PeopleSoft Enterprise Human Resources 9.1 PeopleBook: Manage Base Benefits

Sending Benefit Information

This chapter provides an overview of benefit data extraction and discusses how to:

Specify the data to extract.
Run the Enrollment Reporting Snapshot process.
Send data to benefit providers.
Send HIPAA data to providers.
(USF) Send FEHB data to the OPM.

Understanding Benefit Data Extraction

Just as you provide information to employees regarding provider benefit plans, you also provide information to benefit providers about employee changes to plan elections.

Similarly, federal agencies send changes in health plan elections to the OPM.

To send benefits data to providers:

Specify the information to extract from your HRMS database.
Run the Enrollment Reporting Snapshot program to extract the data and write it to the snapshot tables: BN_SNAP_PER, BN_SNAP_JOB, and BN_SNAP_PLAN.

Run this step only once per reporting period and generate all of your extracts from a single snapshot.
Create carrier extract files for your benefit providers.
Review the data in the snapshot tables or review a log that contains the date and time that the Enrollment Reporting Snapshot, Carrier Extract, and Carrier Interface Supplier Integration processes were run.

Specifying the Data to Extract

To define what data to extract, use the Enrollment Snapshot Options (BN_SNAP_CONFIG) component.

You can extract benefit plan types and other benefit-related information, such as deduction amounts, life and disability coverages, implied terminations, and the original enrollment date.

Page Used to Specify Data to Extract

Page Name	Definition Name	Navigation	Usage
Enrollment Snapshot Options	BN_SNAP_CONFIG	Set Up HRMS, Product Related, Base Benefits, Enrollment Snapshot Options, Enrollment Snapshot Options	Define data to extract from the HRMS database.

Defining Data to Extract

Access the Enrollment Snapshot Options page (Set Up HRMS, Product Related, Base Benefits, Enrollment Snapshot Options, Enrollment Snapshot Options).

Plan Types to Include

Select only the plan types for which you will create a carrier interface extract or transmit data to the Carrier Interface Supplier Integration process in eBenefits.

Note. If you are running the snapshot process only to create a HIPAA EDI 834 file, check only the Health plan type to reduce the time necessary to populate the Snapshot tables.

Include Payroll Deduction Info (include payroll deduction information)

Select to include the last deduction taken and the pay end date for each enrollment.

Calculate Life/Disability Covg (calculate life/disability coverage)

Select to have the Enrollment Reporting Snapshot process calculate coverage for life and disability plans using the plan definitions, calculation rules, and employee's compensation rate or annual benefits base rate.

Include Implied Term (include implied terminations)

Select to include enrollments that are no longer valid because the participant has enrolled in another plan type, waived coverage, or transitioned to COBRA coverage.

Note. You use this field whenever a carrier requires a positive notification of a termination or plan change (some carriers can detect these events simply by noticing a previous enrollment record).

Include Implied Dependent Terminations

Select to create termination records for dependents in the snapshot and report them in the HIPPA file when a termination of an employee also terminated the dependent or when new coverage has been added for an employee and a dependent who was previously covered has been dropped from coverage.

Note. You must select Include Implied Employee Terminations, for Include Implied Dependent Termination to be functional.

Include Original Enrollment Dt (include original enrollment date)

Select to include an employee's earliest continuous enrollment date in the current, active plan. This applies only to employee-level enrollments and allocations. Changes to coverage codes in health plans, employee-specified coverage amounts in life and disability plans, or employee contribution amounts do not constitute a change in plan.

This field applies to employees and dependents.

Running the Enrollment Reporting Snapshot Process

The Enrollment Reporting Snapshot process extracts data that you specified on the Enrollment Snapshot Options page from the HRMS database and writes it to the BN_SNAP_PER, BN_SNAP_JOB, and BN_SNAP_PLAN tables. Each time that you run the Enrollment Reporting Snapshot process, the data in the snapshot tables is cleared and new information is written.

Every time that the Enrollment Reporting Snapshot or Carrier Report processes are run, a record is written to the BN_SNAP_HIST table. You can review this log using the Review Interface Run History page.

This section provides an overview of database record layout details and lists the pages used to run the Enrollment Reporting Snapshot process.

Understanding Database Record Layout Details

The following tables are populated by the Enrollment Reporting Snapshot process and used by the Carrier Interface Extract and Carrier Interface Supplier Integration processes. You need this information when creating a provider-specific SQR (Structured Query Report) extract.

BN_SNAP_PER

This table includes one row per participant (employee, dependent/beneficiary, and so on).

COLUMN	KEY	NOTES
EMPLID	Yes
DEPENDENT_BENEF	Yes	Blank for employees. Populated for dependents and beneficiaries.
EFFDT	No	The as of date specified by the user on the run control page. The value is the same for every row. Simplifies finding related displays and descriptions.
NAME
LAST_NAME	Alt
FIRST_NAME
NAME_PREFIX
NATIONAL_ID		Primary national ID. If the employee, dependent, or beneficiary has not been assigned a primary ID, the field is blank.
BIRTHDATE
SEX
RELATIONSHIP		Blank for employees.
SMOKER		Y/N
STUDENT		Y/N; Applies only to dependents and beneficiaries.
STUDENT_STATUS_DT		Applies only to dependents and beneficiaries.
DISABLED		Applies only to dependents and beneficiaries.
COUNTRY
ADDRESS1
ADDRESS2
ADDRESS3
ADDRESS4
CITY
NUM1
NUM2
HOUSE_TYPE
ADDR_FIELD1
ADDR_FIELD2
ADDR_FIELD3
COUNTY
STATE
POSTAL
GEO_CODE
IN_CITY_LIMIT
HOME_PHONE

BN_SNAP_JOB

One row exists per employee/benefit record/COBRA event; no rows exists for dependents and beneficiaries. For an employee with multiple jobs, all job-related information is taken from the employee's primary job for the indicated benefit record.

COLUMN	KEY	NOTES
EMPLID	Yes
BENEFIT_RCD_NBR	Yes
COBRA_EVENT_ID	Yes	Nonzero indicates a COBRA enrollment event for this employee ID/benefit record number.
EMPL_RCD		Primary job as of the date entered on the run control page.
JOB_EFFDT		Effective date of the primary job on the Job table.
JOB_EFFSEQ		Effective sequence of the primary job on the Job table.
EFFDT	No	The as of date entered on the run control page. The value is the same for every row. Simplifies finding related displays and descriptions.
SERVICE_DT		Primary job.
BENEFIT_PROGRAM
COMPANY		Primary job.
PAYGROUP		Primary job.
CURRENCY_CD		Currency code for the benefit program.
PAY_SYSTEM_FLG		Primary job.

BN_SNAP_PLAN

This table includes one row per employee-level enrollment and one row per dependent/beneficiary attachment to an enrollment.

Column	Key	Notes
EMPLID	Yes
DEPENDENT_BENEF	Yes	A blank entry indicates an employee-level enrollment. A populated entry indicates a dependent enrollment or beneficiary allocation.
BENEFIT_RCD_NBR	Yes	This is the EMPL_RCD field from the enrollment pages.
COBRA_EVENT_ID	Yes	A nonzero entry indicates a COBRA event for this employee ID/benefit record number.
PLAN_TYPE	Yes
COVERAGE_ELECT	Yes	Must be a key to allow for implied terminations.
EFFDT	No	The as of date specified by the user on the run control page. The value is the same for every row. Simplifies finding related displays and descriptions.
BENEFIT_PLAN		Coverage_Elect = E indicates an enrollment. Coverage_Elect = T indicates that the plan is being terminated. If the field is blank and Coverage_Elect = T or W, no prior enrollment was made.
SETID		Comes from the benefit plan definition. It is blank for 7x plans.
VENDOR_ID		Blank for 7x plans.
GROUP_NBR		Blank for 7x plans.
COVRG_CD		Applies only to 1x plan types.
LIFE_ADD_COVRG		Applies only to 2x plan types. This is the code from the plan definition, not an employee enrollment.
COVERAGE_BEGIN_DT		For enrollments, indicates the first day of coverage. For terminations, indicates the first day that coverage is no longer in effect.
COVERAGE_ELECT_DT		Indicates the date that this enrollment/termination was entered into the system.
DEDUCTION_BEGIN_DT		For enrollments, indicates the first day that deductions and credits are in effect. For terminations, it indicates the first day that deductions and credits should stop.
ENROLLMENT_DT		Original enrollment date (coverage begin date) for this plan. This is the earliest continuous coverage begin date for this same benefit plan, ignoring change of coverage code (1x) and coverage amount (2x). Populated only if the INCLUDE_ORIG option is selected, and only for employee-level rows where COVERAGE_ELECT = E.
ANNUAL_PLEDGE		Applies only to 6x plan types.
FLAT_DED_AMT		Applies only to 4x plan types. Zero if employee is not contributing on a before-tax basis or contributing a percent of earnings.
PCT_GROSS		Applies only to 4x plan types. Zero if employee is not contributing on a before-tax basis or contributing a flat amount.
FLAT_DED_AMT_ATAX		Applies only to 4x plan types. Zero if employee is not contributing on an after-tax basis or contributing a percent of earnings.
PCT_GROSS_ATAX		Applies only to 4x plan types. Zero if employee is not contributing on an after-tax basis or contributing a flat amount.
VOLUNTARY_AMT		Applies only to 8x plan types. Zero if employee is not contributing a voluntary flat amount or is contributing a voluntary percentage of earnings.
VOLUNTARY_PCT		Applies only to 8x plan types. Zero if employee is not contributing a voluntary percentage of earnings or is contributing a voluntary flat amount.
VACN_HOURS		Applies only to 9x plan types.
VACN_BUY_FLAT_AMT		Applies only to 9x plan types.
VACN_SELL_FLAT_AMT		Applies only to 9x plan types.
BENEF_PCT		Applies only to beneficiary records in plan types 2x, 4x, or 8x. Zero if the beneficiary allocation is a flat amount.
FLAT_AMOUNT		See the Flat Amount Field section following this table.
FACTOR_XSALARY		Applies only to employee records for 2x plan types. This field contains the salary factor coverage defined at either the plan level or employee level.
EXCESS		Applies only to 2x, nondependent plans and 8x dependent records. A Y in the field indicates that this beneficiary is to receive any excess benefit distribution.
CONTINGENT		Applies only to 2x, nondependent plans and 8x dependent records. A Y in the field indicates that this beneficiary is a contingent beneficiary.
DED_CUR		The amount of the last payroll deduction calculated for this enrollment. This field is populated only if INCLUDE_DED is selected.
PAY_END_DT		The pay end date of the last payroll deduction calculated for this enrollment. This field is populated only if INCLUDE_DED is selected.
CALCULATED_BASE		Applies only to 2x and 3x plans and only if Calculate Life/Disability Covg is selected on the Enrollment Snapshot Options page. This field is zero for dependents and beneficiaries and for employees with Sum of Dependent Coverage elections for Dependent Life/AD&D plans. This field indicates the calculated benefit amount with respect to coverage minimum/maximum, multiple jobs, and rounding rules for coverage purposes.
PREMIUM_BASE		Applies only to 2x and 3x plans and only if Calculate Life/Disability Covg is selected on the Enrollment Snapshot Options page. This field is zero for dependents and beneficiaries and for employees with Sum of Dependent Coverage elections for dependent life/AD&D plans. This field indicates the calculated benefit amount with respect to coverage minimum/maximum, multiple jobs, and rounding rules for premium purposes.
HLTH_PROVIDER_ID		Applies only to 1x plan types. This field indicates the primary care physician.
PREVIOUSLY_SEEN		Applies only to 1x plan types.
DEPBEN_RIDER_FLG		Applies only to dependents and beneficiaries. Y indicates that this coverage or allocation is court-ordered.
CALC_RULES_ID		Applies only to 2x and 3x plans and only if Calculate Life/Disability/Covg is selected on the Enrollment Snapshot Options page. Identifies the calculation rule the system uses when calculating CALCULATED_BASE and PREMIUM_BASE.

Understanding the Flat Amount Field

This field has different meanings depending upon the plan type and the plan context. In general, this field represents a flat amount of Life/AD&D coverage defined at either the plan level or the employee level; the amount may be in addition to a factor of salary coverage. For dependent life and dependent AD&D plans, it may represent the amount of coverage elected for a particular dependent. For nondependent Life/AD&D plans and pension plans, it may represent a flat amount beneficiary allocation.

The following tables show how this field is used in each context.

Nondependent Life/AD&D Plan Types

This table shows how the Flat Amount field is used with nondependent Life and ADD plan types. Each column represents the value of LIFE_ADD_COVRG, which defines how the coverage is calculated for a plan.

Participant	Flat Amount	Flat + Factor	EE-Specified	Special Calc	Sum of Dependents
Employee	Flat amount of coverage	Flat amount portion of total coverage	Flat amount, or flat amount portion of total coverage	Zero (not applicable)	Zero (not applicable)
Dependent/Beneficiary	Beneficiary allocation (if flat amount)	Beneficiary allocation (if flat amount)	Beneficiary allocation (if flat amount)	Beneficiary allocation (if flat amount)	Zero (not applicable)

Dependent Life and Dependent AD&D

This table shows how the Flat Amount field is used with dependent Life and ADD plan types:

Participant	Flat Amount	Flat + Factor	EE-Specified	Special Calc	Sum of Dependents
Employee	Flat amount of coverage for each dependent	Flat amount portion of total coverage for each dependent	Flat amount, or flat amount portion of total coverage for each dependent	Zero (not applicable)	Zero
Dependent/Beneficiary	Zero (not applicable)	Zero (not applicable)	Zero (not applicable)	Zero (not applicable)	This dependent's coverage

Pension Plans

This table shows how the Flat Amount field is used with pension plan types:

Participant	Description
Employee	Zero (not applicable)
Dependent/Beneficiary	Beneficiary allocation (if flat amount allocation is elected)

Pages Used to Run the Enrollment Reporting Snapshot Process

Page Name	Definition Name	Navigation	Usage
Refresh Benefits Snapshot	RUN_BEN100A	Benefits, Interface with Providers, Refresh Benefits Snapshot, Refresh Benefits Snapshot	Extract information from the Manage Base Benefits business process tables into the BN_SNAP_PER, BN_SNAP_JOB, and BN_SNAP_PLAN tables.
Review Interface Run History	BN_SNAP_HIST	Benefits, Interface with Provider, Review Interface Run History, Review Interface Run History	Review a history of when the Enrollment Reporting Snapshot, the Carrier Interface Extract, and the Carrier Interface Supplier Integration processes were run.
Snapshot History Detail	BN_SNAP_HIST_DTL	Click Detail on the Review Interface Run History page.	Review additional information about the history record.
Review Snapshot Information	BN_SNAP_PLAN	Benefits, Interface with Provides, Review Snapshot Information, Review Snapshot Information	Review the information extracted by the Enrollment Reporting Snapshot process.
Enrollment Snapshot Detail	BN_SNAP_PLAN_DTL	Click Detail on the Review Snapshot Information page.	View additional information regarding the selected enrollment or allocation record.

Sending Data to Benefit Providers

After the Enrollment Reporting Snapshot process runs, you can send enrollment data to your plan providers. Two ways are available to send this information:

Run the appropriate SQR Provider Extract process to create a provider extract file.
Use the PeopleSoft Carrier Reporting process in eBenefits.

This section discusses how to:

Create SQR provider extracts.
Run carrier extracts.

Creating SQR Provider Extracts

Provider requirements for enrollment data are seldom the same. The Manage Base Benefits business process includes a set of sample extract SQR programs that you can modify for your providers. Each sample SQR program:

Includes a realistic set of data fields for the associated plan types.
Records a history of each run.
Sends an enrollment termination to a provider only once.

After determining file layout requirements for your providers, clone the appropriate sample SQR program for each file layout that you need and make any necessary changes using the database record layout information for BN_SNAP_PER, BN_SNAP_JOB, and BN_SNAP_PLAN.

Four sample SQRs and two library files are available:

BEN102.SQR: sample file extract for health (1x) plans.
BEN103.SQR: sample file extract for life/AD&D (2x) plans.
BEN104.SQR: sample file extract for disability (3x) plans.
BEN105.SQR: sample file extract for savings (4x) plans.
BENCRFNC.SQC: library of useful functions for developing provider extracts.
BENCRTBL.SQC: library of internal cache tables.

Running Carrier Extracts

Create a flat file that can be sent to your plan providers. Use the Health, Life/ADD, Disability, and Savings Extract pages, or your own provider-specific pages to do this.

If you rerun an extract because of a problem and have set up the extract to send terminations only once, delete the run history record for this extract on the Review Interface Run History page before running the extract again.

Sending HIPAA Data to Providers

The Health Insurance and Portability and Accountability Act of 1996 (HIPAA) requires a standard electronic exchange of administrative and financial health care transactions between health care providers and plans. The PeopleSoft HIPAA EDI File Create process enables you to send these HIPAA 843 transactions.

Before you can send HIPAA data to providers, you must:

Identify the providers on the Benefits EDI Trading Partners page who will be receiving the transaction transmission.
Use the Benefits EDI 834 Transaction Map Table page to convert PeopleSoft code values to the values required by the reporting standard.
Run the Refresh Benefit Snapshot process to populate the Benefit Snapshot extract tables with the health plan data required to create the 834 transactions.

This section discusses how to create the HIPAA EDI 834 file.

See Setting Up HIPAA Tables.

Page Used to Create the HIPAA EDI 834 File

Page Name	Definition Name	Navigation	Usage
Create HIPAA EDI 834 File	RUNCTL_BEN834	Benefits, Interface with Providers, Create HIPAA EDI 834 File, Create HIPAA EDI 834 File	Create the HIPAA EDI 834 file. Identify the EDI trading partner, vendors, plan types, and companies to include in the transmission and run the process to create the 834 transactions.

Creating the HIPAA EDI 834 File

Access the Create HIPAA EDI 834 File page (Benefits, Interface with Providers, Create HIPAA EDI 834 File, Create HIPAA EDI 834 File).

To run the Create HIPAA EDI 834 File process, you must enter an EDI partner ID and at least one vendor, company, and plan type.

As Of Date	Displays the last date that the Enrollment Reporting Snapshot was run.
File Effective Date	Enter a value that the system sends in a DTP segment (which includes a date qualifier of 007).
File Enrollment Date	Enter a value that the system sends in a DTP segment (which includes the date qualifier of 382).
Acknowledgement Requested	Select to request an acknowledgement from the EDI trading partner.
EDI Partner ID	Enter the trading partner for the transmission. EDI partner IDs are defined on the EDI Transaction Partner table.
File Type	Select from one of the following values in this drop-down menu: Full File Audit: Select this value to create a file that contains records for all employees, including terminations. This file type is the default. Full File Replacement: Select this value to create a file that contains current records only as of the date of the file. The system drops all terminated employees from the file. This file is typically used in conjunction with Update Only files and is sent to verify synchronization between the two systems. Update Only File: Select this value to create a file that contains only those records in which changes have occurred to either the employee or any of his or her dependents' records that are relevant to the vendor and can be tracked in HRMS through the use of effective dates. Note. When you select Update Only File, the following fields appear and are required: From Date and To Date.
From Date and To Date	This date range filters the change records to include only those employee records that had changes within the date range. Benefit enrollment records use the Election Date as the date that the change was made. This allows for backdated changes in addition to future changes to be included in the file. The system sets the to date automatically to the snapshot as of date.
Include All Vendors	Select to include all vendors who are classified as providers on the Provider/Vendor table and also appear on the Snapshot Plan table.
Vendor ID	Enter the vendor to be included in the transmission. Valid values are only those vendors who are classified as providers on the Provider/Vendor table and also appear on the Snapshot Plan table. Note. The providers selected for the 834 transaction must have a valid Federal Employer Identification Number (FEIN) entered on the Provider/Vendor table. The system generates a warning if the FEIN is missing for one or more providers.
Include All Companies	Select to include all companies who appear both on the Company table and on the Snapshot Plan table.
Company	Enter the company (employer) to be included in the transmission. Valid values are only those vendors who appear both on the Company table and on the Snapshot Plan table. Note. The companies selected for the 834 transaction must have a valid FEIN entered on the Company table. The system generates a warning message if the FEIN is missing for one or more companies.
Include All Plan Types	Select to include all plan types that appear on the Snapshot Plan table.
Plan Type	Enter the plan type to be included in the transmission. Valid values are only those plan types that appear on the Snapshot Plan table.
Max Members in Transaction Set (maximum members in transaction set)	Specify the maximum number of members to be included in each transaction set of the transmission. The default value is 10,000, which is the maximum allowed by the reporting standard, but you can set a lower number not less than 100.

(USF) Sending FEHB Data to the OPM

Federal agencies must send quarterly reports to major FEHB providers. These reports enable the provider to compare their enrollment records with the agency's records.

To send FEHB data to the OPM:

Identify the employees and dependents who are enrolled in Medicare A, Medicare B, and Champus plans using the Benefits Personal Data and the Federal Medicare Flags pages.
Run the FEHB Carrier Interface process to extract the data and write it to the extract file.

Note. The run control ID cannot be more than 8 characters.

Note. You must specify at least one plan or select the All Plans check box.
Send the data by running the Transmit Enrollments to eBenX.
Review the data using the Review FEHB Interface History page or the FEHB Reconciliation report.

Pages Used Send FEHB Data to the OPM

Page Name	Definition Name	Navigation	Usage
FEHB Carrier Interface	GVT_RUN_FGBN001	Benefits, Interface with Providers, FEHB Carrier Interface, FEHB Carrier Interface	Extract data to send to the OPM.
Transmit Enrollments to eBenX (transmit enrollments to electronic benefits transmission)	BN_M_RUN_CNTL	Benefits, Interface with Providers, Transmit Enrollments to eBenX, Transmit Enrollments to eBenX	Sends data to the OPM.
Review FEHB Interface History	GVT_INT_HIST	Benefits, Interface with Providers, Review FEHB Interface History, Review FEHB Interface History	Review data in the extract file.

Plan Types to Include	Select only the plan types for which you will create a carrier interface extract or transmit data to the Carrier Interface Supplier Integration process in eBenefits. Note. If you are running the snapshot process only to create a HIPAA EDI 834 file, check only the Health plan type to reduce the time necessary to populate the Snapshot tables.
Include Payroll Deduction Info (include payroll deduction information)	Select to include the last deduction taken and the pay end date for each enrollment.
Calculate Life/Disability Covg (calculate life/disability coverage)	Select to have the Enrollment Reporting Snapshot process calculate coverage for life and disability plans using the plan definitions, calculation rules, and employee's compensation rate or annual benefits base rate.
Include Implied Term (include implied terminations)	Select to include enrollments that are no longer valid because the participant has enrolled in another plan type, waived coverage, or transitioned to COBRA coverage. Note. You use this field whenever a carrier requires a positive notification of a termination or plan change (some carriers can detect these events simply by noticing a previous enrollment record).
Include Implied Dependent Terminations	Select to create termination records for dependents in the snapshot and report them in the HIPPA file when a termination of an employee also terminated the dependent or when new coverage has been added for an employee and a dependent who was previously covered has been dropped from coverage. Note. You must select Include Implied Employee Terminations, for Include Implied Dependent Termination to be functional.
Include Original Enrollment Dt (include original enrollment date)	Select to include an employee's earliest continuous enrollment date in the current, active plan. This applies only to employee-level enrollments and allocations. Changes to coverage codes in health plans, employee-specified coverage amounts in life and disability plans, or employee contribution amounts do not constitute a change in plan. This field applies to employees and dependents.