Most MemberPlan records arrive through an integration, but admins and developers do create and test them directly when configuring Benefits Verification or seeding a sandbox. Here is the shape of creating one by hand.
- Confirm Health Cloud and the insurance model are enabled
MemberPlan ships with Health Cloud. Make sure the org has Health Cloud provisioned and that your user has read and edit access to MemberPlan and the related CoverageBenefit objects through a permission set.
- Identify the member and the plan
Decide which patient the coverage belongs to and which plan they enrolled in. You will link the MemberPlan to the patient through the member field and reference the payer and plan details that the coverage represents.
- Create the MemberPlan record
From the MemberPlan tab or via the API, create a new record. Set the member, the plan name, the status, and the effective date range. Add the subscriber relationship if the patient is a dependent rather than the policyholder.
- Attach coverage and benefits
Run Benefits Verification or load CoverageBenefit and CoverageBenefitItem records so the copay, coinsurance, deductible, and out-of-pocket figures hang off the member plan and surface where staff need them.
The patient the coverage belongs to, linked through the Account or Contact the MemberPlan references.
A label for the member plan, often the plan or product name the patient is enrolled in.
Whether the coverage is active, inactive, or pending, which controls whether eligibility treats it as in force.
The start and end dates of the coverage, used so the platform shows only the plan active on the date of service.
- Two active MemberPlan records on the same date for one patient will produce overlapping eligibility and confuse billing. Keep effective dates clean.
- Do not confuse MemberPlan (the patient's coverage) with PurchaserPlan (the plan a sponsor offers). They sit on opposite sides of the model.
- Prefer an integration over manual entry for production data. Hand-keyed coverage falls out of date the day after a patient changes plans.