LIMRA Data Exchange Standards Community Support Forum

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

This will be discussed at the next Tech Spec Team Meeting: Wednesday, April 10, 2024

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

After further discussion, this type of coverage tier mismatch at the implementation level shouldn't be an issue in most cases and should be discussed at the Integration level, which would exclude the coding supplement from updates. We'll consider this issue solved with the recommendation this discussion happens at the integration level early in the project kick-off timeframe. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-29-2024 10:24
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

This will be discussed at the next Tech Spec Team Meeting: Wednesday, April 10, 2024

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 15:06
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 14:49
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
UT

Original Message:
Sent: 03-21-2024 12:09
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-19-2024 14:26
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781

Original Message:
Sent: 03-19-2024 12:44
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

------------------------------
Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 03-13-2024 10:52
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

#LDEx-BEM

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781
------------------------------

If a carrier requires the benefit amounts for Spouse and/or children for a combined coverage tier code is this currently supported? 

We would be getting the Employee benefit amount and even though the coverage tier would be agreed upon as a Combined one, there are times where a downstream system requires the benefit amounts for Spouse and/or Children also to be included.  For example, for port and convert process/letters.

------------------------------
Anjali Patel
Director, Business Systems Analyst - Group Insurance
Prudential
Newark NJ
anjali.patel@prudential.com

Original Message:
Sent: 04-01-2024 11:54
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

After further discussion, this type of coverage tier mismatch at the implementation level shouldn't be an issue in most cases and should be discussed at the Integration level, which would exclude the coding supplement from updates. We'll consider this issue solved with the recommendation this discussion happens at the integration level early in the project kick-off timeframe. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-29-2024 10:24
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

This will be discussed at the next Tech Spec Team Meeting: Wednesday, April 10, 2024

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 15:06
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 14:49
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
UT

Original Message:
Sent: 03-21-2024 12:09
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-19-2024 14:26
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781

Original Message:
Sent: 03-19-2024 12:44
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

------------------------------
Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 03-13-2024 10:52
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

#LDEx-BEM

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781
------------------------------

Do you need multiple Benefit Amounts within one instance of the Coverage Entity , one for the Employee, one for Spouse and one for the Child ?

------------------------------
Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 08-13-2024 19:06
From: Anjali Patel
Subject: CoverageTierCode when it varies per customer and plan

If a carrier requires the benefit amounts for Spouse and/or children for a combined coverage tier code is this currently supported? 

We would be getting the Employee benefit amount and even though the coverage tier would be agreed upon as a Combined one, there are times where a downstream system requires the benefit amounts for Spouse and/or Children also to be included.  For example, for port and convert process/letters.

------------------------------
Anjali Patel
Director, Business Systems Analyst - Group Insurance
Prudential
Newark NJ
anjali.patel@prudential.com

Original Message:
Sent: 04-01-2024 11:54
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

After further discussion, this type of coverage tier mismatch at the implementation level shouldn't be an issue in most cases and should be discussed at the Integration level, which would exclude the coding supplement from updates. We'll consider this issue solved with the recommendation this discussion happens at the integration level early in the project kick-off timeframe. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-29-2024 10:24
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

This will be discussed at the next Tech Spec Team Meeting: Wednesday, April 10, 2024

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 15:06
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 14:49
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
UT

Original Message:
Sent: 03-21-2024 12:09
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-19-2024 14:26
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781

Original Message:
Sent: 03-19-2024 12:44
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

------------------------------
Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 03-13-2024 10:52
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

#LDEx-BEM

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781
------------------------------

Hi Sathish,

Thank you for the reply.  Yes, we would need multiple benefit amounts within the one instance.

------------------------------
Anjali Patel
Director, Business Systems Analyst - Group Insurance
Prudential
Newark NJ
anjali.patel@prudential.com

Original Message:
Sent: 08-14-2024 11:04
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

Do you need multiple Benefit Amounts within one instance of the Coverage Entity , one for the Employee, one for Spouse and one for the Child ?

------------------------------
Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 08-13-2024 19:06
From: Anjali Patel
Subject: CoverageTierCode when it varies per customer and plan

If a carrier requires the benefit amounts for Spouse and/or children for a combined coverage tier code is this currently supported? 

We would be getting the Employee benefit amount and even though the coverage tier would be agreed upon as a Combined one, there are times where a downstream system requires the benefit amounts for Spouse and/or Children also to be included.  For example, for port and convert process/letters.

------------------------------
Anjali Patel
Director, Business Systems Analyst - Group Insurance
Prudential
Newark NJ
anjali.patel@prudential.com

Original Message:
Sent: 04-01-2024 11:54
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

After further discussion, this type of coverage tier mismatch at the implementation level shouldn't be an issue in most cases and should be discussed at the Integration level, which would exclude the coding supplement from updates. We'll consider this issue solved with the recommendation this discussion happens at the integration level early in the project kick-off timeframe. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-29-2024 10:24
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

This will be discussed at the next Tech Spec Team Meeting: Wednesday, April 10, 2024

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 15:06
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 14:49
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
UT

Original Message:
Sent: 03-21-2024 12:09
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

------------------------------
Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-19-2024 14:26
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781

Original Message:
Sent: 03-19-2024 12:44
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

------------------------------
Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 03-13-2024 10:52
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

#LDEx-BEM

------------------------------
Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781
------------------------------

The Benefit Amount under Coverage is not an array, so will not support this scenario.

But curious to know, would the BenefitPlanIdentifier be the same for all 3 participants (Employee, Spouse, Child)?

Hi Sathish,

Thank you for the reply.  Yes, we would need multiple benefit amounts within the one instance.

------------------------------
Anjali Patel
Director, Business Systems Analyst - Group Insurance
Prudential
Newark NJ
anjali.patel@prudential.com

Original Message:
Sent: 08-14-2024 11:04
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

Do you need multiple Benefit Amounts within one instance of the Coverage Entity , one for the Employee, one for Spouse and one for the Child ?

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Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 08-13-2024 19:06
From: Anjali Patel
Subject: CoverageTierCode when it varies per customer and plan

If a carrier requires the benefit amounts for Spouse and/or children for a combined coverage tier code is this currently supported? 

We would be getting the Employee benefit amount and even though the coverage tier would be agreed upon as a Combined one, there are times where a downstream system requires the benefit amounts for Spouse and/or Children also to be included.  For example, for port and convert process/letters.

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Anjali Patel
Director, Business Systems Analyst - Group Insurance
Prudential
Newark NJ
anjali.patel@prudential.com

Original Message:
Sent: 04-01-2024 11:54
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

After further discussion, this type of coverage tier mismatch at the implementation level shouldn't be an issue in most cases and should be discussed at the Integration level, which would exclude the coding supplement from updates. We'll consider this issue solved with the recommendation this discussion happens at the integration level early in the project kick-off timeframe. 

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Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-29-2024 10:24
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

This will be discussed at the next Tech Spec Team Meeting: Wednesday, April 10, 2024

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Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 15:06
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

The schema allows this configuration. We simply need a way to accurately communicate this. We can create an issue and discuss it in the next Tech Spec Team meeting. 

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Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-21-2024 14:49
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

I think so? If the expected/supported values are always the same, or can be determined based on another variable, like product type, it may be something that could be determined on a partner level vs. per customer. If the expected/supported values for a single product can be different across customers within the same trading partner, I wasn't sure how else to identify this, but perhaps I'm missing something. 

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Amanda Lund Anderson
Director, Integrations Engineering
Plansource
UT

Original Message:
Sent: 03-21-2024 12:09
From: Michael Grudgings
Subject: CoverageTierCode when it varies per customer and plan

"I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?"

I see no reason the schema could not support this level of complexity. We may need to discuss adding a column for the coverage tier in the Coverage section. Would that resolve the issue?

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Michael J Grudgings
Business Architect, Data Standards | LL Global, Inc.
300 Day Hill Road, Windsor, CT, 06095
t: (860) 298-3850 | mgrudgings@limra.com

Original Message:
Sent: 03-19-2024 14:26
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

Hi @Sathish Kundan In this case, both plans are 4 tier.

In this example, for plan A the expected corresponding tiers are:

Employee, EmployeeSpouse, EmployeeDependent or EmployeeFamily

For plan B:

Employee, EmployeeSpouse, EmployeeChildren or EmployeeFamily

Both are 4 tier. 

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Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781

Original Message:
Sent: 03-19-2024 12:44
From: Sathish Kundan
Subject: CoverageTierCode when it varies per customer and plan

@Amanda Lund Anderson in your example, is it because Plan A and Plan B have different Tier's? One being a 3 tier Plan vs the other being a 4 tier Plan?

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Sathish Kari Kundan
LDEx FORUM Admin & Moderator

Original Message:
Sent: 03-13-2024 10:52
From: Amanda Lund Anderson
Subject: CoverageTierCode when it varies per customer and plan

If a partner requires a different coverage level depending on the customer or plan, is this currently supported?

Example:

Within a single employer group:

Employee and 1 child are enrolled in both plans.

For plan A, carrier expects EmployeeDependent
For plan B, carrier expects EmployeeChild

I don't see a place to specify the requested difference in CoverageTier on the Coding Supplement. Does this mean that this is not supported and LDEx expects global CoverageTiers per partner?

#LDEx-BEM

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Amanda Lund Anderson
Director, Integrations Engineering
Plansource
Salt Lake City UT
8018692781
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