The plan setup Advanced tab includes the following sub tabs: EDI Change Fields and Billing Wash Rules
EDI Change Fields
The EDI Change Fields tab is specific to companies/plans that are using the Self Service EDI product to transmit files to a carrier. The settings allow admin users to define demographic change tracking rules if a carrier requires modifications to enrollment records when employee demographics change.
The following tabs under the employee profile are supported: Profile, Employment, ACA/Statutory Classifications, and Personal/Medical
When fields are checked off to track changes, the system will require admin users to input an effective change date when any of those fields are changed on an employee record.
Write New Coverage Start Date: The field change should reflect a total change in effective date. When checked and an employee has a change to that field, both the EDI file and the employee's benefit summary will reflect the new effective (change) date. Additionally, the employee data sheet will reflect a prior record with an end date that is the change date - 1 day, and a new, current record with a start date that is the change effective date.
Write Maintenance Code Date: The field change should just write a "maintenance code" to let carrier know when the change is effective. When checked, the employee's benefit summary and data sheet will still reflect the original effective date, and only the change date will be listed on the EDI file.
Billing Wash Rules
The Billing Wash Rules tab allows users to configure optional billing settings to indicate how the carrier charges monthly premiums for employees that are only enrolled for part of the month. When not configured, the system uses the 15th of the month as the default billing wash rule.
Carrier Wash Rules Add: The date used by the carrier to determine if a monthly premium is due for a new enrollment that is not effective for the full month. All new enrollments with an effective start date that falls on or before the selected day will be considered billable for that month.
- Ex: 15 is selected from the drop-down. Premiums will be charged for all new enrollments effective between the 1st - 15th of the month. Premiums will not be charged for any new enrollments effective between the 16th - end of the month.
Carrier Wash Rules Terminate: The date used by the carrier to determine if a monthly premium is due for an ended enrollment that is not effective for the full month. All ended enrollments with an effective end date that falls on or before the selected day will be considered billable for that month.
- Ex: 15 is selected from the drop-down. Premiums will be charged for all ended enrollments with an effective end date between the 1st - 15th of the month. Premiums will not be charged for any ended enrollments with an effective end date between the 16th - end of the month.
Carrier Wash Rules Change: If an employee switches plans/coverage levels mid-month, how will they be charged?
- Ex: If an employee added a spouse effective 11/8 and the change wash rule is 11/15. This means the employee would owe the EE+ Spouse rate for the entire month of November. (the system defaults to the 15th).
- Billing wash rules only apply to the following reports: W-2 Summary, Bill Reconciliation, and the advanced payroll tracking deduction file.