Terminal Liability Reserve (Run Out) Level Funding Pricing

Oracle Revenue Management and Billing provides a mechanism to maintain terminal liability reserve for a self-funded policy through level funding. Now, the system supports the following types of level funding:

  • Regular Enrollment Based Level Funding Without Terminal Liability Reserve (TLR)

  • Flat Rate Based Level Funding Without TLR

  • Regular Enrollment Based Level Funding With TLR

  • Flat Rate Based Level Funding With TLR

The C1-PricingRuleTypeLF and C1-PricingRuleLevelFunded business objects are extended to support the TLR feature. Therefore, you can now define pricing rule types for the above listed types of level funding. While creating a level funding pricing rule type with TLR feature, you need to specify the following:

  • Terminal Liability Reserve (Run Out) Funding Required - Used to indicate whether you want to define a level funding pricing rule type with TLR.

  • Claim Fund Off-Process Request Type - Used to indicate the off-process request type using which the off-process request should be created in the C1-BCLF batch. Through this off-process request, the system creates billable charge when the customer decides to roll forward the claim fund.

  • Run Out Fund Off-Process Request Type - Used to indicate the off-process request type using which the off-process request should be created in the C1-BCLF batch. Through this off-process request, the system creates billable charge when the customer decides to roll forward the run out fund.

  • Run Out Fund Pricing Rule Type - Used to specify a bill period based recurring flat fee pricing rule type or retention type enrollment based pricing rule type which you want to use for calculating the run out fund.

  • Run Out Fund Price Item - Used to specify the price item which you want to use for calculating the run out fund.

  • Run Out Billable Charge Line Type - Used to specify the billable charge line type using which you want to create calculation line while settling charges, stop-loss, or discount through run out fund in the runout period.

  • Run Out Surplus Billable Charge Line Type - Used to specify the billable charge line type using which you want to create the calculation line when the surplus run out funds are left with the ASO provider at the time of settlement.

  • Run Out Deficit Billable Charge Line Type - Used to specify the billable charge line type using which you want to create the calculation line when the run out funds are in deficit at the time of settlement.

Now, the system enables you to specify the settlement rules while creating a level funding pricing rule type with or without TLR feature. While defining settlement rules, you need to specify the following:

  • The policy status for which the settlement rules are applicable

  • The fund type (i.e. claim or run out fund) for which you want to define the settlement rules

  • The customer action (i.e. cancel or renew the self-funded policy) based on which you want to either close or roll forward the surplus or deficit claim or run out fund

The system provides an option to indicate whether the settlement rules specified for a claim or run out fund are editable. Accordingly, you can change the settlement rules when you create a pricing rule using the pricing rule type for a parent customer.

Now, the system enables you to create a different level funded pricing rule for each policy status at the parent customer level.