Carrier Connection &Open Enrollment

Training

5/1/2015

Sentric, Inc.

Introduction

Carolyn VertulaSentric Product Support Specialist7 years experience working with HRIS systems

Questions?Hang on until the end, we’ll have 15 minutes of Q&A or email me at cvertula@sentrichr.com

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Webinar How ToI will not be able to hear you during the webinar until we get to the question and answer portion, but you have some tools to tell me if you need some help.

By your attendee status are some status icons to help me know if you need me to speak up or speak more softly. You can also put out the life saver to tell me if you need some assistance

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Agenda

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Two types of Open Enrollment EDI Requests

1. Open Enrollment Coordination Service

2. Open Enrollment Full Service (Coordination Service and Mapping/Configuration Change Service)

Open Enrollment Services Tasks

1. Requirements Gathering

Open Enrollment Services Planning

Open Enrollment Services Timeline

Poll

Carrier Connections Poll

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Steps Needed to Start the Open Enrollment EDI Process

• Customer will need to contact their CSR and let them know they would like to set up an Open Enrollment Carrier Connection• This needs to be done at least one month prior to

starting Open Enrollment• The case will be assigned to a Sentric Product Support

Specialist who will place the order for Open Enrollment Services with eBN

• eBN assigns an Analyst to the case• Sentric Product Support sets up a meeting between the

Customer, the Carrier, eBN, and Sentric to review next steps

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Who is Ebn?

• eBN is a partner with Sentric for all Carrier Connections and EDI processing

• eBN stands for Electronic Benefits Networking

• EDI stands for Electronic Data Interchange

• There is a fee associated with the 2 different types of Service• OE Coordination Service fee is $150.00 per connection• OE Full Service fee is $250.00 per connection

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Open Enrollment EDI Feed Facts

• eBN needs, at the very minimum, 1 month notice before your Open Enrollment Process begins to prepare for the data feed

• Open Enrollment Services is a totally separate process than that of the Standard Carrier Connection Production process• A Standard Carrier Connection Production feed has to be active or live in order to

perform the Open Enrollment Services• Production files will be stopped while sending Open Enrollment files to the

carrier• It is highly recommended that you leave a 3-4 week window open for

Carrier/eBN testing after you have completed your OE, and before your benefit effective date.

• It will be determined by the Carrier how “changes” get entered into their system during Open Enrollment Processing (example: Life Event - Marriage, Birth of a Child, Divorce), New Hires, Terminations. These changes are usually made by the customer directly logging onto the Carrier’s website portal and making those changes.

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Open Enrollment Services Partner

Service Description Order When …

Open Enrollment Coordination Service

eBN will coordinate the scheduling and handling of an in-production client-carrier connection between the client and the carrier, to include preparation and delivery of client’s Open Enrollment elections file to the carrier when there are no required mapping changes

An Open Enrollment elections file is required by carrier, and there are no mapping/configuration changes required

Open Enrollment Full Service (Bundled Open Enrollment Coordination Plus Mapping/Configuration Change Service)

With this one convenient Open Enrollment service, eBN will handle smoothly and accurately all the required in-production file coordination, scheduling and delivery of Open Enrollment elections file. In addition it includes all required mapping changes and testing with the carrier on behalf of the customer

There are mapping/configuration changes required to the carrier connection mapping due to Open Enrollment changes in client’s plans, codes, etc.

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Open Enrollment Services Planning Survey

Q# Question Yes No1 Does the carrier require that an electronic file of open enrollment elections be submitted prior to the new plan year start

date?

2 Will you be adding, changing or removing plans with this carrier?

3 Will you be making any structure changes with this carrier, such as division or location code changes?

4 Will you be making any changes to group numbers or plan numbers with this carrier?

5 Will you be creating new Year Plans in SentricWorkforce? (example: PPO-2014 changes to PPO-2015, etc.)

6 Will you be changing plan names in SentricWorkforce?

For each carrier connection in production, please complete the following survey to determine which Open Enrollment service(s) you need to order.

• If the answer to Q1 is “Yes” then you need “Open Enrollment Coordination Service”

• If the answer to any Q2 – Q6 is “Yes” then you need “Open Enrollment Full Service (Coordination Service and ‘Mapping/Configuration Change Service’)”

• Submit your Open Enrollment Services order at least 4 weeks ahead of your Open Enrollment start date

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Common Questions Asked to the Carrier

What determines the end of one plan year and the beginning of another? • Benefit Termination Date?• Benefit Termination Status?

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Benefits to HR Customer

Only set-up the details once (in SentricWorkforce) One less set of tasks to coordinate with your carriers No manual Open Enrollment data manipulations New elections delivered on-time No “missed enrollments” No late insurance cards No enrollment errors

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Open Enrollment

Coordination Service

Open Enrollment Full Service (Mapping &

Configuration Change Service)

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eBN Open Enrollment Services Timeline Examples

Test

Test Your Knowledge

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Questions

If you called in on the phone please enter *5 on your phone to ask a question.

=*5If you are listening on your computer please press the File question request button on your screen.

I will un-mute your line one at a time, so once you press *5 or press the button you may need to wait just a bit for your turn.

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Thank You!

Please take a moment to fill out the survey