Identify Refund/Write Off Eligibility (C1-RFWO1)

The Identify Refund/Write Off Eligibility (C1-RFWO1) batch is used to check whether there are any automatic refund/write off instructions in the Pending status. If there is an automatic refund/write off instruction in the Pending status, the system derives the business rule stamped against the fully-insured group policy or individual membership for which the automatic refund/write off instruction is created. If the business rule is not found for the fully-insured group policy or individual membership in the C1_​ENT_​BUS_​RULE table, the system changes the status of the automatic refund/write off instruction to Invalid. In addition, the automatic refund/write off instruction reason is set to INBR (Business Rule Could not be Derived). However, if the business rule is found for the fully-insured group policy or individual membership in the C1_​ENT_​BUS_​RULE table, the system derives the account balance. If the account balance is zero, the system changes the status of the automatic refund/write off instruction to Invalid. In addition, the automatic refund/write off instruction reason is set to INZR (Account Balance Is Zero).

If the account balance is greater than zero but less than the refund threshold amount, the system changes the status of the automatic refund instruction to Invalid. In addition, the automatic refund instruction reason is set to INTH (Account Balance Doesn't Meet Threshold Limit). However, if the account balance is greater than zero and greater than or equal to the refund threshold amount, the system does the following:

  • Changes the status of the automatic refund instruction to Valid.

  • Derives the refund request type from the automatic refund/write off field mapping which is specified in the C1_​REFWO feature configuration.

  • Calculates the automatic refund request creation date using the wait date (calculated earlier using the wait days) and defer refund days specified in the business rule.

If the account balance is less than zero but greater than the write off threshold amount, the system changes the status of the automatic write off instruction to Invalid. In addition, the automatic write off instruction reason is set to INTH (Account Balance Doesn't Meet Threshold Limit). However, if the account balance is less than zero and less than or equal to the write off threshold amount, the system does the following:

  • Changes the status of the automatic write off instruction to Valid.

  • Derives the write off request type from the automatic refund/write off field mapping which is specified in the C1_​REFWO feature configuration.

  • Calculates the automatic write off request creation date using the wait date (calculated earlier using the wait days) and defer write off days specified in the business rule.

Note: If the system is used for both the fully-insured group and fully-insured individual line of business, you need to define two separate field mappings of the Automatic Refund/Write-Off preference category - one for each line of business (i.e. fully-insured group business and fully-insured individual business). Once you define the field mapping for each line of business, you need to set them against the Field Mapping Preference for Individual Membership and Field Mapping Preference for Policy (Small Group) option types, respectively, in the C1_​REFWO feature configuration.

If the netting contract type is not specified in the refund/write off request type, the system changes the status of the automatic refund/write off instruction to Invalid. In addition, the automatic refund/write off instruction reason is set to NCTM (Netting Contract Type Missing).