v3-RoleClassCoveredParty
type: ValueSet
node role: treeRoot
id:
  v: v3-RoleClassCoveredParty
language:
  v: en
text:
  status:
    v: generated
  div: Include codes fromhttp://terminology.hl7.org/CodeSystem/v3-RoleClass where concept is-a COVPTY
url:
  v: http://terminology.hl7.org/ValueSet/v3-RoleClassCoveredParty
identifier:
  system:
    v: urn:ietf:rfc:3986
  value:
    v: urn:oid:2.16.840.1.113883.1.11.19807
version:
  v: 3.0.0
name:
  v: RoleClassCoveredParty
title:
  v: RoleClassCoveredParty
status:
  v: active
experimental:
  v: false
date:
  v: 2014-03-26
publisher:
  v: Health Level Seven International
contact:
  telecom:
    system:
      v: url
    value:
      v: http://hl7.org
  telecom:
    system:
      v: email
description:
  v: **Description:** A relationship between a party that receives benefit coverage under the terms of an insurance policy or program and the underwriter of the policy or program. The role is played by the party that receives benefit coverage under the terms of a particular insurance policy or program. The organization playing the underwriter of that policy or program is the scoping entity. A covered party receives coverage under a policy because of some contractual or other relationship with the policy holder. In most cases, the policy holder has discretion over which parties may be covered under a policy, unless the policy holder assigns or is required by a court to assign this right. A covered party receives coverage under a program by being determined eligible based on program eligibility criteria specified by the program sponsor. **Discussion:** This reason for coverage is specified by use of a role type code from either of the abstract value sets beneath the PolicyOrProgramCoverageRoleType abstract value set. The CoverageRoleType abstract value set can only be used when the role class is the concept code "covered party" (COVPTY) because this value set contains precoordinated coded concepts relating to coverage criteria that was developed for the Canadian realm. This is to avoid overlapping concepts, e.g., the DEPEN role.class cannot be used with the FAMDEP Role.code The CoveredPartyRoleType abstract value set may be used with any of the covered party role class codes to support post coordination of coverage criteria. Where coverage under a policy depends on the concurrence of a policy holder, a relationship link with type code of indirect authority should be included using the policy holder role as the source, and the covered party role as the target. **Note:** A particular policy may cover several parties, one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder. **Note:** Th…
immutable:
  v: true
copyright:
  v: 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
compose:
  include:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleClass
    filter:
      property:
        v: concept
      op:
        v: is-a
      value:
        v: COVPTY