Member
Overview
The C1-MEMBER subject area manages membership data and its lifecycle. It defines member enrollment, links members to policies and plans, manages rate guarantees, and maintains full audit and log details for each member record. This subject is supported by multiple tables that store identifiers, personal relationships (PER), service agreements (SA), characteristics (CHAR), and membership-specific logs (LOG and LOG_PARM).
Conforming Layers
The Payment subject area has the following conforming layers:
MEMBERSHIP_OBJ
| Column | Description | Data Type | Data Length |
|---|---|---|---|
| MEMBERSHIP_ID | Unique identifier assigned to each membership record. | VARCHAR | 15 |
| PLAN_ID | Links the membership to a specific plan through the plan identifier. | VARCHAR | 15 |
| POLICY_ID | Links the membership to a specific policy through the policy identifier. | VARCHAR | 14 |
| START_DT | Start date when the membership service agreement becomes active. | TIMESTAMP | |
| END_DT | End date when the membership service agreement is no longer active. | TIMESTAMP | |
| EXT_MEMBER_ID | External identifier for the member, often used to map records across systems. | VARCHAR | 100 |
| BO_STATUS_CD | Current business object status of the membership. | VARCHAR | 12 |
| BO_STATUS_REASON_CD | Reason code associated with the current business object status. | VARCHAR | 30 |
| STATUS_UPD_DTTM | Date and time when the membership status was last updated. | TIMESTAMP | |
| ILM_ARCH_SW | Indicator whether the accrual is marked for archiving. | VARCHAR | 1 |
| ILM_DT | Date when the accrual is scheduled to be archived. | TIMESTAMP | |
| PAID_THR_DT | Date when the payments have been received. | TIMESTAMP | |
| ORG_END_DT | Original end date of the membership before any extensions or modifications. | TIMESTAMP | |
| MEMBERSHIP_TYPE_FLG | Flag identifying the membership type. | VARCHAR | 4 |
| AUTO_RENEW_SW | Switch indicating whether the membership is set to auto-renew upon expiration. | VARCHAR | 1 |
| EXCHANGE_FLG | Flag indicating whether the membership is linked to an exchange-based enrollment. | VARCHAR | 4 |
| EXCHANGE_ID | Identifier for the exchange to which the membership is tied. | VARCHAR | 50 |
| HOLD_BILLING_SW | Switch indicating whether the billing for the membership is currently on hold. | VARCHAR | 1 |
| THRESHOLD_AMT | Threshold amount defined for the membership, typically used for billing or payment control. | DECIMAL(15,2) | 15,2 |
| RENEWAL_DT | Renewal date for the membership. | TIMESTAMP | |
| CONTRACT_PERIOD | Duration of the membership contract, expressed in months or years, based on the business rules. | DECIMAL(2) | 2 |
| MEMBERSHIP_CAT_FLG | Flag identifying the membership category used to classify the membership into a specific category. | VARCHAR | 4 |
| HEALTH_PLAN_CD | Code of the health plan associated with the membership. | VARCHAR | 30 |
| REPRC_AFTER_DT | Date after which repricing of the membership may occur. | TIMESTAMP | |
| TERM_DATE | Termination date of the membership. | TIMESTAMP | |
| ENRL_END_DT | Date when when the membership enrollment is scheduled to end. | TIMESTAMP | |
| CDF1_CD CDF2_CD CDF3_CD CDF4_CD CDF5_CD CDF6_CD CDF7_CD CDF8_CD CDF9_CD CDF10_CD CDF11_CD CDF12_CD CDF13_CD CDF14_CD CDF15_CD |
Placeholders for future implementation of ORMB characteristics. | VARCHAR | 70 |
| CDF1_VAL CDF2_VAL CDF3_VAL CDF4_VAL CDF5_VAL CDF6_VAL CDF7_VAL CDF8_VAL CDF9_VAL CDF10_VAL CDF11_VAL CDF12_VAL CDF13_VAL CDF14_VAL CDF15_VAL |
Placeholders for values of future implementation of ORMB characteristics. | VARCHAR | 254 |
MEMBERSHIP_PER_OBJ
| Column | Description | Data Type | Data Length |
|---|---|---|---|
| MEMBERSHIP_ID | Unique identifier assigned to each membership record. | VARCHAR | 15 |
| PER_ID | Identifier for the person associated with the membership. | VARCHAR | 10 |
| START_DT | Start date when the membership service agreement becomes active. | TIMESTAMP | |
| END_DT | End date when the membership service agreement is no longer active. | TIMESTAMP | |
| SA_REL_TYPE_CD | Type of service agreement relationship for the person within the membership. | VARCHAR | 8 |
| FIN_RESP_SW | Switch indicating whether the person is financially responsible for the membership. | VARCHAR | 1 |
| MAIN_CUST_SW | Switch indicating whether the person is designated as the main customer for the membership. | VARCHAR | 1 |
| C1_MEMBER_SW | Switch identifying if the person is recognized as a valid member under the C1 membership extension. | VARCHAR | 1 |
| ORG_END_DT | Original end date of the membership before any extensions or modifications. | TIMESTAMP | |
| MEMBER_PER_STATUS_FLG | Captures the current status flag of the person’s membership. | VARCHAR | 4 |
| EXT_MEDICARE_BENF_ID | Identifier for the external Medicare Beneficiary associated with the member. This is used for integration with external healthcare systems. | VARCHAR | 100 |
| MEMB_PERS_STAT_RSN_FLG | Reason flag associated with changes to the person’s membership status. | VARCHAR | 4 |
| ENRL_END_DT | Date when the membership enrollment is scheduled to end. | TIMESTAMP | |
| CDF1_CD CDF2_CD CDF3_CD CDF4_CD CDF5_CD CDF6_CD CDF7_CD CDF8_CD CDF9_CD CDF10_CD CDF11_CD CDF12_CD CDF13_CD CDF14_CD CDF15_CD |
Placeholders for future implementation of ORMB characteristics. | VARCHAR | 70 |
| CDF1_VAL CDF2_VAL CDF3_VAL CDF4_VAL CDF5_VAL CDF6_VAL CDF7_VAL CDF8_VAL CDF9_VAL CDF10_VAL CDF11_VAL CDF12_VAL CDF13_VAL CDF14_VAL CDF15_VAL |
Placeholders for values of future implementation of ORMB characteristics. | VARCHAR | 254 |
| CDF13_EFFDT CDF14_EFFDT CDF15_EFFDT |
Effective date associated with the CDF13, CDF14, CDF15 characteristics, respectively, indicating when the characteristic value becomes valid. | VARCHAR | 8 |
MEMBERSHIP_SA_OBJ
| Column | Description | Data Type | Data Length |
|---|---|---|---|
| BILL_TO_TYPE_FLG | Billing responsibility flag for the membership service agreement, indicating who is responsible for bill payments. | VARCHAR | 4 |
| MEMBERSHIP_ID | Unique identifier assigned to each membership record. | VARCHAR | 15 |
| START_DT | Start date when the membership service agreement becomes active. | TIMESTAMP | |
| SA_ID | Identifier for the service agreement associated with the membership. | VARCHAR | 10 |
| END_DT | End date when the membership service agreement is no longer active. | TIMESTAMP |