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History description 2014-03-26: Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26
description:
Description: A role played by a party that meets the eligibility criteria for coverage under a
program. A program eligible may be either a person, non-person living subject, or
an organization, or a group of persons, non-person living subjects, or organizations.
Discussion: A program as typically government administered coverage for parties determined eligible
under the terms of the program.
Note: The party playing a program eligible is not a claimant in the sense conveyed by the
RoleClassCoveredParty CLAIM (claimant). However a program eligible may make a claim
under program, e.g., an unemployed worker may claim benefits under an unemployment
insurance program, but parties playing these covered party role classes are not, for
purposes of this vocabulary and in an effort to clearly distinguish role classes,
considered claimants.
In the case of a program eligible, a role type code INJWKR (injured worker) subtypes
the class to indicate that the covered party in a workers compensation program is
an injured worker, and as such, has filed a "claim" under the program for benefits.
Likewise, a covered role type code UNEMP (unemployed worker) subtypes the program
eligible class to indicate that the covered party in an unemployment insurance program
has filed a claim for unemployment benefits.
Example: A party meeting eligibility criteria related to health or financial status, e.g.,
in the U.S., persons meeting health, demographic, or financial criteria established
by state and federal law are eligible for Medicaid.
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Value Set RoleClassProgramEligible 2014‑03‑26
Final
