Pricing Rules
The fully-insured group health plan may offer various services to the employer, such as medical insurance, dental insurance, vision care, life insurance, short-term and long-term disability benefits, and so on. Oracle Revenue Management and Billing enables you to define pricing rules for various services offered in the fully-insured group health plan.
| Service | Pricing Rule | Created for.... |
|---|---|---|
| Medical Insurance, Dental Insurance, Vision Care, Life Insurance, Short-Term and Long-Term Disability Benefits, etc. | Age Based | Fully-Insured Group Policy Plan |
| Tier Based | Fully-Insured Group Policy Plan |
You can create the above mentioned pricing rules for the fully-insured group policy plans through a health care inbound message and not from the user interface. The system creates a price assignment for each pricing rule. In the age based pricing rules, you can define different premium fee for employees who belong different age band. You can also offer different premium fee for the employees with the same age band, but with the different set of attributes. The system also enables you to charge additional fee for the eligible member based on certain modifiers. For example, you can charge additional fee when the eligible member is alcoholic and/or consumes tobacco. However, in the tier based pricing rules, you can define different premium fee for employees who belong to different membership tier, such as Employee (E), Employee + Spouse (ES), Employee + Spouse + Children (F), and so on.
The system searches for the pricing rule of a price item (i.e. service) on the policy plan to which the membership belongs. If the effective pricing rule for a price item is not available on the policy plan, the system does not consider the respective price item for billing.