Split Dependent Person Coverage

Until now, when a member person data was received on reinstating a membership, the system created a new record for the dependent person with the Active status instead of updating the old inactive record. However, if a dependent person was active for a particular coverage period (for example, Jan 2025 to Mar 2025) and then reenrolled in the same membership for a different coverage period (for example, Jun 2025 to Dec 2025), the system did not allow to create a new record for the dependent person with the Active status. Instead, the system tried to update the existing record and thereby failed as the start date of coverage period was different.

To support multiple coverage period scenarios for a dependent person, the upstream system needs to send the full coverage snapshot for the dependent person. For example, if DP1 was enrolled in M1 from Jan 2025 to Mar 2025 and then reenrolled in M1 from Jun 2025 to Dec 2025, you need to send two records on reenrolment for the same member person in the Active status – one with the coverage period Jan 2025 to Mar 2025 and another with the coverage period Jun 2025 to Dec 2025.

Note that if the newborn is end dated and then reenrolled within the gift days period, then the newborn will still be eligible for original gift days discount on reenrolment. For example, let’s assume that a newborn is enrolled on 1st May with gift days 31. This means his gift days period is from 1st May to 31st May. Now, if the newborn enrolment is ended on 5th May and then reenrolled from 15th May, the newborn would still be eligible for the gift days till 31st May.

Similarly, if you want to cancel a particular coverage period record of a member person (for example Jun 2025 to Dec 2025) and enroll the member person for a new coverage period (i.e. May 2025 to Dec2025), you need to send the full coverage snapshot of the dependent person along with the cancellation record. For example, if DP1 was enrolled in M1 for two coverage periods - Jan 2025 to Mar 2025 and Jun 2025 to Dec 2025 and if you want to change the coverage period Jun 2025 to Dec 2025 to May 2025 to Dec 2025, you need to send three records for the same member person in the specified sequence through the same inbound message:

  1. One record in the Active status with the coverage period Jan 2025 to Mar 2025

  2. Another record in the Canceled status with the coverage period Jun 2025

  3. Third record in the Active status with the coverage period May 2025 to Dec 2025

The specified sequence helps to address any erroneous results. Note that the split dependent person coverage feature is applicable for the fully insured group and fully insured individual lines of business.