This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. The current version which supercedes this version is 5.2.0. For a full list of available versions, see the Directory of published versions

ActHealthInsuranceTypeCode - TTL Representation

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Raw ttl

Source view

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ValueSet;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "v3-ActHealthInsuranceTypeCode"];
  fhir:Resource.language [ fhir:value "en"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><h2>ActHealthInsuranceTypeCode</h2><div><p><strong>Definition:</strong> Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement).</p>\n</div><p>This value set includes codes based on the following rules:</p><ul><li>Include these codes as defined in <a href=\"CodeSystem-v3-ActCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td><a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-EHCPOL\">EHCPOL</a></td><td>extended healthcare</td><td>Private insurance policy that provides coverage in addition to other policies (e.g. in addition to a Public Healthcare insurance policy).</td></tr><tr><td><a href=\"CodeSystem-v3-ActCode.html#v3-ActCode-HSAPOL\">HSAPOL</a></td><td>health spending account</td><td>Insurance policy that provides for an allotment of funds replenished on a periodic (e.g. annual) basis. The use of the funds under this policy is at the discretion of the covered party.</td></tr></table></li><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-_ActHealthInsuranceTypeCode\">_ActHealthInsuranceTypeCode</a></li></ul></div>"
  ];
  fhir:ValueSet.url [ fhir:value "http://terminology.hl7.org/ValueSet/v3-ActHealthInsuranceTypeCode"];
  fhir:ValueSet.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ];
     fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.1.11.19857" ]
  ];
  fhir:ValueSet.version [ fhir:value "2.0.0"];
  fhir:ValueSet.name [ fhir:value "ActHealthInsuranceTypeCode"];
  fhir:ValueSet.title [ fhir:value "ActHealthInsuranceTypeCode"];
  fhir:ValueSet.status [ fhir:value "active"];
  fhir:ValueSet.date [ fhir:value "2014-03-26T00:00:00-04:00"^^xsd:dateTime];
  fhir:ValueSet.description [ fhir:value "**Definition:** Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement)."];
  fhir:ValueSet.compose [
     fhir:ValueSet.compose.include [
       fhir:index 0;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "EHCPOL" ]       ], [
         fhir:index 1;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "HSAPOL" ]       ]     ], [
       fhir:index 1;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-ActCode" ];
       fhir:ValueSet.compose.include.filter [
         fhir:index 0;
         fhir:ValueSet.compose.include.filter.property [ fhir:value "concept" ];
         fhir:ValueSet.compose.include.filter.op [ fhir:value "is-a" ];
         fhir:ValueSet.compose.include.filter.value [ fhir:value "_ActHealthInsuranceTypeCode" ]       ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.