Adoption Premium Waiver

Some states have regulations requiring health insurance companies to waive off premium for a specified period on adoption of a child or adult. Oracle Revenue Management and Billing enables you to offer gift days or a gift period in case of an adoption. The gift period refers to a specific window immediately following adoption date during which an adopted child or adult is covered without an additional premium. The premium of an adopted person is waived off for a specific period and the individual is not charged for the adopted person during that period. This feature is tested and certified only for the fully insured individual business.

The system enables you to add a person with the adoption date through a health care inbound message. The adoption date indicates that the person is an adopted child or adult. If a newborn is adopted, the system will offer the adoption gift days and not newborn gift days to the adopted newborn. The system enables you to indicate whether the adopted person enrolled to an individual membership is eligible for adoption gift days. In the fully insured individual business, different individuals may be offered different adoption gift days based on their state, health product, health plan, membership, or member person attributes. Hence, the system enables you to derive the following information for an eligible adopted person through an adoption business rule:

  • Gift Days Applicability – Used to indicate whether you want to offer gift days for an adopted child or adult.

  • Gift Days – Used to indicate the number of days you want to offer as gift days from the adoption date. As a result, no premium will be calculated for the gift period.

You need to define the business rules where the category is set to Adoption Business Rule. While creating or editing an individual membership, the system determines the adoption business rule that is applicable for the individual membership if it includes a member person with the adoption date. The system then refers this adoption business rule during the age-based and tier-based premium calculation of the individual membership. For more information, see Adoption Business Rule.