Individual Membership Renewal

Oracle Revenue Management and Billing enables you to renew an individual membership in the following two ways:

  • Manually

  • Automatically

While creating or editing an individual membership through a health care inbound message or membership repricing inbound web service, you must set the Auto Renew option for the individual membership to either Y or N.

If the Auto Renew option for an individual membership is set to N, you need to specify the following details in a health care inbound message or membership repricing incoming message:

  • Membership renewal date

  • Status, status reason, and end date of the main subscriber

  • Status, status reason, and end date of the dependent person

The enrollment system can send the renewal information either during the enrollment period or after the enrollment period. Irrespective of when the renewal information is received, the membership renewal date must be set to the membership end date + 1. For example, if the enrollment period is from 01-01-2021 to 12-31-2021, then the system must receive the membership renewal date as 01-01-2022. On renewing an individual membership, the dependent person in the individual membership is not automatically activated unless the activation information is received for the dependent person from the enrollment system. The associated membership for an add-on health insurance plan is not automatically renewed unless the renewal information is received for the respective membership from the enrollment system.

If the Auto Renew option for an individual membership is set to Y, you need to specify the contract period for which the individual membership should be automatically renewed. The system then creates a record in the CI_​MEMBERSHIP_​PROCESS table with the Pending status. The system stores the following information in the record:

  • Membership ID

  • Main Subscriber ID

  • Whether the member person is a main subscriber

  • Processing date (it is set to the membership end date)

  • Required action (is set to Renew)

On the C1-MEPRC batch execution, the system checks whether there are any records in the CI_​MEMBERSHIP_​PROCESS table with the Pending status. If so, the system checks whether the processing date of the record is earlier than or equal to the system date. If so, the system determines the required action to be taken for the individual membership from the record. If the MEMB_​PROCESS_​FLG column of the record is set to Renew and the MAIN_​CUST_​SW column is set to Y, the system calculates the renewal date and new end date for the individual membership.

The renewal date for the individual membership is set to membership end date + 1. For example, if the enrollment period is from 01-01-2021 to 12-31-2021, the system sets the renewal date to 01-01-2022 (i.e. 12-31-2021 + 1). The new membership end date is calculated using the renewal date and contract period. For example, if the renewal date is 01-01-2022 and contract period is 12 months, the system sets the end date of membership, main subscriber, and dependent persons to 12-31-2022. The associated membership for an add-on health insurance plan is not automatically renewed during the individual membership renewal.

The automatic renewal request for an individual membership must be received during the enrollment period. If the automatic renewal request for an individual membership is received after the enrollment period, the system will not renew the individual membership automatically.

Once the membership end date is changed, the system will trigger the repricing feature and accordingly create or extend the billable charge for the renewed period.