HL7.FHIR.US.DAVINCI-DRUG-FORMULARY\Code for qualifier for coinsurance rate

DaVinci Payer Data Exchange (PDex) US Drug Formulary
1.1.0 - STU 1.1

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CodeSystem: Code for qualifier for coinsurance rate

Summary

Defining URL:

http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS

Version:

1.1.0

Name:

CoInsuranceOptionCS

Title:

Code for qualifier for coinsurance rate

Status:

Active as of 2021-10-15T15:46:55+00:00

Definition:

Code for qualifier for coinsurance rate

Publisher:

HL7 Pharmacy Working Group

Content:

Complete: All the concepts defined by the code system are included in the code system resource

Source Resource:

This Code system is referenced in the content logical definition of the following value sets:

This code system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CoinsuranceOptionCS defines the following codes:

Code	Display	Definition
after-deductible	After Deductible	The consumer first pays the deductible, and after the deductible is met, the consumer pays the coinsurance portion of allowed charges (this indicates that this benefit is subject to the deductible).
no-charge	No Charge	No cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductible	No Charge After Deductible	The consumer first pays the deductible, and after thedeductible is met, no coinsurance is charged (this indicates that this benefit is subject to the deductible).
charge	Charge	The consumer always pays just the coinsurance and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).
not-applicable	Not Applicable	The consumer pays only a copay. Note: When using Not Applicable for coinsurance, Not Applicable cannot also be used for copay (unless the drug tier type is Medical Service Drugs).