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  1. FHIR Specification Feedback
  2. FHIR-23243

Fix subscriber vs covered party - HRex #79

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Details

    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci HRex (FHIR)
    • Financial Mgmt
    • Profile overview
    • Profiles defined as
    • Hide

      refer to comments on PDex regarding same topic – use disposition from PDex

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      refer to comments on PDex regarding same topic – use disposition from PDex
    • Robert Dieterle / May Terry: 7-0-1
    • Clarification
    • Non-substantive

    Description

      Existing Wording: The HRex Coverage Profile defines the constraints for representing the subscriber information to the Payer.

      Proposed Wording: The HRex Coverage Profile defines the constraints for representing the covered party and their plan identification information to the Payer.

      Comment:

      The subscriber is the party who has signed-on for or acquired a plan from the payor, for example for employer supplied/arrainged health insurance typically the employer is the policy holder as they directly contract with the insurer; the employee is the subscriber as they subscribe to the negotiated policy and may select plan characteristics; and, the subscriber, and any identified dependents for a family policy, are beneficiaries under the policy.

      The Coverage resource is per-beneficiary not per-subscriber.

      Summary:

      Fix subscriber vs covered party

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            Unassigned Unassigned
            pknapp Paul Knapp
            Paul Knapp
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            Dates

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              Updated:
              Resolved: