C1-MEMRLSUBT

While adding a membership to a policy plan or while adding or inactivating a member person in a membership, this algorithm derives the member relationship for each member person of the membership from a member relationship structure. It considers the member relationship structure which is defined as a characteristic for the policy plan. While deriving the member relationship structure of the policy plan, it considers the characteristic which is defined using a characteristic type specified in the Member Relationship Structure Characteristic Type attribute of a member relationship and subscription tier preference. It considers the member relationship and subscription tier preference which is specified in the Relation Structure Code Field Mapping option type of the C1-ASOBLLNG feature configuration.

The member relationship structure helps to determine how each member person is related to the main subscriber of the membership. A member relationship is derived for a member person depending on the following:

  • Whether the member person is a self, spouse, or dependent

  • Number of spouses, dependents, and young adults in the membership

While determining the member relationship for a member person, this algorithm derives the following characteristic types from the respective attributes of the member relationship and subscription tier preference:

  • Age Calculation Date Basis

  • Max Age Limit for Max Dependent Count

  • Max Number of Dependents Order Priority

  • Maximum Number of Dependents

  • Member Relationship Derivation Date

  • New Born Gift Days

  • New Born Gift Days Applicability

  • Young Adult Max Age Limit

  • Young Adult Max Age Limit Applicability

It then derives these characteristics from the policy plan. Based on these characteristics defined for the policy plan, it derives the member relationship for each member person from the member relationship structure. If the Member Relationship Derivation Date characteristic type is set to Enrollment Date, this algorithm derives the member relationship for each member person of the membership in order of the member start date. However, if the Member Relationship Derivation Date characteristic type is set to Date of Birth, this algorithm derives the member relationship for each member person of the membership in order of the date of birth.

Once the member relationship is derived for a member person, this algorithm stores the member relationship for the member person. The characteristic type specified in the Member Relationship Characteristic Type attribute of the member relationship and subscription tier preference is used to store member relationship for the member person. On adding a membership to a policy plan or on adding a member person to a membership, the effective date of the member relationship characteristic is set to the member person's start date. If a new born is added to the membership, the effective date of the new born's member relationship characteristic is calculated considering the gift days if applicable.

If a member person is end dated, this algorithm derives the member relationship of all other member persons once again. If the member relationship for a member person is different, it creates a new characteristic to store the member relationship for the member person. The effective date of the new characteristic is set to the member person's end date + 1. For example, if the end date of a member person is set to 06-30-2021, then the effective date of the new characteristic for the remaining member persons is set to 07-01-2021. Similarly, if a member person is inactivated, this algorithm derives the member relationship of all other member persons once again. In this case, if the member relationship for a member person is different, it updates the existing member relationship characteristic of the member person and does not create a new member relationship characteristic for the member person.