• Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActReason version 📍2.1.0

  Code	Display	Definition
  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.
  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.
  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.
  EMPLOY	employment benefit	A person becomes eligible for insurance provided as an employment benefit based on employment status.
  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.
  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
  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.
  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.
  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.
  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.
  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.
  _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.

This value set expansion contains 12 concepts.