SSL Accumulation across Bill Groups

Specific Stop-Loss (SSL) protects the self-funded employers against the excess claims from a single individual who is a member in the self-funded policy. Oracle Revenue Management and Billing enables the customers to configure the SSL pricing rules wherein the SSL Limit and SSL Payout Limit are defined. For the excess claims from a member, arising on top of the SSL Limit defined for the bill group, the insurer will provide the SSL credits (capped with the SSL Payout Limit) to the self-funded employer.

There can be scenarios in which a member moves from one bill group to another. For example, an employee changes the department or work location. ORMB provides the ability to continue the accumulation of the transaction amount across the bill groups, if both bill groups have the same SSL limit and their accounts have same bill cycle. If the SSL Limits of the bill groups are different or if the bill groups' accounts have different bill cycles, the accumulation is calculated individually for each bill group based on the respective SSL Limit.

To enable the SSL Accumulation across Bill Groups feature, you need to set the SSL Member Movement Configuration option type in the C1-ASOBLLNG feature configuration to either of the following:

  • INDIVIDUAL

  • PROPORTIONATE

  • CURRENTBG

If you do not set the value for the SSL Member Movement Configuration option type in the C1-ASOBLLNG feature configuration, by default, it is set to INDIVIDUAL.

While accumulating the SSL charges for a member, the system checks whether the member is associated with more than one bill group. If so, the system derives the value from the SSL Member Movement Configuration option type of the C1-ASOBLLNG feature configuration to determine the manner in which the SSL credits should be given to the bill groups. If the value of the SSL Member Movement Configuration option type is set to PROPORTIONATE, the system does weighted distribution of the total SSL credits across the associated bill groups based on the cumulative aggregation amount of each bill group. If the value of the SSL Member Movement Configuration option type is set to CURRENTBG, the system gives the remaining SSL credits to the present bill group irrespective of the bill group for which the transaction is received. If the value of the SSL Member Movement Configuration option type is set to INDIVIDUAL, the system accumulates the charges which are eligible for SSL and calculates the SSL credits individually for each bill group based on the respective SSL Limit.

Note: In case of a member who has opted for lasering, the system considers the lasered amount instead of the SSL limit during SSL credit calculation.