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Configuring Coverage Plans

Assign rules to charges and pass them through to the payer automatically

Ashley Lawrence avatar
Written by Ashley Lawrence
Updated over a week ago

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:

  • Limited to a quantity: limits the number of units included for no additional charge within a time period (i.e. 2 home visits per year)

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

  • Charged a 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 at no additional cost: always free

  • Included if they cost less than: 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

  • Passed through at cost: cost passed through to the responsible party

  • Surcharge: This amount is applied on top of the configured price of a given item or category

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

    • Yes! Our Limited to a quantity rule allows you to include a specific number of office visits, routine labs, or other services within a time period.

  • 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.

  • Do coverage plan rules apply to recurring membership charges?

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

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