Split in Coverage at Dependent Timeline
(Doc ID 3058705.1)
Last updated on NOVEMBER 13, 2024
Applies to:
Oracle Insurance Revenue Management and Billing Cloud Service - Version 6.1.0.0.0 to 6.1.0.0.0 [Release 6.1]Information in this document applies to any platform.
Symptoms
On RMB v6.1.0.0.0, Split in coverage scenario at Dependent Timeline.
Dependent is having January to February and April to December active coverage; ORMB only considers later one and inbound is processing successfully.
ACTUAL BEHABIOR
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Currently in ORMB, dependent can have one coverage period at Membership.
Membership starts from January 1st 2024 till December 31st 2024.
Spouse: Coverage is April 1st 2024 till December 31st 2024.
Latest inbound message has Spouse coverage with 2 timeline:
1st Timeline: 1st January 2024 till 29th February 2024
2nd Timeline: 1st April 2024 till 31st December 2024
Inbound is getting processed without adding the new timeline. First timeline is missing at membership.
Another example: With Child dependent having split in coverage.
Membership - Latest processed Inbound message:
Child has 2 member data entries in inbound.
Although new timeline received for dependent member for same membership, ORMB is not considering the split in timeline and inbound is getting processed without error but timeline is not updated.
EXPECTED BEHAVIOR
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Dependent member split in coverage should get reflected accordingly.
Dependent split should be billed only for the applicable period.
Below scenarios to be addressed. [For detailed test cases, please check spreadsheet attached]
1. Spouse undergoes Single split with same start date change.
2. Spouse enrolled with split undergoes Multiple splits.
3. Spouse undergoes split leading to continuous coverage.
4. Newborn undergoes split within Gift Days.
5. Spouse not eligible for billing after split.
6. Negative Scenarios.
7. Newborn undergoes split outside Gift Days.
8. Spouse undergoes Single split by inactivation followed by newborn addition and state change.
9. Spouse undergoes Single split and gets cancelled.
10. Spouse enrolled with split continuous coverage.
11. Membership with flat discount charges undergoes split for a dependent.
12. Membership with percentage discount charges undergoes split for a dependent.
13. Membership dependent undergoes split followed by newborn enrollment.
Note : The above test cases has to be tested for below Combinations:
i) Individual Age close end dated membership.
ii) Group Tier Open end dated membership.
iii) Individual Tier open end dated membership.
Cause
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In this Document
| Symptoms |
| Cause |
| Solution |
| References |