Fully-Insured Group Policy Termination

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

• Initiate Policy Termination Process - In this method, you can initiate the policy termination process from the user interface. To initiate the termination process, you need to specify the termination date and termination reason. On initiating the termination process, the status of the policy is changed to Pending Termination. In addition, the system creates an outbound message which request for confirmation whether the policy should be terminated. 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 Terminated.

• Terminate Policy - In this method, you can directly terminate a fully-insured group policy. To terminate a fully-insured group policy, you need to specify the termination reason. You can directly terminate the policy from the user interface or through a health care inbound message. On clicking the Terminate button, the system will terminate the fully-insured group policy on the system date. However, when you terminate a fully-insured group policy through a health care inbound message, the policy is terminated when the health care inbound message is processed in the system. On terminating a fully-insured group policy, the status of the policy is changed to Terminated.

Once the status of the policy is changed to Terminated, the system sets the end date of the following entities to the termination date when the respective condition is met:

• Policy (when the termination date is not earlier than the policy start date or later than the policy end date)

• Policy Person (when the termination date falls within the date range in which the person is associated with the policy)

  Note: The system does not consider those persons associated with policy whose start date is later than the termination date or whose end date is earlier than the termination date.

• Policy Plan (when the termination date falls within the date range of the policy plan)

  Note: The system does not consider those policy plans whose start date is later than the termination date or whose end date is earlier than the termination date.

• Membership (when the termination date falls within the date range of the membership)

  Note: The system does not consider those memberships whose start date is later than the termination date or whose end date is earlier than the termination date.

• Member Person (when the termination date falls within the date range in which the person is associated with the membership)

  Note: The system does not consider those member persons whose start date is later than the termination date or whose end date is earlier than the termination date.

• Contracts Associated with the Membership (when the termination date falls within the date range of the contract)

  Note: The system does not consider those contracts whose start date is later than the termination date or whose end date is earlier than the termination date.

The system also changes the status of all memberships to Terminated irrespective of whether it is effective on the termination date or not. On terminating a membership, the system creates an audit event for the membership. For each audit event, the system identifies the policy plan to which the membership belongs and the active pricing rules defined on the policy plan. It then identifies the pricing rule types using which these active pricing rules are created in the system. An entry for each membership, pricing rule type, and effective date combination is created in the Pending (P) status in the CI_​REPRC_​ENTITY_​DTL table. For more information, see Audit Framework for Fully-Insured Billing.