Membership Benefit Pricing

Oracle Revenue Management and Billing offers a benefit pricing rule type using which you can determine the following:

  • Price items that should be used to create charges for different membership benefits, such as Medicare Part D LIS, Medicare Part D LEP, APTC benefit, etc.

  • Eligibility rule type for the respective price item.

  • Active audit event type of the C1-Benefits business object using which the system should create an audit event whenever the listed elements (such as benefit end date, benefit amount) are updated or when the status of the membership benefit is set to ACTIVE (during creation), INACTIVE (during modification), or DISCARD (when it is discontinued).

Note: The fields and statuses of a membership benefit which you specify in the Event Management section of a benefit pricing rule type should also exits as audit elements for update in the selected audit event type.

The Benefit Pricing Rule Type (C1-PrcRuleTypeBenefit) business object is shipped with the product. You need to create a benefit pricing rule type using the Benefit Pricing Rule Type business object. You can create the benefit charges for Medicare Part D LIS, Medicare Part D LEP, APTC benefit using the benefit pricing rule type. In this way, you can create a benefit charge for the low income subsidy (LIS) and late enrollment penalty (LEP) along with the Medicare Part D premium charge (which is calculated using the age-based or tier based pricing rule).

While creating a benefit charge for the membership, the system considers the benefit pricing rule type which is associated with the health plan or policy plan. The associated benefit pricing rule type should be added as a related pricing rule type in the age-based or tier-based pricing rule type which is associated with the health plan or policy plan. Therefore, while creating a benefit pricing rule type, you need to ensure that the Primary option is not selected and the pricing rule type category is set to Benefit. You need to then add the benefit pricing rule type as a related pricing rule type in the required age-based or tier-based pricing rule type.

While specifying an eligibility rule type for a price item, you need to ensure that the rule type usage of the rule type is set to Price Item Eligibility. Before creating rules for the eligibility rule type, you need to create a parameter where the source entity is set to Benefit, source type is set to Field, source type code is set to Benefit Sub Type, and the Rule Eligibility Criteria option is selected. While creating rules for the eligibility rule type, you need to ensure that the benefit sub type parameter is set to the required benefit sub type. While creating a benefit charge for the membership, the system executes the effective rules of the eligibility rule type in the order of priority. If the rule criteria is met by the group or individual membership (i.e. benefit sub type of the group or individual membership benefit matches with the rule criteria), the system considers the respective price item to create the charge for the membership benefit.

While creating a benefit pricing rule type, you must attach the following algorithms to the respective system events:

System Event Sequence Algorithm
Account and Price Item Derivation 1 C1_​ACCPRIMEM
Account and Price Item Derivation Post-Processing 1 C1-BILLPDRV
Account and Price Item Derivation Post-Processing 2 C1-BILLRPCR
Bill Group Derivation 1 C1_​MEMBGDRV
Billable Charge Creation Post-Processing 1 C1-FICRETBC
Premium Calculation 1 C1_​MEDIPREM
Billable Charge Creation Post-Processing 2 C1-PRLBCVLD
Note:

The system requires the C1-PRLBCVLD algorithm only when the Validate External Price option is selected in the benefit sub type of a membership benefit for which the benefit charge is created.

If you attach the C1-PRLBCVLD algorithm in a benefit pricing rule type, you need to ensure that it is also attached in the primary pricing rule type (i.e. age-based or tier-based) through the membership premium is calculated.