Plan Class Segments (Plan Coverages)

Plan Class Segments displays the list of Sub-Plans (Coverage/Segments) the member is eligible to enroll in on the basis of their membership to the class. The Sub-Plans define Coverage levels of the Plan.

How it Works

Classes may be arranged as a collection called a Class Group based on the Group Customer's business need(s).

• Classes have associated Plans and Classes have members that will be eligible to enroll in the associated Plans.
• The Classes are developed by the Group Customer. The Group Customer also decides what Plans the Class participants/members are eligible to enroll in during the enrollment period.

The logic and rules that define what makes a client a member are defined in the membership rules associated with the Class. By virtue of this association, Members of the Class are assumed to be eligible to participate in the Sub-Plan (Coverage/Segment).

The user may create an association between the Class and the Plan Segment. The user may also terminate the association or remove the association between the Class and the Plan Segment.

Plan Coverage in the Class Group Screen

Plan Coverages under the Classes tab of the Class Group screen provides the list of Sub-Plans the class member is eligible to enroll in. The Segments display in a list section containing the following information: Name, Class Plan Type, ActiveFrom and Active To dates, Plan Name, and Number of Participants.

Once you select a Segment within the listing, you are presented with Segment Details and Class Segment Participants.

• Class Segment Details: displays specific Class Segment data fields such as Type (for example, Billing, Eligibility, Reporting), Active and Expiration Dates.
• Segment Details similar detailed / configurable descriptive information as the Segment Details.
• Class Segment Participants: displays the existing Sub-Plans (Members) associated to the Class and Sub-Plan (Coverage/Segment).