Member Relationship Pricing Parameter

Oracle Revenue Management and Billing enables you to use the member relationship (i.e. how a member is related to the main subscriber of the membership) as a pricing parameter while defining the age based, tier based, and additional fee pricing rules. This feature facilitates you to offer different rates for a price item based on different member relationship.

While adding a membership to a policy plan or while adding or inactivating a member person in a membership, the system automatically derives member relationship for each member person of the membership from a member relationship structure. You can define a member relationship structure through a characteristic on the policy plan. While defining a member relationship structure for a policy plan, you must use the characteristic type specified in the Member Relationship Structure Characteristic Type attribute of a member relationship and subscription tier preference. The system considers the member relationship and subscription tier preference which is specified in the Relation Structure Code Field Mapping option type of the C1-ASOBLLNG feature configuration.

The system enables you to define two types of member relationship structure:

Step Member Relationship Structure - A step member relationship structure helps the system to determine how each member person is related to the main subscriber of the membership. You can specify a list of member relationships in a step member relationship structure. A member relationship is derived for a member person depending on the following:

Whether the member person is a self, spouse, or dependent
Number of spouses, dependents, and young adults in the membership

A relationship matrix indicates whether a member person with a particular relationship type should be considered as self, spouse, or dependent while deriving the member relationship. In a step member relationship structure, a spouse is never considered as a dependent. Only children are considered as dependents.

For example, you can create a step member relationship structure named STEPEX1 as shown below:

Member Relationship	Self	Number of Spouses	Number of Dependents	Number of Young Adults
Self	1	0	0	0
Spouse 1	1	1	0	0
Spouse 2	1	2	0	0
Child 1	1	1	1	0
Young Adult 1	1	1	0	1
CD1 and YA1	1	1	1	1
Child 2	1	1	2	0
Young Adult 2	1	1	0	2
CD2 and YA2	1	1	2	2
Additional Dependent	1	3	3	3

Note: You can only define one member relationship in a step member relationship structure where the sum of self, number of spouses, number of dependents, and number of young adults exceeds the maximum member count specified in the step member relationship structure.

In addition, you can create a relationship matrix in the STEPEX1 member relationship structure as shown below:

Relation	Relationship Type	Relationship
Main Subscriber	Owner	Self
Main Subscriber	Member	Self
Children	Child	Dependent
Spouse	Wife	Spouse
Spouse	Spouse	Spouse

Party Member Relationship Structure - A party member relationship structure helps the system to determine how each member person is related to the main subscriber of the membership. You can specify a list of member relationships in a party member relationship structure. A member relationship is derived for a member person depending on the following:

Whether the member person is a self or dependent
Number of dependents in the membership

A relationship matrix indicates whether a member person with a particular relationship type should be considered as self or dependent while deriving the member relationship. In a party member relationship structure, a spouse is always considered as a dependent. Also, children are not categorized as young adults.

For example, you can create a party member relationship structure named PARTYEX1 as shown below:

Member Relationship	Self	Number of Dependents
Self	1	0
Dependent 1	1	1
Dependent 2	1	2
Dependent 3	1	3
Additional Dependents	1	9

Note: You can only define one member relationship in a party member relationship structure where the sum of self and number of dependents exceeds the maximum member count specified in the party member relationship structure.

In addition, you can create a relationship matrix in the PARTYEX1 member relationship structure as shown below:

Relation	Relationship Type	Relationship
Main Subscriber	Owner	Self
Main Subscriber	Member	Self
Children	Child	Dependent
Spouse	Wife	Dependent
Spouse	Spouse	Dependent

Once the member relationship structure is derived from the policy plan, the system determines the member relationship for each member person in the membership. While determining the member relationship for a member person, the system derives the following characteristic types from the respective attributes of the member relationship and subscription tier preference:

Age Calculation Date Basis
Max Age Limit for Max Dependent Count
Max Number of Dependents Order Priority
Maximum Number of Dependents
Member Relationship Derivation Date
New Born Gift Days
New Born Gift Days Applicability
Young Adult Max Age Limit
Young Adult Max Age Limit Applicability

The system then derives these characteristics from the policy plan. If the Member Relationship Derivation Date characteristic type is set to Enrollment Date, the system derives the member relationship for each member person of the membership in order of the member start date. However, if the Member Relationship Derivation Date characteristic type is set to Date of Birth, the system derives the member relationship for each member person of the membership in order of the date of birth. For example, if a membership with the following member persons is added to a policy plan:

Member Start Date	Member End Date	Person Name	Main Subscriber	Relationship Type	Member	Date of Birth
1-Jan-18	31-Dec-20	Mark	Yes	Self	Yes	15-Jan-68
1-Jan-18	31-Dec-20	Nancy	No	Wife	Yes	20-Apr-72
1-Jan-18	31-Dec-20	Roger	No	Child	Yes	15-May-01
1-Jan-18	31-Dec-20	Tom	No	Child	Yes	16-May-04

Now, if the following characteristics are defined on the policy plan:

Member Relationship Structure - STEPEX1
Member Relationship Derivation Date - Date of Birth
Age Calculation Date Basis - Enrollment Date
Maximum Number of Dependents - 3
Max Number of Dependents Order Priority - YOUNGEST

The system will consider the STEPEX1 member relationship structure and derives the member relationship for each member person as shown below:

Member Person	Effective Date	Characteristic Type	Characteristic Value
Mark	1-Jan-18	Member Relationship	Self
Nancy	1-Jan-18	Member Relationship	Spouse 1
Tom	1-Jan-18	Member Relationship	Child 1
Roger	1-Jan-18	Member Relationship	Child 2

Note that the member relationship of Tom is derived before Roger because he is youngest of all dependents. Now, assume if one more member person named Harry with the date of birth as 05-11-08 and relationship type as Child is added to the membership on 05-Jan-18, then the system derives the member relationship for each member person of the membership as shown below:

Effective Date	Member	Member Person Characteristics	Value
1-Jan-18	Mark	Member Relationship	Self
1-Jan-18	Nancy	Member Relationship	Spouse 1
5-Jan-18	Harry	Member Relationship	Child 1
5-Jan-18	Tom	Member Relationship	Child 2
5-Jan-18	Roger	Member Relationship	Additional Dependent

The member relationship for Harry, Tom, and Roger is derived in the order of their age which is calculated from the enrollment date. Because the member relationship derived for Tom and Roger is different, the system creates a new characteristic to store the member relationship for Tom and Roger. Here, the effective date of the characteristics is set to the new member person's start date.

If a new born is added to the membership, the effective date of the new born's member relationship characteristic is calculated considering the gift days if applicable. If a member person is end dated, the system derives the member relationship of all other member persons once again. If the member relationship for a member person is different, the system creates a new characteristic to store the member relationship for the member person. The effective date of the new characteristic is set to member person's end date + 1. However, if a member person is inactivated, the system derives the member relationship of all other member persons once again. If the member relationship for a member person is different, the system updates the existing member relationship characteristic of the member person.

To use the member relationship as a pricing parameter, you need to define the Member Relationship parameter where:

Value Type is to Adhoc
Source Entity is set to Membership Person
Source Type is set to Characteristic
Source Type Code is set to a characteristic type which is specified in the Member Relationship Characteristic Type attribute of the member relationship and subscription tier preference
Parameter Usage is set to Price Item and Pricing Eligibility Criteria

Once the Member Relationship parameter is defined, you need to associate the parameter with the price items for which you want to define different rates in a pricing rule using the parameter. This helps to define different base fee for a price item based on the member relationship.

A new screen named Member Relationship/Subscription Tier Structure is introduced in this release. It enables you to add, edit, copy, and delete the member relationship and subscription tier structures.

Parent Topic: Health Insurance Business Management