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Inheritance pattern 3

Updated on April 12, 2021

Inheritance for a benefit that works with the Lifetime maximum, Out-of-pocket, Annual maximum, Deductible, Limits, and Variation items, configured at the benefit or grouper level in products or plans (the Configure Benefits step in the product or plan wizards), follows Inheritance pattern 3.

Pega Product Composer for Healthcare

For example, if you have an Orthodontia benefit of $4,000 that is configured at the product level, it is inherited by the plan. To find the value of the Lifetime maximum for the benefit, use the inheritance tree in the following figure and start with a plan benefit (1). Review the plan configuration. If there is no override value, review the product benefit (2) configuration. If the override value is not there, look for the override value at the plan grouper (3), if the grouper contains benefits. If it is not there, look for the override value at the product grouper (4). When you locate the override value, you can stop, because the specified entity is the source of the value.

The rest of the tree does not apply because Inheritance pattern 3 describes benefits configured at the benefit or grouper level, and not at the network level.

Inheritance pattern 3

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