Specific Stop-Loss

The Specific Stop-Loss zone displays the details of the specific 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 specific 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 specific 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 specific 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 specific stop-loss pricing rule is viewed for parent customer.
  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 Pricing Rule	Displays the pricing date range derived from the parent customer's specific stop-loss pricing rule. Note: This field appears when the specific stop-loss pricing rule is viewed for bill group.
  Pricing Start Date	Displays the specific stop-loss pricing rule start date.
  Pricing End Date	Displays the specific stop-loss pricing rule end date.
  Rate Option	Indicates the rate option of the specific stop-loss pricing rule for the price item.
  Pricing Rule Usage	Indicates whether the pricing rule is used only for pricing or for pricing and billing. The valid values are: Pricing Pricing and Billing Note: This field appears when the specific stop-loss pricing rule is viewed for parent customer.
  Accumulation Level	Indicate whether the specific stop-loss is accumulated at the member or main subscriber level. The valid values are: Member Main Subscriber Note: This field appears when the specific stop-loss pricing rule is viewed for parent customer.
  Settlement Frequency	Indicates the settlement frequency that helps to determine the bill after date. The valid values are: Immediately Manually (At Required Intervals) Never Yearly Note: This field appears when the specific 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 specific stop-loss pricing rule is viewed for parent customer.
  Pricing Group	Displays the pricing group of the specific stop-loss pricing rule. Note: This field appears when the specific stop-loss pricing rule is viewed for pricing group.

• Accumulation Parameters - Lists the accumulation parameters in a specific stop-loss pricing rule. It contains the following field:

  Field Name	Field Description
  Accumulation Group ID	Displays the accumulation group ID generated when accumulation parameters are defined for a specific stop-loss..

  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.
  SSL 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.
  Compute Aggregate SSL (ASL)	Indicates whether the aggregate specific stop-loss (ASSL) is calculated or not during the C1-BCSSL batch run for each bill group. The valid values are: Yes No
  ASSL Credit Account	Indicates that the aggregate specific stop-loss amount beyond the ASSL limit paid by the insurance company to the ASSL credit account.
  ASSL Limit

  Note: This section appears when the specific 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 specific stop-loss.
  Run-In Maximum Limit	Displays the maximum specific stop-loss limit defined for the member when the claim transactions were received in the run-in period of the policy.
  SSL Limit	Displays whether the SSL limit indicating the specific stop-loss amount beyond this limit is paid by the insurance company.
  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 specific stop-loss is created for a bill group.

  Accumulation criteria for each rule appears when the specific 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 specific stop-loss. This section contains the following field:

      Field Name	Field Description
      Exclude SSL (Percentage)	Displays the domestic provider claim billable charge line excluding the specific 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 Specific Stop-Loss	Displays whether the line item is eligible or not eligible for specific 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 specific stop-loss is created for a bill group.

  Claim line items for each rule appears when the specific 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 a specific stop-loss pricing
  Incurred Start Date	Displays the incurred start date based on the run-in period of the policy in the specific stop-loss.
  Incurred End Date	Displays the incurred end date based on the run-in period of the policy in the specific stop-loss.
  Paid Start Date	Displays the paid start date based on the run-in period of the policy in the specific stop-loss.
  Paid End Date	Displays the paid end date based on the run-in period of the policy in the specific stop-loss.

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

• Lasering and Exclusion - Lists the lasering and exclusion information in a specific stop-loss pricing rule. It contains the following columns:

  Column Name	Column Description
  Accumulation Group ID	Displays the accumulation group ID generated when the accumulation parameter values were defined for the specific stop-loss.
  Level Identifier	Displays the lasering or exclusion level identifier.
  Lasering or Exclusion Level	Indicates the lasering or exclusion level of the specific stop-loss. The valid values are: Main Subscriber Member Provider
  Exception Type	Indicates the exception type. The valid values are: Lasering Exclusion
  Comments	Displays the comments.
  Lasered Amount	Displays the lasered amount.

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

• Characteristics - Lists the characteristics defined for the specific 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 specific stop-loss pricing rule.
  Characteristic Type	Indicates the characteristic type.
  Characteristic Value	Displays the value of the characteristic type.

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