C1-MEMRLAUD

This algorithm defines an eligible member role for each and every member person involved in the membership. It derives the Member Role Structure attribute defined in the policy plan in a group membership or from the health plan in an individual membership. This attribute is used to identify the member person details that are to be stamped based on the member person relationship. A member person relationship is derived from the member person depending on whether the member person is:

• Self

• Spouse

• Children

• Dependents

This algorithm derives the member person relationship through the Member Person Relationship table, as a common reference. Once the member person relationship is derived, in case of a group membership, the algorithm derives the characteristics, which are mapped on the policy plan, for member role mapping purposes. Whereas in case of an individual membership, the algorithm derives the characteristics, which are defined in the business rules, for member role mapping purposes.