Setting Premium Rates Based on Network

To enter the premium rates for a medical, dental, or vision group benefit plan with multiple networks with various premium rates, use the Premium Rates form.

The rates you enter in the premium rate table relate to the Cost Basis field in the Group Benefit Plans form. For example, if the cost basis is Monthly, the rates represent monthly premium costs.

The fields shown in the form depend on whether the benefit plan is set up to have different rates for tobacco users or different rates by employee and spouse gender.

To maintain premium rates based on network:

Open the Premium Rates form.

Use this option	To define this
Benefit Plan ID	The Benefit Plan ID. It is populated from the Group Benefit Plan form.
Network ID	The Network ID. It is displayed when Premium Rates Vary By Network is selected in the Other Processing Parameters panel. Note: When a benefit plan is set up to use networks (for billing, premium or both) and a network is marked as Inactive, the inactive network now displays in the Network ID dropdown with ‘(Inactive)’ next to it. All inactive networks filter to the bottom of the list in the order that they appear on the networks grid. You cannot modify or add new rates for Inactive networks. However, you can view existing rates for Inactive networks. When an inactive network is selected, the table is disabled. The Save and Delete buttons are also disabled. A warning message displays stating The selected network is inactive. No modifications can be made. Click the OK button to acknowledge the message.
Plan Type	A list of plan types defined for the group benefit plan.
Employee Gender	The employee's gender (Male, Female). This option is available only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.
Spouse Gender	The employee spouse's gender (Male, Female). This option is available only when Spouse Gender Banded is selected in the Other Processing Parameters panel in Group Benefit Plans.
Effective Date	The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

If the benefit plan is set up as tobacco banded:

Use this option	To define this
From Age To Age	The starting age and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line "all encompassing" age range in the From Age and To Age fields, for example, 0-99.
Non-Tobacco Premium	If the benefit plan is set up as tobacco banded, the amount billed to the client for the plan type and age group for non-tobacco using employees.
Tobacco Premium	If the benefit plan is set up as tobacco banded, the amount billed to the client for the plan type and age group for tobacco using employees.
Dependents (Spouse Non-Tobacco)	If the benefit plan is set up as tobacco banded, the cost associated with covering an employee's non-tobacco using spouse for this plan type and age group.
Dependents (Spouse Tobacco)	If covered, enter the cost associated with covering an employee's tobacco using spouse for this plan type and age group.
Total Premium	The amount billed to the client for the benefit rate level. If the benefit plan is not set up as tobacco banded, the Total Premium field is the sum of the Employee Premium and Dependents Premium. Once you enter two values, the third calculates automatically. For example, if you enter a Total Premium of 500 and an Employee Premium of 300, the system populates Dependents Premium with 200.
Employee Premium	The cost for the plan type and age group.
Dependents Premium	If covered, the cost associated with covering an employee's dependents for this plan type and age group.

If the benefit plan is set up as wellness banded:

Use this option	To define this
From Age To Age	Enter the starting age and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line "all encompassing" age range in the From Age and To Age fields, for example, 0-99.
Wellness Premium	The amount billed to the client for the plan type and age group.
Non‑Wellness Premium	The amount billed to the client for the plan type and age group.
Dependent Premium	If covered, the cost associated with covering an employee's dependent for this plan type and age group.

Click Save. The form clears so that you can enter the premiums for another plan type.

Repeat these steps for each plan type.

Click Close when you are finished.