Cafeteria Exchange Overview for Brokers
How to connect a client to the Cafeteria EN-Exchange and Exclude Plans
You still need to select and coordinate the implementation with the vendor and sign any necessary agreements the vendor may need but after that.........
Step 1: From the client’s home page, select Cafeteria under Admin Only
Step 2: Select ‘add a service’, then from the drop down find the vendor you are connecting to, then click ‘add’.
Note: You DO NOT have to use subscriber groups. It is best practice to select "All Employees"
Step 3: There will be a screen a displaying company information. Complete any fields that have missing data.
Step 4: The next page will display brokers premier users and HR users for the company. Select a contact that you want for your primary subscription contact.
Step 5: Verify the plans that will be sent for this client. Any of the plans NOT SELECTED will send on the file. If your vendor administers your clients FSA and Dependent Care but not their Health Savings Account (HSA) then you would want to exclude the HSA.
Click on the 3 dots on the right and select "excluded benefits/plans". Select the box next to plan if the plan should not send on the file. Leave deselected if the plan should send on the file.
IMPORTANT NOTE: If you exclude plans you may need to do so each plan year. Excluded plans DO NOT stay excluded upon renewing the plan.
Check the status of the connection
After you have connected, you can view the status of the connection. Vendors control when the group is moved from new, to pending to active. There are (4) status options:
- New- The connection is in a New status. The Vendor will be reaching out for additional information they may need. No Data is being transmitted to the vendor during this time.
- Pending- The Vendor may move your group to a pending status if they are still gathering additional information from the Company. Usually, the Vendor will also test data to ensure the company's information is coming across on the file accurately. The broker is still responsible for continued data transmissions while it is a pending status.
- Active- It is assumed when the client is moved to Active that the vendor is processing data. In this status, if the vendor has scheduled files, Employee Navigator will generate files in the nightly job on the vendors schedule. However, this status cannot guarantee the vendor is actively processing those files. Confirm with the vendor if they are processing the files being sent.
- Inactive- Vendor is no longer managing the data for the client. The Vendor should notify the Broker / Client before moving a company into Inactive status. Moving a company to Inactive status does not affect any service agreements made between the Vendor and Broker / Client.
Plans transmitted in the Cafeteria EN-Exchange
There is nothing at the plan level that needs to be configured for plans to be sent on the Cafeteria EN-Exchange File. The following plans will send on the file unless they are excluded. Refer to Step 3 of “How to connect a client to the Cafeteria EN-Exchange and Exclude Plans”.
Plans that transmit on the Cafeteria EN-Exchange File.
- Healthcare Reimbursement Account (HRA)
- Healthcare Savings Account (HSA)
- Healthcare FSA
- Dependent Care FSA
- Limited Purpose FSA
- Parking Reimbursement
- Transit Reimbursement
IMPORTANT NOTE: You need to use one of these plan types or the enrollment will not send on the file. For example, a Universal plan will not send on the file. If employees who enroll in a medical plan get a Healthcare Reimbursement Account and there is not an HRA plan built, we cannot send it on file.
Plan setup considerations for HRA
Confirm how the TPA has setup the HRA(s) in their system and match that in EN.
It is common for a TPA to build separate HRA's in their system if they vary in annual contribution or have separate accumulators for say deductibles or prescriptions.
With that said, if a TPA has built 2 HRA plans in their system and an employee should be enrolled in both, EN cannot currently accommodate that. The system will not allow an employee to be enrolled in two HRA's. EN knows this may impact using the data exchange and we have it on our road map to allow enrollment in multiple HRA's.
BUT if the TPA has setup more than one HRA because the HRA's differ from one class of employees to another or from which medical plan they enroll and an EE can only be enrolled in one or the other HRA, EN can accommodate this. You would need to build two HRA's and NOT one HRA that has multiple contingent medical plans. Yes, EN allows you to build one HRA and link multiple contingent medical plans but doing this would not allow the TPA to distinguish which HRA to put the EE into in their system.
Example: Client offers a benefit package where one class of EE's have an HRA with an ER contribution of $1000 (it integrates with Med Low plan). Another class of EE's have an HRA with an ER contribution of $3000 (it integrates with Med High plan). The TPA builds two HRA plans in their system, HRA 1000 & HRA 3000. If you build one HRA in EN and name it HRA and enter both the Med Low and Med High plan as contingent medical plans, the system will work. BUT, and this is the key part, the TPA only sees a plan come over on their file named "HRA" and they have no idea if Sally should be put in the HRA 1000 or HRA 3000 plan.
Best rule of thumb - 1:1 match.
Understanding enrollment types and how it impacts the EN-Exchange
There are 3 enrollment types in Employee Navigator:
Go to an employees benefit summary. Plans displayed under "current period" = current. "History" = Prior. "Open Enrollment" = Open.
The EN-exchange sends two enrollment types on the file: Current and Open. Prior are not sent on the file.
The system does not look at a plans effective start or end date to determine what plans send on the file. It looks at the enrollment type. If enrollment type is "current" then Partner receives the enrollment on a "current file. If enrollment type is "open" then Partner can receive the enrollment on a "open" file.
NOTE: The open enrollment cycle will take current plans and push to prior and take open plans and push to current. KEEP READING. This impacts the data exchange.
Here is an example of an enrollment cycle and how it works with the EN-exchange:
ABC company has Plan 2018 with a plan start date of 1/1/2018 - 12/31/2018.
They are connected to a Partner in the EN-exchange.
Employee, JJ, is enrolled in Plan 2018 and the enrollment type is "current".
Partner receives JJ's enrollment information for Plan 2018 on their "current" file.
On 10/1/2018 the plan is renewed and an open enrollment is setup.
On 10/20/2018 JJ enrolls in the renewed plan, Plan 2019, and the enrollment type is "open".
Partner continues to receive JJ's enrollment information for Plan 2018 on their "current" file but they have not received JJ's enrollment information for Plan 2019 because the Administration Ends Period as not ended. (DISCUSSED IN SECTION THAT FOLLOWS)
On 10/26/2018 the open enrollment Administration Ends date ends.
Partner receives JJ's enrollment information for Plan 2018 and Plan 2019 on their "current" and "open" file.
On 10/31/2018 open enrollment is closed. What happens to JJ's plans? The closeout of open enrollment pushed Plan 2018 to "prior" and pushed Plan 2019 to "current".
Although Plan 2018 has a plan year end date of 12/31/2018, Partner DOES NOT receive Plan 2018 on any file. Partner receives Plan 2019 on their "current" file.
THE ISSUE - Technically Plan 2018 is still current since the plan year ends 12/31/2018 but the system does not look at plan year end date to determine enrollment type. Plan 2018 was pushed to "prior" in the OE closeout. Now the Partner will not get any data associated with Plan 2018 even though there are still 2 months left in the plan year.
RECOMMENDATION - Do not closeout the open enrollment until plan effective date. In the scenario above, the closeout should have been closed on 1/1/2019 NOT 10/31/2018.
Open Enrollment - When Vendors receive the OE elections and best practices
Cafeteria vendors have the option to have open enrollment elections sent on a scheduled file. If they do not select this option then they can generate a file manually.
If the vendor has selected to receive them on their scheduled file, when will they receive them?
EN looks to the open enrollment setup by the agency to determine when open enrollment elections send on our files.
Below is a screenshot of the open enrollment window that is setup by the agency.
Open enrollment elections will send to vendors on their next scheduled file following the "Administration Ends" date.
A few Best Practices with Open Enrollment
- Communicate, Communicate, Communicate! Let your vendor know your clients open enrollment schedule. We do not notify vendors of clients open enrollment schedules so please communicate with them. The sooner they know you have new plans, they can go in and do any necessary plan mapping.
- Do not fully close open enrollment until the new plans effective date. Once you “close” open enrollment fully the system pushes the open enrollment elections to current and the current to prior. That means vendors will no longer receive changes for the current plans that were pushed to prior and those plans may still be in effect for some time.
- IMPORTANT: After the administration ends window closes, the vendor will receive and process the open enrollment elections. If you go in and decline / waive an employees election after the vendor has processed the enrollment, you will need to work with the vendor directly to have them end the election in their system because when you decline / waive the election the employee drops off the file and the vendor does not receive notice to end their election.
Eligibility File - Not a Contribution File
The cafeteria file is a full file (not a change only file) that includes the necessary data elements for vendors to enroll an employee or change / end their coverage as needed. The file includes the employees annual elections in pre-tax plans. The file also includes the per pay contribution but it is an “assumed” per pay. Our system takes the annual election, divides by the number of pay periods to get the per pay. If say the employer stopped an employee’s contribution for a leave of absence or changed the contribution slightly for a few weeks, our system does not have a way of noting that. Therefore we always advise for the contributions to come from the payroll system.
What if you are using an integrated payroll vendor? We do not receive back from the payroll integration the “actual” deductions so you would still need to pull a contribution report from the payroll system.
Cafeteria, Parking and Transit Changes
If a change needs to be made to an employees election, use the "update benefits" > "Adjust Coverage" tool or have the employee use the add or adjust tool on their employee page. This is the only way the system will be able to track prior contributions and ensure the employee does not go over the maximum. Also, this is the only way to get the change correct on the file for the vendor to make the adjustment. You can not import the changed election and have the system work correctly and send the change correctly to the vendor.
Troubleshooting error reports
Employee Navigator does not have visibility into vendors systems nor are we familiar with the vendors error reports. Employee Navigator does not get a copy of the error reports from vendors. If the client receives an error report we ask you to first contact your vendor representative to troubleshoot. We are happy to research issues but please contact the vendor first to try and resolve or understand in detail what the error is.
Here are some pointers to keep in mind and guide you through this switch.
1. Contact the existing Vendor to ensure they are generating current elections for your group in the Vendor Portal. Let them know you are planning to End participation as of X date.
2. Do NOT end participation with the existing vendor right away as this will automatically sever the connection for existing data. You must wait until the plan end date and potentially longer if the existing vendor will be managing any of the run out. We STRONGLY advise discussing this with them and determining the best time to end the participation.
3. You can connect with the new vendor while keeping the connection with the existing vendor.
3. Inform the New vendor when your client is in Open Enrollment and when their administration ends date is scheduled so they are aware of when they can pull OE elections manually (if that is their process) or when they will be received on their scheduled file.
4. REMEMBER to exclude plans as needed from both connections.
- Example 1: If employee John has a current election but did not elect in the new plan year, you would not want the new vendor to receive John's information on their file so you would want to exclude the current (soon to be prior) plans from the new vendor connection.
- Example 2: If employee Mary has an OE election but not a current election, you would not want the existing vendor to receive Mary's OE election so you would want to exclude the new plans from the existing vendor connection.
How to end participation with a Partner
There are 2 ways in which a data feed connection can be ended:
- By the Partner: Notify the Partner to let them know your Company needs to be deactivated. At this point, the Partner can move the Company to an Inactive status immediately. There is no way to enter in a "future" date to end the participation. Please Note: Once in an Inactive Status, it will be the Partners responsibility to Re-connect your company again.
- By the Broker: For each company, select end participation for Partner to ensure the connection to Data Exchange is severed by clicking on the connected exchange> End Participation. This will end participation immediately.
If a Company has been Terminated under your agency please be sure to sever the EN-Exchange connection prior to terminating the group