HL7 Terminology (THO)
5.4.0 - Publication
This page is part of the HL7 Terminology (v5.4.0: Release) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions
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<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><ul><li>Include codes from <a href="CodeSystem-v3-RoleClass.html"><code>http://terminology.hl7.org/CodeSystem/v3-RoleClass</code></a> where concept is-a <a href="CodeSystem-v3-RoleClass.html#v3-RoleClass-SUBSCR">SUBSCR</a></li></ul></div>
<publisher value="Health Level Seven International"/>
value="**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."/>
value="This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license"/>
IG © 2020+ HL7 International - Vocabulary Work Group. Package hl7.terminology#5.4.0 based on FHIR 4.0.1. Generated 2023-11-17
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