Defining a Membership for a Fully-Insured Group Policy Plan

Prerequisites

To define a membership for a fully-insured group policy plan, you should have:

  • Policy and policy plan defined in the application.

  • Person, person identifier, and person identifier types defined in the application.

  • Characteristic types where the characteristic entity is set to Policy Plan and Membership Person.

  • Membership and membership identifier types defined in the application.

  • Values defined for the MEMBERSHIP_​TYPE_​FLG lookup field.

  • Contract relationship types defined in the application.

Procedure

To define a membership for a fully-insured group policy plan:

  1. Do either of the following:
    If you want to...Then...
    Define a membership for a fully-insured group policy plan from the Policy screen

    1. Search for the fully-insured group policy in the Policy screen.

    2. In the Search Results section, click the link in the Policy Information column corresponding to the policy whose details you want to edit.

      The Policy screen appears.

    3. Click the Plan tab.

      The Plan tab appears.

    4. In the Plans zone, click the Broadcast (The Broadcast Icon) icon corresponding to the policy plan for which you want to define a membership.

      The Memberships zone appears.

    5. Click the Add link in the upper right corner of the Memberships zone.
    Define a membership for a fully-insured group policy plan from the Membership screen

    1. Click the Menu link in the Application toolbar.

      A list appears.

    2. From the Main menu, select Customer Management and then click Membership.

      A sub menu appears.

    3. Click the Add option from the Membership sub-menu.

    The Select Business Object screen appears. It contains the following field:

    Field Name Field Description Mandatory (Yes or No)
    Membership Business Object Used to indicate the business object using which you want to create a fully-insured individual membership or fully-insured group membership. Yes
    Note: The Select Business Object screen appears when there are multiple membership business objects defined in the application. If there is only one membership business object defined in the application, the Membership screen appears.

    The Membership screen appears. It contains the following sections:

    • Main - Used to specify the basic details about the membership.

    • Membership Identifiers - Used to define the identifiers for the membership.

    • Characteristics - Used to define the characteristics for the membership.

    The Main section contains the following fields:

    Field Name Field Description Mandatory (Yes or No)
    Plan Information Used to indicate the fully-insured group policy plan for which you want to create the membership.
    Note:

    The Search(The Search Icon) icon appears corresponding to this field. On clicking the Search icon, the Policy Plan Search window appears.

    On specifying the policy plan, the description of the policy plan appears corresponding to the Plan Information field.

    If you are defining a membership for a fully-insured group policy plan through the Plan tab, then the respective plan ID associated with the fully-insured group policy appears in the Plan Information field.

    		 Yes
    Start Date Used to specify the date from when the membership is effective for a fully-insured group policy plan.
    Note:

    The membership start date cannot be later than the membership end date.

    The membership start date cannot be earlier than the policy plan start date or later than policy plan end date.

    		 Yes
    End Date Used to specify the date till when the membership is effective for a fully-insured group policy plan.
    Note:

    The membership end date cannot be earlier than the membership start date.

    The membership end date cannot be earlier than the policy plan start date or later than policy plan end date.

    		 Yes
    Membership Type Used to indicate the type of membership. The valid values are:

    • COBRA

    • Medicare

    • Retiree

    Note: If you want to define an active employee coverage membership, you must leave this field blank.
    		 No
    Main Subscriber Used to indicate the person who is the main subscriber of the membership.
    Note:

    The Search(The Search Icon) icon appears corresponding to this field. On clicking the Search icon, the Person Search window appears.

    On specifying the person, the description of the person appears corresponding to the Main Subscriber field.

    		 Yes
    Relationship Type Used to indicate how the main subscriber is related to the membership. No
    External Membership ID Used to specify the external membership ID.
    Note: Here, you need to specify a membership ID which is maintained in the external source system.
    		 No
    Tip: Alternatively, you can access this screen by clicking the Add button in the Page Title area of the Membership screen.
  2. Enter the required details in the Main section.
  3. Define characteristics for the membership, if required.
  4. Click the Save.
    The membership is defined for the fully-insured group policy plan. The status of the membership and the main subscriber is set to Active.

Related Topics

For more information on... See...
How to search for a fully-insured group policy Searching for a Policy
Policy screen Policy (Used for Viewing)
Plans zone Plans
Memberships zone Memberships
Membership screen Membership (Used for Searching)
How to define a characteristic for a membership Defining a Characteristic for a Membership
How to define a membership identifier type for a membership Defining a Membership Identifier Type