{ "resourceType" : "ValueSet", "id" : "R5-v3-CoverageEligibilityReason-for-R4", "text" : { "status" : "generated", "div" : "

Generated Narrative: ValueSet R5-v3-CoverageEligibilityReason-for-R4

This value set expansion contains 11 concepts.

CodeSystemDisplayDefinition
\u00a0\u00a0AGEhttp://terminology.hl7.org/CodeSystem/v3-ActReasonage eligibility

A person becomes eligible for a program based on age.

\n

Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.

\n
\u00a0\u00a0CRIMEhttp://terminology.hl7.org/CodeSystem/v3-ActReasoncrime victim

A person becomes eligible for insurance or a program because of crime related health condition or injury.

\n

Example: A person is a claimant under the U.S. Crime Victims Compensation program.

\n
\u00a0\u00a0DIShttp://terminology.hl7.org/CodeSystem/v3-ActReasondisability

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.

\n
\u00a0\u00a0EMPLOYhttp://terminology.hl7.org/CodeSystem/v3-ActReasonemployment benefit

A person becomes eligible for insurance provided as an employment benefit based on employment status.

\n
\u00a0\u00a0FINANhttp://terminology.hl7.org/CodeSystem/v3-ActReasonfinancial eligibility

A person becomes eligible for a program based on financial criteria.

\n

Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.

\n
\u00a0\u00a0HEALTHhttp://terminology.hl7.org/CodeSystem/v3-ActReasonhealth status

A person becomes eligible for a program because of a qualifying health condition or injury.

\n

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

\n
\u00a0\u00a0MULTIhttp://terminology.hl7.org/CodeSystem/v3-ActReasonmultiple criteria eligibility

A person becomes eligible for a program based on more than one criterion.

\n

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.

\n
\u00a0\u00a0PNChttp://terminology.hl7.org/CodeSystem/v3-ActReasonproperty 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.

\n

Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.

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\u00a0\u00a0STATUTORYhttp://terminology.hl7.org/CodeSystem/v3-ActReasonstatutory eligibility

A person becomes eligible for a program based on statutory criteria.

\n

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.

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\u00a0\u00a0VEHIChttp://terminology.hl7.org/CodeSystem/v3-ActReasonmotor 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.

\n
\u00a0\u00a0WORKhttp://terminology.hl7.org/CodeSystem/v3-ActReasonwork related

A person becomes eligible for insurance or a program because of a work related health condition or injury.

\n

Example: A person is a claimant under the U.S. Black Lung Program.

\n
" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "fhir" }, { "extension" : [{ "url" : "packageId", "valueId" : "hl7.fhir.uv.xver-r5.r4" }, { "url" : "version", "valueString" : "0.0.1-snapshot-2" }], "url" : "http://hl7.org/fhir/StructureDefinition/package-source" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger" : 0, "_valueInteger" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode" : "trial-use", "_valueCode" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4" }] } }], "url" : "http://hl7.org/fhir/5.0/ValueSet/R5-v3-CoverageEligibilityReason-for-R4", "version" : "0.0.1-snapshot-2", "name" : "R5_v3_CoverageEligibilityReason_for_R4", "title" : "Cross-version VS for R5.CoverageEligibilityReason for use in FHIR R4", "status" : "active", "experimental" : false, "date" : "2025-09-01T22:37:05.089101+10:00", "publisher" : "FHIR Infrastructure", "contact" : [{ "name" : "FHIR Infrastructure", "telecom" : [{ "system" : "url", "value" : "http://www.hl7.org/Special/committees/fiwg" }] }], "description" : "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-CoverageEligibilityReason|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4.", "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" }] }], "compose" : { "include" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "concept" : [{ "code" : "AGE", "display" : "age eligibility" }, { "code" : "CRIME", "display" : "crime victim" }, { "code" : "DIS", "display" : "disability" }, { "code" : "EMPLOY", "display" : "employment benefit" }, { "code" : "FINAN", "display" : "financial eligibility" }, { "code" : "HEALTH", "display" : "health status" }, { "code" : "MULTI", "display" : "multiple criteria eligibility" }, { "code" : "PNC", "display" : "property and casualty condition" }, { "code" : "STATUTORY", "display" : "statutory eligibility" }, { "code" : "VEHIC", "display" : "motor vehicle accident victim" }, { "code" : "WORK", "display" : "work related" }] }] }, "expansion" : { "timestamp" : "2025-09-01T22:37:05.089094+10:00", "contains" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "AGE", "display" : "age eligibility" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "CRIME", "display" : "crime victim" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "DIS", "display" : "disability" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "EMPLOY", "display" : "employment benefit" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "FINAN", "display" : "financial eligibility" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "HEALTH", "display" : "health status" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "MULTI", "display" : "multiple criteria eligibility" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "PNC", "display" : "property and casualty condition" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "STATUTORY", "display" : "statutory eligibility" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "VEHIC", "display" : "motor vehicle accident victim" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason", "version" : "2.1.0", "code" : "WORK", "display" : "work related" }] } }