Overview
Find below a detailed list of the coverage field sets for each coverage.
Field Set List & Fields
| AB Default | Long Term Care |
| AD&D | LTD |
| Dental | Senior Health / RX |
| Drug | STD |
| Health | Vision |
| Life | Worksite Benefits |
In All Fields Sets
| Fields |
|---|
| Carrier Product Coverage Status Coverage Effective Date Coverage Premium Coverage Renewal Date Coverage Termination Policy Coverage Notes Fees |
AB Default
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Coverage Elimination/ Qualifying Period Coverage Termination Coverage Face Amount Coverage Max Benefit Benefit % (Text) |
None | Renewal % |
AD&D
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
|
Coverage Renewal % |
Annualized Premium Target Premium Benefit Reduction Primary Beneficiary (1-5) Primary Beneficiary Amount Contingent Beneficiary (1-5) Contingent Beneficiary Amount Issue Date Policy Date Pay Method |
Premium Rate ($-%) Coverage Waiting Period Renewal % New Hire Eligibility Eligibility Hours |
Dental
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Coverage Elimination Period Co-Pay $ Deductible $ Deductible (Family) $ Max out of Pocket Max out of Pocket (Family) Out of Network Costs Annual Maximum Lifetime Maximum Preventive Co-Insurance % Minor Co-Insurance % Major Co-Insurance % Orthodontic Co-Insurance % Single Rate $ Plus Spouse Rate $ Plus Child(ren) Rate $ Family Rate $ Provider Network |
Primary Care Provider Primary Care Provider ID Pay Method |
Employer Contributions for Single Employer Contributions for Family Employer Contributions for Dependents Preventive Co-Insurance % |
Drug
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
|
Coverage Renewal % |
Pay Method | Employer Contributions for Single Employer Contributions for Family Employer Contributions for Dependents Renewal % New Hire Eligibility Eligibility Hours |
Health
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
|
Coverage Renewal % |
Primary Care Provider Primary Care Provider ID Pay Method |
Coverage Waiting Period Employer Contributions for Single Employer Contributions for Family Employer Contributions for Dependents Renewal % New Hire Eligibility Eligibility Hours |
Life
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Coverage Face Amount AD&D Rider Optional Rider |
Terms Convertible Conversion Expiration Date Annualized Premium $ Flat Extra Premium $ Target Premium $ 1035 Premium $ Commissionable Annualized Premium $ Excess Premium $ Benefit Reduction Risk Class-Applied Risk Class-Approved Loans $ Loan Date Cash Value $ Cash Value Date Primary Beneficiary (1-5) Primary Beneficiary Amount (1-5) Contingent Beneficiaries (1-5) Contingent Beneficiaries Amount (1-5) Issue Date Policy Date Pay Method |
Premium Rate $-% Coverage Waiting Period Renewal % New Hire Eligibility Eligibility Hours |
LTD
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Coverage Elimination/Qualifying Period Coverage Face Amount Benefit Frequency Coverage Max Benefit Benefit % (Text) Definition of Disability Optional Riders |
Issue Date Policy Date Pay Method |
Premium Rate $ - % Coverage Waiting Period Pre-Existing Waiting Period Benefit Period Renewal % New Hire Eligibility Eligibility Hours |
Long Term Care
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
|
Coverage Renewal % |
Pay Option Annual Inflation Rate Primary Beneficiary (1-5) Primary Beneficiary Amount (1-5) Contingent Beneficiary (1-5) Contingent Beneficiary Amount (1-5) Issue Date Policy Date Pay Method |
Premium Rate $ - % Renewal % New Hire Eligibility Eligibility Hours |
Senior Health / RX
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
|
Coverage Renewal % |
Medicaid (Yes/No) Medicare Enrollment Period Separation Reason Pay Option Primary Care Provider Primary Care Provider ID Medicare Rx Plan Finder Password Date Medicare Rx Plan Finder Drug List ID Pay Method |
None |
STD
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Coverage Elimination/Qualifying Period Coverage Termination Coverage Face Amount Benefit Frequency Coverage Max Benefit Benefit % (Text) Optional Riders |
Issue Date Policy Date Pay Method |
Premium Rate $-% Coverage waiting Period Pre-Existing Waiting Period Benefit Period Renewal % New Hire Eligibility Eligibility Hours |
Vision
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Co-Insurance % Deductible $ Deductible (Family) $ Max out of Pocket Max out of pocket (Family) Out of Network costs Annual Maximum Lifetime Maximum Exam Co-Pay Eyeglass Lenses Frequency Eyeglass Lenses Co-Pay Eyeglass Frames Frequency Eyeglass Frames Co-Pay Contact Lenses Frequency Contact Lenses Co-Pay Other Discounts Single Rate $ Plus Spouse Rate $ Plus Child(ren) Rate $ Family Rate $ Provider Network |
Primary Care Provider Primary Care Provider ID Pay Method |
Coverage Waiting Period Employer Contributions for Single Employer Contributions for Family Employer Contributions for Dependents Renewal % New Hire Eligibility Eligibility Hours |
Worksite Benefits
| Both Groups & Individuals | Individual Specific | Group Specific |
|---|---|---|
| Coverage Renewal % Coverage Lives Coverage Face Amount Annual Maximum Lifetime Maximum Single Rate $ Plus Spouse Rate $ Plus Child(ren) Rate $ Family Rate |
Pay Method | Coverage Waiting Period Renewal % New Hire Eligibility Eligibility Hours |