Preferred Name

ActProgramTypeCode
Synonyms
Definitions

<b>Definition:</b>A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds.<i>Discussion:</i>Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

ID

http://purl.bioontology.org/ontology/HL7/C3243387

Context binding of

http://purl.bioontology.org/ontology/HL7/C3243387

cui

C3243387

definition

Definition:A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds.Discussion:Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

Has context binding

http://purl.bioontology.org/ontology/HL7/C3243387

HL7 code status

active

HL7 history item

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.

HL7 internal Id

22098

HL7 is selectable

false

HL7 version date

2014-03-26

HL7PL

true

HL7SCS

2.16.840.1.113883.5.4

HL7SL

en

HL7VC

notation

C3243387

prefLabel

ActProgramTypeCode

tui

T170

subClassOf

http://purl.bioontology.org/ontology/HL7/C3244106

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