Scenario B
This scenario uses a policy with a contract period. The addition of a contract period can change the applicable configurations for the calculation period when compared to a policy with similar enrollments but without a contract. This is because for a contract period all the calculation periods have the same reference date that is based on the settings of the contract period.
Policy 2341
Policy Code |
POL2341 |
Group Account |
- |
Contract Period |
June 1, 2018 - May 31, 2019 |
Advance Collection |
1 [1] |
Member 1 Month |
M. Henderson |
Enrollment Product |
BASIC PLAN with start date June 1, 2018 |
Member 2 |
J. Henderson |
Enrollment Product |
SILVER PLAN with start date January 1, 2019 |
Calculations for Jan 2019
The policy has an advance collection setting of 1 Month and thus no future calculation period beyond the input calculation period are selected. Suppose that there are no mutations on the policy, therefore, the past calculation periods are not recalculated.
Note that if the premium calculation starts with an input calculation period of May 2019, no future calculation periods would get considered for the policy as the contract terminates as of May'19 (May 31, 2019).
The premium calculations process for January 2019 considers M. Henderson’s enrollment for BASIC PLAN and J. Henderson’s for SILVER PLAN.
Calculation for BASIC PLAN
Just like W. Wright (Scenario A), M. Henderson is enrolled on the BASIC PLAN in January 2019. In spite of similar enrollment data, that is the same enrollment product, and the same calculation period, the resultant calculations for M. Henderson are different from that for W. Wright. This is because the reference date that is applied is different. In this scenario the system considers the reference date from the Contract Period, where in scenario A it considered the reference date from the Calculation Period (as there was no contract period there),
The image below shows the configuration that applies for the enrollment product 'BASIC PLAN' for M.Henderson.
In this scenario, the time periods that are selected are BASIC PLAN 17 - 18 and Calendar Year 2017. This is different from the applicable time periods in Scenario A. For scenario A, the enrollment product time period BASIC PLAN 19-20 and default time period Calendar Year 2019 are selected and therefore the configurations that apply in Scenario A are different from Scenario B.
Also, unlike scenario A, the premium amount for M. Henderson will not change from the February 2019 calculation period onwards, even though M. Henderson is 50 years old in Feb'19 (when the age is calculated as of the reference date settings on the calculation period). This because for all the calculation period the applicable age is computed based as on the contract reference date (June 1, 2018).
The calculation result lines for M. Henderson for the calculation period Jan'19 will be as follows. The same calculations will hold true for all the calculation periods within the contract period.
| Start Date | End Date | Input Amount | % | Prorate Factor | Result Amount | Schedule Definition | Premium Schedule |
|---|---|---|---|---|---|---|---|
Jan 1, 2019 |
Jan 31, 2019 |
- |
- |
- |
110.00 |
Age Gender Premium |
Basic Plan |
Jan 1, 2019 |
Jan 31, 2019 |
110.00 |
2 |
- |
2.20 |
Regional Tax |
|
Jan 1, 2019 |
Jan 31, 2019 |
110.00 |
1.75 |
- |
1.93 |
Admin. Surcharge |
Calculations for SILVER PLAN
The image below shows the configurations that apply for the enrollment product 'SILVER PLAN' for J.Henderson during the premium calculation for the calculation period Jan'19.
The selected default time period for the SILVER PLAN is different from the BASIC PLAN. Also, the SILVER PLAN has different adjustment types and add-ons configured within the selected enrollment product time period and different parameter values defined on the policy enrollment product. This results in the applicable adjustment types, adjustment rules and surcharge rules being different for the SILVER PLAN in comparison to the BASIC PLAN.
Enrollment Product Premium
The premium calculation for the enrollment product SILVER PLAN for J.Henderson is based on the method 'Calculation Period Based' as the premium amount Interpretation setting is 'Calculation Period'. The premium schedule lines are based on the dimension Age. J. Henderson’s age as of Jun 1, 2018 is 46 years and, therefore, the premium value of 105.00 applies.
Since the person is fully enrolled for the enrollment product in the calculation period January 2019, and the calculation method is 'Calculation Period Based', the charged premium is equal to the configured premium value, that is 105.00
Add-on Premium
Member J. Henderson is enrolled for the add-on Preventive Care. The add-on overlaps in the time validity with the calculation period and therefore the add-on premium must be computed for the calculation period January 2019.
The system considers (add-on) premium schedules (and underlying premium schedule lines) that apply to the enrollment product time period - SILVER PLAN 18. In this case, it is the (add-on) premium schedule for the Preventive Care add-on that has one premium schedule line that specifies 20. The premium amount is 20 per calculation period as the add-on is fully enrolled for the calculation period. The add-on premium of 20 is therefore charged.
Surcharges
The Regional Tax surcharge of 2.5% is applicable for this policy enrollment product on the base premium, that is the total of enrollment product premium and the add-on premiums.
Regional tax = 2.5% (105.00 + 20) = 3.13 (this tax is distributed across the product premium and add-on premium, so two separate calculation result lines are created).
Adjustments
The Office Visit Co-payment Discount and Payment Frequency Discount are applicable for the SILVER PLAN product on the reference date.
The Payment Frequency Discount adjustment is based on the dimension of the type 'Generic': the Advance Collection setting on the policy. The advance collection setting in this example is 1 Month, therefore, no adjustment rule applies.
The Office Visit Co-payment Discount adjustment is based on the dimension OV Co-pay which is of the type Parameter. In order to identify the applicable adjustment rule, the parameter value must be determined. The parameter value of 20 for OV CO-pay is present at the policy enrollment product level. This value is considered for the evaluation of the adjustment rules. The dimension values within the selected default time period Calendar Year 2018 are compared to the computed parameter value to select the adjustment rule. Once the adjustment rule is identified the system checks for the override value setting for the selected rule within the enrollment product time period to determine if an enrollment product specific adjustment value needs to be applied or not. Here, no override value is configured and therefore, an adjustment value of -5% is applied to the base premium. The scope for this adjustment is set to Total Premium which means that the adjustment is applied to the sum of the base premium and the add-on premium, that is -5% on (105.00 + 20) = -6.25
Surcharges - After Adjustment
The post adjustment Administrative Surcharge of 1.5% is configured for the time period calendar year 2014. The amount charged is 1.5% on 126.25 (base premium + adjustments) = 1.89.
Calculation Results
The calculation result lines for J. Henderson are as follows
| Start Date | End Date | Input Amount | % | Prorate Factor | Result Amount | Add-on | Schedule Definition | Premium Schedule |
|---|---|---|---|---|---|---|---|---|
Jan 1, 2019 |
Jan 31, 2019 |
- |
- |
- |
105.00 |
Age Gender Premium |
Silver Plan |
|
Jan 1, 2019 |
Jan 31, 2019 |
105.00 |
2.5 |
- |
2.63 |
Regional Tax |
||
Jan 1, 2019 |
Jan 31, 2019 |
- |
- |
- |
20 |
Preventive Care |
||
Jan 1, 2019 |
Jan 31, 2019 |
20 |
2.5 |
- |
0.50 |
Regional Tax |
||
Jan 1, 2019 |
Jan 31, 2019 |
125 |
-5.0 |
- |
- 6.25 |
Office Visit Co-payment |
||
Jan 1, 2019 |
Jan 31, 2019 |
126.25 |
1.5 |
- |
1.89 |
Admin. Surcharge |
Calculation for the Calculation Period February 2019 ~ May 2019
The calculation for the period February 19 to May 2019 will be identical to the calculations in January 2019 provided there is no modification in the configuration or policy data that takes effect from the reference date, that is June 1, 2018.