To maintain primary care providers for a plan:Based on your plan design, benefits participants may have the option, or be required, to select a Primary Care Provider (PCP) when electing a benefit plan.
You use the Maintain Plan Primary Care Providers window to define restrictions for the selection of a primary care provider. You also use this window to set high level configuration options for web-based PCP database searches that are performed through Oracle Self-Service Benefits.
To maintain primary care providers for a plan:Select the Name of the plan for which you are maintaining primary care provider data.
Check the From Repository field if you are using Oracle Self-Service Benefits and the benefits participant selects a primary care provider through a searchable database of providers.
Note: As a prerequisite, you must link an organization to this plan (using the Maintain Plan Related Details window) which has an Organization Role Type of Primary Care Provider Locator.
Note: If you do not check the From Repository field, a participant cannot select a PCP from a list of valid PCPs. The participant must enter the PCP ID number or name in a free form text field.
Note: The Can Keep Provider field is reserved for future use.
Select a Designation Code to indicate if a participant who enrolls in this plan is required to select a PCP, or if PCP selection is optional.
Select a Dependent Designation Code to indicate if a participant who enrolls in this plan is required to select a PCP for each dependent covered by the plan, or if PCP selection is optional.
Select a Start Date Code that indicates when the selected provider becomes the participant's primary care provider.
Enter the number of times a participant is permitted to change primary care providers per month in the Number of Changes Allowed field.
For primary care provider searches, select the maximum Radius in miles which the PCP database should consider when returning the results of a search query.
Check the Radius warning field to issue a warning message to the participant indicating that the selected PCP is outside the range allowed by the plan. Checking this field lets a participant override the warning and select a PCP outside the prescribed range.
Note: If you do not check this field, a participant cannot select a PCP outside the radius.
Note: This warning only occurs in the professional forms user interface, not in Self-Service Benefits.
Save your work.
Choose the Option Restrictions button to open the Plan Primary Care Provider Restrictions window if the Plan has options. It is mandatory to enter the restrictions at the option level for the plans with options in order to retain/drop the PCP in the subsequent life event.
Note: For example, if a participant who elects participant only coverage is not required to select a PCP, but a participant who elects employee plus spouse coverage is required to select a PCP for dependent coverage, you would need to specify designation restrictions at the option level, instead of the plan level.
Select the option for which you are specifying PCP designation requirements in the Options field.
Select a Designation Code to indicate if a participant who enrolls in this option is required to select a PCP, or if PCP selection is optional.
Select a Dependent Designation Code to indicate if a participant who enrolls in this option is required to select a PCP for each dependent covered by the plan, or if PCP selection is optional.
Save your work and close the Plan Primary Care Provider Restrictions window.
Choose the Plan Restrictions button if the requirements for designating a primary care provider for this plan vary based on the primary care provider type (such as Gynecology or Pediatric Medicine) and the age or gender of the benefits participant.
Note: The Plan Restrictions button is only activated if you check the From Repository field.
Select a primary care provider type for which you are specifying PCP designation requirements based on the age or gender of the benefits participant.
You maintain primary care provider types using the Lookup Type BEN_PCP_SPCLTY if your primary care providers are stored in an external repository. Use the Lookup Type BEN_PRMRY_CARE_PRVDR_TYP if your PCPs are not stored in a repository.
Enter a Minimum Age if the participant must be of a minimum age or older to select this provider type, such as a geriatric care provider.
Enter a Maximum Age if the participant must be of a maximum age or younger to select this provider type, such as a pediatric care provider.
Select a Gender Allowed Code of Female or Male to restrict the selection of this provider type to one gender, such as female for a gynecology provider.