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.
\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.
\nDiscussion: 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.
\nThis value set includes codes based on the following rules:
http://terminology.hl7.org/CodeSystem/v3-RoleCode
where concept is-a _CoveredPartyRoleTypehttp://terminology.hl7.org/CodeSystem/v3-RoleCode
Code | Display | |
_ClaimantCoveredPartyRoleType | ClaimantCoveredPartyRoleType | **Description**A role recognized through the eligibility of a party play a claimant for benefits covered or provided under an insurance policy. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode
Code | Display | |
_ProgramEligiblePartyRoleType | ProgramEligiblePartyRoleType | **Description:**A role recognized through the eligibility of a party to play a program eligible for benefits covered or provided under a program. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode
Code | Display | |
_IndividualInsuredPartyRoleType | IndividualInsuredPartyRoleType | 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. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode
Code | Display | |
_SubscriberCoveredPartyRoleType | SubscriberCoveredPartyRoleType | **Description:** A role recognized through the eligibility of a party to play a subscriber for benefits covered or provided under a health insurance policy. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode
Code | Display | |
_DependentCoveredPartyRoleType | DependentCoveredPartyRoleType | **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. |