Policy Calculation Period Based

This method of calculation for premiums, adjustments and surcharges applies when the calculation period is a policy calculation period. In order to use the policy calculation period method, the 'Policy Calculation Periods' indicator on the collection settings must be set.

The calculation logic for determining the amount for a calculation period segment is described in the image below:

This calculation method supports two variants:

The per day amount is computed and is then multiplied by the number of enrolled days in the policy calculation period to which the calculation period segment in context belongs (referred to as Calculation Period Days) - this is referred to as amount distribution Daily
The per day amount is computed and is then multiplied by the number of Days factor setting on the policy calculation period. The premium is thus evenly spread over the policy calculation periods in the calendar year period when the days factor is set accordingly. This is referred to as amount distribution Evenly.

The table below explains the calculations:

Table 1. Policy Calculation Period Based
Circumstances	Amount Distribution Daily	Amount Distribution Evenly
Full Enrollment	Daily Amount^[1] # No. of days in the Policy Calculation Period	Daily Amount^[1] # Value of Days setting on the Policy Calculation Period
Partial Enrollment	Daily Amount^[1] # Actual Enrolled Days
Last Split calculation	Amount for the full policy calculation period span - Charged value

The first step in the calculation process is to identify if the calculation period for which the calculations are intended is the last calculation period split in the context of the policy calcuation period span or not.

The system detects that split policy calculation period is the last when the policy calculation period end date is equal to the policy calculation period span end date.

The next step is to determine whether the policy enrollment is full or partial. For this, the system takes into account the overlap in time validity of the policy enrollment with the policy calculation period.

In case of the enrollment product premium, adjustment and surcharge calculations, the system performs checks to determine if the enrollment is partial or full for the policy enrollment product (or add-on for add-on premium). If the enrollment is partial then the system charges the value (and surcharges and adjustments) only for the days that the person or objects is enrolled irrespective of the partial period resolution setting on the enrollment product. The amount is computed by multiplying the daily amount by the actual number of days the person or object is enrolled.

Next, if the enrollment is for the fully enrolled then the system checks for the applicable calculation variant (Daily or Evenly) which is given by the amount distribution setting on the enrollment product, group account product, group account or group client. Based on this setting, the system then charges either the daily based or evenly based amount for the calculation period.

In order to calculate daily or evenly based amounts, the system must first determine the applicable daily amount.

The table below explains the daily amount logic amount when evenly based method is applied.

Table 2. Amount with Evenly-Based Method
Amount Interpretation	Yearly		Specific
Collection Cycle	Not Monthly	Monthly	Not Monthly	Monthly
Daily Amount	Yearly premium amount divided by days in a year	Yearly premium amount divided by days in a year	Specific Premium Amount/ no of days setting on the schedule	Compute applicable monthly premium amount by multiplying the exact daily amount with days in a year and then dividing it by 12, rounded up to two decimals. Applicable monthly amount from the previous step multiplied by 12 and then divided by days in a year

The table below explains the daily amount logic amount when daily based method is applied.

Table 3. Amount with Daily-Based Method
Amount Interpretation	Yearly		Specific
Collection cycle	Not Monthly	Monthly	Not Monthly	Monthly
Daily Amount	Yearly premium amount divided by days in a year	Yearly premium amount divided by days in a year	Specific Premium Amount/ no of days setting on the schedule	Specific Premium Amount/ no of days setting on the schedule

Exact Daily Amount

Exact daily amount is given by the configured premium amount divided by the no.of days setting on the premium schedule.

Days in a Year

For a contracted policy days in a year is considered 365 unless the policy calculation period starts in the contract period that includes Feb 29, in which case it is considered as 366

For a non contracted policy days in a year is considered 365 unless the policy calculation period starts in an annual period as set out from the leap year start month (system property) that includes Feb 29, in which case it is considered as 366. If the system property is not specified, days in a year is considered as 365.

Calculation for the Last Split of Policy Calculation Period

If the system detects that the policy calculation period is the last split, it calculates the target total premium for the full enrolled policy calculation period span given by the span start and end dates. Next, the system retrieves all past calculation results of the other splits that belong to the same policy calculation period span, to determine what has already been charged. Finally, the system determines the premium, adjustments and surcharges for the last split period segment, such that the aggregated result of all calculations in the policy calculation period span equals the target premium amount.

Whether reconciliation for a line will apply or not further dependents on the following:

The retrieved value from the schedule: The system compares the retrieved value for the schedule definition for the previous calculation results that belong to the policy calculation periods within the span with the value retrieved for the current (split) policy calculation period. This value must be the same for all the (split) policy calculation periods in the span.
The nature of the enrollment - full or partial over the policy calculation period span (without split), in combination with the schedule definition type:
- Product Premium: The member must be enrolled over the full policy calculation period span on the product for the product premium to be reconciled.
- Add-on Premium: The member must be enrolled for the full policy calculation period span on the add-on for the add-on premium to be reconciled.
- Percentage based Adjustment: Depends on the scope of adjustment:
  - When the scope is a total premium, then the member must be enrolled for the full policy calculation period span on the product, and add-ons
  - When the scope is a specific add-on premium, then the member must be enrolled for the full policy calculation period span on the add-ons
  - When the scope is a specific product, then the member must be enrolled for the full policy calculation period span on the enrollment product
- Amount based Adjustment: The member must be enrolled over the full policy calculation period span on the product for the adjustment to be reconciled.
- Percentage based Surcharge: Depends on surcharge rule evaluation:
  - When a surcharge is on premium, then the member must be enrolled for the full policy calculation period span on the product and the add-ons.
  - When a surcharge is after adjustment, then surcharge reconciliation applies only if all the adjustments are reconciled by the system
- Amount based Surcharge: The member must be enrolled over the full policy calculation period span on the product for the surcharge to be reconciled.

Examples

Consider some examples to understand the calculations for this method.

Configuration

The system property 'leap year start month' is set to January.

The premium schedule lines that are associated to BASIC PLAN and COPAY PLAN are defined as:

Table 4. Configuration
Premium Schedule Lines - BASIC PLAN (Yearly)
Default Time Period	Premium
2019 - 2020	1200

Table 5. Premium Schedule Lines - COPAY PLAN
Premium Schedule Lines - COPAY PLAN (Specific 7 days)
Default Time Period	Premium
2019 - 2020	10

Amount Interpretation Yearly and Daily Based Calculation

Consider the situation when the policy is enrolled for the enrollment product from Apr 21, 2019 to Mar 10, 2020. The calculations in this scenario are spanning over two calendar year 2019 and calendar year 2020

Table 6. Amount Interpretation Yearly and Daily Based Calculation
Contract Start Date	Contract End Date	Contact Reference Date
-	-	-
Enrollment Product	Policy Enrollment Product Start Date	Policy Enrollment Product End Date
BASIC PLAN	Apr 21, 2019	Mar 10, 2020

The premium calculations for the year 2019 and 2020 that apply to the policy in this situation when policy calculation periods are set out for monthly collection cycles are as shown in the table below.

Table 7. Premium Calculation for the Year 2019 and 2020
Policy Calculation Period	Premium	Calculation
April'19	32.88	1200/365*(10)
May'19	101.92	1200/365*(31)
June'19	98.63	1200/365*(30)
July'19	101.92	1200/365*(31)
Aug'19	101.92	1200/365*(31)
Sep'19	98.63	1200/365*(30)
Oct'19	101.92	1200/365*(31)
Nov'19	98.63	1200/365*(30)
Dec'19	101.92	1200/365*(31)
Jan'20	101.65	1200/366*(31)
Feb'20	95.08	1200/366*(29)
Mar'20	32.79	1200/366*(10)

The amount for each full calculation period is calculated based on the number of days in the policy calculation period.

May'19 = Daily Amount * Calculation Period Days= 1200/365*(31)
June'19 = 1200/365*(30) and so on.

From the Jan'20 calculation period onward the premium amount changes as the 'No.of days in the calendar year' changes from 365 to 366 as given by number of days in the annual period starting Jan 2016, that is, the year in which the calculation period Jan'20 starts. Therefore, for Jan'20 the amount is given by 1200/366*(31) and for Feb'20 the amount is 1200/366*(29).

For the Mar'20 the amount is prorated to 1200/366*(10).

Amount Interpretation Yearly and Evenly Based Calculation

The policy is enrolled for the enrollment product BASIC PLAN from Oct 1, 2019 to Apr 15, 2020.

Table 8. Amount Interpretation Yearly and Evenly Based Calculation
Contract Start Date	Contract End Date	Contact Reference Date
-	-	-
Enrollment Product	Policy Enrollment Product Start Date	Policy Enrollment Product End Date
BASIC PLAN	Oct 1, 2019	Apr 15, 2020

The premium calculations for the enrolled policy calculation period set out for monthly collection cycles in 2019 and 2020 will be as depicted in the table below:

Table 9. Premium Calculations for 2019 and 2020
Policy Calculation Periods	Days (factor)	Daily Premium	Premium
Oct'19	365/12	1200/365	100
Nov'19	365/12	1200/365	100
Dec'19	365/12	1200/365	100
Jan'20	366/12	1200/366	100
Feb'20	366/12	1200/366	100
Mar'20	366/12	1200/366	100
Apr'20	366/12	1200/366	49.18 (1200/366)*(15)

The premium amount 1200 applies for the policy calculation periods from Oct'19 up to and inclusive April'20. an evenly distributed premium amount for the policy calculation period from Oct'19 to Mar'20 is calculated as Days (factor) multiplied by daily premium. The amount for Apr'20 is prorated to (1300/366)*(15) as the enrollment is partial.

Amount Interpretation Specific and Evenly Based Calculation (Monthly Periods)

The policy is enrolled for the enrollment product COPAY PLAN from Oct 1, 2019 to Apr 15, 2020.

Table 10. Amount Interpretation Specific and Evenly Based Calculation
Contract Start Date	Contract End Date	Contact Reference Date
-	-	-
Enrollment Product	Policy Enrollment Product Start Date	Policy Enrollment Product End Date
COPAY PLAN	Oct 1, 2019	Apr 15, 2020

The premium calculations for the enrolled policy calculation period set out for monthly collection cycles in 2019 and 2020 will be as depicted in the table below:

Table 11. Amount Interpretation Specific and Evenly Based Calculation: Policy Calculations for 2019 and 2020
Policy Calculation Periods	Days (factor)	Daily Premium	Premium
Oct'19	365/12	Round((10/7)*365/12,2) multiplied by (12/365)	43.45
Nov'19	365/12	Round((10/7)*365/12,2) multiplied by (12/365)	43.45
Dec'19	365/12	Round((10/7)*365/12,2) multiplied by (12/365)	43.45
Jan'20	366/12	Round((10/7)*366/12,2) multiplied by (12/366)	43.57
Feb'20	366/12	Round((10/7)*366/12,2) multiplied by (12/366)	43.57
Mar'20	366/12	Round((10/7)*366/12,2) multiplied by (12/366)	43.57
Apr'20	366/12	10/7	21.43

The premium amount 10 applies for 7 days. An evenly distributed premium amount for the policy calculation period from Oct'19 to Mar'20 is calculated as Days (factor) multiplied by daily premium. The amount for Apr'20 is prorated to (10/7)*(15) as the enrollment is partial.

Amount Interpretation Specific and Evenly Based Calculation (Weekly Periods)

The policy is enrolled for the enrollment product COPAY PLAN from Oct 1, 2019 to Apr 15, 2020.

Table 12. Amount Interpretation Specific and Evenly Based Calculation
Contract Start Date	Contract End Date	Contact Reference Date
-	-	-
Enrollment Product	Policy Enrollment Product Start Date	Policy Enrollment Product End Date
COPAY PLAN	Oct 1, 2019	Feb 5, 2020

The premium calculations for the enrolled policy calculation period set out for weekly collection cycle in 2019 and 2020 will be as depicted in the table below:

Table 13. Amount Interpretation Specific and Evenly Based Calculation: Premium Calculations for 2019 and 2020
Policy Calculation Periods	Days (factor)	Daily Premium	Premium
Oct 1, 2019 to Oct 8, 2019	7	10/7	10
…	…	….	…
Jan 6, 2020 to Jan 13, 2020	7		10
…	…	…	…
Jan 30, 2020 to Feb 6, 2020	7	10/7	(10/7)*(6)

The premium amount 10 applies for 7 days. An evenly distributed premium amount for the policy calculation periods from Oct'19 to 29th Jan'20 is calculated as Days (factor) multiplied by daily premium. The amount for the policy calculation period starting on 30th Jan'20 is prorated to (10/7)*(6) as the enrollment is partial.

1. Daily amount computation logic depends on amount interpretation, daily or evenly based distribution and the setting Calculation Period UoM applicable for the policy calculation period.