NextAgency: Benefits

The Benefits page of the client/prospect card gives an overview of insurance benefit plans that your agency can provide. They are broken down into system benefits, such as Health, Dental, Life, etc., and custom benefits that are created by NextAgency users. Each tab contains information about respective insurance carriers and relevant plans. It is possible to filter this information by showing either current or past benefits.

For each Benefit, you can do the following:

• Attach relevant documents.

• Open the provider directory and carrier portal.

• Update the effective date and renewal date.

• Duplicate, edit, and remove the plans.

• Assign benefits to employees.

To add a new benefit, click Add Benefit, select the business type for which you are adding the benefit (Individual, Small Group, or Large Group for all benefits except for the Property & Casualty product type, where the business types are Personal, Small Group, and Commercial), and choose the relevant product type on the Profile tab. 

The arrangement of the Add New Benefit form fields will change depending on your choice of the business type and product type. Now we will explore the common fields that are available for all product types.

Common Fields: Profile Tab

• Share With Client: Select this checkbox to make the benefit visible to the client so they can assign it to their employees.
• Carrier/Vendor: Choose the insurance provider that is relevant to the new benefit or add a new one by clicking the link directly in the field.

• Product Type: Choose one of the available benefit types. They are divided into system product types, which are present in the system by default, and custom product types, which you have created yourself.
• Plan Name: Choose the name of the benefit plan or add a new plan by clicking the link directly in the field.

• State: Select the code of the state that is relevant for the benefit.
• Single Deductible: Enter the maximum amount of employee’s own money that they will have to pay for their individual medical expenses before the company starts covering them.
• Family Deductible: Enter the maximum amount of employee’s own money that they will have to pay for their individual and family medical expenses before the company starts covering them.
• Single Out Of Pocket Limit: Enter the maximum amount of employee’s own money that they will have to pay for their individual medical expenses during the year before the company starts covering them.
• Family Out Of Pocket Max: Enter the maximum amount of employee’s own money that they will have to pay for their individual and family medical expenses during the year before the company starts covering them.
• Policy Number: Enter the number of the relevant insurance policy.
• Group Number: Enter the relevant group ID number.
• Total Monthly Premium: Enter the total monthly fee amount that should be paid to an insurance company.
• Total Annual Premium: Enter the total annual fee amount that should be paid to an insurance company.
• Effective Date: Date on which the benefit becomes active.
• Renewal Date: Date on which the benefit has to be renewed.
• Minimum Hours Per Week: Specify the minimum number of hours that the insured person should work per week to be eligible for this insurance plan.
• Eligibility Period: Specify the length of time during which the insured person is eligible for this insurance plan.
• Carrier Portal Link: Enter a carrier portal URL.
• General Agency: Select the general agent that is managing this insurance plan or add a new general agent by clicking the Add General Agent link directly in the field.

• Status: Specify whether this benefit is current or past.
• Policy Stage: Specify the current stage of assigning this benefit.
• Internal/External Note: Add notes, if applicable. Internal notes can be viewed only inside the agency whereas external notes are shared with the employer and employees.
• Add Files: Attach files to the benefit, if applicable.

Common Fields: Contribution Tab

The Contribution tab is available only for the Small Group and Large Group/Commercial business types. This tab is for entering either the percentage or the amount of insurance payment to be covered by the employer for the employee’s family members. The amount of contribution is typically set by employer regardless of the product type or plan type. The total amount is calculated automatically.

Common Fields: Rates Tab

The Rates tab is for entering the insurance rate for the employee and their family members.

Now let's explore the system product-specific fields on the Profile tab.

Product-Specific Fields: Medical

• Plan Type: Choose the type of the insurance plan.
• Metal Level: Choose between the Bronze, Silver, Gold, or Platinum levels for the insurance plan.
• Exchange (not available for the Large Group business type): Specify whether the insurance plan is an exchange, i.e. federally subsidized.
• Minimum Hours Per Week: Specify the minimum number of hours that the insured person should work per week to be eligible for this insurance plan.
• Payment Mode: Choose how the payments will be made under this insurance plan.
• Provider Directory Link: Enter a URL by which the insurance provider can be found in the directory.

Product-Specific Fields: Dental

• Plan Type: Choose the type of the insurance plan.
• Waiting Period(s): Select the length of time after purchasing the dental benefits plan that the client must wait before they can get their full coverage.
• Provider Directory Link: Enter a URL by which the insurance provider can be found in the directory.
• Minimum Hours Per Week: Specify the minimum number of hours that the insured person should work per week to be eligible for this insurance plan.
• Date of Birth (available only for the Individual business type): Specify the birth date of the insured person.
• Payment Mode: Choose how the payments will be made under this insurance plan.
• Provider Directory Link: Enter a URL by which the insurance provider can be found in the directory.
• Maximum Benefit: Specify the limit of the dental benefit.
• Orthodontia: Specify whether the orthodontic services are included with this benefit.
• Orthodontia Waiting Period(s) (visible only if Yes was selected under Orthodontia): Select the length of time after purchasing the dental benefits plan with orthodontic services that the client must wait before they can get their full coverage.
• Orthodontia Maximum Benefit (visible only if Yes was selected under Orthodontia): Specify the limit of the dental benefit for orthodontic services.
• Vision Included: Specify whether the vision benefits are included.
• Vision Maximum Benefit (visible only if Yes was selected under Vision Included): Specify the limit of the vision benefits.

Product-Specific Fields: Vision

• Plan Type: Choose the type of the insurance plan.
• Provider Directory Link: Enter a URL by which the insurance provider can be found in the directory.
• Minimum Hours Per Week: Specify the minimum number of hours that the insured person should work per week to be eligible for this insurance plan.
• Payment Mode: Choose how often the payments will be made under this insurance plan.
• Benefit Frequency: Enter how often the benefit should be provided, i.e. the frequency of eye exams or lense/frame replacement.
• Eye Exam Copay: Enter the co-payment amount for routine eye exams.
• Provider Directory Link: Enter a URL by which the insurance provider can be found in the directory.

Product-Specific Fields: Property & Casualty

• Plan Type: Choose the type of the insurance plan.
• Minimum Hours Per Week: Specify the minimum number of hours that the insured person should work per week to be eligible for this insurance plan.
• Financing: Specify if financing is available for this plan.
• Down Payment Percentage (%) (visible only if Yes is selected under Financing): Specify the minimum percentage of down payment for this plan.
• Financed Percentage (%) (visible only if Yes is selected under Financing): Specify the minimum percentage that is financed for this plan.
• Taxes and Fees ($) (visible only if Yes is selected under Financing): Specify the amount of taxes and fees that are eligible for this plan.
• Finance Company (visible only if Yes is selected under Financing): Select the company that is financing this plan.
• Billing Type: Specify whether the billing type for this plan is direct bill or agency bill.

Product-Specific Fields: Medicare

• Plan Type: Choose the type of the insurance plan.
• Date of Birth (available only for the Individual business type): Specify the birth date of the insured individual.
• Medicare Claim Number/HICN: Enter the claim number or beneficiary's identification number that is relevant to the Medicare plan.
• Start Date - Part A: Specify the date when the Part A of the Medicare plan comes into force.
• Start Date - Part B: Specify the date when the Part B of the Medicare plan comes into force.
• Two-Party Discount: Specify if the two-party discount is available for this Medicare plan, e.g. for spouses that are 65 and older.
• Dual Eligible: Specify if this plan is eligible both for Medicare and Medicaid benefits.
• Medicaid Number (visible only if Yes is selected under Dual Eligible): Specify if this plan is eligible both for Medicare and Medicaid benefits.
• Provider Directory Link: Enter a URL by which the insurance provider can be found in the directory.

Product-Specific Fields: LTC

• Plan Type: Choose the type of the insurance plan.
• Minimum Hours Per Week: Specify the minimum number of hours that the insured person should work per week to be eligible for this insurance plan.
• Issue Age: Enter the age of the insured person with which the LTC insurance plan comes into force.
• Benefit Amount: Enter the amount of the benefit that is eligible for the LTC plan.
• Benefit Amount Type: Specify whether the LTC benefit should be paid on a montly or on a daily basis.
• Benefit Period: Specify the period during which the LTC benefit is active.
• Elimination Period: Specify the period during which the LTC benefit should be eliminated.
• Elimination Period Type: Specify whether the LTC benefit should be eliminated during x calendar days or during x service days.
• Inflation Protection: Specify whether this plan is subject to protection from inflation.
• Enter Percentage (visible only if Yes is selected under Inflation Protection): Enter the interest percentage for inflation protection.
• Interest Type (visible only if Yes is selected under Inflation Protection): Specify whether the inflation protection interest is compound or annual.
• Money Pool: Enter the total amount of money that your insurance agency provides to pay for LTC.
• Waiver of Premium: Specify whether the LTC plan includes a "waiver of premium" feature.
• Life Insurance: Specify whether the LTC plan is combined with life insurance.
• Partnership Plan: Specify whether the LTC plan is combined with Medicaid.
• Return of Premium: Specify whether the LTC plan allows the return of premium.
• Until Age (visible only if Yes is selected under Return of Premium): Specify the age until which the premium should be returned.

Product-Specific Fields: Disability

• Plan Type: Choose the type of the insurance plan.
• Benefit Amount: Enter the amount of the benefit that is eligible for the disability plan.
• Benefit Period: Specify the period during which the disability benefit is active.
• Elimination Period: Specify the period during which the disability benefit should be eliminated.
• Cost of Living: Specify the cost of living of the insured person to adjust the payments under this benefit.

When ready, click Save. The benefit will be added to the corresponding tab.