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.