Employee demographic changes have the potential to affect employee eligibility for plans, employee benefits, ACA eligibility measurements, 1095 reporting, or information that needs to be captured and provided to insurance carriers. Upon demographic changes, the system performs a series processes to identify if the results of the change. If a change is detected, the user will be prompted for an effective date of the change. The change effective date cannot be a future date or prior to another demographic change effective date previously saved.
Note: Demographic changes must be done in chronological order.
The following are potential changes that could occur as a result of demographic triggers:
Employee demographic changes that make an employee newly eligible for one or more plans will be presented to the users after the change is saved. The employee's eligibility will be calculated based on the effective date of the demographic change and the plan entry date and waiting period rules. A new plan setup sub-tab called "Change Rules" has been created to allow a different set of rules to be configured for newly eligible employees. This would be used if a company has a waiting period such as 30-90 days for a new hire, but if an employee has already been employed more that period, wouldn't need to complete that waiting period again once they become benefit eligible. If nothing is set on "Change Rules", the new hire rules will be applied.
Newly eligible dates are displayed on the employee benefit eligibility page (from Manage Employee, Benefit Summary, and then Benefit Eligibility). Demographic change dates are stored on the employee record and displayed on the data sheet.
Important note when using ACA reporting
If a demographic change was processed incorrectly, or out of chronological order, and the employee eligibility date is incorrect, there may be impact in ACA reporting that needs attention. ACA codes are calculated based on eligibility in medical plans. Since there is no way to unset the eligibility dates when a demographic change is processed incorrectly, there is a tool that can be used to override the eligibility date for ACA calculations.
Newly Eligible Enrollment Window
Based on the Newly Eligible date, if the employee is in the enrollment window (based on the employee enrollment setup options company setup/employee options/enrollment window) the Newly Eligible window will open for those applicable plans. We are not tracking the employee completed each plan enrollment before they are allowed to "Agree and Complete". For this reason, only when enrollment is set for "Pending until HR Approves" will newly eligible enrollment pend.
Enrolled but No Longer Eligible
Employee demographic changes that make an employee no longer eligible for an enrolled plan will now be presented to the user with an option to drop or skip. The drop will use the plan termination rules to determine end date.
The 'Skip' was created to allow a user to process the demographic change, without requiring the enrollments are also ended. A new alert was created under the Employees Tab, in the Recent activity section. If any enrollments have been skipped, they will display "n employees with ineligible enrollments that were previously skipped and should be dropped'. When selecting an employee, the date and user who previously skipped the end will be displayed. This information will also display on the data sheet. Employees will only be skipped for the current plan year.
Enrolled with Changes to Benefit
Employee demographic changes may affect enrolled plan benefits or costs. The plan is configured using the rules engine to set up the variations, which include dynamic classes.
For example, employee contribution to a plan may be based on a classification (class/office/division/department/business unit), tobacco usage, participation in a wellness program, or many other options. Another example might be the benefit for a group life or group disability plan may be based on classification.
When the employee demographics are updated, their enrolled benefit also needs to change to reflect the new costs or benefit. When a demographic change results in a change, the affects plans are listed for the user. A new enrollment record is created with the new costs/benefit effective the date of the demographic change. The former enrollment is ended one day prior to the change, and saved for historical reporting.
Changes for Carrier (Advanced Option)
Changes required by carrier, outside of plan design, can be configured through the new sub-tab on plan setup called 'Change Fields'. 'Change Fields' is an optional configuration that is not needed unless special reporting is requested by a carrier. Typically this would occur when a company is using optional reporting classifications for subgroup billing. Upon the change, the carrier either needs a new effective date on the enrollment, or storage of the change date to be used in the 834 Maintenance Effective Date (DTP*303).
Important! Do NOT configure "Write New Coverage Start Date" for demographic fields that are used in the plan design for benefits or costs. See above under ENROLLED WITH CHANGES TO BENEFITS because those automatically create without configuring here.
For example, if carrier needs to know when employee changes Division and plan rules are NOT configured based on Division, you would need to configure Change Fields. Carrier will either need a new effective date on the enrollment or passing a new maintenance effective date.
To configure EDI rules for demographic changes, go to the plan, and the 'Change Fields' sub-tab. Select the drop-down for the type of demographic change field to set the rules on, either Profile, Employment or Personal. Then select "Write New Coverage Start Date" next to the field(s) that will force a new coverage start date upon change. Alternatively, select "Write Maintenance Code Date" to capture the date of the demographic change. The two options are mutually exclusive.
Maintenance Dates are stored on the enrollment record and are displayed on the data sheet. The Maintenance Effective Date has NOT been added to the EDI code yet.
On the Company 'Employees' tab, under 'Recent Activity', you will see notifications of "employees with ineligible enrollments that were previously skipped and should be dropped" and "employees with newly eligible enrollments".
Demographic Updates Imports
Imports serve two purposes to load data to the system. They either a) initially load data elements, or b) update employee records from another system, such as a payroll or HRIS system, as part of a scheduled process.
In the first case, when data elements are being loaded to the employee records, tracking changes is not necessary. In many cases, users have to update employee records multiple times during installation if some data elements were initially left unpopulated and needed to be added later. Once the data and plans are all loaded, the enrollment will be turned on for the employees. In this case, these are NOT maintenance.
In the second case, the company is past the original installation, and now the user is managing the data. There are multiple systems in place and there is a scheduled process to exchange data between systems to keep data in sync. The effective date of the employee demographic changes is important now. This IS when you would use the demographic updates import. Using this import option will store a change effective date, as if the user made the change on the employee HRIS record, and complete the same validations on eligibility and enrolled benefits, if applicable.
On the Options step, select "Demographic Updates" if user wants to invoke the demographic change logic to detect changes that affect eligibility and enrolled benefits. User will be required to add a demographic change effective date If all changes on the file occurred on the same effective date, the date for the entire file can be entered on the Options step of the Demographic Updates Import. However, these dates may also be added in the Demographic Change effective date column on the file if they are different for each employee. If a demographic change is detected, if there is a mapped value for the "Demographic Change Effective Date" for the employee on the file, that date will be stored, otherwise the change effective date for the file will be used. All values will be set as needed if the demographic change made the employee newly eligible. If employee is no longer eligible, the enrollment record will NOT get ended, but it will get set as a "skip" (See above in Enrolled but No Longer Eligible section).
Demographic Updates imports are used to update employee information only. Dependent information cannot be imported using this import type.
If the system detects a column header of "Dependent SSN" or "Relationship" on the file, the import will fail and a message directing the user to remove dependent fields will be displayed. Since these fields are not supported and cannot be mapped on the import, the columns would be skipped during the import process resulting in the dependent data being interpreted as employee information and overwriting the existing values on the employee profile. By failing any Demographic Updates imports which include these fields, the possibility of the import of bad data is reduced significantly.
Where can I view the demographic change date under the ee's record?
From the ee's Employee Management tab, click on the Employee Data Sheet link (located bottom right of page). The Demographic Change Effective Date is reflected under the Employee Review section (far right).