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Step 2: Configuring cost shares for the plan

Suggest edit Updated on September 10, 2021

Configure the custom individual cost shares for your plan by selecting the appropriate cost share types with values. You can keep the current inherited values from an existing product or plan or you can override them.

In addition to overriding cost shares, you can override the following items:

  • Values of the accumulators
  • Order of applying cost shares during claim adjudication
  • Information for the coordination of benefits
  • Default order of cost shares for a specific benefit

Existing network guardrails are applied when plans are configured by using a product. For example, you can apply a rule that requires the copayment for in-network expenses to be less than or equal to the copayment for out-of-network expenses. When you build a plan by using a product, this rule is applied during the cost share selection process on the networks screen.

For this tutorial, you are changing only deductible values.

Before you begin

Ensure that you have entered the details for the plan. See Step 1: Entering details for the plan.

Procedure

  1. To change any of the inherited values, click Edit.
  2. In the Configure or modify coverage dialog box, select the Deductible and Accumulators check boxes, and then click Submit.
  3. In the Deductible section, change the following:
    1. In the Individual row, in the Value list, select Other. Then enter 1000 in the field below.
    2. In the Family row, in the Value list, select 2000.
      All other values are inherited from the product.
      Deductible changes in plan
  4. Click Continue.

What to do next

Configure the network cost shares for the plan. See Step 3: Modifying the network cost shares for the plan.

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