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 - XML Representation

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Raw xml

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="v3-CoveredPartyRoleType"/>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <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>
<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>
<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>
</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>
  </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"/>
  <date value="2014-03-26T00:00:00-04:00"/>
  <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>