Overview
The scenarios to follow explain the premium calculation process. Each scenario focuses on different and multiple aspects of the premium calculation process. The scenario describes the evaluation of the premium configuration and then applies the evaluated configuration to create calculation result lines and calculation results for the calculation period(s). The look back date for each scenario is 1 Jan 2018. The advance length/advance UoM is a premium calculation done in advance, expressed in numbers and is a measure of time.
Scenarios
Scenario A
This scenario explains premium calculation for a policy without a group account or contract period. The policy has only one policy enrollment fore the member W. Wright. W. Wright is enrolled on the BASIC PLAN product. The premium calculation in this scenario uses system calculation periods.
This scenario focuses on:
-
The evaluation of the configuration
-
The calculation period based method for premium calculation
-
The creation of the calculation results for the premiums, adjustments and surcharges.
Scenario B
This scenario explains premium calculation for a policy with a contract period. The policy has two policy enrollments, one for M. Henderson and one for J. Henderson. M. Henderson is enrolled on the BASIC PLAN product. J. Henderson is enrolled on the SILVER PLAN product with the Preventive Care add-on. The premium calculation in this scenario uses system calculation periods.
This scenario focuses on:
-
The definition of a contract period on the policy and using the contract period based method for premium calculation.
The system considers the reference date of the contract period as the reference date for all time dependent data for all calculation periods within that contract period. -
The calculation of two different enrollment products within one policy.
-
The calculation of add-on premiums.
Scenario C
This scenario explains premium calculation for a policy within a group account, without a contract period. The addition of a group account introduces changes in the way the system evaluates time periods. Therefore, the applicable adjustment rules and surcharges change in comparison to a policy without a group account for the same enrollment product. The premium calculation in this scenario uses system calculation periods.
This scenario focuses on:
-
Time period resolution for a policy within a group account.
-
The effect of reference date changing with the calculation periods on the calculation period based method.
Scenario D
This scenario explains premium calculation for a policy within a group account and having a contract period. The premium calculation in this scenario uses system calculation periods.
This scenario focuses on:
-
The contract period based calculation method
-
The evenly distribution of amounts
Scenario E
This scenario explains premium calculation for a policy within a group account, a contract period, enrollment product adjustments, and group account product adjustments. The premium calculation in this scenario uses system calculation periods.
This scenario focuses on:
-
The combination of enrollment product adjustments and group account product adjustments.
Scenario F
This scenario explains the premium calculations when the group account and the contract period change within a calculation period. The premium calculation in this scenario uses system calculation periods.
This scenario focuses on:
-
Multiple changes within one calculation period. The calculation period splits into multiple calculation period segments.
Scenario G
This scenario explains premium calculations for a weekly collection setting. The policy has no group account or contract period. It has one policy enrollment product. The premium calculation in this scenario uses policy calculation periods.
This scenario focuses on:
-
Weekly collection cycles
-
Policy period split to charge different premiums as soon as members age changes
Premium Configuration
The scenarios use the following premium configuration.
Default Time Periods
Code | Start Date | End Date |
---|---|---|
Calendar Year 2017 |
January 1, 2017 |
December 31, 2017 |
Calendar Year 2018 |
January 1, 2018 |
December 31, 2018 |
Calendar Year 2019 |
January 1, 2019 |
December 31, 2019 |
System Calculation Periods
Alias | Start Date | End Date | Reference Date |
---|---|---|---|
Jan 2019 |
January 1, 2019 |
January 31, 2019 |
January 1, 2019 |
Feb 2019 |
February 1, 2019 |
February 28, 2019 |
February 1, 2019 |
Mar 2019 |
March 1, 2019 |
March 31, 2019 |
March 1, 2019 |
Apr 2019 |
April 1, 2019 |
April 30, 2019 |
April 1, 2019 |
May 2019 |
May 1, 2019 |
May 31, 2019 |
May 1, 2019 |
Jun 2019 |
June 1, 2019 |
June 30, 2019 |
June 1, 2019 |
Jul 2019 |
July 1, 2019 |
July 31, 2019 |
July 1, 2019 9 |
Aug 2019 |
August 1, 2019 |
August 31, 2019 |
August 1, 2019 |
Sep 2019 |
September 1, 2019 |
September 30, 2019 |
September 1, 20199 |
Oct 2019 |
October 1, 2019 |
October 31, 2019 |
October 1, 20199 |
Nov 2019 |
November 1, 2019 |
November 30, 2019 |
November 1, 2019 |
Dec 2019 |
December 1, 2019 |
December 31, 2019 |
December 1, 2019 |
Premium Schedules
BASIC PLAN - Amount Interpretation: Calculation Period
Default Time Period | Age From | Age To | Gender | Premium |
---|---|---|---|---|
Calendar Year 2017 |
- |
49 |
- |
90.00 |
Calendar Year 2017 |
50 |
- |
- |
110.00 |
Calendar Year 2018 |
- |
49 |
- |
100.00 |
Calendar Year 2018 |
50 |
- |
- |
120.00 |
Calendar Year 2019 |
- |
49 |
- |
105.00 |
Calendar Year 2019 |
50 |
- |
- |
125.00 |
SILVER PLAN - Amount Interpretation: Calculation Period
Default Time Period | Age From | Age To | Gender | Premium |
---|---|---|---|---|
Calendar Year 2017 |
- |
49 |
- |
100.00 |
Calendar Year 2017 |
50 |
- |
- |
120.00 |
Calendar Year 2018 |
- |
49 |
- |
105.00 |
Calendar Year 2018 |
50 |
- |
- |
122.00 |
Calendar Year 2019 |
- |
49 |
- |
110.00 |
Calendar Year 2019 |
50 |
- |
- |
135.00 |
GOLD PLAN - Amount Interpretation: Yearly
Default Time Period | Age From | Age To | Gender | Premium |
---|---|---|---|---|
Calendar Year 2017 |
- |
49 |
- |
1300.00 |
Calendar Year 2017 |
50 |
- |
- |
1400.00 |
Calendar Year 2018 |
- |
49 |
- |
1400.00 |
Calendar Year 2018 |
50 |
- |
- |
1500.00 |
Calendar Year 2019 |
- |
49 |
- |
1500.00 |
Calendar Year 2019 |
50 |
- |
- |
1700.00 |
KINETIC VISION PLAN - Amount Interpretation: Yearly
Default Time Period | Age From | Age To | Gender | Premium |
---|---|---|---|---|
Calendar Year 2018 |
- |
49 |
- |
1400.00 |
Calendar Year 2018 |
50 |
- |
- |
1500.00 |
Adjustment Rules
Payment Frequency Discount
-
Per Calculation Period
-
Premium Scope = Total
-
Line/Rule Evaluation Condition for Payment Frequency Discount
EVALUATE_COLLECT_FREQ isreturnpolicyEnrollmentProduct.policyEnrollment.policy.policyCollectionSettings. asOf(referenceDate)[0].advanceLength = adjustmentRule.paymentFrequency.longValue()
Time Period | Frequency (CPs) Dimension type 'Generic' |
Value | Type |
---|---|---|---|
Calendar Year 2017 |
6 |
-1 |
Percentage |
12 |
-1.5 |
Percentage |
|
Calendar Year 2018 |
6 |
-1 |
Percentage |
12 |
-1.5 |
Percentage |
|
Calendar Year 2019 |
6 |
-1.75 |
Percentage |
12 |
-2.5 |
Percentage |
Surcharge Rules
Enrollment Products
BASIC PLAN
Enrollment Product Time Period | Adjustment | Add-on Premium Schedule | ||
---|---|---|---|---|
BASIC PLAN 17-18 |
January 1, 2017 |
December 31, 2018 |
Payment Frequency Discount |
- |
BASIC PLAN 19-20 |
January 1, 2019 |
December 31, 2020 |
Payment Frequency Discount |
- |
SILVER PLAN
Enrollment Product Time Period | Adjustment | Add-on Premium Schedule | ||
---|---|---|---|---|
SILVER PLAN 17 |
January 1, 2017 |
December 31, 2017 |
- |
Preventive Care, premium schedule line specifying a flat charge of 20 |
SILVER PLAN 18 |
January 1, 2018 |
December 31, 2018 |
Office Visit Co-payment |
Preventive Care, premium schedule line specifying a flat charge of 20 |
SILVER PLAN 19 |
January 1, 2019 |
December 31, 2019 |
Office Visit Co-payment |
Preventive Care, premium schedule line specifying a flat charge of 20 (amount interpretation is calculation period) |
GOLD PLAN
-
Amount Distribution Evenly
Enrollment Product Time Period | Adjustment | Add-on Premium Schedule | ||
---|---|---|---|---|
BASIC PLAN 17-18 |
January 1, 2017 |
December 31, 2018 |
Payment Frequency Discount |
Preventive Care, premium schedule line specifying a flat charge of $15 |
BASIC PLAN 19-20 |
January 1, 2019 |
December 31, 2020 |
Payment Frequency Discount |
Preventive Care, premium schedule line specifying a flat charge of $10 |
Group Accounts
ORCL 2019
Group Account Time Period - ORCL 2019: 1-Jun-2018 To 31-May-2019
Group Account Product: SILVER PLAN |
Add-on:
|
Adjustment: Office Visit Co-payment
|
|
Group Account Product: GOLD PLAN |
Add-on: - |
Adjustment: Office Visit Co-payment
|
Group Account Time Period - ORCL 2020: 1-Jun-2019 To 31-May-2020
Group Account Product: SILVER PLAN |
Add-on: - |
Adjustment: Office Visit Co-payment
|
|
Group Account Product: GOLD PLAN |
Add-on: - |
Adjustment: Office Visit Co-payment
|
ORCL CORP 2019
Group Account Time Period - ORCL CORP: 1-Jun-2018 To 31-May-2019
Group Account Product: SILVER PLAN | Adjustment sequence 1: Office Visit Co-payment * Co-payment of 10 gives 0% discount * Co-payment of 20 gives 5% discount * Co-payment of 30 gives 6% discount Adjustment sequence 2: Payment Frequency Discount * Payment Frequency of 6 gives 1% discount * Payment Frequency of 12 gives 1.5% discount |
---|