The three types of license that govern use of SNOMED CT are Affiliate licenses, Sub-licenses and National licenses.

Affiliate licenses

Vendors and other organizations that develop or distribute products or services that include or provide access to SNOMED CT must be IHTSDO Affiliates.
An Affiliate license is a contractual agreement between IHTSDO and the Affiliate. The Affiliate license grants rights to use SNOMED CT worldwide, subject to:

• Meeting conditions for reporting its use and making appropriate payment where used in non-member territories
• Holding and conforming to the conditions of a National license for use in IHTSDO Member Countries

The Affiliate license agreement can be found at: http://snomed.org/license.
To obtain an IHTSDO Affiliate License:

• In an IHTSDO Member country, please check the relevant IHTSDO Member web page for advice on how to register: http://snomed.org/members
• In countries that are not IHTSDO Members, or in IHTSDO Member countries that do not provide a national registration service, you can request a license using the SNOMED CT Member Licensing and Distribution Service (MLDS): https://mlds.ihtsdotools.org.

Organizations that use SNOMED CT must all be either an IHTSDO Affiliate or a sub-licensee of an IHTSDO Affiliate. IHTSDO Affiliates are required to issue sublicenses to organizations (or individuals) who use their products or services, unless the user organization is itself an IHTSDO Affiliate. More information on sublicenses is available later in this section.

Sub-licenses

Affiliate license holders who supply SNOMED CT enabled products or services to others are required to:

• Issue and manage sub-licenses and make information about these available to IHTSDO
• Report and ensure appropriate payment when SNOMED CT is used in non-member territories

National Licenses

IHTSDO Members can impose additional requirements related to the use of SNOMED CT International Edition in their territory. For example they may require use of their National Extension of SNOMED CT.
IHTSDO Members may issue National licenses to IHTSDO Affiliates. A National license usually grants use of a National SNOMED CT Extension which may include translations, content additions and reference sets. The terms of a National license may apply similar conditions on the use of the National Extension as the SNOMED CT Affiliate License applies to the International Edition. It may also be part of a broader licensing scheme covering other nationally licensed works
National licenses can only be issued to IHTSDO Affiliates. However, if an applicant for a National License is not already an Affiliate, the Member may issue an Affiliate License on behalf of IHTSDO. Note that an Affiliate license issued in this way is still an agreement between the IHTSDO and the licensee and the terms of the Affiliate License Agreement are the same.

License charges

• IHTSDO does not charge for licensed use of SNOMED CT in IHTSDO Member countries
• IHTSDO Members are permitted to charge for the use of SNOMED CT within their country, provided that these charges are limited to cost recovery
• There are fees for use of SNOMED CT in non-Member territories
  • These charges depend on the wealth of the country in which the use of SNOMED CT occurs. For detail of the fee structures see http://snomed.org/license.
  • Intended use in non-Member territories must be reported to IHTSDO (via MLDS: https://mlds.ihtsdotools.org) before this use begins.
• Fee-waivers may apply for limited use of SNOMED CT in IHTSDO approved research projects and 'public good' initiatives.

Figure 17. Responsibilities of Affiliate license holders to report usage and where appropriate to pay the fees which are due
Further details can be found via the IHTSDO website at http://snomed.org/license.

Online Browser Licensing

IHTSDO has published guidance about licensing implications of web-based SNOMED CT browsers and other publicly available software or services and which incorporate, or provide access to SNOMED CT: http://snomed.org/browserlicenseguidance.