Policy Events and Aggregate Events

The creation, modification and removal of a tracked entity (as described in Change Event Rules) leads to the creation of a policy event for change event rules of type Recalculation, Output, Fee or Message. Policy events of type Message lead to the creation of the more granular aggregate events. A policy event maps 1-to-1 to the triggering event (for example, an event that indicates that product XYZ has changed). A policy event of the type 'message' may roll up/ down to generate one or more aggregate events.

The policy event holds a logical reference to the entity that triggered its creation. The following attributes are populated for a policy event of type message.

Fields Description

Type

The type of the event -Message

Action

The triggering action (C, U or D)

Event Level

The event level.

Possible values:

  • Insurable Entity

  • Organization

  • Policy

  • Enrollment Product

  • Enrollment Product Type

  • Group Client

  • Group Account

Event Level Id

The internal identifier of the event level subject (row id)

Effective Date

Date and time the event is created

Cause

The cause of the event, being a combination of Trigger Action (C, U or D) - Subject of the change event rule (Alias of the entity) - Type (M). Examples of the format:

  • Create Policy Enrollment Product (Message) → C POEP M

  • Create Policy (Message) → C POLI M

Change Log

Describes the cause of an event by listing which entity/attributes were added, deleted or updated; for the updates the log also specifies the old and new value of the attributes.

Each policy event holds the subject id as reference to the entity that triggered its creation or to its parent entity/entities. So, a change event rule on subject:

  • Person (and its details), Person Address leads to a policy event of level 'Insurable Entity' with the event level id of the insurable entity (that is, the person)

  • Organization (and its details, for example, Bank account number of the organization), Organization Address leads to a policy event of level 'Organization' with the event level id of the organization

  • Policy Enrollment, Policy Group Account, Policy Enrollment Product, Policy Add-on, Policy, Policy Enrollment Insurable Class, Policy Premium Bill Allocation, Policy Bill Receiver, Policy Contract Period, Policyholder, Policy alculation Period, Attached Data or Parameter Value leads to a policy event of level 'Policy' with with the event level id of the policy (note that this means in logical terms a combination of the policy code and the version)

  • Collection Setting

    • In the context of a policy leads to a policy event of level 'Policy' with the event level id of the policy (note that this means in logical terms a combination of the policy code and the version)

    • In the context of a group account leads to a policy event of level 'Group Account' with the event level id of the group account

    • In the context of a group client leads to a policy event of level 'Group Client' with with the event level id of the group client

  • Assigned Broker Agent

    • In the context of a policy leads to a policy event of level 'Policy' with the event level id of the policy (note that this means in logical terms a combination of the policy code and the version)

    • In the context of a group account leads to a policy event of level 'Group Account' with the event level id of the group account

  • In the context of a group client leads to a policy event of level 'Group Client' with the event level id of the group client

  • Enrollment Product leads to a policy event of level 'Enrollment Product' with the event level id of the enrollment product

  • Assigned Premium Schedule

    • In the context of an enrollment product leads to a policy event of level 'Enrollment Product' with the event level id of to the enrollment product

    • In the context of a group account product leads to a policy event of level 'Group Account' with the event level id of the group account

    • In the context of a group account leads to a policy event of level 'Group Account' with the event level id of the group account

    • In the context of a group client leads to a policy event of level 'Group Client' with the event level id of the group client

  • Assigned Adjustment

    • In the context of an enrollment product leads to a policy event of level 'Enrollment Product' with the event level id of the enrollment product

    • In the context of a group account product leads to a policy event of level 'Group Account' with the event level id of the group account

    • In the context of a group account leads to a policy event of level 'Group Account' with the event level id of the group account

    • In the context of a group client leads to a policy event of level 'Group Client' with the event level id of the group client

  • Adjustment Value

    • In the context of an enrollment product (for adjustment rules) leads to a policy event of level 'Enrollment Product' with the event level id of the enrollment product

    • In the context of a group account product (for group adjustment rules) leads to a policy event of level 'Group Account' with the event level id of the group account

  • Group Client leads to a policy event of level 'Group Client' with the event level id of the group client

  • Group Account or Broker Agent Switch Rule leads to a policy event of level 'Group Account' with the event level id of the group account

  • Premium Bill Allocation or Bill Receiver

    • In the context of a group client leads to a policy event of level 'Group Client' with the event level id of the group client.

    • In the context of a group account leads to a policy event of level 'Group Account' with the event level id of the group account* Group Commission Rate

    • In the context of a group client leads to a policy event of level 'Group Client' with the event level id of the group client.

    • In the context of a group account leads to a policy event of level 'Group Account' with the event level id of the group account

  • Billing Account

    • In the context of a policy leads to a policy event of level 'Policy' with the event level id of the policy (note that this means in logical terms a combination of the policy code and the version)

    • In the context of a group client leads to a policy event of level 'Group Client' with the event level id of the group client

  • Group Account Product leads to a policy event of level 'Group Account ' with the event level id of the group account

  • Enrollment Product Type leads to a policy event of level 'Enrollment Product Type' with the event level id of the enrollment product type

The application includes a separate process that rolls up/down the policy event to aggregate events, details of which can be found in the Integration Guide. Note that once the aggregate events have been generated, the policy event record itself is removed.

An aggregate event record consists of the following fields:

Fields Description

Aggregation Type

The type of the aggregate object, with the code that needs to used during configuration in brackets:

  • Enrollment Product (ENPR)

  • Group Client (GROC)

  • Group Account (GRAC)

  • Organization (ORGA)

  • Person (PERS)

  • Policy (POLI)

Aggregate Id

The internal identifier of the aggregate (row id)

Source Event Action

The action on the subject of change event tracking 1) Create, 2) Update or 3) Delete

Source Event Level

The level of the policy event

Source Event Level Id

The internal id of the event level subject (row id)

Source Event Date time

The date and time the policy event was logged

Source Change Log

Describes cause of the policy event by listing which entity/attributes were added, deleted or updated; for the updates the log also specifies the old and new value of the attributes.

The aggregate events are then de-duplicated based on their type and id. For each distinct aggregate type and id (after de-duplication), the system triggers message generation process based on the 'Connector Configuration' settings. For more details on the 'Connector Configuration' and the process flow to generate messages refer section 'Using the Oracle Health Insurance Integration Connector to integrate with External Systems' in the Integration Guide.

Policy event of level

  • Insurable Entity leads to an aggregate event of

    • type 'Person' with a reference* to the insurable entity (that is, the person)

    • type 'Policy' with a reference to the policy

      • The system retrieves the latest approved version of every policy that has a policy enrollment for the specified insurable person. The system creates an aggregate event for each policy retrieved in this way.

      • The system retrieves the latest approved version of every policy that has policyholder as the specified insurable person. The system creates an aggregate event for each policy retrieved in this way

  • Organization leads to an aggregate event of

    • type 'Organization' with a reference to the organization

    • type 'Group Client 'with a reference to the group client

      • The system retrieves the group clients with either bill organization or employer organization as the specified organization. The system creates an aggregate event for each group client retrieved in this way.

  • Policy leads to an aggregate event of type 'Policy' with a reference to the policy (note that this means in logical terms a combination of the policy code and the version)

  • Enrollment Product leads to an aggregate event of

    • type 'Enrollment Product' with a reference to the enrollment product

    • type 'Group Account' with a reference to the group account

      • The system retrieves the group accounts with group account product referring to the enrollment product. The system creates an aggregate event for each group account retrieved in this way.

  • Group Client leads to an aggregate event of type 'Group Client' with a reference to the group client

  • Group Account leads to an aggregate event of type 'Group Account' with a reference to the group account

  • Enrollment Product Type leads to an aggregate event

    • type Enrollment Product with a reference to the enrollment product

    • type Group Account with a reference to the group account ***The system retrieves the group accounts with group account product referring to the enrollment product that is of the specified enrollment product type. The system creates an aggregate event for each group account retrieved in this way.