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Remove insurance coverage limit amount per year and add consumed insurance amount in insurance payload

This commit is contained in:
Djery-Tom 2022-02-28 15:53:07 +01:00
parent 1fbeafbeba
commit 47e65a84d7
11 changed files with 203 additions and 29 deletions
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89
app/Http/Controllers/HealthCareSheetController.php
View File

@ -25,6 +25,7 @@ use App\Models\NhMedicalPrescription;
use App\Models\NhNetworksConfig;
use App\Models\NhPerformance;
use App\Models\NhProviderClass;
use App\Models\NhTmpHealthCareSheet;
use Illuminate\Http\Request;
use Illuminate\Support\Facades\DB;
use Illuminate\Support\Facades\Event;
@ -644,6 +645,8 @@ class HealthCareSheetController extends Controller
}
$parts = $this->getConfigInsuranceParts($nhConfig, $request->input('care_condition'));
$currency_code = $this->getNetworkCurrency($insurance->network_id);
try {
DB::beginTransaction();
@ -698,7 +701,7 @@ class HealthCareSheetController extends Controller
// Calculer les parts de l'assurance et l'assuré pour cette feuille de soins
$this->calculateInsuranceAmounts($healthCareSheet);
// Verification de la limite de couverture
$this->verifyInsuranceCoverageAmount($nhConfig, $insurance, $healthCareSheet, $beneficiary ?? null);
$this->verifyInsuranceCoverageAmount($nhConfig, $insurance, $healthCareSheet, $beneficiary ?? null, $currency_code);
// Mettre à jour la couverture d'assurance de l'assuré
$this->updateInsuranceCoverageAmount($healthCareSheet, $insurance, $datetime, $beneficiary ?? null);
@ -763,26 +766,40 @@ class HealthCareSheetController extends Controller
* @throws AppException
*/
// Verification de la limite de couverture
private function verifyInsuranceCoverageAmount(NhNetworksConfig $nhConfig, NhInsurance $insurance, NhHealthCareSheet $sheet, NhHavingRight $beneficiary = null
, $currentInsuranceAmount = 0) // Current Insurance Amount en cas de mise à jour de la feuille de soins pour ne pas prendre en compte la couverture deja affecté
private function verifyInsuranceCoverageAmount(NhNetworksConfig $nhConfig, NhInsurance $insurance, NhHealthCareSheet $sheet, NhHavingRight $beneficiary = null,
$currency_code = 'XAF', $currentInsuranceAmount = 0) // Current Insurance Amount en cas de mise à jour de la feuille de soins pour ne pas prendre en compte la couverture deja affecté
{
$insurance_coverage_amount = isset($beneficiary) ? $beneficiary->insurance_coverage_amount : $insurance->insurance_coverage_amount;
$insurance_amount = $sheet->insurance_amount;
$monthPrice = $nhConfig->monthsPricesGrid()->where('nh_network_config_id', $nhConfig->id)
->where('number_of_months', $insurance->number_of_months)->first();
if (!isset($monthPrice))
throw new AppException(trans('errors.month_price_grid_not_found'));
if (!$nhConfig->family_coverage_sharing) {
$total_insurance_amount = $insurance_coverage_amount + $insurance_amount - $currentInsuranceAmount;
if ($total_insurance_amount > $nhConfig->coverage_limit_per_insured_per_year) {
if ($total_insurance_amount > $monthPrice->max_insurance_coverage_amount) {
DB::rollBack();
throw new AppException("La limite de couverture a été atteinte pour cet assuré");
throw new AppException(trans('errors.insurance_coverage_amount_exceeded', [
'consumption' => $this->toMoneyWithCurrencyCode($insurance_coverage_amount, $currency_code),
'remaining' => $this->toMoneyWithCurrencyCode($monthPrice->max_insurance_coverage_amount - $insurance_coverage_amount, $currency_code),
]));
}
} else {
$total_insurance_amount = $insurance_amount + $insurance->insurance_coverage_amount - $currentInsuranceAmount;
// Montant de l'assurance deja consomé à date
$family_consumed_amount = $insurance->insurance_coverage_amount;
foreach ($insurance->beneficiaries as $b) {
$total_insurance_amount += $b->insurance_coverage_amount;
$family_consumed_amount += $b->insurance_coverage_amount;
}
if ($total_insurance_amount > ($nhConfig->coverage_limit_per_insured_per_year * ($insurance->number_of_beneficiaries + 1))) {
$total_insurance_amount = $family_consumed_amount + $insurance_amount - $currentInsuranceAmount;
$family_limit_amount = $monthPrice->max_insurance_coverage_amount * ($insurance->number_of_beneficiaries + 1);
if ($total_insurance_amount > $family_limit_amount) {
DB::rollBack();
throw new AppException("La mutualisation familiale a été atteinte pour cet assuré");
throw new AppException(trans('errors.insurance_coverage_amount_exceeded', [
'consumption' => $this->toMoneyWithCurrencyCode($family_consumed_amount, $currency_code),
'remaining' => $this->toMoneyWithCurrencyCode($family_limit_amount - $family_consumed_amount, $currency_code),
]));
}
}
}
@ -950,6 +967,7 @@ class HealthCareSheetController extends Controller
}
$parts = $this->getConfigInsuranceParts($nhConfig, $sheet->care_condition);
$currency_code = $this->getNetworkCurrency($sheet->insurance->network_id);
$prescriptionsIds = array_map(function ($r) {
return $r['id'];
@ -1046,7 +1064,7 @@ class HealthCareSheetController extends Controller
// Calculer les parts de l'assurance et l'assuré pour cette feuille de soins
$this->calculateInsuranceAmounts($healthCareSheet);
// Verification de la limite de couverture
$this->verifyInsuranceCoverageAmount($nhConfig, $sheet->insurance, $healthCareSheet, $sheet->beneficiary);
$this->verifyInsuranceCoverageAmount($nhConfig, $sheet->insurance, $healthCareSheet, $sheet->beneficiary, $currency_code);
// Mettre à jour la couverture d'assurance de l'assuré
$this->updateInsuranceCoverageAmount($healthCareSheet, $sheet->insurance, $datetime, $sheet->beneficiary,);
@ -1769,6 +1787,7 @@ class HealthCareSheetController extends Controller
}
$parts = $this->getConfigInsuranceParts($nhConfig, $request->input('care_condition', $sheet->care_condition));
$currency_code = $this->getNetworkCurrency($sheet->insurance->network_id);
$performances = $request->input('performances', []);
$prescriptions = $request->input('prescriptions', []);
@ -1933,7 +1952,7 @@ class HealthCareSheetController extends Controller
// Calculer les parts de l'assurance et l'assuré pour cette feuille de soins
$this->calculateInsuranceAmounts($sheet);
// Verification de la limite de couverture
$this->verifyInsuranceCoverageAmount($nhConfig, $sheet->insurance, $sheet, $sheet->beneficiary, $currentInsuranceAmount);
$this->verifyInsuranceCoverageAmount($nhConfig, $sheet->insurance, $sheet, $sheet->beneficiary, $currency_code, $currentInsuranceAmount);
// Mettre à jour la couverture d'assurance de l'assuré
$this->updateInsuranceCoverageAmount($sheet, $sheet->insurance, $datetime, $sheet->beneficiary, $currentInsuranceAmount);
@ -2001,6 +2020,12 @@ class HealthCareSheetController extends Controller
* @OA\Schema(
* schema="check_insurance_coverage_amount",
* title = "Verifier si une ligne de la feuille est applicable",
* @OA\Property(
* property="tmp_sheet_id",
* description = "ID de temporaire de le feuille de soins generrée par le frontend",
* type="string",
* example= "XXXXXXXXXXXXXXXXXXX"
* ),
* @OA\Property(
* property="insurance_id",
* description = "ID de l'assurance",
@ -2120,6 +2145,7 @@ class HealthCareSheetController extends Controller
* )
*/
$this->validate($request, [
'tmp_sheet_id' => 'required|string',// Temporal sheet ID generate by frontend
'insurance_id' => 'required|exists:nh_insurances,id',
'beneficiary_id' => 'nullable|exists:nh_having_rights,id',
'care_condition' => 'required|in:CURRENT_AFFECTION,LONG_TERM_AFFECTION,EXONERATION',
@ -2155,7 +2181,14 @@ class HealthCareSheetController extends Controller
return $this->errorResponse(trans('errors.nano_health_not_activated'));
}
$monthPrice = $nhConfig->monthsPricesGrid()->where('nh_network_config_id', $nhConfig->id)
->where('number_of_months', $insurance->number_of_months)->first();
if (!isset($monthPrice))
return $this->errorResponse(trans('errors.month_price_grid_not_found'));
$parts = $this->getConfigInsuranceParts($nhConfig, $request->input('care_condition'));
$currency_code = $this->getNetworkCurrency($insurance->network_id);
$insurance_amount = 0;
switch ($act_type) {
@ -2182,13 +2215,15 @@ class HealthCareSheetController extends Controller
return $this->errorResponse(trans('errors.unexpected_error'));
}
// Montant temporaire de la feuille de soins
$tmp_sheet_amount = NhTmpHealthCareSheet::where('sheet_id', $request->input('tmp_sheet_id'))->sum('insurance_amount');
$insurance_coverage_amount = isset($beneficiary) ? $beneficiary->insurance_coverage_amount : $insurance->insurance_coverage_amount;
$current_insurance_amount = 0;
if ($act_action == 'UPDATE') {
if (!isset($act)) {
return $this->errorResponse(trans('errors.act_not_found'));
}
// En cas de modification d'une feuille de soins , considéré le montant de couverture actuel de l'acte deja pris en compte
// En cas de modification d'une feuille de soins, considéré le montant de couverture actuel de l'acte deja pris en compte
switch ($act_type) {
case 'PERFORMANCE':
$current_insurance_amount = $act->insurance_amount;
@ -2201,20 +2236,36 @@ class HealthCareSheetController extends Controller
}
if (!$nhConfig->family_coverage_sharing) {
$total_insurance_amount = $insurance_coverage_amount + $insurance_amount - $current_insurance_amount;
if ($total_insurance_amount > $nhConfig->coverage_limit_per_insured_per_year) {
return $this->errorResponse("La limite de couverture a été atteinte pour cet assuré");
// Montant de l'assurance deja consomé à date
$insurance_consumed_amount = $insurance_coverage_amount + $tmp_sheet_amount;
$total_insurance_amount = $insurance_consumed_amount + $insurance_amount - $current_insurance_amount;
if ($total_insurance_amount > $monthPrice->max_insurance_coverage_amount) {
return $this->errorResponse(trans('errors.insurance_coverage_amount_exceeded', [
'consumption' => $this->toMoneyWithCurrencyCode($insurance_consumed_amount, $currency_code),
'remaining' => $this->toMoneyWithCurrencyCode($monthPrice->max_insurance_coverage_amount - $insurance_consumed_amount, $currency_code),
]));
}
} else {
$total_insurance_amount = $insurance_amount + $insurance->insurance_coverage_amount - $current_insurance_amount;
// Montant de l'assurance deja consomé à date
$insurance_consumed_amount = $insurance->insurance_coverage_amount + $tmp_sheet_amount;
foreach ($insurance->beneficiaries as $b) {
$total_insurance_amount += $b->insurance_coverage_amount;
$insurance_consumed_amount += $b->insurance_coverage_amount;
}
if ($total_insurance_amount > ($nhConfig->coverage_limit_per_insured_per_year * ($insurance->number_of_beneficiaries + 1))) {
return $this->errorResponse("La mutualisation familiale a été atteinte pour cet assuré");
$total_insurance_amount = $insurance_consumed_amount + $insurance_amount - $current_insurance_amount;
$family_limit_amount = $monthPrice->max_insurance_coverage_amount * ($insurance->number_of_beneficiaries + 1);
if ($total_insurance_amount > $family_limit_amount) {
return $this->errorResponse(trans('errors.insurance_coverage_amount_exceeded', [
'consumption' => $this->toMoneyWithCurrencyCode($insurance_consumed_amount, $currency_code),
'remaining' => $this->toMoneyWithCurrencyCode($family_limit_amount - $insurance_consumed_amount, $currency_code),
]));
}
}
NhTmpHealthCareSheet::create([
'sheet_id' => $request->input('tmp_sheet_id'),
'insurance_amount' => $insurance_amount
]);
return $this->successResponse("Can be applied");
}
}

12
app/Http/Controllers/InsuranceController.php
View File

@ -204,7 +204,7 @@ class InsuranceController extends Controller
$type = $request->input('type');
$pagination = $request->input('pagination');
$query = NhInsurance::with(['network:id,name', 'beneficiaries'])->where('user_id', $userId);
$query = NhInsurance::with(['network:id,name', 'beneficiaries', 'nhNetworkConfig'])->where('user_id', $userId);
if (!empty($state)) {
$query = $query->where('state', $state);
@ -228,6 +228,8 @@ class InsuranceController extends Controller
$array = $pagination ? $insurances->items() : $insurances;
foreach ($array as $insurance) {
$monthPrice = $insurance->nhNetworkConfig->monthsPricesGrid()->where('number_of_months', $insurance->number_of_months)->first();
$insurance->state = trans('states.' . $insurance->state);
if ($type == 'EDITABLE') {
@ -242,11 +244,15 @@ class InsuranceController extends Controller
$insurance->state = trans($insurance->state);
$insurance->bonus_amount = $this->toMoneyWithCurrencyCode($insurance->bonus_amount, $currency_code);
$insurance->total_bonus_amount = $this->toMoneyWithCurrencyCode($insurance->total_bonus_amount, $currency_code);
$insurance->insurance_coverage_amount = $this->toMoneyWithCurrencyCode($insurance->insurance_coverage_amount, $currency_code);
$insurance->insurance_consumed_amount = $this->toMoneyWithCurrencyCode($insurance->insurance_coverage_amount, $currency_code);
$insurance->insurance_remaining_amount = $this->toMoneyWithCurrencyCode(($monthPrice->max_insurance_coverage_amount ?? 0) - $insurance->insurance_coverage_amount, $currency_code);
foreach ($insurance->beneficiaries as $b) {
$b->bonus_amount = $this->toMoneyWithCurrencyCode($b->bonus_amount, $currency_code);
$b->insurance_coverage_amount = $this->toMoneyWithCurrencyCode($b->insurance_coverage_amount, $currency_code);
$b->insurance_consumed_amount = $this->toMoneyWithCurrencyCode($b->insurance_coverage_amount, $currency_code);
$b->insurance_remaining_amount = $this->toMoneyWithCurrencyCode(($monthPrice->max_insurance_coverage_amount ?? 0) - $b->insurance_coverage_amount, $currency_code);
}
unset($insurance->nhNetworkConfig);
}
return $this->successResponse($insurances);

14
app/Http/Controllers/InsuredController.php
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@ -87,8 +87,9 @@ class InsuredController extends Controller
$name = $request->input('name');
$phone = $request->input('phone');
$network_id = $request->input('network_id');
$currency_code = $this->getNetworkCurrency($network_id);
$q = NhInsurance::with(['user:id,firstname,lastname,phone,email', 'network:id,name', 'beneficiaries'])->where('network_id', $network_id);
$q = NhInsurance::with(['user:id,firstname,lastname,phone,email', 'network:id,name', 'beneficiaries', 'nhNetworkConfig'])->where('network_id', $network_id);
if (!empty($insured_id)) {
$q = $q->where('insured_id', $insured_id);
@ -107,6 +108,17 @@ class InsuredController extends Controller
}
$insured = $q->get();
foreach ($insured as $i) {
$monthPrice = $i->nhNetworkConfig->monthsPricesGrid()->where('number_of_months', $i->number_of_months)->first();
$i->insurance_consumed_amount = $this->toMoneyWithCurrencyCode($i->insurance_coverage_amount, $currency_code);
$i->insurance_remaining_amount = $this->toMoneyWithCurrencyCode(($monthPrice->max_insurance_coverage_amount ?? 0) - $i->insurance_coverage_amount, $currency_code);
foreach ($i->beneficiaries as $b) {
$b->insurance_consumed_amount = $this->toMoneyWithCurrencyCode($b->insurance_coverage_amount, $currency_code);
$b->insurance_remaining_amount = $this->toMoneyWithCurrencyCode(($monthPrice->max_insurance_coverage_amount ?? 0) - $b->insurance_coverage_amount, $currency_code);
}
unset($i->nhNetworkConfig);
}
return $this->successResponse($insured);
}
}

4
app/Models/NhNetworksConfig.php
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@ -40,7 +40,7 @@ class NhNetworksConfig extends Model
'max_number_of_beneficiaries' => 'int',
'age_limit_of_insured_and_spouse' => 'int',
'age_limit_of_child_beneficiary' => 'int',
'coverage_limit_per_insured_per_year' => 'float',
// 'coverage_limit_per_insured_per_year' => 'float',
'family_coverage_sharing' => 'boolean',
'current_affection_percentage_insurer' => 'float',
'current_affection_percentage_insured' => 'float',
@ -56,7 +56,7 @@ class NhNetworksConfig extends Model
'max_number_of_beneficiaries',
'age_limit_of_insured_and_spouse',
'age_limit_of_child_beneficiary',
'coverage_limit_per_insured_per_year',
// 'coverage_limit_per_insured_per_year',
'family_coverage_sharing',
'current_affection_percentage_insurer',
'current_affection_percentage_insured',

31
app/Models/NhTmpHealthCareSheet.php Normal file
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@ -0,0 +1,31 @@
<?php
/**
* Created by Reliese Model.
*/
namespace App\Models;
use Carbon\Carbon;
use Illuminate\Database\Eloquent\Model;
/**
* Class NhHealthCareSheet
*
* @property int $id
* @property string $sheet_id
* @property float $insurance_amount
* @property Carbon $created_at
* @property Carbon $updated_at
*
* @package App\Models
*/
class NhTmpHealthCareSheet extends Model
{
protected $table = 'nh_tmp_health_care_sheets';
protected $fillable = [
'sheet_id',
'insurance_amount',
];
}

2
database/migrations/2021_10_04_161135_create_nh_networks_configs_table.php
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@ -19,7 +19,7 @@ class CreateNhNetworksConfigsTable extends Migration
$table->enum('provider_billing_period', ['WEEKLY', 'BIMONTHLY', 'MONTHLY'])->default('WEEKLY')->comment('Période de facturation des prestataires : hebdomadaire ou bimensuel ,mensuel ');
$table->decimal('max_number_of_beneficiaries', 1, 0)->default(0)->comment('Nombre d’ayant droit maximum : un nombre à un chiffre');
$table->decimal('age_limit_of_child_beneficiary', 2, 0)->default(0)->comment('Age limite de l’ayant droit enfant : un nombre à 2 chiffres');
$table->decimal('coverage_limit_per_insured_per_year', 10, 2)->default(0)->comment("Limite de la couverture par assuré par an");
// $table->decimal('coverage_limit_per_insured_per_year', 10, 2)->default(0)->comment("Limite de la couverture par assuré par an");
$table->decimal('current_affection_percentage_insurer', 3, 0)->default(0)->comment("Affection courante: % part assureur");
$table->decimal('current_affection_percentage_insured', 3, 0)->default(0)->comment("Affection courante: % part assuré");
$table->decimal('long_term_affection_percentage_insurer', 3, 0)->default(0)->comment("Affection longue durée: % part assureur");

2
database/migrations/2022_02_16_153852_add_family_coverage_sharing_to_nh_networks_configs.php
View File

@ -14,7 +14,7 @@ class AddFamilyCoverageSharingToNhNetworksConfigs extends Migration
public function up()
{
Schema::table('nh_networks_configs', function (Blueprint $table) {
$table->boolean('family_coverage_sharing')->default(0)->after('coverage_limit_per_insured_per_year')
$table->boolean('family_coverage_sharing')->default(0)->after('age_limit_of_child_beneficiary')
->comment("Mutualisation ou partage de couverture familiale");
});
}

33
database/migrations/2022_02_25_120207_add_max_coverage_amount_to_nh_months_prices_grid.php Normal file
View File

@ -0,0 +1,33 @@
<?php
use Illuminate\Database\Migrations\Migration;
use Illuminate\Database\Schema\Blueprint;
use Illuminate\Support\Facades\Schema;
class AddMaxCoverageAmountToNhMonthsPricesGrid extends Migration
{
/**
* Run the migrations.
*
* @return void
*/
public function up()
{
Schema::table('nh_months_prices_grid', function (Blueprint $table) {
$table->decimal('max_insurance_coverage_amount', 10)->default(0)
->after('min_amount')->comment("Montant limite de couverture");
});
}
/**
* Reverse the migrations.
*
* @return void
*/
public function down()
{
Schema::table('nh_months_prices_grid', function (Blueprint $table) {
//
});
}
}

33
database/migrations/2022_02_25_120459_create_nh_tmp_health_care_sheets.php Normal file
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@ -0,0 +1,33 @@
<?php
use Illuminate\Database\Migrations\Migration;
use Illuminate\Database\Schema\Blueprint;
use Illuminate\Support\Facades\Schema;
class CreateNhTmpHealthCareSheets extends Migration
{
/**
* Run the migrations.
*
* @return void
*/
public function up()
{
Schema::create('nh_tmp_health_care_sheets', function (Blueprint $table) {
$table->id();
$table->string('sheet_id');
$table->decimal('insurance_amount', 10);
$table->timestamps();
});
}
/**
* Reverse the migrations.
*
* @return void
*/
public function down()
{
Schema::dropIfExists('nh_tmp_health_care_sheets');
}
}

6
resources/lang/en/errors.php
View File

@ -51,5 +51,9 @@ return [
'already_insured' => "Vous avez deja souscrit à cette assurance",
'no_sheet_accepted' => "No care sheet accepted",
'no_sheet_available' => "No care sheet available",
"act_not_found" => "Act not found"
"act_not_found" => "Act not found",
'month_price_grid_not_found' => "La grille tarifaire de ce mois n'existe pas",
"insurance_coverage_amount_exceeded" => "La limite autorisée est dépassée.
Consommation : :consommation
Reste : :remaining"
];

6
resources/lang/fr/errors.php
View File

@ -51,5 +51,9 @@ return [
'already_insured' => "Vous avez deja souscrit à cette assurance",
'no_sheet_accepted' => "Aucune feuille de soins acceptée",
'no_sheet_available' => "Aucune feuille de soins disponible",
"act_not_found" => "Acte introuvable"
"act_not_found" => "Acte introuvable",
'month_price_grid_not_found' => "La grille tarifaire de ce mois n'existe pas",
"insurance_coverage_amount_exceeded" => "La limite autorisée est dépassée.
Consommation : :consumption
Reste : :remaining"
];