Shared Costs by Group

This file contains the copayment and coinsurance applicable to each insured individual/member of a group within the policy.

Additionally, this file specifies the minimum amount required for an authorization to qualify for direct billing.

The product group codes originate from a list provided by Osigu during the integration process. Below are some examples:

#	Group Name	Description
1	generic-drug	Group containing all medications considered generic.
2	non-generic-drug	Group containing branded medications.
3	x-ray	Grouping of various diagnostic tests under the X-ray category.
4	medical-evaluation	Group covering medical evaluation services, such as general outpatient consultations or pediatrics.

Version 2

File Name: v2_gr_costs_sharings.csv

The data specified in this file will apply to each insured individual/member belonging to the indicated policy number and group.

The required fields are marked in bold.

#	Field Name	Type	Description
1	insurer_slug	String[64]	Slug of the Payer provided by Osigu.
2	policy_number	String[32]	Policy/plan number, must match a record included in the `v2_policies.csv` file.
3	group_code	String[32]	Group code belonging to the policy, specified in the `v2_groups.csv` file.
4	currency_code	String[3] using the ISO 4217	Currency code in which amounts are expressed.
5	product_group	String[128]	Name of the product/service group affected by this configuration.
6	provider_category	String[64]	Category of provider to which this configuration applies. If not applicable, use the value `DEFAULT`.
7	minimum_total_amount	Decimal(15,5)	Minimum amount required for direct billing.
8	copayment_amount	Decimal(15,5)	Fixed copayment amount in the currency applicable to the insured individual/member.
9	coinsurance_percent	Decimal(15,5)	Coinsurance percentage is applicable to the insured individual/member.

Version 3

File Name: v3_gr_costs_sharings.csv

This version includes the maximum_total_amount field as a limit for direct billing. When exceeded in a transaction, pre-authorization will be required.

The required fields are marked in bold.

#	Field Name	Type	Description
1	insurer_slug	String[64]	Slug of the Payer provided by Osigu.
2	policy_number	String[32]	Policy/plan number must match a record included in the `v2_policies.csv` file.
3	group_code	String[32]	Group code belonging to the policy, specified in the `v2_groups.csv` file.
4	currency_code	String[3] using the ISO 4217	Currency code in which amounts are expressed.
5	product_group	String[128]	Name of the product/service group affected by this configuration.
6	provider_category	String[64]	Category of provider to which this configuration applies. If not applicable, use the value `DEFAULT`.
7	minimum_total_amount	Decimal(15,5)	Minimum amount required for direct billing.
8	maximum_total_amount	Decimal(15,5)	The maximum amount allowed for direct billing without requiring pre-authorization.
9	copayment_amount	Decimal(15,5)	Fixed copayment amount in the currency applicable to the insured individual/member.
10	coinsurance_percent	Decimal(15,5)	Coinsurance percentage is applicable to the insured individual/member.

Notes

Use this file to define shared costs at the group level within a policy.
The maximum_total_amount in Version 3 helps enforce limits for direct billing, triggering pre-authorization if exceeded.
Product group codes must align with the codes provided during integration.