updating amount calculations for npt h41/1095A

app/models/insurance_policies/aca_individuals/enrollment.rb

@@ -59,10 +59,29 @@ def enrollment_end_on
         end_on.present? ? end_on : insurance_policy.start_on.end_of_year
       end
 
-      # rubocop:disable Metrics/AbcSize
+      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
+
       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)
+        if insurance_policy.term_for_np
+          end_on = insurance_policy.end_on
+          next_month = calendar_month == 12 ? 1 : calendar_month + 1
+          # if ends mid month on the current month, set to blank
+          if mid_month_end?(end_on, calendar_month)
+            nil
+          # if ends EOM current month OR ends mid month next month, set to 0
+          elsif eom_end?(end_on, calendar_month) || mid_month_end?(end_on, next_month)
+            format('%.2f', 0.0)
+          end
         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)
@@ -99,7 +118,6 @@ 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

@@ -120,6 +120,8 @@ def valid_enrollment_tax_household?(enr_thh, tax_household)
       # rubocop:disable Metrics/MethodLength
       # rubocop:disable Metrics/CyclomaticComplexity, Metrics/PerceivedComplexity
       def applied_aptc_amount_for(enrollments_for_month, calender_month, tax_household)
+        return nil if term_for_np && mid_month_end?(policy_end_on, calender_month)
+
         en_tax_households = enrollments_tax_households(enrollments_for_month)
         enr_thhs_for_month = en_tax_households.select do |enr_thh|
           valid_enrollment_tax_household?(enr_thh, tax_household) && enr_thh.tax_household.is_aqhp
@@ -154,7 +156,10 @@ def applied_aptc_amount_for(enrollments_for_month, calender_month, tax_household
       # rubocop:enable Metrics/MethodLength
       # rubocop:enable Metrics/CyclomaticComplexity, Metrics/PerceivedComplexity
 
-      def fetch_aptc_tax_credit(enrs_for_month, tax_household = nil)
+      def fetch_aptc_tax_credit(enrs_for_month, calendar_month, tax_household = nil)
+
+        return nil if term_for_np && mid_month_end?(policy_end_on, calendar_month)
+
         applied_aptc = enrs_for_month.map(&:total_premium_adjustment_amount).max
         return format('%.2f', (applied_aptc || 0.0)) if tax_household.blank?
 
@@ -185,9 +190,32 @@ def fetch_enrollments_tax_households(enrs_for_month)
           .where(:enrollment_id.in => enrs_for_month.pluck(:id))
       end
 
+      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
+
       def fetch_slcsp_premium(enrs_for_month, calendar_month, tax_household = nil, aptc_tax_credit = nil)
         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
+
+        if term_for_np
+          end_on = policy_end_on
+          next_month = calendar_month == 12 ? 1 : calendar_month + 1
+          # if ends mid month on the current month, set to blank
+          if mid_month_end?(end_on, calendar_month)
+            return nil
+          # if ends EOM current month OR ends mid month next month, set to 0
+          elsif eom_end?(end_on, calendar_month) || mid_month_end?(end_on, next_month)
+            return format('%.2f', 0.0)
+          end
+        end
 
         enr_thhs = fetch_enrollments_tax_households(enrs_for_month)
         slcsp_premium = enr_thhs.map(&:household_benchmark_ehb_premium).compact.sum

app/operations/generators/reports/irs_monthly_xml.rb

@@ -103,7 +103,7 @@ def thh_to_pick(_tax_household, calendar_month)
         enrs_for_month = ::InsurancePolicies::AcaIndividuals::InsurancePolicy
                          .enrollments_for_month(calendar_month, calendar_year, policies)
         enrs_for_month.each do |enrollment|
-          aptc = enrollment.insurance_policy.fetch_aptc_tax_credit([enrollment])
+          aptc = enrollment.insurance_policy.fetch_aptc_tax_credit([enrollment], calendar_month)
           aptc_to_pick << aptc.to_f
         end
 
@@ -189,7 +189,7 @@ def serialize_address(person_xml, address)
       def serialize_associated_policy(hh_xml, tax_household, calendar_month, enrollment)
         enrolled_thh_members = enrollment.enrolled_members_from_tax_household(tax_household)
         pre_amt_tot = enrollment.pre_amt_tot_values(enrolled_thh_members, calendar_month)
-        aptc_tax_credit = enrollment.insurance_policy.fetch_aptc_tax_credit([enrollment], tax_household)
+        aptc_tax_credit = enrollment.insurance_policy.fetch_aptc_tax_credit([enrollment], calendar_month, tax_household)
         slcsp = enrollment.insurance_policy.fetch_slcsp_premium([enrollment], calendar_month, tax_household)
         pediatric_dental_pre = enrollment.pediatric_dental_premium(tax_household.tax_household_members, calendar_month)
         total_premium = pre_amt_tot.to_f + pediatric_dental_pre
@@ -237,7 +237,7 @@ def serialize_insurance_coverages(insured_pol_xml, policy)
             enrolled_members_for_month = [[sorted_enrollments.map(&:subscriber)] +
               sorted_enrollments.map(&:dependents)].flatten.uniq(&:person_id)
             pre_amt_tot = sorted_enrollments.first.pre_amt_tot_values(enrolled_members_for_month, calendar_month)
-            aptc_tax_credit = policy.fetch_aptc_tax_credit(sorted_enrollments)
+            aptc_tax_credit = policy.fetch_aptc_tax_credit(sorted_enrollments, calendar_month)
             slcsp = sorted_enrollments.first.insurance_policy.fetch_slcsp_premium(sorted_enrollments, calendar_month)
             pediatric_dental_pre = sorted_enrollments.first.pediatric_dental_premium(thh_members,
                                                                                      calendar_month)

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

@@ -453,8 +453,31 @@ def construct_coverage_information(insurance_policy, covered_individuals, tax_ho
           end
         end
 
+        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
+
         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 ends mid month on the current month, set to blank
+            if mid_month_end?(end_on, calendar_month)
+              return nil
+            # if ends EOM current month OR ends mid month next month, set to 0
+            elsif eom_end?(end_on, calendar_month) || mid_month_end?(end_on, next_month)
+              return format('%.2f', 0.0)
+            end
+          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 mid month end date' do
+      it 'returns nil' do
+        expect(enrollment_npt_mid_month.pre_amt_tot_values([subscriber], 3)).to eq(nil)
+      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
+  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
@@ -288,6 +298,36 @@
       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 nil if on second grace period month" do
+      calendar_month = 3
+      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).to eq nil
+    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_aptc_tax_credit" do
+    context "when in second grace period month" do
+      let(:tax_household) { FactoryBot.create(:tax_household, is_aqhp: false) }
+      it "should return nil" do
+        expect(insurance_policy_npt_mid_month.fetch_aptc_tax_credit([enrollment_1], 3, tax_household)).to eq nil
+      end
+    end
   end
 
   context "#fetch_slcsp_premium" do
@@ -315,6 +355,18 @@
         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 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)
+        expect(result_eom).to eq "0.00"
+        expect(result_next_month_mid_month).to eq "0.00"
+      end
+
+      it "should return nil if in second grace period month" do
+        result_mid_month = insurance_policy_npt_mid_month.fetch_slcsp_premium([enrollment], 3, aqhp_tax_household, 4.0)
+        expect(result_mid_month).to eq nil
+      end
     end
 
     context "when aptc is non zero" do