Individual Membership

Oracle Revenue Management and Billing enables you to create and edit individual memberships from the user interface and through a health care inbound message or membership repricing inbound web service. Note that the user interface for adding and editing individual memberships is not yet well-designed and should only be used by the presales and sales teams for learning and demo purposes and not by the customers.

A new business object for individual membership named C1-IndMembership is introduced in this release. While creating an individual membership through a health care inbound message, you need to specify the following details:

Health Plan - Used to indicate the health plan for which the main subscriber has enrolled.
Member Person Status - Used to indicate the main subscriber or dependent person's status.
Status Reason - Used to indicate the reason why you want to change the status of the main subscriber or dependent person.
Auto Renew - Used to indicate whether the individual membership should be automatically renewed.
Contract Period - Used to indicate the period (in months) for which the individual membership should be automatically renewed.
Membership Renewal Date - Used to indicate the date when the individual membership should be renewed. It is required for manual renewal of the individual membership. In case of automatic renewal, the membership renewal date is calculated by the system.
Associated Membership Details - Used to associate the individual membership with another individual membership which is created for the add-on health insurance plan.
Member Identifiers - Used to specify one or more identifiers for the individual membership.
Exchange Details - Used to indicate whether the individual membership is purchased from the exchange. If the individual membership is purchased from the exchange, you need to specify the exchange ID.
Binder Payment Details - Used to indicate whether the binder payment is required for the individual membership. If so, you need to specify the following details:
- Grace Days
- Binder Liability Amount (if required)
- Threshold Percentage (if required)
- Hold Billing
For more information about the binder payments, see the Binder Payment for Individual Membership section.

Note: On creating an individual membership for a health plan, the membership category is set to INDV. However, on creating a group membership for a policy plan, the membership category is set to GRUP.

The following table lists the statuses introduced in the lifecycle of the C1-IndMembership business object:

Individual Membership Status	Description
Draft	An individual membership is created in the Draft status and then transitioned to either the Pending Effectuation or Active status as mentioned in the health care inbound message or membership repricing incoming message.
Pending Effectuation	If the main subscriber status is set to Pending Effectuation, the system sets the status of the individual membership to Pending Effectuation. The system determines the individual membership status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration. The system monitors whether the binder payments (if required) are received for the individual membership in the Pending Effectuation status. If the binder payments are received, the status of the individual membership is not automatically transitioned to Active. The status of the individual membership is changed from Pending Effectuation to Active only when the main subscriber status update information is received through a health care inbound message or membership repricing inbound web service.
Active	If the main subscriber status is set to Active, the system sets the status of the individual membership to Active. The system determines the individual membership status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration. If the binder payments are not required for the individual membership, you can directly set the status of main subscriber to Active. In addition, if you want to reinstate the individual membership, you must set the status of main subscriber to Active. The system will then change the status of the individual membership from Terminated to Active. In case of reinstatement of the individual membership, the status of the dependent persons is not changed automatically from Inactive to Active unless the dependent person status update information is received through a health care inbound message or membership repricing inbound web service.
Terminated	If the main subscriber status is set to Inactive, the system sets the status of the individual membership to Terminated. The system determines the individual membership status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration. Once the status of the individual membership is set to Terminated, the system automatically changes the status of the dependent persons to Inactive. Note that while inactivating the dependent persons, the system only considers the dependent persons who are in the Active status. The system determines the dependent person status reason using the membership status reason preference. The system also updates the end date of the individual membership, main subscriber, and dependent persons. For more information, see the Individual Membership Termination section.
Canceled	If the main subscriber status is set to Canceled, the system sets the status of the individual membership to Canceled. The system determines the individual membership status reason using the membership status reason preference which is specified in the Status Reason Mapping option type of the C1-ASOBLLNG feature configuration. Once the status of the individual membership is set to Canceled, the system automatically changes the status of the dependent persons to Canceled. The system determines the dependent person status reason using the membership status reason preference. The system will also cancel the billable charges and bill segment (if any) created for the individual membership or financially responsible member person account.

The system also enables you to change the status of a dependent person in the individual membership through a health care inbound message or membership repricing inbound web service. On changing the status of a member person to Pending Effectuated or Active, the system considers the member person during premium calculation.

On changing the status of the individual membership and member person, the system creates an audit event to trigger the repricing feature. The C1-IndMembership business object is configured for the entity audit framework. However, the repricing is triggered only when an active audit event type for the C1-IndMembership business object is created in the system.

The system creates appropriate log entries during the individual membership and member person status transition. You can view the status transition logs of individual membership in the Log tab of the Membership (Used for Viewing) screen. A new zone named Member Person Log is introduced in the Main tab of the Membership (Used for Viewing) screen. It enables you to view the log entries generated on the member person status transition.

You can define individual membership status reasons through the Status Reason screen. A new lookup field named MEMB_PERS_STAT_RSN_FLG is introduced in this release. Here, you can add the status reasons for the member person.