New Born Credit Waiver

Oracle Revenue Management and Billing enables you to waive off premium for a newborn while calculating the health insurance premium for the group and individual memberships. However, the newborn premium waiver benefit for the group and individual memberships was not recorded and maintained in ORMB for the General Ledger (GL) posting.

Now, the system calculates the premium for the newborn credit waiver period and stores the amount in the billable charge when a newborn member exists in the group and individual memberships and the newborn applicability for the membership is set to Yes. The system stamps two SQIs in the billable charge - one SQI stores the newborn premium (i.e. debit amount) and another SQI stores the newborn premium waiver benefit (i.e. credit amount). This mechanism ensures that the system records the newborn premium in the system, but at the same time does not charge the newborn premium for the membership. It helps to maintain GL entries for the newborn premium which is waived off during premium calculation. To enable this feature, you need to set the New Born Waiver Credit Calculation option type of the C1-ASOBLLNG feature configuration to Y.

To implement this business requirement, the following changes are made in the system:

  • While deriving the eligible members for a membership, while deriving the member relationship for a member person, and while deriving the subscription tier for a membership, the system checks whether the New Born Waiver Credit Calculation option type is set to Y or N. If the New Born Waiver Credit Calculation option type is set to Y, the system derives the list of eligible members for the membership, member relationship for a member person, or subscription tier for the membership considering with and without newborn gift days.

    If you are using an age based pricing rule wherein the member relationship derivation algorithm is attached, the system will set the following characteristics for each member person in the membership:

    • Member Relationship - Stores the member relationship for the member person considering newborn gift days

    • Member Role Without New Born Gift Days - Stores the member relationship for the member person without considering newborn gift days

    However, if you are using a tier based pricing rule, the system will set the following characteristics for the membership:

    • Subscription Tier - Stores the subscription tier for the membership considering newborn gift days

    • Subscription Tier without Gift Days - Stores the subscription tier for the membership without considering newborn gift days

  • While calculating premium for a membership, the system checks whether there is a newborn member person in the membership and whether the New Born Gift Days Applicability option is set to Yes for the membership. If so, the system checks whether the New Born Waiver Credit Calculation option type in the C1-ASOBLLNG feature configuration is set to Y. If so, the system calculates the newborn gift period start and end dates. While deriving the timeline during premium calculation, the system checks whether the timeline is within the newborn gift days period. If so, the system calculates the premium for the newborn and creates a record in the CI_​PRCE_​CALC_​LN table where the NEW_​BORN_​CMT_​FLG column is set to Without Gift Days. In addition, the system creates a reverse entry record in the CI_​PRCE_​CALC_​LN table where the NEW_​BORN_​CMT_​FLG column is set to Reversal. If the amount calculated with and without gift days do not match, the system stamps two SQIs in the billable charge - one SQI stores the newborn premium (i.e. debit amount) and another SQI stores the newborn premium waiver benefit (i.e. credit amount). The system considers the SQIs specified in the New Born Waiver SQI and New Born Waiver Credit SQI option types of the C1-ASOBLLNG feature configuration, respectively.

  • During premium proration, the system stores the distributed amount for the newborn member person in an SQI which is specified in the New Born Distributed SQI option type of the C1-ASOBLLNG feature configuration.