Products & Benefits Module
Insurance product management including benefit design, accumulator tracking, plan comparison, and CMS product submission for Medicare Advantage.
5
Pages
4
API Endpoints
3
High-Priority Orgs
5
Requirements
Organization Relevance
Health Plan: High MCO: High TPA: High IPA: Medium ACO: Medium PHO: Medium FQHC: Low MSO: Low
How It Works
The products module manages the complete product catalog. Benefit design tools configure coverage levels, cost sharing, and network types. Accumulators track member deductible and out-of-pocket progress. Plan comparison enables side-by-side evaluation of product features. CMS submission tools support Medicare Advantage bid and benefit package filing.
Requirements
- Benefit configuration engine
- Accumulator tracking system
- CMS HPMS integration for MA products
- Plan document generation
- Rate filing support
Target Audience
Product Managers, Actuaries, Regulatory Affairs, Sales Teams
Pages (5)
| Page | Purpose | Key Features |
|---|---|---|
| Product Catalog | Complete product listing with key features and status | Product directory, Status tracking, Feature summary, Market assignment |
| Benefit Design | Configure benefit structures, cost sharing, and coverage rules | Benefit builder, Cost sharing config, Network rules, Limit management |
| Accumulators | Track member deductible, copay, and out-of-pocket accumulators | Accumulator display, Real-time tracking, Family aggregation, Reset rules |
| CMS Submission | Prepare and submit Medicare Advantage bid and benefit packages to CMS | Bid preparation, Benefit package, Submission tracking, CMS response |
| Plan Comparison | Side-by-side plan comparison for analysis and sales support | Comparison builder, Feature matrix, Cost comparison, Export capability |
API Integrations
Benefit configuration APIAccumulator inquiry APIPlan comparison APICMS HPMS submission API
Referenced Resources
CMS Medicare Advantage Bid InstructionsACA Essential Health BenefitsState benefit mandatesNAIC Model Laws
Expected Results
Market-competitive product portfolio with compliant benefit designs, accurate accumulator tracking, and streamlined regulatory submissions.