...
Business Unit | Subscriber Name | Relationship Type | Issuer Subscriber Id | Issuer Member Id |
|---|---|---|---|---|
MP_GA | John Doe | Self | U70523453 | U7052345301 |
Enrollment SpansSpan - 1
Enrollment Span Code | Start Date | End Date | QHP ID | Group Policy Id | Status |
|---|---|---|---|---|---|
9800423 | 1/1/2023 |
4/ |
30/2023 | 42354GA33463-01 | 2374734 | ENROLLED |
Premium Spans
Premium Span Code | Start Date | End Date | PRE AMT 1 | PRE AMT TOT | APTC AMT | TOT RES AMT | Member Count |
|---|---|---|---|---|---|---|---|
9800423-1 | 1/1/2023 | 2/28/2023 | 1000 | 1309.76 | 1300.00 | 9.76 | 2 |
9800423-1 | 3/1/2023 | 4/30/2023 | 1000 | 1309.76 | 900 | 409.76 | 2 |
Enrollment Span - 2
Enrollment Span Code | Start Date | End Date | QHP ID | Group Policy Id | Status |
|---|---|---|---|---|---|
9800523 | 5/1/2023 | 12/31/2023 | 42354GA33463-02 | 2374734 | ENROLLED |
Premium Spans
Premium Span Code | Start Date | End Date | PRE AMT 1 | PRE AMT TOT | APTC AMT | TOT RES AMT | Member Count |
|---|---|---|---|---|---|---|---|
9800523-1 | 5/1/2023 | 7/31/2023 | 1000 | 1309.76 | 1300.00 | 9.76 | 2 |
9800523-1 |
8/1/2023 | 12/31/2023 | 1000 | 1309.76 |
800 |
509.76 | 2 |
Member 2: Spouse
Business Unit | Subscriber Name | Relationship Type | Issuer Subscriber Id | Issuer Member Id |
|---|---|---|---|---|
MP_GA | Jane Doe | Spouse | U70523453 | U7052345302 |
Enrollment SpansSpan - 1
Enrollment Span Code | Start Date | End Date | QHP ID | Group Policy Id | Status |
|---|---|---|---|---|---|
9800424 | 1/1/2023 | 124/3130/2023 | 42354GA33463-01 | 2374734 | ENROLLED |
...
Premium Span Code | Start Date | End Date | PRE AMT 1 | PRE AMT TOT | APTC AMT | TOT RES AMT |
|---|---|---|---|---|---|---|
9800424-1 | 1/1/2023 | 2/28/2023 | 309.76 | 0 | 0 | 0 |
9800424-2 | 3/1/2023 | 4/30/2023 | 309.76 | 0 | 0 | 0 |
Enrollment Span - 2
Enrollment Span Code | Start Date | End Date | QHP ID | Group Policy Id | Status |
|---|---|---|---|---|---|
9800524 | 5/1/2023 | 12/31/2023 | 42354GA33463-02 | 2374734 | ENROLLED |
Premium Spans
Premium Span Code | Start Date | End Date | PRE AMT 1 | PRE AMT TOT | APTC AMT | TOT RES AMT |
|---|---|---|---|---|---|---|
9800524-1 | 5/1/2023 | 7/31/2023 | 309.76 | 0 | 0 | 0 |
9800524-2 |
8/1/2023 | 12/31/2023 | 309.76 | 0 | 0 | 0 |
...
Transaction Received
Member | Received Date | Transaction Type | QHP ID | Group Policy Id | 348 Date | PRE AMT TOT Effective Date | PRE AMT TOT | APTC AMT Effective Date | APTC AMT | TOT RES AMT Effective Date | TOT RES AMT |
|---|---|---|---|---|---|---|---|---|---|---|---|
John Doe | 5/15/2023 | CHANGE | 42354GA33463-02 | 2374734 | 1/1/2023 | 3/25/2023 | 1623.07 | 3/1/2023 | 961.59 | 1/26/2023 | 661.48 |
Jane Doe | 5/15/2023 | CHANGE | 42354GA33463-02 | 2374734 | 1/1/2023 | N/A | N/A | N/A | N/A | N/A | N/A |
Baby Doe | 5/15/2023 | ADD | 42354GA33463-02 | 2374734 | 3/25/2023 | N/A | N/A | N/A | N/A | N/A | N/A |
...