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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 | 6/30/2023 | 1000400 | 1309.76 | 1300.00 | 9.76600 | 400 | 200 | 2 |
9800423-2 | 7/1/2023 | 12/31/2023 | 1000400 | 1309.76600 | 900300 | 409.76300 | 2 |
Member 2: Spouse
Business Unit | Subscriber Name | Relationship Type | Issuer Subscriber Id | Issuer Member Id |
|---|---|---|---|---|
MP_GA | Jane Doe | Spouse | U70523453 | U7052345302 |
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Premium Span Code | Start Date | End Date | PRE AMT 1 | PRE AMT TOT | APTC AMT | TOT RES AMT |
|---|---|---|---|---|---|---|
9800424-1 | 1/1/2023 | 6/30/2023 | 309.76200 | 0 | 0 | 0 |
9800424-2 | 7/1/2023 | 12/31/2023 | 309.76200 | 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 | 42354GA33463-01 | 2374734 | 1/1/2023 | 3/25/2023 | 1623.07550 | 3/1/2023 | 961.59500 | 3/25/2023 | 661.4850 |
Jane Doe | 5/15/2023 | CANCEL | 42354GA33463-01 | 2374734 | 3/24/2023 (349) | N/A | N/A | N/A | N/A | N/A | N/A |
Baby Doe | 5/15/2023 | ADD | 42354GA33463-01 | 2374734 | 3/25/2023 | N/A | N/A | N/A | N/A | N/A | N/A |
...
Update all the effective date of all the amounts with the date that is received for PRE AMT TOT effective date.
Retrieve the PRE AMT TOT from the latest premium span and populate as PRE AMT TOT in the transaction
Calculate the TOT RES AMT based on the equation => PRE AMT TOT - APTC AMT - OTH PAY AMT 1 - OTH PAY AMT 2
Populate the APTC AMT as received in the transaction
Populate the effective dates of PRE AMT TOT, TOT RES AMT, OTH PAY 1 (if present), OTH PAY 2 (if present), to be same as APTC AMT effective date
Dependents:
Include all the dependents except for the dependents who has the transaction type ADD.
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 | 42354GA33463-01 | 2374734 | 1/1/2023 | 3/25/2023 | 600 | 3/25/2023 | 961.59 | 3/25/2023 | 348.17 |
Jane Doe | 5/15/2023 | CANCEL | 42354GA33463-01 | 2374734 | 3/24/2023 (349) | N/A | N/A | N/A | N/A | N/A | N/A |
Once the above created Spin off transaction is processed in ERM the enrollment span of the members will be as below
Member 1: Self
Business Unit | Subscriber Name | Relationship Type | Issuer Subscriber Id | Issuer Member Id |
|---|---|---|---|---|
MP_GA | John Doe | Self | U70523453 | U7052345301 |
Enrollment Spans
Enrollment Span Code | Start Date | End Date | QHP ID | Group Policy Id | Status |
|---|---|---|---|---|---|
9800423 | 1/1/2023 | 12/31/2023 | 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 | 3/24/2023 | 1000 | 1309.76 | 1300.00 | 9.76 | 2 |
9800423-2 | 7/1/2023 | 7/1/2023 | 1000 | 1309.76 | 900 | 409.76 | 2 |
9800423-3 | 3/25/2023 | 12/31/2023 | 1000 | 1309.76 | 961.59 | 348.17 |
Spin Off Transaction 2:
Create the transaction as follows
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Include all the dependents exception except for the dependents who has the transaction type ADD.
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