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Calculating Benefits Eligibility

To determine a customer's eligibility for services, the field agent typically asks the customer a series of scripted questions and records the answers. Assessment information can be collected using Assessments, Siebel SmartScript or Siebel eAdvisor. These tools capture assessment data that is then used to match a customer with one or more benefit fulfillment programs. In instances where the rules governing benefits delivery are highly complex, integration to back-office calculation systems or eligibility determination systems is required.

The final eligibility determination is made by a qualified field agent or manager who completes the evaluation based on program rules. The benefits determination also can be made using Siebel UAN to integrate with existing legacy rules systems that determine benefits.

To perform assessments and determine benefits eligibility, you can employ the methods described in the following topics:

• Using Siebel SmartScript to Gather Benefits Assessment Information
• Using eAdvisor to Manage a Benefits Eligibility Assessment
• Assessment of Benefits Using Templates and Activities