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Enhancement: Premium Calculation Dynamic Logic Conditions (Doc ID 2593159.1)

Last updated on OCTOBER 03, 2019

Applies to:

Oracle Health Insurance Enterprise Policy Administration - Version 3.19.2.0.0 and later
Information in this document applies to any platform.

Goal

ENHANCEMENT REQUEST:
=====================

Currently, the premium calculation activity has to be triggered for each group at one customer, and they have 8000 groups.

GROUP CLIENT DYNAMIC LOGIC CONDITION
They need to be able to perform premium calculations only for group clients that have a status of 'APPROVED'. This group status is a dynamic field on the group client.
Current implementation design is for OHI Integration Gateway to extract the list of group clients with status 'APPROVED' and start premium calculation for each group separately.
This enhancement would enable a single premium calculation activity being started after which the dynamic logic condition would limit the group clients for which premium is calculated.

POLICY DYNAMIC LOGIC CONDITION
They want to block premium from being calculated for policies that are not in 'APPROVED' status. OHI currently uses the latest policy version with 'APPROVED' status.
This enhancement would make it possible to stop premium calculation for a policy where the latest version is not status 'APPROVED'.

They also have the requirement to block the premium calculation for a complete group if one of the policies for that group is on 'PENDED' status. In this case, the bill should not be sent to the group as it does not accurately resemble the list of employees for the group. This may lead to a voided bill since the employer is missing employees on his bill.

GROUP ACCOUNT DYNAMIC LOGIC CONDITION
Not a requirement for this customer but might well be for other customers.


Solution

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In this Document
Goal
Solution
References


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