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Method Detail

Value

Visibility

Public

Method Parameters

AccountDto, Account, Sting (Ztcn)

Return Parameter

void

Functionality

The main objective of this method is to retrieve the enrollment spans present in the Account entity and convert them into dto object and set them in the Account Dto object.

This method also internally invokes the premium span helper to set the premium span dto in the respective enrollment span dto object.

Update Enrollment Span

Method Detail

Value

Visibility

Public

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Method Detail

Value

Visibility

Private

Method Parameter

PremiumSpanDto

Return Parameter

void

Functionality

If the premium span start date is not equal to end date or if they are equal and the status is "ACTIVE" then,

  1. Set the end date same as that of the start date

  2. Set the status of the premium span to "CANCEL"

  3. Set the "Changed" flag to TRUE.

Cancel Premium Spans

Method Detail

Value

Visibility

Private

Method Parameter

Set<PremiumSpanDto>

Return Parameter

void

Functionality

Iterate through each premium span and invoke cancel premium span (cancelPremiumSpan) method to cancel the premium span.

Determine Effectuation Date

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Method Detail

Value

Visibility

Private

Method Parameters

TransactionMemberDto (Primary Subscriber Info)

Return Parameter

String (Exchange Subscriber Id)

Functionality

Iterate through the identifiers list of the member to find an identifier of type "EXCHSUBID" and return the value.

Get Overlapping Enrollment Spans

Method Detail

Value

Visibility

Private

Method Parameters

AccountDto, LocalDate (Effective Start date), LocalDate (Effective End Date), String (coverageTypeCode)

Return Parameter

List<EnrollmentSpanDto>

Functionality

Follow the below steps to identify the enrollment spans that will overlap with the the effective date received for the transaction.

  1. Get all the enrollment spans that are present for the year for which the effective date is received and has the same coverage type code that is passed to the method. i.e. if the effective date is 2/1/2023 get all the enrollment spans that belong to the year 2023 and also has the same coverage type code "FAM" or "DEP".

  2. From the enrollment spans filtered from step 1, get all the enrollment spans that have the end date that is greater than the effective start date. This eliminates all the enrollment spans that are termed prior to the effective start date of the transaction.

  3. From the enrollment spans filtered from step 2, Get all enrollment spans that have the start date that is before the effective end date received in the transaction and is not in CANCEL status.

  4. After completion of steps 1, 2 and 3, if there are any overlapping enrollment spans still, present, return that list, else return NULL.

Get Primary Member

Method Detail

Value

Visibility

Private

Method Parameters

TransactionDto

Return

TransactionMemberDto

Functionality

Iterate through the members in the transaction the retrieve the member with the relationship type code "HOH"

Note: No exception handling is added if no member with relationship type code of "HOH" is not present, because such validations should have been done by rules well before the transaction is at this step.

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Method Detail

Value

Visibility

Private

Method Parameter

AccountDto, LocalDate (Start Date), boolean (match cancel span or not)

Return Parameter

List<EnrollmentSpanDto>

Functionality

Get all the enrollment spans that are in the account with end date that is prior to the start date of the transaction.

If the match cancel span boolean is set to false then remove any canceled enrollment spans (removeCanceledSpans) from the list and then return the enrollment that has the max end date among all of the remaining enrollment spans.

Is Delinquent

Method Detail

Value

Visibility

Private

Method Parameters

EnrollmentSpan (Current Enrollment Span), List<EnrollmentSpanDto> priorEnrollmentSpans

Return Parameter

int

Functionality

This method returns one of the three below values

1 - To indicate the current enrollment span should be set to delinquent

-1 - To indicate that the current enrollment span should be set to suspended

0 - To indicate that the current enrollment span is not delinquent.

Below is how the logic is perform the determine which of the above three should be sent.

Check for below conditions

  1. Current Enrollment Span effectuation date is not NULL

  2. Current Enrollment Span delinquency indicator is set to TRUE

  3. Current Enrollment Span start date is greater than the end date (Cancel span condition)

If any of the above conditions are false, then span is not delinquent return the value "0"

If all of the above conditions are true, then follow the below logic.

  1. If the current enrollment span does not have claim paid through date, then return the value -1 (Suspended - Note at this point the delinquency indicator is true and the effectuation date is not null)

  2. If the current enrollment span has a claim paid through date then

    1. If the the current system date is before or equal to the claim paid through date and

    2. There is no gap in coverage between the current enrollment and the prior enrollment span, and

    3. Both enrollments are for the same plan and

    4. The prior enrollment span is in delinquent status

    5. If all of the above conditions are true, then return the value "1" (Delinquent)

    6. If any of the above conditions are false, then return the value "-1" (Suspended)

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Method Detail

Value

Visibility

Private

Method Parameter

List<EnrollmentSpanDto>

Return Parameter

List<EnrollmentSpanDto>

Functionality

Iterate through the input list of enrollment spans and remove the enrollment spans that are canceled and return the remaining enrollment spans.

Save Updated Enrollment Spans

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