Individual and small group accounts that use Pega Sales Automation for Healthcare as the system of record can start the process of renewing account plans when the enrolled plan end date approaches.
Healthcare plan details and rates often change each year. To keep the same logical plan, you need to map last year's plans to current year’s plans before starting the renewals process.
To find expiring plans and create renewal opportunities and quotes requests automatically, configure the renewals job scheduler and dynamic system settings to your needs.
For manual renewals, find active accounts in the User Portal and explicitly start the renewal process for their expiring plans.
In addition to the application-provided renewals features, you can extend the application to include the following renewals features:
- Renewals for large group and Medicare accounts
- Renewals for healthcare accounts from an external system of record
For information about how to extend the Pega Sales Automation for Healthcare, see Technical details for developers extending the account renewal features.
Renewal case types
An account that has an enrolled plan that is expiring soon and a status of Open-Enrolled is eligible for renewal.
Eligible accounts are added to a Renewal Batch case by an automatic or manual renewal process.
A Renewal Batch case ID has a prefix of RB-, and it includes a Quote Request- child case for each account in the batch.
Quote Request cases created by the renewals process are very similar to new business quote requests. A Quote Request case ID has a prefix of QRIND- for individual accounts or QRSG for small group accounts.