1. In the header of Dev Studio, click Launch portalProduct Development.
2. In the left navigation panel of your workspace, click NewPlan.
3. Select the method for creating the plan.
   If you select Create from product, some fields are filled in because the plan inherits from the product.
4. Enter a name.
   For a new version of a plan, you can keep the same name as the old version but you must change the effective dates. For a new plan, even if you have different effective dates, you cannot have the same name as another plan.
5. Complete the basic information that describes your organization such as effective date, line of business, and coverage levels.

   The following figure shows the creation of a plan by copying a product:

   

   

6. To populate the Market segment field, click the Add a row icon to make the field available. Then select an option from the list.
   If you select Medicare in the Market segment field, you must select your rating in the Medicare star rating field.
7. Select Plan type as:
   • Non-Standard
     1. Select Contract type as Group or Individual.
     2. Specify Customer, Customer-Specific, and other properties.
   • Standard
     1. If required, specify other properties
   The customer specific and other properties are displayed if the Is legacy properties display enabled ? check box is selected in the PCS configuration page.
8. Complete the remaining fields, and click Save to complete your product at a later time or Continue to configure cost shares and accumulators.

1. To change any of the inherited values, click Edit.
   1. In the Configure or modify coverage dialog box, select the check boxes for the cost shares, accumulators, order of applying cost shares during claim adjudication, coordination of benefits, and authorization that you want to change.
      If you select the Accumulators check box, a Configure the contributions of icon appears on the Plan cost shares page. When you click it, you can select the check boxes to specify how the cost shares accumulate.
   2. Click .
   3. Based on your selections, complete all the fields that you selected for editing on the Plan cost shares page.
   4. Optional: To restore the values to those of the product template, click Restore and clear the check boxes for which you are restoring the inherited values. Click .
2. Click Save to complete your plan at a later time or Continue.

   The following figure shows the cost shares step within the plan wizard:

   

   

1. In the Network cost shares step of the plan wizard, in the Networks section on the Configure networks page, click a network name link to update coverage at the network level.

   The following figure shows network configuration within the plan wizard.

   

   
2. Modify covered and required services:
   1. In the Coverage section, click the Set services required link or the Set services NOT required link, and click OK in the confirmation dialog box.
   2. In the Coverage section, click the Set services covered link or the Set services NOT covered link, and click OK in the confirmation dialog box.
   3. Click Close.
   4. If you are not making any other changes to the networks, click Continue.
3. Modify the coverage values that you set in the product template:

   

   

   1. On the Configure network details page, on the Cost shares and accumulators tab, click Edit.
   2. In the Configure or modify coverage dialog box, select the check boxes for the values that you want to modify, and then click OK.
   3. On the Configure network details page, modify the values as needed in the selected sections, click Save, and then click Close.
      If you click Close without saving the changes, an error message is displayed. You can discard the unsaved changes by closing the dialog box.
   4. Optional: To restore the original values, click Restore. In the Clear the check boxes to restore values dialog box, clear the check boxes that you previously selected, and click OK.
   5. On the Configured network page, click Save and Mark complete when you are finished editing the coverage values for networks.
   6. For each network whose coverage you are modifying, on the Configure networks page, click the network name link and repeat these steps.
   7. Click Continue if you are not making any other changes to the networks.
4. Add variations:
   1. On the Configured network details page, click the Variations tab and click Edit.
   2. Click Add variation.
   3. Name the variation, provide the effective and end dates, select the check box for the type of variation, and select a condition type.
   4. Complete the corresponding fields that appear, based on your selections, and click OK.
   5. Repeat steps b through d for each variation that you are adding.
   6. When you finish adding or editing the variations for the specified network, click Save, then click Mark complete.
      If you click Close without saving the changes, an error message is displayed. You can discard the unsaved changes by closing the dialog box.
      Always add a unique combination of the variation name and effective date. An error message is displayed if you choose a combination that is already been used.
   7. For each network to which you are adding variations, on the Configure networks page, click the network name link and repeat these steps.
   8. To view more details about the variations, click the variation count link.
      Variation count shows the presence of variation(s) configured on the network.

      

      

   9. Click Continue if you are not making any other changes.
5. Edit network details:
   1. On the Configure network details page, click Edit.
   2. Click the Additional network details tab, and then click Edit.
   3. Complete the fields, click Save to save the changes, click Mark complete, and then click Close.
      If you click Close without saving the changes, an error message is displayed. You can discard the unsaved changes by closing the dialog box.
   4. For each network to which you are adding details, on the Configure networks page, click the network name link and repeat these steps.
6. When you finish making changes, on the Configure networks page, click Mark all as complete, and then click Continue.

1. To add a benefit or grouper, follow these steps:
   1. Click Add benefit/grouper.
   2. Complete the fields in the Add Benefit/Grouper to benefit tree window to add the grouper or benefit and click Submit.
      Result: The Grouper/Benefit section shows the benefits, groupers, and their cost share values per network.
2. To modify the coverage of a single benefit, a grouper that contains multiple benefits, or one benefit within a grouper, follow these steps:
   1. On the Configure groupers and benefits page, click the Configure item icon to the right of the benefit or grouper name.
   2. In the Configure details for plan window, click the network for which you are modifying the benefit coverage.
   3. In the expanded Configure details for plan window, click Edit.
   4. In the Configure or modify benefit-specific coverage dialog box, in the To edit, select one or more check boxes for corresponding fields section, select the Covered and required check box and click OK.
   5. Based on the specified benefit or grouper, click Covered or Not covered.
      The shaded button shows the current setting.
   6. Click Mark complete, and then click Close.
      If you click Close without saving the changes, an error message is displayed. You can discard the unsaved changes by closing the dialog box.
3. To modify the requirement for services of a single benefit, a grouper that contains multiple benefits, or one benefit within a grouper, follow these steps:
   For example: Some services are required as part of the plan.
   1. On the Configure groupers and benefits page, click the Configure item icon to the right of the benefit or grouper name.
   2. In the Configure details for plan window, click the network for which you are modifying the benefit requirement.
   3. In the expanded Configure details for plan window, click Edit.
   4. In the Configure or modify benefit-specific coverage dialog box, in the To edit, select one or more check boxes for corresponding fields section, select the Covered and required check box and click OK.
   5. Based on the specified benefit or grouper, click Required or Not required.
      The shaded button shows the current setting.
   6. Click Mark complete and then click Submit.
4. To configure the coverage of a new or an existing item, follow these steps:
   1. On the Configure groupers and benefits page, click the Configure item icon at the right of the benefit or grouper name in the list.
   2. In the Configure details for plan window, on the Coverage tab, click the network name.
   3. In the Configure details for plan expanded window, to update coverage information, click Edit.
   4. In the Configure or modify benefit-specific coverage dialog box, to update the network coverage values, select the check boxes in the Select the check box to edit the corresponding fields section or the Select the check box to configure the corresponding coverage section that you want to modify and click OK.
      For example: You might want to increase the values of copayment or coinsurance or change the accumulators. Additionally, you can modify coordination of benefits and authorizations. You also might want to change the values of your deductible or out-of-pocket expenses for the benefit.
   5. In the corresponding sections in the Configure details for plan window, modify the values, and then click Save or Save across networks. If you select Save across networks, select the network name check boxes that appear in the dialog box, and then click Close.
   6. To remove one or all changes that you made in steps c through e and restore the original values, click Restore, clear the check boxes in the dialog box, and click OK.
   7. Repeat step 4 to configure or modify each benefit or grouper.
5. To configure the values and network contributions of annual maximum and lifetime maximum, follow these steps:
   1. On the Configure groupers and benefits page, click the Configure item icon at the right of the benefit or grouper name in the list.
   2. In the Configure details for plan window, on the Coverage tab, click the network name.
   3. In the Configure details for plan expanded window, to update coverage information, click Edit.
   4. In the Configure or modify benefit-specific coverage dialog box, select the Accumulators check box. Then based on your business needs, select either the Annual maximum or Lifetime maximum check box, or both, and click OK.
   5. In the Configure details for plan window, in the Annual maximum and Lifetime maximum fields, select the values.
   6. In each field, click the Cross network for icon, select one or more network name check boxes in the dialog box, and then click Close.
   7. Repeat step 5 as needed for each benefit.
6. To specify that a benefit limit in a plan applies to multiple networks, follow these steps:
   1. Configure item Click the icon next to the benefit.
   2. On the Configure benefit details page, select a network.
   3. Click Edit.
   4. In the Configure or modify benefit-specific coverage dialog box, select the Accumulators and Limit check boxes and click OK.
   5. In the Accumulators section, clear the Limit not applicable check box.
   6. Enter the limit information in the fields.
   7. Click the Configure the cross-network for limit icon, select the networks that apply, and click Submit.
   8. Click Save.
7. To create or modify variations of benefits or groupers, follow these steps:
   Note: Use variations sparingly and only when you need to configure an item that is not standard.
   1. On the Configure groupers and benefits page, click the Configure item icon next to the benefit or grouper.
   2. In the Configure details for plan window, click the Variations tab.
   3. Click the network link and then click Edit.
   4. Add or edit variations, click Save, and then click Close.
      If you click Close without saving the changes, an error message is displayed. You can discard the unsaved changes by closing the dialog box.
      Always add a unique combination of the variation name and effective date. An error message is displayed if you choose a combination that is already been used.
      The variation count link under the network columns shows how many variations are configured for the grouper or benefit. For example, if a benefit at the plan or network level inherits two variations from its parent product and adds another variation to the plan or network, the variation count is three. If an update in the product variation occurs, the variation count of the plan is also updated unless the variations have been overridden at the plan level. The total count of all inherited variations (network + grouper + benefit) is displayed.
   5. To review details about the variations that are configured for a grouper or benefit, click the variation count link.

      

   6. Repeat these steps for each benefit or grouper variation that you are creating or modifying.
8. To configure additional details for a benefit or grouper, follow these steps:
   1. On the Configure groupers and benefits page, click the Configure item icon next to the added benefit or grouper.
   2. In the Configure details for plan window, click Additional details.
   3. Click the network link
   4. In the expanded Configure details for plan window, click Edit.
      To meet your business needs, you can configure fields for compliance support, documentation support, and claims instructions.
   5. Click Save, and then click Close.
      If you click Close without saving the changes, an error message is displayed. You can discard the unsaved changes by closing the dialog box.
   6. Repeat these steps for each new benefit or grouper detail that you are creating or modifying.
9. To review the mapping for a benefit, follow these steps:
   1. On the Configure groupers and benefits page, click the Configure item icon next to the added benefit or grouper.
   2. In the Configure details for plan window, click the Mapping tab.
   3. Review the information that you previously entered. Click Mark Complete and then click Submit.
      If you need to make changes based on your review of the Mapping tab, you must modify the specific benefit. For additional information, see Configuring a benefit.
10. When you finish configuring benefits and groupers, click Mark all as complete and then click Continue.

1. In the Configure benefit categories step of the wizard, in the Benefit category column, click a tab to expand it.
2. For the benefit that you are setting as default, click the Gear icon and click Set as default display benefit.
   Result: The default benefit displays Yes. Other benefits within the benefit category display No.
3. Click Finish.

In this wizard step, you can also change the default benefit.

1. In the Configure benefit categories step of the wizard, in the Benefit category column, click a tab to expand it.
2. Click the Gear icon to the right of the benefit that you are modifying.
3. Click Change benefit categories.
4. In the Change benefit categories dialog box, click Add benefit category and then enter and click a category from the list.
5. Click Submit.
6. When you have completed your changes, click Finish.

1. In the Select SBC metadata step, in the SBC template field, enter and click the specified template.
2. In the Select network order section, select the appropriate networks.
3. In the Network name field, enter a descriptive name that corresponds to the network to the left.
4. If you do not want to generate the SBC document in PDF format, select the Skip SBC PDF Generation check box.
   This means that no SBC document in PDF format will be attached to the product.
5. Click Continue to display the document.

1. To preview the document, click Preview document.
2. To edit the document by overriding values that were in the SBC template, follow the steps to edit a specific tab in the SBC template section.
3. When you have finished editing the template, return to the product to complete the step.
4. To restore all changed values to the values in the product, click Restore.
5. Click Finish.