Benefits Flashcards
Benefitplan table
Stores detailed info about a grouping of benefits
Plancopay table
Stores the co-pays defined for a specific benefit plan
copaytype table
Stores all co-pay types available in the working enviornment
benefitplancointype tables
stores the co-insurance options defined for aspecific benefit plan
coinstype table
stores all co-insurance types in the working enviornment
Planrestrictiongroup table
defines the restriction groups assigned to a benefit plan
codegrouper table
Stores all restriction group data and configuration
PlanGroup table
Stores the services that a specific benefit plan does not cover
Connects a benefit plan with the service groups that its excluding
Benefit table
Stores detail infomration for an individual benefit
Benefitdocument tables
Stores document restrictions for a benefit
* the has documents field in the benefit table populates with a ‘Y’ when the benfit requires a document.
QDocument table
Stores all documents in the working eviornment
BENELOCATION table
stores locations covered for a specific benefit
HCFApostlocation table
Accumulator table
Stores all accumulators available in the working enviornment
* Accumulators are counting mechanisms that track copay, coinsurance, deductable, max-out-of-pocket, and other max limit items.
* an accumulator can attach to a single benefit or multiple benefits.
* some of these fields use foreign key restraints while others use application restraints only
* The values of the accumulator ID’s are stored in the benefits table
