Extensions for Using Data Elements from FHIR R5 in FHIR R4
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR R4
0.1.0 - STU
Extensions for Using Data Elements from FHIR R5 in FHIR R4 - Downloaded Version null See the Directory of published versions
| Page standards status: Trial-use | Maturity Level: 0 |
<ValueSet xmlns="http://hl7.org/fhir">
<id value="R5-v3-PolicyOrProgramCoverageRoleType-for-R4"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet R5-v3-PolicyOrProgramCoverageRoleType-for-R4</b></p><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4"> </a><a name="hcR5-v3-PolicyOrProgramCoverageRoleType-for-R4"> </a><p>This value set expansion contains 35 concepts.</p><table class="codes"><tr><td><b>System</b></td><td><b>Version</b></td><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-ACTMIL"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-ACTMIL">ACTMIL</a></td><td>active duty military</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a program based on active military status.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as active duty military meets jurisdictional or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-ADOPT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-ADOPT">ADOPT</a></td><td>adopted child</td><td><div><p>A child taken into one's family through legal means and raised as one's own child.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-COCBEN"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-COCBEN">COCBEN</a></td><td>continuity of coverage beneficiary</td><td><div><p><strong>Description:</strong> A person playing the role of an individual insured with continuity of coverage under a policy which is being terminated based on loss of original status that was the basis for coverage. Criteria for qualifying for continuity of coverage may be set by law.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a continuity of coverage beneficiary meets jurisdictional or policy criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-CRIMEVIC"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-CRIMEVIC">CRIMEVIC</a></td><td>crime victim</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a program based on allegations of being the victim of a crime.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a crime victim meets jurisdictional or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-DIFFABL"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-DIFFABL">DIFFABL</a></td><td>differently abled</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a program based on meeting criteria for health or functional limitation set by law or by the program.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible", "named insured", "individual insured", or "dependent", and the person's status as differently abled meets jurisdictional, policy, or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-FAMDEP"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-FAMDEP">FAMDEP</a></td><td>family dependent</td><td><div><p>The player of the role is dependent of the scoping entity.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-FSTUD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-FSTUD">FSTUD</a></td><td>full-time student</td><td><div><p>Covered party to an insurance policy has coverage through full-time attendance at a recognized educational institution as defined by a particular insurance policy.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-GCHILD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-GCHILD">GCHILD</a></td><td>grandchild</td><td><div><p>A child of one's son or daughter.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-GPARNT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-GPARNT">GPARNT</a></td><td>grandparent</td><td><div><p>parent of a parent of the subject.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-HANDIC"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-HANDIC">HANDIC</a></td><td>handicapped dependent</td><td><div><p>Covered party is a dependent of the policy holder with a physical or mental disability causing a disadvantage that makes independent achievement unusually difficult.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-INDIG"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-INDIG">INDIG</a></td><td>member of an indigenous people</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a program based on aboriginal ancestry or as a member of an aboriginal community.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a member of an indigenous people meets jurisdictional or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-INJ"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-INJ">INJ</a></td><td>injured plaintiff</td><td><div><p>Covered party is an injured party with a legal claim for compensation against a policy holder under an insurance policy.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-INJWKR"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-INJWKR">INJWKR</a></td><td>injured worker</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a workers compensation program based on the filing of work-related injury claim.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is used when the CoveredPartyRole class code is either "program eligible", a "named insured", and "individual insured", or "dependent", and the person's status as differently abled or "handicapped" meets jurisdictional, policy, or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-MIL"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-MIL">MIL</a></td><td>military</td><td><div><p><strong>Definition:</strong> A person playing the role of program eligible under a program based on military status.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a member of the military meets jurisdictional or program criteria</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-NAT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-NAT">NAT</a></td><td>natural child</td><td><div><p>A child as determined by birth.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-NIENE"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-NIENE">NIENE</a></td><td>niece/nephew</td><td><div><p>A child of one's brother or sister or of the brother or sister of one's spouse.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-PARNT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-PARNT">PARNT</a></td><td>parent</td><td><div><p>One that begets or brings forth offspring or a person who brings up and cares for for another (Webster's Collegiate Dictionary)</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-PSTUD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-PSTUD">PSTUD</a></td><td>part-time student</td><td><div><p>Covered party to an insurance policy has coverage through part-time attendance at a recognized educational institution as defined by a particular insurance policy.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-RETIREE"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-RETIREE">RETIREE</a></td><td>retiree</td><td><div><p><strong>Description:</strong> A person playing the role of an individual insured under a policy based on meeting criteria for the employment status of retired set by law or the policy.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the person's status as a retiree meets jurisdictional or policy criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-RETMIL"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-RETMIL">RETMIL</a></td><td>retired military</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a program based on retired military status.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as retired military meets jurisdictional or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-SELF"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-SELF">SELF</a></td><td>self</td><td><div><p>Covered party is the policy holder. Also known as the subscriber.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-SPON"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-SPON">SPON</a></td><td>sponsored dependent</td><td><div><p>Covered party is an individual that the policy holder has assumed responsibility for, such as foster child or legal ward.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-SPSE"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-SPSE">SPSE</a></td><td>spouse</td><td><div><p>A marriage partner; a husband or wife.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-STEP"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-STEP">STEP</a></td><td>step child</td><td><div><p>A child receiving parental care and nurture from a person who is related to them through marriage to their parent.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-STUD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-STUD">STUD</a></td><td>student</td><td><div><p>Covered party to an insurance policy has coverage through full-time or part-time attendance at a recognized educational institution as defined by a particular insurance policy.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-VET"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-VET">VET</a></td><td>veteran</td><td><div><p><strong>Description:</strong> A person playing the role of program eligible under a program based on status as a military veteran.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as a veteran meets jurisdictional or program criteria.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-WARD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-WARD">WARD</a></td><td>ward</td><td><div><p><strong>Description:</strong> A person, who is a minor or is deemed incompetent, who plays the role of a program eligible where eligibility for coverage is based on meeting program eligibility criteria for status as a ward of a court or jurisdiction.</p>
<p><strong>Discussion:</strong> This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is a "claimant", "program eligible", a "named insured", an "individual Insured" or a "dependent", and the person's status as a ward meets program or policy criteria. In the case of a ward covered under a program providing financial or health benefits, a governmental agency may take temporary custody of a minor or incompetent for his/her protection and care, e.g., if the ward is suffering from neglect or abuse, or has been in trouble with the law.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_ClaimantCoveredPartyRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_ClaimantCoveredPartyRoleType">_ClaimantCoveredPartyRoleType</a></td><td>ClaimantCoveredPartyRoleType</td><td><div><p><strong>Description</strong>A role recognized through the eligibility of a party play a claimant for benefits covered or provided under an insurance policy.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_CoverageRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_CoverageRoleType">_CoverageRoleType</a></td><td>CoverageRoleType</td><td><div><p>Role recognized through the issuance of insurance coverage to an identified covered party who has this relationship with the policy holder such as the policy holder themselves (self), spouse, child, etc</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_CoveredPartyRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_CoveredPartyRoleType">_CoveredPartyRoleType</a></td><td>covered party role type</td><td><div><p>A role recognized through the eligibility of an identified living subject for benefits covered under an insurance policy or a program. Eligibility as a covered party may be conditioned on a relationship with (1) the policy holder such as the policy holder who is covered as an individual under a poliy or as a party sponsored for coverage by the policy holder.</p>
<p>**Example:**An employee as a subscriber; or (2) on being scoped another covered party such as the subscriber, as in the case of a dependent.</p>
<p><strong>Discussion:</strong> 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". Other codes in the Abstract Value Set CoveredPartyRoleType domain can be "post-coordinated" with the EligiblePartyRoleType codes to denote comparable concepts. Decoupling the concepts is intended to support a wider range of concepts and semantic comparability of coded concepts.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_DependentCoveredPartyRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_DependentCoveredPartyRoleType">_DependentCoveredPartyRoleType</a></td><td>DependentCoveredPartyRoleType</td><td><div><p><strong>Description:</strong> A role recognized through the eligibility of a party to play a dependent for benefits covered or provided under a health insurance policy because of an association with the subscriber that is recognized by the policy underwriter.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_IndividualInsuredPartyRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_IndividualInsuredPartyRoleType">_IndividualInsuredPartyRoleType</a></td><td>IndividualInsuredPartyRoleType</td><td><div><p>A role recognized through the eligibility of a party to play an individual insured for benefits covered or provided under an insurance policy where the party is also the policy holder.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_PolicyOrProgramCoverageRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_PolicyOrProgramCoverageRoleType">_PolicyOrProgramCoverageRoleType</a></td><td>PolicyOrProgramCoverageRoleType</td><td><div><p><strong>Description:</strong> 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.</p>
<p>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:</p>
<ol>
<li>The sole basis for coverage, e.g., being differently abled may qualify a person for disability coverage</li>
<li>May more fully qualify a covered party role e.g, being differently abled may qualify an adult child as a dependent</li>
<li>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.</li>
</ol>
<p><strong>Discussion:</strong> 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.</p>
<p>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.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_ProgramEligiblePartyRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_ProgramEligiblePartyRoleType">_ProgramEligiblePartyRoleType</a></td><td>ProgramEligiblePartyRoleType</td><td><div><p>**Description:**A role recognized through the eligibility of a party to play a program eligible for benefits covered or provided under a program.</p>
</div></td></tr><tr><td><a name="R5-v3-PolicyOrProgramCoverageRoleType-for-R4-http://terminology.hl7.org/CodeSystem/v3-RoleCode-_SubscriberCoveredPartyRoleType"> </a><code>http://terminology.hl7.org/CodeSystem/v3-RoleCode</code></td><td>2.2.0</td><td style="white-space:nowrap"> <a href="CodeSystem-v3-RoleCode.html#v3-RoleCode-_SubscriberCoveredPartyRoleType">_SubscriberCoveredPartyRoleType</a></td><td>SubscriberCoveredPartyRoleType</td><td><div><p><strong>Description:</strong> A role recognized through the eligibility of a party to play a subscriber for benefits covered or provided under a health insurance policy.</p>
</div></td></tr></table></div>
</text>
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<valueCode value="fhir"/>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/package-source">
<extension url="packageId">
<valueId value="hl7.fhir.uv.xver-r5.r4"/>
</extension>
<extension url="version">
<valueString value="0.1.0"/>
</extension>
<extension url="uri">
<valueUri
value="http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="0">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
</extension>
</valueInteger>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
</extension>
</valueCode>
</extension>
<url
value="http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-PolicyOrProgramCoverageRoleType-for-R4"/>
<version value="0.1.0"/>
<name value="R5V3PolicyOrProgramCoverageRoleTypeForR4"/>
<title
value="Cross-version ValueSet R5.PolicyOrProgramCoverageRoleType for use in FHIR R4"/>
<status value="active"/>
<experimental value="false"/>
<date value="2026-03-17T21:02:03.8104715+00:00"/>
<publisher value="FHIR Infrastructure"/>
<contact>
<name value="FHIR Infrastructure"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fiwg"/>
</telecom>
</contact>
<description
value="This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-PolicyOrProgramCoverageRoleType|2.0.0` for use in FHIR R4."/>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
<display value="World"/>
</coding>
</jurisdiction>
<purpose
value="This value set is part of the cross-version definitions generated to enable use of the
value set `http://terminology.hl7.org/ValueSet/v3-PolicyOrProgramCoverageRoleType|2.0.0` as defined in FHIR R5
in FHIR R4.
The source value set is bound to the following FHIR R5 elements:
*
Note that all concepts are included in this cross-version definition because no concepts have compatible representations
Following are the generation technical comments:
FHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-PolicyOrProgramCoverageRoleType|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4"/>
<compose>
<include>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<concept>
<code value="ACTMIL"/>
<display value="active duty military"/>
</concept>
<concept>
<code value="ADOPT"/>
<display value="adopted child"/>
</concept>
<concept>
<code value="COCBEN"/>
<display value="continuity of coverage beneficiary"/>
</concept>
<concept>
<code value="CRIMEVIC"/>
<display value="crime victim"/>
</concept>
<concept>
<code value="DIFFABL"/>
<display value="differently abled"/>
</concept>
<concept>
<code value="FAMDEP"/>
<display value="family dependent"/>
</concept>
<concept>
<code value="FSTUD"/>
<display value="full-time student"/>
</concept>
<concept>
<code value="GCHILD"/>
<display value="grandchild"/>
</concept>
<concept>
<code value="GPARNT"/>
<display value="grandparent"/>
</concept>
<concept>
<code value="HANDIC"/>
<display value="handicapped dependent"/>
</concept>
<concept>
<code value="INDIG"/>
<display value="member of an indigenous people"/>
</concept>
<concept>
<code value="INJ"/>
<display value="injured plaintiff"/>
</concept>
<concept>
<code value="INJWKR"/>
<display value="injured worker"/>
</concept>
<concept>
<code value="MIL"/>
<display value="military"/>
</concept>
<concept>
<code value="NAT"/>
<display value="natural child"/>
</concept>
<concept>
<code value="NIENE"/>
<display value="niece/nephew"/>
</concept>
<concept>
<code value="PARNT"/>
<display value="parent"/>
</concept>
<concept>
<code value="PSTUD"/>
<display value="part-time student"/>
</concept>
<concept>
<code value="RETIREE"/>
<display value="retiree"/>
</concept>
<concept>
<code value="RETMIL"/>
<display value="retired military"/>
</concept>
<concept>
<code value="SELF"/>
<display value="self"/>
</concept>
<concept>
<code value="SPON"/>
<display value="sponsored dependent"/>
</concept>
<concept>
<code value="SPSE"/>
<display value="spouse"/>
</concept>
<concept>
<code value="STEP"/>
<display value="step child"/>
</concept>
<concept>
<code value="STUD"/>
<display value="student"/>
</concept>
<concept>
<code value="VET"/>
<display value="veteran"/>
</concept>
<concept>
<code value="WARD"/>
<display value="ward"/>
</concept>
<concept>
<code value="_ClaimantCoveredPartyRoleType"/>
<display value="ClaimantCoveredPartyRoleType"/>
</concept>
<concept>
<code value="_CoverageRoleType"/>
<display value="CoverageRoleType"/>
</concept>
<concept>
<code value="_CoveredPartyRoleType"/>
<display value="covered party role type"/>
</concept>
<concept>
<code value="_DependentCoveredPartyRoleType"/>
<display value="DependentCoveredPartyRoleType"/>
</concept>
<concept>
<code value="_IndividualInsuredPartyRoleType"/>
<display value="IndividualInsuredPartyRoleType"/>
</concept>
<concept>
<code value="_PolicyOrProgramCoverageRoleType"/>
<display value="PolicyOrProgramCoverageRoleType"/>
</concept>
<concept>
<code value="_ProgramEligiblePartyRoleType"/>
<display value="ProgramEligiblePartyRoleType"/>
</concept>
<concept>
<code value="_SubscriberCoveredPartyRoleType"/>
<display value="SubscriberCoveredPartyRoleType"/>
</concept>
</include>
</compose>
<expansion>
<timestamp value="2026-03-17T21:02:03.8104715+00:00"/>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="ACTMIL"/>
<display value="active duty military"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="ADOPT"/>
<display value="adopted child"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="COCBEN"/>
<display value="continuity of coverage beneficiary"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="CRIMEVIC"/>
<display value="crime victim"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="DIFFABL"/>
<display value="differently abled"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="FAMDEP"/>
<display value="family dependent"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="FSTUD"/>
<display value="full-time student"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="GCHILD"/>
<display value="grandchild"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="GPARNT"/>
<display value="grandparent"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="HANDIC"/>
<display value="handicapped dependent"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="INDIG"/>
<display value="member of an indigenous people"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="INJ"/>
<display value="injured plaintiff"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="INJWKR"/>
<display value="injured worker"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="MIL"/>
<display value="military"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="NAT"/>
<display value="natural child"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="NIENE"/>
<display value="niece/nephew"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="PARNT"/>
<display value="parent"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="PSTUD"/>
<display value="part-time student"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="RETIREE"/>
<display value="retiree"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="RETMIL"/>
<display value="retired military"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="SELF"/>
<display value="self"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="SPON"/>
<display value="sponsored dependent"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="SPSE"/>
<display value="spouse"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="STEP"/>
<display value="step child"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="STUD"/>
<display value="student"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="VET"/>
<display value="veteran"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="WARD"/>
<display value="ward"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_ClaimantCoveredPartyRoleType"/>
<display value="ClaimantCoveredPartyRoleType"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_CoverageRoleType"/>
<display value="CoverageRoleType"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_CoveredPartyRoleType"/>
<display value="covered party role type"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_DependentCoveredPartyRoleType"/>
<display value="DependentCoveredPartyRoleType"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_IndividualInsuredPartyRoleType"/>
<display value="IndividualInsuredPartyRoleType"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_PolicyOrProgramCoverageRoleType"/>
<display value="PolicyOrProgramCoverageRoleType"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_ProgramEligiblePartyRoleType"/>
<display value="ProgramEligiblePartyRoleType"/>
</contains>
<contains>
<system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<version value="2.2.0"/>
<code value="_SubscriberCoveredPartyRoleType"/>
<display value="SubscriberCoveredPartyRoleType"/>
</contains>
</expansion>
</ValueSet>
IG © 2025+ FHIR Infrastructure. Package hl7.fhir.uv.xver-r5.r4#0.1.0 based on FHIR 4.0.1. Generated 2026-03-20
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