C1-DTCAGEIM

This algorithm would be used for the calculation of a date that is further used for age-based calculations of the members in the fully-insured Individual Membership when the specific conditions are present.

  • This algorithm is plugged-in in the system event Audit present in the Algorithms Tab of the BO Individual Membership

  • It gets invoked whenever there is an update in the Individual Membership entity to perform date calculation and store the calculated date in the BO_​DATA_​AREA of this individual membership.

The essential pre-requisite for this algorithm to work as intended is as follows:

  • If an individual has continuous coverage on different Medical Health Plans with the same first 5-digit of HIOS (legal entity) within the same plan year window, then age at the time of enrolment into the first plan is used throughout the plan year.

  • The business rule category - 'Fully-Insured Pricing Rules' for this individual membership will have the criteria: 
    AGE CALCULATION DATE = Member Enrollment Date
and
AGE RECALCULATION DATE = Membership Renewal Date

When the above conditions are configured in the system, the algorithm works as follows:

  • It lists out the enrollment start date of all memberships having the same main subscriber person and same account for the identified plan year window.

  • It then determines the oldest date among the enrollment start date such that there is continuous coverage between the consecutive memberships.

  • The calculated date is then stored in the BO_​DATA_​AREA column in the Membership table in the format:
    <calculatedDateMemberAgeContCoverage>YYYY-MM-DD</calculatedDateMemberAgeContCoverage>

The corresponding algorithms responsible for member age calculation, that are present in the pricing rule type of the health plan for this membership entity, will fetch the value of the calculated date available in the BO_​DATA_​AREA column and determine the age for the member-person in the membership.

Parameter:

  • Healthcare Coverage Class - This parameter is mandatory where the value indicates the valid value for Medical present in lookup Product Healthcare Category.

  • Plan Year Start Month - This parameter is mandatory where the numeric value represents the month in a calendar year. For example, 1-Jan, 3-March, 6-June, etc.