Defining a Membership Benefit

Prerequisites

To define a membership benefit, you should have:

  • Required benefit sub types defined in the application

  • Required Medicare plan benefit package defined in the application

Procedure

To define a membership benefit:

  1. Click the Menu link in the Application toolbar.
    A list appears.
  2. From the Main menu, select Customer Management and then click Benefit.
    A sub-menu appears.
  3. Click the Add option from the Benefit sub-menu.

    The Benefit screen appears. It contains the following sections:

    • Main - Used to specify basic details of the membership benefit.

    • Characteristics - Used to define the characteristics for the membership benefit.

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Membership Information Used to indicate the membership for which the benefit is availed.
    Note:

    The Search The Search Icon icon appears corresponding to the Membership ID field. On clicking the Search icon, the Membership Search window appears.

    On specifying the membership information, the membership details appears corresponding to the Membership Information field.

    		 Yes
    Benefit Source Used to indicate the source (i.e. health insurance exchange) from where the benefit is received for the membership. The valid values are:

    • Centers for Medicare and Medicaid Services

    • State

    Note: The list includes the values which are defined in the BENEFIT_​SRC_​FLG lookup field.
    		 Yes
    Benefit Type Used to indicate the type of benefit availed for the membership. The valid value is:

    • Commercial

    • Medicare Affiliated

    Note: The list includes the values which are defined in the BENEFIT_​TYPE_​FLG lookup field.
    		 Yes
    Benefit Sub Type Used to indicate whether the membership benefit is a Medicare Part A, Part B, or Part D benefit, Medicare Part D LIS, Medicare Part D LEP, APTC benefit, or any other membership benefit.
    Note: The list includes only those benefit types which are defined through the Benefit Sub Type screen.
    		 Yes
    Medicare Plan Benefit Package Used to indicate the Medicare plan benefit package (i.e. 800 series plan) which is applicable for the membership benefit.
    Note:

    The list includes those Medicare plan benefit packages which are defined using the Medicare Plan Benefit preference category through the Field Mapping screen.

    This field appears only when the value type in the benefit sub type is set to Not Applicable.

    		 Yes (Conditional)
    Note: This field is required while creating the Medicare Part A, Part B, or Part D membership benefit.
    Start Date Used to specify the date from when the benefit is availed for the membership.
    Note:

    The start date of the membership benefit cannot be earlier than the membership start date or later than the membership end date.

    The membership benefit start date cannot be later than the membership benefit end date.

    		 Yes
    End Date Used to specify the date till when the benefit is availed for the membership.
    Note:

    The end date of the membership benefit cannot be earlier than the membership start date or later than the membership end date.

    The membership benefit end date cannot be earlier than the membership benefit start date.

    		 No
    Benefit Amount Used to specify the pass-through amount for the availed membership benefit.
    Note: This field appears only when the value type in the benefit sub type is set to Flat.
    		 Yes (Conditional)
    Note: This field is required while creating the Medicare Part D LIS, Medicare Part D LEP, APTC, or other membership benefits.
    Tip: Alternatively, you can access this screen by clicking the Add button in the Page Title area of the Benefit screen.
  4. Enter the required details in the Main section.
  5. Define characteristics for the membership benefit, if required.
  6. Click Save.
    The membership benefit is defined for the member person in the Active status.
    Note: You cannot define more than one membership benefit for the same membership, member person, benefit source, benefit type, and benefit sub type combination.

Related Topics

For more information on... See...
Benefit screen Benefit (Used for Searching)
How to define a characteristic for a membership benefit Defining a Characteristic for a Membership Benefit
How to define a Medicare plan benefit package Defining a Medicare Plan Benefit Package