Defining a Specific Stop-Loss Pricing Rule for a Bill Group

Prerequisites

To define a specific stop-loss pricing rule for a bill group, you should have:

  • Business Object C1-PricingRule defined for pricing rule.

  • Business Object C1-PricingRuleSSL defined for specific stop-loss pricing rule.

  • Pricing rule type defined in the application.

  • Policy status defined in the application.

  • Price item defined in the application.

  • Rate option defined in the application.

  • Values defined for the Reinsurer Person Relationship Type option type in the C1-ASOBLLNG feature configuration.

Procedure

To define a specific stop-loss pricing rule for a bill group:

  1. Search for the account, person, or policy whose pricing details you want to view in the Customer 360° View screen.
  2. In the Search Results section, click the View (The View Icon) icon corresponding to the account, person, or policy whose pricing details you want to view.
    The Account, Person, or Policy tab in the Customer 360° Information screen appears.
  3. Click the Pricing tab and then 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 Displays the person name. Not applicable
    Person Type Displays the person type. Not applicable
    Pricing Rule Type Used to indicate the pricing rule type to create the pricing rule.
    Note: You can create a specific stop-loss pricing rule using the Pricing Rule Type for specific stop-loss.
    		 Yes
    Pricing Group Used to indicate the pricing group. No
    Policy Status Used to indicate the policy status for pricing rule. The valid values are:

    • In Force/Active

    • Post Runout

    • Runout

    Note: Specific stop-loss pricing rule cannot be created for Runout or Post Runout policy status where the policy run out end date is missing.
    		 Yes
  4. Click OK.

    The Specific Stop-Loss (SSL) Pricing Rule screen appears. It contains the following sections:

    • Customer Information - Displays the customer information for bill group.

    • Main - Used to specify basic details about the specific stop-loss pricing rule.

    • Accumulation Criteria - Used to define the accumulation criteria in a specific stop-loss pricing rule.

    • Pricing Information - Used to define stop-loss eligibility for claim line items.

    • Characteristics - Used to define the characteristics for the specific stop-loss pricing rule.

    The Customer Information section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Bill Group Information Displays the bill group information. Not applicable
    Policy Start Date Displays the policy start date. Not applicable
    Policy End Date Displays the policy end date. Not applicable
    Policy Status Indicates the policy status for pricing rule. The valid values are:

    • In Force/Active

    • Post Runout

    • Runout

    		 Not applicable
    Pricing Rule Type Indicates the pricing rule type. Not applicable

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Price Item Used to indicate the price item.
    Note: Once an option is selected for this field, the field appears disabled.
    		 Yes
    Parent Customer's SSL Pricing Rules Used to indicate the pricing date range derived from the parent customer's specific stop-loss pricing rule.
    Note: This field is enabled for selection when an option from Price Item field is selected.
    		 Yes
    Pricing Start Date Displays the pricing rule start date.
    Note: This field displays the Policy Start Date.
    		 Not applicable
    Pricing End Date Displays the pricing rule end date.
    Note: This field displays the Policy End Date.
    		 Not applicable
    Rate Option Used to indicate the rate option to define the specific stop-loss pricing rule for the price item.
    Note: Rate options in this field appears for selection, when you select an option from the Price Item field.
    		 Yes
    Reinsurer Account Used to indicate the account of the reinsurer person (associated with the parent customer of the bill group) which you want to use for defining the specific stop-loss pricing rule for the price item. No
  5. Enter the required details in the Main section.
  6. Define accumulation criteria in a specific stop-loss pricing rule, if required.
    Note:

    The Accumulation Criteria section appears when an option from Parent Customer's SSL Pricing Rules field is selected.

    You can also define the Accumulation Criteria for each rule in a specific stop-loss pricing rule.

  7. Define stop-loss eligibility for claim line items, if required.
    Note:

    The Pricing Information section appears when an option from Parent Customer's SSL Pricing Rules field is selected.

    You can also define the Pricing Information for each rule in a specific stop-loss pricing rule.

  8. Define characteristics for a specific stop-loss pricing rule, if required.
  9. Click Save.
    The specific stop-loss pricing rule for a bill group is defined.
    Note: A price list and price assignment is created, the price list created is assigned to the specific stop-loss pricing rule.

Related Topics

For more information on... See...
Customer 360° Information - Pricing Information tab Customer 360° Information - Pricing Information
Bill Group ASO Policy Pricing Rules zone Bill Group Self-Funded Policy Pricing Rules
How to define accumulation criteria in a specific stop-loss pricing rule Defining Accumulation Criteria in a Specific Stop-Loss Pricing Rule
How to define claim pricing information in a specific stop loss pricing rule Defining Claim Pricing Information in a Specific Stop Loss Pricing Rule
How to define a characteristic for a specific stop-loss pricing rule Defining a Characteristic for a Specific Stop-Loss Pricing Rule