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Manage Coverages

On the Coverages screen, create and update the codes that determine who is covered by a benefit plan. You can also set limits on the number of individuals covered by COBRA under each relation code. The coverage codes are user-defined and based on dependent relation types.

Go to: Home > Codes and Criteria > General > Coverages

* indicates a required field

Field Description
Coverage Code* The name of the code for the specific coverage.
Description A description of the coverage code.
HIPAA Coverage Code

A predefined HIPAA code that identifies the level of insurance a member can have. This field associates the coverage code with the HIPAA code. The HIPAA code populates Loop 2300, HD05 when you generate outgoing HIPAA 834 transactions:

  • CHD—Children Only.
  • DEP—Dependents Only.
  • E1D—Employee and One Dependent.
  • E2D—Employee and Two Dependents.
  • E3D—Employee and Three Dependents.
  • E5D—Employee and One or More Dependents.
  • E6D—Employee and Two or More Dependents.
  • E7D—Employee and Three or More Dependents.
  • E8D—Employee and Four or More Dependents.
  • E9D—Employee and Five or More Dependents.
  • ECH—Employee and Children.
  • EMP—Employee Only.
  • ESP—Employee and Spouse.
  • FAM—Family.
  • IND—Individual.
  • SPC—Spouse and Children
  • SPO—Spouse Only.
  • TWO—Two Party.
Relation

The dependent relation code:

  • M—Member.
  • S—Spouse.
  • D—Dependent.
  • O—Other.
Minimum

The minimum number of individuals in the specified relation type who can be covered by COBRA in this coverage code. If you enter a minimum value, you must enter a maximum value. The Member minimum must be 0 or 1.

Maximum The maximum number of individuals in the specified relation type who can be covered by COBRA in this coverage code. If you enter a maximum value, you must enter a minimum value. The Member maximum must be 1.

Add a Coverage Code

  1. Click .
  2. Enter a name for the coverage code and click .

  3. Enter an optional description for the coverage code.
  4. If needed, enter the HIPAA Coverage Code.
  5. To add a relation, click .
  6. Select the relation. You can only add one occurrence of each relation for the coverage. For example, you can only add Member once.
  7. Set the Minimum and Maximum values.

    8. Note: The Minimum and Maximum values are only used during the COBRA election process. You can enter the same value for Minimum and Maximum.
  8. Click Save icon to save.

Update a Coverage Code

  1. Select a coverage code to update from the Coverage Code list.
  2. Edit the Description, HIPAA Coverage Code, or Relations information.

  3. Click Save icon to save.

Delete a Relation from a Coverage Code

  1. To delete a relation, select the relation to delete and click .

  2. At the message “Are you sure you want to delete this relation?” click .

  3. The relation is deleted from the Relations table.
  4. Click Save icon to save.

Delete a Coverage Code

  1. Select a coverage code to delete from the Coverage Code list.
  2. Click .
  3. At the message “Are you sure you want to delete this Coverage Code?” click .

  4. The coverage code is deleted from the list.

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