Delinquency Process Type Preference

A delinquency process type preference enables you to set the attributes which are used while creating a delinquency process for a person or an account. You need to create two distinct delinquency process type preferences – one for the fully insured group business and another for the fully insured individual business. A delinquency process type preference for the fully insured group business enables the system to create a delinquency process for a person or an account to which the policies are billed. However, a delinquency process type preference for the fully insured individual business enables the system to create a delinquency process for an account to which the individual memberships are billed. Once you create a delinquency process type preference for the fully insured group business, you need to specify the preference code in the Delinquency Process Type Field Mapping – Group parameter of the C1-DLNQMNRL algorithm. Similarly, Once you create a delinquency process type preference for the fully insured individual business, you need to specify the preference code in the Delinquency Process Type Field Mapping – Individual parameter of the C1-DLNQMNRL algorithm.

You can define, edit, delete, and copy a delinquency process type preference using the C1-FieldMapping business object through the Field Mapping screen. You can create a delinquency process type preference using the Delinquency Process Type preference category. While creating a delinquency process type preference for the fully insured individual business, you can specify the following attributes:

• Active Individual Delinquency – Used to indicate the delinquency process type using which you want to create a delinquency process for an account when its main customer is an active customer. An individual is deemed to be an active customer when at least one membership of the individual customer is in the Active status.

• Effectuated Individual Delinquency for Ancillary – Used to indicate the delinquency process type using which you want to create a delinquency process for an account when the following conditions are met:

  • The Active Individual Delinquency attribute is not defined in the delinquency process type preference

  • Paid through date is present on the account

  • Earliest unpaid coverage period does not include benefit charges

  • Individual is enrolled to a health plan which belongs to a non-medical health product

• Effectuated Individual without Benefit – Used to indicate the delinquency process type using which you want to create a delinquency process for an account when the following conditions are met:

  • The Active Individual Delinquency attribute is not defined in the delinquency process type preference

  • Paid through date is present on the account

  • Earliest unpaid coverage period does not include benefit charges

  • Individual is enrolled to a health plan which belongs to a medical health product

• Effectuated Individual with Benefit – Used to indicate the delinquency process type using which you want to create a delinquency process for an account when the following conditions are met:

  • The Active Individual Delinquency attribute is not defined in the delinquency process type preference

  • Paid through date is present on the account

  • Earliest unpaid coverage period includes benefit charges

• Benefit Sub Type – Used to indicate the benefit sub type. The system considers the benefit charges of the specified benefit sub type to derive the appropriate delinquency process type for an account. The system considers this attribute when the following conditions are met:

  • The Active Individual Delinquency attribute is not defined in the delinquency process type preference

  • Paid through date is present on the account

  • The value is defined for the Effectuated Individual with Benefit attribute in the delinquency process type preference

• Non-Effectuated Individual Delinquency – Used to indicate the delinquency process type using which you want to create a delinquency process for an account when the following conditions are met:

  • The Active Individual Delinquency attribute is not defined in the delinquency process type preference

  • Paid through date is not present on the account

• Termed Individual Delinquency – Used to indicate the delinquency process type using which you want to create a delinquency process for an account when its main customer is an inactive customer. An individual is deemed to be an inactive customer when all memberships of the individual customer are in the Terminated status.

However, while creating a delinquency process type preference for the fully insured group business, you can specify the following attributes:

• Active Group Customers – Account Level – Used to indicate the delinquency process type using which you want to create the delinquency process for an account when its main customer is an active customer. A person is deemed to be an active customer when at least one policy associated with the person (i.e. policy holder) is in the Active status.

• Active Group Customers – Person Level – Used to indicate the delinquency process type using which you want to create the delinquency process for an active person. A person is deemed to be an active customer when at least one policy associated with the person (i.e. policy holder) is in the Active status.

• Inactive Group Customers – Account Level – Used to indicate the delinquency process type using which you want to create the delinquency process for an account when its main customer is an inactive customer. A person is deemed to be an inactive customer when all policies associated with the person (i.e. policy holder) are in the Terminated status.

• Inactive Group Customers – Person Level – Used to indicate the delinquency process type using which you want to create the delinquency process for an inactive person A person is deemed to be an inactive customer when all policies associated with the person (i.e. policy holder) are in the Terminated status.

You can define, edit, delete, and copy a delinquency process type preference through the Field Mapping screen.

For more information about the attribute, see Defining a Delinquency Process Type Preference

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