HL7 Terminology (THO)
5.2.0 - Publication
This page is part of the HL7 Terminology (v5.2.0: Release) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
Official URL: http://terminology.hl7.org/ValueSet/v3-CoverageEligibilityReason | Version: 2.0.0 | |||
Active as of 2014-03-26 | Computable Name: CoverageEligibilityReason | |||
Other Identifiers: id: urn:oid:2.16.840.1.113883.1.11.19735 |
Description:Identifies the reason or rational for why a person is eligible for benefits under an insurance policy or program.
Examples: A new employee is eligible for health insurance as an employment benefit. A person meets eligibility criteria for government program coverage based on financial, age or health status.
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-ActReason
where concept is-a _CoverageEligibilityReason
This value set contains 11 concepts
Expansion based on ActReason v2.1.1 (CodeSystem)
Level | Code | System | Display | Definition |
1 | _CoverageEligibilityReason | http://terminology.hl7.org/CodeSystem/v3-ActReason | CoverageEligibilityReason | Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status. |
2 | AGE | http://terminology.hl7.org/CodeSystem/v3-ActReason | age eligibility | A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare. |
2 | CRIME | http://terminology.hl7.org/CodeSystem/v3-ActReason | crime victim | A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program. |
2 | DIS | http://terminology.hl7.org/CodeSystem/v3-ActReason | disability | A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization. |
2 | EMPLOY | http://terminology.hl7.org/CodeSystem/v3-ActReason | employment benefit | A person becomes eligible for insurance provided as an employment benefit based on employment status. |
2 | FINAN | http://terminology.hl7.org/CodeSystem/v3-ActReason | financial eligibility | A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP. |
2 | HEALTH | http://terminology.hl7.org/CodeSystem/v3-ActReason | health status | A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program |
2 | MULTI | http://terminology.hl7.org/CodeSystem/v3-ActReason | multiple criteria eligibility | A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles. |
2 | PNC | http://terminology.hl7.org/CodeSystem/v3-ActReason | property and casualty condition | A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises. |
2 | STATUTORY | http://terminology.hl7.org/CodeSystem/v3-ActReason | statutory eligibility | A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security. |
2 | VEHIC | http://terminology.hl7.org/CodeSystem/v3-ActReason | motor vehicle accident victim | A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury. |
2 | WORK | http://terminology.hl7.org/CodeSystem/v3-ActReason | work related | A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program. |
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 |
System | 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 | Custodian | Author | Comment |
2022-10-18 | revise | TSMG | Marc Duteau | Fixing missing metadata; up-349 |
2020-05-06 | revise | Vocabulary WG | Ted Klein | Migrated to the UTG maintenance environment and publishing tooling. |
2014-03-26 | revise | 2014T1_2014-03-26_001283 (RIM release ID) | Vocabulary (Woody Beeler) (no record of original request) | Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26 |