Editing a Policy

Prerequisites

To edit a policy, you should have:

  • Values defined for the C1-SourceSystemLookup extendable lookup

    Note: This prerequisite is applicable only when you want to define a fully-insured group policy.

  • Values defined for the RUNOUT_​ADM_​OPT_​FLG lookup field

    Note: This prerequisite is applicable when you want to define a self-funded policy.

Procedure

To edit a policy:

  1. Search for the policy in the Policy screen.
  2. In the Search Results section, click the link in the Policy Information column corresponding to the policy whose details you want to edit.
    The Policy screen appears.
  3. Ensure that the Main tab is selected.
  4. Click the Edit button in the Policy zone.

    The Policy screen appears. It contains the following sections:

    • Main - Used to specify the basic details about the policy.

    • Persons - Used to associate persons with the policy.

    • Characteristics - Used to define the characteristics for the policy.

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Policy Information Displays information about the policy. Not applicable
    Policy Type Indicates the policy type using which the policy is defined. Not applicable
    Status Indicates the status of the policy. The valid values are:

    • Pending

    • In Force/Active

    • Runout

    • Post Runout

    Note: This field appears when you are editing a policy which is created using a policy type where the policy category is set to Self-Funded.
    		 Not applicable
    Policy Number Used to specify the policy number. Yes
    Description Used to specify the description for the policy. Yes
    Source System Used to indicate the external system from where the policy is originated.
    Note: This field appears when you are editing a policy which is created using a policy type where the policy category is set to Fully-Insured Group or Fully-Insured Individual.
    		 Yes
    Start Date Used to specify the date from when the policy is effective.
    Note:

    The policy start date cannot be later than the policy end date.

    You cannot change the start date of a self-funded policy when it is in the In Force/Active, Runout, or Post Runout status.

    		 Yes
    End Date Used to specify the date till when the policy is effective.
    Note: The policy end date cannot be earlier than the policy start date.

    You cannot change the end date when the self-funded policy is in the Runout status.

    You cannot set the end date of a self-funded policy to a date which is later than or equal to the start date of a pricing rule which is defined for the Runout status.

    You cannot change the end date when the policy is renewed.

    		 Yes
    Runout End Date Used to specify the date when the runout period of the self-funded policy ends.
    Note: This field appears when you are editing a policy which is created using a policy type where the policy category is set to Self-Funded.

    The runout end date cannot be earlier than or equal to the policy end date.

    The runout end date cannot be earlier than or equal to the system date when the policy is in the Runout status.

    You cannot remove the runout end date when the policy is in the Runout or Post Runout status.

    You cannot set the runout end date to a date which is later than or equal to the start date of a pricing rule which is defined for the Post Runout status.

    You cannot set the runout end date to a date which is earlier than the end date of a pricing rule which is defined for the Runout status.

    		 No
    Runout Administration Fees Used to indicate whether the administration fees must be charged when the claim transaction for the self-funded policy is processed in the runout period. The valid values are:

    • None

    • Percentage of Claim

    Note:

    At present, this field is used only for the informational purposes and is not considered during the billable charge creation for the claim transactions which are received in the runout period of the policy.

    This field appears when you are editing a policy which is created using a policy type where the policy category is set to Self-Funded.

    		 No
    Advance Level Funding Eligibility Indicates whether the self-funded policy is eligible for the advance billing feature of level funding.
    Note:

    This is a read-only field. By default, the value is set to No. You can edit the advance level funding eligibility only through a health care inbound message.

    This field appears when you are defining a policy using a policy type where the policy category is set to Self-Funded.

    		 Not applicable
    Advance Deposit Applicability Used to indicate whether the advance deposit is applicable for the policy.
    Note:

    This field is required only when the advance deposit level of the respective policy holder (i.e., parent customer) is set to PG. However, this field is not mandatory.

    This field appears only when you create a policy using a policy type where the policy category is set to Fully-Insured Group.

    		 No
    Advance Deposit Amount Used to specify the advance deposit amount.
    Note:

    You must specify a positive value in this field.

    This field appears only when you create a policy using a policy type where the policy category is set to Fully-Insured Group

    .
    		 Yes (Conditional)
    Note: This field is required when the Advance Deposit Applicability option is selected.
    Advance Deposit Grace Days Used to specify the grace days. The system then uses the grace days to derive the grace period within which the advance deposit should be received from the group customer for the policy. While calculating the grace period, the system considers the policy start date as the grace start date. Once the grace start date is derived, the system calculates the grace end date (i.e., grace start date + grace days). For example, if a parent customer is the policy holder of the P1 policy (01-Jan-2022 to 31-Dec-2022) and advance deposit grace days is set to 6 days, then the system considers 01-Jan-2022 as the grace start date and sets the grace end date to 07-Jan-2022.
    Note:

    You must specify an integer value in this field.

    This field appears only when you create a policy using a policy type where the policy category is set to Fully-Insured Group.

    		 Yes (Conditional)
    Note: This field is required when the Advance Deposit Applicability option is selected.
    Advance Deposit Account Used to indicate the account of the parent customer where the advance deposit is parked for the policy.
    Note:

    This field appears only when you create a policy using a policy type where the policy category is set to Fully-Insured Group.

    You must specify an account with the account relationship type that is specified in the Advance Deposit Account Relationship Type attribute of the delinquency process preference. The system considers the delinquency process preference which is specified in the Delinquency Process Field Mapping option type of the DELINPROC feature configuration. For more information about the feature configuration, see Setting the DELINPROC Feature Configuration.

    The Search (The Search Icon) icon appears corresponding to the Advance Deposit Account field. On clicking the Search icon, the Account Search window appears.

    		 Yes (Conditional)
    Note: This field is required when the Advance Deposit Applicability option is selected.
    Note:

    The Edit button appears when a policy of the respective category is in either of the following status:

    Policy Category Status
    Fully-Insured Group or Fully-Insured Individual

    • In Force/Active

    • Canceled

    • Pending Cancellation

    • Pending

    • Pending Reinstatement

    • Pending Termination

    • Terminated
    Self-Funded

    • In Force/Active

    • Pending

    • Runout
  5. Modify the required details in the Main section.
  6. Associate the persons with the policy, if required.
    Note: While editing a policy, you must ensure that one person is associated as the main customer of the policy.
  7. Define, edit, or remove characteristics of the policy, if required.
  8. Click Save.
    The changes made to the policy are saved.

Related Topics

For more information on... See...
How to search for a policy Searching for a Policy
Policy screen Policy (Used for Viewing)
Policy zone Policy
How to associate a person with a policy Associating a Person with a Policy
How to define a characteristic for a policy Defining a Characteristic for a Policy