HL7 Terminology (THO)
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HL7 Terminology (THO), published by HL7 International - Vocabulary Work Group. This is not an authorized publication; it is the continuous build for version 5.0.0). This version is based on the current content of https://github.com/HL7/UTG/ and changes regularly. See the Directory of published versions

ValueSet: CoveredPartyRoleType

Official URL: http://terminology.hl7.org/ValueSet/v3-CoveredPartyRoleType Version: 2.0.0
Active as of 2014-03-26 Computable Name: CoveredPartyRoleType
Other Identifiers: id: urn:oid:2.16.840.1.113883.1.11.19805

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 “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.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

This value set includes codes based on the following rules:

This value set excludes codes based on the following rules:

 

Expansion

This value set contains 15 concepts

CodeSystemDisplayDefinition
  _CoveredPartyRoleTypehttp://terminology.hl7.org/CodeSystem/v3-RoleCodecovered party role type

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 "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.

  CRIMEVIChttp://terminology.hl7.org/CodeSystem/v3-RoleCodecrime victim

Description: A person playing the role of program eligible under a program based on allegations of being the victim of a crime.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a crime victim meets jurisdictional or program criteria.

  INJWKRhttp://terminology.hl7.org/CodeSystem/v3-RoleCodeinjured worker

Description: A person playing the role of program eligible under a workers compensation program based on the filing of work-related injury claim.

Discussion: This CoveredPartyRoleType.code is used when the CoveredPartyRole class code is either "program eligible", a "named insured", and "individual insured", or "dependent", and the person's status as differently abled or "handicapped" meets jurisdictional, policy, or program criteria.

  COCBENhttp://terminology.hl7.org/CodeSystem/v3-RoleCodecontinuity of coverage beneficiary

Description: A person playing the role of an individual insured with continuity of coverage under a policy which is being terminated based on loss of original status that was the basis for coverage. Criteria for qualifying for continuity of coverage may be set by law.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a continuity of coverage beneficiary meets jurisdictional or policy criteria.

  DIFFABLhttp://terminology.hl7.org/CodeSystem/v3-RoleCodedifferently abled

Description: A person playing the role of program eligible under a program based on meeting criteria for health or functional limitation set by law or by the program.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible", "named insured", "individual insured", or "dependent", and the person's status as differently abled meets jurisdictional, policy, or program criteria.

  WARDhttp://terminology.hl7.org/CodeSystem/v3-RoleCodeward

Description: A person, who is a minor or is deemed incompetent, who plays the role of a program eligible where eligibility for coverage is based on meeting program eligibility criteria for status as a ward of a court or jurisdiction.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is a "claimant", "program eligible", a "named insured", an "individual Insured" or a "dependent", and the person's status as a ward meets program or policy criteria. In the case of a ward covered under a program providing financial or health benefits, a governmental agency may take temporary custody of a minor or incompetent for his/her protection and care, e.g., if the ward is suffering from neglect or abuse, or has been in trouble with the law.

  RETIREEhttp://terminology.hl7.org/CodeSystem/v3-RoleCoderetiree

Description: A person playing the role of an individual insured under a policy based on meeting criteria for the employment status of retired set by law or the policy.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a retiree meets jurisdictional or policy criteria.

  INDIGhttp://terminology.hl7.org/CodeSystem/v3-RoleCodemember of an indigenous people

Description: A person playing the role of program eligible under a program based on aboriginal ancestry or as a member of an aboriginal community.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a member of an indigenous people meets jurisdictional or program criteria.

  MILhttp://terminology.hl7.org/CodeSystem/v3-RoleCodemilitary

Definition: A person playing the role of program eligible under a program based on military status.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a member of the military meets jurisdictional or program criteria

  ACTMILhttp://terminology.hl7.org/CodeSystem/v3-RoleCodeactive duty military

Description: A person playing the role of program eligible under a program based on active military status.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as active duty military meets jurisdictional or program criteria.

  RETMILhttp://terminology.hl7.org/CodeSystem/v3-RoleCoderetired military

Description: A person playing the role of program eligible under a program based on retired military status.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as retired military meets jurisdictional or program criteria.

  VEThttp://terminology.hl7.org/CodeSystem/v3-RoleCodeveteran

Description: A person playing the role of program eligible under a program based on status as a military veteran.

Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as a veteran meets jurisdictional or program criteria.

  INJhttp://terminology.hl7.org/CodeSystem/v3-RoleCodeinjured plaintiff

Covered party is an injured party with a legal claim for compensation against a policy holder under an insurance policy.

  STUDhttp://terminology.hl7.org/CodeSystem/v3-RoleCodestudent

Covered party to an insurance policy has coverage through full-time or part-time attendance at a recognized educational institution as defined by a particular insurance policy.

  FSTUDhttp://terminology.hl7.org/CodeSystem/v3-RoleCodefull-time student

Covered party to an insurance policy has coverage through full-time attendance at a recognized educational institution as defined by a particular insurance policy.

  PSTUDhttp://terminology.hl7.org/CodeSystem/v3-RoleCodepart-time student

Covered party to an insurance policy has coverage through part-time attendance at a recognized educational institution as defined by a particular insurance policy.


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
System 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
2022-10-18reviseMarc DuteauTSMGFixing missing metadata; up-349
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