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Article

Sep 16, 2019

Configuring a plan bundle is optional. A plan bundle is an aggregation of different stand-alone plans that are sold as one item. A plan bundle is used to group plans such as medical, dental, vision, and pharmacy and market them as a bundle. A fixed bundle is one where the products are always sold…

Article

Sep 16, 2019

When you create a plan, you set a default benefit for each benefit category according to your business needs. You set a default benefit to best represent the cost share for the benefit category. The cost share, such as copay or coinsurance, on the benefit category displays in a Summary of Benefits…

Article

Sep 16, 2019

Although each benefit or grouper inherits the cost share values from the product template or product, or from the values that you modified when defining the network, you can modify them at the benefit level. You also define the benefit- or grouper-specific values that are not inherited. In addition…

Article

Sep 16, 2019

Modify the values for the network coverage and guardrails that are defined in the plan and make changes if necessary. For example, you might want to define the cost shares at the network level when several benefits always have a $50 copayment for out-of-network services. Instead of configuring this…

Article

Sep 16, 2019

Configure the custom individual cost shares for your plan by selecting the appropriate cost share types with values. You can keep the current inherited values from an existing product or plan or you can override them. In addition to overriding cost shares, you can override the following items:…

Article

Sep 16, 2019

Configure a new plan by using an approved product or copying an approved plan, which helps you build the plan more quickly. A product outlines the network structure, list of benefits, cost share ranges and defaults, and accumulator design that support the new plan. Before you begin Ensure that you…

Article

Sep 16, 2019

You configure a healthcare plan for a specific customer or to meet a particular mandated requirement. When you configure a plan, for example, if you have a small number of core products that can result in hundreds of plans for large accounts and thousands of plans for small groups and individuals,…

Article

Sep 16, 2019

During product creation, you can change the default benefit within a category or change benefit categories. When you configure a product or plan, you set a default benefit to best represent the cost share for the benefit category. The cost share, such as copay or coinsurance, on the benefit…

Article

Sep 16, 2019

You can modify the coverage, for example, copayment or coinsurance, for a benefit that was previously included as part of a benefit set for a specific network. During this step, add the product-specific values that are not inherited and therefore are not built into the product template. You can…

Article

Sep 16, 2019

To meet the specifications for your product, you can modify the values for the network coverage and guardrails that were defined in the product from the product template. For example, you might want to increase the amount of the cost shares to accommodate out-of-network services because the…