Setting Family Rated Plan Billing Rates

To set up billing rates for a family rated group benefit plan, use the Billing Rates form. Use this form when the Family Rated Premiums and Age Banded Medical Billing options are selected in the Group Benefit Plans form and billing is done by rate group.

To set billing rates for family rated plans:

1. Start on the Group Benefit Plans form.
2. Enter the ID of the plan you want to edit.
3. On the Actions menu, click Billing Rates.
4. Set the following parameters.
Use this option To define this

Copy from Premium Rates

This option will be listed under the Actions menu on this form. If you select this option, then Age-range information from the Premium Rates record is copied for this benefit plan for Billing Rates record. 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 This value is auto-populated from the Group Benefit Plan form.

Rate Group

The Rate Group field displays when you select No or Both in the Billing Rates Vary By Network list in the Other Processing Parameters panel. The rates you enter apply only to this rate group.

You can enter a Rate Group or click the Rate Group link. A dialog box opens stating Search for rate groups already used for this plan? If you select:

• Yes - A list of existing rate groups for this Plan ID is listed on the form.
• No - The Select Rate Group dialog box opens and you can select from there.

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.
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 you have selected an existing rate group above, you will a list of effective dates for that rate group on the form. You can select one or enter a new one.

For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision.
5. When Family Rated Premiums is selected in the Other Processing Parameters panel, define the following information for each age. If you need an additional age row, click + to or press Tab.
Use this option To define this
From Age The first age.
Billing Amount The Premium cost for that age.
Tobacco Surcharge A Tobacco Surcharge, if any
6. Click Save to save the changes, close the form and return to the Group Benefit Plans form. Repeat these steps for each plan type.
7. Click Delete to delete the record.
8. Click Cancel to clear the form. The Benefit Plan ID field will not be cleared.
9. Click Close to close this form.