Code
|
Display
|
Definition
|
after-deductible
|
After Deductible |
The 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). |
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 the deductible is met, no cost share amount is charged (this indicates that this benefit is subject to the deductible). |
charge
|
Charge |
The 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-applicable
|
Coinsurance 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). |
deductible-waived
|
Deductible Waived |
The consumer pays the cost share amount with deductible requirement waived. |