Product Enhancements 2016

Product enhancement means adding some benefits to existing health plans. Different insurance companies offer different types of health plans having different benefits including terms and conditions. Health plans are the marketing names of insurance companies. But in reality, at the root of every health plan, there is a product and it is known by its Product Id. Benefits including terms and conditions of the health plans are tagged to this product id.

In Facets, there are different application groups to manage the product ids and add benefits as well restrictions to these product ids. The application groups are Dental Plan application group, FSA Plan application group , ITS Plan application group, Medical Plan application group and  Vision Plan application group. Under each application group, their are different applications. Developers and  Configuration analysts will use specific application or database table to perform specific task.

In order to meet regulatory requirements and sometimes for their own reasons, insurance companies need to enhance their products. For example, Insurance companies are required to implement USPSTF Grade A & B recommendations as part of regulatory requirements. On the other hand, some insurance companies need to increase copayment and deductible amount in their existing products. Sometimes they also put cap on some benefits. So, in order to perform these types of changes, insurance companies start special projects known as Product Enhancement projects.

As part of ACA requirements, Health Insurance companies implemented product enhancements in 2016. Major areas of Product Enhancement 2016 are:

Ø  Cardiovascular Disease Counseling

Ø  Childhood Obesity

Ø  Mental Health & Autism

Ø  Non Transport Ground Ambulance

Ø  Telemedicine

Ø  Victim of Sex Crimes Mandate

Among these benefits, Cardiovascular Disease Counseling for adult 18 & older having  overweight and additional risk factors and Childhood Obesity(age 6-18) are mandatory for NGF Self-Funded Groups. It may be mentioned that Affordable care Act requires Preventive and Wellness Service coverage per US Preventive Services Task Force(USPSTF)recommendation levels 'A' & 'B'. These preventive and wellness services will be covered at first dollar when provided by Network Provider.