HL7 Terminology
1.0.0 - Publication

This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

CoveredPartyRoleType - JSON Representation

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{
  "resourceType" : "ValueSet",
  "id" : "v3-CoveredPartyRoleType",
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<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>\n<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>\n<p><strong>Discussion:</strong> 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.</p>\n</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>"
  },
  "url" : "http://terminology.hl7.org/ValueSet/v3-CoveredPartyRoleType",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.1.11.19805"
    }
  ],
  "version" : "2.0.0",
  "name" : "CoveredPartyRoleType",
  "title" : "CoveredPartyRoleType",
  "status" : "active",
  "date" : "2014-03-26T00:00:00-04:00",
  "description" : "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.\r\n\r\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.\r\n\r\n**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" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "filter" : [
          {
            "property" : "concept",
            "op" : "is-a",
            "value" : "_CoveredPartyRoleType"
          }
        ]
      },
      {
        "valueSet" : [
          "http://terminology.hl7.org/ValueSet/v3-ClaimantCoveredPartyRoleType"
        ]
      },
      {
        "valueSet" : [
          "http://terminology.hl7.org/ValueSet/v3-ProgramEligibleCoveredPartyRoleType"
        ]
      },
      {
        "valueSet" : [
          "http://terminology.hl7.org/ValueSet/v3-IndividualInsuredCoveredPartyRoleType"
        ]
      },
      {
        "valueSet" : [
          "http://terminology.hl7.org/ValueSet/v3-SubscriberCoveredPartyRoleType"
        ]
      },
      {
        "valueSet" : [
          "http://terminology.hl7.org/ValueSet/v3-DependentCoveredPartyRoleType"
        ]
      }
    ],
    "exclude" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "concept" : [
          {
            "code" : "_ClaimantCoveredPartyRoleType"
          }
        ]
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "concept" : [
          {
            "code" : "_ProgramEligiblePartyRoleType"
          }
        ]
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "concept" : [
          {
            "code" : "_IndividualInsuredPartyRoleType"
          }
        ]
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "concept" : [
          {
            "code" : "_SubscriberCoveredPartyRoleType"
          }
        ]
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
        "concept" : [
          {
            "code" : "_DependentCoveredPartyRoleType"
          }
        ]
      }
    ]
  }
}