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
| 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
This value set includes codes based on the following rules:
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS version 📦2.0.0http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE version 📦2.1.0
Expansion performed internally based on:
This value set contains 38 concepts
| System | Code | Display (en) | Definition | JSON | XML |
http://terminology.hl7.org/CodeSystem/coverage-copay-type | gpvisit | GP Office Visit | An office visit for a general practitioner of a discipline. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | spvisit | Specialist Office Visit | An office visit for a specialist practitioner of a discipline | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | emergency | Emergency | An episode in an emergency department. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | inpthosp | Inpatient Hospital | An episode of an Inpatient hospital stay. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | televisit | Tele-visit | A 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 | urgentcare | Urgent Care | A visit to an urgent care facility - typically a community care clinic. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | copaypct | Copay Percentage | A standard percentage applied to all classes or service or product not otherwise specified. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | copay | Copay Amount | A standard fixed currency amount applied to all classes or service or product not otherwise specified. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | deductible | Deductible | The accumulated amount of patient payment before the coverage begins to pay for services. | ||
http://terminology.hl7.org/CodeSystem/coverage-copay-type | maxoutofpocket | Maximum out of pocket | The 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 | FamOutDed | Family Out of Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamInDed | Family In Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamRxOutDed | Family Pharmacy Out of Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamRxInDed | Family Pharmacy In Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamOutMax | Family Out of Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamInMax | Family In Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamRxOutMax | Family Pharmacy Out of Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | FamRxInMax | Family Pharmacy In Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndOutDed | Invidual Out of Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndInDed | Individual In Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndRxOutDed | Individual Pharmacy Out of Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndRxInDed | Individual Pharmacy In Network Deductible | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndOutMax | Individual Out of Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndInMax | Individual In Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndRxOutMax | Individual Pharmacy Out of Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | IndRxInMax | Individual Pharmacy In Network Out of Pocket Maximum | |||
http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS | rx | Prescription | |||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | generic | Generic | Commonly 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 | preferred | Preferred | Commonly prescribed drugs that are preferred by the plan. | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | non-preferred | Non-preferred | Commonly 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-generic | Preferred Generic | Commonly prescribed generic drugs. | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | non-preferred-generic | Non-preferred Generic | Generic drugs that cost more than drugs in ‘generic’ tier. | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | specialty | Specialty | Drugs 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 | brand | Brand | Brand name drugs that cost more than ‘preferred brand’ drugs. | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | preferred-brand | Preferred Brand | Brand name drugs | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | non-preferred-brand | Non-preferred Brand | Brand 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-preventative | Zero cost-share preventative | Preventive medications and products available at no cost. | ||
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS-TEMPORARY-TRIAL-USE | medical-service | Medical Service | Drugs 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 |