Scenario 1

Description

Account contains only one enrollment span that is related to the transaction received and the enrollment span has only one premium span. Transaction is received with a new dependent added.

Account in UMV

Member information in UMV prior to transaction receipt.

Member 1: Self

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id

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

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

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	12/31/2023	1000	1309.76	1300.00	9.76	2

Member 2: Spouse

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id
MP_GA	Jane Doe	Spouse	U70523453	U7052345302

Enrollment Spans

Enrollment Span Code	Start Date	End Date	QHP ID	Group Policy Id	Status

Enrollment Span Code	Start Date	End Date	QHP ID	Group Policy Id	Status
9800424	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

Premium Span Code	Start Date	End Date	PRE AMT 1	PRE AMT TOT	APTC AMT	TOT RES AMT
9800424-1	1/1/2023	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

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	1/26/2023	1623.07	1/1/2023	961.59	1/26/2023	661.48
Jane Doe	5/15/2023	CHANGE	42354GA33463-01	2374734	1/1/2023	N/A	N/A	N/A	N/A	N/A	N/A
Baby Doe	5/15/2023	ADD	42354GA33463-01	2374734	1/26/2023	N/A	N/A	N/A	N/A	N/A	N/A

Transaction Processing

Send transaction to Transaction initiator to create spin off transactions

Spin Off Transaction 1:

Create the transaction as follows

Update all the effective date of all the amounts with the date that is received for APTC AMT 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 exception 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

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	1/1/2023	1309.76	1/1/2023	961.59	1/1/2023	348.17
Jane Doe	5/15/2023	CHANGE	42354GA33463-01	2374734	1/1/2023	N/A	N/A	N/A	N/A	N/A	N/A

Enrollment Spans In UMV after the Spin Off Transaction # 1 is completed processing

Member 1: Self

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id

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

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

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	1/1/2023	1000	1309.76	1300.00	9.76	2
9800423-2	1/1/2023	12/31/2023	1000	1309.76	961.59	348.17	2

Member 2: Spouse

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id
MP_GA	Jane Doe	Spouse	U70523453	U7052345302

Enrollment Spans

Enrollment Span Code	Start Date	End Date	QHP ID	Group Policy Id	Status

Enrollment Span Code	Start Date	End Date	QHP ID	Group Policy Id	Status
9800424	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

Premium Span Code	Start Date	End Date	PRE AMT 1	PRE AMT TOT	APTC AMT	TOT RES AMT
9800424-1	1/1/2023	1/1/2023	309.76	0.00	0.00	0.00
9800424-2	1/1/2023	12/31/2023	309.76	0.00	0.00	0.00

Spin Off Transaction 1:

Create the transaction as follows

Update all the effective date of all the amounts with the date that is received for PRE AMT TOT effective date.
Populate all the amounts as they are received in the original transaction
Populate the APTC AMT as received in the transaction

Dependents:

Include all the dependents present in the transaction

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

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	1/26/2023	1623.07	1/26/2023	961.59	1/26/2023	661.48
Jane Doe	5/15/2023	CHANGE	42354GA33463-01	2374734	1/1/2023	N/A	N/A	N/A	N/A	N/A	N/A
Baby Doe	5/15/2023	ADD	42354GA33463-01	2374734	1/26/2023	N/A	N/A	N/A	N/A	N/A	N/A

Final Enrollment Span Disposition

Member 1: Self

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id

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

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

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	1/1/2023	1000	1309.76	1300.00	9.76	2
9800423-2	1/1/2023	1/25/2023	1000	1309.76	961.59	348.17	2
9800423-3	1/26/2023	12/31/2023	1000	1623.07	961.59	661.48	3

Member 2: Spouse

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id

Business Unit	Subscriber Name	Relationship Type	Issuer Subscriber Id	Issuer Member Id
MP_GA	Jane Doe	Spouse	U70523453	U7052345302

Enrollment Spans

Enrollment Span Code	Start Date	End Date	QHP ID	Group Policy Id	Status

Enrollment Span Code	Start Date	End Date	QHP ID	Group Policy Id	Status
9800424	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

Premium Span Code	Start Date	End Date	PRE AMT 1
9800424-1	1/1/2023	1/1/2023	309.76
9800424-2	1/1/2023	1/25/2023	309.76
9800424-3	1/26/2023	12/31/2023	309.76