Newborn Waiver is Not Given to Newborn Child (Doc ID 2957771.1)

Last updated on JUNE 27, 2023

Applies to:

Symptoms

On RMB v5.1.0.0.0, Newborn Waiver is not given to newborn child.

Newborn Waiver is not given to newborn child when calculated age for premium calculation is 1 due to the Membership Renewal Date age calculation rule.

Data Setup done as follow:
- Install Membership to a PA Medical Health Plan with the following details:
  * Membership Start Date = 01/01/2023
  * Membership End Date = 12/31/2023
  * Membership Renewal Date = 01/01/2024
  * Covered Members:
  Relationship Type Name Member Start Date Birth Date
  Main Subscriber Smith, John 01-01-2023 03-12-1977
  Child Smith, Jane 01-01-2023 12-15-2022
  Child Smith, Jack 01-20-2023 01-20-2023

ACTUAL BEHAVIOR
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• Info shown in Membership – Main & Membership – Contracts and Charges tables that newborn waiver for Smith, Jane not reflected in the billable charge timeline (for the 01-01-2023 to 01-14-2023 period). In fact, the pricing calculation details for the 01-01-2023 to 01-19-2023 period shows a prorated amount for Smith, Jane.
• The pricing calculation details for the 01-20-2023 to 01-31-2023 and 02-01- 2023 to 02-19-2023 period shows newborn waiver is given to Smith, Jack, which is as per expected results.

EXPECTED BEHAVIOR
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Based on the Fully Insured Pricing Rule and New Born Rules configured, the age used for premium calculation for 2023 and the gift period end date for the newborn dependents are:

Relationship Type Name Member Start Date Birth Date Age for Premium Calculation Gift Period End Date
Main Subscriber Smith, John 01-01-2023 03-12-1977 46 n/a
Child Smith, Jane 01-01-2023 12-15-2022 10 1-14-2023
Child Smith, Jack 01-20-2023 01-20-2023 00 2-19-2023

In summary:
- For Smith, Jane:

•   For year 2023, premium for Smith, Jane is calculated based on Age = 1
•   A newborn waiver credit is given for 01-01-2023 to 01-14-2023, resulting in a net zero premium amount for Smith, Jane for this period.
•   For the remainder of the year, the calculated premium for Smith, Jane is used.

- For Smith, Jack:

•   For year 2023, premium for Smith, Jack is calculated based on Age = 0
•   A newborn waiver credit is given for 01-20-2023 to 02-19-2023, resulting in a net zero premium amount for Smith, Jack for this period.
•   For the remainder of the year, the calculated premium for Smith, Jack is used.

Concern is why the premium calculation process is not giving the newborn waiver as expected when the calculated age of the newborn child is 1 due to the Membership Renewal Date age calculation rule.
Please advise.

Cause

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