Policy

The Policy zone displays the details of the fully-insured group or self-funded policy. It contains the following sections:

• Main - Displays basic information about the policy. It contains the following fields:

  Field Name	Field Description
  Base Policy Information	Displays information about the base policy. Note: This field appears when you are viewing the details of a renewed policy which is created using a policy type where the policy category is set to Self-Funded.
  Policy Information	Displays information about the policy.
  Policy Type	Indicates the policy type using which the policy is created. Note: It has a link. On clicking the link, the Policy Type screen appears where you can view the details of the respective policy type.
  Status	Indicates the status of the policy. If the policy is created using the C1-POLICY business object, the valid values are: Pending In Force/Active Pending Cancellation Canceled Pending Reinstatement Reinstated Pending Termination Terminated However, if the policy is created using the C1-ASOPolicy business object, the valid values are: Pending In Force/Active Runout Post Runout
  Status Reason	Indicates the reason why the policy is terminated. Note: It has a link. On clicking the link, the Status Reason screen appears where you can view the details of the respective termination reason. This field appears when you are viewing the details of a terminated or reinstated policy which is created using a policy type where the policy category is set to Fully-Insured Group or Fully-Insured Individual.
  Policy Number	Displays the policy number.
  Description	Displays the description of the policy.
  Source System	Indicates the external system from where the policy is originated.
  Start Date	Displays the date from when the policy is effective.
  End Date	Displays the date till when the policy is effective.
  Renewal Date	Displays the date when the policy is renewed. Note: This field appears when you are viewing the details of a policy which is renewed.
  Paid Through Date	Indicates the term end date of the last fully or partially paid term. The system considers the term to be fully paid when the threshold limit is met. Note: This field appears when the following conditions are met: When you are viewing the details of a policy which is created using a policy type where the policy category is set to Fully-Insured Group or Fully-Insured Individual. When the paid through date is calculated at the policy level. The paid through date is calculated while freezing or canceling a payment or adjustment depending on whether the required algorithm is attached to the respective system event: Entity System Event Algorithm Customer Class Payment Freeze C1-PSPTDCAL Customer Class Payment Cancellation C1-PXPTDCAL Adjustment Type Adjustment Freeze C1-ADPTDCAL Adjustment Type Adjustment Cancellation C1-AXPTDCAL The following table indicates when the paid through date is calculated at the policy and/or membership level: If the Paid Through Date Calculation Level parameter is set to… If the following characteristics are defined for the billable charge or adjustment… Then… P C1-POLID Paid through date is calculated at the policy level P C1-MPID Paid through date is calculated at the policy level P C1-POLID and C1-MPID Paid through date is calculated at the policy level M C1-POLID Paid through date is not calculated at the membership level M C1-MPID Paid through date is calculated at the membership level M C1-POLID and C1-MPID Paid through date is calculated at the membership level P, M C1-POLID Paid through date is calculated at the policy level P, M C1-MPID Paid through date is calculated at both the policy and membership levels P, M C1-POLID and C1-MPID Paid through date is calculated at both the policy and membership levels
  Runout End Date	Displays the date when the runout period of the self-funded policy ends. Note: This field appears when you are viewing the details of a policy which is created using a policy type where the policy category is set to Self-Funded.
  Runout Administration Fees	Indicates whether the administration fees must be charged when the claim transaction for the self-funded policy is processed in the runout period. The valid values are: None Percentage of Claim Note: This field appears when you are viewing the details of a policy which is created using a policy type where the policy category is set to Self-Funded.
  Advance Level Funding Eligibility	Indicates whether the self-funded policy is eligible for advance billing feature of level funding. Note: This field appears when you are viewing the details of a policy which is created using a policy type where the policy category is set to Self-Funded.

• Persons - Lists the persons which are associated with the policy. It contains the following columns:

  Column Name	Column Description
  Person Information	Indicates the person who is associated with the policy. In addition, this column has a context menu which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Person screen appears where you can view the details of the respective person.
  Sequence	Displays the sequence number of the associated person.
  Policy Person Role	Indicates the role of the person in the policy.
  Main Customer	Indicates whether the person is the main customer of the policy.
  Start Date	Displays the date from when the person is associated with the policy.
  End Date	Displays the date till when the person is associated with the policy.

• Record Actions - This section contains the following buttons:

  Button Name	Button Description
  Edit	Used to edit the details of the fully-insured group or self-funded policy. Note: The Edit button appears only when a policy of the respective category is in either of the following status: Policy Category Status Fully-Insured Group or Fully-Insured Individual In Force/Active Canceled Pending Cancellation Pending Pending Reinstatement Pending Termination Terminated Self-Funded In Force/Active Pending Runout
  Activate	Used to activate the fully-insured group or self-funded policy. Note: The Activate button appears when a policy of the respective category is in either of the following status: Policy Category Status Fully-Insured Group or Fully-Insured Individual Pending Pending Termination Self-Funded Pending
  Initiate Cancellation	Used to initiate the cancellation process for the fully-insured group policy. Note: The Initiate Cancellation button appears when the fully-insured group policy is in the In Force/Active status.
  Cancel	Used to cancel the fully-insured group policy. Note: The Cancel button appears when the fully-insured group policy is in the Pending Cancellation status.
  Initiate Termination	Used to initiate the termination process for the fully-insured group policy. Note: The Initiate Termination button appears when the fully-insured group policy is in the In Force/Active status.
  Terminate	Used to terminate the fully-insured group policy. Note: The Terminate button appears when the fully-insured group policy is in the In Force/Active, Pending Reinstatement, or Pending Termination status.
  Initiate Reinstatement	Used to initiate the reinstatement process for the terminated policy. Note: The Initiate Reinstatement button appears when the fully-insured group policy is in the Terminated status.
  Reinstate	Used to reinstate the terminated policy. Note: The Reinstate button appears when the fully-insured group policy is in the Pending Reinstatement or Terminated status.
  Runout	Used to transition the self-funded policy to the Runout status. Note: The Runout button appears when the self-funded policy is in the In Force/Active status. You cannot transition a self-funded policy to the Runout status when: The self-funded policy is renewed. The runout end date is not specified. The policy end date is earlier than the system date.

• Record Information - This section contains the following fields:

  Field Name	Field Description
  Business Object	Indicates the business object using which the policy is created. In addition, a context menu appears corresponding to this field which helps in navigating to other screens in the application. Note: It has a link. On clicking the link, the Business Object screen appears where you can view the details of the respective business object.
  Status Date/Time	Displays the date and time when the policy status is updated.
  Create Date/Time	Displays the date and time when the policy is created.

• Termination Information - Displays the termination details of the fully-insured group policy. It appears when the policy is in the Pending Termination status. It contains the following fields:

  Field Name	Field Description
  Terminate Date	Displays the date when you want to terminate the policy.
  Terminate Reason	Indicates the reason why the termination process is initiated for the policy. Note: It has a link. On clicking the link, the Status Reason screen appears where you can view the details of the respective termination reason.

• Reinstate Information - Displays the reinstatement details of the terminated policy. It appears when the policy is in the Pending Reinstatement status. It contains the following fields:

  Field Name	Field Description
  Reinstate Reason	Indicates the reason why you want to reinstate the fully-insured group policy. Note: It has a link. On clicking the link, the Status Reason screen appears where you can view the details of the respective reinstatement reason.

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