C1-INDACCT

This algorithm evaluates the individual membership to determine the account to associate it with. If the membership is already associated with an account, no further action is required. If the membership is not yet associated with an account, new account creation rules are assessed and if met, a new account is created for the main subscriber and linked to the membership. Otherwise, the account linked to the prior membership of the individual for the same health coverage class is used.

A new account is created for an individual's first enrollment to a health coverage class. If the individual subsequently changes plans within a health coverage class, a new account is created if there is a gap in coverage from the prior enrollment or one of the configurable health plan characteristic criteria is met, that is:

  1. If a health plan char type is provided as a parameter and the old and new values are also provided, a new account is created if the health plan char value from the prior membership = old value and the health plan char value from the current membership = new value.

  2. If a health plan char type is provided as a parameter and the old and new values are not provided, a new account is created if the health plan char value from the prior membership <> health plan char value from the current membership.