Defining a Level Funded Pricing Rule for a Bill Group

Prerequisites

To define a level funded pricing rule for a bill group, you should have:

  • Pricing rule type where the category is set to Level Funded.

  • Price items associated with the level funded pricing rule type.

  • Specific stop-loss pricing rule of the parent customer, whose accumulation parameters you want to inherit for level funding.

  • Policy status defined in the application.

Procedure

To define a level funded pricing rule for a bill group:

  1. Search for the Administrative Services Only (ASO) person, whose person type is set to Bill Group, in the Customer 360° View screen.
  2. In the Search Results section, click the View (The View Icon) icon corresponding to the person whose pricing details you want to view.
    The Person tab appears in the Customer 360° Information screen.
  3. Click the Pricing tab.
    The Pricing tab appears.
  4. Click the Broadcast (The Broadcast Icon) icon in the Bill Group ASO Policy Information zone, corresponding to the Bill Group Information column, whose bill group details you want to view.
    The Bill Group ASO Policy Pricing Rules zone is displayed.
  5. Click the Add link in the upper right corner of the Bill Group ASO Policy Pricing Rules zone.

    The Pricing Rule screen appears. It contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Person Name Indicates the name of the parent customer. Not applicable
    Person Type Indicates the type of the parent customer.
    Note: If you are defining the pricing rule type for the parent customer, then the person type will be Parent Customer.
    		 Not applicable
    Pricing Rule Type Used to indicate the pricing rule type using which you want to create a level funded pricing rule.
    Note: Select the Level Funded Pricing Rule Type option, as the pricing rule.
    		 Yes
    Note: If the pricing rule type is not selected then the application displays an error message.
    Pricing Group Used to indicate the pricing group which is used while defining the pricing. No
    Policy Status Used to indicate the policy status for the pricing rule. The valid values are:

    • In Force/Active

    • Runout

    		 Yes (Conditional)
    Note: Policy Status is required once the Pricing Rule Type is selected.
  6. Click OK.

    The Level Funded (LF) Pricing Rule screen appears. It contains the following sections:

    • Customer Information - Displays the information about the bill group. It contains the following columns:

      Column Name Column Description
      Bill Group Information Displays the bill group information.
      Policy Start Date Displays the date from when the policy is effective.
      Policy End Date Displays the date till when the policy is effective.
      Policy Status Indicates the policy status for the pricing rule.
      Pricing Rule Type Indicates the pricing rule type for whom the level funded pricing rule is created.

    • Main - Used to specify basic details in the level funding pricing rule.

    • Accumulation Criteria - Used to define the accumulation criteria in a level funded pricing rule.

    • Pricing Information for rule type category : Claim - Used to define the line items in a particular claim pricing rule or those which are associated with the level funded rule type category.

    • Pricing Information for rule type category : Ancillary - Used to define the line items in a particular ancillary pricing rule or those which are associated with the level funded rule type category.

    • Pricing Information for rule type category : Discount - Used to define the discount arrangement pricing rule which is effective for level funding calculations.

    • Pricing Information for rule type category : Retention - Used to define the retention pricing rule which is effective for level funding calculations.

    • Characteristics - Used to define the characteristics for the level funded pricing rule.

    Note:

    The Accumulation Criteria, Pricing Information for rule type category: Claim, Pricing Information for rule type category: Ancillary, Pricing Information for rule type category: Discount, and Pricing Information for rule type category: Retention section appear when you specify a price item in the Main section.

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Price Item Used to indicate the price item for which you want to define the level funded pricing rule. Yes
    Parent Customer's Pricing Rule Used to indicate the date range of each specific stop-loss pricing rule, defined for the parent customer.
    Note: On selecting the specific stop-loss pricing rule of the parent customer, the level funded Pricing Start Date and Pricing End Date field is set automatically.
    		 Yes
    Pricing Start Date Used to specify the date from when the level funded pricing rule is effective.
    Note: The pricing start date cannot be later than the pricing end date.
    		 Not applicable
    Pricing End Date Used to specify the date till when the level funded pricing rule is effective.
    Note: The pricing end date cannot be earlier than the pricing start date.
    		 Not applicable
    Rate Option Used to indicate the rate option that you want to use while defining the pricing for the price item. Yes
    Settlement Fund Price Item Used to indicate the price item derived from the level funded pricing rule type, used to create the level funded pricing rule type. Not applicable
  7. Enter the required details in the Main section.
  8. Define the accumulation criteria in the level funded pricing rule for a bill group.
  9. Define the pricing information for the claim rule type category for a bill group.
  10. Define the pricing information for the ancillary rule type category for a bill group, if required.
  11. Define the pricing information for the discount rule type category for a bill group, if required.
  12. Define the pricing information for the retention rule type category for a bill group, if required.
  13. Define characteristics for the level funded pricing rule for a bill group, if required, if required.
  14. Click Save.
    The level funded pricing rule is defined for a bill group.

Related Topics

For more information on... See...
How to search for a parent customer Searching for a Person
Parent Customer Pricing Rules zone Parent Customer Pricing Rules
How to define accumulation criteria in a level funded rule for a bill group Defining Accumulation Criteria in a Level Funded Pricing Rule
How to define claim pricing information in a level funded pricing rule Defining Claim Pricing Information in a Level Funded Pricing Rule
How to define ancillary pricing information in a level funded pricing rule Defining Ancillary Pricing Information in a Level Funded Pricing Rule
How to define discount pricing information in a level funded pricing rule Defining Discount Arrangement Pricing Information in a Level Funded Pricing Rule
How to define retention type claim based and/or retention type enrollment based pricing information in a level funded pricing rule Defining Retention Type Claim Based and/or Retention Type Enrollment Based Pricing Rule Information in a Level Funded Pricing Rule
How to define a characteristic for the level funded pricing rule for a bill group Defining a Characteristic for a Level Funded Pricing Rule