Delinquency Termination Date Rule Business Rule

Oracle Revenue Management and Billing enables you to define business rules for determining the termination date rule during the delinquency management. The termination date rule is used to derive the termination date for a policy or individual membership. The insurance company may derive different termination date rule for different policies or individual memberships based on certain parameters, such as division, customer class, region, and jurisdiction, in which the group or individual customer has availed for the policy plan or health plan coverage. The system will then accordingly use the termination date rule to calculate the termination date for the delinquency event type that requests to terminate the following:

  • Policies billed to the delinquent person or account

  • Individual memberships billed to the delinquent account

The system always derives the termination date rule through a delinquency termination date rule business rule. The system executes the C1-DERTRBR algorithm attached to the Termination Date Rule Derivation system event of the respective delinquency process type to derive the termination date rule for the delinquency event. For more information on how the termination date rule is derived, refer to the C1-DERTRBR algorithm description in the Delinquency Process Type Algorithms section.

While defining the delinquency termination date rule business rule criteria, you can use the parameters which are defined on the following entities:

The following table lists the entities on which the parameters are used while defining the delinquency termination date rule business rule criteria
Line of Business Source Entity Supported Source Type
Fully Insured Group Health Insurance Account Field and Characteristic
Customer Class Field
Division Field
Membership Field and Characteristic
Membership Person Field and Characteristic
Policy Field and Characteristic
Policy Plan Field and Characteristic
Fully Insured Individual Health Insurance Account Field and Characteristic
Customer Class Field
Division Field
Health Plan Field and Characteristic
Health Product Field and Characteristic
Membership Field and Characteristic
Membership Person Field and Characteristic
Note:

If the delinquency process is created at the person level and if an attribute of a division or customer class is used in the business rule criteria, the system will check whether the division or customer class is present on the person (i.e. on the parent customer or bill group, respectively) while evaluating the business rule criteria. If so, the system will use the details of the person to evaluate the business rule criteria. However, if the division or customer class is not present on the person, the system will use the details of any account where the person is added as the main customer to evaluate the business rule criteria.

If the delinquency process is created at the account level and if an attribute of a division or customer class is used in the business rule criteria, the system will use the details of the respective account to evaluate the business rule criteria.

You can define, edit, and delete a delinquency termination date rule business rule through the Business Rule screen. While defining a delinquency termination date rule business rule, you need to set its category to Delinquency Termination Date Rule Business Rule and specify the following details:

  • Criteria Description - Used to indicate the business criteria that a policy or individual membership must satisfy in order to derive the termination date rule from the business rule.

  • Effective Date - Used to specify the date from when the business rule is effective.

  • Status - Used to indicate the status of the business rule. The valid values are:

    • Active

    • Inactive

  • Termination Date Rule - Used to indicate the termination date rule using which you want to calculate the termination date. The valid values are:

    • Latest Billed Coverage End Date

    • Latest Due Coverage End Date

    • X days After Paid Through Date

    • X Months After Paid Through Date

    • Month End of Grace Period Start

    • Month End of Termination Letter Creation

    • Month End of Termination Request Event

    • X days After Grace End Date

    • X days After Termination Request Event

Once the business rule is created, the business rule ID is generated. While creating a business rule, the status is, by default, non-editable and set to Active. While editing a business rule, you can change its status from Active to Inactive and vice-versa. Note that you cannot edit or delete a business rule if it is referred in the system. You can view the delinquency termination date rule business rules through the Business Rule screen.

For more information on how the termination date rule is used to calculate the termination date, refer to the C1-DETTERMDT algorithm description in the Delinquency Event Activation section.

Parent topic: Business Rules