Aggregate Stop-Loss

The Aggregate Stop-Loss zone displays the details of the aggregate stop-loss pricing rule for respective parent customer, bill group or a bill group using a pricing group. It contains the following sections:

• Main - Displays basic details of the aggregate stop-loss pricing rule. It contains the following fields:

  Field Name	Field Description
  Parent Customer Information	Displays the parent customer information. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Person, Account or Policy screen appears where you can view the details of the parent customer. This field appears only when the aggregate stop-loss pricing rule is viewed for parent customer.
  Bill Group Information	Displays the bill group information. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Person, Account or Policy screen appears where you can view the details of the bill group. This field appears when the aggregate stop-loss pricing rule is viewed for bill group.
  Policy Information	Displays the policy information. Note: It has a link. On clicking the link, the Policy screen appears where you can view the details of the policy. This field appears when the aggregate stop-loss pricing rule is viewed for bill group.
  Pricing Rule Type	Indicates the pricing rule type.
  Price Item Information	Indicates the price item information. Note: It has a link. On clicking the link, the Price Item screen appears where you can view the details of the price item.
  Parent Customer's SSL or ASL Pricing Rules	Displays the pricing date range derived from the parent customer's specific stop-loss or aggregate stop-loss pricing rule.
  Pricing Start Date	Displays the pricing rule start date.
  Pricing End Date	Displays the pricing rule end date.
  Rate Option	Indicates the rate option of the aggregate stop-loss pricing rule for the price item.
  Settlement Frequency	Indicates the settlement frequency that helps to determine the bill after date. The valid values are: Immediately Manually (At Required Intervals) Monthly Yearly Note: This field appears when the aggregate stop-loss pricing rule is viewed for parent customer.
  Underwriter Review	Indicates whether the underwriter settlement review flag is on or off. The valid values are: Yes No Note: This field appears when the aggregate stop-loss pricing rule is viewed for parent customer.
  Pricing Group	Displays the pricing group of the aggregate stop-loss pricing rule. Note: This field appears when the aggregate stop-loss pricing rule is viewed for pricing group.

• Accumulation Parameters - Lists the accumulation parameters in an aggregate stop-loss pricing rule. It contains the following fields:

  Field Name	Field Description
  Accumulation Group ID	Displays the accumulation group ID generated when accumulation parameters are defined for a specific stop-loss..
  ASL Credit Account	Indicates the account in which the aggregate stop-loss amount is credited.

  This section also lists the following columns:

  Column Name	Column Description
  Incurred Start Date	Displays the incurred start date based on the accumulated specific stop-loss.
  Incurred End Date	Displays the incurred end date based on the accumulated specific stop-loss.
  ASL Payout Limit	Displays the maximum limit for the specific stop-loss at member or main subscriber level.
  Paid Start Date	Displays the paid start date based on the accumulated specific stop-loss.
  Paid End Date	Displays the paid end date based on the accumulated specific stop-loss.
  Settlement Days	Indicates the settlement days used in calculating the settlement date.
  ASL Limit (During Policy Period)	Indicates the aggregate stop-loss limit that was set during the policy period. The valid values are: Policy Based Limit Enrollment Based Limit Percentage of Enrollment Based Limit Enrollment Based or Minimum ASL Limit (Whichever is Greater)
  ASL Limit (During Settlement Period)	Indicates the aggregate stop-loss limit that was set during the settlement period. The valid values are: Policy Based Limit Enrollment Based Limit Enrollment Based or Minimum ASL Limit (Whichever is Greater)
  Minimum ASL Limit	Displays the minimum ASL limit. Note: This field displays value when the Enrollment Based or Minimum ASL Limit (Whichever is Greater) option appears for the ASL Limit (During Policy Period) or ASL Limit (During Settlement Period) field.
  Percentage of Enrollment Based Limit	Displays the percentage of enrollment based limit. Note: This field displays value when the Percentage of Enrollment Based Limit option appears for theASL Limit (During Policy Period) field.
  Policy Based Limit	Displays the policy based limit. Note: This field displays value when the Policy Based Limit option appears for the ASL Limit (During Policy Period) or ASL Limit (During Settlement Period) field.

  Note: This section appears when the aggregate stop loss is created for parent customer.

• Accumulation Criteria - This section contains the following columns:

  Column Name	Column Description
  Accumulation Group ID	Displays the accumulation group ID generated when the accumulation criteria values were defined for a aggregate stop-loss.
  Price Item Information	Displays the price item information. Note: It has a link. On clicking the link, the Price Item screen appears where you can view the details of the price item.
  Price Item Parameters	This field contains the following columns: Column Name Column Description Price Item Parameter Displays the multiple parameters based on which you have determined the price item utilization. Note: It has a link. On clicking the link, the Parameter screen appears where you can view the details of the parameter. Parameter Value Displays the value of the parameter.

  Note:

  This section appears when the aggregate stop-loss is created for a bill group.

  Accumulation criteria for each rule appears when the aggregate stop-loss is created for a bill group using a pricing group.

• Pricing Information - This section contains the following sub-section:

  • Claim Pricing Rule - This sub-section contains the following field:

    Field Name	Field Description
    Effective Claim Pricing Rule	Indicates the claim pricing rule effective for pricing.

    This sub-section contains the following sections:

    • Domestic Provider Claims - Displays the domestic provider claim while calculating aggregate stop-loss. This section contains the following field:

      Field Name	Field Description
      Exclude ASL (Percentage)	Displays the domestic provider claim billable charge line excluding the aggregate stop-loss in percentage created for domestic provider claim calculation lines.

    • Markup or Markdown Values - Displays the markup or markdown values for billable charge line. This section contains the following fields:

      Field Name	Field Description
      Pricing Strategy	Indicates the pricing strategy. The valid values are: Markdown Markup None
      Markup or Markdown Type	Indicates the markup or markdown value type for claim line items. The valid values are: Flat Amount Percentage
      Markup or Markdown Amount	Displays the markup or markdown amount. Note: This field displays amount when Markup or Markdown Type field is Flat Amount.

    • Line Items - Displays the associated line items eligible for billing. This section contains the following fields:

      Field Name	Field Description
      Sequence	Displays the sequence number for the line items.
      Line Item	Displays the billing line items.
      Eligible for Aggregate Stop-Loss	Displays whether the line item is eligible or not eligible for aggregate stop-loss.
      Markup or Markdown Percentage Eligibility	Displays whether the line item is eligible or not eligible for markup or markdown percentage. The valid values are: Eligible Not Eligible
      Markup or Markdown Percentage	Displays the percentage for markup or markdown value.

  Note:

  This section appears when the aggregate stop-loss is created for a bill group.

  Claim line items for each rule appears when the aggregate stop-loss is created for a bill group using a pricing group.

• Run-In Parameters - This section contains the following columns:

  Column Name	Column Description
  Run-In	Displays whether the run-in parameters of the run-in period of policy are to be considered or not in an aggregate stop-loss pricing
  Accumulation Group ID	Displays the accumulation group ID that is generated when the accumulation parameter values were defined for an aggregate stop-loss.
  Incurred Start Date	Displays the incurred start date based on the run-in period of the policy in the aggregate stop-loss. Note: This field displays value when the checkbox for the Run-In field is selected.
  Incurred End Date	Displays the incurred end date based on the run-in period of the policy in the aggregate stop-loss. Note: This field displays value when the checkbox for the Run-In field is selected.
  Paid Start Date	Displays the paid start date based on the run-in period of the policy in the aggregate stop-loss. Note: This field displays value when the checkbox for the Run-In field is selected.
  Paid End Date	Displays the paid end date based on the run-in period of the policy in the aggregate stop-loss. Note: This field displays value when the checkbox for the Run-In field is selected.
  Run-In Maximum Limit	Displays the maximum limit of the run-in parameters. Note: This field displays value when the checkbox for the Run-In field is selected.

  Note: This section appears when the specific stop loss is created for parent customer.

• Characteristics - Lists the characteristics defined for the aggregate stop-loss pricing rule. It contains the following columns:

  Column Name	Column Description
  Effective Date	Displays the date from when the characteristic is effective for the aggregate stop-loss pricing rule.
  Characteristic Type	Indicates the characteristic type.
  Characteristic Value	Displays the value of the characteristic type.

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