Sample Individual Membership Premium Simulation Request and Response in XML Format
Using the below example, you can do the following:
-
Simulate the premium calculation process for an individual membership
| Person Name | Person Type | Policy Number | Plan Number | Main Subscriber |
|---|---|---|---|---|
|
REPRC1011_ MAINSUB |
PERSON |
REPRC1011_ POLICY |
REPRC1011_ DENTAL_ PLAN |
YES |
<schema>
<responseDetails>
<membershipId>229160661076798</membershipId>
<responseStatus>SUCCESS</responseStatus>
<message></message>
</responseDetails>
<simulationSw>Y</simulationSw>
<action></action>
<readFilters>
<dateFilter>
<startDate></startDate>
<endDate></endDate>
</dateFilter>
<priceItemFilter>
<priceItemList>
<priceItemCode></priceItemCode>
</priceItemList>
</priceItemFilter>
<responseType></responseType>
</readFilters>
<person>
<personData>
<sequence>1</sequence>
<personType>P</personType>
<personName>
<sequence>1</sequence>
<entityName>REPRC1011_MAINSUB</entityName>
<nameType>P</nameType>
</personName>
<identifiers>
<idType>WEB</idType>
<idValue>REPRC1011_MAINSUB</idValue>
<isPrimary>Y</isPrimary>
</identifiers>
<division>HC</division>
<birthDate>1982-07-07</birthDate>
<sinceDate>2019-01-01</sinceDate>
<collectionClass></collectionClass>
<postponeCreditReviewUntil></postponeCreditReviewUntil>
<lastCreditReviewDate></lastCreditReviewDate>
<dragDays></dragDays>
<advanceDepositAmount></advanceDepositAmount>
<advanceDepositGraceDays></advanceDepositGraceDays>
<advanceDepositLevel></advanceDepositLevel>
<address>
<addressEffDate>2019-01-01</addressEffDate>
<addressType>MAIN</addressType>
<mailingName>MR.JAMES BENNETT</mailingName>
<address1>FINS COBRA SOFTWARE SERVICES</address1>
<address2>BESIDES HUB MALL</address2>
<address3>OPPOSITE TO WEH</address3>
<address4>THANES CITY</address4>
<city>DALLAS</city>
<state>TX</state>
<zip>400081</zip>
<country>USA</country>
<houseType>RANCH</houseType>
<streetNumber1></streetNumber1>
<streetNumber2></streetNumber2>
<inCityLimit></inCityLimit>
<taxVendorGeographicalCode>
</taxVendorGeographicalCode>
<county></county>
<addressStatus></addressStatus>
</address>
<email>reprc_sd001_001_p1@sofs.com</email>
<overrideMailingName1>
reprc_sd001_001_p1@sofs.com
</overrideMailingName1>
<overrideMailingName2>
reprc_sd001_001_p1@sofs.com
</overrideMailingName2>
<overrideMailingName3>
reprc_sd001_001_p1@sofs.com
</overrideMailingName3>
<phones>
<phoneType>BUSN</phoneType>
<phoneValue>+1.610.415.7111</phoneValue>
<extension>250</extension>
</phones>
<relatedPersons>
<idType></idType>
<idValue></idValue>
<personRelationshipType></personRelationshipType>
<startDate></startDate>
<endDate></endDate>
<financialRelationshipSw></financialRelationshipSw>
<parentOrChild></parentOrChild>
<relatedPersonsCharacteristicsList>
<characteristic>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristic>
</relatedPersonsCharacteristicsList>
</relatedPersons>
<personCharacteristicList>
<characteristic>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristic>
</personCharacteristicList>
<accountData>
<accountType></accountType>
<customerClass></customerClass>
<billCycle></billCycle>
<billLeadDays></billLeadDays>
<division></division>
<currency></currency>
<setUpDate></setUpDate>
<acctUsageFlg></acctUsageFlg>
<comments></comments>
<deferAutoPayDt></deferAutoPayDt>
<collectionClass></collectionClass>
<billRouteType></billRouteType>
<billAddressSource></billAddressSource>
<accountIdentifiers>
<idType></idType>
<idValue></idValue>
<isPrimary></isPrimary>
</accountIdentifiers>
<characteristics>
<characteristicsList>
<characteristicType></characteristicType>
<characteristicValue></characteristicValue>
<effectiveDate></effectiveDate>
</characteristicsList>
</characteristics>
</accountData>
</personData>
</person>
<membership>
<sourceSystem>UHG</sourceSystem>
<policyNumber>REPRC1011_POLICY</policyNumber>
<planNumber></planNumber>
<healthPlanCode>REPRC1011_DENTAL_PLAN</healthPlanCode>
<startDate>2019-01-01</startDate>
<endDate>2019-12-31</endDate>
<boStatusCd></boStatusCd>
<paidThroughDate>2019-01-01</paidThroughDate>
<membershipType></membershipType>
<mainSubscriber>
<mainSubsIdType>WEB</mainSubsIdType>
<mainSubsIdValue>REPRC1011_MAINSUB</mainSubsIdValue>
<membershipType></membershipType>
</mainSubscriber>
<autoRenew>N</autoRenew>
<associatedMemberIdentifierType>
</associatedMemberIdentifierType>
<associatedMemberIdentifier>
</associatedMemberIdentifier>
<exchangeFlag>ON</exchangeFlag>
<exchangeId>HPLN027</exchangeId>
<binderLiabilityAmount>600</binderLiabilityAmount>
<binderPayApplicability>y</binderPayApplicability>
<binderPayGraceDays>10</binderPayGraceDays>
<binderPayThreshold>400</binderPayThreshold>
<holdBilling>N</holdBilling>
<membershipRenewalDate></membershipRenewalDate>
<contractPeriod>0</contractPeriod>
<repriceAfterDate></repriceAfterDate>
<membershipIdentifierList>
<membershipIdentifier>
<membershipIdentifierType>
AADHAR
</membershipIdentifierType>
<membershipIdentifierValue>
HLPN022
</membershipIdentifierValue>
</membershipIdentifier>
</membershipIdentifierList>
<membershipCharacteristicList>
<characteristic>
<characteristicType>
BL_1
</characteristicType>
<characteristicValue>
REPRC1011
</characteristicValue>
<effectiveDate>
2019-01-01
</effectiveDate>
</characteristic>
</membershipCharacteristicList>
<membershipRateGuarantee>
<membershipRateGuaranteeList>
<rateGuaranteeStartDate>2019-01-01</rateGuaranteeStartDate>
<rateGuaranteeEndDate>2019-12-31</rateGuaranteeEndDate>
<rateGuaranteeStatus>ACTIVE</rateGuaranteeStatus>
</membershipRateGuaranteeList>
</membershipRateGuarantee>
<memberDataList>
<memberData>
<memberIdType>WEB</memberIdType>
<memberIdValue>REPRC1011_MAINSUB</memberIdValue>
<enrollmentStartDate>2019-01-01</enrollmentStartDate>
<enrollmentEndDate>2019-12-31</enrollmentEndDate>
<memberRelationship>OWNER</memberRelationship>
<membershipPersonStatus>ACTIVE</membershipPersonStatus>
<membershipPersonstatusReason>
</membershipPersonstatusReason>
<memberId>REPRC_SD001_001_M1</memberId>
<financeRespFlag>Y</financeRespFlag>
<isMemberSw>Y</isMemberSw>
<externalMedicareBeneficiaryId>
</externalMedicareBeneficiaryId>
<memberCharacteristicList>
<characteristic>
<characteristicType>DRUGGIST</characteristicType>
<characteristicValue>Y</characteristicValue>
<effectiveDate>2019-01-01</effectiveDate>
</characteristic>
</memberCharacteristicList>
<benefitData>
<benefitDataList>
<sequence>1</sequence>
<startDate>2019-02-01</startDate>
<endDate>2021-10-31</endDate>
<benefitStatus>ACTIVE</benefitStatus>
<benefitSourceFlag>ST</benefitSourceFlag>
<benefitSubTypeFlag>LEP</benefitSubTypeFlag>
<planBenefitPackageId>
MDCR078_P1
</planBenefitPackageId>
<benefitAmount>200</benefitAmount>
<benefitCharacteristicsList>
<characteristic>
<characteristicType>
GENDER
</characteristicType>
<characteristicValue>
MALE
</characteristicValue>
<effectiveDate>
2019-02-01
</effectiveDate>
</characteristic>
</benefitCharacteristicsList>
<benefitDataList>
</benefitData>
</memberData>
</memberDataList>
<premiumCalculationDetails>
<premiumCalculation>
<priceItemCd>DENTAL</priceItemCd>
<startDt>2019-01-01</startDt>
<endDt>2019-02-31</endDt>
<calcAmt>200.00</calcAmt>
<distAmt>0</distAmt>
<currencyCd>USD</currencyCd>
<acctIdType>ACCT_NM</acctIdType>
<acctIdVal>REPRC1011BG10519S1</acctIdVal>
<accountId>6573747915</accountId>
<billableChgId>094032550028</billableChgId>
<pricingRuleId>181910202193698</pricingRuleId>
<priceAsgnId>8220029141</priceAsgnId>
<premiumCalcLineDetails>
<premiumCalcLines>
<proFactor>1</proFactor>
<calcAmt>200.000000000000000000</calcAmt>
<distAmt>0</distAmt>
<month>0</month>
<totalCalcAmt>0</totalCalcAmt>
<currencyCd>USD</currencyCd>
<entityTypeFlg>PERS</entityTypeFlg>
<entityId>5055198762</entityId>
<referenceIdType>WEB</referenceIdType>
<referenceIdValue>REPRC1011_MAINSUB</referenceIdValue>
<pricingParameters>AGEBASED</pricingParameters>
<description>AGE BASED PARAMETER</description>
</premiumCalcLines>
</premiumCalcLineDetails>
</premiumCalculation>
</premiumCalculationDetails>
</membership>
<accountBalance>
<accountBalanceData>
<accountIdentifierType></accountIdentifierType>
<accountNumber></accountNumber>
<accountId></accountId>
<division></division>
<sourceSystem></sourceSystem>
<c1ExternalTransactionId></c1ExternalTransactionId>
<externalSourceId></externalSourceId>
<accountInfoDtls>
<currentBalance></currentBalance>
<lastBillAmount></lastBillAmount>
<statusCd></statusCd>
<messageText></messageText>
</accountInfoDtls>
</accountBalanceData>
</accountBalance>
</schema>
Note: We have given the above sample
to illustrate how the tags should be nested while sending an individual
membership premium simulation request 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.