Hierarchy 1
What is actually sold to a group /individual (multiple products)
Plan
A list of benefits and/or groupers that represent a full set of services offered to a member
Benefit set
The foundations of plans and are built from product templates but are configured with specific cost share information (includes specific cost share assigned to benefits)
Product
A group of two or more benefits that have a commonality that inherit any cost share or variation defined
Grouper
Acts as a base/foundation to create multiple products/plans and is submitted to Dept. of Insurance
Product Template
The building blocks for product templates, products, and plans that define a service, contain a code(s), and code group(s) that define benefit mapping
Benefit
Defines the point of access for a member and is the structural element in products and plans offering the ability to differentiate how a benefit should function when rendered by different types of providers
Network