CoverageEligibilityReason - HL7 Terminology (THO) v7.1.0

HL7 Terminology (THO)
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HL7 Terminology (THO), published by HL7 International - Vocabulary Work Group. This guide is not an authorized publication; it is the continuous build for version 7.1.0 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

ValueSet: CoverageEligibilityReason

Official URL: http://terminology.hl7.org/ValueSet/v3-CoverageEligibilityReason	Version: 3.0.0	Highlight text changes?
	Responsible: Health Level Seven International	Computable Name: CoverageEligibilityReason
Other Identifiers: OID:2.16.840.1.113883.1.11.19735
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:Identifies the reason or rational for why a person is eligible for benefits under an insurance policy or program.

Examples: A new employee is eligible for health insurance as an employment benefit. A person meets eligibility criteria for government program coverage based on financial, age or health status.

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)

Language: en

Include codes fromhttp://terminology.hl7.org/CodeSystem/v3-ActReason version 📦4.0.0 where concept is-a _CoverageEligibilityReason

Expansion

Expansion performed internally based on codesystem ActReason v4.0.0 (CodeSystem)

This value set contains 12 concepts

Level	System	Code	Display (en)	Definition	JSON	XML
1	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	_CoverageEligibilityReason	CoverageEligibilityReason	Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	AGE	age eligibility	A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	CRIME	crime victim	A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	DIS	disability	A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	EMPLOY	employment benefit	A person becomes eligible for insurance provided as an employment benefit based on employment status.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	FINAN	financial eligibility	A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	HEALTH	health status	A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	MULTI	multiple criteria eligibility	A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	PNC	property and casualty condition	A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	STATUTORY	statutory eligibility	A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	VEHIC	motor vehicle accident victim	A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
2	`http://terminology.hl7.org/CodeSystem/v3-ActReason`	WORK	work related	A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program.