Accelerate the creation, management and implementation of Plans from pre-packaged standard Plan designs to one-off custom Plans using FJA's Plan Configurator. The Plan Configurator houses all product component data (Operational, business and compliance rules, all Plan elements, and calculations) and the automated workflows to streamline the creation and maintenance of Plans.
Leveraging The Product Components from The Product Machine, The Plan Configurator automatically applies the appropriate restrictions, actuarial calculations, compliance and business rules. Labor intensive processes are reduced. Redundancy is removed. Hard dollar cost savings and operational improvement are achieved.
Key Features
Create Plans
- Plan set-up is based on sophisticated version and variant management. The user is only presented with the valid options available for a given effective-date, market segment, funding arrangement, and/or state. Other criteria may be added.
- The system may be plan design-based, when pre-configured plans are set up within Product Machine
- The system may be configuration-based, when Product Machine maintains plan components and the configuration rules
- Support for standard and custom plans
- Plans are stored free of redundancy. No two plans stored in the database are identical. Component structure is highly leveraged
Configure Plan Options
- Configure plan option values at the plan level, including co-insurance percentage, co-payment amounts, and deductible limits
- User-defined cross-accumulation rules
- Track and display optional benefits and riders
- Support for multiple networks (e.g. preferred, non-preferred, custom)
Configure Benefits
- User selects and configures applicable deductible, co-insurance, co-pay, penalties and limitations by benefit
- Support for tiered calculations (e.g. pay co-pay for the first five visits, then switch to deductible and co-insurance).
- Supports carve-outs, specialty programs and extended term of coverage
- Support for special instructions, including exclusions and inclusions
- Include/ exclude claim-specific service codes
- Benefit configuration dynamically adjusted after plan option changes
Rating
- Plan Configurator displays the rates obtained from Product Machine
- Rates are updated incrementally with configuration changes, so that the impact on rates is shown instantly
- Alternative rates are produced for up to two different change dimensions (e.g. deductible and co-insurance)
- Non standard plan set-up is supported (manual rates)
Mass Maintenance
- Apply changes to the entire plan portfolio, in an automated fashion
- Maintenance can be turn-key or renewal-based
- Plans may be "grandfathered", i.e. visible and available, based on organizational decisions from the past
- System supports impact analysis after product change
Output
- Plan Information can be exported in XML formats
- Benefit Summaries and other marketing collateral are generated as PDF or MS Word documents
- Universal Explanation of Coverage
External System Integration Options
- API: Open Interfaces allow for retrieval, creation and update of plan information
- Data Extracts for Datawarehouse consumption
- The Plan Configurator is fully web-service enabled
