Pharmacy Benefits Management
Prescription Drugs
Administration Capabilities
All of the key features of our administration system, for the performance of rating, enrollment, billing, cash receipts, posting, delinquency tracking, agent commission calculations, financial reporting, and more, are also available for the support of vision and prescription drug programs, whether sold as individual, group, or voluntary contracts. Functionality that may be of special value in handling vision and prescription drug policies include:
- User-definable plans carrying unique data regarding underwriting carrier, policy number, plan year period, certificate issue flags, and other elements which allow these coverages to be handled as a mainstay, or as ancillary to a primary product line.
- Ability to have any number of insurance carriers underwrite different policies, to support various geographic areas or other parameters, and to bill on a consolidated invoice.
- Flexibility in rating by product using rate tables or composite premiums. Rate tables allow for geographic loads, rating by number of children, and other routines.
- Ability to self-fund by product type or plan code while other coverages are fully-insured.
- Certificate issue with ID cards carrying data such as dependent age limit, deductible amount, benefit expiration date, (as opposed to a termination date,) and other information valuable for benefit verification.
- Carrier and group numbers that automatically feed to interface files for transfer of eligibility to a third-party.
Claims Capabilities
Our vision and prescription drug claims system provides additional features especially designed to increase accuracy and efficiency including:
- User defined maximum number of services, maximum benefits, daily allowances, co-pays, coinsurance levels, deductibles and other parameters by type of service,
- Capture of codes to distinguish eye exams and rechecks including the number of months during which services are valid.
- Provisions for dual- and triple-option PPO/EPO capabilities, giving you complete flexibility to link benefits to a preferred or exclusive provider, and increase or reduce both benefit allowances and plan provisions based on point-of-service.
- The flexibility to combine benefits and deductibles under a common accumulator with medical plans, or to distinguish these services as a separate plan.
- User-defined cause codes (three-digit alphanumeric field) that let you classify claims activity in a meaningful way, and report on all your claims experience.
- Seamless, real-time integration with our administration system so the current eligibility status of each insured is recognized immediately as changes are made.
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| States Available | AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, DC, WV, WI, WY |
| Provider Type | General Agency |
| Carriers | Varies |
| Carrier Ratings | Varies |
| Commission | Varies |
| Min Premium | Varies |
Coverages
Pharmacy Benefits Management Insurance
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