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Plan Liability Definition Section - MSO

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Use the Plan Liability Definition Section within the Plan Definition form in myAvatar MSO to enter plan liability information.

  1. In the Plan Liab Rules Level table, select Add New Item.
    • You can also select an existing item in the table and choose Edit Selected Item.
  2. In the Plan Coverage Levels Included field, select the coverage levels. These are set up in the Plan Coverage Definition section.
    • Plan limits must not be greater than overall plan limits. These are set up in the Plan Definition section.
    • If any plan level limit exceeds the overall plan limit it overrides the general plan limit.
  3. In the Lifetime fields, define the highest amount for the duration of a benefit plan level.
  4. In the Annual fields, define the highest amount for a year for the benefit plan level.
  5. In the Co-Pay Visit Ceiling fields, enter the maximum amount, or percentage (of the service charge) a member can be charged for a group of visits.
    Note: Member co-pays affect the Annual, Lifetime, and Out-of Pocket plan limits fields for the benefit plan coverage level.
  6. In the Out of Network fields, enter the maximum payment for out of network services.
  7. In the Maximum fields, define plan limits for the plan level.
    • Plan limits with higher allowances can override a plan limit with lower amounts.
  8. In the Annual fields, define the highest amount for a year for the plan coverage level.
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