pocket Maximum
  IndRxOutMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual Pharmacy Out of Network Out of Pocket Maximum
  IndRxInMaxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSIndividual Pharmacy In Network Out of Pocket Maximum
  rxhttp://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCSPrescription
  generichttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEGenericCommonly prescribed generic drugs that cost more than drugs in the 'preferred generic' tier.
  preferredhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEPreferredCommonly prescribed drugs that are preferred by the plan.
  non-preferredhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USENon-preferredCommonly prescribed drugs that cost more than drugs in the 'preferred' tier.
  preferred-generichttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEPreferred GenericCommonly prescribed generic drugs.
  non-preferred-generichttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USENon-preferred GenericGeneric drugs that cost more than drugs in ‘generic’ tier.
  specialtyhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USESpecialtyDrugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary.
  brandhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEBrandBrand name drugs that cost more than ‘preferred brand’ drugs.
  preferred-brandhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEPreferred BrandBrand name drugs
  non-preferred-brandhttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USENon-preferred BrandBrand name drugs that cost more than ‘brand’ drugs.
  zero-cost-share-preventativehttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEZero cost-share preventativePreventive medications and products available at no cost.
  medical-servicehttp://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USEMedical ServiceDrugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.

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