You can modify the coverage, for example, copayment or coinsurance, for a benefit that was previously included as part of a benefit set for a specific network. During this step, add the product-specific values that are not inherited and therefore are not built into the product template.

You can also perform these actions:

• Assign cost shares for specific conditions or assign limits to a benefit.
• Add other benefits and groupers to the product. For example, when you configure benefits for a product, you might limit Physical Therapy to 60 visits per year or require an authorization for certain conditions.
• Set services that are covered and set services that are required.

For this tutorial, change only the copayment for a benefit.

Before you begin

Ensure that you modified your network cost shares. For additional information, see Step 3: Modifying network cost shares for a new product.

Procedure

1. On the Configure groupers and benefits page, click the Configure item icon next to the FAC-Urgent Care benefit.
2. In the Configure benefit details for product window, click the PPO-Out-of-network link and then click Edit.
3. In the Configure or modify benefit-specific coverage dialog box, select Coinsurance and click OK.
4. In the Coinsurance row, in the Value column, select 30.
5. Click Save.
6. For this tutorial, ignore all other fields.
7. Click Mark complete.
8. Click Submit.
   On the Configure groupers and benefit page, you can see that the coinsurance for FAC-Urgent Care in Out-of-network has been overriden. The hyphen (--) shows that the inheritance for this benefit in Out-of-network has been broken.

   

   

9. Click Mark all as complete.
10. Click Continue.

What to do next

Configure the benefit categories. See Step 5: Configuring benefit categories for a new product.