Individual Membership Termination Delinquency Process

There might be scenarios wherein the individual customers fail to pay premium for their health plan coverage even after sending continuous reminders. In such scenarios, you may want to terminate their individual memberships in the system. Oracle Revenue Management and Billing enables you to initiate the termination process for an individual membership through the Delinquency Management feature. You can configure the system such that a delinquency process is created for the individual membership’s account to send a termination outbound message to the enrollment system when the overdue bills do not meet the tolerance limit. Only when an inbound message is received from the enrollment system to terminate an individual membership, the system changes the status of the individual membership to Terminated.

To create a delinquency process to initiate termination request for an individual membership through an outbound message, you need to design the delinquency process type using which you want to create a delinquency process in a particular manner.

The following table illustrates how you can design the delinquency process type using which you want to create the delinquency process to initiate cancellation request for an individual membership through an outbound message.
Delinquency Process Type	Delinquency Event Type	System Event	Algorithm	Algorithm Purpose
DP1	Send First Reminder Notification	Event Activation	C1-DLQCRTODO	Updates the status reason of the individual memberships billed to the delinquent account
	Send a Warning Letter	Event Activation	C1-DLQSENDCC	Sends a warning letter via a customer contact
	Send a Termination Request	Event Activation	C1-DETTERMDT	Calculates the termination date for an individual membership
		Event Activation	C1-DETTRTGDT	Calculates the termination request date
		Monitor Completed Event	C1-TRNTERTRG	Updates the status of the delinquency process on the termination request date
DP2	Send a Warning Letter	Event Activation	C1-DLQSENDCC	Sends a warning letter via a customer contact
	Calculate Termination Date	Event Activation	C1-DETTERMDT	Calculates the termination date for an individual membership
	Send Termination Request	Event Activation	C1-DETTRTGDT	Calculates the termination request date
	Send Termination Request	Monitor Completed Event	C1-TRNTERTRG	Updates the status of the delinquency process on the termination request date

Note that sending a To Do notification and a warning or dunning letter before initiating the termination 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 termination request for individual memberships billed to the delinquent account. However, you need to attach the C1-DETTERMDT, C1-DETTRTGDT, and C1-TRNTERTRG algorithms to the above-mentioned system events to initiate termination request for an individual membership. For more information about these algorithms, see C1-DETTERMDT, C1-DETTRTGDT, and C1-TRNTERTRG.

Note:

A delinquency event type where the C1-DETTRTGDT and/or C1-TRNTERTRG algorithms are attached should be added at the last in the delinquency process type (as shown in the above examples – DP1 and, DP2.

You can attach an algorithm to either or both of the system events (i.e. Event Activation and Monitor Completed Event) in a delinquency event type.

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. After calculating the termination date and termination request date, the status of the respective delinquency events is changed to Completed. However, the status of the delinquency process changes to a status which is specified in the Delinquency Process Pending Termination Status attribute of the delinquency process preference only on or after the termination request date when the C1-DPMON batch is executed. Once the status of the delinquency process is changed to Pending Termination, the system executes the C1-MEMTRMRSN algorithm attached to the Pending Termination status in the lifecycle of the C1-DelinquencyProcess business object.

The C1-MEMTRMRSN algorithm updates the status reason of the active individual memberships which are billed to the delinquent account. The system considers the active individual memberships depending on the value defined for the Skip Termination of Guaranteed Available Memberships(Valid Values-Y,N) parameter. If the Skip Termination of Guaranteed Available Memberships(Valid Values-Y,N) parameter is set to Y, the system does not consider the active individual memberships where the Evaluate Guaranteed Availability flag is set to true. However, if the Skip Termination of Guaranteed Available Memberships(Valid Values-Y,N) parameter is set to N, the system considers the active individual memberships irrespective of whether the Evaluate Guaranteed Availability flag is set to true or false.

If the individual membership’s start date is later than the respective termination date, this algorithm does the following:

Updates the status reason of the individual membership. 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
Creates a log entry for each individual membership in the delinquency process

However, if the individual membership’s start date is earlier than the respective termination date and if the individual membership’s end date is later than the respective termination date, this algorithm does the following:

Updates the status reason of the individual membership. It considers the status reason which is specified in the Membership Termination Reason for Delinquency 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.
Adds the termination date and termination reason (i.e. status reason) corresponding to the individual membership in the CI_MEMBERSHIP table.
Sets the individual membership’s end date to the termination date corresponding to the individual membership in the CI_MEMBERSHIP table.
Creates a log entry in each individual membership indicating that it is terminated due a delinquency process.
Creates a log entry for each individual membership in the delinquency process.
Stamps the delinquency process ID as a characteristic using the C1-DELPO characteristic type on the individual membership.

Once the status reason of the individual memberships is changed, you need to execute the C1-MTOMT batch to generate the cancellation or termination outbound messages for the individual memberships. For more information about the batch, see Outbound Message Generation for Delinquency Management. Before creating the cancellation or termination outbound messages for the individual memberships, you need to setup some pre-requisites for the cancellation or termination outbound message generation. For more information about the pre-requisites, see Membership Cancellation Outbound Message and Membership Termination Outbound Message, respectively.

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

Once the status of the delinquency process is changed to Customer Terminated, the system executes the following algorithms (if configured) attached to the respective status of the C1-DelinquencyProcess business object:

C1-CRDPTERM - It creates a subsequent delinquency process for the terminated customer. A subsequent delinquency process includes all the unpaid bills which were present in the primary delinquency process through which the individual membership is terminated. In ORMB, the primary delinquency process is referred to as the related delinquency process for the subsequent delinquency process. This algorithm stores the related delinquency process ID in the REL_DELIN_PROC_ID column corresponding to the subsequent delinquency process in the C1_DELIN_PROC table.
C1-DLQCCDPS - It creates a customer contact to send a letter (for example, a harsh letter) to the terminated customer to communicate any penalty or legal notice on defaulting or delaying payments. If the delinquency process is created for an account, this algorithm checks whether the Receives Notification option is selected in the bill routing information of any person associated with the account. If the Receives Notification option is selected in the bill routing information of a person, this algorithm creates a customer contact for the person. Note that if the value is specified for the Account Relationship Type parameter, this algorithm will consider only those persons who are associated with the account using the given relationship type.

In addition, this algorithm does the following:
- Creates a log entry for each customer contact in the delinquency process.
- Stamps the delinquency process ID as a characteristic using the C1-DELPO characteristic type on the customer contact.
- Stamps the account ID as a characteristic using the given characteristic type on the customer contact.

The system may receive a payment or an adjustment against the overdue bill for which a delinquency process is created to initiate the termination 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, On Hold, or Pending Terminationstatus, 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. 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.
If a payment or an adjustment is made when a delinquency process is in the Customer Terminated status, you need to wait till an inbound message request is received from the enrollment system to reinstate an individual membership. Once the status of the individual membership is changed to Active, the system does the following:
- Changes the status of the primary delinquency process through which the termination request was initiated to a status (for example, Customer Reinstated) which is specified in the Delinquency Process Customer Reinstated Status attribute of the delinquency process preference.
- Changes the status of the subsequent delinquency process to a status (for example, Canceled) which is specified in the Delinquency Process Canceled Status attribute of the delinquency process preference if it meets the cancel criteria.
Note that the status of the primary and subsequent delinquency processes is changed only through C1-DPMON batch. For more information on how the delinquency process is automatically canceled, see Canceling a Delinquency Process.

If the payment or adjustment is canceled due to any reason, the system executes the C1-RODPDUEPX or C1-RODPONADX 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.

Note: The system considers the delinquency process preference which is specified in the Delinquency Process Field Mapping option type of the DELINPROC feature configuration. For more information about the feature configuration, see Setting the DELINPROC Feature Configuration.