Change Event Rules

Changes to operational data, especially retro-active changes, may have relevant operational consequences. The application uses configurable business rules to detect these changes and process them. These rules are called Change Event Rules.

There are five types of Change Event Rules:

  • Recalculation: To recalculate Premium on a Policy.

  • Output Generation: To create a new collateral document like an ID card.

  • Fee Generation: To generate a onetime fee for a member.

  • Function: To add some logic to the Change Event.

  • Message: To display a message to other applications.

A Change Event Rule has the following fields:

Table 1. Change Event Rule
Field Description

Code

The Code of the Change Event Rule

Subject

The subject of the modification.
Generic API Post/Patch requests only result into change event rules when applied to the generic resource represented by the subject.

(Trigger) Action

The change action that needs to trigger an event

Field List

The list of fields that trigger an event on update (Specify only if the action is Update). Not specifying a list leads to monitoring all the fields for an update.

Type

The type of the event (Recalculation, Output, Fee, Message, or Function)

Output Definition

A reference to a configured output definition (Essential for Output type)

Fee Definition

A reference to a configured fee definition (Essential for Fee type)

Function

A reference to the Dynamic Logic function:

  • To generate the effective date of the Policy Event for types Recalculation, Output, and Fee.

  • To execute a function for type Function.

Each Change Event Rule has a trigger. The trigger manipulates data on a specific entity. For example, creating a new Person record or updating an Enrollment Product description. The following examples explain the unique effects that occur when a trigger manipulates data:

  • System Effect: A flag to notify the application to recalculate the affected Policy in the next calculation run.

  • Immediate Effect: The Function event type that sets default values after creating a new Group Client.

The effect of a change event rule does not trigger other change event rules.
For example: adding an enrollment to a policy triggers a change event rule that sets the value of a custom status field on the policy. This change on the custom status field does not trigger any change event rules on that field. Only changes made directly to that field trigger its change event rules.

The change event rule’s effect depends on the chosen subject entity. The following list specifies the entities that serve as a trigger for Change Event Rules. The list is restricted to entities that represent operational data:

  • Address

    • Person and Organization Address

    • Available types: recalculation, output, fee, and message

  • Adjustment Value

    • Also applicable for values of surcharges

    • Available types: recalculation, output, fee, and message

  • Assigned Adjustment

    • Available types: recalculation, output, fee, and message

  • Assigned Broker Agent

    • Available types: recalculation, output, fee, and message

  • Assigned Premium Schedule

    • Available types: recalculation, output, fee, and message

  • Attached Policy Data

    • Available types: message

  • Bill Receiver

    • Available types: recalculation, output, fee, function, and message

  • Billing Account

    • Available types: recalculation, output, fee, and message

  • Broker Agent Switch Rule

    • Available types: recalculation, output, fee, and message

  • Collection Setting

    • Available types: recalculation, output, fee, and message

  • Enrollment Product

    • Available types: recalculation, output, fee, message, and function

  • Enrollment Product Type

    • Available types: recalculation, output, fee, and message

  • Group Account

    • Available types: recalculation, output, fee, message, and function

  • Group Account Product

    • Available types: recalculation, output, fee, message, and function

  • Group Account Product Provider Group

    • Available types: recalculation, output, and fee

  • Group Client

    • Available types: recalculation, output, fee, message, and function

  • Group Client Event

    • Available types: message

  • Group Commission Rate

    • Available types: recalculation, output, fee, and message

  • Object(s)[1]

    • Available types: recalculation, output, and fee

  • Organization

    • Available types: message

  • Parameter Value

    • Available types: recalculation, output, fee, and message

  • Person[1]

    • Person titles, marital statuses, bank account numbers, contract alignments, and person covered services are seen as part of a person

    • Change event rules are triggered when doing modification to titles only, marital statuses, bank account numbers, contract alignments, and person covered services through persons Generic API

    • Available types: recalculation, output, fee, message, and function

      Change Events generate only for active Persons. Person copies with unapproved changes are ignored.

  • Person Assigned Provider[1]

    • Available types: recalculation, output, and fee

  • Policy

    • Available types: recalculation, output, fee, and message

  • Policy Add-on

    • Available types: recalculation, output, fee, and message

  • Policy Bill Receiver

    • Available types: recalculation, output, fee, and message

  • Policy Calculation Period

    • Available types: recalculation, output, fee, message, and function

  • Policy Contract Period

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Detail

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Cara Status

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Ethnicity

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Part D Late Enrollment Penalty

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Part D Low Income Subsidy

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Period

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Race

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Medicare Part D Creditable Coverage

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Insurable Class

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product Medicare Detail

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product Medicare Election Response

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product Medicare Ic Model Status

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product Medicare Other Insurance Detail

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product Medicare Part D 4 Rx Data

    • Available types: recalculation, output, fee, and message

  • Policy Enrollment Product Medicare Premium Payment Option

    • Available types: recalculation, output, fee, and message

  • Policy Group Account

    • Available types: recalculation, output, fee, and message

  • Policy Premium Bill Allocation

    • Available types: recalculation, output, fee, and message

  • Policyholder

    • Available types: recalculation, output, fee, and message

  • Premium Bill Allocation

    • Available types: recalculation, output, fee, and message

  • Premium Schedule

    • Available types: recalculation, output, and fee

  • Premium Schedule Line

    • Available types: recalculation, output, and fee

  • Reinsurance Setting

    • Reinsurance exclusions are seen as part of a reinsurance setting

    • Available types: recalculation, output, and fee

  • Schedule Definition

    • Only for definition types Adjustment, Group Adjustment and Surcharge

    • Available types: recalculation, output, and fee

  • Schedule Dimension Value

    • Only in the context of premium schedule lines, and adjustment/surcharge rules

    • Available types: recalculation, output, and fee

Separate Change Event Rules are necessary for each trigger. For example, one for recalculation and one for ID card regeneration. Output Generation references a configured output definition like a summary plan description or an ID card. Fee Generation references a configured fee definition like a new Policy fee.

For Recalculation, Output, and Fee, it is necessary to define the date after which the modification has an effect. For a Time-Valid record like a Policy Enrollment Product, it is the Start Date of the record. If changing the Start Date, then the date is the earliest of the old or the new value for the Start Date. Configure this through function Dynamic Logic with signature Change Event Rule (Effective Date).

For type Function, it is necessary to define a Dynamic Logic with a signature Change Event Rule (Function). For example, some logic that sets default values. Refer to the "Functions" section in the Dynamic Logic chapter of the Developer Guide for details of these signatures.

Upon modification of a subject, the application evaluates all the Change Event Rules. This evaluation also considers the trigger action and the field list. If all conditions are met, then:

  • For types Recalculation, Output, and Fee, stores a Policy Event (described in Policy Events and Mutations).

  • For type Message, stores a Message Event (described in Policy Events and Mutations).

  • For type Function, executes the Dynamic Logic function (Note that no Policy Event is stored for this type).

Following are the actions possible on a Change Event Rule:

  • Create

  • Update

  • Delete

    • Updates on Person details using the Relation Integration Point replace the existing details with the details in the request. So, to track updates on a subject’s Address or Assigned Provider, create a Change Event Rule with an Update trigger action and a Change Event Rule for the Create trigger action.

    • Delete is not available for subjects: Enrollment Product, Organization, Person, Policy, Group Account, and Group Client with Message type.

    • The relationIdentifierList attribute is available as a detail on a relation, but an update operation on a change event rule on the relation does not monitor the list for changes. To set up a change event rules on the relation identifiers, select the relationIdentifier as the subject.

    Field List: For an update, it is important to provide a list of all the fields (fixed and dynamic) on the entity that is worth monitoring. Not providing a list leads to monitoring all the fields for an update.

1. Person and Person Assigned Provider are only in the list if an insurable Person Type is configured on the system.
Object(s) are only in the list if one or more insurable object types are configured in the system.
Values in the list for persons or objects display the singular display names of the insurable entity type.
For example, when an insurable person type with display name 'Member' and two insurable objects with the display names 'Car' and 'Truck' have been configured, then the top part of the list shows:
* Member,
* Member Address,
* Member Assigned Provider,
* Car,
* Truck,
* ..