HL7 Terminology
2.0.0 - Publication
HL7 Terminology
2.0.0 - Publication
This page is part of the HL7 Terminology (v2.0.0: 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 
Summary
| Defining URL: | http://terminology.hl7.org/ValueSet/v3-PolicyOrProgramCoverageRoleType |
| Version: | 2.0.0 |
| Name: | PolicyOrProgramCoverageRoleType |
| Status: | Active as of 2014-03-26 |
| Definition: | Description: A role recognized through the eligibility of an identified party for benefits covered under an insurance policy or a program based on meeting eligibility criteria. Eligibility as a covered party may be conditioned on the party meeting criteria to qualify for coverage under a policy or program, which may be mandated by law. These criteria may be:
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". These role.codes may only be used with COVPTY to avoid overlapping concepts that would result from using them to specify the specializations of COVPTY, e.g., the role.class DEPEN should not be used with the role.code family dependent because that relationship has overlapping concepts due to the role.code precoodination and is conveyed in FICO with the personal relationship role that has a PART role link to the covered party role. For the same reasons, the role.class DEPEN should not be used with the role.code HANDIC (handicapped dependent); the role.code DIFFABLE (differently abled) should be used instead. In summary, the coded concepts in the Abstract Value Set "CoveredPartyRoleType" can be "post-coordinated" with the "RoleClassCoveredParty" Abstract Value Set. Decoupling these concepts is intended to support an expansive range of covered party concepts and their semantic comparability. |
| OID: | 2.16.840.1.113883.1.11.19809 (for OID based terminology systems) |
| Source Resource: | XML / JSON / Turtle |
References
This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)
http://terminology.hl7.org/CodeSystem/v3-RoleCode where concept is-a _PolicyOrProgramCoverageRoleType
This value set contains 27 concepts
Expansion based on RoleCode v2.1.0 (CodeSystem)
All codes from system http://terminology.hl7.org/CodeSystem/v3-RoleCode
| Code | Display | Definition |
| _PolicyOrProgramCoverageRoleType | PolicyOrProgramCoverageRoleType | **Description:** A role recognized through the eligibility of an identified party for benefits covered under an insurance policy or a program based on meeting eligibility criteria. Eligibility as a covered party may be conditioned on the party meeting criteria to qualify for coverage under a policy or program, which may be mandated by law. These criteria may be: 1. The sole basis for coverage, e.g., being differently abled may qualify a person for disability coverage 2. May more fully qualify a covered party role e.g, being differently abled may qualify an adult child as a dependent 3. May impact the level of coverage for a covered party under a policy or program, e.g., being differently abled may qualify a program eligible for additional benefits. **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". These role.codes may only be used with COVPTY to avoid overlapping concepts that would result from using them to specify the specializations of COVPTY, e.g., the role.class DEPEN should not be used with the role.code family dependent because that relationship has overlapping concepts due to the role.code precoodination and is conveyed in FICO with the personal relationship role that has a PART role link to the covered party role. For the same reasons, the role.class DEPEN should not be used with the role.code HANDIC (handicapped dependent); the role.code DIFFABLE (differently abled) should be used instead. In summary, the coded concepts in the Abstract Value Set "CoveredPartyRoleType" can be "post-coordinated" with the "RoleClassCoveredParty" Abstract Value Set. Decoupling these concepts is intended to support an expansive range of covered party concepts and their semantic comparability. |
| _CoverageRoleType | CoverageRoleType | Role recognized through the issuance of insurance coverage to an identified covered party who has this relationship with the policy holder such as the policy holder themselves (self), spouse, child, etc |
| FAMDEP | family dependent | The player of the role is dependent of the scoping entity. |
| HANDIC | handicapped dependent | Covered party is a dependent of the policy holder with a physical or mental disability causing a disadvantage that makes independent achievement unusually difficult. |
| INJ | injured plaintiff | Covered party is an injured party with a legal claim for compensation against a policy holder under an insurance policy. |
| SELF | self | Covered party is the policy holder. Also known as the subscriber. |
| SPON | sponsored dependent | Covered party is an individual that the policy holder has assumed responsibility for, such as foster child or legal ward. |
| STUD | student | Covered party to an insurance policy has coverage through full-time or part-time attendance at a recognized educational institution as defined by a particular insurance policy. |
| FSTUD | full-time student | Covered party to an insurance policy has coverage through full-time attendance at a recognized educational institution as defined by a particular insurance policy. |
| PSTUD | part-time student | Covered party to an insurance policy has coverage through part-time attendance at a recognized educational institution as defined by a particular insurance policy. |
| ADOPT | adopted child | A child taken into one's family through legal means and raised as one's own child. |
| GCHILD | grandchild | A child of one's son or daughter. |
| GPARNT | grandparent | parent of a parent of the subject. |
| NAT | natural child | A child as determined by birth. |
| NIENE | niece/nephew | A child of one's brother or sister or of the brother or sister of one's spouse. |
| PARNT | parent | One that begets or brings forth offspring or a person who brings up and cares for for another (Webster's Collegiate Dictionary) |
| SPSE | spouse | A marriage partner; a husband or wife. |
| STEP | step child | A child receiving parental care and nurture from a person who is related to them through marriage to their parent. |
| _CoveredPartyRoleType | covered party role type | 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. |
| _ClaimantCoveredPartyRoleType | ClaimantCoveredPartyRoleType | **Description**A role recognized through the eligibility of a party play a claimant for benefits covered or provided under an insurance policy. |
| CRIMEVIC | crime victim | **Description:** A person playing the role of program eligible under a program based on allegations of being the victim of a crime. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a crime victim meets jurisdictional or program criteria. |
| INJWKR | injured worker | **Description:** A person playing the role of program eligible under a workers compensation program based on the filing of work-related injury claim. **Discussion:** This CoveredPartyRoleType.code is used when the CoveredPartyRole class code is either "program eligible", a "named insured", and "individual insured", or "dependent", and the person's status as differently abled or "handicapped" meets jurisdictional, policy, or program criteria. |
| _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. |
| COCBEN | continuity of coverage beneficiary | **Description:** A person playing the role of an individual insured with continuity of coverage under a policy which is being terminated based on loss of original status that was the basis for coverage. Criteria for qualifying for continuity of coverage may be set by law. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a continuity of coverage beneficiary meets jurisdictional or policy criteria. |
| DIFFABL | differently abled | **Description:** A person playing the role of program eligible under a program based on meeting criteria for health or functional limitation set by law or by the program. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible", "named insured", "individual insured", or "dependent", and the person's status as differently abled meets jurisdictional, policy, or program criteria. |
| WARD | ward | **Description:** A person, who is a minor or is deemed incompetent, who plays the role of a program eligible where eligibility for coverage is based on meeting program eligibility criteria for status as a ward of a court or jurisdiction. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is a "claimant", "program eligible", a "named insured", an "individual Insured" or a "dependent", and the person's status as a ward meets program or policy criteria. In the case of a ward covered under a program providing financial or health benefits, a governmental agency may take temporary custody of a minor or incompetent for his/her protection and care, e.g., if the ward is suffering from neglect or abuse, or has been in trouble with the law. |
| _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. |
| RETIREE | retiree | **Description:** A person playing the role of an individual insured under a policy based on meeting criteria for the employment status of retired set by law or the policy. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a retiree meets jurisdictional or policy criteria. |
| _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. |
| INDIG | member of an indigenous people | **Description:** A person playing the role of program eligible under a program based on aboriginal ancestry or as a member of an aboriginal community. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a member of an indigenous people meets jurisdictional or program criteria. |
| MIL | military | **Definition:** A person playing the role of program eligible under a program based on military status. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a member of the military meets jurisdictional or program criteria |
| ACTMIL | active duty military | **Description:** A person playing the role of program eligible under a program based on active military status. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as active duty military meets jurisdictional or program criteria. |
| RETMIL | retired military | **Description:** A person playing the role of program eligible under a program based on retired military status. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as retired military meets jurisdictional or program criteria. |
| VET | veteran | **Description:** A person playing the role of program eligible under a program based on status as a military veteran. **Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as a veteran meets jurisdictional or program criteria. |
| _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. |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| Source | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |
History
| Date | Action | Author | Custodian | Comment |
| 2020-05-06 | revise | Ted Klein | Vocabulary WG | Migrated to the UTG maintenance environment and publishing tooling. |
| 2014-03-26 | revise | Vocabulary (Woody Beeler) (no record of original request) | 2014T1_2014-03-26_001283 (RIM release ID) | Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26 |
IG © 2020+ HL7 International - Vocabulary Work Group. Package hl7.terminology#2.0.0 based on FHIR 4.0.1. Generated 2020-11-07
Links: Table of Contents |
QA Report
| Version History |
Propose a change