Updating benefit sets
You can update existing benefit sets or use them as the base to replicate new benefit
sets or create new versions of the benefit sets. After selecting the benefit sets, you
determine which target action that you want to apply to your selected benefit sets. For
example, you might select three benefit sets to create new versions. Select your benefit sets and the target actions. When the system either updates existing entities or creates or replicates new
entities, the algorithm determines whether any errors exist that you must correct before
proceeding, and then checks for warnings that are informational to you. For the warnings,
you can decide when you want to correct the issues. Read-only
information is displayed in the Benefit set
overview and
Structure tabs. Withdraw is now an
available option. For more information, see Entity
configuration. Define the benefit set batch by adding the benefit sets to the batch and then
selecting the metadata options that you want to change. For example, you might create a
benefit set batch that contains two benefit sets each of which has unique configuration
changes. Then you might create another batch that contains three benefit sets with the same
configuration changes. To make different changes to several benefit sets, configure the information on this
tab, one benefit set at a time. Configure the changes in your benefit sets in batches if the changes that you want to
make are the same for the multiple benefit sets that you have selected. You can conveniently
modify values for multiple benefit sets in one Smart Update case. For example, you need to add a new benefit for COVID-19 to all your benefit sets. In
one batch, you can choose each benefit set and add the new COVID-19 benefit. As a
result, every benefit set that you choose, is updated to include the COVID-19
benefit. The new benefit is added at the end of the list of pre-existing benefits in the
ranking order. For example, if there are five benefits, the new benefit is ranked as
the sixth benefit. If you have errors in the updated benefit sets, you need to correct them. Otherwise,
you decide on your next step such as proceeding to approval or product templates. You cannot add other product templates or
remove any of the product templates that are already in the
list. If you created a new version or replicated an existing
version of the benefit set, you cannot add other product
templates, but you can remove product templates from the
list. You can approve your benefit sets before updating a product template except when your
target action is updating existing benefit sets. Perform this task so that your work is
reviewed for accuracy. If you select Update existing as your target
action, you cannot have this benefit set approved until you complete the
Smart Update case all the way through to the plan (or to any entity that
was built from this benefit set). For example, if only product templates
have been built from this benefit set, then you must complete the
process through the product template to send the update for approval. To
maintain structural integrity, any structural changes, such as adding a
new benefit, must be followed through to the plan or any entity that is
built from this benefit set. Use these rules to extend the benefit sets to meet your business needs. Selecting benefit sets and target actions
Reviewing the selected benefit sets
Create the benefit set Correct the benefit set errors Configuring metadata for your benefit set
Configuring content for a single benefit set
Configuring content in batches
Reviewing updated benefit sets
Approving benefit sets
Benefit set extension rules
Rule name Class Description ValidateSUBSModelTypeApplicabilityEXT Rule-HC-PCS-BenefitSet Use this data transform to validate the
applicability of the model type based on the target action and the
system configuration. CreateBenefitSetEXT PegaPCS-HC-USA-Work-SmartUpdate Use this activity to add or copy more
properties or include more validations when creating a benefit set SUBSMetaDataClientConfiguration SUBSMetaDataClientConfiguration Use this section rule to define any
implementation-layer metadata properties. EditSUBSMetadataPostEXT Embed-HC-PCS-SUBatch Use this data transform to validate and
copy any implementation-layer properties for metadata in the benefit
set. ConfigureIndBenefitSetContentPreEXT Rule-HC-PCS-BenefitSet Use this activity to add
implementation-layer properties to display in the dialog box for the
Configure content - individual benefit set. ConfigureIndBenefitSetContentPostEXT Rule-HC-PCS-BenefitSet Use this activity to save the changes
that you made in the above rule in the dialog box for the individual
benefit set. ConfigureBenefitSetContentPreEXT Embed-HC-PCS-SUBatch Use this data transform to add
implementation-layer properties for display in the dialog box for the
batch benefit set content. ConfigureBenefitSetContentPostEXT Embed-HC-PCS-SUBatch Use this data transform to save the
changes that you made in the above rule in the dialog box for all the
benefit sets in the batch. UpdateBSMetadataEXT Rule-HC-PCS-BenefitSet Use this data transform to define any
implementation-layer metadata properties. ValidateBenefitSetsEXT Rule-HC-PCS-BenefitSet Use this data transform to add more
validations to the benefit sets, for example, restriction of Vision
benefits to a Medical benefit set. UpdateBaseBSWithCloneBS_EXT Rule-HC-PCS-BenefitSet When your target action is Update existing
version, use this data transform to save the values (any
implementation-layer properties) on the actual or base benefit
set.
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