Membership Benefits

Oracle Revenue Management and Billing enables you to maintain the following types of membership benefits for the fully-insured group and individual businesses:

• Medicare benefits, such as, Part A, Part B, Part D for which premium is calculated using the age-based or tier-based pricing rules

• Medicare benefits, such as Medicare Part D Low-Income Subsidy (LIS) and Medicare Part D Late Enrollment Penalty (LEP) for which charges are calculated using the benefit pricing rule type

• Advance Premium Tax Credit (APTC) benefits for which charges are calculated using the benefit pricing rule type

In addition, it enables you to setup the following Medicare membership benefits for the fully insured individual business:

• PW (Premium with Hold)

• LEPWH (LEP with Hold)

• LEP (LEP Memo Only)

• LEPD ( LEP Direct Pay)

• LIS

The system enables you to define a benefit at the membership level and not at the member person level. This is because the system assumes the following:

• There will be only one member person in the Medicare membership who will avail the Membership benefit.

• The other benefits such as APTC would be availed by all member persons of the group or individual membership.