Adding a Group Policy (Individual)

These instructions should be used when adding Group policy coverage for an Individual. You can add a Group policy from the Individual Profile, Case or Service File.

A Group policy offers the same rates of coverage (i.e. the number of authorized Service Units, specific Service Units, date and dollar limits) to everyone who has the policy.

Employee Assistance Programs (EAPs) and grant funding are typically handled using a Group policy.

Adding a Group Policy – Individual Profile

1. Navigate to the client’s Individual Profile.

2. Click on the Policy tab.

   

3. Click Add.

   

4. In the Funder field begin typing the name of the Funder and select from the Suggested Lookup options.

   

5. From the Select a Policy list choose the required Group Policy template. Group policies are denoted by the Group prefix.

   

6. Click Next.

7. Complete the required Policy Member fields (details on each field below). Depending on your Penelope configuration you may also have the option to enter a Funder Department.

   

8. Click Next.

9. On the Group Policy Summary page confirm all details are correct and click Finish.

   

You will now need to add the policy to the applicable Service. If the Service has already been added you can do this by adding the policy to the Billing Sequence. Alternatively, add the Service and then add the policy to the Billing Sequence.

Group Policy Field Details

Policy Member Fields

Policy Name – Displays the Policy Name.

Active – Ensure the Active box is selected.

Relation – Displays the relationship of the client to the Policy Holder.

Member No. By – Choose how the Policy Member will be identified (Payor, NII or SSN).

Member No. – If applicable type the client’s Policy Member number.

Group No. – If applicable type the client’s Policy Group Member number.

Funder Department – If applicable enter the client’s Funder Department.

Notes – Type any notes about the Policy Member.

Adding a Group Policy – Case and Service File

1. From the Case or Service File click Billing Information from the right-hand side menu.

2. Select the Individual to be covered from the drop-down.

3. Follow steps 4-9 as above.

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   ADD A GROUP POLICY

   THE BASICS

   This type of policy offers the same rates of coverage (i.e. number of authorized units, as well as date and dollar limits) for each individual who belongs to the policy.

   Employee Assistance Programs (EAPs) and grant funding can typically be handled as group policies.

STEP 1

On the Funder Profile page, open the Group Policy Setup sidebar and click ‘Add.’

STEP 2

Enter a Policy Name. This is the name workers will select when associating the policy with each client.

STEP 2

If you have entered collateral contacts for the funder, you can choose the main contact in relation to this policy from the dropdown here. Leave blank if no collateral contacts have been entered for this funder.

STEP 3

Choose the Policy Type. This drop-down list is configured by your system administrator.

STEP 4

Check the Active box to make sure the policy is active in Penelope.

STEP 5

Disable FFS means ‘Disable Fee for Service.’ Most likely, this will be checked – if it is not, then Penelope will look to charge the client a FFS amount wherever there is a difference between the full charge for a service unit in the system and whatever the coverage rates (including co-pay) are in a given policy.

STEP 6

Disable Fee Override = disable the ability to set a service unit fee override for any FFS amount charged to the client. Disable SS = disable the Sliding Scale applied to FFS amounts charged to the client. If Disable FFS is checked, these two can be left unchecked as they will be not applicable.

STEP 7

Check the Confirmed box if the details of the policy have been confirmed.

STEP 8

For EAP contracts, choose between inclusive and non-inclusive for type of contract. Inclusive means the funder will not be billed for each service covered under the policy (i.e. they pay a set amount no matter the value of the actual services provided). Noninclusive means the opposite.

STEP 9

For EAP contracts only, choose whether the policy will cover services for employees or the company itself (corporate). If the funder is not marked as an EAP funder on their profile, this option will not be shown.

STEP 10

Enter any applicable notes here, then click Next.

STEP 11

Because everyone has the same coverage under a group policy, the following steps cover how to add the coverage. For Step 11, check the Active box to make sure the coverage is active in the policy.

STEP 12

If applicable, enter the authorization number for the coverage here. If no such number exists, leave this field blank.

STEP 13

Check the Confirmed box if the details of the coverage have been confirmed with the funder.

STEP 14

If the funder agrees to pay a percentage of the fee even if a client is a no show, then enter that percentage here. Otherwise, leave at zero.

STEP 15

Here you can set the parameters of the coverage under this policy, including any item (service unit) limits, date range limits for the coverage and / or dollar limits. Keep in mind the dollar limit is for each individual covered under the policy, not the total amount for the policy itself.

STEP 16

Enter any applicable notes here, then click Next.

STEP 17

From the Service Unit drop-down, select an item covered by this policy. For each item, add the coverage rate and co-pay. If there is no co-pay, enter 0 in the co-pay box.

STEP 18

SSQ Rate means subsequent payer rate. If the funder agrees to be a subsequent payer, check the SSQ Rate box and enter the appropriate rate(s) here. If not, leave unchecked. Click the ‘plus’ button to add each item to the coverage. Continue adding items until you are finished. Click next.

STEP 19

The Group Policy Setup Summary page allows you to review what you entered when setting up the policy. To make any changes, click the back button at the bottom of the screen and update the appropriate fields (you will not lose any information you have already entered). If you are finished, click the Finish button at the bottom of the screen.

The group policy is created.