Fully-Insured Group Policy Reinstatement

The system enables you to reinstate the terminated policy whenever required. There are two ways in which you can reinstate a fully-insured group policy:

  • Initiate Policy Reinstatement Process - In this method, you can initiate the policy reinstatement process from the user interface. To initiate the reinstatement process, you need to specify the reinstatement reason. On initiating the reinstatement process, the status of the policy is changed to Pending Reinstatement. In addition, the system creates an outbound message which request for confirmation whether the policy should be reinstated. This outbound message can be sent to the policy processing system via custom mechanism. On receiving confirmation from the policy processing system through a health care inbound message, the system changes the status of the policy to Reinstated.

  • Reinstate Policy - In this method, you can directly reinstate a fully-insured group policy. To reinstate a fully-insured group policy, you need to specify the reinstatement reason. You can directly reinstate the policy from the user interface or through a health care inbound message. On clicking the Reinstate button, the system will reinstate the fully-insured group policy on the system date. However, when you reinstate a fully-insured group policy through a health care inbound message, the policy is reinstated when the health care inbound message is processed in the system. On reinstating a fully-insured group policy, the status of the policy is changed to Reinstated.

Once the status of the policy is changed to Reinstated, the system updates the end date of the following entities to the respective original end date:

  • Policy

  • Policy Person

  • Policy Plan

  • Membership

  • Member Person

  • Contracts Associated with the Membership

Note:

The system stores the original end date of the above listed entities when you define or edit a policy, policy plan, or membership.

Here, the assumption is that the pass-through billable charges information for the membership will be sent again through an inbound message along with the reinstatement reason. And, therefore the exiting billable charges will not be extended.

Finally, the system automatically transitions the fully-insured group policy from Reinstated to In Force/Active.