Benefit Plan management and communication made easy. Create and manage Benefit Schedules and Benefit Plans for communication with clients, staff and vendors. Create and distribute the Summary of Benefits and Coverage (SBC) for PPACA compliance.

Benefit Schedules

Create and manage benefit schedules:

  • Medical
  • Prescription Drug
  • Dental
  • Vision
  • Weekly Income

Benefit schedules are defined by completing a questionnaire for each service and coverage.

  • Configure services by benefit type for your specific requirements.
  • Define schedules by Plan Types including Network, Network with Domestic option, HDHP and Indemnity.
  • Coverage terms may be replicated across like services to quickly and efficiently complete the questionnaire.
  • Copy an existing schedule to quickly create a new one and then modify for the different benefits.
  • Quickly modify standard Co-Payments and Co-Insurance across all services in one step.

Benefit Plans

Combine distinct benefit parameters to define a benefit plan provisions:

  • Primary and wrap networks for the Medical benefits.
  • Dental network.
  • Utilization Review and Pre-Certification Vendors.
  • Medicare, Late Enrollees, and Pre-Existing Condition Limitation provisions.
  • Employee and Dependent Eligibility provisions.
  • Designate Medical, Prescription Drug, Dental, Vision and Weekly Income schedules included with the Plan.
  • Attach the Plan Document as a PDF for easy access

Communicate

Print a single benefit schedule or the complete benefit plan to distribute to plan builders, employer groups, and vendors.

Create and print a Schedule of Benefits and Coverage (SBC) for distribution to plan participants for PPACA compliance.

Integrate

Benefit Plan Management is integrated with Contact Management to manage groups, networks, Utilization Review and Pre-Certification vendors. Benefit Plan Management may be accessed as a stand-alone software solution or may be combined with all applications in tpaAdvantage for a complete integrated software solution for Third Party Administrators.

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