HL7 Terminology (THO), published by HL7 International - Vocabulary Work Group. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/UTG/ and changes regularly. See the Directory of published versions

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ValueSet: PolicyOrProgramCoverageRoleType

Official URL: http://terminology.hl7.org/ValueSet/v3-PolicyOrProgramCoverageRoleType				Version: 3.0.0
Active as of 2014-03-26			Responsible: Health Level Seven International	Computable Name: PolicyOrProgramCoverageRoleType
Other Identifiers: OID:2.16.840.1.113883.1.11.19809
Copyright/Legal: 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.html

Description: A role recognized through the eligibility of an identified party for benefits covered under an insurance policy or a program based on meeting eligibility criteria.

Eligibility as a covered party may be conditioned on the party meeting criteria to qualify for coverage under a policy or program, which may be mandated by law. These criteria may be:

1. The sole basis for coverage, e.g., being differently abled may qualify a person for disability coverage
2. May more fully qualify a covered party role e.g, being differently abled may qualify an adult child as a dependent
3. May impact the level of coverage for a covered party under a policy or program, e.g., being differently abled may qualify a program eligible for additional benefits.

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". These role.codes may only be used with COVPTY to avoid overlapping concepts that would result from using them to specify the specializations of COVPTY, e.g., the role.class DEPEN should not be used with the role.code family dependent because that relationship has overlapping concepts due to the role.code precoodination and is conveyed in FICO with the personal relationship role that has a PART role link to the covered party role. For the same reasons, the role.class DEPEN should not be used with the role.code HANDIC (handicapped dependent); the role.code DIFFABLE (differently abled) should be used instead.

In summary, the coded concepts in the Abstract Value Set "CoveredPartyRoleType" can be "post-coordinated" with the "RoleClassCoveredParty" Abstract Value Set. Decoupling these concepts is intended to support an expansive range of covered party concepts and their semantic comparability.

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)

 

Expansion

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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