7Manage Open Enrollment

This chapter contains the following:

The benefits open enrollment process comprises three phases: preparation, the enrollment period, and post enrollment activities. This chapter provides a sample timeline, checklists, and instructions to guide you through the phases of open enrollment.

Open Enrollment Period Opportunities

The open enrollment period is an opportunity for eligible participants to:

  • Enroll in a plan if not currently enrolled

  • Change coverage from one plan to another

  • Change enrollment status of eligible family members

  • Decline coverages

Open enrollment is also an opportunity for your organization to:

  • Modify plan configuration

  • Update rates

  • End benefits offerings

  • Start new benefits offerings

Sample Open Enrollment Timeline

This sample timeline and the instructions in this chapter assume the following dates and rules:

  • Open enrollment elections are effective on the event date, January 1.

  • Coverages and rates start on the event date, January 1.

  • Previous year coverages and rates end one day before the event date.

You must thoroughly test the open enrollment procedures using your configuration if either of the following conditions is true:

  • Your organization's open enrollment is effective on any other date within the year.

  • You apply different coverage and rate start and end date rules to meet your business requirements.

The following timeline outlines suggested activities before, during, and after an open enrollment period that lasts throughout the month of November.

Month Details

September and October

Update plan configuration

Run a trial open enrollment:

  • Test performance

  • Test self-service enrollment

November 1

Run the open event processing:

  • Evaluate Scheduled Event Participation

  • Enroll in Default Benefits

Throughout November

Elect benefits:

  • Participants enter elections using the self-service guided process.

  • Benefits administrators enter elections in the Benefits Service Center page.

December 2 -- 15

  • Benefits administrators can still enter elections as necessary by setting a session effective date within the enrollment period of November.

December 15

Run the Close Enrollment process to close all elections.

Phase One Checklist: Before the Open Enrollment Period Starts

Follow these steps to prepare for the open enrollment period:

Task Work Area

Check payroll calendars.

Contact payroll administrator

Check plan year periods.

Plan Configuration

Assess and update eligibility profiles and derived factors.

Plan Configuration

Prepare program and plan configurations:

  • End existing plans no longer offered.

  • Add new plans.

  • Add new options to existing plans.

Plan Configuration

Add the open scheduled life event to the program or plan not in program.

Plan Configuration

Manage standard and variable rates:

  • Add rates to new benefits objects.

  • Modify rates on existing benefits objects.

  • Modify elements on existing rates.

  • Modify flex credit offerings.

Plan Configuration

Start new coverage for flexible spending accounts (FSA)

Plan Configuration

Configure enrollment and rate display.

Plan Configuration

Identify and resolve in-progress life events:

  • Identify conflicting and incomplete life events

  • Identify and finalize open action items and suspensions

  • Evaluate and resolve temporal event participation

Evaluation and Reporting

Enrollment

Process trial open enrollment.

Evaluation and Reporting

  • Test trial open enrollment.

Enrollment

Me - Benefits (Self-Service)

  • Analyze and tune performance.

Evaluation and Reporting

Phase Two Checklist: During the Open Enrollment Period

Follow these steps to administer the open enrollment period:

Task Work Area

Generate the Participant Enrollment Results report.

Reports and Analytics

Manage the open enrollment period.

  • Run the Evaluate Scheduled Event Participation and Enroll in Default Benefits processes.

Evaluation and Reporting

  • Monitor processes and resolve errors.

Evaluation and Reporting

  • Enter enrollments.

Me - Benefits (Self-Service)

Enrollment

  • Process life events that occur during the open enrollment period.

Enrollment

Manage and close the open enrollment window.

Evaluation and Reporting

Generate the Participant Enrollment Results report.

Reports and Analytics

Phase Three Checklist: After the Open Enrollment Period Ends

Follow these steps to complete the open enrollment activities:

Task Work Area

Verify enrollment.

Enrollment

Investigate incorrect enrollments.

Enrollment

Close action items and certifications.

Enrollment

Enter overrides.

Enrollment

Inactivate plans that are no longer offered.

Plan Configuration

Process life events that occur after open enrollment.

Enrollment

Process Trial Open Enrollment

One month before your actual open enrollment, run a trial open enrollment in a test instance to tune performance and validate plan configuration for the upcoming plan year.

At this point, in your production instance, you have:

  • Prepared your programs and plans

  • Updated your standard and variable rates

  • Configured enrollment and rate display

  • Configured flexible spending account plans to start new coverage

  • Closed in-progress life events

  • Finalized and closed action items

  • Processed and resolved temporal event participation

Now, you create a separate test instance from this production instance with all or a representative sample of your participants and manage your trial open enrollment.

The trial open enrollment mimics many aspects of the actual open enrollment process, as shown with the following basic high-level tasks:

Task Work Area Phase I Trial Open Enrollment Phase II Actual Open Enrollment

Generate the Participant Enrollment Results report.

Reports and Analytics

Identify test participants.

Compare enrollments before and after open enrollment.

Identify any in-progress life events and resolve them before processing open enrollment.

Run the Evaluate Scheduled Event Participation and Enroll in Default Benefits processes.

Evaluation and Reporting

Yes

Yes

Monitor processes and resolve any errors.

Evaluation and Reporting

Enrollment

Yes

Yes

Identify and fix performance issues.

Evaluation and Reporting

Yes

Refine as required.

Iteratively, check plan configuration and rates using sample employees and fix errors as required.

  1. Back out the open life event.

  2. Correct setup.

  3. Rerun the open event.

Evaluation and Reporting

Enrollment

Self-Service

Plan Configuration

Yes

Validate on an exception basis.

Enter enrollments.

Self-Service

Enrollment

On a test basis

Yes

Identify and Fix Performance Issues

It's difficult to determine the amount of time it takes to process a single person due to the variables that can impact performance. These variables include:

  • Complexity in plan configuration

  • Hardware

  • Network usage

  • Optimized table usage

  • General database tuning

Poor performance times often result from not running table statistics on a regular basis. In the Evaluation and Reporting work area:

  • Check that the threads parameter is set to the number of processors for the computer, at a minimum.

  • Check that the chunk size is appropriate to the quantity of rows that processes are writing to the database.

    Use a smaller value when writing many rows, such as when processing participants and converting annual enrollments.

  • Analyze and adjust your maximum error threshold as required using the Manage Batch Parameters task.

    Example: If you process your trial open enrollment using your entire participant population, processes might fail because they reached the maximum errors threshold.

  • Analyze all index column statistics and gather column, schema, and table statistics before the following processes.

    • Evaluate Scheduled Event Participation

    • Enroll in Default Benefits

    • Close Enrollment

Manage Open Enrollment Period

Process your open scheduled event so that participants can make their benefits elections.

At this point, you have:

  • Completed your trial open enrollment where you validated your:

    • Programs and plans

    • Standard and variable rates

    • Enrollment and rate display configuration

  • Configured flexible spending plans to start new coverage

  • Closed unprocessed life events

  • Finalized and closed action items

  • Processed and resolved temporal event participation

During your trial open enrollment, you focused on performance and validation. Now during your actual open enrollment period, you focus on monitoring and managing the:

  • Open enrollment period

  • Participant enrollments

  • Intervening life events

Task Work Area Phase I Trial Open Enrollment Phase II Actual Open Enrollment

Generate the Participant Enrollment Results report.

Reports and Analytics

Identify test participants.

Compare enrollments before and after open enrollment.

Identify any in-progress life events and resolve them before processing open enrollment.

Run the Evaluate Scheduled Event Participation and Enroll in Default Benefits processes.

Evaluation and Reporting

Yes

Yes

Monitor processes and resolve any errors.

Evaluation and Reporting

Enrollment

Yes

Yes

Identify and fix performance issues.

 

Yes

Refine as required.

Iteratively, check plan configuration and rates using sample employees and fix errors as required.

  1. Back out the open life event.

  2. Correct setup.

  3. Rerun the open event.

Evaluation and Reporting

Plan Configuration

Yes

Validate on an exception basis.

Enter enrollments.

Self-Service

Enrollment

On a test basis

Yes

Process life events that occur during the open enrollment period.

Enrollment

Not applicable

Yes

Manage the open enrollment window.

Evaluation and Reporting

Not applicable

Yes

Close open enrollment.

Evaluation and Reporting

Not applicable

Yes

Scheduled Event Participation Process Options

When preparing to submit the Evaluate Scheduled Event Participation process in the Evaluation and Reporting work area, pay particular attention to setting the following key parameters.

Parameter Comments

Effective Date

Select the first day of your open enrollment period, for example, November 1, 2015.

Detect Temporal Events

Regardless of whether you decide to detect all, some, or no temporal life events, during processing the open event evaluates each participant's:

  • Age

  • Length of service

  • Salary

  • Other temporal factors

Person Type

To exclude terminated participants, select Employee or Participant.

Life Event Occurred Date

Select the date as of which to evaluate eligibility and determine rates.

For the open event, this date is typically the first day of the new benefit year, for example, January 1, 2016.

Life Event

Select Open.

Apply Defaults

Select Yes to run the Enroll in Default Benefits process automatically after the Evaluate Scheduled Event Participation process completes so that participants can view their default enrollments when they enroll.

Select No to apply default enrollments later using the Enroll in Default Benefits process.

Example: You might run the process after participants finish electing their enrollments and before you close the enrollment period.

Audit Log

Select Yes only for troubleshooting. It causes the application to generate detailed audit logs. Processing stops for any process generating an audit log, after that log becomes full.

Select No to generate only summary information if you are processing your entire participant population.

Tip: To limit the population processed, you can set additional parameters, such as Benefits Group, Location, Legal Entity, and others, or write a person selection formula.

Process Default Enrollments

Depending on how you configured your programs and plans, the Enroll in Default Benefits process does the following:

  • Enrolls participants using their current enrollments if they make no explicit election choices

  • Assigns participants new default enrollments

  • Changes current elections to a new default election

    Example: You have a dependent care spending plan configuration that sets current participants to nothing or a waive plan or option.

Monitor Processes and Resolve Errors

When processing open enrollment, always check the process-generated log files to identify and fix any errors in your trial and production instances.

  • You identify and fix many issues during the trial open enrollment, which reduces, but does not eliminate, issues raised during the actual open enrollment.

  • Run the Restart Participation Evaluation and Back Out Life Events processes, as required.

Use the Evaluation and Reporting work area.

This topic covers:

  • Monitoring processing

  • Restarting participation evaluation

  • Backing out life events

Monitor Processing

Use the Monitor Process Request section of the Overview page to view the percentage of completion for processes and the process-generated logs and reports.

Example: The Evaluate Scheduled Event Participation process:

  • Log files identify who failed and how to fix the issue

  • Summary report provides an overall summary of the following:

    • Participants that processed successfully, in error, or were unprocessed

    • Open life events with a Started status

If you can't run a process that generates an audit log, then in the Maintenance Processes section:

  1. Run the Purge Participation Evaluation Audit Data process.

    The purge process protects ongoing activities by purging data only from completed batch processes. Purging the audit logs does not affect life event or election information.

  2. Restart the interrupted process.

Caution: You want to generate audit logs only during trial open enrollment.

Check that production processes do not generate audit logs, especially for batch processes that use the entire participant population.

Restart Participation Evaluation

Run the Restart Participation Evaluation process after fixing errors, such as errors resulting from reaching the maximum allowable errors or full audit logs.

Back Out Life Events

If the open event must be backed out for the entire participant population or a select group of participants, run the Back Out Life Events process for the Open life event. You do this most typically during the trial open enrollment to retest edited plan configurations.

When backing out open life events, set the resulting life event status to:

  • Unprocessed to include it for future processing

  • Voided to exclude it from any further processing

Life Events That Occur During Open Enrollment Period

You must act on any intervening life events that occur during an open enrollment period. This topic explains what causes intervening life events, provides an example, and lists reports to detect them.

Causes of Intervening Life Events

Any of the following actions can generate intervening life events based on their setup:

  • The Evaluate Temporal Event Participation process detects temporal life events for workers, such as grade or age changes.

  • The administrator or participant adds a contact, for example, a spouse or child, using the Contacts page.

  • The administrator adds a life event manually using the Person Life Events page in the Benefits Service Center page.

Example of Intervening Life Event

Scenario: During the open enrollment period, a participant experiences a gain dependent life event that affects eligibility for electable choices.

The administrator or specialist must:

  1. Allow the life event to back out the open event.

  2. Take steps to process the intervening life event.

  3. Reprocess the open event.

Reports to Detect Intervening Events

Use the sources in the following table to review evaluation processing results and identify intervening life events:

Population Processed Life Event Report Location

All participants or selected population

Life Event tab on the Summary page of the Evaluation and Reporting work area

  1. Search for events in the Detected status with other report parameters.

  2. Click Details to view the participant list.

Specific participant

Use the Person Life Events task in the Benefits Service Center page

  1. Select the Potential Life Events tab.

  2. View any detected or unprocessed life events for that worker.

Examples of Processing Life Events That Occur During Open Enrollment

This topic provides three intervening life event scenarios along with the steps to process and resolve each event.

The following intervening life event scenarios share common open enrollment dates:

  • Life event changes electability

  • Life event doesn't change electability

  • Life event added manually

You can remove the processing of a life event performed by participation evaluation processing, and you can prevent further processing of a life event.

  • Close a life event to prevent further processing.

  • Back out a life event to roll back any updates generated by the participation evaluation processing, such as updates to eligibility, rates, and automatic de-enrollments

  • Void a life event to roll back any updates and prevent further processing by participation evaluation processing.

Common Open Enrollment Dates

All examples in this topic assume the following main dates:

  • The open enrollment period is from November 1 to 28, 2015.

  • The new plan year starts January 1, 2016.

  • Coverage and rates for elections made during the open enrollment period start on January 1, 2016.

Life Event Changes Electability

Scenario:

  • A participant gains a spouse on November 20, 2015 and reports the event to the benefits administrator who updates the contact information.

    • Evaluation processing detects the gain dependent life event.

    • The life event provides new electable choices, with rates and coverage effective November 20, 2015.

  • New electable choices are also currently available for open enrollment.

To resolve this event:

  1. Evaluate the gain dependent life event for the participant in the Benefits Service Center using the Process Life Event task.

    Allow the life event to back out the open enrollment event for that participant. The status of the life event changes to Started.

  2. Ask the participant to make elections based on the gain dependent life event.

    • Participants open self-service enrollment by selecting Benefits under Me on the Navigator menu.

    • Benefits professionals can make elections on the participant's behalf in the Benefits Service Center using the Enrollments task.

  3. Close the gain dependent life event for the participant in the Benefits Service Center using the Life Events tab of the Person Life Events task.

    The status of the life event changes to Processed.

  4. Reprocess the open enrollment for that participant using the Process Open Enrollment task.

    Ask the participant to make elections.

Life Event Doesn't Change Electability

Scenario: A participant changes address on November 13, 2015, but remains in the same postal code.

  • The process detects an address change life event for the participant and backs out the open event.

  • You know that this address change doesn't affect rates, coverages, or electable choices, so you want to void it.

To resolve this event, in the Benefits Service Center:

  1. Void the address change event using the Person Life Events task.

    1. On the Life Events tab, select the event.

    2. On the Actions menu, select Back out event.

    3. In the Potential Life Event Status field, select Voided.

  2. Reprocess open enrollment for that participant using the Process Open Enrollment task.

    The reinstatement rule restores any open enrollment elections already made.

Life Event Added Manually

Scenario: A participant gains a child on November 20, 2015.

  • The participant reports the event to the benefits specialist.

  • The specialist:

    1. Adds a gain dependent life event manually in the Benefits Service Center using the Person Life Events task.

    2. Sets the life event status to Manual.

To resolve this event, in the Benefits Service Center:

  1. Change the status of the gain dependent life event to Unprocessed.

    Use the Potential Life Events tab of the Person Life Events task.

  2. Evaluate the gain dependent life event using the Process Life Event task.

    • Allow the gain dependent life event to back out the open enrollment event for that participant.

    • The status of the gain dependent life event changes to Started.

    • The event provides new electable choices, with rates and coverage effective on the date of childbirth.

  3. Continue as in steps 2 -- 5 of the first scenario, Life Event Changes Electability.

How Participants and Administrators Enter Enrollments

Multiple methods exist for entering enrollments and the open enrollment process typically uses all of them.

  • Participants make their elections using the self-service enrollment guided process.

    If participants have election opportunities, they can click Me - Benefits on the Home page.

    Tip: In your trial environment, you must first select Parameter Display on the Manage Self-Service Enrollment Configuration page before you can make elections as a participant.
  • Benefits administrators enter enrollments for specific participants in the Enrollments work area.

    1. Benefits professionals can generate a Benefit Enrollment document on the Manage Person Life Events page and send it to participants.

    2. Participants can use the document to make their election choices and return the completed document.

    3. Benefits professionals use the completed document to enter the participant elections into the Enrollments page in the Benefits Service Center page.

  • Benefits administrators can make default enrollments for participants who didn't elect any benefits. They use the Enroll in Default Benefits process in the Evaluation and Reporting work area.

    The Enroll in Default Benefits process might have already run automatically depending on whether you elected to apply defaults as part of the Evaluate Scheduled Event Participation process.

Set Up and Process an Open Enrollment Period

This example contains a basic scenario with setup steps to define an open enrollment period and run the process to evaluate scheduled event participation.

The following table summarizes key decisions in this scenario.

Decisions to Consider In This Example

Are there any new offerings that you want to add for the open enrollment period?

Yes, add the InFusion Vision plan to the InFusion Wellness program.

What are the start and end dates for the open enrollment period?

Starts November 1, 2015. Ends November 15, 2015.

When do you want eligibility to be evaluated and new rates determined based on elections?

Start date of the new plan year, which is January 1, 2016 in this example.

When do you want the new coverage to start?

Start date of the event

When do you want the previous coverage to end?

One day before the event

When do you want the new rates to become effective?

Start date of the event

When do you want previous rates to end?

One day before the event

Task Summary

  1. Add the new plan to the program.

  2. Define the open enrollment period for the program.

  3. Process the open event as of the first day of the open enrollment period.

  4. Check the enrollment page of a sample worker to verify that all electable choices appear as expected.

Prerequisites

In the Plan Configuration work area, ensure that you created a:

  1. Plan type called InFusion Wellness

    Use the Manage Plan Types task to create the plan type.

  2. Program called InFusion Wellness with the following configuration:

    Field Value

    Program Type

    Core

    Year Periods

    Year periods for the current plan year and the new plan year:

    • January 1, 2015 to December 31, 2015

    • January 1, 2016 to December 31, 2016

  3. Plan called InFusion Vision with the following configuration:

    Field Value

    Plan Type

    InFusion Wellness

    Usage

    In program

    Year Periods

    Year periods for the current plan year and the new plan year:

    • January 1, 2015 to December 31, 2015

    • January 1, 2016 to December 31, 2016

Adding the Plan to the Program

Use the Plan Configuration work area to complete this task with the default values for fields unless the steps specify other values.

  1. In the Tasks panel drawer, click Benefit Program Details to open the Manage Benefit Program Details.

  2. In the Search Results table, click InFusion Wellness.

  3. In the Session Effective Date field, select the first day of the current plan year, for example, January 1, 2015.

  4. In the Plans and Plan Types section, click Select and Add Plan.

  5. Complete the fields, as shown in this table.

    Field Value

    Sequence

    Enter a unique sequence based on the sequence of existing plans in your program.

    Plan

    InFusion Vision

    Status

    Pending

  6. Click OK to return to the Edit Program Basic Details page.

  7. Click Save.

  8. Review the effective start date of the plan that you added.

    The date should be the first day of the current plan year, for example, January 1, 2015.

  9. In the Session Effective Date field, select the first day of the new plan year, for example, January 1, 2016.

  10. In the Plans and Plan Types section, select the InFusion Vision plan.

  11. On the Edit menu, select Update.

  12. Set the plan status to Active.

  13. Click OK to return to the Edit Program Basic Details page.

  14. Click Save.

  15. Review the status and effective date of the InFusion Vision plan.

    The status should be Active and the effective date should be the first day of the new plan year, for example, January 1, 2016.

Defining the Open Enrollment Period

  1. Click the Enrollment step.

  2. Select the InFusion Wellness program in the hierarchy.

  3. On the Scheduled tab, select Open, the default event is Administrative.

  4. In the Periods section, click Create.

  5. Complete the fields, as shown in this table.

    Field Value

    Enrollment Period Start Date

    November 1, 2015

    Enrollment Period End Date

    November 15, 2015

    Close Enrollment Period Date Rule

    When enrollment period ends

    Assigned Life Event Date

    January 1, 2016

    Year Period

    January 1, 2016 to December 31, 2016

    Coverage Start Date

    Event

    Previous Coverage End Date

    One day before the event

    Rate Start Date

    Event

    Previous Rate End Date

    One day before the event

  6. Click OK to return to the Edit Program Enrollment page.

  7. Click Save and Close to return to the Programs tab.

Processing the Open Event

Use the Evaluation and Reporting work area to complete these steps with the default values for fields unless the steps specify other values.

  1. Select the Processes tab.

  2. In the Evaluate Scheduled Event Participation row of the Evaluation Summary Process Life Events table, click the Submit icon button.

  3. In the Parameters section, complete the fields as shown in this table.

    Field Value

    Effective Date

    The first day of the open enrollment period, for example, November 1, 2015

    Life Event Occurred Date

    The first day of the new plan year, for example, January 1, 2016

    Life Event

    Open

  4. Select additional parameters to limit processing to a test population.

  5. Click Submit.

  6. In the Monitor Process Request section, search for the process that you submitted and verify that it completed successfully.

  7. Click the View Report icon button of the process that you submitted.

  8. On the process details page, check the Results section to see how many worker records processed successfully and how many processed with errors.

    Click the number to view details about the specific worker records that processed.

  9. In the Benefits Service Center page of any worker in the processed test population:

    1. Click the Enrollments task.

    2. Verify that the new InFusion Vision plan appears as an electable choice.

How You Manage an Open Enrollment Window

The day after your open enrollment period ends, run the Close Enrollment process in the Evaluation and Reporting work area. If necessary, you can extend or adjust the open enrollment window.

Tip: If you haven't already done so, run the Enroll in Default Benefits process before closing enrollment.

Close Enrollment

To close enrollment:

  1. Optionally, run the Close Enrollment process with the:

    • Validate parameter set to Roll back - database will not be updated

    • Audit Log parameter optionally set to Yes.

    Analyze the generated logs and reports. Investigate and fix any errors.

  2. Run the Close Enrollment process with the

    • Validate parameter set to Save - database will be updated

    • Audit Log parameter set to No

Extend Open Enrollment

You can extend an open enrollment period when unexpected delays require additional days for certain participant population segments, or the entire population, to complete their annual enrollment selections.

In the Evaluation and Reporting work area use the Adjust Open Enrollment Window process to:

  • Update the enrollment period end date, processing end date, and default enrollment date

  • Provide an appropriate number of extension days

The generated log file displays the details of the new enrollment period for all participants.

If you ran the Close Enrollment process and you now want to reopen the event, you can run the Reopen Life Event process, selecting the event and the population parameters.

Tip: Use the Reopen Life Event process, selecting the Open event, with the Adjust Open Enrollment Window process to extend the annual enrollment window after reopening a closed Open scheduled event.

How You Manage Tasks After the Open Enrollment Closes

Now that your open enrollment period is closed, you're ready to perform the following tasks in the production instance:

  • Verify enrollment.

  • Investigate incorrect enrollments.

  • Close action items and certifications.

  • Enter overrides.

  • Inactivate plans that are no longer offered.

  • Process intervening life events that occur after the open enrollment period.

Verify Enrollment

Generate the Participant Enrollment Results report in the Reports and Analytics work area and compare it with the same report that you generated before you opened enrollment.

Use the preenrollment and postenrollment reports as well as the reports on the Life Events tab of the Evaluation and Reporting work area to verify that:

  • Participants are no longer enrolled in plans that aren't offered in the new plan year

  • Eligibility evaluated correctly

  • Rates and premiums changes are reflected for the new plan year

  • Default plan and option enrollments processed correctly

  • Coverage restarted for flexible spending plans

  • Enrollment included any other plan configuration changes

  • Element entry values are correct for benefit elements

Also verify interim assignments and suspensions, action items and certifications, payroll results, and third-party interfaces.

Investigate Incorrect Elections

For any elections that failed during open enrollment:

  • Analyze the issue to determine if the failure occurred for one participant, many, or all.

  • Review the setup of the benefit objects involved to determine if there:

    • Was an oversight in making plan configuration changes

    • Were incorrect data on an employee

Close Action Items and Certifications

To indicate that participants have fulfilled outstanding action items and certifications:

  1. On the Enrollments page in the Benefits Service Center page, click Manage Enrollment Activities to open the Manage Enrollment Activities page.

  2. Depending on what item the participant is fulfilling, select the election and in the Enrollment Activities section enter and save the:

    • Dependent or beneficiary information

    • Received date for the certification

  3. On the Action Items tab, confirm that your action or certification shows as completed and the date of completion.

  4. To close unresolved action items and certifications, in the Evaluation and Reporting work area run the Close Action Items process.

Note: The application doesn't process the next life event until all unresolved action items for the prior life event are resolved, even if the prior life event has a Closed status.

Enter Overrides

In the Benefits Service Center page, use the following tasks:

Task Description Examples

Eligibility Override

Maintain override information for a potential participant who's otherwise ineligible for a particular program or plan.

  • A few employees live outside of a service area, but work inside the service area and your provider allows for this eligibility override.

  • Special approval has been given to continue coverage for dependents who exceed the plan age limits.

Enrollment Override

Override election information.

You might have to override eligibility first, to specify that a participant can enroll in a plan or option for which the participant was originally ineligible.

  • An employee received a special rate for a certain length of time.

  • Certain retirees have grandfathered rates that you don't want to change during the annual open enrollment.

Caution: Exercise caution when you override eligibility or enrollment so that the enrollment record doesn't extend indefinitely, for example, when you terminate an employee. Ensure that you enter the through date when you override eligibility, and the coverage end date, when you override an enrollment record.

Inactivate Plans That Are No Longer Offered

To inactivate plans:

  1. Disenroll all participants from the plans and options that are no longer offered.

  2. Verify in the Plan Configuration work area that these plans and options inactivate at the start of the new plan year.

For any plans and options that you haven't already scheduled to inactivate:

  1. Set the session effective date to the first day of the new plan year.

  2. Change the status to Inactive.

Process Intervening Life Events That Occur After the Open Enrollment Period

You must act on any intervening life events that might occur after an open enrollment period, and before the start date of the new plan year.

Example: A participant experiences an address change life event after the open enrollment period. As a result, the participant:

  • Might no longer be eligible for the elections made during the open enrollment period

  • Might be eligible for other offerings

The benefits administrator must:

  1. Process the intervening life event and allow it to back out the open event.

  2. Ask the participant to make necessary elections if required.

  3. Reprocess the open event as of any date within the open enrollment period if the intervening life event affects the eligibility of the open enrollment elections.

  4. Work with the participant to make or update elections using the Benefits Service Center page.