Plans and Options Detail Screen





 

Parameter Name

Function
Plan ID Here the operator may enter/modify the Plan ID. The operator should be familiar with the system and understand the customary naming conventions used in their system.
Type Here the operator may enter/modify the Plan Type. Options may include MED, DEN, VIS and STD.
Group The operator may enter which Group the Plan was made for.
Plan Name Here the operator may enter/modify the name of the Plan.
Plan Renewal Day and Month Annually on this day and month the plan will be renewed.
Carryover Months Ded. This number is the number of months added to the date of service (after being adjusted by the rotate months number), to check for deductible carryover. Example: If DOS Month = 12, Deductible Carryover Number = 1, Rotate Months = 1 then Month after rotation = 11, Month after Deductible Number = 12, so the 12th month is not past December so there is no carryover into the next year.
Carryover Months OOP This number is the number of months added to the date of service (after being adjusted by the rotate months number), to check for oop carryover. Example: If DOS Month = 12, OOP Carryover Number = 2, Rotate Months = 1 then Month after rotation = 11, Month after OOP Carryover Number = 13, so the 13th month is past December so there is carryover.
Age Limit Dep. Here the operator may enter/modify the age at which a dependent may no longer qualify for plan benefits.
Age Limit Student Here the operator may enter/modify the age at which a student may no longer qualify for plan benefits.
Rotate Months The rotate months number represents the number of months at the beginning of a year that will be counted in the previous plan year for a date of service. Example: If the rotate months number is positive and the date of service is in January, the claim will be accounted for in the previous plan year. If the Date of Service was in December, and the rotate months number is negative, the claim will be applied to the following plan year.
Allowed Coverage Types (6 Blank Options) In these 6 fields, the operator may select which coverage types are applicable to the plan. An explanation of the six coverage types can be found on the Coverage Type Explanation Page.
UCR Reprice % Here the operator may select the Usual and Customary Repricing percent. Options include P50, P60, P65, P70, P75, P80, P85, P90 and P95.
COB Method Coordination Of Benefits method options include C and B. In COB Method Type C, the amount charged to the employee (aside from co-pay) for a claim is the total amount of the claim after the network discount, co-pay, deductible, other insurance, third party, and co-insurance have been deducted. With COB Method Type B, the employee responsibility is always 0, and the plan will pay the total Amount of the claim after the network discount, other insurance and third party contributions have been deducted.


 

Button Name

Function
New Plan Clicking here will clear all fields below so that the operator may enter the information for a new plan.
Save Changes Clicking here will save the newly entered plan or any changes made to an existing plan.
Delete Plan Clicking here will delete the plan that is currently displayed in Plan Detail panel.
Add Clicking here will open a window for the operator to enter a new plan accumulator.
Edit Clicking here will open a window so that the operator may edit the currently selected plan accumulator.
Delete Clicking here will delete the currently selected plan accumulator.


 

Parameter Name

Function
Option Name Here the operator may enter the option name.
Option ID Here the operator may enter the option ID.
In-Network Individual Deductible The operator may enter the In-Network Individual Deductible for the option here. The program prevents entry of letters in this field.
In-Network Family Deductible The operator may enter the In-Network Family Deductible for the option here. The program prevents entry of letters in this field.
In-Network Individual OOP The operator may enter the In-Network Individual OOP for the option here. The program prevents entry of letters in this field.
In-Network Family OOP The operator may enter the In-Network Family OOP for the option here. The program prevents entry of letters in this field.
Out-Network Individual Deductible The operator may enter the Out-Network Individual Deductible for the option here. The program prevents entry of letters in this field.
Out-Network Family Deductible The operator may enter the Out-Network Family Deductible for the option here. The program prevents entry of letters in this field.
Out-Network Individual OOP The operator may enter the Out-Network Individual OOP for the option here. The program prevents entry of letters in this field.
Out-Network Family OOP The operator may enter the Out-Network Family OOP for the option here. The program prevents entry of letters in this field.
Merge Deductibles If this option is selected, In-Network deductibles will also satisfy Out-Network deductibles, and vice-versa.
Merge OOP If this option is selected, In-Network OOP Maximums will also satisfy Out-Network OOP Maximums, and vice-versa.


 

Button Name

Function
New Option Clicking here will clear all Options fields so that the operator may enter the information for a new option.
Save Changes Clicking here will save the newly entered option or any changes made to an existing option.
Delete Option Clicking here will delete the currently displayed option from the plan.
Add Rate Clicking here will open a window for the operator to enter information for a new rate.
Edit Rate Clicking here will open a window for the operator to edit information about the selected rate.
Delete Rate Clicking here will delete the currently selected rate.
Add Benefit Clicking here will open a window for the operator to enter information about a new benefit line code of coverage.
Edit Benefit Clicking here will open a window for the operator to edit information about the selected benefit.
Delete Benefit Clicking here will delete the currently selected benefit.


 

Tab Name

Function
Plan List Clicking here will show the Plan List panel on top of the Plan Detail panel.
Plan Detail This shows that the Plan Detail panel is open.
Copy/AgeBands Clicking here will show the Copy/AgeBands panel on top of the Plan List panel.
Option List Clicking here will show the Option List panel on top of the Option List panel.
Option Detail This shows that the Option Detail panel is open.


 

Button Name

Function
RPT This opens the Eligibility Reports window.
LTR This opens the Letters window.
ADM This opens the Administration Tools window.
ELG This opens the Enrollment screen.
CLM This opens the Claims Entry screen.
NWK This opens the Networks and Providers screen.
EVT This opens the Event Tracking screen.
PLN This shows that the Plans and Options screen is open.
GRP This opens the Groups, Locations, and Units screen.


  This button closes the Claims Manager program.