To meet the specifications for your product, you can modify the values for the network coverage and guardrails that were defined in the product from the product template. For example, you might want to increase the amount of the cost shares to accommodate out-of-network services because the copayment for an out-of-network service might be higher than the cost of the same service within a network.
Each network line displays the source of the cost shares and the cost share values.
- If the cost shares for the network are inherited from the product template, the abbreviation PT appears in the Inheritance column.
- If the cost shares are not all inherited and you manually entered some of them, a Click to view the inheritance pattern icon appears in the Inheritance column.
- If the cost shares have been overridden, the hyphen (--) shows that the inheritance has been broken.
Before you begin
Ensure that you have configured cost shares and accumulators for your product. See Step 2: Configuring cost shares and accumulators for a new product.
- Click the PPO Out-of-network link to update coverage at the network level.
- Click Edit.
- In the Configure or modify coverage dialog box, select the Coinsurance and Deductible check boxes and click OK.
- In the Coinsurance row, in the Value list, select 20.
- In the Deductible section, in the Value column for Individual, select 200.
- In the Deductible section, in the Value column for Family, select 2000.
By changing these values, you are keeping within the guardrails that you previously set up. The deductible for the PPO In-network must be less than the deductible for PPO Out-of-network.
- Ignore the other fields on this page. Click Submit. and then click
- In the Inheritance column for the PPO Out-of-network link, click the Click to review the inheritance pattern icon.
The legend shows that the values for Coinsurance and Deductible have been overridden.
- Click OK to dismiss the dialog box.
- On the Configure networks page, click Mark all as complete.
- Click Continue.
What to do next
Configure the benefits for your product. See Step 4: Configuring benefits for a new product.