Benefit Catalog Item
Individual item of a benefits, services, and fees catalog.
A benefit catalog item is a description of data that is used for the following:
Documentation of a benefit or service
Cost reimbursement / compensation calculation
Standardized communication between service providers and insurance carriers
Benefit catalog items provide you with the following functionality:
Capturing claim items by way of benefit catalog items
Automatic determination of benefit type for settlement purposes
Automatic determination of information via evaluation quantities and/or prices
Check on whether benefit catalog items exist
Checks on benefit catalog contents (like whether an item is reimbursable)
You have the following options for making a benefit catalog item available to the Claims Management system:
You can import external benefit catalog items, and change and enhance them if necessary.
For more information, see Creating a Benefit Catalog Item via Direct Input.
You can create own benefit catalog items.
Structure
Attributes of a Benefit Catalog Item
The benefit catalog specifies the possible attributes of the individual benefit catalog item, meaning that all benefit catalog items in a benefit catalog have the same attributes.
There are two types of attributes, namely standard attributes specified by SAP and additional attributes defined by customers:
Standard attributes
The SAP standard delivery attributes include:
External/technical number
Short and long text
Validity period
Catalog item type
Evaluation
For the evaluation of a benefit catalog item, you can enter a quantity and a value per unit.
You can also use the following for the evaluation:
BRFplus expression that changes the specified or calculated price again
For more information, see the documentation of data element ICL_SERVCAT_CALCULATION_EXP_D.
BRFplus expression that controls which text module is displayed in the differences log.
For more information, see the documentation of data element ICL_SERVCAT_TEXT_SAMPLE_EXP_D.
Tax information and simulation of tax
You can assign a tax variant to each benefits/services catalog item. When you create an invoice with benefit catalog items during claims processing, the system transfers the relevant tax variant to the invoice.
When editing the benefit catalog item you can simulate the tax calculation. To do so, choose the
Simulate Tax Calculation
pushbutton.Benefit type
Different indicators, such as lock indicator, or reimbursability
Additional attributes
In addition to those standard attributes specified by SAP, you can add own attributes. To do so, perform the following Customizing activities:
Enhance Benefit Catalog Attributes
Define Benefit Catalog Attributes for Each Benefit Catalog
These additional attributes are user-defined text information that is not checked by the system by default.
Point values for calculation of the price
You can use point values to calculate the price of a benefit catalog item. This gives you greater flexibility with the prices of benefit catalog items.
If you use point values, the price of the benefit catalog item comprises one or several assigned subservices or standalone services. These subservices or standalone services are themselves items of another benefit catalog. You can only assign items that belong to a benefit catalog with composite services.
The system calculates the total price of the composite service as follows:
Total of products (price of subservice that is assigned to the composite service * point value that is assigned to the subservice), where n subservices are assigned to a composite service.
Composite service Z comprises the subservices A, B, and C.
Subservice A: Price (= USD 15) * Point Value (= 3) = 45
Subservice B: Price (= USD 20) * Point Value (= 3) = 60
Subservice C: Price (= USD 15) * Point Value (= 2) = 30
The total amount of the composite services is therefore USD 135 (45 + 60 + 30).
If you want to use point values, you must do the following in Customizing:
You must flag the benefit catalogs that comprise composite services. In Customizing activity
Define Benefit Catalogs
in theCatlg Type
field (type of benefits, services and fees catalog), choose the value Composite Services (path:
SAP Insurance
Claims Management
Master Data
Benefits, Services and Fees Catalogs
Define Benefit Catalogs
).You must assign a corresponding screen sequence to a benefit catalog with the composite services (Customizing path:
SAP Insurance
Claims Management
Master Data
Benefits, Services, and Fees Catalogs
Define Screen Sequences for Benefits/Services/Fees Catalogs
). SAP provides the screen sequence ICLB06 for this purpose.
Screen sequences
Using the screen control of the Business Data Toolset (BDT) you can configure the screens for maintaining benefit catalog items to suit your own requirements.
You define the screen sequences in Customizing activity Define Screen Sequences for Benefits/Services/Fees Catalogs
. This screen sequence is then valid for all benefit catalog items of the relevant benefit catalog.
Versioning
In contrast to benefit catalogs, benefit catalog items have versioning.
If you change a benefit catalog item (such as the evaluation quantity), the system creates a new version of the benefit catalog item with the status of Active
. The old version of this benefit catalog item is given the status of Inactive
, but it remains in the system for existing claims.
By default, the system uses in claims processing the version of a benefit catalog item that is or was valid at the time of the claim (date of loss). You can also use BRFplus expressions to determine this validity date. Define the relevant BRFplus expressions in Customizing activity Configure Internal Claim Types
at the level of Claim Item Group
under Permitted Subclaim Types
Permitted Claim Item Grouping Categories
in the fields VR Key Date From
and VR Key Date To
.
Example
A benefit catalog item in accident insurance is:
Dismemberment schedule – Loss or functional impairment of an eye
with the following attributes, for example:
Long text: One eye
Evaluation quantity: 50% (indicates the degree of disability)
Benefit type: 5ACC_INV