Products, plans and agreements are all interrelated in a Group insurance setting. The product is the highest level of coverage containing all possible plan offerings. The plans are more specific selections that the Group Customer selects from the Product to offer to eligible members. The agreement contains the contract information detailing the plan selections.
A product is defined as the line of business or highest level of coverage packaged to include all possible plan offerings, benefit packages, features and ranges. Dental, Life, Health or Disability are examples of products.
A product can be broken down into distinct child products. For example, a Dental Product can be broken down into child products such as Dental DMO or Dental PPO. At the Plan Coverage level, a Dental DMO or Dental PPO could additionally offer a Hi, Low, Preventative or Comprehensive coverage.
The data associated with a product contains all options, rules, rates and events necessary to define every variation of the product that may be offered to a customer. Products, like plans, can be organized in a hierarchical fashion to create product “templates” that are subsets of the parent product.
The templates inherit rules and data from their parent product and make it easy to pre-define the subsets of options and data that will be offered to a group insurance customer. A child product or template will, unless otherwise overridden, inherit the data values and rules from the parent template or product.
See the Creating and Editing Products page for more information on working with products.
A plan is a specific selection of product offerings selected by the Group Customer to offer to groups of employees. A plan can also be described as the collection of specific benefits and rates packaged when a Group Customer selects from the Carrier's product ranges. A plan is an instance of the product.
The Group Customer decides which members the plan(s) is offered to - all active employees, or a subset of employees, known as a class. Plans are offered during the enrollment period to either all active employees or a class of employees.
Plans are created as Group Customer specific instances of a product and inherit the rules selected from the product. Plan inheritance allows the field configuration defined at the Product and Plan level overrides of the PlanScreen business rule to be displayed in OIPA on the screen at the same time with no impact to the appearance of the fields.
A Class Sub-Plan is a subset of plan benefits available for election and enrollment by a participant. This is also known as Plan Coverage. The Sub-Plan, or coverage, can be attached and removed via an association to the class.
A plan is an instance of the product. The ProductGUID relates AsPlan to AsProduct.
The plan is a subset of what is contained within AsProduct.
The following information only applies when the Product structure is in use.
For the following entities, a Plan will inherit configuration defined in a Product-level override:
For example if “Product A” and “Plan A” are directly related to each other, and each has it’s own override of the PlanScreen business rule, the PlanScreen displayed in the application will be the combination of the two overrides because of the direct relationship. This data inheritance works exactly the same for Plan Fields and Segments used throughout the system.
The data inheritance also functions in a similar way if the relationship between the Product and Plan is indirect. For example, if “Product A” has a direct relationship to “Child Product B” and “Child Product B” has a direct relationship to “Plan A,” but the PlanScreen Business Rule only has overrides for “Product A” and “Plan A,” the PlanScreen that is displayed in the application will be the combination of the two overrides because of the indirect relationship between “Product A” and “Plan A.” Again, this data inheritance works the same for Plan Fields and Segments.
Fields configured in multiple related overrides of the PlanScreen will display in the system UI in the following order:
When a field with the same name is present in multiple related overrides, the field will display on the screen at its earliest definition. The field will not be able to be moved, only hidden.
Under the Group Customer context, an Agreement links a Product to a Group Customer creating a Plan. Under the Agreement Definition, the PRODUCT and PLAN attributes define whether one or more Products and one or more Plans can be linked to an Agreement. Under each agreement, ability is provided to have more than one plan which can then be offered to the group members basis eligibility and other business constraints applicable.