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 2025-10-10 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

SystemCodeDisplay (en)DefinitionJSONXML
http://terminology.hl7.org/CodeSystem/coverage-copay-type  gpvisitGP Office VisitAn office visit for a general practitioner of a discipline.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  spvisitSpecialist Office VisitAn office visit for a specialist practitioner of a discipline
http://terminology.hl7.org/CodeSystem/coverage-copay-type  emergencyEmergencyAn episode in an emergency department.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  inpthospInpatient HospitalAn episode of an Inpatient hospital stay.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  televisitTele-visitA visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  urgentcareUrgent CareA visit to an urgent care facility - typically a community care clinic.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  copaypctCopay PercentageA standard percentage applied to all classes or service or product not otherwise specified.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  copayCopay AmountA standard fixed currency amount applied to all classes or service or product not otherwise specified.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  deductibleDeductibleThe accumulated amount of patient payment before the coverage begins to pay for services.
http://terminology.hl7.org/CodeSystem/coverage-copay-type  maxoutofpocketMaximum out of pocketThe maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamOutDedFamily Out of Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamInDedFamily In Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamRxOutDedFamily Pharmacy Out of Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamRxInDedFamily Pharmacy In Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamOutMaxFamily Out of Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamInMaxFamily In Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamRxOutMaxFamily Pharmacy Out of Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  FamRxInMaxFamily Pharmacy In Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndOutDedInvidual Out of Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndInDedIndividual In Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndRxOutDedIndividual Pharmacy Out of Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndRxInDedIndividual Pharmacy In Network Deductible
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndOutMaxIndividual Out of Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndInMaxIndividual In Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndRxOutMaxIndividual Pharmacy Out of Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  IndRxInMaxIndividual Pharmacy In Network Out of Pocket Maximum
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS  rxPrescription
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  genericGenericCommonly prescribed generic drugs that cost more than drugs in the 'preferred generic' tier.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  preferredPreferredCommonly prescribed drugs that are preferred by the plan.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  non-preferredNon-preferredCommonly prescribed drugs that cost more than drugs in the 'preferred' tier.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  preferred-genericPreferred GenericCommonly prescribed generic drugs.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  non-preferred-genericNon-preferred GenericGeneric drugs that cost more than drugs in ‘generic’ tier.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  specialtySpecialtyDrugs 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.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  brandBrandBrand name drugs that cost more than ‘preferred brand’ drugs.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  preferred-brandPreferred BrandBrand name drugs
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  non-preferred-brandNon-preferred BrandBrand name drugs that cost more than ‘brand’ drugs.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  zero-cost-share-preventativeZero cost-share preventativePreventive medications and products available at no cost.
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE  medical-serviceMedical 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