BN004_Discontinued_Plan_Defaults



Application: HRMS

Module: Benefits

Business Process: Administer Open Enrollment

Requirement Number: BN004

Requirement Title: Open Enrollment Benefit Plan Defaults when Plan is discontinued during or in a New Benefit Year

Module Leads: Nancy McMahon, State of Connecticut

Amie Robison, Accenture

1. Requirement Description

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

During Open Enrollment and Event Maintenance, the default coverage for each employee is their current coverage. When employees do not make elections during these events, they are defaulted into their current coverage. If their current coverage is no longer available or they are no longer eligible for it, the default is to waive coverage.

When a benefit plan is discontinued, either during or at the end of a contract period, there needs to be a way to default employees into a ‘comparable’ benefit plan.

2. Business Need

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

During Open Enrollment, employees that do not return an enrollment form are defaulted into the same benefit plan in which they are currently enrolled. The requirement stems from the fact that sometimes benefit plans are discontinued or replaced. We need a way to map the old plan to a comparable new plan. Without modification, the default in this situation would be to default to waive coverage.

During open enrollment, participation is approximately 2500 out of 58,000 employees. If there was a change to a major benefit plan, this could negatively impact thousands of people. While this hopefully will not be an annual occurrence, the State has had a carrier back out in the middle of a benefit year and had to change all of the effected employees’ health plans.

3. Required By: (Y/N)

Federal ____ Agency ____ Bargaining Unit ____

State Statutory ____ State Regulatory ____ State Procedural __Y__

4. Requirement Priority

__M____ (High, Medium, Low – please see “Requirements Prioritization Criteria”)

5. Recommended Solution

Enter an “X” next to the appropriate category

__X__ Process Solution

_1__ Option Number

_____ Application Modification

___ Option Number

6. Explanation for Recommendation

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

This option provides a way to ensure that employees whose plans are being discontinued will not lose coverage. This modification will be included in the Production Support Listing.

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 program would have to be customized each time one of these major changes occurs. The Central Benefits Specialist would have to request this special batch job to run as part of the open enrollment process.

8. Process Solutions

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

Option 1.

All employees enrolled in a discontinued plan at the end of open enrollment would be identified via a query and notified by their agency benefits specialist that their coverage will be waived at the beginning of the new benefit year. The employees would have to participate in that open enrollment and change their plan to remain covered.

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): Batch

Complexity (Easy, Medium, Difficult): Difficult

Description:

Create an SQR that would identify employees during open enrollment that are being defaulted to waived coverage. It would look at the coverage the employee had before the open enrollment period, and determine the ‘comparable coverage’ available. The comparable coverage would be defined by Central Benefits and updated in this program each time a major coverage change occurred.

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