CostShareOptionCS

Codes qualifying the type of cost share amount

activeDa Vinci Drug Formulary2.1.0complete8 concepts

Codes for qualifier of copay amount

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE
ID
usdf-CostShareOptionCS-TEMPORARY-TRIAL-USE
Version
2.1.0
Publisher
HL7 International / Pharmacy
Case Sensitive
Yes

Concepts (8)

CodeDisplayDefinition
after-deductibleAfter DeductibleThe consumer first pays the deductible, and after the deductible is met, the consumer is responsible only for the cost-share amount (this indicates that this benefit is subject to the deductible).
before-deductibleBefore DeductibleThe consumer first pays the cost share amount, and any net remaining allowed charges accrue to the deductible (this indicates that this benefit is subject to the deductible).
no-chargeNo ChargeNo cost sharing is charged (this indicates that this benefit is not subject to the deductible).
no-charge-after-deductibleNo Charge After DeductibleThe consumer first pays the deductible, and after the deductible is met, no cost share amount is charged (this indicates that this benefit is subject to the deductible).
chargeChargeThe consumer always pays just the cost share amount and the issuer pays the remainder of allowed charges (this indicates that this benefit is not subject to the deductible).
coinsurance-not-applicableCoinsurance Not ApplicableThe 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).
copay-not-applicableCopay Not ApplicableDeductible is not applicable: Zero-deductible cost sharing represented by a co-pay value of 'Not applicable' and co-insurance value of 'No charge'.
deductible-waivedDeductible WaivedThe consumer pays the cost share amount with deductible requirement waived.