Benefit Services

Here's how VBASoftware's Benefit Services can help you:
  • Subscriber/Member, in-network versus out-of-network deductibles, out-of-pocket maximums, co-insurance, co-pay, annual/lifetime maximums, all configurable by plan or benefit
  • Family level coverages used for restricting family size when determining OOP and Deductibles while leveraging the already existing Plan and Benefit for payment specifics
  • Highly configurable place code details, including: Coverage, service, allowed/disallowed authorization requirement, auth penalty, taxes, and more
  • Benefit definitions are mutually exclusive to plan setup allowing for a single benefit structure to be applied to any number of plans and updated/synced with a single change
  • Procedure, Diagnosis, Benefit and Plan age restrictions that can be applied by plan type independently or in conjunction with covered benefits and riders
  • Ability to accumulate into multi-benefit buckets allowing for additional levels of OOP, Deductible and payable maximums
  • Categorize Plans into Plan Types allowing for additional reporting options as well as allowing users to enroll members into multiple of the same type of Plan and have them accumulate into one bucket (e.g. Medical Plan A that cascades into Medical Plan B with no deductible but wants to share the same OOP maximums)
  • Ability to “clone” a Benefit Plan which allows quick and easy modifications to an existing plan without recreating from scratch and then have that plan applied across any number of group offerings
  • Ability to define benefits that cascade into other defined benefits which allows for tiered coverages across any number of benefit offerings
  • Define pre-existing condition identifiers and enrollment ranges that affect claims payment during adjudication automatically
  • Define Disability Waiting Periods, Survivor Benefit Range, Maximum Disability, Payment Intervals
  • Highly configurable benefit plan structure allows the covering of unique and non-standard benefits (e.g. create a benefit that covers shoveling a driveway or Meals on Wheels for a senior citizen plan, legal protection plans offered by lawyers or pet insurance plans)
  • Categorize benefits for ease of reporting and administration (e.g. when performing state or county Encounter Reporting for Medicaid/Medicare)
  • Customizable and dynamic limits that can be defined for Visit, Service Count, Payable, Co-Pay and Deductible. Lag date range or by defined Calendar year/month or Plan Year
Ready to learn more about VBASoftware? Download your free VBASoftware overview brochure.

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