Add Benefits Decision Support

Before You Begin: The following procedure includes several fields that you must set to add a decision support configuration. For descriptions of these fields and the coverage categories that you need to set them for, see Benefits Decision Support Coverage Categories and Benefits Decision Support Settings.

To add a decision support configuration for a medical plan:

1. Go to Benefits Setup > Benefits Decision Support.
2. Do one of the following:
   • To add the first decision support configuration for a plan, click the Add drop-down list and select Plan. In the Add Plan dialog box, select the plan for which you want to add decision support information. Dayforce adds the plan name to the left sidebar and adds the new configuration under the plan. The setup screen for the configuration shows to the right.
   • To add a subsequent decision support configuration for a plan, in the left sidebar, click the name of the plan that you want to add the configuration for. Then in the Add drop-down list, click Effective Date. Ensure that the configurations for the plan don’t have overlapping effective dates (the effective date defaults to today). Dayforce adds the new configuration to the left sidebar under the plan. The setup screen for the configuration shows to the right.
3. In the General section:
   1. Effective From: Enter or select a date.
   2. Accumulation Method: Select an option in the drop-down list.
   3. Referral Required: Select or leave the checkbox cleared.
   4. Out-of-Network Coverage Included: Select or leave the checkbox cleared.
4. In the Option Configuration section:
   1. Select the Excluded checkbox for any plan options that should be excluded from decision support.
   2. Enter an amount in the Employer HSA Contribution field for each plan option, if applicable.
   3. Select the checkboxes for the coverage tier or tiers (Employee Only, Employee +Spouse) that each option should be mapped to.
5. In the Coverage Thresholds section, set the following fields for each tier:
   1. Medical Deductible: Enter a value in the field.
   2. Rx Deductible Type: Select an option in the drop-down list.
   3. Rx Deductible: If you selected Separate Rx Deductible in the Rx Deductible Type drop-down list, enter a value in the field.
   4. Rx OOP Max: Enter a value in the field.
   5. OOP Max: Enter a value in the field.
6. In the Required Coverage Details section:
   1. Select a benefit design for each of the listed services in the In-Network drop-down list. The benefit design options are as follows:
      • Not Covered
      • Copay
      • Coinsurance
      • Combo
      • Greater of maximum:
      • Dual
      • No Charge
   2. Depending on which benefit design you've selected, Dayforce shows several fields. Set these as required. See Benefits Decision Support Settings.
7. In the Optional Coverage Details section, select the checkboxes of the services for which you want to enter coverage details. When you select a checkbox, Dayforce shows several fields. For services that you have selected, repeat step 6.
8. Click Save, and Dayforce automatically validates your configuration. If there are problems with the configuration, Dayforce shows the Please Confirm dialog box where you can either click Ignore and Save, or Cancel to review the problems. When you ignore problems and save anyway, the configuration is marked as invalid, and the plan options in that configuration aren't included in decision support in the enrollment. See Validate Benefits Decision Support Configurations.

When you add a subsequent configuration for a plan, Dayforce end-dates one of the configurations upon save, to ensure that configurations for a single plan don’t have overlapping effective dates.

After you've completed the configuration, you can enable it in an enrollment. See Enable Benefits Decision Support in Enrollments.