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Inheritance of cost shares and maximum dollar limits

Suggest edit Updated on January 26, 2021

In Pega Product Composer for Healthcare, when you configure a product by using a product template, the product inherits all cost share values and maximum dollar limits from the product template.   In turn, these values are inherited by a plan when you configure a plan by using a product.  

Pega Product Composer for Healthcare

If needed, you can override these values at the product level if you configured a product by using a product template or at the plan level if you configured a plan by using a product.

However, within product templates, products, plans, benefits, and  groupers do not inherit the following values from the network:

  • Lifetime maximum
  • Out-of-pocket maximum
  • Annual maximum
  • Deductible
If you need to configure benefit-specific or grouper-specific values for Lifetime maximum, Out-of-pocket maximum, Annual maximum, or Deductible, select the appropriate network within the benefit or grouper and configure the values.
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