Setting Billing Rates by Rate Group, Network, and Age

Use the Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan that charges different rates by rate group, network, and age.

Different fields display in the form depending on whether the benefit plan is set up as tobacco banded by selecting Tobacco Banded Rates in the Other Processing Parameters panel in Group Benefit Plans.

To set health plan billing rates by rate group, network, and age:

Start on the Group Benefit Plans form.

Enter the ID of the plan you want to edit.

On the Actions menu, click Billing Rates.

Set the following parameters.

Use this option	To define this
Copy from Premium Rates	Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.
Benefit Plan ID	A value that is populated from the Group Benefit Plan form.
Network ID	The Network field displays when Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel.
Rate Group	The Rate Group field displays when Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.
Plan Type	A list of only the plan types defined for the group benefit plan.
Employee Gender	The list displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.
Spouse Gender	The gender of the employee's spouse. The list displays only when Spouse Gender Banded Rates 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.

Enter the following information for each year of age. If you need to create an additional age row, click + or press Tab.

Use this option	To define this
From Age To Age	The starting age for each line 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.

Use this option

To define this

From Age

To Age

The starting age for each line 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.

If the benefit plan is set up as tobacco banded:

Use this option	To define this
Non-Tobacco Premium	The amount billed to the client for the plan type and age group for non-tobacco using employees.
Tobacco Premium	The amount billed to the client for the plan type and age group for tobacco using employees.
Dependents (Spouse Non-Tobacco)	The cost associated with covering an employee's non-tobacco using spouse for this plan type and age group.
Dependents (Spouse Tobacco)	If covered, the cost associated with covering an employee's tobacco using spouse for this plan type and age group.

If the benefit plan is not set up as tobacco banded:

Use this option	To define this
Total Bill Amount	The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.
Employee Bill Amount	The amount to bill the employee for this plan.
Dependents Bill Amount	The amount to bill the depending for this plan.

Use this option

To define this

Total Bill Amount

The total amount to bill to the client for the cost of this plan.

The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount

The amount to bill the employee for this plan.

Dependents Bill Amount

The amount to bill the depending for this plan.

Click Save. The form clears so that you can enter billing rates for another plan type.

Click Close when you are finished.