APS - Enrollment Span Helper

Visibility

Public

Below are the steps to create the enrollment span.

1. Identify the primary subscriber in the transaction (getPrimaryMember)

2. Generate a unique code for the new enrollment span to be created.

3. Create the enrollment span entity with the below details retrieved from the transaction

   1. Set the account enrollment span sk to NULL, since this is a new enrollment span.

   2. Set the enrollment span code

   3. Set the account for which the enrollment span is being created

   4. Set the zeus transaction control number

   5. Set the state type code

   6. Set the marketplace type code

   7. Set the business unit type code

   8. Set the coverage type code

   9. Set the start date

   10. Set the end date (determineEndDate)

   11. Set the exchange subscriber id

   12. Set the effectuation date (determineEffectuationDate)

   13. Set the plan

   14. Set the product type

   15. Set the group policy id

   16. Set the changed flag to "TRUE"

   17. Set the enrollment span status (determineEnrollmentSpanStatus)

4. Save the enrollment span

5. Call the premium span helper instance to create the premium spans (createPremiumSpans)

Visibility

Public

Method Parameters

EnrollmentSpan(Current Enrollment Span), List<EnrollmentSpanDto> (Prior Enrollment Spans)

Return Parameter

String

Functionality

If the prior enrollment span is delinquent (isDelinquent) then the status of the current enrollment span is either "DELINQUENT" or "SUSPENDED"

If the end date of the current enrollment span is less than the start date, then status is "CANCELED"

If the prior enrollment span is not delinquent and if the end date of the current enrollment span is greater than the start date and if the effectuation date is not NUL, then the status is "ENROLLED"

If the If the prior enrollment span is not delinquent and if the end date of the current enrollment span is greater than the start date and if the effectuation date is NUL, then the status is "PRE_MEMBER"

If none of the above conditions are met, then return the status as "NO_VALID_STATUS"

Visibility

Public

Method Parameters

EnrollmentSpanStatusDto

Return Parameter

String

Functionality

Invoke the enrollment span status determination method (determineEnrollmentSpanStatus) by passing the current enrollment span the list of prior enrollment span.

Visibility

Public

Visibility

Public

Visibility

Private

Visibility

Private

Visibility

Private

Method Parameters

TransactionDto, List<EnrollmentSpan> (Prior Enrollment Spans)

Return parameter

LocalDate

Functionality

Perform the below steps to determine if an effectuation date should be returned or not.

1. If the responsibility amount for the enrollment is zero then, return the current date as the effectuation date.

2. If there is at least one prior enrollment span that is in Enrolled Status, and

   1. It has the same plan (isSamePlan) and

   2. There is no gap in coverage between the prior enrollment span and the new enrollment (isThereGapInCoverage)

   3. Then return the current date as the effectuation date.

3. If current date is not returned as effectuation date in steps 1 and 2, then return NULL.

Visibility

Private

Method Parameters

LocalDate (Start Date), LocalDate (End Date)

Return Parameter

LocalDate

Functionality

If the end date is passed in as a non-null value, then return the end date value.

If the end date is passed in as NULL, then get the year of the start date and return the last day of the same year as the end date.

Visibility

Private

Visibility

Private

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.

Visibility

Private

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)

Visibility

Private

Method Parameters

String (Current plan), String (Prior Plan)

Return Parameter

Boolean

Functionality

Return true if the current plan and prior plan are same, return false if they are different.

Visibility

Private

Method Parameters

Local Date(Effective Start Date), EnrollmentSpanDto (Prior Enrollment Span)

Return Parameter

boolean

Functionality

If the prior enrollment span is in "CANCEL" status, then return true.

Determine the number of days between the last day of the prior enrollment span and the effective start date.

If the number of days gap is greater than 1 then return true, else return false.

Visibility

Private

Visibility

Private

Visibility

Private

Visibility

Private