Discount Guarantee

In the discount guarantee method, the discount is calculated while processing the claim transaction. It is calculated as follows:

Targeted Guaranteed Amount = Covered Charge Amount * Discount Guarantee Percentage

Billable Discount Amount = Discount Savings Amount - Targeted Guaranteed Amount

Note that the discount guarantee percentage varies depending on various parameters (such as health coverage class, In or Out Network, etc). Therefore, the system enables you to define different discount percentage for the claim transactions which are received from employees with different set of attributes. The system allows you to define maximum discount amount that can be charged per claim transaction. You can optionally configure the minimum and maximum discount limit on the contract. Note that the minimum limit is applicable during the settlement and maximum limit is applicable when you execute the C1-ACDA batch. The minimum and maximum limit can be a flat limit or enrollment based limit. Once the discount is accumulated, you can charge the customer at the pre-defined frequency. If the discount amount exceeds the maximum discount limit per claim or if the discount amount exceeds maximum discount limit defined on the contract, a credit billable charge is created for the customer.