Membership Processing

Class Membership Rules were created in OIPA using Math Variable like syntax within Class Rules and Class Rule Variables.

The Membership Rules define the characteristics and requirements of each Class. The Class Membership Rules will be used to evaluate employee/sponsor clients to determine if they can be included for Membership into a particular Class.

Establishing Membership in Classes within a Class Group can be used for any employee/sponsor client grouping purpose and application of common treatment/values, such as for plan eligibility, billing, or reporting. See Classes for Class Rules and Class Rule Variables

How it Works

Note: At the Client Level, the evaluation will occur on the client that activity is processed on. At the Policy Level, Class Membership will be evaluated for the Client designated as the Primary Member role on the Policy.

Transaction and Activity Level Membership Rule Processing

Both Client and Policy level transactions will make use of the Class Rule Variables and Class Rules during the execution of the Class Membership process.

Class Rule Variables can be defined at the Global, Group Customer, Class Group, and Class Levels. Rule Variables defined at the Class level are specific to that particular Class and not shared or viewed across Classes.

For Activity Processing at both the Client and Policy levels, the system will retrieve the Group Customer data for Policy and Client level activities through the Relationship Association. The Primary Relationship will indicate "Employment".

Important   Execution of Membership Rules will automatically assign any employees evaluated against the Class Group which do not resolve to any of the terminal/leafClass nodes will default to a default (Orphan) Class.

Note: An Orphan Class is set up as a default Class anytime a New Class Group is set up in OIPA.

Membership Activity Processing

A Transaction is configured in the Rules Palette at the Client or Policy Level that will evaluate Membership to a Class.

Important   The Client must have a Relationship to the Group Customer as an Employee to imply Membership / Eligibility to become a Member of a Class.

The Data Intake File from the Group Customer containing a Member Record to Add will imply that eligibility/membership needs to be assessed and a Membership related activity will be spawned for processing at the Client or Policy Level.

The system code pulls in the Class Rule Variables and Class Rules, not the configuration. The configuration within the Transaction will be comprised of the Membership Element and its components for the Class Groups, Write Membership, Effective From/To.

We have developed Membership syntax within the configuration specific to writing the Membership records to the database. For more information, please consult the XML Configuration Guide> Transactions > Membership Element.

Example:

Class Membership Activity Results

A Class Membership tab will be housed on the Activity Results screen of the Activities determining Class Membership. The Class Membership tab will contain a table listing all available Class Names and Class Group Names.

If the Class Membership syntax was not used within the Transaction, a message will display indicating “No Membership Processing Performed”.

Membership records will be committed to the database (optional) unless the process is to provide a quote. We allow the override of writing the records to the database. The default action is to write the records, but the quote capabilities in the application provides an instance / circumstances where the need is not necessary to write a record to the database. Membership records will exist for the "leaf" records only - the leaf Class Membership only.

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