Last updated: 9/8/2016
Plans tab: This page configures the plans included in the file and the HD03 code.
- Include in File: Select the check box next to all plans that will be transmitted in the file.
- Insurance Line Code (HD03): If carrier needs a value for HD03 (Loop 2300, HD segment) select from the drop down.
Common Dates: This page configures logic for employee eligibility dates (Loop 2000, DTP*356) and effective dates (Loop 2300, DTP*348)
- 348 – Common Effective Date: Enrollment start date is transmitted in the DTP*348, coverage start date. In the instances of a plan change, carriers may want to see a common effective date for anyone who was enrolled prior to the plan change. When common effective date is set, if coverage start date is before the common effective date, transmit the common effective date. If coverage is after the common effective date, transmit the coverage start date.
- 356 – Common Eligibility Date: Employee’s eligibility is calculated based on the employee’s hire date and plan’s entry/waiting period rules, and written to the file in the 2000 Loop, DTP*356. The Common Eligibility Date is the date the plan was originally offered by the carrier. Common Eligibility Date should be used when the carrier wants to report the date employee was originally eligible for the plans with that carrier.
Company decided to change carriers and offer a new medical plan with Aetna 1/1/2013. All employees eligible prior to 1/1/13 would receive a DTP*356 = 1/1/2013. At renewal, the employees eligible prior to 1/1/2014 will receive a DTP*356 = 1/1/2014.
When Common Eligibility Date is set to 1/1/13, employees who were hired and eligible prior to 1/1/13 (value stored as employee’s hired eligibility date) will get their DTP*356 set to 1/1/13, and employee’s eligible for the plan after the common eligibility date will get their DTP*356 set to their hired eligibility date.
HD04: This page configures the logic to insert a Benefit Amount or Requested Benefit Amount into the Loop 2300 HD04 field.
- This should ONLY be used when you are using the EDI engine to send plans that have a benefit volume (for example a Guardian file with ancillary lines) otherwise it should remain unset.
Plan Bundles: Some carriers bundle benefits together into one plan; e.g. prescription as part of a medical plan. However, when transmitting enrollments, the carrier expects to receive separate coverage sections (HD) for each.
- The bundling tool allows the additional bundled benefits to be specified so that the export tool writes the same benefit information -- dates, etc. -- but with a different 834 insurance code.
- Known carriers who frequently require Plan Bundles are: UHC, SelectHealth, and Guardian (when life plans are combined, such as Vol Life & Vol AD&D are combined into 1 plan).
- Please note, a separate HD04 value is not a supported feature for bundled products.
New Transactions Sets: more to come