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{ "resourceType" : "ValueSet", "id" : "v3-CoveredPartyRoleType", "language" : "en", "text" : { "status" : "generated", "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><h2>CoveredPartyRoleType</h2><div><p>A role recognized through the eligibility of an identified living subject for benefits covered under an insurance policy or a program. Eligibility as a covered party may be conditioned on a relationship with (1) the policy holder such as the policy holder who is covered as an individual under a poliy or as a party sponsored for coverage by the policy holder.</p>\n<p>**Example:**An employee as a subscriber; or (2) on being scoped another covered party such as the subscriber, as in the case of a dependent.</p>\n<p><strong>Discussion:</strong> The Abstract Value Set "CoverageRoleType", which was developed for use in the Canadian realm "pre-coordinate" coverage roles with other roles that a covered party must play in order to be eligible for coverage, e.g., "handicapped dependent". Other codes in the Abstract Value Set CoveredPartyRoleType domain can be "post-coordinated" with the EligiblePartyRoleType codes to denote comparable concepts. Decoupling the concepts is intended to support a wider range of concepts and semantic comparability of coded concepts.</p>\n</div><p>This value set includes codes based on the following rules:</p><ul><li>Include codes from <a href=\"CodeSystem-v3-RoleCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></a> where concept is-a <a href=\"CodeSystem-v3-RoleCode.html#v3-RoleCode-_CoveredPartyRoleType\">_CoveredPartyRoleType</a></li><li>Import all the codes that are contained in <a href=\"ValueSet-v3-ClaimantCoveredPartyRoleType.html\">http://terminology.hl7.org/ValueSet/v3-ClaimantCoveredPartyRoleType</a></li><li>Import all the codes that are contained in <a href=\"ValueSet-v3-ProgramEligibleCoveredPartyRoleType.html\">http://terminology.hl7.org/ValueSet/v3-ProgramEligibleCoveredPartyRoleType</a></li><li>Import all the codes that are contained in <a href=\"ValueSet-v3-IndividualInsuredCoveredPartyRoleType.html\">http://terminology.hl7.org/ValueSet/v3-IndividualInsuredCoveredPartyRoleType</a></li><li>Import all the codes that are contained in <a href=\"ValueSet-v3-SubscriberCoveredPartyRoleType.html\">http://terminology.hl7.org/ValueSet/v3-SubscriberCoveredPartyRoleType</a></li><li>Import all the codes that are contained in <a href=\"ValueSet-v3-DependentCoveredPartyRoleType.html\">http://terminology.hl7.org/ValueSet/v3-DependentCoveredPartyRoleType</a></li><li>Exclude these codes as defined in <a href=\"CodeSystem-v3-RoleCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</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-RoleCode.html#v3-RoleCode-_ClaimantCoveredPartyRoleType\">_ClaimantCoveredPartyRoleType</a></td><td>ClaimantCoveredPartyRoleType</td><td>**Description**A role recognized through the eligibility of a party play a claimant for benefits covered or provided under an insurance policy.</td></tr></table></li><li>Exclude these codes as defined in <a href=\"CodeSystem-v3-RoleCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</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-RoleCode.html#v3-RoleCode-_ProgramEligiblePartyRoleType\">_ProgramEligiblePartyRoleType</a></td><td>ProgramEligiblePartyRoleType</td><td>**Description:**A role recognized through the eligibility of a party to play a program eligible for benefits covered or provided under a program.</td></tr></table></li><li>Exclude these codes as defined in <a href=\"CodeSystem-v3-RoleCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</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-RoleCode.html#v3-RoleCode-_IndividualInsuredPartyRoleType\">_IndividualInsuredPartyRoleType</a></td><td>IndividualInsuredPartyRoleType</td><td>A role recognized through the eligibility of a party to play an individual insured for benefits covered or provided under an insurance policy where the party is also the policy holder.</td></tr></table></li><li>Exclude these codes as defined in <a href=\"CodeSystem-v3-RoleCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</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-RoleCode.html#v3-RoleCode-_SubscriberCoveredPartyRoleType\">_SubscriberCoveredPartyRoleType</a></td><td>SubscriberCoveredPartyRoleType</td><td>**Description:** A role recognized through the eligibility of a party to play a subscriber for benefits covered or provided under a health insurance policy.</td></tr></table></li><li>Exclude these codes as defined in <a href=\"CodeSystem-v3-RoleCode.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</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-RoleCode.html#v3-RoleCode-_DependentCoveredPartyRoleType\">_DependentCoveredPartyRoleType</a></td><td>DependentCoveredPartyRoleType</td><td>**Description:** A role recognized through the eligibility of a party to play a dependent for benefits covered or provided under a health insurance policy because of an association with the subscriber that is recognized by the policy underwriter.</td></tr></table></li></ul></div>" }, "url" : "http://terminology.hl7.org/ValueSet/v3-CoveredPartyRoleType", "identifier" : [ { "system" : "urn:ietf:rfc:3986", "value" : "urn:oid:2.16.840.1.113883.1.11.19805" } ], "version" : "2.0.0", "name" : "CoveredPartyRoleType", "title" : "CoveredPartyRoleType", "status" : "active", "date" : "2014-03-26T00:00:00-04:00", "description" : "A role recognized through the eligibility of an identified living subject for benefits covered under an insurance policy or a program. Eligibility as a covered party may be conditioned on a relationship with (1) the policy holder such as the policy holder who is covered as an individual under a poliy or as a party sponsored for coverage by the policy holder.\r\n\r\n**Example:**An employee as a subscriber; or (2) on being scoped another covered party such as the subscriber, as in the case of a dependent.\r\n\r\n**Discussion:** The Abstract Value Set \"CoverageRoleType\", which was developed for use in the Canadian realm \"pre-coordinate\" coverage roles with other roles that a covered party must play in order to be eligible for coverage, e.g., \"handicapped dependent\". Other codes in the Abstract Value Set CoveredPartyRoleType domain can be \"post-coordinated\" with the EligiblePartyRoleType codes to denote comparable concepts. Decoupling the concepts is intended to support a wider range of concepts and semantic comparability of coded concepts.", "compose" : { "include" : [ { "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "filter" : [ { "property" : "concept", "op" : "is-a", "value" : "_CoveredPartyRoleType" } ] }, { "valueSet" : [ "http://terminology.hl7.org/ValueSet/v3-ClaimantCoveredPartyRoleType" ] }, { "valueSet" : [ "http://terminology.hl7.org/ValueSet/v3-ProgramEligibleCoveredPartyRoleType" ] }, { "valueSet" : [ "http://terminology.hl7.org/ValueSet/v3-IndividualInsuredCoveredPartyRoleType" ] }, { "valueSet" : [ "http://terminology.hl7.org/ValueSet/v3-SubscriberCoveredPartyRoleType" ] }, { "valueSet" : [ "http://terminology.hl7.org/ValueSet/v3-DependentCoveredPartyRoleType" ] } ], "exclude" : [ { "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "concept" : [ { "code" : "_ClaimantCoveredPartyRoleType" } ] }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "concept" : [ { "code" : "_ProgramEligiblePartyRoleType" } ] }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "concept" : [ { "code" : "_IndividualInsuredPartyRoleType" } ] }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "concept" : [ { "code" : "_SubscriberCoveredPartyRoleType" } ] }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode", "concept" : [ { "code" : "_DependentCoveredPartyRoleType" } ] } ] } }