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Editing the Plan overview tab

Suggest edit Updated on January 26, 2021

The Plan overview page of the SBC document contains the plan high-level information such as overall deductible and out-of-pocket values. You edit the information on the Plan overview tab so that it reflects the information about your products or plans.

Members use this section of the SBC document that you create to understand some of the health plan’s costs, including deductible amounts and out-of-pocket limits. This section also contains information on coverage for different networks, based on the structure of your products and plans.

In the header, the product name or plan name, Coverage period, Coverage for, and Plan Type fields are populated from your product or plan when you create the SBC documents within your product or plan.

By clicking on the blue hyperlinks, you are directed to a healthcare glossary of medical terms.

Information about how the values are determined includes the following:
  • The values for the deductible and out-of-pocket (OOP) expenses in the What is the overall deductible? and the What is the out-of-pocket limit for this plan? questions in the Answers column come from the values on the networks in the applicable product or plan. If there is no overall deductible, the value is $0. If there are no out-of-pocket limits, the value is Not Applicable.
  • The statements for the deductible and out-of-pocket (OOP) expenses in the Why This Matters column are based on the calculation method selected for the network deductible and OOP in the product or plan.
Plan overview tab
  1. On the Document template page, in the header of the Plan Overview tab, click the logo image:
    You can also accept the default values on this tab, and click Continue.
    1. In the right pane, click Choose File to upload an image of your company logo.
      Ensure that you followed the steps in Uploading and displaying your company logo in Summary of Benefits and Coverage template.
    2. In the text editor, edit the disclaimer information that displays below the logo.
    3. Click Apply to apply your changes.
  2. In the Important Questions column, to change the text, follow these steps:
    Note: This column is pre-populated with the questions on the SBC from the Centers for Medicare & Medicaid Services (CMS) template.
    1. Click the text in the cell of the question that you want to change.
    2. In the right pane, in the Important Questions section, enter the modified text in the text box, and click Apply.
  3. To edit information in the Answers and Why This Matters columns, click a cell in the Answers column and then follow the appropriate steps in the following table:

    If there is text in the cell of the Answers column, you can change the default answer of Yes and edit the text or you might just edit the text. For example, you might click this answer to modify it:

    Yes. See [insert direct link or URL to plan-specific provider directory] or call 1-800 [insert number] for a list of network providers.

    1. For this example, in the right pane, to the right of the Answer 1- Default, click the Edit answer icon.
    2. Clear the Default check box to change the default, if needed.
    3. In the Answer Details and Why This Matters fields, modify the text according to your product or plan.
    4. Click Apply to apply your changes.

    If the Answers column has no text in a cell, it means that the answer is based on the calculation method of the deductible or out-of-pocket maximum that you specified in the product or plan. For example, you might want to change the answer content for the following question:

    What is the overall deductible?

    1. Click the empty cell in the Answers column.
    2. In the right pane, next to the text for the calculation method that you are changing, click the Edit why this matters icon.
    3. In the Answer Details and the Why This Matters fields, edit or add text.
    4. Click Apply to apply your changes.
  4. Click Save.

Optional: Extending rules related to the Plan overview tab

As an administrator, you can extend rules that are related to the Plan overview tab by using the data transforms to modify text that meets your business needs.

  1. To modify the rules that are listed in the following table, in Dev Studio, enter the rule name from the following table in the search box.
  2. Click the rule name.
  3. On the Data Transform page, click Save as and save the rule to your implementation layer.
  4. Make your changes and click Save.
    For more information about data transforms, see Data transforms.
  5. Repeat these steps for each rule that you want to modify.

    ActionRule name
    Override values in the header on the Plan overview tab, such as the disclaimer section or the company name.InitializeOverviewDetailEXT
    Override the default text in the Important Questions column on the Plan overview tab. InitializeDocDataForSBCQuestionsEXT
    Override the default text in the Answers and Why this matters columns on the Plan overview tab based on whether the default answer is Yes or No. InitializeDataForSBCAnsAndWhyThisMattersEXT
    For the What is the overall deductible? question, override the default description in the Why this matters column based on the calculation method. SetDefaultWhyThisMatters_OverAllDeductible EXT
    For the Are there services covered before you meet your deductible? question, override the default text in the WhyThisMatters column based on whether the default answer is Yes or No. SetDefaultWhyThisMatters_ServicesCoveredBeforeDeductible EXT
    For the Are there other deductibles for specific services question, override the default text in the WhyThisMatters column based on whether the default answer is Yes or No. SetDefaultWhyThisMatters_OtherDeductibleServicesEXT
    For the What is the out-of-pocket limit for this plan? question, override the default text in the Why This Matters column, which is based on the calculation method.SetDefaultWhyThisMatters_WhatIsOOPEXT
    For the What is not included in the out-of-pocket limit? question, overrides the default text in the WhyThisMatters column based on whether the default answer is Yes or No.SetDefaultWhyThisMatters_WhatIsNotInOOPEXT
    For the Will you pay less if you use a network provider? question, override the default text in the Answers and WhyThisMatters columns based on whether the default answer is Yes or No.SetDefaultWhyThisMatters_PayLessInNetworkEXT
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