Defining a Fully-Insured Pricing Business Rule

To define a fully-insured pricing business rule, you should have:

  • Business rule type defined in the application

  • Fully-Insured pricing business rule category defined in the application

  • Values defined in the following lookup fields:

    • BUS_​RULE_​CAT_​FLG lookup field

    • DEP_​ORDER_​PRIORITY_​FLG lookup field

    • AGE_​CAL_​DT_​BASED_​ON_​FLG lookup field

    • AGE_​RECAL_​DT_​BASED_​ON_​FLG lookup field

    • MEM_​ROLE_​DERV_​DT_​BASED_​ON_​FLG lookup field

  • Status defined for the fully-insured pricing business rule in the application

Procedure

To define a fully-insured pricing business rule:

  1. Click the Admin link in the Application toolbar.
    A list appears.
  2. From the Admin menu, select B and then click Business Rule.
    A sub-menu appears.
  3. Click the Add option from the Business Rule sub-menu.

    The Select Business Category screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Business Rule Category Used to indicate the business rule category using which you want to create a business rule. The valid values are:

    • Binder Payment Business Rule

    • Fully-Insured Pricing Business Rule

    • New Born Business Rule

    • Rate Guarantee Business Rule

    		 Yes
    Note: Alternatively, you can access the Business Rule Category screen by clicking the Add button in the Page Title area of the Business Rule screen.
  4. Select the Fully-Insured Pricing Business Rule option from the Business Rule Category list.
  5. Click OK.
    The Fully-Insured Pricing Business Rule screen appears. It contains the following fields:
    Field Name Field Description Mandatory (Yes or No)
    Criteria Description Used to indicate the business criteria for the fully-insured pricing business rule.
    Note: The Search (The Search Icon) icon appears corresponding to the Criteria Description field. On clicking the Search icon, the Business Rule Criteria Search window appears.
    		 Yes
    Effective Date Used to specify the date from when the fully-insured pricing business rule is effective. Yes
    Status Used to indicate the status of the fully-insured pricing business rule.
    Note:

    It is a read-only field.

    By default, the Active option is selected.

    		 Not applicable
    Maximum Dependents Used to specify the maximum number of children which are eligible for premium calculation.
    Note: The value for this field must either be zero (0) or a positive integer.
    		 No
    Dependent Max Age Limit Used to specify the maximum age limit for children eligible for premium calculation.
    Note: The value for this field must either be zero (0) or a positive integer.
    		 Yes (Conditional)
    Note: This field is required when you have specified zero (0) in the Maximum Dependents field while defining a fully-insured pricing business rule.
    Dependent Order Priority Used to indicate the order priority of the dependent during premium calculation. The valid values are:

    • Eldest

    • Youngest

    		 Yes (Conditional)
    Note: This field is required when you have specified zero (0) in the Maximum Dependents field while defining a fully-insured pricing business rule.
    Age Calculation Date Used to indicate whether the member person's age should be calculated using the member person's enrollment date or policy's start or renewal date. The valid values are:

    • Member Enrollment Date

    • Member Enrollment Nearest Age

    • Membership Renewal Date

    		 Yes
    Age Recalculation Date Used to indicate whether the member person's age should be recalculated using the member person's enrollment date or policy's start or renewal date. The valid values are:

    • After Birthday Month

    • Membership Renewal Date

    • Nearest Birthday

    		 No
    Young Adult Applicability Used to indicate that the child or dependent enrolling in the membership becomes the young adult in the enrollment period. No
    Young Adult Max Age Limit Used to specify the maximum age limit for young adults which are eligible for premium calculation.
    Note: This field is enabled only when the Young Adult Applicability check box is selected.
    		 Yes (Conditional)
    Note: This field is required if you have selected the Young Adult Applicability check box.
    Member Relationship Derivation Date Used to indicate the member relationship for a member person. The valid values are:

    • Member Date of Birth

    • Member Enrollment Date

    		 Yes
  6. Enter the required details in the Fully-Insured Pricing Business Rule screen.
  7. If you want to define more than one fully-insured pricing business rule, click the Add (The Add Icon) icon and then repeat step 6.
    Note: However, if you want to remove a fully-insured pricing business rule, click the Delete (The Delete Icon) icon corresponding to the Criteria Description field.
  8. Click Save.
    The fully-insured pricing business rule is defined.

Related Topics

For more information on... See...
Business Rule screen Business Rule (Used for Searching)