Sample Health Care Inbound Message for Pricing Rules
Using the below example, you can create the following:
-
Tier-based pricing rule for the DD_BASIC policy plan -
The following table provides sample data for a tier-based pricing rule of the policy plan: Policy Plan Pricing Rule Type Base Rate Parameter Parameter Value DD_BASIC TIER_BASED 20 EMPBAND IC1 SUBSCRIPTIONTIER E GENDER MALE 40 EMPBAND IC2 SUBSCRIPTIONTIER ES GENDER FEMALE 60 EMPBAND IC3 SUBSCRIPTIONTIER ES GENDER FEMALE 80 EMPBAND IC4 SUBSCRIPTIONTIER E GENDER MALE -
Age-based pricing rule for the PPO_MED_BRONZE_RETIRED policy plan -
The following table provides sample data for an age-based pricing rule of the policy plan: Policy Plan Pricing Rule Type Base Rate Lower Age Limit Upper Age Limit Parameter Parameter Value Modifier Modifier Value Modifier Rate PPO_MED_
BRONZE_
RETIRED
AGE_
BASED
200 0 19 GENDER FEMALE TOBUSE Y 20 200 0 19 GENDER MALE TOBUSE Y 20 300 20 39 GENDER FEMALE TOBUSE Y 30 300 20 39 GENDER MALE TOBUSE Y 30 450 40 59 GENDER FEMALE TOBUSE Y 40 450 40 59 GENDER MALE TOBUSE Y 40 550 60 130 GENDER FEMALE TOBUSE Y 50 550 60 130 GENDER MALE TOBUSE Y 50 -
Additional fee pricing rule for the COBRA_DENTAL policy plan -
The following table provides sample data for an additional fee pricing rule of the policy plan: Policy Plan Pricing Rule Type Base Rate Modifier Modifier Value Modifier Rate COBRA_DENTAL CAPITATION_FEES 100 IC_BAND IC1 10 200 M1_BAND M1 20 300 M2_BAND M2 30 400 M3_BAND M3 40 -
Rate Guarantee pricing rule for the RATE_LOCK_MED policy plan -
The following table provides sample data for a rate guarantee pricing rule of the policy plan: Policy Plan Pricing Rule Type Base Rate Lower Age Limit Upper Age Limit Start Date End Date Rate Guarantee RATE_
LOCK_
MED
AGE_BASED 200 20 39 01-01-2021 31-03-2021 Y TIER_BASED 400 40 59 01-02-2021 31-07-2021 Y TIER_BASED 600 60 79 01-02-2021 31-10-2021 Y AGE_BASED 800 80 99 01-01-2021 30-11-2021 Y -
Discount charge pricing rule for the DISC_CHG_MED policy plan -
The following table provides sample data for a discount charge pricing rule of the policy plan: Bill Group Policy Plan Pricing Rule Type Base Fee Modifier Modifier Value Modifier Rate United
Antarctica
Group
DISC_
CHG_
MED
DISCOUNT_
CHARGE
50 VP_BAND VP1 10 70 M_BAND M1 20 90 IC_BAND IC1 30
<schema>
<c1InboundMessage></c1InboundMessage>
<bo>C1-HCInboundMessage</bo>
<characteristics>
<inboundMessageCharacteristic>
<adhocCharacteristicValue></adhocCharacteristicValue>
<characteristicType>C1-EXTBTCT</characteristicType>
<effectiveDate>2019-01-01</effectiveDate>
<characteristicValue>DATAEXT3</characteristicValue>
<characteristicValueForeignKey1></characteristicValueForeignKey1>
<characteristicValueFK2></characteristicValueFK2>
<characteristicValueFK3></characteristicValueFK3>
<characteristicValueFk4></characteristicValueFk4>
<characteristicValueFK5></characteristicValueFK5>
<searchCharacteristicValue></searchCharacteristicValue>
<version></version>
</inboundMessageCharacteristic>
</characteristics>
<customerStructureMessage>
<headerData>
<messageType>C1-HEALTHCARE-INB-MSG-TYPE</messageType>
<sourceSystem>SMALLPRIME</sourceSystem>
<externalTransactionId>12344</externalTransactionId>
<externalBatchId>433443</externalBatchId>
<externalSourceId>656565</externalSourceId>
</headerData>
<customerStructureData>
<personData>
<personType></personType>
<personName>
<sequence></sequence>
<entityName></entityName>
<nameType></nameType>
</personName>
<identifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</identifiers>
<division></division>
<birthDate></birthDate>
<sinceDate></sinceDate>
<accessGroup></accessGroup>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate></addressEffDate>
<addressType></addressType>
<mailingName></mailingName>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode></taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email></email>
<overrideMailingName1></overrideMailingName1>
<overrideMailingName2></overrideMailingName2>
<overrideMailingName3></overrideMailingName3>
<phones>
<phoneType></phoneType>
<phoneValue></phoneValue>
<extension></extension>
</phones>
<relatedPersons>
<idType></idType>
<idValue></idValue>
<personRelationshipType></personRelationshipType>
<startDate></startDate>
<endDate></endDate>
<financialRelationshipSw></financialRelationshipSw>
<parentOrChild></parentOrChild>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</relatedPersons>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<billLevelParameters>
<sequence></sequence>
<sourceSystem></sourceSystem>
<billLevelInfo1></billLevelInfo1>
<billLevelInfo2></billLevelInfo2>
<billLevelInfo3></billLevelInfo3>
<billLevelInfo4></billLevelInfo4>
<effectiveDate></effectiveDate>
</billLevelParameters>
<memberData>
<sequence>10</sequence>
<startDate></startDate>
<endDate></endDate>
<repriceAfterDate></repriceAfterDate>
<paidThroughDate></paidThroughDate>
<memberId></memberId>
<memberRelationship></memberRelationship>
<membershipPersonStatus></membershipPersonStatus>
<membershipPersonstatusReason></membershipPersonstatusReason>
<autoRenew></autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag></exchangeFlag>
<exchangeId></exchangeId>
<binderLiabilityAmount></binderLiabilityAmount>
<binderPayApplicability></binderPayApplicability>
<binderPayGraceDays></binderPayGraceDays>
<binderPayThreshold><binderPayThreshold>
<holdBilling></holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod></contractPeriod>
<membershipIdentifier>
<membershipIdentifierType></membershipIdentifierType>
<membershipIdentifierValue></membershipIdentifierValue>
</membershipIdentifier>
<isMemberSw></isMemberSw>
<isFinanciallyResponsibleSw></isFinanciallyResponsibleSw>
<membershipType></membershipType>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<mainSubscriber>
<idType></idType>
<idValue></idValue>
<membershipType></membershipType>
</mainSubscriber>
<policyNumber></policyNumber>
<sourceSystem></sourceSystem>
<planNumber></planNumber>
<healthPlanCode></healthPlanCode>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate></rateGuaranteeStartDate>
<rateGuaranteeEndDate></rateGuaranteeEndDate>
<rateGuaranteeStatus></rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<membershipPersonCharacteristic>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</membershipPersonCharacteristic>
<benefitData>
<benefitDataList>
<sequence></sequence>
<startDate></startDate>
<endDate></endDate>
<benefitStatus></benefitStatus>
<benefitSourceFlag></benefitSourceFlag>
<benefitTypeFlag></benefitTypeFlag>
<benefitSubTypeFlag></benefitSubTypeFlag>
<planBenefitPackageId></planBenefitPackageId>
<benefitAmount></benefitAmount>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</benefitDataList>
</benefitData>
<billableChargeData>
<sequence></sequence>
<accountIdType></accountIdType>
<accountIdValue></accountIdValue>
<chargeType></chargeType>
<startDate></startDate>
<endDate></endDate>
<priceItemCode></priceItemCode>
<description></description>
<recurringMethod></recurringMethod>
<billPeriod></billPeriod>
<frequency></frequency>
<billAfterDt></billAfterDt>
<billableChargeLines>
<descriptionOnBill></descriptionOnBill>
<currencyCode></currencyCode>
<chargeAmount></chargeAmount>
<showOnBillSw></showOnBillSw>
<appearInSummarySw></appearInSummarySw>
<distributionCode></distributionCode>
</billableChargeLines>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</billableChargeData>
</memberData>
<accountData>
<accountType></accountType>
<customerClass></customerClass>
<billCycle></billCycle>
<billLeadDays></billLeadDays>
<division></division>
<dragDays></dragDays>
<currency></currency>
<setUpDate></setUpDate>
<acctUsageFlg></acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType></billRouteType>
<billAddressSource></billAddressSource>
<accessGroup></accessGroup>
<skipAutoMaintenanceSw></skipAutoMaintenanceSw>
<identifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</identifiers>
<address>
<addressEffDate></addressEffDate>
<addressType></addressType>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<state></state>
<zip></zip>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode></taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<autoPayDetails>
<priority></priority>
<startDate></startDate>
<endDate></endDate>
<percentage></percentage>
<autoPayMethod></autoPayMethod>
<autoPayRouteType></autoPayRouteType>
<autoPaySourceCode></autoPaySourceCode>
<accountNumber></accountNumber>
<expiryMonth></expiryMonth>
<expiryYear></expiryYear>
<name></name>
<maxWithdrawalAmount></maxWithdrawalAmount>
<comments></comments>
</autoPayDetails>
<accountPerson>
<idType></idType>
<idValue></idValue>
<accountRelationshipType></accountRelationshipType>
<isFinanciallyResponsible></isFinanciallyResponsible>
<personAddressOverride>
<address1></address1>
<address2></address2>
<address3></address3>
<address4></address4>
<city></city>
<zip></zip>
<state></state>
<country></country>
<houseType></houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode></taxVendorGeographicalCode>
<county></county>
<zip></zip>
<addressStatus></addressStatus>
</personAddressOverride>
<accountPersonRouting>
<billRouteType></billRouteType>
<shouldReceiveCopyOfBill></shouldReceiveCopyOfBill>
<billFormat></billFormat>
<numberOfBillCopies></numberOfBillCopies>
<receivesNotification></receivesNotification>
<billAddressSource></billAddressSource>
</accountPersonRouting>
</accountPerson>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
<policyData>
<policyType></policyType>
<sourceSystem></sourceSystem>
<policyNumber></policyNumber>
<description></description>
<advancedLevelFundingEligibility>
</advancedLevelFundingEligibility>
<startDate></startDate>
<endDate></endDate>
<runOutEndDate></runOutEndDate>
<runOutAdminOption></runOutAdminOption>
<renewalDate></renewalDate>
<advanceDepositApplSW></advanceDepositApplSW>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositAccountIdentifierType>
</advanceDepositAccountIdentifierType>
<advanceDepositAccountIdentifierValue>
</advanceDepositAccountIdentifierValue>
<policyPersons>
<idType></idType>
<idValue></idValue>
<policyPerRole></policyPerRole>
<startDate></startDate>
<endDate></endDate>
</policyPersons>
<terminationInformation>
<terminateDate></terminateDate>
<terminationReason></terminationReason>
</terminationInformation>
<reinstateInformation>
<reinstatementDate></reinstatementDate>
<reinstateReason></reinstateReason>
</reinstateInformation>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<planData>
<planNumber></planNumber>
<priceItemCode></priceItemCode>
<planName></planName>
<pricingRuleTypeList>
<pricingRuleType></pricingRuleType>
</pricingRuleTypeList>
<startDate></startDate>
<endDate></endDate>
<primaryPlanSw></primaryPlanSw>
<benefitTypeFlag></benefitTypeFlag>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
<policyPlanProrationRuleList>
<effectiveDate></effectiveDate>
<prorationEventType></prorationEventType>
<prorationType></prorationType>
<numberOfDays></numberOfDays>
<membershipType></membershipType>
</policyPlanProrationRuleList>
</planData>
</policyData>
</personData>
<pricingRuleData>
<sequence>1</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLCY</entityIdentifierType>
<entityIdentifierValue>AP234389</entityIdentifierValue>
</entityIdentifiersList>
<entityIdentifiersList>
<entityIdentifierType>SSYS</entityIdentifierType>
<entityIdentifierValue>SMALLPRIME</entityIdentifierValue>
</entityIdentifiersList>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>DD_BASIC</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<pricingRuleType>TIER_BASED</pricingRuleType>
<priceItemCd>DEN_PREM_FEE</priceItemCd>
<rateOption>TIERBASED</rateOption>
<pricingType></pricingType>
<modifierApplicability></modifierApplicability>
<modifierMethod></modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>20</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>EMPBAND</parameterCode>
<parameterValue>IC1</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>2</sequence>
<parameterCode>SUBSCRIPTIONTIER</parameterCode>
<parameterValue>E</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>3</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>MALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>2</sequence>
<baseFee>40</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>EMPBAND</parameterCode>
<parameterValue>IC2</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>2</sequence>
<parameterCode>SUBSCRIPTIONTIER</parameterCode>
<parameterValue>ES</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>3</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>FEMALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>3</sequence>
<baseFee>60</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>EMPBAND</parameterCode>
<parameterValue>IC3</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>2</sequence>
<parameterCode>SUBSCRIPTIONTIER</parameterCode>
<parameterValue>ES</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>3</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>FEMALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>4</sequence>
<baseFee>80</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>EMPBAND</parameterCode>
<parameterValue>IC4</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>2</sequence>
<parameterCode>SUBSCRIPTIONTIER</parameterCode>
<parameterValue>E</parameterValue>
</pricingParameter>
<pricingParameter>
<sequence>3</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>MALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>2</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLCY</entityIdentifierType>
<entityIdentifierValue>AP234389</entityIdentifierValue>
</entityIdentifiersList>
<entityIdentifiersList>
<entityIdentifierType>SSYS</entityIdentifierType>
<entityIdentifierValue>SMALLPRIME</entityIdentifierValue>
</entityIdentifiersList>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>
PPO_MED_BRONZE_RETIRED
</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<pricingRuleType>AGE_BASED</pricingRuleType>
<priceItemCd>MED_PREM_FEE</priceItemCd>
<rateOption>AGEBASED</rateOption>
<pricingType></pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>FLAT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>200</baseFee>
<lowerAgeLimit>0</lowerAgeLimit>
<upperAgeLimit>19</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>FEMALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>20</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>2</sequence>
<baseFee>200</baseFee>
<lowerAgeLimit>0</lowerAgeLimit>
<upperAgeLimit>19</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>MALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>20</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>3</sequence>
<baseFee>300</baseFee>
<lowerAgeLimit>20</lowerAgeLimit>
<upperAgeLimit>39</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>FEMALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>30</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>4</sequence>
<baseFee>300</baseFee>
<lowerAgeLimit>20</lowerAgeLimit>
<upperAgeLimit>39</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>MALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>30</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>5</sequence>
<baseFee>450</baseFee>
<lowerAgeLimit>40</lowerAgeLimit>
<upperAgeLimit>59</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>FEMALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>40</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>6</sequence>
<baseFee>450</baseFee>
<lowerAgeLimit>40</lowerAgeLimit>
<upperAgeLimit>59</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>MALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>40</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>7</sequence>
<baseFee>550</baseFee>
<lowerAgeLimit>60</lowerAgeLimit>
<upperAgeLimit>130</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>FEMALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>50</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>8</sequence>
<baseFee>550</baseFee>
<lowerAgeLimit>60</lowerAgeLimit>
<upperAgeLimit>130</upperAgeLimit>
<pricingParameter>
<sequence>1</sequence>
<parameterCode>GENDER</parameterCode>
<parameterValue>MALE</parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>TOBUSE</parameterCode>
<parameterValue>Y</parameterValue>
<rate>50</rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>3</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLCY</entityIdentifierType>
<entityIdentifierValue>AP234389</entityIdentifierValue>
</entityIdentifiersList>
<entityIdentifiersList>
<entityIdentifierType>SSYS</entityIdentifierType>
<entityIdentifierValue>SMALLPRIME</entityIdentifierValue>
</entityIdentifiersList>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>COBRA_DENTAL</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<pricingRuleType>CAPITATION_FEES</pricingRuleType>
<priceItemCd>CAPITATIONFEES</priceItemCd>
<rateOption>AGEBASED</rateOption>
<pricingType>FLAT</pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>100</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>IC_BAND</parameterCode>
<parameterValue>IC1</parameterValue>
<rate>10</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>2</sequence>
<baseFee>200</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>M1_BAND</parameterCode>
<parameterValue>M1</parameterValue>
<rate>30</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>3</sequence>
<baseFee>300</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>M2_BAND</parameterCode>
<parameterValue>M2</parameterValue>
<rate>30</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>4</sequence>
<baseFee>400</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>M3_BAND</parameterCode>
<parameterValue>M3</parameterValue>
<rate>40</rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>4</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>RATE_LOCK_MED</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2021-01-01</startDate>
<endDate>2021-03-31</endDate>
<pricingRuleType>AGE_BASED</pricingRuleType>
<priceItemCd>ZZ_AGE_PI</priceItemCd>
<rateOption>AGEBASED</rateOption>
<pricingType>FLAT</pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>200</baseFee>
<lowerAgeLimit>20</lowerAgeLimit>
<upperAgeLimit>39</upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>5</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>
RATE_LOCK_MED
</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2021-02-01</startDate>
<endDate>2021-07-31</endDate>
<pricingRuleType>TIER_BASED</pricingRuleType>
<priceItemCd>ZZ_TIER_PI</priceItemCd>
<rateOption>TIERBASED</rateOption>
<pricingType></pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>400</baseFee>
<lowerAgeLimit>40</lowerAgeLimit>
<upperAgeLimit>59</upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>6</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>RATE_LOCK_MED</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
status></status>
<startDate>2021-02-01</startDate>
<endDate>2021-10-31</endDate>
<pricingRuleType>TIER_BASED</pricingRuleType>
<priceItemCd>ZZ_TIER_PI</priceItemCd>
<rateOption>TIERBASED</rateOption>
<pricingType></pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>600</baseFee>
<lowerAgeLimit>60</lowerAgeLimit>
<upperAgeLimit>79</upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>7</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>
RATE_LOCK_MED
</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2021-02-01</startDate>
<endDate>2021-11-30</endDate>
<pricingRuleType>AGE_BASED</pricingRuleType>
<priceItemCd>ZZ_AGE_PI</priceItemCd>
<rateOption>AGEBASED</rateOption>
<pricingType>FLAT</pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>800</baseFee>
<lowerAgeLimit>80</lowerAgeLimit>
<upperAgeLimit>99</upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
<rate></rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<pricingRuleData>
<sequence>8</sequence>
<entityIdentifiers>
<entityIdentifiersList>
<entityIdentifierType>PLAN</entityIdentifierType>
<entityIdentifierValue>
DISC_CHG_MED
</entityIdentifierValue>
</entityIdentifiersList>
</entityIdentifiers>
<status></status>
<startDate>2021-01-01</startDate>
<endDate>2021-12-31</endDate>
<pricingRuleType>DISCOUNT_CHARGE</pricingRuleType>
<priceItemCd>ZZ_DC_PI</priceItemCd>
<rateOption>ZZ_CAPPCT_PK</rateOption>
<pricingType>PCNT</pricingType>
<modifierApplicability>Y</modifierApplicability>
<modifierMethod>EXPT</modifierMethod>
<baseRate>
<sequence>1</sequence>
<baseFee>50</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>VP_BAND</parameterCode>
<parameterValue>VP1</parameterValue>
<rate>10</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>2</sequence>
<baseFee>70</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>M_BAND</parameterCode>
<parameterValue>M1</parameterValue>
<rate>20</rate>
</modifierInformation>
</baseRate>
<baseRate>
<sequence>3</sequence>
<baseFee>90</baseFee>
<lowerAgeLimit></lowerAgeLimit>
<upperAgeLimit></upperAgeLimit>
<pricingParameter>
<sequence></sequence>
<parameterCode></parameterCode>
<parameterValue></parameterValue>
</pricingParameter>
<modifierInformation>
<sequence>1</sequence>
<parameterCode>IC_BAND</parameterCode>
<parameterValue>IC1</parameterValue>
<rate>30</rate>
</modifierInformation>
</baseRate>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</pricingRuleData>
<statementConstructsData>
<personStatementConstructs>
<personIdentifier></personIdentifier>
<personIdentifierType></personIdentifierType>
<statementConstructIdentifier></statementConstructIdentifier>
<statementAddressSource></statementAddressSource>
<statementCycle></statementCycle>
<statementRouteType></statementRouteType>
<effectiveStatus></effectiveStatus>
<addressId></addressId>
<numberOfCopies></numberOfCopies>
<statementFormat></statementFormat>
<description></description>
<statementConstructDetails>
<serviceAgreement></serviceAgreement>
<accountNumber></accountNumber>
<accountNumberTypeCd></accountNumberTypeCd>
<division></division>
<statementPrintDescription></statementPrintDescription>
<printOrder></printOrder>
<startDate></startDate>
<endDate></endDate>
</statementConstructDetails>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</personStatementConstructs>
</statementConstructsData>
</customerStructureData>
</customerStructureMessage>
</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.