Benefit OverviewTab
Click Start to begin exploring the Benefit Overview Tab.
Start
Homepage
Click the highlighted box to view the Benefit Overview.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Congratulations!
Now you've learned the Benefit Overview Tab
Start Again
Reimbursement Guidelines
Each health plan has its direct member process (use your resources). Everything under the Reimbursement Guidelines section is related to Direct Claims. The Direct Indicators correspond to the fields on the Direct Claim Entry screen. These fields dictate the information required when a direct claim is entered.
- For example, with Allergy Coverage - does the plan cover allergy medications on direct claims?
- Receipts required with a claim - does the plan require receipts when submitting a request for reimbursement?
Next
Benefit Types
Note: Benefit Types include information such as Deductible or OOP. The Account Summary link can be used to navigate back to the Account Summary page to review dollar amounts applied to an individual and/or family unit's accumulator within a benefit period. The other links display medications filled for the member(s) on this account.
Next
Carrier Information
Carrier Information includes basic information about the member's plan.Note: Medicaid or Medicare will display in the Carrier type field, if applicable.
Next
Review & Appeals
Lastly, the Reviews & Appeals section gives basic information about where to direct reviews and appeals. Subtabs, outlined below, provide details about Administrative and Clinical reviews and appeals. Each plan should follow its own A&G internal process. • Overview • Administrative Reviews and Appeals • Clinical Reviews and Appeals
Next
Grievance Address
Instructs you on how to direct grievances. Follow the current plan process.
Next
Home Delivery
This section contains administrative details regarding using the home delivery service. This includes, for instance, what to include when mailing in a prescription and the address to which it should be mailed.If applicable, it also includes drop-downs for:
- Mail to Location
- New Rx Mail Order Process
- Fax New Mail Order Process
- Shipping Guidelines
Next
Copayment Information
Note: The Copayment Information identifies copayment parameters for the group. Includes tabs for: • Mail • Card • Direct • Drug Coverage link to navigate to the Drug Coverage screen. • Includes an expandable section for Copayment/Tiers to review copayment and tier details.
Next
Internet Indicators
In other words, it's how the system is accessed and viewed by the member and others on their plan.
Next
Days Supply
Days Supply shows the days' supply allowed for different types of pharmacy claims. The blue drop-down arrow, as shown in the example to the left for Rx Consolidation, reveals a detailed explanation of that section.
Next
Contract Information
Contract information relates to the plan structure. Eligibility structure for a plan can be set up with a hierarchy of carrier, contract, and group. Various details regarding the plan are set at each level.
Next
Benefit Overview Tabs
Stephanie Flint
Created on October 30, 2025
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Transcript
Benefit OverviewTab
Click Start to begin exploring the Benefit Overview Tab.
Start
Homepage
Click the highlighted box to view the Benefit Overview.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
$615.00 for every 12 months.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Homepage
Click the highlighted box to view more details.
Congratulations!
Now you've learned the Benefit Overview Tab
Start Again
Reimbursement Guidelines
Each health plan has its direct member process (use your resources). Everything under the Reimbursement Guidelines section is related to Direct Claims. The Direct Indicators correspond to the fields on the Direct Claim Entry screen. These fields dictate the information required when a direct claim is entered.
Next
Benefit Types
Note: Benefit Types include information such as Deductible or OOP. The Account Summary link can be used to navigate back to the Account Summary page to review dollar amounts applied to an individual and/or family unit's accumulator within a benefit period. The other links display medications filled for the member(s) on this account.
Next
Carrier Information
Carrier Information includes basic information about the member's plan.Note: Medicaid or Medicare will display in the Carrier type field, if applicable.
Next
Review & Appeals
Lastly, the Reviews & Appeals section gives basic information about where to direct reviews and appeals. Subtabs, outlined below, provide details about Administrative and Clinical reviews and appeals. Each plan should follow its own A&G internal process. • Overview • Administrative Reviews and Appeals • Clinical Reviews and Appeals
Next
Grievance Address
Instructs you on how to direct grievances. Follow the current plan process.
Next
Home Delivery
This section contains administrative details regarding using the home delivery service. This includes, for instance, what to include when mailing in a prescription and the address to which it should be mailed.If applicable, it also includes drop-downs for:
Next
Copayment Information
Note: The Copayment Information identifies copayment parameters for the group. Includes tabs for: • Mail • Card • Direct • Drug Coverage link to navigate to the Drug Coverage screen. • Includes an expandable section for Copayment/Tiers to review copayment and tier details.
Next
Internet Indicators
In other words, it's how the system is accessed and viewed by the member and others on their plan.
Next
Days Supply
Days Supply shows the days' supply allowed for different types of pharmacy claims. The blue drop-down arrow, as shown in the example to the left for Rx Consolidation, reveals a detailed explanation of that section.
Next
Contract Information
Contract information relates to the plan structure. Eligibility structure for a plan can be set up with a hierarchy of carrier, contract, and group. Various details regarding the plan are set at each level.
Next