BN102_Tracking FLES



Application: HRMS

Module: Benefits

Business Process: Maintain Benefits Plans and Programs

Requirement Number: BN102

Requirement Title: Tracking FLES eligible participants based on National ID/SSN

Module Leads: Nancy McMahon, Amie Robison

1. Requirement Description

Describe the requirement (gap). Include a description of the delivered PeopleSoft functionality.

PeopleSoft has the ability to link the National ID from the employee record to the National ID (NID) on the dependent/beneficiary NID record. However, the National ID field on dependent/beneficiary page is not a required field by PeopleSoft.

The State would like to use the NID field in the Dependent/Beneficiary page to manage Family Less Employed Spouse (FLES) health rate. FLES is available when both spouses work for the State, have at least one child enrolled in coverage, and are enrolled in the same health plan. One spouse is enrolled in individual coverage; the other spouse is enrolled in Family coverage with their child(ren), at the FLES rate. The carrier receives the premium for family coverage and the State pays two employer shares of the premium. Currently, the state has no automatic way to identify FLES eligible employees, unless the employee tells their Agency that they are eligible for this coverage or the payroll staff knows the spouse. If the other spouse works for another agency, the agency must inquire from the spouses’ agency as to their health coverage to verify eligibility for the FLES rate.

2. Business Need

Provide a justification for the requirement. Include information about frequency, volume, number of users impacted, etc.

The State needs an automatic way to identify FLES eligible employees. PeopleSoft will be able to handle this, if the NID field is populated for spouses on the dependent/beneficiary page.

This is State practice that cannot be changed without union negotiations. Approximately 1,700 employees currently pay the FLES rate.

3. Required By: (Y/N)

Federal ____ Agency ____ Bargaining Unit __Y__

State Statutory ____ State Regulatory ____ State Procedural __Y__

4. Requirement Priority

_High__ (High, Medium, Low)

5. Recommended Solution

Enter an “X” next to the appropriate category

____ Process Solution

____ Option Number

__X__ Application Modification

__1__ Option Number

6. Explanation for Recommendation

Provide reasons for recommendation. Please do not re-state the description of the solution itself.

This easy report would allow for agencies with incomplete dependent/beneficiary information to still complete benefits enrollment for those people while allowing for identification of FLES coverage eligibility if the NID is indicated for spouses. While this recommendation may not identify all eligible employees it will be much improved from the current method.

Health insurance carriers require National ID when enrolling dependents, so in reality, this field should be populated regardless of the FLES requirement.

7. Organizational Impact of Recommendation

Describe the changes to the organization that result from the recommended solution. Include a description of any role, process, statute, or bargaining unit agreement affected.

The agency benefits specialist must know how to run the report and populate the National ID field when entering spouses on the dependent/beneficiary page.

8. Process Solutions

Describe the possible Process Solutions. Include a description of impacts and benefits of each solution.

Option 1.

The FLES rate is explained in the Health Care Options for Employees brochure issued by the State Comptroller. Employees who believe they are eligible for FLES would inform their Agency Benefits Specialist and request the FLES rate. The Agency Benefits Specialist would manually verify their eligibility. This is very similar to the as-is process and as a high level of potential errors.

9. Application Modifications

Describe the possible Application Modifications. Include a description of impacts and benefits of each solution.

Option 1.

Modification Type (On-line, Batch, Interface, Report, Workflow): Report

Complexity (Easy, Medium, Difficult): Easy

Description:

Strongly encourage all agencies to enter a NID for spouse on the Dependent/Beneficiary Personal Profile page. Then, each agency would run the simple report before defined processing (such as Open Enrollment) to prompt ‘data cleanup’ for their agency where any spouses without a NID would be identified.

NID is required by the health insurance carriers already.

Option 2.

Modification Type (On-line, Batch, Interface, Report, Workflow): On-Line

Complexity (Easy, Medium, Difficult): Medium

Description:

Make NID a required field on Dep_Benef_NID. This would create problems because newborns may not have an NID until after they must be enrolled into the system and international employees’ spouses/children may never have a SSN.

Option 3.

Modification Type (On-line, Batch, Interface, Report, Workflow): On-line

Complexity (Easy, Medium, Difficult): Difficult

Description:

Use PeopleCode to make NID a required field only if the relationship is spouse.

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