Adoption Business Rule
Oracle Revenue Management and Billing enables you to define business rules to determine whether gift ways should be offered to an adopted child or adult. The insurance company may offer different adoption gift days to different individuals based on certain parameters, such as health plan, division, membership, or member person characteristic, etc. The system will then accordingly derive the adoption gift days for the individual membership and waive off the premium of an adopted child or adult for the gift period. In addition, the adoption business rule enables you to determine whether adoption enrollment timeline regulations should be enforced on the individual memberships. If so, the system will calculate the adoption enrollment notice period and allow to waive off premium for the adopted child or adult only when the enrollment received date is within the cutoff date.
On enrolling an adopted child or adult to an individual membership, the system derives the business rules with the Adoption Business Rule category that are effective on the processing date. Note that the system considers only those effective business rules which are in the Active status. The system then executes the criteria of each effective business rule and considers the business rule that meet the criteria. If two or more business rules meet the criteria, the system considers the business rule with the highest priority. The system stamps the adoption business rule against the individual membership in the C1_ENT_BUS_RULE table.
While defining criteria for an adoption business rule, you can use the parameters that are defined on the following source entities:
| Source Entity | Supported Source Type |
|---|---|
| Account | Field, Characteristic |
| Customer Class | Field |
| Division | Field |
| Health Plan | Field, Characteristic |
| Health Product | Field, Characteristic |
| Membership | Field, Characteristic |
| Membership Person | Field, Characteristic |
You can define, edit, and delete an adoption business rule through the Business Rule screen. While defining an adoption business rule, you need to set the category to Adoption Business Rule. The adoption business rule enables you to define the following parameters:
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Gift Days Applicability – Used to indicate whether you want to offer gift days for an adopted child or adult.
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Gift Days –Used to specify the number of days you want to offer as gift days from the adoption date.
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Notice Rule Applicability – Used to indicate whether you want to enforce enrollment timeline regulations for an adopted person.
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Notice Rule Days – Used to indicate the number of days you want to offer to determine the adoption enrollment notice period.
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Adoption Notice Rule Calculation – Used to indicate whether you want to calculate the adoption enrollment notice period starting from the adoption date or member person start date. The system will then derive the adoption enrollment notice period using the given date and notice rule days.
Once the business rule is created, the business rule ID is generated. While creating a business rule, the status is, by default, non-editable and set to Active. While editing a business rule, you can change its status from Active to Inactive and vice-versa. Note that you cannot edit or delete a business rule if it is referred in the system. You can use the same criteria in multiple business rules with a different effective date to derive different gift days. You can view the adoption business rules through the Business Rule screen.