Coverage plans allow you to create a set of charge rules that apply to patients enrolled on a given membership plan including if the charge is discounted, paid for by the employee or sponsor, included in the membership, etc.

Follow these steps to create a coverage plan:

  1. Go to Admin > Membership Options > Coverage Plans

  2. Click '+ New Coverage Plan'

  3. Name your plan

  4. Select the connected membership plan(s)

  5. Click 'Add Coverage Rule' and create the rule

    1. Select whether the rule applies to specific charge items (i.e. CBC) or a charge category (i.e. Labs)

    2. Select the Coverage Rule. Hint supports the following coverage rules:

  • Discounted: percentage-based discount applied to the charge item/category default price (i.e. 20% off all supplements)

  • Flat amount: dollar value that overrides the charge item/category set price (i.e. all labs are charged to the patient/sponsor at $5 regardless of list price)

  • Included in Plan: always free

  • Included in Plan if Under Certain $ value: all items within a category under a certain $ value. Items that exceed the dollar value are routed to the paid for by party at full price

  • Pass through: cost passed through to the responsible party

  • Surcharge: This percentage is applied on top of the configured price of a given item or category ex: 1.x% * configured price where x=coinsurance

The last step is to select who pays for the item: the patient or sponsor (employer).

Once you have added all of your coverage rules click 'Publish'.

Use the global charge modal to add charges to an employer or patient invoices based on coverage plans.


Coverage Plan Frequently Asked Questions:

  • Can I split the charge between the employer and patient?

    • No, fees cannot be split. This is on our roadmap but is not currently available.

  • I offer pre-employement screening paid for by the employer. Can I create a coverage plans to manage this?

    • Yes, eligible but inactive employees who have charges routed to the employer invoice will use the employer's coverage plan. This means employees do not have to be enrolled with the employer to receive discounted rates.

  • Can I create a plan to limit the number of visits/services per year?

    • No, our coverage plans do not support packages.

  • Do coverage plan rules apply to recurring membership charges?

    • No, recurring membership charges are not currently affected by the rules.

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