Additional Repricing Entity Detail Records

Until now, while creating repricing entity detail records for an audit event, the system used to create two repricing entity detail records for each membership and pricing rule type combination – one with the effective date as the membership start date and another with the effective date as the auditable element effective date. In addition, the system used to set the Message_​PARAM4 column to Y corresponding to the latter repricing entity detail record (with the effective date as the auditable element effective date) so that the system creates a repricing request only for the latter repricing entity detail record and not for the former repricing entity detail record.

A new option type named Additional Repricing is added in the C1-ASOBLLNG feature configuration. It enables the system to determine whether you want to create repricing entity detail records for all auditable elements (such as fields, business statuses, and characteristics) of the membership, member person, or person that are updated within the membership period. You can set the Additional Repricing option type to either of the following:

  • Y – Used when you want to create repricing entity detail records for all auditable elements (such as fields, business statuses, and characteristics) of the membership, member person, or person that are updated within the membership period.

  • N – Used when you want to create repricing entity detail records in the traditional manner (i.e. one with the effective date as the membership start date and another with the effective date as the auditable element effective date).

If you do not specify the value for this option type, the system, by default, sets it to N. Note that this option type is only applicable for the fully insured individual business.

Let us assume the following:

  • M1 membership is effective from 01-Jan-2023 to 31-Dec-2023 on the HP1 health plan

  • AGE_​BASED1 and BENEFIT_​1 pricing rule types are associated with the HP1 health plan

  • The following auditable elements at the membership or member person level are already updated till 01-08-2023:

Element Name Element Value Modified On
benefitAmount Field 10-Jan-2023
billLevel1 Field 20-Feb-2023
emailAddress Field 22-Mar-2023
C1SMOKER Characteristic 04-Apr-2023
C1TOBCC Characteristic 05-May-2023
INACTVAL Characteristic 01-Aug-2023

Now, if the Additional Repricing option type is set to Y and you update the INACTVAL characteristic of the M1 membership on 01-Aug-2023, the system will create the following repricing entity detail records for the audit event:

  • M1, AGE_​BASED1, 01-Jan-2023 (Message_​PARAM4 = N)

  • M1, BENEFIT_​1, 01-Jan-2023 (Message_​PARAM4 = N)

  • M1, AGE_​BASED1, 10-Jan-2023 (Message_​PARAM4 = N)

  • M1, BENEFIT_​1, 10-Jan-2023 (Message_​PARAM4 = N)

  • M1, AGE_​BASED1, 20-Feb-2023 (Message_​PARAM4 = N)

  • M1, BENEFIT_​1, 20-Feb-2023 (Message_​PARAM4 = N)

  • M1, AGE_​BASED1, 22-Mar-2023 (Message_​PARAM4 = N)

  • M1, BENEFIT_​1, 22-Mar-2023 (Message_​PARAM4 = N)

  • M1, AGE_​BASED1, 04-Apr-2023 (Message_​PARAM4 = N)

  • M1, BENEFIT_​1, 04-Apr-2023 (Message_​PARAM4 = N)

  • M1, AGE_​BASED1, 05-May-2023 (Message_​PARAM4 = N)

  • M1, BENEFIT_​1, 05-May-2023 (Message_​PARAM4 = N)

  • M1, AGE_​BASED1, 01-Aug-2023 (Message_​PARAM4 = Y)

  • M1, BENEFIT_​1, 01-Aug-2023 (Message_​PARAM4 = Y)

Note: The system will create repricing requests only for the repricing entity detail records where the Message_​PARAM4 column is set to Y.