Enrollment Product Overruled Adjustment

Let us revisit the Example 3 Co-payment value discount from the "Adjustment Rules" page in the Premium and Fees Configuration chapter of the Configuration Guide to understand how the column values and discount values apply when multiple time periods are involved.

The example mentioned has one time period "Calendar year 2015". This is extended to two default time periods.

The following time periods are defined

Table 1. Enrollment Product Overruled Adjustment

Display Name	Start Date	End Date
Calendar year 2015	2015/01/01	2015/12/31
Calendar year 2016	2016/01/01	2016/12/31

The Adjustment rules for Calendar year 2015 are:

Table 2. Adjustment Rules for Calendar Year 2015

Adjustment Rules
OV Co-pay	Adjustment
10.00 USD	0.00 USD
20.00 USD	-5.00 USD
30.00 USD	-10.00 USD

The column values for OV Copay are changed for the next year and the adjustment rules for Calendar year 2016 are set up as:

Table 3. Adjustment Rules for Calendar Year 2016

Adjustment Rules
OV Co-pay	Adjustment
12.00 USD	0.00 USD
22.00 USD	-5.00 USD
32.00 USD	-10.00 USD

In the example mentioned, the Co-payment value discount is configured for the enrollment product COPAY PLAN. Here we will try to understand how the different adjustment rules will apply within the context of the enrollment product time period.

Consider that enrollment product time periods are defined as:

Table 4. Enrollment Product Time Periods

Display Name	Start Date	End Date
EP Plan 2015-1	2015/06/01	2015/12/31
EP Plan 2016-1	2016/01/01	2016/06/30
EP Plan 2016 -2	2016/01/07	2016/12/31

The adjustment rule consists of two things: the column value and the adjustment value. The column values applicable for the adjustment rules are the values defined for the applicable default time period. The adjustment value is either the default adjustment value or the enrollment product specific adjustment value.

How is an Enrollment Product Time Period Mapped to a Default Time Period?

The application looks at the start date of the selected enrollment product time period and determines the default time period to which the start date belongs to. Hence for the EP Plan 2015-1, the applicable default time period is Calendar year 2015.

The enrollment product adjustment and the adjustment rules for COPAY PLAN within enrollment product time period EP Plan 2015-1 without overriding values are shown below.

Table 5. How is an Enrollment Product Time Period Mapped to a Default Time Period?

Enrollment Product Adjustment
Seq.	Code	Start Date	End Date
1	DC_COP	2015/06/01

Table 6. Adjustment Rules for COPAY PLAN

Adjustment Rules
OV Co-pay	Adjustment
10.00 USD	0.00 USD
20.00 USD	-5.00 USD
30.00 USD	-10.00 USD

For the enrollment product time period EP Plan 2016-1, the corresponding default time period changes to Calendar year 2016. The enrollment product adjustment specified above does not have an end date so it also applies in Calendar year 2016. The adjustment rules for COPAY PLAN within enrollment product time period EP Plan 2016-1 with adjustment values modified at enrollment product level look like:

Table 7. Adjustment Rules with Adjustment Values Modified

Adjustment Rules
OV Co-pay	Adjustment
12.00 USD	-2.00 USD
22.00 USD	-6.00 USD
32.00 USD	-11.00 USD

For the enrollment product time period EP plan 2016-2 the applicable default time period is still Calendar year 2016, so the column values continue to be the same as they were for EP plan 2016-1, however the overriding adjustment values can be different.

Table 8. Different Overriding Adjustment Values

Adjustment Rules
OV Co-pay	Adjustment
12.00 USD	-2.00 USD
22.00 USD	-6.00 USD
32.00 USD	-10.00 USD

Here the adjustment value for OV Co-pay 32.00 is reduced to -10.00 in EP plan 2016-2.