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?