HL7 Terminology (THO)
5.3.0 - Publication International flag

This page is part of the HL7 Terminology (v5.3.0: 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

: CoveredPartyRoleType - XML Representation

Active as of 2014-03-26

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="v3-CoveredPartyRoleType"/>
  <language value="en"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">Placeholder</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"/>
  <experimental value="false"/>
  <date value="2014-03-26"/>
  <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 &quot;CoverageRoleType&quot;, which was developed for use in the Canadian realm &quot;pre-coordinate&quot; coverage roles with other roles that a covered party must play in order to be eligible for coverage, e.g., &quot;handicapped dependent&quot;. Other codes in the Abstract Value Set CoveredPartyRoleType domain can be &quot;post-coordinated&quot; 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>