Skip to main content

This content has been archived and is no longer being updated.

Links may not function; however, this content may be relevant to outdated versions of the product.

Step 4: Configuring cost shares and accumulators for your product template

Suggest edit Updated on September 10, 2021

You define individual cost ranges for your product template. These values are inherited at the product, plan, benefit, and network levels, which saves you time during the configuration of these entities. Based on the increment that you select, the cost share ranges are displayed in a list when you select specific cost share values in your product. You can also define the order of which cost shares are applied during claim adjudication.

Before you begin

Ensure that you selected a benefit set. For additional information, see Step 3: Selecting a benefit set for your product template.

Procedure

  1. Click Set default cost share ranges and select Medium from the list.
    Values are filled in for all the cost shares. The value in the Increment field defines how much the value of the cost share increases within the range of low to high.
  2. To edit the copayment:
    1. In the Copay row, in the Contributes to column, click the Configure the contributions of copay icon.
    2. In the dialog box, select the all check boxes and click Submit.
      This means that the copayment contributes to both the family's and the individual's deductible and out-of-pocket expenses.
    3. Repeat steps a and b in the Coinsurance row.
      Cost share ranges
  3. In the Deductible and out-of-pocket calculation methods list, select Embedded.
    1. In the Individual row, in the Low field, enter 100, in the High field, enter 700, and in the Increment field, enter 100.
    2. In the Family row, in the Low field, enter 1000, in the High field, enter 5000, and in the Increment field, enter 1000.
    3. In the Contributes to field, click the icon.
    4. In the dialog box, select both check boxes and click Submit.
      This means that the deductible costs contribute to the individual and family out-of-pocket expenses.
  4. In the Out-of-pocket section:
    1. In the Individual row, in the Low field, enter 1000, in the High field, enter 5000, and in the Increment field, enter 500.
    2. In the Family row, in the Low field, enter 5000, in the High field, enter 10000, and in the Increment field, enter 1000.
  5. In the Accumulators section, in the Individual deductible,Family deductible, Individual OOP, and Family OOP lists, select Accumulates only within product.
    Other cost shares and accumulators
  6. Keep the default values for the Benefit contributes to annual maximum and Benefit contributes to lifetime maximum fields.
  7. In the Default order of cost shares section, complete the following fields:
    1. In the First list, select Copayment.
    2. In the Second list, select Deductible.
    3. In the Third list, select Coinsurance.
    4. In the Fourth list, select Penalty.
  8. For this tutorial, ignore the optional Coordination of benefits (COB) section.
  9. For this tutorial, there are no authorizations, which is the default value. Keep the Authorization not applicable? check box selected.
  10. Click Continue.

What to do next

Configure the cost shares for your product template. See Step 5: Configuring cost shares for your product template.

Did you find this content helpful? YesNo

Have a question? Get answers now.

Visit the Collaboration Center to ask questions, engage in discussions, share ideas, and help others.

Ready to crush complexity?

Experience the benefits of Pega Community when you log in.

We'd prefer it if you saw us at our best.

Pega.com is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us