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            Plan Benefits Sample Information

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            Plan Benefits Sample Information

            Use the plan benefits information to model the medical, dental, and vision coverage products under the Employee Benefits root product.

            Required Editions

            Available in: Lightning Expereince
            Available in: Professional, Enterprise, and Unlimited Editions where Financial Service Cloud and Insurance Brokerage are enabled

            Medical Coverage Product

            Product Component group (sequence) product classification product classification Attributes benefit product (sequence) attribute definitions (datatype) (sequence)
            General Plan Information (1) Annual Deductable Deductible Annual Deductible/Individual (1) Deductible ($) (1)
            Annual Deductible/Family (2) Deductible ($) (1)
            Annual Plan Max Annual Maximum Annual Plan Maximum (3)  
              Annual Maximum ($) (1)
            Reasonable Customary Percentile Percentile Reasonable & Customary Percentile (4)  
              Percentile (Picklist)
            Waiting Period Penalty Waiting Period (5)  
              Penalty (Picklist) (1)
            Diagnostic and Preventitive Services (2) Preventitive Services Benefit Maximum Preventitive Services (1)  
              Benefit Maximum (%) (1)
            Basic Major Services Benefit Maximum, Coinsurance Basic Services (2)  
              Benefit Maximum (%) (1)
              Coinsurance (%) (2)
            Major Services (3)  
              Benefit Maximum (%) (1)
              Coinsurance (%) (2)
            Endodontic Benefit Maximum Endodontic Treatment (4)  
              Benefit Maximum (%) (1)
            Periodontic Benefit Maximum Periodontic Treatment (5)  
              Benefit Maximum (%) (1)
            Orthodontia Services (3) Orthodontia Benefit Maximum, Covered Members Orthodontia Services (1)  
              Benefit Maximum (%) (1)
              Covered Members (Picklist) (2)
            Lifetime Plan Max Annual Maximum Lifetime Plan Maximum (2)  
              Annual Maximum ($) (1)

            Dental Coverage Product

            Product Component group (Sequence) product classification product classification attributes benefit product (sequence) Attribute definitions (data type) (sequence)
            General Plan Information (1) Exam and Materials Copay, Benefit Frequency Exam  
              Copay ($) (1)
              Benefit Frequency (Picklist) (2)
            Materials  
              Copay ($) (1)
              Benefit Frequency (Picklist) (2)
            Lenses Frames and Contacts Benefit Frequency Lenses  
              Benefit Frequency (Picklist) (1)
            Frames  
              Benefit Frequency (Picklist) (1)
            Contacts  
              Benefit Frequency (Picklist) (1)
            Covered Services - Lenses (2) Single Bi Tri Focal Lenses Benefit Maximum, Reimbursed Upto Single Vision Lens  
              Benefit Maximum (%) (1)
              Reimbursed Upto ($) (2)
            Bifocal  
              Benefit Maximum (%) (1)
              Reimbursed Upto ($) (2)
            Trifocal  
              Benefit Maximum (%) (1)
              Reimbursed Upto ($) (2)
            Covered Services - Contacts (3) Effective Reimbursed Upto, Copay Waiver, In-network limitations Effective  
              Reimbursed Upto ($) (1)
              Copay Waiver (Picklist) 2
              In-network Limitations (Picklist) (2)
            Covered Services - Frames (4) Frames Reimbursed Upto, Copay Waiver, In-network limitations Frames  
              Reimbursed Upto ($) (1)
              Copay Waiver (2)
              In-network limitations (Picklist) (2)

            Vision Coverage Product

            Product Component group (Sequence) product classification product classification Attributes benefit product (sequence) Attribute definitions (Datatype) (Sequence)
            General Plan Information (1) Annual Deductible Deductible Annual Deductible/ Individual (1)  
              Deductible ($) (1)
            Annual Deductible/ Family (2)  
              Deductible ($) (1)
            OOP Limit OOP Max Annual Out-of-Pocket Limit/Individual (3)  
              OOP Max ($) (1)
            Annual Out-of-Pocket Limit/Family (4)  
              OOP Max ($) (1)
            Office Visit PCP Copay,Coinsurance,Deductible Waiver Office Visit | PCP (5)  
              Copay ($) (1)
              Coninsurance (%) (1)
              Deductible Waiver (Picklist) 2
            Office Visit Spec Virt Copay,Coinsurance,Deductible Waiver,Notes Office Visit | Specialist (6)  
              Copay ($) (1)
              Coninsurance (%) (1)
              Deductible Waiver (Picklist) (2)
              Notes (Text) (3)
            Office Visit | Virtual (7)  
              Copay ($) (1)
              Coninsurance (%) (1)
              Deductible Waiver (Picklist) (2)
              Notes (Text) (3)
            Outpatient Services (2) Preventive Care Copay,Coinsurance,Deductible Waiver Preventive Care (1)  
              Copay ($) (1)
              Coninsurance (%) (1)
              Deductible Waiver (Picklist) (2)
            Inpatient Outpatient Copay,Coinsurance Inpatient Hospital (2)  
              Copay ($) (1)
              Coninsurance (%) (1)
            Outpatient Surgery (3)  
              Copay ($) (1)
              Coninsurance (%) (1)
            Emergency Room Copay,Coinsurance,Emergency Room Copay Waived Emergency Room (4)  
              Copay ($) (1)
              Coninsurance (%) (1)
              Emergency Room Copay Waived (Picklist) (2)
            Urgent Care_Imaging Copay (with subsequent Coinsurance),Coinsurance Urgent Care (5)  
              Copay (with subsequent Coinsurance) ($) (1)
              Coinsurance (%) (2)
            Lab + Imaging (6)  
              Copay (with subsequent Coinsurance) ($) (1)
              Coinsurance (%) (2)
            Complex Imaging (7)  
              Copay (with subsequent Coinsurance) ($) (1)
              Coinsurance (%) (2)
            Chiropractic Services (3) Chiropractic Care Copay,Coinsurance,Visit Limit,Currency Limit Chiropractic Care (1)  
              Copay ($) (1)
              Coinsurance (%) (2)
              Visit Limit (Number) (3)
              Currency Limit ($) (3)
            Acupuncture Visit Limit,Currency Limit Acupuncture (2)  
              Visit Limit (Number) (1)
              Currency Limit ($) (1)
            Prescription Drugs (4)        
            Rx Deductible Individual Not Applicable,Deductible Rx Deductible | Individual (1)  
              Deductible ($) (1)
              Not Applicable (Picklist) (1)
            Rx Retail Generic Copay,Copay Min,Copay Max,Coinsurance,Deductible Waiver,Notes Rx Retail | Generic (2)  
              Copay ($) (1)
              Copay Min ($) (1)
              Copay Max ($) (2)
              Coinsurance (%) (2)
              Deductible Waiver (Picklist) (3)
              Notes (Text) (3)
            Rx Retail Preferred Generic CopayCopay MaxCopay MinCoinsuranceDeductible WaiverNotes Rx Retail | Preferred Generic (3)  
              Copay ($) (1)
              Coinsurance (%) (1)
              Deductible Waiver (Picklist) (2)
              Notes (Text) (2)
            Rx High Cost Gen Preferred Copay,Copay Min,Copay Max,Coinsurance Rx Retail | High-cost Generic (4)  
              Copay ($) (1)
              Coinsurance ($) (1)
              Copay Min ($) (2)
              Copay Max (%) (3)
            Rx Retail | Preferred Brand (5)  
              Copay ($) (1)
              Copay Min ($) (1)
              Copay Max ($) (2)
              Coinsurance (%) (3)
            Rx Retail Non-preferred Brand Copay,Copay Min,Copay Max,Coinsurance,Deductible Waiver,Notes Rx Retail | Non-preferred Brand (6)  
              Copay ($) (1)
              Copay Min ($) (1)
              Copay Max ($) (1)
              Coinsurance (%) (1)
              Deductible Waiver (Picklist) (2)
              Notes (Text) (2)
            Rx Mail-order Retail Copay Multiplier,Retail Copay Multiplier with Coinsurance,Coinsurance,Notes Rx Mail-order (7)  
              Retail Copay Multiplier (Picklist) (1)
              Retail Copay Multiplier with Coinsurance (Picklist) (1)
              Coinsurance (%) (2)
              Notes (Text) (2)
             
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