Introduction

This document details the functionality handled by the Cúram Eligibility and Entitlement Engine when using Rules. Please be advised that this guide does not cover eligibility and entitlement processing when using Cúram Express Rules (CER). For information on eligibility and entitlement processing when using CER, see the Inside Cúram Eligibility and Entitlement Using Cúram Express Rules guide.

The Cúram Eligibility and Entitlement Engine is responsible for the following:

• Determination of customer eligibility over time

  The eligibility and entitlement engine uses the rules engine to generate decisions over a period of time. These decisions indicate whether or not the client or clients being assessed are eligible for that product.

• Passing decision information to the rules engine.

  The eligibility and entitlement engine can pass decision information to the rules engine so that the rules engine can use this information to make new decisions. In effect, the decision information passed into the rules engine can be used as evidence.

• Calculation of financial benefit over time

  The eligibility and entitlement engine calculates the financial benefit due using the decision details produced by the rules engine over a period of time. The financial benefit due is the amount that the client or clients being assessed are entitled to.

• Calculation of liability over time

  The eligibility and entitlement engine calculates the value of a liability using the decision details produced by the rules engine over a period of time.

• Creation of financial schedules

  The eligibility and entitlement engine creates financial schedules, called financial components, from the decisions produced by the rules engine. Financial components are schedules of transactions to be realized into actual financial transactions.

• Financial Component assignment

  Financial components are assigned to nominees. By default, all financial components are assigned to the primary client unless otherwise specified. The eligibility and entitlement engine processes the financial components on a nominee by nominee basis.

• Reassessment, i.e., calculation of under/over payments/bills

  Reassessment occurs when there is a change in circumstance for a period that has already been assessed. The eligibility and entitlement engine compares new financial components to processed financial components to determine if any under/over payments/bills exist. If an under/over payment/bill exists, the eligibility and entitlement engine calculates the amount of the under/over payment/bill.