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 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ValueSet;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "v3-CoveredPartyRoleType"];
  fhir:Resource.language [ fhir:value "en"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.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>"
  ];
  fhir:ValueSet.url [ fhir:value "http://terminology.hl7.org/ValueSet/v3-CoveredPartyRoleType"];
  fhir:ValueSet.identifier [
     fhir:index 0;
     fhir:Identifier.system [ fhir:value "urn:ietf:rfc:3986" ];
     fhir:Identifier.value [ fhir:value "urn:oid:2.16.840.1.113883.1.11.19805" ]
  ];
  fhir:ValueSet.version [ fhir:value "2.0.0"];
  fhir:ValueSet.name [ fhir:value "CoveredPartyRoleType"];
  fhir:ValueSet.title [ fhir:value "CoveredPartyRoleType"];
  fhir:ValueSet.status [ fhir:value "active"];
  fhir:ValueSet.date [ fhir:value "2014-03-26T00:00:00-04:00"^^xsd:dateTime];
  fhir:ValueSet.description [ fhir: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.\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."];
  fhir:ValueSet.compose [
     fhir:ValueSet.compose.include [
       fhir:index 0;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
       fhir:ValueSet.compose.include.filter [
         fhir:index 0;
         fhir:ValueSet.compose.include.filter.property [ fhir:value "concept" ];
         fhir:ValueSet.compose.include.filter.op [ fhir:value "is-a" ];
         fhir:ValueSet.compose.include.filter.value [ fhir:value "_CoveredPartyRoleType" ]       ]     ], [
       fhir:index 1;
       fhir:ValueSet.compose.include.valueSet [
         fhir:value "http://terminology.hl7.org/ValueSet/v3-ClaimantCoveredPartyRoleType";
         fhir:index 0;
         fhir:link <http://terminology.hl7.org/ValueSet/v3-ClaimantCoveredPartyRoleType>       ]     ], [
       fhir:index 2;
       fhir:ValueSet.compose.include.valueSet [
         fhir:value "http://terminology.hl7.org/ValueSet/v3-ProgramEligibleCoveredPartyRoleType";
         fhir:index 0;
         fhir:link <http://terminology.hl7.org/ValueSet/v3-ProgramEligibleCoveredPartyRoleType>       ]     ], [
       fhir:index 3;
       fhir:ValueSet.compose.include.valueSet [
         fhir:value "http://terminology.hl7.org/ValueSet/v3-IndividualInsuredCoveredPartyRoleType";
         fhir:index 0;
         fhir:link <http://terminology.hl7.org/ValueSet/v3-IndividualInsuredCoveredPartyRoleType>       ]     ], [
       fhir:index 4;
       fhir:ValueSet.compose.include.valueSet [
         fhir:value "http://terminology.hl7.org/ValueSet/v3-SubscriberCoveredPartyRoleType";
         fhir:index 0;
         fhir:link <http://terminology.hl7.org/ValueSet/v3-SubscriberCoveredPartyRoleType>       ]     ], [
       fhir:index 5;
       fhir:ValueSet.compose.include.valueSet [
         fhir:value "http://terminology.hl7.org/ValueSet/v3-DependentCoveredPartyRoleType";
         fhir:index 0;
         fhir:link <http://terminology.hl7.org/ValueSet/v3-DependentCoveredPartyRoleType>       ]     ];
     fhir:ValueSet.compose.exclude [
       fhir:index 0;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "_ClaimantCoveredPartyRoleType" ]       ]     ], [
       fhir:index 1;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "_ProgramEligiblePartyRoleType" ]       ]     ], [
       fhir:index 2;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "_IndividualInsuredPartyRoleType" ]       ]     ], [
       fhir:index 3;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "_SubscriberCoveredPartyRoleType" ]       ]     ], [
       fhir:index 4;
       fhir:ValueSet.compose.include.system [ fhir:value "http://terminology.hl7.org/CodeSystem/v3-RoleCode" ];
       fhir:ValueSet.compose.include.concept [
         fhir:index 0;
         fhir:ValueSet.compose.include.concept.code [ fhir:value "_DependentCoveredPartyRoleType" ]       ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.