Individual Membership Cancellation Delinquency Process

There might be scenarios wherein the individual customers fail to pay the binder payment for their health plan coverage. As a result, their individual memberships cannot be activated in the system. Such individual memberships should be canceled in the system in a timely manner. To adhere to this requirement, you can now configure the system such that a delinquency process is created for the individual membership's account to send a cancellation outbound message to the enrollment system when the payment for the first bill (i.e. binder payment) is not made within the due date. This enables you to initiate the cancellation process for an individual membership through the Delinquency Management feature. Only when an inbound message is received from the enrollment system to cancel an individual membership, the system changes the status of the individual membership to Canceled.

To create a delinquency process to initiate cancellation request for an individual membership through an outbound message, you need to design the delinquency process type (using which you want to create the delinquency process) in the following manner:

For more information about these algorithms, refer to the Delinquency Event Type section. Note that sending a To Do notification and a warning or dunning letter before initiating the cancellation request for an individual membership through a delinquency process is optional. You may or may not include these event types while designing a delinquency process type to initiate cancellation request for individual memberships billed to the delinquent account. However, you need to attach the C1-DLEVMBCNC algorithm to initiate cancellation request for individual memberships billed to the delinquent account. The C1-DLEVMBCNC algorithm updates the status reason of the individual memberships which are billed to the delinquent account. It considers the status reason which is specified in the Awaiting Membership Cancellation Reason attribute of the delinquency process preference. Before updating the status reason of the individual membership, the system validates whether the status reason is defined for the Active status of the C1-IndMembership business object.

Once a delinquency process is created for an account, the status of the delinquency process is set to the value (for example, Initiated) specified in the Delinquency Process Initiated Status attribute of the delinquency process preference. Once the first event in the delinquency process is triggered, the status of the delinquency process is changed to the value (for example, Delinquency In Progress) specified in the Delinquency Process InProgress Status attribute of the delinquency process preference. Once the status reason of the active individual memberships is updated, the status of the delinquency event is changed to Complete. If all the events in the delinquency process are triggered successfully, the status of the delinquency process is changed to the value (for example, Completed) specified in the Delinquency Process Completed Status attribute of the delinquency process preference. However, if there are any more events that are yet to be triggered, the status of the delinquency process remains as Delinquency In Progress.

You need to then execute the C1-MTOMT batch to generate the cancellation outbound messages for the individual memberships. For more information about the batch, refer to the Outbound Message Generation for Delinquency Management section. Before creating the cancellation outbound messages for the individual memberships, you need to setup some pre-requisites for the cancellation outbound message generation. For more information about the pre-requisites, refer to the Membership Cancellation Outbound Message section.

Once the cancellation outbound message is sent to the enrollment system, you need to wait for the enrollment system to send the inbound message to cancel the individual membership in ORMB. Once the inbound message to cancel an individual membership is processed, the status of the individual membership is changed to Canceled. Once the individual membership is canceled in ORMB, the status of the delinquency process is changed to the value (for example, Canceled) specified in the Delinquency Process Canceled Status attribute of the delinquency process preference when the C1-DPMON batch is executed.

The system may receive a payment or an adjustment against the overdue bill for which a delinquency process is created to initiate the cancellation request for an individual membership through an outbound message. In such case, the system behaves in the following manner depending on the status of the delinquency process:

• If a payment or an adjustment is made when a delinquency process is in the Initiated, Delinquency In Progress, or On Hold status, the status of the delinquency process is changed to the value (for example, Canceled) specified in the Delinquency Process Canceled Status attribute of the delinquency process preference. For more information on how the delinquency process is automatically canceled, see Canceling a Delinquency Process

• If a payment or an adjustment is made when a delinquency process is in the Pending Termination status, the status of the delinquency process is changed to the value (for example, Canceled) specified in the Delinquency Process Canceled Status attribute of the delinquency process preference. For more information on how the delinquency process is automatically canceled, see Canceling a Delinquency Process. This scenario is addressed only when such delinquency processes are automatically canceled through the C1-DPMON batch.

• If a payment or an adjustment is made when a delinquency process is in the Completed status, no action takes place on the individual membership cancellation delinquency process.

However, if the payment or adjustment is canceled due to any reason, the system executes the C1-CDPPAYCAN or C1-DPADJCAN algorithm attached to the customer class or adjustment type, respectively, to resume the delinquency process. For more information on how the delinquency process is automatically resumed, see Resuming a Delinquency Process.