Self-Funded Policy

You can create a self-funded policy using a policy type where the policy category is set to Self-Funded. The policy type indicates the business object using which the self-funded policy should be created in the system.

As per the self-funded health insurance business, the system enables you to create a self-funded policy for a bill group where the parent customer is the policy holder. You can create or edit a self-funded policy from the Policy screen. In addition, you can create or edit a self-funded policy through a customer registration object or a health care inbound message. If the self-funded policy information is given for a bill group in a health care inbound message, the system does the following:

Associates the bill group with the policy using the policy person role which is specified in the Bill Group Policy Person Role option type of the C1-ASOBLLNG feature configuration
Associates the parent customer with the policy using the policy person role which is specified in the Parent Customer Policy Person Role option type of the C1-ASOBLLNG feature configuration

A self-funded policy encapsulates the following information:

Policy Persons - While creating a self-funded policy, you need to associate the person who is the main customer of the policy. While associating a person with a self-funded policy, you need to specify the policy person role which indicates the role of the person in the policy. For example, whether the person associated with the policy is the policy holder, broker, or underwriter. You can associate multiple persons with a self-funded policy using the same or different policy person role. However, at a time, only one person can be the main customer of the policy.
Policy Contracts - The system creates a contract for a self-funded policy when the policy is created either from the user interface or through an inbound message. For more information, refer to Self-Funded Policy Contract Creation.

On defining a self-funded policy, the status of the policy is set to Pending. You can then edit, delete or activate a policy. Once a self-funded policy is activated, you can renew the policy whenever required.

Note: If a self-funded policy is created through a customer registration object or a health care inbound message, the status of the policy is set to Pending.

In a self-funded policy, you can specify the policy period as well as the runout period. Here, the policy period means the period between the policy start and end dates when the policy is active. And, the runout period means the period between the runout start and end dates when the policy is no more active. Note that the system sets the runout start date to the policy end date + 1 Day when you specify the runout end date.

The system enables you to create a self-funded policy for the following contract types which are used in the self-funded health insurance business:

Contract Type	Policy (Example)	Policy Period (i.e. Period when Policy will be in the Active Status)	Runout Period (i.e. Period when Policy will be in the Runout Status)	Comments
12/12 (Claims Incurred and Paid During the Policy Period)	P1	01-01-2019 to 12-31-2019	-	Here, you will not specify the runout end date for the self-funded policy (i.e. P1).
12/15 (Claims Incurred During the Policy Period and Paid During the Policy and Runout Periods)	P2	01-01-2019 to 12-31-2019	01-01-2020 to 03-31-2020	Here, the runout period is derived when you set the runout end date of the self-funded policy (i.e. P2) to 03-31-2020.
12/18 (Claims Incurred During the Policy Period and Paid During the Policy and Runout Periods)	P3	01-01-2019 to 12-31-2019	01-01-2020 to 06-30-2020	Here, the runout period is derived when you set the runout end date of the self-funded policy (i.e. P3) to 06-30-2020.
15/12 (Claims Incurred Three Months Prior to the Policy Start Date and During the Policy Period and Paid During the Policy Period)	P4	01-01-2019 to 12-31-2019	-	Here, you will not specify the runout end date for the self-funded policy (i.e. P4).

The system enables you to offer different pricing for different policy periods, such as active, runout, and post runout.

Parent Topic: Self-Funded Group Health Insurance