Sample Health Care Inbound Message for Fully-Insured Group Policy Renewal
Using the below example, you can do the following:
-
Renew a fully-insured group policy
| Person Name | Person Type | Policy Number | Plan Number | Policy Renewal Date | Policy End Date |
|---|---|---|---|---|---|
| WALSH_TYPES_CORP | Group Customer | PL_MED_HEALTH_001 | WALSH_TC_MED_PLAN_101 | 2024-01-01 | 2024-12-31 |
<schema>
<c1InboundMessage></c1InboundMessage>
<bo>C1-HCInboundMessage</bo>
<boStatus></boStatus>
<statusReason></statusReason>
<messageType>C1-HEALTHCARE_INB_MSG_TYPE</messageType>
<sourceSystem>ZZUHG</sourceSystem>
<externalTransactionId>773445</externalTransactionId>
<externalBatchId>433443</externalBatchId>
<externalSourceId>653465</externalSourceId>
<person></person>
<statusDateTime></statusDateTime>
<creationDateTime></creationDateTime>
<version></version>
<characteristics>
<inboundMessageCharacteristic>
<adhocCharacteristicValue></adhocCharacteristicValue>
<characteristicType>C1-EXTBTCT</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
<characteristicValue>DATAEXT2</characteristicValue>
<characteristicValueForeignKey1>
</characteristicValueForeignKey1>
<characteristicValueFK2></characteristicValueFK2>
<characteristicValueFK3></characteristicValueFK3>
<characteristicValueFk4></characteristicValueFk4>
<characteristicValueFK5></characteristicValueFK5>
<searchCharacteristicValue></searchCharacteristicValue>
<version></version>
</inboundMessageCharacteristic>
</characteristics>
<customerStructureMessage>
<headerData>
<messageType></messageType>
<sourceSystem></sourceSystem>
<externalTransactionId></externalTransactionId>
<externalBatchId></externalBatchId>
<externalSourceId></externalSourceId>
</headerData>
<customerStructureData>
<personData>
<sequence>1</sequence>
<personType>PG</personType>
<personName>
<sequence>1</sequence>
<entityName>WALSH_TYRES_CORP</entityName>
<nameType>PRIM</nameType>
</personName>
<identifiers>
<idType>SSN</idType>
<idValue>910-70-5110</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<address>
<addressEffDate>2023-01-01</addressEffDate>
<addressType>MAIN</addressType>
</address>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>+1.222.414.6125</phoneValue>
<extension>7894</extension>
</phones>
<relatedPersons>
<idType>WEB</idType>
<idValue>WALSH_TYRES_CORP</idValue>
<personRelationshipType>SPOUSE</personRelationshipType>
<startDate>2023-01-01</startDate>
<endDate>2023-12-31</endDate>
<financialRelationshipSw>Y</financialRelationshipSw>
<parentOrChild>P</parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType>CMSTISSE</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
</characteristicsList>
<characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType>PER_CAT</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence>1</sequence>
</billLevelParameters>
<accountData>
<identifiers>
<idType>ACCT_NM</idType>
<idValue>WTC_BG_0124578</idValue>
<isPrimary>TRUE</isPrimary>
</identifiers>
<autoPayDetails>
<priority>100</priority>
<startDate>2023-01-01</startDate>
<endDate>2024-12-31</endDate>
<percentage>100</percentage>
<autoPayMethod>C1DD</autoPayMethod>
<autoPayRouteType>NEFT</autoPayRouteType>
<autoPaySourceCode>CITYBANKCHK</autoPaySourceCode>
<accountNumber>442252</accountNumber>
<expiryMonth>11</expiryMonth>
<expiryYear>2024</expiryYear>
<name>WT</name>
<maxWithdrawalAmount>100</maxWithdrawalAmount>
<comments>NONE</comments>
</autoPayDetails>
<accountPerson>
<idType>WEB</idType>
<idValue>AC_WTC_789</idValue>
<accountRelationshipType>MAIN_CUSTOMER</accountRelationshipType>
<isFinanciallyResponsible>Y</isFinanciallyResponsible>
<personAddressOverride>
<address1>ADDR_1</address1>
<address2>ADDR_2</address2>
<address3>ADDR_3</address3>
<address4>ADDR_4</address4>
<city>OAKLAND</city>
<postal>34567</postal>
<state>CA</state>
<country>USA</country>
<houseType>CONDO</houseType>
<streetNumber1>25</streetNumber1>
<streetNumber2>78</streetNumber2>
<inCityLimit>Y</inCityLimit>
<taxVendorGeographicalCode>3055
</taxVendorGeographicalCode>
<county>CA</county>
<zip>21354</zip>
<addressStatus>Y</addressStatus>
</personAddressOverride>
</accountPerson>
<characteristics>
<characteristicsList>
<characteristicType>INVRACTE</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
<policyData>
<policyType>GROUP CUSTOMER</policyType>
<sourceSystem>ZZ_PRIME</sourceSystem>
<policyNumber>PL_MED_HEALTH_001</policyNumber>
<startDate>2023-01-01</startDate>
<endDate>2024-12-31</endDate>
<renewalDate>2024-01-01</renewalDate>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<characteristics>
<characteristicsList>
<characteristicType>C1PRBASE</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber>WALSH_TC_MED_PLAN_101</planNumber>
<pricingRuleTypeList>
<pricingRuleType>AGE_BASED</pricingRuleType>
</pricingRuleTypeList>
<characteristics>
<characteristicsList>
<characteristicType>MAGEDEP</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
</characteristicsList>
</characteristics>
</planData>
</policyData>
</personData>
<pricingRuleData>
<sequence>1</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>WALSH_TC_MED_PLAN_101</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status>ACTV</status>
<startDate>2023-01-01</startDate>
<endDate>2024-12-31</endDate>
<pricingRuleType>AGE_BASED</pricingRuleType>
<priceItemCd>MED_PREMIUM</priceItemCd>
<rateOption>AGE_TIER_FLA</rateOption>
<pricingType>FLAT</pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>100</baseFee>
<lowerAgeLimit>0</lowerAgeLimit>
<upperAgeLimit>30</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>EMPBAND</parameterCode>
<parameterValue>IC1</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>DRUG_USE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>50</rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType>AGE_CHAR</characteristicType>
<effectiveDate>2023-01-01</effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
</customerStructureData>
</customerStructureMessage>
<toDoRetry>
<retryDateTime></retryDateTime>
<numberOfRetries></numberOfRetries>
<currentErrorState></currentErrorState>
<isRetried></isRetried>
</toDoRetry>
</schema>
Note: We have given the above sample to illustrate how the tags should
be nested while sending an inbound message from the external system.
However, you should not seamlessly use this sample in your environment
because the required pre-requisite data may not be available in your
environment. In such case, the system will give erroneous results.