HL7 Terminology (THO)
6.1.0 - Publication International flag

This page is part of the HL7 Terminology (v6.1.0: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

: ManagedCarePolicy - XML Representation

Active as of 2014-03-26

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="v3-ManagedCarePolicy"/>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><p class="res-header-id"><b>Generated Narrative: ValueSet v3-ManagedCarePolicy</b></p><a name="v3-ManagedCarePolicy"> </a><a name="hcv3-ManagedCarePolicy"> </a><a name="v3-ManagedCarePolicy-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p></div><ul><li>Include codes from<a href="CodeSystem-v3-ActCode.html"><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></a> where concept  is-a <a href="CodeSystem-v3-ActCode.html#v3-ActCode-MCPOL">MCPOL</a></li></ul></div>
  </text>
  <url value="http://terminology.hl7.org/ValueSet/v3-ManagedCarePolicy"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.1.11.19860"/>
  </identifier>
  <version value="3.0.0"/>
  <name value="ManagedCarePolicy"/>
  <title value="ManagedCarePolicy"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2014-03-26"/>
  <publisher value="Health Level Seven International"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="hq@HL7.org"/>
    </telecom>
  </contact>
  <description
               value="**Definition:** Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

Managed care policies specifically exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.

*Discussion:* Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member."/>
  <copyright
             value="This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html"/>
  <compose>
    <include>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <filter>
        <property value="concept"/>
        <op value="is-a"/>
        <value value="MCPOL"/>
      </filter>
    </include>
  </compose>
</ValueSet>