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

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

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

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

Zeus