A contract term states that implant charges are reimbursed at 90% only if the total amount of charges for implants exceeds $2,000. Otherwise implants are not reimbursed. Which extension is needed?

A contract term states that implant charges are reimbursed at 90% only if the total amount of charges for implants exceeds $2,000. Otherwise implants are not reimbursed. Which extension is needed?

• A. Group extension
• B. Selection extension
• C. Pricing extension
• D. Stopping extension

Answer: (B)

This scenario hinges on including or excluding charges based on a calculated condition, which is what a selection extension is designed to handle. A selection extension evaluates a set of charges and decides, based on criteria like a total threshold, which items should be reimbursed. Here, implant charges are reimbursed at 90% only if their combined total exceeds 2,000; if not, none are reimbursed. The selection extension can perform the sum of implant charges, check if the threshold is met, and then apply the 90% reimbursement (or exclude them) accordingly. The other extension types don’t fit this rule-driven inclusion/exclusion. A group extension applies policies to a group of charges generally, not to a conditional selection based on a subtotal. A pricing extension adjusts prices themselves, not whether items qualify for reimbursement. A stopping extension halts processing rather than implementing a conditional reimbursement rule.

This scenario hinges on including or excluding charges based on a calculated condition, which is what a selection extension is designed to handle. A selection extension evaluates a set of charges and decides, based on criteria like a total threshold, which items should be reimbursed. Here, implant charges are reimbursed at 90% only if their combined total exceeds 2,000; if not, none are reimbursed. The selection extension can perform the sum of implant charges, check if the threshold is met, and then apply the 90% reimbursement (or exclude them) accordingly.

The other extension types don’t fit this rule-driven inclusion/exclusion. A group extension applies policies to a group of charges generally, not to a conditional selection based on a subtotal. A pricing extension adjusts prices themselves, not whether items qualify for reimbursement. A stopping extension halts processing rather than implementing a conditional reimbursement rule.