Alternative Benefit Plan (ABP)

Template B18 – Alternative Benefit Plan Components

INTRODUCTION

This template is used by the State to name the Alternative Benefit Plan and to associate with the Plan each of its component parts:

• The Alternative Benefit Plan Population that will be covered by the Plan

• The Alternative Benefit Plan Benefit Package that will be provided to the Population

• The Service Delivery System that will be used to deliver the Alternative Benefit Plan Benefit Package

This template may also be used for existing Alternative Benefit Plans to associate a new or different Benefit Package or a new or different Service Delivery System with the Alternative Benefit Plan Population.

BACKGROUND

The State defines the Population that will be offered an Alternative Benefit Plan in the B2-Alternative Benefit Plan Populations.

The State defines the Benefit Package for the Alternative Benefit Plan through a use of the B4-Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package and Cost Sharing template and the related Benchmark Package or Benchmark-Equivalent Package templates for FEHBP, State Employee Coverage, Commercial HMO Coverage, Secretary-Approved Coverage or Benchmark Equivalent Coverage.

The State defines the Service Delivery System it will use for the Alternative Benefit Plan in the B8-Alternative Benefit Plan Service Delivery System template.

In the Alternative Benefit Plan Components template the State names a new Alternative Benefit Plan or selects an existing plan. It then creates the association with the Alternative Benefit Plan of the Population, Benefit Package and Service Delivery System defined in the other templates mentioned above.

Once an Alternative Benefit Plan is established and an Alternative Benefit Plan Population associated with it, the State may not change this association as the Population is the key element of the Alternative Benefit Plan. The State may change the composition of the Population by redefining it in the B2 Alternative Benefit Plan Populations template, but it may not change its association with an existing Alternative Benefit Plan.

The State may, however, change the benefit package associated with a given Alternative Benefit Plan or change the service delivery system associated with the Plan’s benefit package.

TECHNICAL GUIDANCE

PREREQUISITE: The State must have created at least one of each of the following Alternative Benefit Plan components before completing this template:

1. An Alternative Benefit Plan Population by completing the B2-Alternative Benefit Plan Populations, B3a-Volunatary Enrollment Assurances and B3b-Mandatory Enrollment Assurances templates.

2. An Alternative Benefit Plan Benchmark Benefit Package or Benchmark-Equivalent Benefit Package by completing the B4-Selection of Benchmark Benefit Package or Benchmark-Equivalent Benefit Package and Cost Sharing template and the related Benchmark Package or Benchmark-Equivalent Package templates for FEHBP, State Employee Coverage, Commercial HMO Coverage, Secretary-Approved Coverage or Benchmark Equivalent Coverage.

3. An Alternative Benefit Plan Service Delivery System by completing the B8-Service Delivery Systems template.

New Alternative Benefit Plans:

To define a new Alternative Benefit Plan, do the following:

• Select “Add a New Alternative Benefit Plan” from the list of Alternative Benefit Plans.

• Name the Alternative Benefit Plan in the text box provided.

• Select the Population that is associated with the Alternative Benefit Plan from the list of available previously defined populations.

• Select the Benefit Package that is associated with the Alternative Benefit Plan from the list of available Alternative Benefit Plan Benefit Packages.

• Select a Service Delivery System to provide the Benefit Package benefits from the list of Alternative Benefit Plan Service Delivery Systems.

Modify an Existing Alternative Benefit Plan

To modify the components of an existing Alternative Benefit Plan, do the following:

• Select an Alternative Benefit Plan from the list of available Plans.

• The existing Population, Benefit Package and Service Delivery Systems associated with the selected Alternative Benefit Plans will display.

• The State may not change the Population associated with the Alternative Benefit Plan. The Population is a key component of the Alternative Benefit Plan.

• The State may change the Benefit Package associated with the Plan by selecting a different Benefit Package from the list of available Benefit Packages or keep the existing Benefit Package.

• The State may change the Service Delivery System associated with the Benefit Package by selecting another Service Delivery System, or it may keep the Service Delivery System associated with the previous Benefit Package if only the Benefit Package is changing.