Scenario 2.1

Below is the transaction for dependent only coverage received from the marketplace

Member Name

Relationship Type

Effective Date

Seeking Coverage

Plan Id

Group Policy Id

Member Name

Relationship Type

Effective Date

Seeking Coverage

Plan Id

Group Policy Id

John Doe

Self

1/1/2023

No

73223FL332539501

02463234

Jane Doe

Spouse

1/1/2023

Yes

73223FL332539501

02463234

Christy Doe

Child

1/1/2023

Yes

73223FL332539501

02463234

Policy Amounts

Amount Type

Amount

Effective Date

Amount Type

Amount

Effective Date

PRE AMT TOT

100

1/1/2023

TOT RES AMT

80

1/1/2023

APTC AMT

20

1/1/2023


Transaction Processing

Once the transaction has completed processing the data will look as below in the member management service

Enrollment Span

Start Date

End Date

Plan Id

Group Policy Id

Start Date

End Date

Plan Id

Group Policy Id

1/1/2023

12/31/2023

73223FL3325395

02463234

Enrollment Span

Start Date

End Date

CSR Variance

Total Premium Amount

Total Responsible Amount

APTC Amount

CSR Amount

Other Pay Amount

Start Date

End Date

CSR Variance

Total Premium Amount

Total Responsible Amount

APTC Amount

CSR Amount

Other Pay Amount

1/1/2023

12/31/2023

01

100

80

20