Data Model
This page describes the data model of the group client and group account.
Group Client
Field | Description |
---|---|
Code |
The code of the group client |
Description |
The description of the group client |
Display Name |
The display name of the group client |
Status |
The status of the group client |
Group Client |
The parent group client this group client is part of |
Employer Organization |
The organization to which the group account belongs to |
Bill to Organization |
The organization to which the premium invoices can be billed |
Amount Distribution |
The way an amount is divided over calculation periods: on a daily basis or evenly |
Partial Period Resolution |
Charge for a partial period (per day, no charge, full period, enrolled days threshold, or split periods) |
Enrolled Days Threshold |
The enrolled days threshold for the partial period resolution or the splitter day of the period used to split the calculation period into two parts in the split periods option for the partial period resolution |
Contact Relation |
The contact relation for the group client |
Group Representative |
The group’s representative |
Object Last Update By |
Reference to the user who last updated the group client entity or updated an entity within context of the group client |
Object Last Update Date |
Date of the last update to the group client entity or to an entity within context of the group client |
Process Flow |
The group of process steps and process rules that apply to a group client. |
Data Access Group |
Reference to the data access group. |
Require Enrollment File Review? |
If set to null, then enrollment files for this group client are auto-accepted. |
Constraints:
-
The enrolled days threshold must and may only be specified if the partial period resolution is set to either the enrolled days threshold or the split periods.
Group Client Collection Setting
A group client collection setting specifies how often the premium is collected. Group client collection settings also control the generation of policy specific calculation periods.
A group client can have one or more collection settings.
Field | Description |
---|---|
Group Client |
The group client that has the collection setting |
Span Reference Date |
The date to determine the start of a span of calculation periods |
Advance Length |
Length of a span of calculation periods |
Advance UoM |
Unit of measure for a span of calculation periods (Days / Months / Years) |
Policy Calculation Periods? |
Indicator that defines whether policy specific calculation periods are used for this group client |
Policy Calculation Period Length[1] |
Length of the generated policy calculation periods |
Policy Calculation Period UoM[1] |
Unit of measure for the generated policy calculation periods (Days / Months / Years) |
Start Date[2] |
The start date of the collection setting |
End Date |
The end date of the collection setting |
Constraints:
-
It is not allowed to have an overlap in time validity for group client collection settings with the same group client
-
Both Advance Length and Advance UoM (unit of measure) have to be set or both have to be unspecified
-
Both Policy Calculation Period Length and Policy Calculation Period UoM (unit of measure) have to be set or both have to be unspecified
Group Client Billing Account
A group client can have one or more group client billing accounts. A group client billing account is an account that is used for billing purposes on a group client. Note that the allocation of a bill to a group client billing account is configured within the premium bill allocations and bill receivers setup (described in the Premium Bill Allocation section).
Field | Description |
---|---|
Group Client |
The group client that has the billing account |
Code |
The code of the group client billing account (unique across billing accounts) |
Description |
The description of the group client billing account |
Contact Relation |
The contact relation for the group client billing account. The values of contacts associated with the particular group client or group account are visible. |
Default? |
Is this the default billing account for the group client? (if set to Yes, this billing account will be the default bill receiver if not specified otherwise on the Premium Bill Allocations and Bill Receivers) |
Constraints:
-
There can be only one default billing account for a group client
Group Client Broker Agent
Brokers and agents are described in the Brokers and Agents section of the Policy data model. A group client has a single group client broker and/or agent at any point in time, but the group client can be transferred from one broker and/or agent to another.
Field | Description |
---|---|
Group Client |
The group client that the group client broker agent is intermediary for |
Enrollment Product Category |
The category of the enrollment products that the group client broker agent is intermediary for |
Broker |
The broker that serves as intermediary |
Agent |
The agent that serves as intermediary |
Start Date |
The start date of the group client broker agent |
End Date |
The end date of the group client broker agent |
Constraints:
-
At least one of broker and agent must be specified
-
It is not allowed to have an overlap in time validity for group client brokers agents with the same group client and enrollment product category
Group Client Premium Schedule
Group client premium schedules specify which premium schedules are assigned to a group client.
Field | Description |
---|---|
Group Client |
The group client that has the group client premium schedule |
Enrollment Product |
The enrollment product that the premium schedule is assigned to in the context of the group client |
Enrollment Product Category |
The enrollment product category that the premium schedule is assigned to in the context of the group client |
Add-on |
The premium schedule is assigned to add-on in the context of the group client |
Premium Schedule |
The premium schedule (unique in combination with the group client, enrollment product and enrollment product category) |
Start Date |
The start date of the assignment of the premium schedule |
End Date |
The end date of the assignment of the premium schedule |
Constraints:
-
Only one of enrollment product or enrollment product category can be specified
-
The amount interpretations of the premium schedules of a group client must be the same for an enrollment product or an enrollment product category (all Calculation Period or all Calendar Year)
-
The schedule definition types of the premium schedules of a group client must be the same for an enrollment product or an enrollment product category (all Premium or all Policy Based Premium)
-
The schedule definition types of the premium schedules of a group client must be Premium for an add-on
-
It is not allowed to have an overlap in time validity for group client premium schedules with the same group client, enrollment product category, enrollment product and premium schedule
- IMPORTANT
-
Premium schedules can be assigned on multiple levels: enrollment product (see enrollment product date model), group account product (see below), group account (see below) or group client. During premium calculation the system only considers assigned premium schedules that are effective on the reference date. If the system finds effective premium schedules for a policy enrollment product on multiple levels, it uses the following priority to select the applicable premium schedules:
-
Group Account Product
-
Group Account
-
In the context of a specific Enrollment Product Category (assigned premium schedule with a specified Enrollment Product Category)
-
For all enrollment products (assigned premium schedule without a specified Enrollment Product Category)
-
-
Group Client
-
In the context of a specific Enrollment Product (assigned premium schedule with a specified Enrollment Product)
-
In the context of a specific Enrollment Product Category (assigned premium schedule with a specified Enrollment Product Category)
-
For all enrollment products (assigned premium schedule without a specified Enrollment Product or Enrollment Product Category)
-
-
Parent Group Client (and further up the Group Client hierarchy): same sub levels apply as specified for the Group Client level
-
Enrollment Product
-
The system only selects the premium schedules of the most specific level. This is also the level on which the system expects the premium schedules for add-on premium calcuation.
Group Client Adjustment
Group client adjustments specify which adjustments are assigned to a group client.
The adjustments are calculated in the ascending order of the sequence.
This is especially relevant for the adjustments that are based on a percentage.
The adjustment types having the same sequence, say N
, take the same base amount for the percentage based adjustment calculations and it is premium +/- all the adjustments up to and including (N-1) sequence.
More information on how adjustment amounts are evaluated can be found in the Premium Calculation chapter of the Operations Guide.
Field | Description |
---|---|
Group Client |
The group client that has the group client adjustment |
Enrollment Product |
The enrollment product that the adjustment is assigned to in the context of the group client |
Enrollment Product Category |
The enrollment product category that the adjustment is assigned to in the context of the group client |
Adjustment Type |
The schedule definition of the type group adjustment |
Sequence |
The sequence specifies the order in which adjustments get applied |
Start Date |
The start date of the assignment of the adjustment |
End Date |
The end date of the assignment of the adjustment |
Constraints:
-
The schedule definition must be of type group adjustment
-
It is not allowed to have an overlap in time validity for group client adjustments with the same group client, enrollment product category, enrollment product and adjustment type (schedule definition)
-
Only one of enrollment product or enrollment product category can be specified
Group Client Event
Group client event history holds the history of changes that were applied to the group client.
Field | Description |
---|---|
Group Client |
The group client for which the event was raised |
Description |
The description of the event |
Event Datetime |
The date and time the event happened |
Username |
Display name of the user responsible for the creation of the event |
Policy |
The policy for which the event was raised |
Activity |
The acivity in whcih the event was raised |
Group Account |
The group account for which the event was raised |
Constraints:
-
The policy, group account and activity hold only the value of the code resp. the id; not a real link to the object.
Policy Message or Group Client Message
A policy message or group client message is the message that is stored during processing of the policy or validation o the group client
Field | Description |
---|---|
Policy |
The policy for which the message was raised |
Group Client |
The group client for which the message was raised |
Message |
The message that was raised |
Process Step |
The process step in which the message was raised |
Value0 .. Value9 |
The value for the message placeholder 0 .. 9 |
Policy messages and group client messages are both stored under the name policy messages. A message will have a reference either to the policy or to the group client.
Group Client Notes
Group Client notes represent the record of discussions, conversations, actions carried out within the Group Client. A Group Client can have one or more notes.
Field | Description |
---|---|
Group Client |
The Group Client to which the note belongs. |
Version |
The version of the note (updating an existing note creates a new version of that note containing the updates. Existing records of notes never update). |
Note Text |
The text of the note. |
Group Account
The group account defines the level that assembles the enrollment products in an offering. It represents an organization and the benefits offerings. Group accounts facilitate the mechanism to offer selected enrollment products with a defined set of parameters, add-ons, premium-adjustments and premium bill allocations to a group of people who are grouped by some characteristics for example group of people belonging to a common organization or part of an organization (as employees of a company or a department of a company). The group accounts make it possible to offer benefits coverage and premium-adjustments that are uniform in nature, that is, offering the same benefits and premium-adjustments to all the members of the group for a given enrollment product.
Field | Description |
---|---|
Group Client |
The reference to the group client |
Code |
The code of the group account |
Description |
The description of the group account |
Display Name |
The display name of the group account |
Start Date |
The start date of the group account for benefits limit evaluation purposes |
Amount Distribution |
The way an amount is divided over calculation periods: on a daily basis or evenly |
Partial Period Resolution |
Charge for a partial period (per day, no charge, full period, enrolled days threshold, or split periods) |
Enrolled Days Threshold |
The enrolled days threshold for the partial period resolution or the splitter day of the period used to split the calculation period into two parts in the split periods option for the partial period resolution |
Data Access Group |
The reference to the data access group |
Contact Relation |
The contact relation for the group account |
Constraints:
-
The enrolled days threshold must and may only be specified if the partial period resolution is set to either the enrolled days threshold or the split periods.
Group Account Time Period
This is a time period that is used in the context of the group account. The group account time period has the following attributes
Field | Description |
---|---|
Display Name |
The name ofthe group account time period (unique in combination with the group account) |
Start Date |
The start date for the group account time period |
End Date |
The end date for the group account time period |
Group Account |
The group account |
Constraints:
-
It is not allowed to have overlapping time periods
Group Account Insurable Class
The group account insurable class defines the insurable classes that are available in a group account.
Field | Description |
---|---|
Group Account |
The group account |
Insurable Class |
The insurable class |
Group Account Collection Setting
A group account collection setting specifies how often the premium is collected. Group account collection settings also control the generation of policy specific calculation periods.
A group account can have one or more collection settings.
Field | Description |
---|---|
Group Account |
The group account that has the collection setting |
Span Reference Date |
The date to determine the start of a span of calculation periods |
Advance Length |
Length of a span of calculation periods |
Advance UoM |
Unit of measure for a span of calculation periods (Days / Months / Years) |
Policy Calculation Period? |
Indicator that defines whether policy specific calculation periods are used for this group account |
Policy Calculation Period Length[1] |
Length of the generated calculation periods |
Policy Calculation Period UoM[1] |
Unit of measure for the generated calculation periods (Days / Months / Years) |
Start Date [2] |
The start date of the collection setting |
End Date |
The end date of the collection setting |
Note - Modifying the collection setting after policy calculation period generation may result in inconsistency, it is recommended that periods are re-generated if the collection setting is modified.^
Constraints:
-
It is not allowed to have an overlap in time validity for group client collection settings with the same group client
-
Both Advance Length and Advance UoM (unit of measure) have to be set or both have to be unspecified
-
Both Policy Calculation Period Length and Policy Calculation Period UoM (unit of measure) have to be set or both have to be unspecified
Group Account Broker Agent
Brokers and agents are described in the Brokers and Agents section of the Policy data model. A group account has a single group account broker and/or agent at any point in time, but the group account can be transferred from one broker and/or agent to another.
Field | Description |
---|---|
Group Account |
The group account that the group account broker agent is intermediary for |
Enrollment Product Category |
The category of the enrollment products that the group client broker agent is intermediary for |
Broker |
The broker that serves as intermediary |
Agent |
The agent that serves as intermediary |
Start Date |
The start date of the group account broker agent |
End Date |
The end date of the group account broker agent |
Constraints:
-
At least one of broker and agent must be specified
-
It is not allowed to have an overlap in time validity for group account brokers agents with the same group account and enrollment product category
Broker Agent Switch Rule
Broker agent switch rules specify how the commission is distributed when the applicable assigned broker agent for a policy changes in the middle of the group account time period.
Field | Description |
---|---|
Group Account |
The group account that has the broker agent switch rule |
Commission Existing Enrollment |
The commission for the policy enrollment product enrolled before the broker agent switch is paid to 1) the broker agent that enrolled the member to the product (old broker agent[3]), or to 2) the broker agent that is currently active (new broker agent) or to 3) the third party. Possible values:
3. For group account renewal scenario when the policy enrollment product start date is before the group account time period start date, the broker agent that is applicable on the start date of the group account time period is considered as the 'Old Broker Agent'
|
Commission New Enrollment |
The commission for the policy enrollment product enrolled after the broker agent switch is paid to 1) the broker agent that is currently active (new broker agent) or to 2) the third party. Possible values:
|
Third Party |
Relation to which the commission is payed when a switch rule specifies 'Third Party' for existing enrollments or new enrollments or both |
Start Date |
The start date of the broker agent switch rule |
End Date |
The end date of the broker agent switch rule |
Constraints:
-
Third party must be specified if the setting commission existing enrollment or commission new enrollment or both are selected as 'Third Party'
-
It is not allowed to have an overlap in time validity for broker agent switch over rules in context of a group account
Group Account Premium Schedule
Group account premium schedules specify which premium schedules are assigned to a group account.
Field | Description |
---|---|
Group Account |
The group account that has the group account premium schedule |
Enrollment Product Category |
The enrollment product category that the premium schedule is assigned to in the context of the group account |
Add-on |
The premium schedule is assigned to add-on in the context of the group account |
Premium Schedule |
The premium schedule (unique in combination with the group account and enrollment product category) |
Start Date |
The start date of the assignment of the premium schedule |
End Date |
The end date of the assignment of the premium schedule |
Constraints:
-
The amount interpretations of the premium schedules of a group account must be the same for an enrollment product category (all Calculation Period or all Calendar Year)
-
The schedule definition types of the premium schedules of a group account must be Premium Policy, Based Premium or a combination of these types for an enrollment product category
-
The schedule definition types of the premium schedules of a group client must be Premium for an add-on
-
It is not allowed to have an overlap in time validity for group account premium schedules with the same group account, enrollment product category and premium schedule
Group Account Adjustment
Group account adjustments specify which adjustments are assigned to a group account.
Field | Description |
---|---|
Group Account |
The group account that has the group account adjustment |
Enrollment Product Category |
The enrollment product category that the adjustment is assigned to in the context of the group account |
Adjustment Type |
The schedule definition of the type group adjustment |
Sequence |
The sequence specifies the order in which adjustments get applied |
Start Date |
The start date of the assignment of the adjustment |
End Date |
The end date of the assignment of the adjustment |
Constraints:
-
The schedule definition must be of type group adjustment
-
It is not allowed to have an overlap in time validity for group account adjustments with the same group account, enrollment product category and adjustment type (schedule definition)
Group Account Notes
Group Account notes represent the record of discussions, conversations, actions carried out within the Group Account. A Group Account can have one or more notes.
Field | Description |
---|---|
Group Account |
The Group Account to which the note belongs. |
Version |
The version of the note (updating an existing note creates a new version of that note containing the updates. Existing records of notes never update). |
Note Text |
The text of the note. |
Group Account Product
The group account products define which enrollment products are offered by the group account.
Field | Description |
---|---|
Group Account |
The group account |
Enrollment Product |
The enrollment product (unique in combination with the group account) |
Display Name |
The display name for the group account product |
Display Sequence |
The display sequence for the enrollment product within the group account |
Amount Distribution |
The way an amount is divided over calculation periods: on a daily basis or evenly |
Partial Period Resolution |
Charge for a partial period (per day, no charge, full period, enrolled days threshold, or split periods) |
Enrolled Days Threshold |
The enrolled days threshold for the partial period resolution or the splitter day of the period used to split the calculation period into two parts in the split periods option for the partial period resolution |
Constraints:
-
The enrolled days threshold must and may only be specified if the partial period resolution is set to either the enrolled days threshold or the split periods.
Group Account Product Premium Schedule
Group account product premium schedules specify which premium schedules are assigned to a group account product.
Field | Description |
---|---|
Group Account Product |
The group account product that has the group account product premium schedule |
Add-on |
The premium schedule is assigned to add-on in the context of the group account product |
Premium Schedule |
The premium schedule (unique in combination with the group account product) |
Start Date |
The start date of the assignment of the premium schedule |
End Date |
The end date of the assignment of the premium schedule |
Constraints:
-
The amount interpretations of the premium schedules of a group account product must be the same (all Calculation Period or all Calendar Year)
-
The schedule definition types of the premium schedules of a group account product must be the same (all Premium or all Policy Based Premium)
-
The schedule definition types of the premium schedules of a group acount product must be Premium for an add-on
-
It is not allowed to have an overlap in time validity for group account product premium schedules with the same group account product and premium schedule
Group Account Product Adjustment
Group account product adjustments specify which adjustments are assigned to a group account product.
Field | Description |
---|---|
Group Account Product |
The group account product that has the group account product adjustment |
Adjustment Type |
The schedule definition of the type group adjustment |
Sequence |
The sequence specifies the order in which adjustments get applied |
Start Date |
The start date of the assignment of the adjustment |
End Date |
The end date of the assignment of the adjustment |
Constraints:
-
The schedule definition must be of type group adjustment
-
It is not allowed to have an overlap in time validity for group account product adjustments with the same group account product and adjustment type (schedule definition)
Group Account Product Adjustment Value
The group product adjustment value is a value for the adjustment rule used in the context of the group account, that is, it overrides the default adjustment value. This is only possible for a schedule definition of type group account adjustment.
Field | Description |
---|---|
Amount |
The adjustment amount (negative means that the premium is lowered) |
Currency |
The currency of the adjustment amount |
Percentage |
The adjustment percentage (negative means that the premium is lowered) |
Amount Function |
Reference to a function dynamic logic function with signature 'Adjustment' that determines the adjustment amount |
Adjustment Rule |
The reference to an adjustment rule (unique in combination with the group account time period and the group account product) |
Group Account Time Period |
The group account time period to which this value belongs to |
Let us revisit the Example 3 Co-payment value discount from the "Adjustment Rules" page in the Premium and Fees Configuration chapter of the Configuration Guide for understanding how the column values and adjustment values - default and override are applied when multiple time periods are involved.
The example mentioned has one time period "Calendar year 2015". This is extended to two default time periods.
The following default time periods are defined
Display Name | Start Date | End Date |
---|---|---|
Calendar year 2015 |
1/1/2015 |
31/12/2015 |
Calendar year 2016 |
1/1/2016 |
31/12/2016 |
The adjustment rules for Calendar year 2015 are:
Adjustment Rules | |
---|---|
OV Co-pay |
Adjustment |
10.00 USD |
0.00 USD |
20.00 USD |
-5.00 USD |
30.00 USD |
-10.00 USD |
The adjustment values, if not zero, have a negative sign because they are a discount.
The column values for OV Copay are changed for the next year and the adjustment rules for Calendar year 2016 are set up as:
Adjustment Rules | |
---|---|
OV Co-pay |
Adjustment |
12.00 USD |
0.00 USD |
22.00 USD |
-5.00 USD |
32.00 USD |
-10.00 USD |
In the example mentioned, the Co-payment value adjustment is configured for the enrollment product COPAY PLAN in the group account ORCL. This explains how the different adjustment rules will apply within the context of the group account time period.
Consider that group account time periods are defined as:
Display Name | Start Date | End Date |
---|---|---|
ORCL Plan 2015-1 |
1/6/2015 |
31/12/2015 |
ORCL Plan 2016-1 |
1/1/2016 |
30/6/2016 |
ORCLPan 2016 -2 |
1/7/2016 |
31/12/2016 |
The adjustment rule consists of two things: the column value and the adjustment value. The column values applicable to the adjustment rules are the values defined for the applicable default time period. The adjustment value is either the default adjustment value or the group account product specific adjustment value.
- Group Account Time Period Mapping to a Default Time Period
-
The application looks at the start date of the selected group account time period and determines the default time period to which the start date belongs to. Hence for theORCLPlan 2015-1, the applicable default time period is Calendar year 2015.
The group account product adjustment and adjustment rules for product COPAY PLAN within group account time periodORCLPlan 2015-1 without overriding values are shown below.
Group Account Product Adjustment | ||
---|---|---|
Seq. |
Code |
Start Date |
End Date |
1 |
DC_COP |
Adjustment Rules | |
---|---|
OV Co-pay |
Adjustment |
10.00 USD |
0.00 USD |
20.00 USD |
-5.00 USD |
30.00 USD |
-10.00 USD |
For the group account time periodORCLPlan 2016-1, the corresponding default time period changes to Calendar year 2016. The group account product adjustment specified above does not have an end date so it also applies in Calendar year 2016. The adjustment rules for COPAY PLAN within group account time periodORCLPlan 2016-1 with adjustment values modified at group account product level look like:
Adjustment Rules | |
---|---|
OV Co-pay |
Adjustment |
12.00 USD |
-2.00 USD |
22.00 USD |
-6.00 USD |
32.00 USD |
-11.00 USD |
For the group account time periodORCLplan 2016-2 the applicable default time period is still Calendar year 2016, so the column values continue to be the same as they were forORCLplan 2016-1, however the overriding adjustment values can be different.
Adjustment Type | ||
---|---|---|
Seq. |
Code |
Override Value |
1 |
DC_COP |
Yes |
Adjustment Rules | |
---|---|
OV Co-pay |
Adjustment |
12.00 USD |
-2.00 USD |
22.00 USD |
-6.00 USD |
32.00 USD |
-10.00 USD |
Here the adjustment value for OV Co-pay 32.00 is reduced to -10.00 in ORCL plan 2016-2.
Group Account Product Provider Group
Group account product provider groups specify which provider groups are assigned to a group account product.
Field | Description |
---|---|
Group Account Product |
The group account product that has the group account product provider group |
Provider Group |
The provider group that is assigned to the group account product |
Assigned Provider Group Label |
The qualifying label for the assignment of a provider group to a group account product (assigned provider group labels are configured separately; they have a code and a display name) |
Start Date |
The start date of the assignment of the provider group |
End Date |
The end date of the assignment of the provider group |
Constraints:
-
It is not allowed to have an overlap in time validity for group account product provider groups with the same group account product, assigned provider group label and provider group
Group Account Add-on
The group account add-ons define which add-ons are offered by the group account.
Field | Description |
---|---|
Group Account |
The group account |
Add-on |
The add-on (unique in combination with the group account) |
Display Name |
The display name for the group account add on |
Display Sequence |
The display sequence for the add on within the group account |
Group Account Available Product
The group account available product defines which group account products are available for a group account. The availability can be defined per a specific insurable class or for all insurable classes within a group account.
Field | Description |
---|---|
Group Account Product |
The group account product |
Insurable Class |
The insurable class |
Start Date |
The first date of availability of the group account product |
End Date |
The last date of availability of the group account product |
Group Account Available Product Add-on
The group account available product add on defines which group account add-ons are available for a group account product in a group account time period.
Field | Description |
---|---|
Group Account Available Product |
The group account available product |
Group Account Add-on |
The group account add-on |
Insurable Class |
The insurable class |
Parameter Domain and Domain Value
A parameter domain defines per enrollment product/group account product and parameter alias combination if a non discrete value is applicable or that the parameter domain holds a list of predefined values.
Parameter Domain
A parameter domain has the following attributes:
Field | Description |
---|---|
Parameter Alias |
The parameter alias |
Enrollment Product |
The enrollment product to which the parameter domain applies |
Group Account Product |
The group account product to which the parameter domain applies |
Discrete |
Indicates whether the parameter domain is a list of predefined discrete values or a single non-discrete value. |
Amount |
The default value (amount) of a non discrete parameter domain (only for parameter aliases of type Amount) |
Currency |
The currency of the amount (only for parameter aliases of type Amount; it will automatically be set to the parameter currency that is specified on the enrollment product) |
Percentage |
The default value (percentage) of a non discrete parameter domain (only for parameter aliases of type Percentage) |
Number of Units |
The default value (number of units) of a non discrete parameter domain (only for parameter aliases of type Number of Units) |
Service Days |
The default value (service days) of a non discrete parameter domain (only for parameter aliases of type Service Days) |
Constraints:
-
Either the enrollment product or the group account product must be specified
Parameter Domain Value
Parameter domain values are allowed values for a parameter alias in a policy enrollment product. Parameter domain values can only be defined for discrete parameter domains.
A parameter domain value has the following attributes:
Field | Description |
---|---|
Parameter Domain |
The parameter domain |
Amount |
The value (amount) of the parameter (only for parameter aliases of type Amount) |
Currency |
The currency of the amount (only for parameter aliases of type Amount; it will automatically be set to the parameter currency that is specified on the enrollment product) |
Percentage |
The value (percentage) of the parameter (only for parameter aliases of type Percentage) |
Number of Units |
The value (number of units) of the parameter (only for parameter aliases of type Number) |
Service Days |
The value (service days) of the parameter (only for parameter aliases of type Service Days) |
Default |
Indicates whether the value is the default value for the parameter domain |
Condition |
Reference to a condition dynamic logic function with signature 'Parameter Value' that determines if the domain value is applicable for a person or object for an enrollment product in a policy Note : This condition is applicable only for ADF UI |
Start Date |
The start date of the parameter domain value. |
End Date |
The end date of the parameter domain value. |
Constraints:
-
The value (amount, number of units, percentage or service days) that matches the type (amount, number, percentage or service days) of the parameter alias is required and the other values are not allowed
-
Only 1 domain value can be the default value within a parameter domain
-
A condition can only be set for a domain value that is not the default value
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The start date of the parameter domain value is mandatory.
Premium Bill Allocation
Premium bill allocations define how the premium bill is allocated to bill receivers in the context of a group client based on the applicable group account, schedule definition, premium schedule type, insurable class, enrollment product, enrollment product category and add-on. The start date of the parameter domain value is mandatory.
Allocation
A premium bill allocation stores the specification on how to allocate the premium bill.
Field | Description |
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Group Client |
The group client that has the premium bill allocation |
Group Account |
The group account for which the premium bill allocation is defined |
Insurable Class |
The insurable class for which the premium bill allocation is defined |
Schedule Definition |
The schedule definition for which the premium bill allocation is defined |
Premium Schedule Type |
The type of premium schedules for which the premium bill allocation is defined |
Enrollment Product |
The enrollment product for which the premium bill allocation is defined |
Enrollment Product Category |
The enrollment product category for which the premium bill alloca tion is defined |
Add-on |
The add-on for which the premium bill allocation is defined |
Start Date |
The start date of the premium bill allocation |
End Date |
The end date of the premium bill allocation |
Active |
Is the premium bill allocation currently active? |
Constraints:
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It is not allowed to have an overlap in time validity for premium bill allocations with the same group client, group account, insurable class, schedule definition, premium schedule type, enrollment product, enrollment product category and add-on
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The group account (if specified) must be part of the group client
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Only one of enrollment product or enrollment product category can be specified
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Only one of schedule definition, premium schedule type or add-on can be specified
Receiver
A premium bill allocation can have one or more bill receivers. The bill receiver defines who pays what percentage of the policy premium.
Field | Description |
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Premium Bill Allocation |
The premium bill allocation that applies |
Function |
Dynamic logic function that retrieves the bill receiver |
Group Client Billing Account |
The group client billing account that is the bill receiver |
Percentage |
The percentage of the premium that this bill receiver has to pay |
Constraints:
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A dynamic logic function or a group client billing account (only one) must be specified
Group Commission Rate
Group commission rate defines the commission rate (% or amount) that is paid out for the policy enrollment product in the context of a group client based on the applicable group account, enrollment product, enrollment product category, broker and agent.
Field | Description |
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Group Client |
The group client that has the commission rate |
Group Account |
The group account for which the commission rate is defined |
Enrollment Product |
The enrollment product for which the commission rate is defined |
Enrollment Product Category |
The enrollment product category for which the commission rate is defined |
Broker |
The broker for which the commission rate is defined |
Agent |
The agent for which the commission rate is defined |
Percentage |
The commission is calculated as specified percentage of applicable premiums, adjustments and surcharges The adjustment type and surcharge type is applicable for commission when indicator 'In Scope % Commission' on the schedule definition is set to Y(es). Similarly, the premium schedule is considered as applicable for % commission when the indicator 'In Scope % Commission' on the premium schedule is set to Y(es). |
Amount Interpretation |
The way amounts are interpreted (per Calendar Year, per Calculation Period or Specific (number of days)) |
No. of Days |
Number of days for which the commission is specified when Amount Interpretation Specific is chosen (must and may only be specified if the amount interpretation is Specific) |
Amount |
The commission amount per calculation period for the policy enrollment product |
Amount Currency |
The currency of the commission amount |
Start Date |
The start date of the commission rate |
End Date |
The end date of the commission rate |
Constraints:
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It is not allowed to have an overlap in time validity for group commission rates with the same group client, group account, enrollment product, enrollment product category, broker and agent
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The group account (if specified) must be part of the group client
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Only one of enrollment product or enrollment product category can be specified
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Exactly one of amount or percentage must be specified
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Commission amount and currency must both be specified or must both be empty