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<ValueSet xmlns="http://hl7.org/fhir"> <id value="v3-CoveredPartyRoleType"/> <language value="en"/> <text> <status value="generated"/> <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> <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> <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> </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> </text> <url value="http://terminology.hl7.org/ValueSet/v3-CoveredPartyRoleType"/> <identifier> <system value="urn:ietf:rfc:3986"/> <value value="urn:oid:2.16.840.1.113883.1.11.19805"/> </identifier> <version value="2.0.0"/> <name value="CoveredPartyRoleType"/> <title value="CoveredPartyRoleType"/> <status value="active"/> <date value="2014-03-26T00:00:00-04:00"/> <description value="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. **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. **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 value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <filter> <property value="concept"/> <op value="is-a"/> <value value="_CoveredPartyRoleType"/> </filter> </include> <include> <valueSet value="http://terminology.hl7.org/ValueSet/v3-ClaimantCoveredPartyRoleType"/> </include> <include> <valueSet value="http://terminology.hl7.org/ValueSet/v3-ProgramEligibleCoveredPartyRoleType"/> </include> <include> <valueSet value="http://terminology.hl7.org/ValueSet/v3-IndividualInsuredCoveredPartyRoleType"/> </include> <include> <valueSet value="http://terminology.hl7.org/ValueSet/v3-SubscriberCoveredPartyRoleType"/> </include> <include> <valueSet value="http://terminology.hl7.org/ValueSet/v3-DependentCoveredPartyRoleType"/> </include> <exclude> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <concept> <code value="_ClaimantCoveredPartyRoleType"/> </concept> </exclude> <exclude> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <concept> <code value="_ProgramEligiblePartyRoleType"/> </concept> </exclude> <exclude> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <concept> <code value="_IndividualInsuredPartyRoleType"/> </concept> </exclude> <exclude> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <concept> <code value="_SubscriberCoveredPartyRoleType"/> </concept> </exclude> <exclude> <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> <concept> <code value="_DependentCoveredPartyRoleType"/> </concept> </exclude> </compose> </ValueSet>