---
schema_version: "1"
id: 0f34265ad52305f81750ff539d5ebf7babcae2329c28849813ee4fc7c5031ef1
title: Create Plans and Benefits
collection: admin
version: current
locale: en-us
portal_url: https://docs.salesforce.com/admin/current/en-us/ind/264-0-0/bre_hc_create_plans.md
canonical_url: https://help.salesforce.com/s/articleView?id=ind.bre_hc_create_plans.htm&release=264.0.0&type=5
source_site: help.salesforce.com
content_type: documentation
content_hash: 6ae9998b5b3335001c4f9fed000daaed5c3f6d25ab293d549424dcbf0d5d3463
description: Create Member Plans, Purchaser Plans, Coverage Benefits, and Coverage Benefit Items to ensure that the Health Cloud prior authorization workflow accurately reflects the rules and coverage details required to assess user eligibility and calculate benefits. These objects are the data sources for context definition and Business Rules Engine.
products:
  - Industry Solutions
  - Cross Cloud
release: "264"
---
# Create Plans and Benefits

Create Member Plans, Purchaser Plans, Coverage Benefits, and Coverage Benefit Items to ensure that the Health Cloud prior authorization workflow accurately reflects the rules and coverage details required to assess user eligibility and calculate benefits. These objects are the data sources for context definition and Business Rules Engine.

### Required Editions

<table class="slds-table slds-table_bordered slds-max-medium-table_stacked slds-m-bottom_small edition"><colgroup><col style="width:100%"></colgroup><tbody><tr class=""><td class="slds-cell-wrap" style="vertical-align:top;">Available in: Lightning Experience</td></tr><tr class=""><td class="slds-cell-wrap" style="vertical-align:top;">Available in: <strong>Enterprise</strong> and <strong>Unlimited</strong> Editions for clouds that have Business Rules Engine enabled</td></tr></tbody></table>

<table class="slds-table slds-table_bordered slds-max-medium-table_stacked slds-m-bottom_small permission">
        <colgroup>
          <col style="width:50%">
          <col style="width:50%">
        </colgroup>
        <thead class="slds-text-title_caps ">
          <tr class="">
            <th scope="colgroup" class="slds-cell-wrap" colspan="2" style="text-align:center;vertical-align:top;" id="d27869e67">User Permissions
              Needed</th>
          </tr>
        </thead>
        <tbody>
          <tr class="">
            <td data-label="User Permissions Needed" class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">To create member plan records:</td>

            <td class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">Health Cloud Foundation (for Health Cloud) permission set</td>

          </tr>
          <tr class="">
            <td data-label="User Permissions Needed" class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">To create purchaser plan records:</td>

            <td class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">Health Cloud Foundation (for Health Cloud) permission set</td>

          </tr>
          <tr class="">
            <td data-label="User Permissions Needed" class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">To create a coverage benefit:</td>

            <td class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">Health Cloud Starter OR Health Cloud Foundation</td>

          </tr>
          <tr class="">
            <td data-label="User Permissions Needed" class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">To create a coverage benefit item:</td>

            <td class="slds-cell-wrap" style="vertical-align:top;" headers="d27869e67 ">Health Cloud Starter OR Health Cloud Foundation</td>

          </tr>
        </tbody>
      </table>

## Purchaser Plan

1. From the App Launcher (![App Launcher](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/resources-global/_corporate/images/app_launcher_icon.png)), find and select **Purchaser Plans**.
2. Click **New**.
3. Add these details.
    - Name: Cigna Medicare Purchaser Plan
    - Payer: Cigna International
    - Plan Number: P1234567
    - Plan Type: Medicare
    - Plan Status: Active
    - Effective From: \[Current Date\]
    - Effective To: \[Future Date\]
4. Save your changes.

## Member Plan

1. From the App Launcher (![App Launcher](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/resources-global/_corporate/images/app_launcher_icon.png)), find and select **Member Plans**.
2. Click **New**.
3. Add these details.
    - Name: Cigna Medicare Advantage Plan
    - Member: Steve Smith
    - Member Number: 675858989
    - Group Number: 7878787878
    - Plan: Cigna Medicare Purchaser Plan
    - Payer: Cigna International
    - Subscriber: Victor Kent
    - Effective From: \[Current Date\]
    - Effective To: \[Future Date\]
    - Status: Active
    - Verification Status: Active - Verified
    - Relationship to Subscriber: Spouse
4. Save your changes.

## Coverage Benefit

1. From the App Launcher (![App Launcher](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/resources-global/_corporate/images/app_launcher_icon.png)), find and select **Coverage Benefit**.
2. Click **New**.
3. Add these details.
    - Name: Medicare Coverage Benefit
    - Member: Steve Smith
    - Member Plan: Cigna Medicare Advantage Plan
4. Save your changes.

## Coverage Benefit Item

1. From the App Launcher (![App Launcher](https://sf-zdocs-cdn-prod.zoominsoftware.com/tdta-ind-business_rules_engine-264-0-0-production-enus/b2d6dd5c-c231-428b-abbf-3dd2cd51a11f/resources-global/_corporate/images/app_launcher_icon.png)), find and select **Coverage Benefit Item**.
2. Click **New**.
3. Add these details.
    - Name: Cardiovascular Monitoring Services
    - Member: Steve Smith
    - Coverage Benefit: Medicare Coverage Benefit
    - Service Type Code: CPT23456
    - Save your changes.
4. Similarly, create coverage benefit items with these details.
    
    | Name | Member | Coverage benefit | Service Type Code |
    | --- | --- | --- | --- |
    | Echocardiography Procedures | Steve Smith | Medicare Coverage Benefit | CPT23457 |
    | Non-invasive Physiologic Studies and Procedures | Steve Smith | Medicare Coverage Benefit | CPT23458 |
    | TMT Test | Steve Smith | Medicare Coverage Benefit | CPT23459 |