Premium Rates Rate Groups

The following table provides at a glance the rate template for Premium Rates Rate Groups.

Group Benefit Plan Setup

Rate Template (header) file & Import Fields

A benefit plan setup as follows:

Insurance Class = Medical, Dental or Vision

Family Rated Premiums = No

Termination Date = [blank] OR Date > current date

Rate Group for Premium Rates = Yes

Tobacco Banded Rates = No

Gender Banded Rates = Yes or No

Spouse Gender Banded = Yes or No

Wellness Banded Rates = No

Age Banded Medical Rates = Yes or No

Premium Rates Vary By Network = Yes or No

Benefit Plan ID

Network ID (if applicable)

Rate Group

Plan Type

Employee Gender

Spouse Gender

Effective Date

From Age

To Age

10.

Total Premium

11.

Employee Premium

12.

Dependents Premium

Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

For Plan ID

You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import..

Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

The following are required values for this import. [Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group, Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable), Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

If the Benefit Plan ID on the import file

does not exist in PrismHR, then you will receive an error message stating Plan ID <Plan ID> does not exist.

is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID <Plan ID> is not in the Template Builder and cannot be included in this Rate Template.

Age Banded Medical Rates

If Age Banded Medical Rates = No, then only one line of rate is allowed.

If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID <Plan ID> is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

ii.

If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

iii.

If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

ii.

Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

iii.

The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

iv.

Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

If the Network ID on the import file does not exist under the section Plan Networks on the Group Benefit Plans form, you will receive an error message stating Network ID <Network ID> does not exist on Plan ID <Plan ID>.

If the Plan Type on the import file:

does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type <Plan Type> does not exist on the Plan ID <Plan ID>.

has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, you will receive an error stating Spouse coverage is not allowed for Plan Type <Plan Type>.

The Rate Group for this import must be:

an existing Rate Group on the Billing Rate Groups form. Else you will get an error message stating Rate Group <Billing Rate Group> does not exist.

on the Billing Rate Groups form with the field Premium Rate Group checked, otherwise you will get an error message stating Rate Group <Billing Rate Group> is not a Premium Rate Group.

an active Rate Group on the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group <Billing Rate Group> is inactive.

If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender <Employee Gender> is not found.

If the Spouse Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Spouse Gender <Employee Gender> is not found.

10.

If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

11.

If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group, Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable) and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

12.

The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

is negative, you will receive an error message stating Negative amounts are not allowed.

13.

Total Premium must equal Employee Premium PLUS Dependent Premium. If Employee Premium is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium, otherwise the import will fail with the following error message:

Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

Plan Type <Plan Type> has Coverage Class Single. Employee Premium must equal Total Premium.

14.

If Dependent Premium > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Premium > 0 is not allowed for Plan Type <Plan Type>.

15.

Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

If Dependent Premium is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, the import will fail with an error message stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

If Dependent Premium is blank on the import file, then Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)