Parameter Name
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Function
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Benefit Line Code
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Here the operator may select the Benefit Line Code from the list.
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Deductible Applies
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Here the operator may select whether or not the deductible will apply to this benefit line or not.
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Contributes to OOP Max(1)
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Here the operator may select if the Deductible will contribute to the Out of Pocket Maximum or not.
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Copay Amount
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Here the operator may select the Copay Amount to associate with this Benefit Line.
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Contributes to OOP Max(2)
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Here the operator may select if the Copay Amount will contribute to the Out of Pocket Maximum or not.
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Co-insurance %
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Here the operator may select the percentage of Co-insurance to associate with the benefit line.
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Contributes to OOP Max(3)
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Here the operator may select if the Co-Insurance will contribute to the Out of Pocket Maximum or not.
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OOP Co-Ins %
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Here the operator may select the percentage of Co-insurance to associate with the benefit line.
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Contributes to OOP Max(4)
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Here the operator may select if the Out of Pocket Co-Insurance will contribute to the Out of Pocket Maximum or not.
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First to Fifth Associated Accumulators
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Here the operator may choose which accumulators to associate with the Benefit Line.
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Requires Precert
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Selecting this triggers a message in the claims screen whenever the cursor leaves the benefit line text entry field informing the user that the benefit line requires precertification.
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Include SPEC
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Selecting this will include the benefit line in the Individual Stop Loss Report.
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Include in AGGR
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Selecting this will include the benefit line in the Aggregate Stop Loss Report.
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