Benefit Sub Type

The Benefit Sub Type zone displays the details of the benefit sub type. It contains the following sections:

• Main - Displays the basic information about the benefit sub type. It contains the following fields:

  Field Name	Field Description
  Benefit Sub Type	Displays the benefit sub type.
  Description	Displays the description of the benefit sub type.
  Status	Indicates the status of the benefit sub type. The valid values are: Active Inactive
  Value Type	Indicates whether the benefit amount should be a flat or calculated amount. The valid values are: Flat - Used when you want to specify the pass-through amount while creating a membership benefit for Medicare Part D LIS, Medicare Part D LEP, APTC, etc. Not Applicable - Used when you to want the system to calculate the benefit amount for the availed Medicare Part A, Part B, or Part D membership benefit.
  Externally Priced	Indicates whether the benefit amount is calculated in the enrollment system. Note: This field appears when Flat option is selected from the Value Type list.
  Validate External Price	Indicates that you want to validate whether the externally calculated benefit amount is within the threshold range. Note: This field appears when the Externally Priced option is selected.
  Validate Price Item	Indicates the price item using which you want to create the membership benefit charge for validation. Note: It has a link. On clicking the link, the Price Item screen appears where you can view the details of the respective price item. This field appears when the Validate External Price option is selected.
  Charge Negatively	Indicates whether you want to create a negative charge for the benefit amount. Note: This field appears when the Flat option is selected from the Value Type list and the Externally Priced option is not selected.
  Benefit SQI	Indicates the SQI using which you want to create an SQI based billable charge for the membership benefit. If you do not specify the value, the system will derive the SQI from the Proration SQI option type of the C1-ASOBLLNG feature configuration. Note: This field appears when the Flat option is selected from the Value Type list and the Externally Priced option is not selected.
  Charge Benefit Sponsor	Indicates whether you want to create a reverse charge for the benefit sponsor. The reverse charge can then be used by the health insurance payer for reconciliation. Note: This field appears when Flat option is selected from the Value Type list and the Externally Priced option is not selected.
  Benefit Sponsor Account	Indicates the account of sponsor on which you want to create the reverse charge. Note: This field appears when the Charge Benefit Sponsor option is selected.
  Sponsor Account Derivation Algorithm	Indicates an algorithm using which the system can derive the sponsor account for the individual membership. The C1-SPONSAC algorithm is shipped with the product. For more information about the algorithm, refer to Membership Benefit Sub Type. Note: It has a link. On clicking the link, the Algorithm screen appears where you can view the details of the respective algorithm. This field appears when the Charge Benefit Sponsor option is selected.
  Benefit Sponsor Price Item	Indicates the price item using which you want to create the reverse charge. Note: This field appears when the Charge Benefit Sponsor option is selected.
  Benefit Sponsor SQI	Indicates the SQI using which you want to create a reverse SQI based billable charge for the benefit sponsor. If you do not specify the value, the system will derive the SQI from the Proration SQI option type of the C1-ASOBLLNG feature configuration. Note: This field appears when the Charge Benefit Sponsor option is selected.

• Characteristics - Lists the characteristics defined for the benefit sub type. It contains the following columns:

  Column Name	Column Description
  Characteristic Type	Indicates the characteristic type.
  Characteristic Value	Displays the value of the characteristic type.

• Record Actions - This section contains the following buttons:

  Button Name	Button Description
  Edit	Used to edit the details of the benefit sub type. Note: The Edit button appears only when the benefit sub type is not yet used.
  Delete	Used to delete the benefit sub type.
  Duplicate	Used to create a new benefit sub type using an existing benefit sub type.

• Record Information - This section contains the following fields:

  Field Name	Field Description
  Business Object	Indicates the business object using which the benefit sub type is created in the system. 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 Business Object screen appears where you can view the details of the respective business object.

By default, the Benefit Sub Type zone does not appear in the Benefit Sub Type screen. It appears only when you click theBroadcast ( ) icon corresponding to a benefit sub type in the Benefit Sub Type List zone.

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