Facets and Health Insurance Lines of Business

Now-a-days health care market is very challenging. Health care payer organizations need such a tool that supports multiple lines of business and complex products offerings. TriZetto’s Facets system is a great answer for all the challenges that the complex health care market pose. The Facets system contains broad functionality to serve a wide range of lines of business from commercial to government programs to specialty.

The Facets system provides a comprehensive solution that supports the administration of each of insurance company's  business line on one integrated platform. Lines of business that can be serviced through Facets are:

Commercial Business Lines	Govt. Programs	Special Business lines
Large Group	Medicare Advantage	Behavioral Health
Small Group	Medicaid	Dental
Family/Individual	Medicare Part D	Disability
Consumer-Directed	Medicare Supplemental	Vision

Group: In Facets, members/subscriber belongs to a group. A Group is a logical collection of subscribers/members who are treated as a single unit.

Consumer-Directed Health Plan: Consumer-Directed Health Plan (CDHP) means offering a high-deductible health plan paired with a spending account for out-of-pocket costs such as a Health Savings Account (HSA) or Integrated Health Reimbursement Arrangement (HRA). What all CDHPs have in common is a personal healthcare account used to pay for medical expenses.

Medicare:

A federal health insurance program for people 65 and older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Original Medicare:

Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).

Medicare Advantage

Medicare Advantage is a type of Medicare health plan offered by a private company that contracts with Medicare to provide policy holders with all their Part A and Part B benefits. It is known as Medicare Part C.  Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most Medicare services are covered through the plan that aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D

A program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage.

Medicare Supplemental:

Medicare Supplemental  Insurance policy known as Medigap is a policy that is sold by private companies. It can help pay some of the health care costs that Original Medicare doesn't cover like copay, coinsurance, and deductibles.

Medicaid:

Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. Each state has different rules about eligibility and applying for Medicaid.

Behavioral Health Services:

Behavioral Health Services are needed when depression, changes in eating and sleeping habits, sudden poor performance in work, avoiding tendency, anxiety, suicidal tendency, feelings of worthlessness or guilt, hopelessness, lack of motivation and enthusiasm ,etc. are visible in a person's life.