Young Adult Coverage in an Individual Membership

Oracle Revenue Management and Billing enables you to calculate premium for the young adults who are covered in an individual membership. While creating or editing an individual membership, or while adding, editing, or inactivating a member person in an individual membership through a health care inbound message or through membership repricing inbound web service, the system derives the fully-insured pricing business rule for the individual membership. The system enables you to define the following young adult related output parameters in the fully-insured pricing business rules:

• Young Adult Applicability - Used to indicate whether you want to consider the young adults during the premium calculation. The valid values are - Yes and No.

• Young Adult Max Age Limit - Used to indicate the maximum age limit for young adults who are eligible for premium calculation. This output parameter is mandatory when the Young Adult Applicability parameter is set to Yes.

While deriving member relationship for each member person of the individual membership from a member relationship structure, the system considers the following information from the fully-insured pricing business rule of the individual membership:

• Young Adult Applicability

• Young Adult Max Age Limit

Similarly, while deriving subscription tier for the individual membership from a subscription tier structure, the system considers the following information from the fully-insured pricing business rule of the individual membership:

• Young Adult Applicability

• Young Adult Max Age Limit

Thus, while calculating the premium for an individual membership using an age based or tier based pricing rule, the system considers the young adult for the premium calculation based on the above two parameters set in the fully-insured pricing business rule.