Product Plan Overview

Product

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 that is filed with the insurance commission. For example, Dental, Life, Health, Disability.

The Dental Product can be broken down into distinct Plan or Sub-Products such as Dental DMO or Dental PPO. Lastly, at the Segment or Plan Coverage level a Dental DMO or Dental PPO could offer a Hi, Low, Preventative, or Comprehensive Coverage(s).

The Product is defined by the Carrier and filed with the State or Regulatory Boards. A Product / Sub-Product is a Group Benefits Plan Template that provides the basis for a Group Customer level Plan and serves to group similar Group Benefits Plan Templates (referred to as “Sub-Products”) together for rules sharing and data inheritance. Examples of this include Group Dental, Group Term Life and Group Disability.

At the Product level there is a specific Enrollment percentage that requires the minimum number of members participating in order to offer specific benefits. Enrollment is the process of registering for coverage and benefits. For more information, see Enrollment

Underwriting is performed on the entire group as a whole. And rates are often negotiated between the Group Customer and the Carrier.

 

Product > Plan > Enrollment

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 so as 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 typically 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.

Plan is an instance of the Product.

The ProductGUID relates AsPlan to AsProduct.

The Plan is a subset of what is contained within AsProduct.

Plan

A Plan is a Benefit Plan/Option(s) for groups of employees for a Group Customer. 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 perhaps a particular subset of Employees, known as a Class. Plans are offered during the enrollment period to either all active employees or a subset (specific Class) of employees.

The Plans are created as Group Customer specific instances of and inherit the rules selected from the Product/Sub-Product. Plan inheritance allows for the field configuration defined at the Product level override of the same Plan screen business rule to be displayed in OIPA on the screen at the same time with no impact to the appearance of the fields.

Currently, the rule inheritance is specific to Plan and Segment Name rules. Plan Coverage is also a naming convention for the Sub-Product or a specific subset of Plan features. Also known as a Segment Name.

A Plan Segment is a specific level or subset of Plan benefits available for election and enrollment by Participant; aka “Plan Coverage”. The Plan Segment will also be known as a Segment or Coverage. For more details on Plan Segments , see Plan Segments The Sub-Plan or Segment/Coverage can be attached and removed via an association to the Class. For more details, see Add / Remove Plans Segments to a Class.

Agreements

The Agreement will provide information on the contract between the Carrier and the Group Customer detailing the Plan offerings available to members. The Agreement screen provides a table view in OIPA of the Plans under the Master Policy Agreement where the user can drill down to Plan details. The Master Agreement will identify the Group Customer's elected Product/Sub-Products, those available for use in adding new Plans. See Agreements.

The Master Agreement will contain a listing of associated Plans. New Plans can be added to the Agreement within OIPA. Plan details and Plan Coverages are tabs within the Agreement Screen hierarchy for the Master Agreement under Plans.