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Step 4: Configuring benefits for the plan

Suggest edit Updated on September 10, 2021

Although each benefit or grouper inherits the cost share values from the product template or product, or from the values that you modified when defining the network, you can modify them at the benefit level.

You also define the benefit- or grouper-specific values that are not inherited. In addition, you can add new benefits or benefit groupers. You can make changes to coverage and policies, provide additional information that is related to benefits, and provide details for compliance, support documentation, and claim instructions. Additionally, you can set services that are covered and set services that are required.

For this tutorial, you are going to modify a benefit.

Before you begin

Ensure that you configured the network cost shares. See Step 3: Configuring network cost shares for the plan.

Procedure

  1. On the Configure groupers and benefits page, click the Configure item icon to the right of PRO Urgent Care.
  2. On the Configure benefit details for plan page, click PPO Out-of-network.
  3. Click Edit, select Coinsurance and Accumulators in the dialog box, and click OK.
  4. In the Coinsurance row, in the Value list, click Other.
  5. In the field below, enter 25.
  6. Click the Configure the contributions of Coinsurance icon.
  7. In the dialog box, select all the check boxes, and click Submit.
    Modified benefit cost share
  8. Click Save, and then click Submit.
  9. Click Mark all as complete.
  10. Click Continue.

What to do next

Set the benefit categories. See Step 5: Setting or changing the default benefit and changing benefit categories.

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