Defining a Membership for a Fully-Insured Group Policy Plan

Prerequisites

To define a membership for a fully-insured group policy plan, you should have:

  • Plans defined in the policy

  • Persons defined in the application

  • Contract relationship types defined in the application

Procedure

To define a membership for a fully-insured group policy plan:

  1. Do either of the following:
    If you want to...Then...
    Define a membership for a fully-insured group policy plan from the Policy screen

    1. Search for the fully-insured group policy in the Policy screen.

    2. In the Search Results section, click the link in the Policy Information column corresponding to the policy whose details you want to edit.

      The Policy screen appears.

    3. Click the Plan tab.

      The Plan tab appears.

    4. In the Plans zone, click the Broadcast (The Broadcast Icon) icon corresponding to the policy plan for which you want to define a membership.

      The Memberships zone appears.

    5. Click the Add link in the upper right corner of the Memberships zone.
    Define a membership for a fully-insured group policy plan from the Membership screen

    1. Click the Menu link in the Application toolbar.

      A list appears.

    2. From the Main menu, select Customer Management and then click Membership.

      A sub menu appears.

    3. Click the Add option from the Membership sub-menu.

    The Membership screen appears. It contains the following sections:

    • Main - Used to specify the basic details about the membership.

    • Characteristics - Used to define the characteristics for the membership.

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Plan ID Used to indicate the policy plan for which you want to define the membership.
    Note:

    The Search(The Search Icon) icon appears corresponding to this field. On clicking the Search icon, the Policy Plan Search window appears.

    On specifying the policy plan, the description of the policy plan appears corresponding to the Plan field.

    If you navigate to the Membership screen from the Policy screen, the data automatically appears in this field. You can change the plan, if required.

    		 Yes
    Start Date Used to specify the date from when the membership is effective for a fully-insured group policy plan.
    Note:

    The membership start date cannot be later than the membership end date.

    The membership start date cannot be earlier than the policy plan start date or later than policy plan end date.

    		 Yes
    End Date Used to specify the date till when the membership is effective for a fully-insured group policy plan.
    Note:

    The membership end date cannot be earlier than the membership start date.

    The membership end date cannot be earlier than the policy plan start date or later than policy plan end date.

    		 Yes
    Membership Type Used to indicate the type of membership. The valid values are:

    • COBRA

    • Medicare

    Note: If you want to define an active employee coverage membership, you must leave this field blank.
    		 No
    Main Subscriber Used to indicate the person who is the main subscriber of the membership.
    Note:

    The Search(The Search Icon) icon appears corresponding to this field. On clicking the Search icon, the Person Search window appears.

    On specifying the person, the description of the person appears corresponding to the Main Subscriber field.

    		 Yes
    Relationship Type Used to indicate how the main subscriber is related to the membership. Yes
    External Membership ID Used to specify the external membership ID.
    Note: Here, you need to specify a membership ID which is maintained in the external source system.
    		 No
    Tip: Alternatively, you can access this screen by clicking the Add button in the Page Title area of the Membership screen.
  2. Enter the required details in the Main section.
  3. Define characteristics for the membership, if required.
  4. Click Save.
    The membership is defined for the fully-insured group policy plan. The status of the membership and the main subscriber is set to Active.

Related Topics

For more information on... See...
How to search for a fully-insured group policy Searching for a Policy
Policy screen Policy (Used for Viewing)
Plans zone Plans
Memberships zone Memberships
Membership screen Membership (Used for Searching)
How to define a characteristic for a membership Defining a Characteristic for a Membership