{
  "tool_id": "art-344-compute-mlr-rebate",
  "note": "golden_hash filled by golden-parity.test.mjs --update. Vector 1: fully-credible large group meets the 85% threshold, no rebate. Vector 2: partially-credible individual market plan below the 80% threshold with 3-year premium-weighted averaging, rebate owed above the de minimis floor. Vector 3: non-credible tiny plan (< 1,000 member life-years) deemed compliant per 158.232, no rebate calculation performed. Vector 4: adjusted earned premium <= 0 (finite gate) -- ratios zeroed, not NaN/Infinity.",
  "vectors": [
    {
      "name": "large_group_fully_credible_meets_threshold",
      "description": "$5,000,000 earned premium, $200,000 taxes/fees, $4,260,000 adjusted incurred claims, 100,000 member life-years (fully credible, >= 75,000). Raw and adjusted MLR both 88.75%, above the large-group 85% threshold -- no rebate owed.",
      "policy_parameters": {
        "market": "large_group",
        "reporting_year": 2026,
        "earned_premium": 5000000,
        "federal_taxes_fees": 150000,
        "state_taxes_fees": 50000,
        "incurred_claims": 4200000,
        "quality_improvement_expenditures": 60000,
        "reinsurance_recoveries": 0,
        "risk_adjustment_net": 0,
        "risk_corridors_net": 0,
        "member_life_years": 100000,
        "prior_year_1_adjusted_mlr_pct": null,
        "prior_year_1_earned_premium": 0,
        "prior_year_2_adjusted_mlr_pct": null,
        "prior_year_2_earned_premium": 0
      },
      "output_payload": {
        "market": "large_group",
        "reporting_year": 2026,
        "constants_version": "2026",
        "adjusted_incurred_claims": 4260000,
        "adjusted_earned_premium": 4800000,
        "raw_mlr_pct": 88.75,
        "member_life_years": 100000,
        "credibility_tier": "fully_credible",
        "credibility_adjustment_pct_points": 0,
        "current_year_adjusted_mlr_pct": 88.75,
        "three_yr_average_mlr_pct": 88.75,
        "years_included_in_average": 1,
        "threshold_pct": 85,
        "rebate_owed": false,
        "rebate_pct_points": 0,
        "rebate_amount": 0,
        "de_minimis": false,
        "regulatory_basis": "45 CFR 158 (ACA Medical Loss Ratio rule): numerator/denominator 158.140-158.162, credibility adjustment 158.230-158.232, 3-year averaging 158.221, rebate calculation 158.240, de minimis 158.243.",
        "note": "Credibility-adjustment table is a REPRESENTATIVE linear taper, not the exact CMS deductible-banded schedule -- confirm the precise add-on against the current CMS MLR credibility-adjustment table before filing. De minimis check approximates per-enrollee rebate using member_life_years as the enrollee-count proxy."
      },
      "compliance_flags": [],
      "golden_hash": "1950ff6ae8740a57db51596fe0d38354ef005f79bac0d87176fd10fd94d0b6a3"
    },
    {
      "name": "individual_partially_credible_rebate_owed_3yr_avg",
      "description": "$20,000,000 earned premium, $500,000 taxes/fees, $13,200,000 adjusted incurred claims, 38,000 member life-years (partially credible, midpoint of the 1,000-75,000 band, +4.00pp credibility add-on). Raw MLR 67.69%, current-year adjusted MLR 71.69%. Premium-weighted 3-year average with two prior years (75.00% / 78.00%) comes to 74.75%, below the individual-market 80% threshold -- $1,023,750 rebate owed, $26.94/life above the $5 de minimis floor.",
      "policy_parameters": {
        "market": "individual",
        "reporting_year": 2026,
        "earned_premium": 20000000,
        "federal_taxes_fees": 400000,
        "state_taxes_fees": 100000,
        "incurred_claims": 13000000,
        "quality_improvement_expenditures": 200000,
        "reinsurance_recoveries": 0,
        "risk_adjustment_net": 0,
        "risk_corridors_net": 0,
        "member_life_years": 38000,
        "prior_year_1_adjusted_mlr_pct": 75,
        "prior_year_1_earned_premium": 18000000,
        "prior_year_2_adjusted_mlr_pct": 78,
        "prior_year_2_earned_premium": 17000000
      },
      "output_payload": {
        "market": "individual",
        "reporting_year": 2026,
        "constants_version": "2026",
        "adjusted_incurred_claims": 13200000,
        "adjusted_earned_premium": 19500000,
        "raw_mlr_pct": 67.69,
        "member_life_years": 38000,
        "credibility_tier": "partially_credible",
        "credibility_adjustment_pct_points": 4,
        "current_year_adjusted_mlr_pct": 71.69,
        "three_yr_average_mlr_pct": 74.75,
        "years_included_in_average": 3,
        "threshold_pct": 80,
        "rebate_owed": true,
        "rebate_pct_points": 5.25,
        "rebate_amount": 1023750,
        "de_minimis": false,
        "regulatory_basis": "45 CFR 158 (ACA Medical Loss Ratio rule): numerator/denominator 158.140-158.162, credibility adjustment 158.230-158.232, 3-year averaging 158.221, rebate calculation 158.240, de minimis 158.243.",
        "note": "Credibility-adjustment table is a REPRESENTATIVE linear taper, not the exact CMS deductible-banded schedule -- confirm the precise add-on against the current CMS MLR credibility-adjustment table before filing. De minimis check approximates per-enrollee rebate using member_life_years as the enrollee-count proxy."
      },
      "compliance_flags": [
        "MLR_BELOW_THRESHOLD_REBATE_OWED"
      ],
      "golden_hash": "ae09a90193bcb2c09ec2681e1fc3a6e53be0ed329c0634bbdeca7a81fe772c05"
    },
    {
      "name": "non_credible_tiny_plan_deemed_compliant",
      "description": "500 member life-years, below the 1,000 non-credible floor per 158.232. No credibility adjustment, no 3-year average, no rebate calculation -- deemed compliant regardless of the raw 62.89% MLR.",
      "policy_parameters": {
        "market": "small_group",
        "reporting_year": 2026,
        "earned_premium": 500000,
        "federal_taxes_fees": 10000,
        "state_taxes_fees": 5000,
        "incurred_claims": 300000,
        "quality_improvement_expenditures": 5000,
        "reinsurance_recoveries": 0,
        "risk_adjustment_net": 0,
        "risk_corridors_net": 0,
        "member_life_years": 500,
        "prior_year_1_adjusted_mlr_pct": null,
        "prior_year_1_earned_premium": 0,
        "prior_year_2_adjusted_mlr_pct": null,
        "prior_year_2_earned_premium": 0
      },
      "output_payload": {
        "market": "small_group",
        "reporting_year": 2026,
        "constants_version": "2026",
        "adjusted_incurred_claims": 305000,
        "adjusted_earned_premium": 485000,
        "raw_mlr_pct": 62.89,
        "member_life_years": 500,
        "credibility_tier": "non_credible",
        "credibility_adjustment_pct_points": 0,
        "current_year_adjusted_mlr_pct": null,
        "three_yr_average_mlr_pct": null,
        "years_included_in_average": 0,
        "threshold_pct": 80,
        "rebate_owed": false,
        "rebate_pct_points": 0,
        "rebate_amount": 0,
        "de_minimis": false,
        "regulatory_basis": "45 CFR 158 (ACA Medical Loss Ratio rule): numerator/denominator 158.140-158.162, credibility adjustment 158.230-158.232, 3-year averaging 158.221, rebate calculation 158.240, de minimis 158.243.",
        "note": "Credibility-adjustment table is a REPRESENTATIVE linear taper, not the exact CMS deductible-banded schedule -- confirm the precise add-on against the current CMS MLR credibility-adjustment table before filing. De minimis check approximates per-enrollee rebate using member_life_years as the enrollee-count proxy."
      },
      "compliance_flags": [
        "MLR_NON_CREDIBLE_DEFAULT_COMPLIANT"
      ],
      "golden_hash": "38c7827bb9f5cd07cc9012d92a947c66e0b726197d5b34c4a6b3543f3205d8f0"
    },
    {
      "name": "zero_adjusted_premium_edge",
      "description": "$100,000 earned premium against $105,000 combined taxes/fees -- adjusted earned premium is negative. Finite gate must zero the MLR instead of producing Infinity/NaN and flag MLR_ZERO_PREMIUM; no rebate math is attempted.",
      "policy_parameters": {
        "market": "individual",
        "reporting_year": 2026,
        "earned_premium": 100000,
        "federal_taxes_fees": 60000,
        "state_taxes_fees": 45000,
        "incurred_claims": 50000,
        "quality_improvement_expenditures": 0,
        "reinsurance_recoveries": 0,
        "risk_adjustment_net": 0,
        "risk_corridors_net": 0,
        "member_life_years": 2000,
        "prior_year_1_adjusted_mlr_pct": null,
        "prior_year_1_earned_premium": 0,
        "prior_year_2_adjusted_mlr_pct": null,
        "prior_year_2_earned_premium": 0
      },
      "output_payload": {
        "market": "individual",
        "reporting_year": 2026,
        "constants_version": "2026",
        "adjusted_incurred_claims": 50000,
        "adjusted_earned_premium": -5000,
        "raw_mlr_pct": 0,
        "member_life_years": 2000,
        "credibility_tier": "indeterminate",
        "credibility_adjustment_pct_points": 0,
        "current_year_adjusted_mlr_pct": null,
        "three_yr_average_mlr_pct": null,
        "years_included_in_average": 0,
        "threshold_pct": 80,
        "rebate_owed": false,
        "rebate_pct_points": 0,
        "rebate_amount": 0,
        "de_minimis": false,
        "regulatory_basis": "45 CFR 158 (ACA Medical Loss Ratio rule): numerator/denominator 158.140-158.162, credibility adjustment 158.230-158.232, 3-year averaging 158.221, rebate calculation 158.240, de minimis 158.243.",
        "note": "Credibility-adjustment table is a REPRESENTATIVE linear taper, not the exact CMS deductible-banded schedule -- confirm the precise add-on against the current CMS MLR credibility-adjustment table before filing. De minimis check approximates per-enrollee rebate using member_life_years as the enrollee-count proxy."
      },
      "compliance_flags": [
        "MLR_ZERO_PREMIUM"
      ],
      "golden_hash": "353d088e482727b5c792b4de30db5df5dfe8f9afa455a952c3f3e174614e8d4e"
    }
  ]
}