Enrollment Prototype

Employees/Members of a specific group customer class can be enrolled to the benefits offered by a Group Customer. OIPA allows for evaluating the eligibility of a specific member and enrolling the employee/member to appropriate benefits. The following prototype transactions and business rules are created to demonstrate the ability to enroll employees/members into benefits.

Prototype Explanation

The following transactions – EvaluateMembership, EnrollmentPrototype and Activate - have been created in the Prototype company.

The EvaluateMembership transaction will evaluate the membership rules defined for the class and determine the benefits eligible. The transaction is defined as a

Group Prototype Product override.

The Enrollment Prototype transaction is the Enrollment type transaction which will be presented as part of the Enrollment screen when specific benefit coverage(s) are selected for enrollment. The process of enrolling creates the enrollment record. The Enrollment Prototype transaction creates a policy with the selected coverages. The client upon whom this executes takes the roles of Eligible Member, Insured and Owner on the new policy and Participant-Member on each coverage. The transaction Activate will be added as an activity to the new policy. The transaction is defined as a Group Prototype Product override.

The Activate transaction updates a policy, to which it is added, with an activation date and changes the policy status to active. The transaction is defined as a Group Prototype Product Override

To execute enrollment, the following prerequisites must be satisfied:

1. A Group Customer record should exist in the Prototype company.

2. An agreement should exist under the Group Customer that establishes an association of the Group Prototype Product and the segment definitions BaseCoveragePlus and BaseCoverageBasic

3. A Class Group should be linked under the Agreement in which one or more classes of type Eligibility should be available,. Using the Plans and Segments created under the Group Customer, one or more Class Sub-plan records should be created.

4. An Employment type of relationship needs to be established between the Group Customer and 1 or more of the Group Customer’s client population Prior to running eligibility.

View Prototype in OIPA

  1. Log in to the Rules Palette.

  2. In the Global Rules Explorer window, navigate to Transaction.

  3. View the EvaluateMembership and EnrollmentPrototype transactions.

  4. In the Admin Explorer window, select the Enrollment Transaction node. The existing enrollment transaction records can be viewed.

  5. Expand navigation to the EnrollmentPrototype transaction and right click to “View Details” or “View Enrollment Transaction”.

  6. Login to OIPA with a Prototype company user credentials.

  7. Search for the Group Customer, per the prerequisites listed above through the Customer -> Search menu option.

  8. Select the Group Customer and navigate to the Client Relationship link.

  9. Go to the Individual Client by selecting "Edit Client" right click menu option under relationships and click "Add Activity".

  10. Add and process the EvaluateMembership activity at the client level.

  11. Now select the Enrollment screen from the left navigation options under the Client. The same Enrollment screen can be accessed by using right click context menus in Client Relationship Screen as well.

  12. All the coverages that are eligible for the client are available for selection. Select one or more of the coverages and proceed to enter details for the EnrollmentPrototype transaction (presented as part of the enrollment screen) and press "Enroll" or “Save” button.

  13. On Click of Enroll, the client is enrolled for the coverage(s) a policy is created and the PolicyName can be found in the transaction math of the processed EnrollmentPrototype Transaction).

  14. On Click of Save a pending EnrollmentPrototype transaction will be present in the Client Activities Screen.

  15. Once a client is enrolled he is not allowed to enroll again.

     
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