Description
Validate nonnegative listedCost, excludedCost, priorExclusionCost, and compatible overlappingExclusions.
Health-benefit calculations depend on explicit eligibility flags, coverage periods, caps, exclusions, and payment order. Applying supplied arithmetic is separate from determining actual insurance terms or a legally payable claim.
Validate nonnegative listedCost, excludedCost, priorExclusionCost, and compatible overlappingExclusions.
When to use this tool
Use Benefit Package Exclusion Base when you need one transparent benefit or reimbursement component under a declared rule.
How to use the tool and how it works
- Enter listedCost, excludedCost, overlappingExclusions, priorExclusionCost. Use the units and conventions below.
- Run the tool. Correct any format, range, or cross-field input error before interpreting the output.
- Read eligibleCost, uniqueExcluded. Use the output convention below.
Validate nonnegative listedCost, excludedCost, priorExclusionCost, and compatible overlappingExclusions. Subtract their union for eligibleCost and report uniqueExcluded.1
| Input field | Meaning and units | Accepted input |
|---|---|---|
| listedCost | Listed Cost | Required. Finite number; minimum 0. |
| excludedCost | Excluded Cost | Required. Finite number; minimum 0. |
| overlappingExclusions | Overlapping Exclusions | Required. Finite number; minimum 0. |
| priorExclusionCost | Prior Exclusion Cost | Required. Finite number; minimum 0. |
| Output field | Interpretation | Returned shape |
|---|---|---|
| eligibleCost | Eligible Cost | Required. Finite number. |
| uniqueExcluded | Unique Excluded | Required. Finite number. |
{
"input": {
"listedCost": 100,
"excludedCost": 20,
"overlappingExclusions": 5,
"priorExclusionCost": 10
},
"output": {
"eligibleCost": 75,
"uniqueExcluded": 25
}
}Limitations and assumptions
- All costs share currency and scope; supplied exclusions and overlap do not establish insurance coverage, legal entitlement, or reimbursement rights.
- Inputs must satisfy both the field types and the cross-field conditions above. Invalid input causes an error; a successful false flag or documented placeholder is a different result.
- Numeric calculations use binary floating point unless exact decimal-integer arithmetic is explicitly stated. No hidden measurement tolerance or decimal rounding is added; nonfinite or out-of-contract results are rejected. Numeric signed-zero results are exported as zero.
Alternative or Complementary methods
Confirm policy terms, verified enrollment, claim eligibility, and appropriate accounting or legal interpretation before relying on a payment result.
References
Similar or alternative tools
- Benefit Package Exclusion Token Pair
Compare serviceCode with included and excluded lists literally.
- Insurer Out Of Pocket Remaining Cap
Clip cap-previousEligible at zero, apply remaining cap capacity to claimEligible for the patient portion, and place excess eligible claim cost in coveredByCap.