Defining a Plan for a Fully-Insured Group Policy

Prerequisites

To define a plan for a fully-insured group policy, you should have:

  • Policy plan business objects defined in the application

  • Price items defined in the application

Procedure

To define a plan for a fully-insured group policy:

  1. Search for the fully-insured group policy in the Policy screen.
  2. In the Search Results section, click the link in the Policy Information column corresponding to the policy for which you want to define a plan.
    The Policy screen appears.
  3. Click the Plan tab.
    The Plan tab appears.
  4. Click the Add link in the upper right corner of the Plans zone.

    The Select Business Object screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Policy Plan Business Object Used to indicate the business object using which you want to create a plan for a fully-insured group policy. Yes
    Tip: Alternatively, you can access this screen by clicking the Add link in the upper right corner of the Policy Plan zone in the Policy Plan screen.
    Note: The Select Business Object screen appears when there are multiple policy plan business objects defined in the application. If there is only one policy plan business object defined in the application, the Plan screen appears.
  5. Select the required policy plan business object from the respective field.
  6. Click OK.

    The Policy Plan screen appears. It contains the following sections:

    • Main - Used to specify the basic details about the policy plan.

    • Pricing Rule Types - Used to associate the pricing rule types with the policy plan.

    • Proration Rules - Used to define the proration rules for the policy plan.

    • Characteristics - Used to define the characteristics for the policy plan.

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Policy Information Indicates the fully-insured group policy for which you want to create the policy plan. Not applicable
    Price Item Used to indicate the price item which you want to directly associate with the policy plan.
    Note:

    The Search (The Search Icon) icon appears corresponding to this field. On clicking the Search icon, the Price Item Search window appears.

    On specifying the price item, the description of the price item appears corresponding to the Price Item field.

    		 Yes (Conditional)
    Note: You must either specify the price item or associate at least one pricing rule type with the policy plan.
    Plan Number Used to specify the plan number. Yes
    Plan Name Used to specify the description for the policy plan. No
    Benefit Type Used to indicate the type of health insurance plan. The valid values are:

    • Commercial

    • Medicare Affiliated

    		 No
    Start Date Used to specify the date from when the policy plan is effective.
    Note:

    The policy plan start date cannot be earlier than the policy start date and later than the policy end date.

    The policy plan start date cannot be later than the policy plan end date.

    		 Yes
    End Date Used to specify the date till when the policy plan is effective.
    Note:

    The policy plan end date cannot be earlier than the policy start date and later than the policy end date.

    The policy plan end date cannot be earlier than the policy plan start date.

    		 No
  7. Enter the required details in the Main section.
  8. Associate the pricing rule types with the fully-insured group policy plan, if required.
    Note: You must associate at least one pricing rule type with the policy plan when the price item is not specified in the fully-insured group policy plan.
  9. Define the proration rules for the fully-insured group policy plan, if required.
  10. Define the characteristics for the fully-insured group policy plan, if required.
  11. Click Save.
    The plan is defined for the fully-insured group policy.

Related Topics

For more information on... See...
How to search for a fully-insured group policy Searching for a Policy
Policy screen Policy (Used for Viewing)
Plans zone Plans
Policy Plan zone Policy Plan
How to associate a pricing rule type with a fully-insured group policy plan Associating a Pricing Rule Type with a Fully-Insured Group Policy Plan
How to define a proration rule for a fully-insured group policy plan Defining a Proration Rule for a Fully-Insured Group Policy Plan
How to define a characteristic for a fully-insured group policy plan Defining a Characteristic for a Fully-Insured Group Policy Plan