Plan Design Copy Process: The Missing Pieces

The plan design copy feature available in OAB is life saver. It really does make the setup
migration process a piece of cake. However, there are some things that it does not copy over and at times this can be a cause of concern. These are some of the things that I have found which were not copied over by the process

- People group criteria attached to eligibility / variable rate profiles
- Some of the coverage and rate rules defined at Enrollment Period for Plan
- Some of the formulas attached at Enrollment Period for Plan
- Life events triggers
- Life event Collapse rules
- Life events not attached to the program enrollment definition
- Eligibility criteria Enrolled in Another plan information
- Eligibility criteria Covered in Another plan information
- I am assuming most of the related coverage based eligibility criteria
- Communication type setup

Setting OAB Conversion Profile

Use the following steps to set up the profile to prevent life events from triggering in OAB. This should generally be used when converting HR Data

1. Log in to US Super HRMS Manager or US HRMS Manager responsibility
2. Navigate to Other Definitions > Action Parameters form
3. Create a new parameter group name called OAB Conversion (if OAB Conversion does not exist)
4. Add Data Migrator Mode parameter (DATA_MIGRATOR_MODE) and set it to ‘P’.
5. Save the changes.
6. Log in as Application Administrator
7. Navigate to System Profile Values form.
8. From the Find window, select User Name, enter your username, and enter profile option ‘HR:Action Parameter Group Name’. Hit the Find button.
9. Under your user name, select ‘OAB Conversion’.
10. Save the changes.

This profile can be set at any level, setting it to user level will ensure that the life events are triggering for other users when they are making changes.

COBRA Notification Letter

It is difficult to setup the COBRA Notification Letter correctly the first time. There is no comprehensive documentation around it which makes it all the more challenging. These are some of the things to keep in mind

1. The seeded report refers to the COBRA Beneficiary tables. If a COBRA beneficiary record is not created for a participant, the report will not work. On the Program > Participation Eligibility > Life Event form, ensure that the "Applies To" field is null for the COBRA Initial life event. This field should only be setup for life events, such as Divorce, Child Becomes Ineligible etc., that allow dependents to enroll as participant in the COBRA program.

2. Ensure that you have attached the COBRA and HIPAA regulation to the COBRA compensation objects

3. Ensure that you have created a COBRA reporting group and included all the COBRA compensation objects to it. Also attach the COBRA regulation to it.

4. Create an Organization for the Benefits Department and attach it to the COBRA Program. The Organization details are listed on the COBRA report generated by OAB. You should also specify the Organization Role (Name of the Person) and Organization Role Type as Administrator

This setup will ensure that the COBRA notification letter is correctly generated.

How to setup Interim Coverage (Coverage Restriction)

Requirement:
You want to restirct a participant's coverage, in an insurance plan, that can be selected without a certificate. Untill the person provides the certificate you want him/herto receive a restricted coverage (interim).

Navigation:
Plan Enrollment Requirements > General > Plan > Coverage > Coverage Restrictions

Setup:

1. Set the Restrict Change Based On to

• Benefit Restrictions Applies: If the interim is to be setup based on the coverage amount selected
• Option Restrictions Applies: If the interim si to be setup based on the option included in the plan (e.g. cases where coverage is setup as multiple of salary)

2. Set the Change Restrictions to NULL

3. Define the Values based on which the restriction are to be imposed

• No Min check box: Select if there is no minimum for the plan
• Min: Select if you have not selected the no min check box. Enter the min coverage amount that should always be selected
• Min Rule: If the min amount is determined dynamically enter the name of the rule that returns the min amount
• No Max check box: Select if there is no maximum for the plan (very unlikely)
• Max: If you have not selected the No Max check box, enter the max coverage amount that can be selected (without certificate)
• Max Rule: If the max amount is determined dynamically enter the name of the rule that returns the max amount
• Max with Certifications: Enter the max amount that a person can ever select with a certificate.

4. Enter the details in the Interim region

• Assign Code: Controls the interim coverage that is assigned, when a person elects an amount that is more than the max amount defined in step 3.e/3.f. There are various codes available that help's in handling situations where a person is already enrolled in the plan and is increasing coverage or when a person is newly electing the benefits. E.g: If the code selected was Current Same Option in Plan, Same; New, Default. For an existing participant the interim would be same as his previous enrollment. For a new participant the default option would be set as the interim
• Unsuspend Code: Select the code that determines when coverage in the interim plan ends

5. Increases Region: Use only setting up Benefits Restrictions. Applies when an existing participant is increasing coverage

• Max: Control the maximum increase a person can make on his existing coverage. Setting this to 0 would not allow a person to increase coverage
• Max with Certification: Controls the max increase allowed with certification

6. Multiple Increases: Use only if you setting up Options Restrictions. Applies when an existing participant is increasing coverage

• Max: Controls the maximum permitted option levels jump. Level are determined based on the seq in which options are entered in a plan
• Max with Certification: Controls the max option level jump allowed with certification.

This setups can also be made specific to a life events by clicking on the life event button andentering the data on the form. This provides a finer control over interim coverages across life events.