Retention Type Enrollment Based Pricing

Some of the charges, such as stop-loss premium, administrative fees, etc. are typically calculated based on the number of enrollments. In addition, the ASL limit can also be based on the number of enrollments for the month. These charges can be calculated using the retention type enrollment based pricing rules.

You can define a retention type enrollment based pricing rule at the parent customer and bill group levels. The retention type enrollment based pricing rule at the bill group level takes precedence over the retention type enrollment based pricing rule at the parent customer level. You can define retention type enrollment based pricing rules for parent customers and bill groups from the Customer 360° Information screen. You can define a retention type enrollment based pricing rule using a retention type enrollment based pricing rule type. It is the retention type enrollment based pricing rule type which helps the system to determine:

  • Business object using which the retention type enrollment based pricing rule should be created in the system.

  • Whether it is the primary pricing rule type.

Note: You must select the Primary option while defining a retention type enrollment based pricing rule type. On selecting the Primary option, the Related Pricing Rule Types and Transaction Field Mapping sections appear in the Retention Type Enrollment Based Pricing Rule Type screen. At present, the system does not allow you to define any pricing rule type which inherits the attributes from the retention type enrollment based pricing rule type.

  • Transaction fields from where the data for retention type enrollment based processing should be retrieved.

  • Algorithm which should be triggered while validating a transaction.

Note: An algorithm type for validating a transaction is not shipped from the product. You need to create a custom algorithm type, if required.

  • Algorithms which should be triggered while deriving bill group, account, and price item for a transaction.

Note: You must create an algorithm using the C1_​TXNBGDRV algorithm type and attach it to the Bill Group Derivation system event. Similarly, you must create an algorithm using the C1_​ACCPRIDRV algorithm type and attach it to the Account and Price Item Derivation system event.

  • Algorithm which should be triggered while determining the bill after date.

Note: You must create an algorithm using the C1_​BAFTDRV algorithm type and attach it to the Bill After Date Determination system event. The C1_​BAFTDRV algorithm sets the bill after date to the end date of the aggregation schedule which is specified in the respective rate option. For example, if the aggregation schedule is monthly, the bill after date is set to the last day of the month.

  • Post-processing algorithm which should be triggered once the retention type enrollment based pricing rule is derived.

Note: A post-processing algorithm type is not shipped from the product. You need to create a custom algorithm type, if required.

  • Price items for which you can define retention type enrollment based pricing rules using the retention type enrollment based pricing rule type.

  • Rate options that you can use while defining the pricing for a price item.

  • Different type of account to which the price item should be billed based on the specified priority.

  • Price item parameters which you can use while defining retention type enrollment based pricing rules.

  • Additional information, such as:

    • Whether the price items included in the retention type enrollment based pricing rule type are used while accumulating specific stop-loss and aggregate stop-loss.

    • Retroactivity indicator which helps to determine whether the enrollment transaction is retro or non-retro transaction.

Once a retention type enrollment based pricing rule type is defined, you can create retention type enrollment based pricing rules using the retention type enrollment based pricing rule type. While defining a retention type enrollment based pricing rule for a parent customer and bill group, you need to specify the following:

  • Price item for which you want to define the pricing.

  • Pricing date range during which the pricing is effective.

  • Rate option which you want to use while defining the retention type enrollment based pricing.

  • Whether you want to exempt the retrospective transactions while calculating retention type enrollment based fees.

  • Price item parameters based on which you want to define the pricing.

Note: You can only use those price item parameters which are included in the respective retention type enrollment based pricing rule type.

  • Price item parameters based on which you want to define the pricing.

Note: You can only use those price item parameters which are included in the respective retention type enrollment based pricing rule type.

  • Flat fee which you want to charge for a price item and price item parameters combination.

The system enables you to define different flat fee for different set of price item parameters combination. For example, you can define one flat fee for the enrollment transactions where health coverage class is set to Medical and health coverage tier is set to Family and another flat fee for the enrollment transactions where health coverage class is set to Dental and health coverage tier is set to Employee.

Once a retention type enrollment based pricing rule is defined for a parent customer and bill group, the system creates one price assignment for each set of price item parameters combination, one price list, and one price list assignment.

Related Topics

For more information on... See...
Pricing Rule Type screen Pricing Rule Type

Parent Topic: Self-Funded Pricing