Defining a Benefit Sub Type

The Benefit Sub Type screen appears. It contains the following sections:

• Main - Used to specify basic details about the benefit sub type. It contains the following fields:

  Field Name	Field Description	Mandatory (Yes or No)
  Benefit Sub Type	Used to specify the benefit sub type.	Yes
  Description	Used to specify the description for the benefit sub type.	Yes
  Status	Used to indicate the status of the benefit sub type. Active Inactive	Yes
  Value Type	Used to indicate 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.	Yes
  Externally Priced	Used to indicate whether the benefit amount is calculated in the enrollment system. Note: This field appears when Flat option is selected from the Value Type list.	No
  Validate External Price	Used when 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.	No
  Validate Price Item	Used to indicate the price item using which you want to create the membership benefit charge for validation. Note: The Search () icon appears corresponding to the Validate Price Item field. On clicking the Search icon, the Search window appears. This field appears when the Validate External Price option is selected.	Yes (Conditional) Note: This field is required when the Validate External Price option is selected.
  Charge Negatively	Used to indicate 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.	No
  Benefit SQI	Used to specify 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.	No
  Charge Benefit Sponsor	Used to indicate 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.	No
  Benefit Sponsor Account	Used to indicate the account of sponsor on which you want to create the reverse charge. Note: The Search () icon appears corresponding to the Benefit Sponsor Account field. On clicking the Search icon, the Search window appears. On specifying the benefit sponsor amount, the description of the benefit sponsor amount appears corresponding to the Benefit Sponsor Account field. This field appears when the Charge Benefit Sponsor option is selected.	Yes (Conditional) Note: This field is required when the Charge Benefit Sponsor option is selected and the value is not specified in the Sponsor Account Derivation Algorithm field.
  Sponsor Account Derivation Algorithm	Used to attach 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: The Search () icon appears corresponding to the Sponsor Account Derivation Algorithm field. On clicking the Search icon, the Search window appears. On specifying the sponsor account derivation algorithm, the description of the sponsor account derivation algorithm appears corresponding to the Sponsor Account Derivation Algorithm field. This field appears when the Charge Benefit Sponsor option is selected.	Yes (Conditional) Note: This field is required when the Charge Benefit Sponsor option is selected.
  Benefit Sponsor Price Item	Used to indicate the price item using which you want to create the reverse charge. Note: The Search () icon appears corresponding to the Benefit Sponsor Price Item field. On clicking the Search icon, the Search window appears. This field appears when the Charge Benefit Sponsor option is selected.	Yes (Conditional) Note: This field is required when the Charge Benefit Sponsor option is selected.
  Benefit Sponsor SQI	Used to specify 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.	No

  Note: If the Charge Benefit Sponsor option is selected, you need to specify the value in either the Benefit Sponsor Account or Sponsor Account Derivation Algorithm field.