Agreements

The Agreements screen in OIPA can be accessed when a customer record is displayed. The Entity Navigation list for a customer contains an Agreements link, when clicked, will launch the Agreement screen.

A user can add new agreements, assign class rule variables, add agreement activities, and assign roles to the agreement.

Agreements house the characteristics and information regarding the contract between a Carrier and the Group Customer. The Group Customer and Carrier define the agreement. The agreement details may consist of the product/plan offerings available to members, how the coverage will be administered, or how the servicing and billing will be handled between the Group Customer and the Carrier. The Group Customer can have multiple agreements based on the business needs surrounding servicing, billing and plan administration.

Important: Agreements may also be structured in a parent and child relationship. Please see Parent and Child Agreements for more information.

Roles can be attached to an agreement for the purpose of designating the relationship a client has to the agreement. An agreement does not require a plan association, since some agreements are created outside of any plans. Please see Agreement Roles for more details.

Agreement Details

Agreements are used to define the contract between the Carrier and the Group Customer. OIPA allows for complex hierarchies of agreements to be built t multiple levels. Agreements could include data relating to funding or financial agreements.

  • Funding Agreements are similar to a bank account. The customer money is held by the Carrier.

  • Financial Agreements are subdivided into:

    • Fully Insured: The Carrier covers all risks for benefit payments of covered expenses.

    • Administrative Service Agreement (ASA): Self Funded - Carrier provides ONLY administrative services.

    • Minimum Premium: The Carrier pays for covered expenses only after the group customer covers the risk for a pre-determined limit.

How it Works

The Agreement screen provides the user with the ability to add, view and edit agreements associated with a group customer. The agreement screen provides information pertaining to the list of agreements that are in "Pending and Active" status. It includes the group customer agreement fields in following tabs .The user can create a new agreement by entering these agreement details .

  • Bank Letter
  • Contract
  • Enrollment
  • Funding
  • Performance Guarantee

Security Considerations

Each user is assigned security privileges based on the login ID used when first logging onto OIPA. Buttons and links in OIPA will only be available for users with the proper security privileges. If a button is not visible, then that means the user does not have the security privileges needed to access the button.

Miscellaneous Screen Details - Agreements

  • Agreement Name is a required field. An error message will display if Agreement Name is not entered.

Steps to Create a New Agreement

  1. Open a Customer record (using the search for a customer).

  2. Click Agreements on the Entity Navigation menu. The Agreement screen will display. The following tabs can be displayed, configuration will control which tabs appear under each agreement type:
    • Bank Letter
    • Contract
    • Enrollment
    • Funding
    • Performance Guarantee

  1. Click each tab, enter the details and click Save when finished in each tab.

Important: When agreement is created for the first time on the customer, in each tab listed above, on mouse hover over the icon, the create new button will be visible. Click the button to create agreement details. Each tab listed above in turn includes the sub-tab links, which may be the same links that are available in other sub-tab, the user can enter those details from any of these tabs.

When the tabs are clicked, the Agreement detail fields are displayed with Class Groups, Products, Plans Roles tabs.

  • Agreement Details tab: The user can add/ update data relating to the agreement.
  • Class Groups: The user can add / copy a class group to be associated with the agreement.

  • Products: The user can add a product to be associated with the agreement.

  • Plans tab: The user can add plan and segments to be associated with the agreement.
  • Roles: The user can add a role to be associated with the agreement.

Add Roles to an Agreement

Multiple roles can be attached to the agreement for the purposes of a point of contact. Agreement Roles have different types that will be selected at the time of assigning a Role to the selected Agreement. The Agreement Role Types are configurable in AsCodeAgreementRoleType code name. See Agreement Roles for information on adding, deleting, and editing Agreement Roles.

View Agreement Plans

The existing Plans for the Master Agreement will be display upon selecting the Plans tab. The Agreement Plans tab provides for paging, if the plan list is too long to display in the current view. Viewing a Plan from the hamburger menu will take the user to the Plan Setup Screen where the user can view existing Plans and Plan Coverage details and features, as well as information regarding the Product and Sub-Product on which the Plan is based.

Note: To view a Plan, Role, Class groups from the respective tabs, utilize the shortcut (hamburger) menu for the applicable Plan/Role/Class Group, and select Go To Plan/Role/Class Group. The hamburger menu is displayed in the record rows of these in the respective screens.