Membership Benefits

Oracle Revenue Management and Billing enables you to maintain the following types of membership benefits for the fully-insured group and individual businesses:

• Medicare benefits, such as, Part A, Part B, Part D for which premium is calculated using the age-based or tier-based pricing rules

• Medicare benefits, such as Medicare Part D Low-Income Subsidy (LIS) and Medicare Part D Late Enrollment Penalty (LEP) for which charges are calculated using the benefit pricing rule type

• Advance Premium Tax Credit (APTC) benefits for which charges are calculated using the benefit pricing rule type

The system enables you to define a benefit at the membership level and not at the member person level. This is because the system assumes the following:

• There will be only one member person in the Medicare membership who will avail the Membership benefit.

• The other benefits such as APTC would be availed by all member persons of the group or individual membership.