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Siebel eHealthcare Guide > Group Policies > End-User Procedures >

Designing Plans for Group Policies

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End users can design plans for group polices by adding information about products, product classes, and rate bands. A rate band is pricing information about the deductible, the premium, and the payroll deduction for each insurance product. The following lists are available in the Plan Design view:

Product Attributes. This view contains the Plan Design Product list and the Attributes list. Use the Plan Design Product list to associate a product with the policy that appears in the Group Policy form. Use the Attributes list to view attribute information and change attribute values.
Product Classes. This view contains the Plan Design Product list and the Classes list. Use the Classes list to select employee classes that you want to associate with the selected product.
Product Class Matrix. This view contains the Plan Design Product Class Matrix list. In this list, you associate an employee class with the selected product.
Product Class Rate Bands. This view contains the Plan Design Product Class Rate Band list. Use this list to associate a rate band with the selected product/class.

To add a plan design

From the application-level menu, choose View > Site Map > Group Policies > My Policies/Quotes.
In the Policies/Quotes list, select a group policy and click the Plan Design view tab.

The Plan Design Products list appears, showing the selected policy.

NOTE:  If you need to add a product, in the Plan Design Products list, click New and complete the fields.

From the Show drop-down list, select Product Attributes and scroll down to the Attributes list.
In the Attributes list, change the appropriate information.
From the Show drop-down list, select Product Classes and scroll down to the Classes list.
In the Classes list, click New to associate an employee class with the selected product.
In the Class Name field, click the select button.
In the Pick Class dialog box, select an employee class from the Class Name field and click OK.

NOTE:  Only employee classes available for the selected product appear in the Pick Class dialog box. You can add employee classes to the list in this dialog box by using Adding Employee Classes.

From the Show drop-down list, select Product Class Matrix.
In the Product Class Matrix list, click the appropriate product column for each class.

A check mark appears to indicate your selection.

NOTE:  To delete a check mark, click it.

From the Show drop-down list, select Product Class Rate Bands.
In the Product Class list, select a record with the appropriate product and class and scroll down to the Rate Bands list.
In the Rate Bands list, click New to associate a rate band with the selected product and class.
In the Rate Bands field, click the select button.
In the Pick Product Rate Bands dialog box, select a Rate Band and click OK.

NOTE:  Only available rate bands for the selected product appear in the Pick Product Rate Bands dialog box. Rate Bands are created in the Insurance Administration > Health and Group Products view. For more information about how to add Rate Bands, see Adding Rate Bands.

NOTE:  To generate a proposal for this plan, see Generating Proposals.

How Enrollment Waiting Periods Impact the Start of Coverage

You can control how Siebel eHealthcare calculates the start of coverage by defining the enrollment waiting period in the Group Policies screen. When you add a Plan Design, you define Product Classes that you then associate with a specific product. In the Classes list you can specify the Waiting Period, that is the number of days that must pass prior to the start of coverage. The actual start of coverage appears in the Effective Date field in the Group Policies, Enrollment view. The Waiting Period you specify in the Plan Design, Classes list directly impacts this Effective Date.

By default, Siebel eHealthcare has the following defined rules:

If a Waiting Period is specified, the Effective Date is set to the number of waiting days from today's date.
If a Waiting Period is not specified, the application checks today's date. If that date is before the 15th of the month, the Effective Date is set to the first of the month. If that date is after the 15th of the month, the Effective Date is set to the first of the following month.

When a user enrolls a new member in the Group Policy, Enrollment view, the Effective Date field defaults to a value based on these two rules and the application sets the Status field to Waiting.

The FINS Member Enrollment Rules Workflow enforces these rules. Users can invoke this workflow by submitting a Repeating Component Request that repeats every 24 hours in batch mode. It will check the Effective Date of existing enrollment records and update the Status from Waiting to Active if:

The Effective Date of a record is less than or equal to today's date
The Status is still set to Waiting

For more information, see Siebel Server Administration Guide.

To view the FINS Group Policy Member Benefits business component

In Siebel Tools, lock the appropriate project.
In the Object Explorer, click the Business Component folder to expand the hierarchical tree.
Search for FINS Group Policy Member Benefits.
In the Object Explorer, click the Fields folder.
Locate the following fields:
Effective Date Cal. This field calculates the Waiting Period.
Effective Date Cal Date. This field determines when coverage begins based on the values in Effective Date Cal field.

For more information, see Developing and Deploying Siebel eBusiness Applications and Siebel Tools Reference.

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