InsEnrollmentService:enrollPlans

Class: InsEnrollmentService

Method: enrollPlans

How It Works for Insurance Policy Records

Enrollment services can either write to the Insurance Policy and related objects (Harmonized policy data model) or Asset objects (Vlocity model) , depending on the isFsc parameter, and the custom setting for defaultIsFSCOption. The service does the following:

1. The service takes the input JSON and looks for the information to create the policies (Insurance Policy).

   defaultIsFSCOption	isFsc parameter	Policies Created
   True	NA	Insurance Policy (InsurancePolicy) records
   False	True	Insurance Policy (InsurancePolicy) records
   False	False	Asset (Asset) records
   NA	True	Insurance Policy (InsurancePolicy) records
   NA	False	Asset (Asset) records

2. For Insurance Policy record, the member can be represented either as a Contact or a Person Account. When a member (primary or dependent) is represented as an account and contact both, the service uses the account representation.

3. Associates dependents to the policies as Insurance Policy Participants (InsurancePolicyParticipants). It creates another Insurance Policy Participant (InsurancePolicyParticipant) for the primary member.

   The records for InsurancePolicyParticipants are populated according to these rules:

   Person Account Flow

   You can create Person Accounts for the members in the given census. To support the Person Account flow:

   • If Primary Member is represented as a Person Account, then the member’s Person Account Id is set as the policy’s Account.

   • If Primary Member is represented as a Person Account, then Primary Participant Account Id of primary’s InsurancePolicyParticipant record is Primary member’s person account Id and Primary Participant Contact Id is personAccount.personContactId.

   • If Primary member of the dependent is represented as Person Account, then Primary Participant Account Id of dependent’s InsurancePolicyParticipant record is Primary member’s person account Id.

   • Primary Participant Contact Id of dependent’s InsurancePolicyParticipant record is Primary member’s personAccount.personContactId.

   • If dependent is represented as a Person Account, then Related Participant Account Id of dependent’s InsurancePolicyParticipant record is Related member’s person account Id.

   • If dependent is represented as a Person Account, then Related Participant Contact Id of dependent’s InsurancePolicyParticipant record is Related member’s personAccount.personContactId.

   Non-Person Account Flow

   • If Primary Member is represented as a Contact, then the member’s Account.Id is set as the policy’s Account.

   • If Primary Member is represented as a Contact, then Primary Participant Contact Id of primary’s InsurancePolicyParticipant record is Primary member’s Contact Id.

   • If Primary member of the dependent is represented as Contact, Primary Participant Contact Id of InsurancePolicyParticipant is Primary member’s contact ID.

   • if dependent is represented as Contact, Related Participant Contact Id of InsurancePolicyParticipant is Primary member’s contact ID.

4. Gets the ProductId from the plan and stamps InsurancePolicy.ProductId = plan.Product2Id.

5. Creates these relationships:

   Insurance Policy
   InsurancePolicy.EffectiveDate= Contract.StartDate or the EffectiveStart in the input JSON.
   InsurancePolicy.ExpirationDate = Contract.EndDate or the EffectiveEnd in the input JSON.
   InsurancePolicy.ContractLineItemId__c = Plan.Id

6. The service calculates InsurancePolicy.PolicyTerm based on Contract.ContractTerm:

   Insurance Policy
   ContractTerm = 12, InsurancePolicy.PolicyTerm= Annual.
   ContractTerm = 6, InsurancePolicy.PolicyTerm= Semi-Annual
   ContractTerm = 1, InsurancePolicy.PolicyTerm= Monthly
   ContractTerm = Any other value, InsurancePolicy.PolicyTerm= Custom.

7. Gets the Price key from the input JSON and creates these relationships:

   Insurance Policy
   InsurancePolicy.PremiumAmount = Price
   InsurancePolicy.TermPremiumAmount = prorated price based on the effective dates specified in #5.
   InsurancePolicy.MonthlyPremium__c = Price/ContractTerm

8. Creates Insurance Policy Coverages (InsurancePolicyCoverages) for the coverage items.

How It Works for Assets

1. The service takes the input JSON and looks for the information to create the policies (assets).

   defaultIsFSCOption	isFsc parameter	Policies Created
   True	NA	Insurance Policy (InsurancePolicy) records
   False	True	Insurance Policy (InsurancePolicy) records
   False	False	Asset (Asset) records
   NA	True	Insurance Policy (InsurancePolicy) records
   NA	False	Asset (Asset) records

2. Associates the primary member’s contactId with the policy as a Contact.

3. Stamps the enrollment contract’s accountId as the policy’s Account.

4. Takes the RawPriceData key or the RateBandTierPriceData key from the input JSON and stamps it to the Asset.PricingLogData__c field.

5. Gets the ProductId from the plan and stamps Asset.Product2Id = plan.Product2Id__c.

6. Creates the following relationships:

   Assets
   Asset.EffectiveDate__c = Contract.StartDate or the EffectiveStart in the input JSON.
   Asset.ExpirationDate__c = Contract.EndDate or the EffectiveEnd in the input JSON.
   Asset.BenefitPlanId__c = Plan.Id

7. The service calculates Asset.Term__c based on Contract.ContractTerm:

   Assets
   ContractTerm = 12, Asset.Term__c = Annual.
   ContractTerm = 6, Asset.Term__c = Semi-Annual
   ContractTerm = 1, Asset.Term__c = Monthly
   ContractTerm = Any other value, Asset.Term__c = Custom.

8. Gets the Price key from the input JSON and creates these relationships:

   Assets
   Asset.StandardPremium__c = Price
   Asset.TotalPremiumTerm__c = prorated price based on the effective dates specified in #7
   Asset.AnnualPremium__c = Price/ContractTerm*12
   Asset.MonthlyPremium__c = Price/ContractTerm

9. Associates dependents to the policies as Held Product Relationships (AssetPartyRelationship__c). While creating asset party relationship for dependents, the partyId must be provided in the dependents node.

   

   Note

   Another Insurance Policy Participant (InsurancePolicyParticipant) is created for the primary member, but no record is created for the primary member in Held Product Relationship (AssetPartyRelationship__c).

10. Creates Policy Coverages (AssetCoverage__c) for the coverage items.

Remote Options

Input JSON

The service takes the input JSON specified by the inputKey. In this example, inputKey = enrollmentJson.

The service requires:

• contractId: <value>

• Dependents: <list of maps for contactId and relationshipType of the dependents>.

  

  Note

  While using enrollPlans service to generate Asset and AssetPartyRelationship, if dependents are passed in enrollmentJson, then corresponding partyId must be provided.

• Product JSON Structure Model including attributes and child products

This input JSON can have either a list of objects or a map, because the service supports creating either one policy or multiple policies.

To support Person Account Id, primaryMemberId is a new node added to the enrollmentJson. It supports both Person Account Id and ContactId for backward compatibility. Based on the Id type of primaryMemberId, the services work as described in service description.

Similarly, for dependents, memberId node is added. It supports both Person Account Id and contact Id for backward compatibility. Based on the Id type of memberId, the services work as described in service description.

In this example, the JSON includes three policies.

{
   "enrollmentJson":[
      {
         "primaryMemberContactId":"0035w00003HjCFcAAN",
                  "primaryMemberId" : "0015e00000DvQ89AAF"
         "contractId":"8005w000001mT4MAAU",
         "dependents":{
            "IsSpouse":false,
            "contactId":"0035w00003HhfXPAAZ",
            "memberId": "0015e00000RvO24IAJ"
            "LastName":"Jones",
            "FirstName":"Jean",
            "relationshipType":"Child"
         },
         "Id":"01t5w00000EZUtMAAX",
         "Name":"HMO 500",
         "Family":"Other",
         "ProductCode":"SG-HMO-500",
         "Type__c":"Medical",
         "SubType__c":"HMO",
         "RecordTypeName__c":"Product",
         "IsConfigurable__c":false,
         "PricingFormula__c":"GroupPremium",
         "productId":"01t5w00000EZUtMAAX",
         "currencyCode":"USD",
         "currencySymbol":"$",
         "Price":300,
         "planId":"a2S5w0000034B2cEAE",
         "planRateType":"Age",
         "attributeCategories":{
            "totalSize":1,
            "records":[
               {
                  "Code__c":"SG_Medical",
                  "Name":"SG Medical",
                  "id":"a085w00000uA9v6AAC",
                  "productAttributes":{
                     "totalSize":1,
                     "records":[
                        {
                           "rulesCode":"SG-HMO-500.SG_annualDed_INN",
                           "productCode":"SG-HMO-500",
                           "code":"SG_annualDed_INN",
                           "dataType":"text",
                           "inputType":"text",
                           "multiselect":false,
                           "required":false,
                           "readonly":true,
                           "disabled":true,
                           "filterable":true,
                           "attributeId":"a095w000010zIYkAAM",
                           "label":"Deductible",
                           "hasRules":false,
                           "hidden":false,
                           "cloneable":true,
                           "isNotTranslatable":false,
                           "values":[
                              {
                                 "readonly":true,
                                 "disabled":true
                              }
                           ],
                           "userValues":"$500 / $1,000",
                           "attributeGroupType":"In-Network"
                        }
                     ]
                  }
               }
            ]
         },
         "childProducts":{
            "totalSize":1,
            "records":[
               {
                  "Id":"01t5w00000EZUA7AAP",
                  "Name":"Emergency Services",
                  "ProductCode":"SG_Emerg_Serv",
                  "Type__c":"Medical",
                  "IsRecommended__c":false,
                  "RecordTypeName__c":"CoverageSpec",
                  "IsConfigurable__c":true,
                  "productId":"01t5w00000EZUA7AAP",
                  "pciId":"a3A5w000000Ib6fEAC",
                  "isOptional":false,
                  "isSelected":true,
                  "attributeCategories":{
                     "totalSize":1,
                     "records":[
                        {
                           "Code__c":"SG_Medical",
                           "Name":"SG Medical",
                           "id":"a085w00000uA9v6AAC",
                           "productAttributes":{
                              "totalSize":1,
                              "records":[
                                 {
                                    "code":"SG_urgentCareFacility_OON",
                                    "dataType":"text",
                                    "inputType":"dropdown",
                                    "multiselect":false,
                                    "required":false,
                                    "readonly":false,
                                    "disabled":false,
                                    "filterable":true,
                                    "attributeId":"a095w000010zIZRAA2",
                                    "label":"Urgent Care Facility",
                                    "hasRules":false,
                                    "hidden":false,
                                    "cloneable":true,
                                    "isNotTranslatable":false,
                                    "values":[
                                       {
                                          "id":"0",
                                          "label":"Not Covered",
                                          "readonly":false,
                                          "disabled":false,
                                          "value":"Not Covered"
                                       },
                                       {
                                          "id":"1",
                                          "label":"40% Coins After Ded",
                                          "readonly":false,
                                          "disabled":false,
                                          "value":"40% Coins After Ded"
                                       },
                                       {
                                          "id":"2",
                                          "label":"50% Coins After Ded",
                                          "readonly":false,
                                          "disabled":false,
                                          "value":"50% Coins After Ded"
                                       },
                                       {
                                          "id":"3",
                                          "label":"30% Coins After Ded",
                                          "readonly":false,
                                          "disabled":false,
                                          "value":"30% Coins After Ded"
                                       }
                                    ],
                                    "userValues":"Not Covered",
                                    "attributeGroupType":"Out-Of-Network"
                                 }
                              ]
                           }
                        }
                     ]
                  }
               }
            ]
         }
      }
   ]
}

Output JSON

The list of policies created by the service.

{
   "assetIds":[
      {
         "assetId":"0036F00002Q4wlSQAR"
      },
      {
         "assetId":"0036F00002Q4wlSQAQ"
      }
   ],
   "policyIds":[
      "0036F00002Q4wlSQAR",
      "0036F00002Q4wlSQAQ"
   ]
}