mid month npt fix for 1095A values (#165)

* updating amount calculations for npt h41/1095A

* fixing indendation

* fixing variable naming

* adding specs to insurance policy

* formatting

* correcting whitespace

* rubocop

* cv3 payload specs

* rspec for payload

* updating spec

* updating path

* refactor spec

* testing spec'

* removing spec

* removing extra piece

* adding h36 updates and specs

* fixing spec:

* fixing spec name

* adding calendar month"

* fixing spelling

* removing comment

* fixing for nil values

* adding spec for cv3 constructor

* fixing format

* rubocop

* expanding tests and handling nil values

* fixing slcsp value

* fixing spec

* rubocop fix

* removing returning nil and return 0 instead

* typo

* updating to remove mid month from aptc csr houshold

* removing whitespace

* moving date functions into separate module

* rubocop fix

* updating to include uqhp second gpm

---------

Signed-off-by: Esme Rubinstein <[email protected]>
Co-authored-by: Sai Praveen Gudimetla <[email protected]>

app/helpers/date_helper.rb

@@ -0,0 +1,16 @@
+# frozen_string_literal: true
+
+# Helper methods for date-related calculations
+module DateHelper
+  def mid_month_end?(end_on, month)
+    ends_this_month = end_on.month == month
+    last_day_of_month = Date.new(end_on.year, month, -1)
+    (end_on.day != last_day_of_month.day) && ends_this_month
+  end
+
+  def eom_end?(end_on, month)
+    ends_this_month = end_on.month == month
+    last_day_of_month = Date.new(end_on.year, month, -1)
+    (end_on == last_day_of_month) && ends_this_month
+  end
+end

app/models/insurance_policies/aca_individuals/enrollment.rb

@@ -7,6 +7,7 @@ class Enrollment
       include Mongoid::Document
       include Mongoid::Timestamps
       include DomainModels::Domainable
+      include ::DateHelper
 
       has_many :enrollments_tax_households,
                class_name: 'InsurancePolicies::AcaIndividuals::EnrollmentsTaxHouseholds',
@@ -59,15 +60,18 @@ def enrollment_end_on
         end_on.present? ? end_on : insurance_policy.start_on.end_of_year
       end
 
-      # rubocop:disable Metrics/AbcSize
       def pre_amt_tot_values(enrolled_thh_people, calendar_month)
-        if insurance_policy.term_for_np && insurance_policy.policy_end_on.month == calendar_month
-          format('%.2f', 0.0)
-        else
-          pre_amt_tot_month = enrolled_thh_people.map { |mem| mem.premium_schedule.premium_amount.to_f }.sum
-          pre_amt_tot_month = (pre_amt_tot_month * insurance_policy.insurance_product.ehb).to_f.round(2)
-          format('%.2f', pre_amt_tot_month)
+        if insurance_policy.term_for_np
+          end_on = insurance_policy.end_on
+          next_month = calendar_month == 12 ? 1 : calendar_month + 1
+          # if npt policy ends on the last day of the month or mid month next month
+          # set to 0 as we are in the first or second (for uqhp) grace period month
+          gpm = eom_end?(end_on, calendar_month) || mid_month_end?(end_on, next_month) || mid_month_end?(end_on, calendar_month)
+          return format('%.2f', 0.0) if gpm
         end
+        pre_amt_tot_month = enrolled_thh_people.sum { |mem| mem.premium_schedule.premium_amount.to_f }
+        pre_amt_tot_month = (pre_amt_tot_month * insurance_policy.insurance_product.ehb).to_f.round(2)
+        format('%.2f', pre_amt_tot_month)
       end
 
       # Fetch eligible enrollees based on tax household members.
@@ -99,7 +103,6 @@ def pediatric_dental_premium(enrollments_for_month, tax_household_members, calen
                                                                           health_enrolled_people: eligible_enrollees,
                                                                           month: calendar_month }).value!.to_f
       end
-      # rubocop:enable Metrics/AbcSize
 
       def enrolled_member_by_hbx_id(hbx_id)
         [[subscriber] + dependents].flatten.detect do |enrollee|

app/models/insurance_policies/aca_individuals/insurance_policy.rb

@@ -7,6 +7,7 @@ class InsurancePolicy
       include Mongoid::Document
       include Mongoid::Timestamps
       include DomainModels::Domainable
+      include ::DateHelper
 
       has_many :enrollments, class_name: 'InsurancePolicies::AcaIndividuals::Enrollment'
 
@@ -187,8 +188,16 @@ def fetch_enrollments_tax_households(enrs_for_month)
       end
 
       def fetch_slcsp_premium(enrs_for_month, calendar_month, tax_household = nil, aptc_tax_credit = nil)
+        if term_for_np
+          end_on = policy_end_on
+          next_month = calendar_month == 12 ? 1 : calendar_month + 1
+          # if npt policy ends on the last day of the month or mid month next month
+          # set to 0 as we are in the first or second (for uqhp) grace period month
+          gpm = eom_end?(end_on, calendar_month) || mid_month_end?(end_on, next_month) || mid_month_end?(end_on, calendar_month)
+          return format('%.2f', 0.0) if gpm
+        end
+
         return format('%.2f', 0.0) if aptc_tax_credit.blank? || aptc_tax_credit.to_f.zero?
-        return format('%.2f', 0.0) if term_for_np && policy_end_on.month == calendar_month
 
         enr_thhs = fetch_enrollments_tax_households(enrs_for_month)
         slcsp_premium = enr_thhs.map(&:household_benchmark_ehb_premium).compact.sum

app/operations/insurance_policies/aca_individuals/insurance_policies/construct_cv3_payload.rb

@@ -10,6 +10,7 @@ module InsurancePolicies
       # Operation to create insurance policy
       class ConstructCv3Payload
         include ::FloatHelper
+        include ::DateHelper
         send(:include, Dry::Monads[:result, :do])
 
         def call(params)
@@ -430,6 +431,9 @@ def construct_coverage_information(insurance_policy, covered_individuals, tax_ho
               next unless any_thh_members_enrolled?(tax_household, enrollments_for_month)
               next if enrollments_tax_household_for_month_empty?(enrollments_for_month, tax_household)
 
+              # if npt and mid month end date, do not include that month if aqhp
+              next if insurance_policy.term_for_np && mid_month_end?(insurance_policy.end_on, month) && tax_household.is_aqhp
+
               if tax_household.is_aqhp && covered_individuals.present?
                 update_covered_individuals_end_date(covered_individuals, enrollments_for_month, tax_household)
               end
@@ -455,7 +459,15 @@ def construct_coverage_information(insurance_policy, covered_individuals, tax_ho
         end
 
         def calculate_ehb_premium_for(insurance_policy, tax_household, enrollments_for_month, calendar_month)
-          return format('%.2f', 0.0) if insurance_policy.term_for_np && insurance_policy.policy_end_on.month == calendar_month
+
+          if insurance_policy.term_for_np
+            end_on = insurance_policy.end_on
+            next_month = calendar_month == 12 ? 1 : calendar_month + 1
+            # if npt policy ends on the last day of the month or mid month next month
+            # set to 0 as we are in the first or second (for uqhp) grace period month
+            gpm = eom_end?(end_on, calendar_month) || mid_month_end?(end_on, next_month) || mid_month_end?(end_on, calendar_month)
+            return format('%.2f', 0.0) if gpm
+          end
 
           calender_month_begin = Date.new(insurance_policy.start_on.year, calendar_month, 1)
           calender_month_end = calender_month_begin.end_of_month

spec/models/insurance_policies/aca_individuals/enrollment_spec.rb

@@ -12,6 +12,16 @@
   let(:insurance_policy) do
     FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1), end_on: Date.new(year, 12, 31))
   end
+  let(:insurance_policy_npt_eom) do
+    FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1),
+                                         end_on: Date.new(year, 5, 31),
+                                         term_for_np: true)
+  end
+  let(:insurance_policy_npt_mid_month) do
+    FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1),
+                                         end_on: Date.new(year, 3, 3),
+                                         term_for_np: true)
+  end
   let(:subscriber) { FactoryBot.build(:enrolled_member, person: subscriber_person) }
   let(:dependents) do
     [
@@ -29,6 +39,24 @@
                                    dependents: dependents)
   end
 
+  let(:enrollment_npt_eom) do
+    FactoryBot.create(:enrollment, start_on: Date.new(year, 1, 1),
+                                   effectuated_on: Date.new(year, 1, 1),
+                                   end_on: Date.new(year, 5, 31),
+                                   insurance_policy: insurance_policy_npt_eom,
+                                   subscriber: subscriber,
+                                   dependents: dependents)
+  end
+
+  let(:enrollment_npt_mid_month) do
+    FactoryBot.create(:enrollment, start_on: Date.new(year, 1, 1),
+                                   effectuated_on: Date.new(year, 1, 1),
+                                   end_on: Date.new(year, 5, 31),
+                                   insurance_policy: insurance_policy_npt_mid_month,
+                                   subscriber: subscriber,
+                                   dependents: dependents)
+  end
+
   let(:tax_household_members) do
     [
       double('InsurancePolicies::AcaIndividuals::TaxHouseholdMember', is_medicaid_chip_eligible: true, person: subscriber_person),
@@ -91,4 +119,24 @@
       end
     end
   end
+
+  describe '#pre_amt_tot_values' do
+    context 'insurance_policy term_for_np is true and eom end date' do
+      it 'returns 0.00' do
+        expect(enrollment_npt_eom.pre_amt_tot_values([subscriber], 5)).to eq('0.00')
+      end
+    end
+
+    context 'insurance_policy term_for_np is true and next month mid month end date' do
+      it 'returns 0.00' do
+        expect(enrollment_npt_mid_month.pre_amt_tot_values([subscriber], 2)).to eq('0.00')
+      end
+    end
+
+    context 'insurance_policy term_for_np is true and mid month end date' do
+      it 'returns 0.00' do
+        expect(enrollment_npt_mid_month.pre_amt_tot_values([subscriber], 3)).to eq('0.00')
+      end
+    end
+  end
 end

spec/models/insurance_policies/aca_individuals/insurance_policy_spec.rb

@@ -7,6 +7,16 @@
 
   let(:year) { Date.today.year }
   let(:insurance_policy) { FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1), end_on: Date.new(year, 12, 31)) }
+  let(:insurance_policy_npt_eom) do
+    FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1),
+                                         end_on: Date.new(year, 5, 31),
+                                         term_for_np: true)
+  end
+  let(:insurance_policy_npt_mid_month) do
+    FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1),
+                                         end_on: Date.new(year, 3, 3),
+                                         term_for_np: true)
+  end
   let(:subscriber) { FactoryBot.build(:enrolled_member, person: subscriber_person) }
   let(:dependents) { FactoryBot.build(:enrolled_member, person: dependent_person) }
   let!(:enrollment_1) do
@@ -313,6 +323,20 @@
       result = insurance_policy.applied_aptc_amount_for(enrollments_for_month, calendar_month, aqhp_tax_household_3)
       expect(result).to eq "0.00"
     end
+
+    it "should return a value if on first grace period month with EOM end date" do
+      calendar_month = 5
+      enrollments_for_month = insurance_policy_npt_eom.enrollments_for_month(calendar_month, year)
+      result = insurance_policy_npt_eom.applied_aptc_amount_for(enrollments_for_month, calendar_month, aqhp_tax_household_3)
+      expect(result).not_to eq nil
+    end
+
+    it "should return a value if on first grace period month with next month mid month end date" do
+      calendar_month = 2
+      enrollments_for_month = insurance_policy_npt_mid_month.enrollments_for_month(calendar_month, year)
+      result = insurance_policy_npt_mid_month.applied_aptc_amount_for(enrollments_for_month, calendar_month, aqhp_tax_household_3)
+      expect(result).not_to eq nil
+    end
   end
 
   context "#fetch_slcsp_premium" do
@@ -340,6 +364,15 @@
         expect(insurance_policy.fetch_slcsp_premium([enrollment], 1, aqhp_tax_household,
                                                     aqhp_enrollment_tax_household.applied_aptc)).to eq "0.00"
       end
+
+      it "should return 0 if in first or second (for uqhp) grace period month" do
+        result_eom = insurance_policy_npt_eom.fetch_slcsp_premium([enrollment], 5, aqhp_tax_household, 4.0)
+        result_next_month_mid_month = insurance_policy_npt_mid_month.fetch_slcsp_premium([enrollment], 2, aqhp_tax_household, 4.0)
+        result_mid_month = insurance_policy_npt_mid_month.fetch_slcsp_premium([enrollment], 3, aqhp_tax_household, 4.0)
+        expect(result_eom).to eq "0.00"
+        expect(result_next_month_mid_month).to eq "0.00"
+        expect(result_mid_month).to eq "0.00"
+      end
     end
 
     context "when aptc is non zero" do

spec/operations/insurance_policies/aca_individuals/insurance_policies/construct_cv3_payload_spec.rb

@@ -500,6 +500,98 @@
     end
   end
 
+  context "when on an npt policy" do
+    let(:enrollment_1_subscriber) { FactoryBot.build(:enrolled_member, person: subscriber_person) }
+    let(:enrollment_2_subscriber) { FactoryBot.build(:enrolled_member, person: subscriber_person) }
+
+    let!(:aqhp_tax_household_1) { FactoryBot.create(:tax_household, is_aqhp: true) }
+    let!(:uqhp_tax_household_1) { FactoryBot.create(:tax_household, is_aqhp: false) }
+
+    let!(:aqhp_tax_household_member_1) do
+      FactoryBot.create(:tax_household_member, tax_household: aqhp_tax_household_1, person: subscriber_person,
+                                               is_tax_filer: true)
+    end
+
+    let!(:uqhp_tax_household_member_1) do
+      FactoryBot.create(:tax_household_member, tax_household: uqhp_tax_household_1, person: subscriber_person,
+                                               is_tax_filer: true)
+    end
+
+    let(:npt_eom_insurance_policy) do
+      FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1), end_on: Date.new(year, 5, 31), term_for_np: true)
+    end
+    let(:enrollment_npt_eom) do
+      FactoryBot.create(:enrollment, start_on: Date.new(year, 1, 1),
+                                     effectuated_on: Date.new(year, 1, 1),
+                                     end_on: Date.new(year, 5, 31),
+                                     created_at: Time.now,
+                                     insurance_policy: npt_eom_insurance_policy,
+                                     subscriber: enrollment_1_subscriber)
+    end
+
+    let(:npt_mid_month_insurance_policy) do
+      FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1), end_on: Date.new(year, 3, 3), term_for_np: true)
+    end
+    let(:enrollment_npt_mid_month) do
+      FactoryBot.create(:enrollment, start_on: Date.new(year, 1, 1),
+                                     effectuated_on: Date.new(year, 1, 1),
+                                     end_on: Date.new(year, 3, 3),
+                                     created_at: Time.now,
+                                     insurance_policy: npt_mid_month_insurance_policy,
+                                     subscriber: enrollment_1_subscriber)
+    end
+
+    let(:npt_mid_month_uqhp_insurance_policy) do
+      FactoryBot.create(:insurance_policy, start_on: Date.new(year, 1, 1), end_on: Date.new(year, 3, 3), term_for_np: true)
+    end
+
+    let(:enrollment_npt_mid_month_uqhp) do
+      FactoryBot.create(:enrollment, start_on: Date.new(year, 1, 1),
+                                     effectuated_on: Date.new(year, 1, 1),
+                                     end_on: Date.new(year, 3, 3),
+                                     created_at: Time.now,
+                                     insurance_policy: npt_mid_month_uqhp_insurance_policy,
+                                     subscriber: enrollment_2_subscriber)
+    end
+
+    let!(:premium_schedule_1) { FactoryBot.create(:premium_schedule, enrolled_member: enrollment_npt_eom.subscriber) }
+    let!(:premium_schedule_2) { FactoryBot.create(:premium_schedule, enrolled_member: enrollment_npt_mid_month.subscriber) }
+    let!(:premium_schedule_3) { FactoryBot.create(:premium_schedule, enrolled_member: enrollment_npt_mid_month_uqhp.subscriber) }
+
+    let!(:aqhp_enrollment_tax_household_1) do
+      FactoryBot.create(:enrollments_tax_households, enrollment_id: enrollment_npt_eom.id,
+                                                     tax_household_id: aqhp_tax_household_1.id)
+    end
+
+    let!(:aqhp_enrollment_tax_household_2) do
+      FactoryBot.create(:enrollments_tax_households, enrollment_id: enrollment_npt_mid_month.id,
+                                                     tax_household_id: aqhp_tax_household_1.id)
+    end
+
+    let!(:uqhp_enrollment_tax_household_1) do
+      FactoryBot.create(:enrollments_tax_households, enrollment_id: enrollment_npt_mid_month_uqhp.id,
+                                                     tax_household_id: uqhp_tax_household_1.id)
+    end
+
+    it "should return success on eom npt policies" do
+      result = subject.call({ insurance_policy: npt_eom_insurance_policy })
+      expect(result.success?).to be_truthy
+    end
+
+    it "should not return aptc_csr_household for month after GPM for mid month aqhp npt policies" do
+      result = subject.call({ insurance_policy: npt_mid_month_insurance_policy })
+      expect(result.value![:aptc_csr_tax_households][0][:months_of_year].count).to eq 2
+      expect(result.success?).to be_truthy
+    end
+
+    it "should include mid month for uqhp npt policies" do
+      result = subject.call({ insurance_policy: npt_mid_month_uqhp_insurance_policy })
+      expect(result.value![:aptc_csr_tax_households][0][:months_of_year].count).to eq 3
+      print(result.value![:aptc_csr_tax_households][0][:months_of_year])
+      expect(result.success?).to be_truthy
+    end
+  end
+
   context 'rounding down total_ehb_premium' do
     let(:subscriber_person) { FactoryBot.create(:people_person) }
     let(:dependent_person) { FactoryBot.create(:people_person) }