Class and Class Groups

Class Groups

The class group represents the entire tree node structure for a collection or arrangement of classes in the Class Group screen. The Group client must arrange classes into a class group. The arrangement may be constructed for any number of reasons, based on the client's business needs, including billing, reporting, and eligibility.

How it Works

Within the Class Group screen, the user has the ability to view a list of class groups for a given Group client. Selecting a Class Group link on the Entity Navigation list, will display the Class Group screen. The Classes tab time slice record will display a tree-structured view of the classes and their relationships for the selected class group.

The group client population is divided into classes, and each individual client becomes a member of a class. A client becomes a class member by the execution of class rules and class rule variables that "funnel" a client through the root node class (with the icon at the top of the tree) to the terminal node class (the "leaf" icon). The configuration of the class rules and variables determines each client's eligibility to be a member of the class where they are configured.

Class definitions may be created at class group and individual class level contexts. The Add Class Group and Copy Class Group buttons provide those actions.

Creating and copying class definitions includes membership rules both individually and as a complete, intact hierarchy via class groups. Membership Rules provide the logic for a member to be included in a class, as the class rules and class rule Variables are used in Client / client and Policy level transactions. See Membership Processing for information on the execution of logic rules defining how a client becomes a member of a class.

For any new class group, a root node class is created in the tree structure to support the linking of classes. In addition to the new root node class in each new class group, a default class is created as a child of the root node class. The default child class is an "orphan" class. When class membership rules are executed:

  • Every client is evaluated for membership in each one of the leaf node classes.
  • Each client who satisfies the membership rules for a class is assigned to that class.
  • Any client who does not meet the rules for any of the leaf node classes is considered an "orphan" and is assigned to the orphan class.

When a new class group is added or copied from another class group, it will shows up in the time slice list table of the Class Group screen.

Important   Copying and Creating class groups and classes operates within the same Group customer. A class group or class cannot be copied from one Group customer to another, or at the Global level.
Important   When copying a class group, all of the class group's classes, relationships, details, and membership rules are included in the new class group. The existing class members and plan coverage or segment associations are NOT included in the new classes in the new class group.

Classes

Classes represent a distinct subset of the population of clients within a Group customer. For example, dividing clients into subsets could be based on groups of employees with similar characteristics. Classes are used to perform actions on, or for, all individuals in the given subset. To make clients members of a class, activities can be configured at the Policy and Client level to execute an evaluation of membership.

The Group customer may wish to define a class structure to divide the customer's members into different populations for reporting, eligibility, or billing purposes. Other examples to divide the population might include:

  • Management
  • Non-Management
  • Union
  • Non-Union
  • Full-Time
  • Part-Time
  • Active
  • Retired
  • Payroll Location or Branch.

How it Works

Classes are developed by the Group customer. Classes must be arranged as a collection called a class group based on the Group customer's business needs. Classes established for the purpose of eligibility will have associated plans or sub-plans. Classes have members that will be eligible to enroll in the associated plans or sub-plans.

The Group customer also decides eligibility requirements for class participants or members to enroll in plans or sub-plans during the enrollment period. The logic and rules that define what makes a client a member are defined in the membership rules associated with the class. The membership rules are defined using global, Group customer, class group, and class level variables. See Membership Rules and Membership Processing for explanation of the execution of membership logic. Execution of membership rules occurs in policy and client-level activities.

Class Tree Structure

OIPA provides the ability to link classes into a tree-like structure. In each structure, there is one root node (which has no parent node) and one default orphan class node. Within OIPA, the user may copy and also create a new child class.

Each class will have one or more rules that specify the properties or criteria an individual must have in order to be included in the class. One such property for inclusion is an implied condition that the individual must be included in the class's parent for every node except the root node. It is possible for a class group to have just a single class. A member may only exist in one terminal class (which has no child node) within the class group.