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SBC inheritance

Updated on April 12, 2021

The data and text that is included in an SBC template are inherited by the SBC document that is created for specific products and plans which use that SBC template if there are no overrides at the product or plan level.

Pega Product Composer for Healthcare

The following list describes the typical SBC template inheritance (no overrides):

  • Template selection (is inherited by the product and the plan)
  • Plan overview (inherits the structure from the SBC template which, in turn, is inherited by the product and plan)
  • Common medical event (inherits the structure from the SBC template which, in turn, is inherited by the product and plan)
  • Exclude and other covered services (inherits the structure from the SBC template which, in turn, is inherited by the product and plan)
  • Coverage examples (inherits the structure from the SBC template which, in turn, is inherited by the product and plan)
  • Addendum page (inherits the structure from the SBC template which, in turn, is inherited by the product and plan)

Clicking Edit on a tab of the SBC template created for a product or plan and making changes is considered an override for that tab for the specific product or plan and breaks inheritance from the SBC template for that tab. After the content on a tab is overridden, subsequent changes made to that tab in the SBC template are not inherited by the SBC document for that product or plan.

Clicking Restore on a tab of an SBC template which has been overridden at the product or plan restores inheritance. This action restores the data in the SBC template to the data in the parent tab. For example, if the SBC template for a plan which was overridden is restored, it changes the SBC data to the data on the SBC template for the product. If the SBC template for a product which was overridden is restored, it changes the SBC data back to what is on the SBC template. This is applied based on the sections listed above.

Note: The inheritance described above applies to the SBC data/structure, but not to the actual cost share values which are sourced from the respective products or plans in which the base SBC templates are consumed. For example, the copayments, coinsurance, deductibles, and limits for a benefit that are mapped to a common medical event are always sourced from the values that are configured in the respective product or plan.

For coverage examples, after you select the SBC template at the product level and approve the product, the plan inherits the text/structure and calculation algorithms for the coverage examples of the SBC template including any overrides that were made at the product level. The plan also keeps the benefit mapping. However, the calculations for the product uses the data from the product and the calculations for the plan uses data from the plan.

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