InsuranceBenefitType

Insurance Benefit Type Code System

activeNational Directory1.0.0complete114 concepts

Categories of insurance benefits.

Metadata

Canonical URL: http://terminology.hl7.org/CodeSystem/insurance-benefit-type
ID: insurance-benefit-type
Version: 1.0.0
Publisher: HL7 International / Patient Administration
Case Sensitive: Yes

Concepts (114)

Code	Display	Definition
`medical`	Medical	Medical insurance coverage.
`dental`	Dental	Dental insurance coverage.
`menthlth`	Mental Health	Mental health insurance coverage.
`substanceabuse`	Substance Abuse	Substance abuse services insurance coverage.
`vision`	Vision	Vision insurance coverage.
`drug`	Drug	Prescription drug coverage.
`stc`	Short Term Care	Short term care.
`ltc`	Long Term Care	Long term care.
`hospice`	Hospice	Hospice insurance coverage.
`homehealth`	Home Health	Home health services insurance coverage.
`dmepos`	DMEPOS	Durable Medical Equipment, Prosthetics/Orthotics and Supplies.
`imagingadv`	Advanced Imaging (CT/PET Scans, MRIs)	Advances imaging techniques services (CT/PET Scans, MRIs) coverage.
`rehab`	Rehabilitation	Rehabilitation.
`pcpov`	Primary Care Visit to Treat an Injury or Illness	Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services.
`specialistov`	Specialist Office Visit	Covered healthcare service rendered to a patient by a specialty provider.
`mlpov`	Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional	Benefit plan covers covered health related services rendered by a practitioner other than MD or DO and referred to as other practitioner.
`outpatient`	Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission.
`outpatstx`	Outpatient Surgery Physician/Surgical Services	Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.
`hospserv`	Hospice Services	Benefit plan covers hospice services.
`routinedental`	Routine Dental Services (Adult)	Benefit plan covers routine dental services.
`infertilitytx`	Infertility Treatment	Benefit plan covers eligible infertility treatment services.
`ltnhc`	Long-Term/Custodial Nursing Home Care	Long-Term/Custodial Nursing Home Care.
`privatenurse`	Private-Duty Nursing	Private-Duty Nursing.
`routineeye`	Routine Eye Exam (Adult)	Routine Eye Exam (Adult).
`ucservice`	Urgent Care Centers or Facilities	Urgent Care Centers or Facilities.
`erservice`	Emergency Room Services	Emergency Room Services.
`ambulance`	Emergency Room Services	Emergency Room Services.
`inpatienthospital`	Inpatient Hospital Services (e.g., Hospital Stay)	A person who is hospitalized for at least one night to receive treatment or participate in a study.
`inpatientprovider`	Inpatient Physician and Surgical Services	A healthcare provider who is delivering healthcare services in a hospital environment.
`bariatricsurg`	Bariatric Surgery	Bariatric surgery service Skilled nursing service (qualifier value).
`cosmeticsurg`	Cosmetic Surgery	Cosmetic surgery service Skilled nursing service (qualifier value).
`skillednursing`	Skilled Nursing Facility	Skilled nursing service (qualifier value).
`ppnatalcare`	Prenatal and Postnatal Care	Prenatal and Postnatal services.
`maternitycare`	Delivery and All Inpatient Services for Maternity Care	All maternity care services.
`menthlthoutp`	Mental/Behavioral Health Outpatient Services	Mental health service delivered in an outpatient setting.
`menthlthinp`	Mental/Behavioral Health Inpatient Services	Mental health service delivered in an hospital or inpatient facility setting.
`sadoutp`	Substance Abuse Disorder Outpatient Services	Substance abuse related services delivered in a outpatient setting.
`sadinp`	Substance Abuse Disorder Inpatient Services	Substance abuse related services delivered in a inpatient setting.
`drggenric`	Generic Drugs	Generic drugs eligible benefits.
`drgbrand`	Preferred Brand Drugs	Preferred brand drugs eligible benefits.
`drgnonpreferred`	Non-Preferred Brand Drugs	Non-Preferred drugs brands eligible benefits.
`drgspecialty`	Specialty Drugs	Benefit plan covers specialty drugs.
`rehaboutp`	Outpatient Rehabilitation Services	Benefit plan covers outpatient rehabilitation services.
`servicehablitation`	Habilitation Services	Habilitation Services.
`chiro`	Chiropractic Care	Benefit plan covers chiropractor eligible benefits.
`dme`	Durable Medical Equipment	Benefit plan covers Durable medical equipment eligible benefits.
`hearingaids`	Hearing Aids	Benefit plan covers hearing aids.
`imgctpetmri`	Imaging (CT/PET Scans, MRIs)	Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.
`prev`	Preventive Care/Screening/Immunization	Routine healthcare services to prevent health related problems eligible benefits.
`rtnpod`	Routine Foot Care	Routine Foot Care.
`acupuncture`	Acupuncture	Benefit plan covers acupuncture treatment.
`weightloss`	Weight Loss Programs	Benefit plan covers weight loss services eligible benefits.
`rtneyechld`	Routine Eye Exam for Children	Routine eye exam for children eligible benefits.
`glasseschld`	Eye Glasses for Children	Eye glasses children eligible benefits.
`rtndntlchld`	Dental Check-Up for Children	Dental Check-Up for Children.
`speachthpy`	Rehabilitative Speech Therapy	Benefit plan covers rehabilitative speech therapy eligible benefits.
`rehaboccandpt`	Rehabilitative Occupational and Rehabilitative Physical Therapy	Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.
`wellbaby`	Well Baby Visits and Care	Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency.
`laboutp`	Laboratory Outpatient and Professional Services	Benefit plan covers laboratory testing and related professional services received as outpatient.
`imagingdx`	X-rays and Diagnostic Imaging	Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.
`dntlbaschld`	Basic Dental Care - Child	Benefit plan covers diagnostic basic dental care.
`orthochld`	Orthodontia - Child	Benefit plan covers orthodontia for children.
`dntlmajchld`	Major Dental Care - Child	Benefit plan covers major dental care for children.
`dntlbasadlt`	Basic Dental Care - Adult	Benefit plan covers basic dental care for adults.
`orthodadlt`	Orthodontia - Adult	Benefits plan covers services provided that are required for orthodontic purposes for an adult.
`dntlmajadlt`	Major Dental Care - Adult	Benefit plan covers major dental care for adult.
`abortion`	Abortion for Which Public Funding is Prohibited	Benefit plan covers services for abortion for which public funding is prohibited.
`transplant`	Transplant	Benefit plan covers transplant related services.
`accdntl`	Accidental Dental	Benefit plan covers dental care services related to an accident.
`dialysis`	Dialysis	The plan benefit covers services used to treat end stage renal disease.
`testallrgy`	Allergy Testing	The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities.
`chemotherapy`	Chemotherapy	The plan benefits cover services the use of drugs and approved chemicals to treat disease.
`radiation`	Radiation	The plan benefits cover services the use radiation to treat disease.
`edudiab`	Diabetes Education	The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes.
`prosthetic`	Prosthetic Devices	Plan benefit covers services related to prosthesis devices.
`infusiontx`	Infusion Therapy	Plan benefit covers services related to infusion therapy.
`tmjtx`	Treatment for Temporomandibular Joint Disorders	Plan benefit covers services related to treatment of Temporomandibular Joint disorder.
`nutrition`	Nutritional Counseling	Nutritional Counseling.
`reconsurg`	Reconstructive Surgery	Plan benefit covers services related to reconstructive surgery.
`days`	Days	Measure of service covered by the plan benefit expressed in a definite number of days.
`visit`	Visits	Measure of service covered by the plan benefit expressed in a definite number of visits.
`procedure`	Procedures	Measure of service covered by the plan benefit expressed in a set of actions covered.
`admission`	Admissions	Measure of services covered by the benefit plan expressed in relation to patient's acceptance for medical and nursing care in a hospital or other health care institution.
`visithrs`	Hours per visit	Measure expresses how many hours per visit are covered by the insurance benefit plan.
`weekhrs`	Hours per week	Measure expresses how many hours per week are covered by the insurance benefit plan.
`mthhrs`	Hours per month	Measure expressed how many hours per month are covered by the insurance benefit plan.
`yrhrs`	Hours per year	Measure expreses how many hours per year are covered by the insurance benfit plan.
`daysperwk`	Days per week	Measure of service covered by the plan benefit expressed in a how many days are covered in a week.
`dayspermth`	Days per month	Measure of service covered by the plan benefit expressed in a how many days are covered in a month.
`daysperyr`	Days per year	Measure of service covered by the plan benefit expressed in a how many days are covered in a year.
`mthsperyr`	Months per year	Measure of service covered by the plan benefit expressed in a how many month are covered in a year.
`visitsperday`	Visits per day	Measure of service covered by the plan benefit expressed in a definite number of visits covered per day.
`visitsperweek`	Visits per week	Measure of service covered by the plan benefit expressed in a definite number of visits covered per week.
`visitspermth`	Visits per month	Measure of service covered by the plan benefit expressed in a definite number of visits covered per month.
`visitsperyr`	Visits per year	Measure of service covered by the plan benefit expressed in a definite number of visits covered per year.
`lifetimevisits`	Lifetime visits	Measure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime.
`txperweek`	Treatments per week	Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week.
`txpermnth`	Treatments per month	Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month.
`txlifetime`	Lifetime treatments	Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime.
`admitslifetime`	Lifetime admissions	Measure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime.
`procperwk`	Procedures per week	Measure of service covered by the plan benefit expressed in a definite number procedure covered per week.
`procpermnth`	Procedures per month	Measure of service covered by the plan benefit expressed in a definite number procedure covered per month.
`procperyr`	Procedures per year	Measure of service covered by the plan benefit expressed in a definite number procedure covered per year.
`proclifetime`	Lifetime procedures	Measure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime.
`daysperadmission`	Days per admission	Measure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission.
`procperepi`	Procedures per episode	Measure of service covered by the plan benefit expressed in a definite number of procedures covered for each individual treatment episode.
`cat`	Catastrophic	'Catastrophic' health insurance plans have low monthly premiums and very high deductibles. They may cover worst-case scenarios, like getting seriously sick or injured. Patient pays most routine medical expenses.
`bronze`	Bronze	'Bronze' type plan defines the estimated split costs of the plan, where patient is responsible for 40% of their healthcare cost while 60% is covered by the plan.
`bronzeexp`	Expanded Bronze	The 'extended bronze' plan is an addition to the bronze metal level which establishes the de minimis variation range for the actuarial value (AV) level of coverage to allow variation in the AV to -4/+2 percentage points.
`silver`	Silver	'Silver' type plan defines the estimated split costs of the plan, where patient is responsible for 30% of their healthcare cost while 70% is covered by the plan.
`gold`	Gold	'Gold' type plan defines the estimated split costs of the plan, where patient is responsible for 20% of their healthcare cost while 80% is covered by the plan.
`platinum`	Platinum	'Platinum' type plan defines the estimated split costs of the plan, where patient is responsible for 10% of their healthcare cost while 90% is covered by the plan.
`lowded`	Low deductible	A health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan.
`highded`	High deductible	A health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan.