Group Customer Overview

Group Customer

Group Insurance provides a single insurance policy that covers groups of employees and their dependents on behalf of the company or organization to which they belong. The company or organization is referred to as a Group Customer in the Oracle Insurance Group Policy Administration system.

The display of the Group Customer screen in OIPA is controlled through the configuration in the GroupCustomerScreen business rule.

Agreements

Based on the organization's needs, the terms of the Group insurance product are negotiated and Group Customer enters into an agreement with the Insurance Carrier. The agreement provides information on the contract between the Carrier and the Group Customer detailing the plan offerings available to members. Agreements may be funding, financial, or service related and will not have plan offerings or coverage attached. New plans can be created within the Plans tab under a specific Master Agreement. See Agreements for information on configuring agreements.

Relationships

The Group Customer has relationships with clients and non-group customer entities. The ability to connect or link the Group Customer to employees, contacts, Human Resource Administrators, Account Managers and other affiliations is key in establishing relationships within OIPA. Relationships can be designated as primary or secondary. A primary relationship type describes the general point of contact. The secondary relationship further defines the specific title and characteristics of the relationship. For example, the primary relationship may be an employee. The secondary relationship further defines the employee as Full-Time, Part-Time or Retired. Userscan add and maintain relationships in OIPA. The type of relationship drives what activities (Client-Relationship activities) are eligible for processing for the Group Customer relationship. See Relationships for information on configuring relationships.

Classes and Class Groups

The Group Customer selects the product and plan offerings to offer various subsets, or Classes, of its overall employee population. Classes provide a way for the employee population to be divided into groups based on similar characteristics the employees share.

Examples of classes include:

Classes may be arranged into a collection called a Class Groupbased on the Group Customer's needs. See Classes for information on configuring classes and class groups.

Plan Eligibility and Enrollment

Eligibility provides the stipulated requirements that mark a class member as qualified to enroll in a plan. Based on parameters and rules set by the Group Customer, plans are filtered and made available to the members at a particular point in time, via classes. As a member's characteristics change over time (salary change, job title or status qualifying life event ) the member may become eligible for different plans.

Enrollment is the act of selecting coverage for members. The enrollment period can be any of the following types:

Data Intake

Carriers must be able to receive, process and apply Group Customer Data Intake files, which provide employee and policy coverage data. The files include additions, changes and deletions pertaining to both employee and coverage data. The employee information as well as the coverage information will need to be updated. This is achieved through the use of a transaction at the Group Customer level where the receipt of the intake file triggers and produces individual transactions at the policy/certificate level. The process is housed on the Data Intake screen. The transactions may be viewed, filtered or reversed. Users can also drill down into member record level details.

     
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