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

RoleClassNamedInsured

Summary

Defining URL:http://terminology.hl7.org/ValueSet/v3-RoleClassNamedInsured
Version:2.0.0
Name:RoleClassNamedInsured
Status:Active
Title:RoleClassNamedInsured
Definition:

Description: A role played by a party to an insurance policy to which the insurer agrees to indemnify for losses, provides benefits for, or renders services. A named insured may be either a person, non-person living subject, or an organization, or a group of persons, non-person living subjects, or organizations.

Discussion: The coded concept NAMED should not be used where a more specific child concept in this Specializable value set applies. In some cases, the named insured may not be the policy holder, e.g., where a policy holder purchases life insurance policy in which another party is the named insured and the policy holder is the beneficiary of the policy.

Note: The party playing the role of a named insured is not a claimant in the sense conveyed by the RoleClassCoveredParty CLAIM (claimant). However, a named insured may make a claim under a policy, e.g., e.g., a party that is the named insured and policy holder under a comprehensive automobile insurance policy may become the claimant for coverage under that policy e.g., if injured in an automobile accident and there is no liable third party. In the case of a named insured making a claim, a role type code INSCLM (insured claimant) subtypes the class to indicate that a named insured has filed a claim for a loss.

Example: The named insured under a comprehensive automobile, disability, or property and casualty policy that is the named insured and may or may not be the policy holder.

OID:2.16.840.1.113883.1.11.19808 (for OID based terminology systems)
Source Resource:XML / JSON / Turtle

References

This value set is not used

Content Logical Definition

Logical Definition (CLD)

 

Expansion

This value set contains 4 concepts

Expansion based on RoleClass v2.0.0 (CodeSystem)

All codes from system http://terminology.hl7.org/CodeSystem/v3-RoleClass

LvlCodeDisplayDefinition
0NAMEDnamed insured**Description:** A role played by a party to an insurance policy to which the insurer agrees to indemnify for losses, provides benefits for, or renders services. A named insured may be either a person, non-person living subject, or an organization, or a group of persons, non-person living subjects, or organizations. **Discussion:** The coded concept NAMED should not be used where a more specific child concept in this Specializable value set applies. In some cases, the named insured may not be the policy holder, e.g., where a policy holder purchases life insurance policy in which another party is the named insured and the policy holder is the beneficiary of the policy. **Note:** The party playing the role of a named insured is not a claimant in the sense conveyed by the RoleClassCoveredParty CLAIM (claimant). However, a named insured may make a claim under a policy, e.g., e.g., a party that is the named insured and policy holder under a comprehensive automobile insurance policy may become the claimant for coverage under that policy e.g., if injured in an automobile accident and there is no liable third party. In the case of a named insured making a claim, a role type code INSCLM (insured claimant) subtypes the class to indicate that a named insured has filed a claim for a loss. **Example:** The named insured under a comprehensive automobile, disability, or property and casualty policy that is the named insured and may or may not be the policy holder.
1  DEPENdependent**Description:** A role played by a person covered under a policy or program based on an association with a subscriber, which is recognized by the policy holder. **Note:** The party playing the role of a dependent is not a claimant in the sense conveyed by the RoleClassCoveredParty CLAIM (claimant). However, a dependent may make a claim under a policy, e.g., a dependent under a health insurance policy may become the claimant for coverage under that policy for wellness examines or if injured and there is no liable third party. In the case of a dependent making a claim, a role type code INSCLM (insured claimant) subtypes the class to indicate that the dependent has filed a claim for services covered under the health insurance policy. **Example:** The dependent has an association with the subscriber such as a financial dependency or personal relationship such as that of a spouse, or a natural or adopted child. The policy holder may be required by law to recognize certain associations or may have discretion about the associations. For example, a policy holder may dictate the criteria for the dependent status of adult children who are students, such as requiring full time enrollment, or may recognize domestic partners as dependents. Under certain circumstances, the dependent may be under the indirect authority of a responsible party acting as a surrogate for the subscriber, for example, if the subscriber is differently abled or deceased, a guardian ad Lidem or estate executor may be appointed to assume the subscriberaTMs legal standing in the relationship with the dependent.
1  INDIVindividual**Description:** A role played by a party covered under a policy as the policy holder. An individual may be either a person or an organization. **Note:** The party playing the role of an individual insured is not a claimant in the sense conveyed by the RoleClassCoveredParty CLAIM (claimant). However, a named insured may make a claim under a policy, e.g., a party that is the named insured and policy holder under a comprehensive automobile insurance policy may become the claimant for coverage under that policy if injured in an automobile accident and there is no liable third party. In the case of an individual insured making a claim, a role type code INSCLM (insured claimant) subtypes the class to indicate that an individual insured has filed a claim for a loss. **Example:** The individual insured under a comprehensive automobile, disability, or property and casualty policy that is the policy holder.
1  SUBSCRsubscriber**Description:** A role played by a person covered under a policy based on association with a sponsor who is the policy holder, and whose association may provide for the eligibility of dependents for coverage. **Discussion:** The policy holder holds the contract with the policy or program underwriter. The subscriber holds a certificate of coverage under the contract. In legal proceedings concerning the policy or program, the terms of the contract takes precedence over the terms of the certificate of coverage if there are any inconsistencies. **Note:** The party playing the role of a subscriber is not a claimant in the sense conveyed by the RoleClassCoveredParty CLAIM (claimant). However, a subscriber may make a claim under a policy, e.g., a subscriber under a health insurance policy may become the claimant for coverage under that policy for wellness examines or if injured and there is no liable third party. In the case of a subscriber making a claim, a role type code INSCLM (insured claimant) subtypes the class to indicate that the subscriber has filed a claim for services covered under the health insurance policy. **Example:** An employee or a member of an association.

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
Source 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

DateActionAuthorCustodianComment
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.
2014-03-26reviseVocabulary (Woody Beeler) (no record of original request)2014T1_2014-03-26_001283 (RIM release ID)Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26