Business Requirements Document - payroll.ucop.edupayroll.ucop.edu/.../SR101377_Core_Enrollment_for_BELI_Changes_BRD.pdf · This BRD includes a new “BELI-Change and Medical Plan

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Business Requirements Document

SR101377—Allow Core Enrollment to Persist for Compatible BELI Changes (Lean version)

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Document Information

Document Attributes Information ID SR101377 Owner Esther Cheung-Hill, Benefits Information Systems Author(s) Joe Cutter, Benefits Information Systems Contributor(s) Kenneth Smith, Benefits Information Systems

Revision History

Version Issue Date Changes 1.0 6/23/17 Initial Version 1.1 7/17/17 B. Burkart – Added questions and suggested changes 1.2 7/18/17 B. Burkart – worked on functional requirements and other suggested changes 1.3 7/18/17 Updated in meeting with Joe, Maria, Mary, Alex. 1.4 7/19/17 Updated in meeting with Joe, Maria, Mary, Alex. 1.5 7/19/17 B. Burkart – added some regression testing requirements. 1.6 7/24/17 B. Burkart – updated in meeting with Joe, Mary, Alex and Maria. 1.7 7/25/17 B. Burkart – worked on functional requirements for regression testing.

Updated in meeting with team 1.8 8/1/17-

8/2/17 B. Burkart – worked on functional requirements.

1.9 8/3/17 B. Burkart – worked on requ 23 re: postdocs. 1.10 8/3/17 B. Burkart – updated with team 8/3. 1.11 8/7/17 B. Burkart – updated based on 8/2 notes from team meeting. Updated in team

meeting 8/7. Replaced chart with revised chart. 1.12 8/8/17 J. Cutter – replaced chart with Excel object. 1.13 8/8/17 B. Burkart – working on functional requirements and updating references. 1.14 8/9/17 Updated during team meeting 8/9, then a few updates after meeting 1.15 8/10/17 B. Burkart – updated during meeting with team. 1.16 8/16/17 Updated during team meetings 8/16, and updated after meeting. 1.17 8/17/17 B. Burkart – combined assumptions 19 and 21. 1.18 8/22/17 B. Burkart – commented R0018A 1.19 3/20/18 B. Burkart – Started creating LEAN version of BRD. Highlighted Functional

Requirements that will be removed. 1.20 3/26/18 B. Burkart – reviewed BRD to see if it is consistent with the selection of

requirements we will work on in Phase I. 1.21 4/10/18 B. Burkart – we will include requirements 7 and 10 in the “lean” version of the

project. Reviewed the BRD to make sure it is consistent with including requ 7, 8, 9, 10, 11, 18A, 23, and all regression testing.

1.22 5/10/18 B. Burkart – deleted assumptions that are duplicated in the functional requirements.

1.23 5/14/18 B. Burkart – added to requirement #15. Also made some modifications per the kickoff meeting.

1.24 5/15/18 B. Burkart – made some revisions in preparation for the continuation of the kickoff. 1.25 5/16/18 B. Burkart – moved some items to the Out of Scope section. 1.26 5/21/18 B. Burkart – updated during team meeting. 1.27 5/22/18 B. Burkart – updated spreadsheet case numbers associated with 25 and 25A. 1.28 5/24/18 B. Burkart – updated assumptions

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1.29 5/24/18 J. Cutter – Updated Overview, Background, Excluded from Scope, Business Rules, Business Requirements, External Reference

1.30 6/6/18 B. Burkart – wording change on Requ 14 and 19 1.31 6/7/18 B. Burkart – finalized for posting. 1.32 6/13/18 B. Burkart – updated with team regression testing requirements. 1.33 6/19/18-

6/20/18 B. Burkart – updated with team.

Document Approvals Role Name Signature Date Project Director Esther Cheung-Hill

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Table of Contents

1 Overview .............................................................................................................................................................. 5

2 Product/Solution Scope ....................................................................................................................................... 8

3 Business Rules .................................................................................................................................................... 10

4 Business Requirements ...................................................................................................................................... 11

5 Non-Functional Requirements ........................................................................................................................... 23

6 External References ........................................................................................................................................... 24

7 Attachments ....................................................................................................................................................... 24

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1 Overview

This BRD originally combined business requirement updates to Payroll and Personnel System (PPS) that refine the requirements of R2196 (SR101029) along with several potential maintenance fixes to resolve technical issues that arose in R2196 development as well as pre-existing maintenance issues.

Given the relatively limited service life remaining for PPS, business needed information to weigh what maintenance issues should still be considered for inclusion in this project. ITS provided an estimate of the development and test resources required for each of the maintenance requirements; then business considered the required resources as well as the impact of including or excluding each business/maintenance requirement. Business gave high priority to allow for comprehensive testing of all BRD requirements, including thorough regression testing for the related existing functional requirements. Following some iteration, a scaled down “lean” project plan was approved including one maintenance requirement, and the BRD was revised to its present “Lean” version. The resulting modifications to PPS are considered “Urgent,” but are not date-mandated modifications to PPS.

Some maintenance items that are not in scope, and thus are not included in the Base project release can be considered for implementation at the discretion of hosted systems or individual PPS locations after the install from this BRD.

This BRD includes a new “BELI-Change and Medical Plan Transition Table” to summarize medical plan enrollment and effective date updates as a result of BELI change and subsequent employee enrollment action. The table shows the dependency on the reason that BELI changed (1000-hr rule), the type of medical plan enrolled (or not) prior to the BELI change, and when and how the employee responds (or does not) to the PIE created by the BELI change.

The business requirement updates will simplify requirements and reduce the need for employees to re-enroll in an eligible health plan when they are currently enrolled in a plan and their BELI has changed. The business refinements will not change the cessation of automatic enrollment of new hires to default Medical, Dental and Vision plans that was introduced in R2196. Business requirements that maintain existing enrollments through some BELI changes, and those that default into Core medical when BELI is changed from Full or Mid-Level benefits to Core Benefits will be restored closer to the behavior prior to Release R2196.

1.1 Background

1.1.1 Origin of Automatic Enrollment in UC’s PPS Processes in PPS that automatically enroll employees in medical, dental, and vision coverage were implemented in the late 1980’s as part of the UC’s strategy for compliance with Internal Revenue Code Section 89 which was enacted as part of the Tax Reform Act of 1986. Although Section 89 was repealed in late 1989, the associated PPS changes were left intact.

1.1.2 Period of Initial Enrollment (PIE) A PIE is a 31-day period, most commonly commencing when a new employee is hired into a benefit-eligible appointment. During the PIE, the employee can enroll herself and her family in a selection of optional UC benefits without any waiting periods or qualifying examinations.

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1.1.3 Automatic Enrollment Up to 2016, if a benefit-eligible employee reached end of PIE, had not enrolled in a medical plan, a dental plan, or the vision plan, and had not explicitly opted out of coverage, PPS would enroll the employee in the respective plan type/s for which he was eligible but not enrolled. The automatically assignable plans are Core Medical, Dental PPO, and Vision.

In addition to the end of PIE, other circumstances prior to 2016 would cause PPS to enroll an employee into a default plan automatically. For example, if an employee had been re-assigned to Core Benefits (BELI 4), she would have automatically be enrolled in default medical coverage without a PPS-managed PIE.

1.1.4 Behavior R2196 (SR101029) After R2196, new hire auto-enrollment was effectively discontinued. Transitions between BELI that offered a choice of additional benefits continued to create a PIE. We wanted to reduce the number of unintentional Core level benefit members from previous auto-enrollments, so we de-enrolled existing Core members that were transitioning BELI so they could re-enroll intentionally if they wanted to keep Core plans. For employees changing to BELI 4, we created a PIE in PPS to facilitate their choice of Core Medical, or an explicit Opt out via AYSO Benefits enrollment. The Opt out could also be accomplished by default at the end of the employee’s PIE.

After R2196 was released, we found that some employees who were enrolled in Core medical and had a change in BELI from BELI 1, 2, or 3 to BELI 4 were being surprised by the discontinuance of their existing Core medical plan although they remained eligible for their existing plan with their new BELI. As a practical matter, we could not be sure that existing Core members making a BELI transition would always be made aware that they needed to re-enroll if they chose to maintain their existing plan. This BRD modifies some BELI change transition rules to allow Core enrollments to continue without intervention for compatible BELI changes.

1.1.5 Replacing the PIE That R2196 Added for BELI Transitions to BELI 4 Prior to R2196, a BELI change to BELI 4 did not result in a PIE date being created in PPS. This BRD restores some of the prior behavior for BELI changes from BELI 1, 2, or 3 to BELI 4 by eliminating the creation of a PPS-aware PIE and instead providing some rules to determine continued medical enrollment. For exceptions where these rules do not correctly anticipate an employee’s desired medical enrollment, a paper enrollment during the PIE can provide the desired override.

1.1.6 Causes for a PIE and Effect on Auto-Enrollment Various events other than a new hire will cause an employee to receive a PIE. If PPS is cognizant of an employee’s PIE, it sets a PIE end date for the employee; then there is a potential for PPS to perform some actions at various stages of the PIE. If a PIE end date is not set in PPS, HR administers the PIE, and there is no automatic mechanism to take action with respect to the PIE. The following exemplifies PIE events that fall into these two main categories with respect to PPS:

• PPS-aware PIE Events-- these cause PPS to enter a new PIE End date in the Employee Database (EDB). These are both current process, and processing should remain as is: 1. The employee receives a new appointment that changes his BELI (to 1, 2, or 3 from any BELI). 2. The employee who was not previously full-benefit eligible accumulates 1000 or more hours of service during

12 successive months. (Check for 1,000 hours is included in monthly maintenance process. A UCRS stored procedure determines benefits eligibility.)

• PPS-unaware, HR-administered PIE Events—these are generally paper form initiated changes that DO NOT cause a new PIE End date to be entered for the employee in PPS :

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1. The employee presents a paper form for a change in enrollment due to a life change such as marriage or a new child added to the family. HR validates that the form was submitted within 31 days of the qualifying event

2. The employee returns from a leave of absence which exceeds 120 days 3. The employee moves to a new zip code out of coverage area for his current medical provider.

Formerly, a PPS-aware PIE could trigger an auto enrollment if end of PIE circumstances dictate one or more auto enrollments. R2196 halted all auto-enrollment. Regardless of R2196, if PPS is unaware of the PIE, the PIE could never cause an auto enrollment.

1.2 Objectives • Continue to prevent New Hire auto-enrollment in default medical, dental, and/or vision benefits. • To avoid or minimize the need to re-enroll in medical benefits when the BELI changes to 4:

o If an employee is covered under the Core plan they should retain the Core plan. o If an employee is covered under full/mid-level benefit medical plan, they should be automatically

enrolled in the Core plan. • Perform maintenance corrections for some technical issues that arose from the implementation of SR101029

(R2196)

1.3 Stakeholders Acronym Description Role * Authorize Has ultimate signing authority for any changes to the document R Responsible Responsible for creating this document A Accountable Accountable for accuracy of this document (e.g. project manager) S Supports Provides supporting services in the production of this document C Consulted Provides input I Informed Must be informed of any changes

Name Position * R A S C I Esther Cheung Hill Director, HR-BIS X Joe Cutter Business Systems Analyst X Ken Smith Business Systems Analyst X X Jaime Espinoza Principal Analyst X Shaun Ruiz Payroll Coordinator X Christy Thompson Manager, HR-BIS X X X Alex Tayag Programmer-Analyst X X Beth Burkart Business Analyst X X X Santhosh Katakam QA Analyst X X

1.4 Proposed Strategy N/A

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1.5 Glossary Term Description

BELI Benefit Eligibility Level Indicator BRD Business Requirements Document EDB Employee Database — prefix to data element number EE Employee ER Employer GIR Group Insurance Regulation ITS Information Technology Services LBNL Lawrence Berkeley National Laboratory OE Open Enrollment PATH Payroll, Academic Personnel, Timekeeping and Human Resources PPS Payroll and Personnel System PIE Period of Initial Enrollment UC University of California UCOP University of California Office of the President UCRS University of California Retirement System

2 Product/Solution Scope

2.1 Included in Scope

• Updates to PPS to implement the requirements documented in this BRD.

• Modify benefits auto-enrollment behavior in PPS when an employee’s BELI changes

• Related maintenance fixes

2.2 Excluded from Scope

• Changes to non-PPS payroll systems such as at LBNL • Changes to the business rules documented in the UC Health and Welfare Benefits Programs for Faculty & Staff

Group Insurance Regulations (GIRs) and other explanatory communication media • Changes to PPS test interfaces used for PATH and PATH-related information systems • Any changes to the PPS Web Interface • Retroactive hires or BELI changes, where the date of the hire or BELI change precedes the entry date by more

than the length of a PIE, are not defined under R2196 or this BRD. (The person responsible for such an entry should verify the PPS response to the retroactive change, make manual corrections if needed, and verify that a new PIE is provided either within PPS or via manual enrollment if the employee qualifies for a new PIE.)

The limited remaining service life for PPS was a significant factor in the decision to exclude the issues listed below. Contributing factors in the decision to exclude these issues from scope were:

o The resources required to resolve the issues are could not be justified o There are manual workarounds to avoid or correct adverse results o The issues could not be reliably reproduced for testing

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o The occurrence of an issue is infrequent • When an eligible employee who is not enrolled in a medical plan receives a PIE, but does not enroll in a plan

during their PIE, they are correctly given an opt-out medical code (‘XX’) with an opt-out reason code of ‘Z’ to indicate that their PIE ran out without enrollment in the medical plan. The mechanism is similar for dental and vision if they are eligible for Full benefit.

o The Opt out code ‘Z’ does not appear to be consistently applied when an employee has a PIE date in PPS and does not make an election of a plan.

o When there has been an error in establishing the ‘Z’ opt out code, or for any reason payroll or HR wants to remove it, the z code is not directly removable. It cannot be changed online and it will not change with an X1 transaction. Re-derivation to clear the Z will happen when the plan code is changed. (cosmetic – no adverse impacts)

• PIE recalculates dates to the past when an employee’s hire date is changed. This issue did not originate with SR101029, but is reportedly “worse” (occurs more frequently) since the R2196 release. This issue is relatively infrequent, and it can be fixed manually if it does occur. It is low impact, and a decision was made to not address it, due to the limited remaining life of PPS.

• DM in future plan: is it getting cleared out when employee selects a new plan? There is an issue where someone selects a plan, but then it is end dated and replaced by the DM. (Daily Maintenance) Appears to be the plans that are going straight into the current medical plan rather than going into the future plan. Their new medical plan may be effective prior to the effective date of the future DM.

• Each month some employees who change BELI, but are not changing to BELI 4 Core benefits, have had their Medical Plan, or Medical, Dental, and Vision plans end-dated. Generally, they are going to BELI 1. The exact sequence has not been determined, as it could not be recreated in testing. Exceptions are being manually corrected at the locations.

• For employees who are opted out after reaching their PIE end date, all PPA rows for the plan they are being opted out of should be deleted. These PPA rows are pending premiums for the default plans (DM, DD, DV) that are created during the compute.

2.3 Assumptions & Constraints

ID Assumption / Constraint 2.3.1 Current Process: If an employee is still within her PIE and has a medical plan of DM, the

CICS functions IFBC, IFDB and IINP and IINS use the Core plan code (AC) to look up the employer and employee contributions and display them. These contribution indications for the former default plan do not reflect any enrollments, nor will they change any enrollments. This was unchanged by R2196 and their removal is not a required change for this BRD. However if the implementation of the requirements of this BRD caused these indications to be zeroed or removed, this would be a permissible unintended consequence.

2.3.2 Current Process: If an employee is still in PIE and has a medical plan of DM, the PPS Web interface will display employer and employee contributions for Core medical. These indications do not reflect any enrollments, nor will they change any enrollments. This display was out of scope and not intentionally changed by R2196; it may or may not be affected by this BRD as web interface changes and testing remain out of scope.

2.3.3 Dependent enrollment behavior should follow the employee. 2.3.4 Regression testing comments were verified during QA testing. This is not intended to

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cover all possible cases. Unspecified pre-existing anomalies are out of scope of the slimmed down project.

2.3.5 There is an existing anomaly involving dropped dependents in some cases when the BELI changes and the employee had an existing XX opt out with reason code Z. There may be other conditions in which this occurs beside the ones we encountered in testing. Users making online updates to an employee that has previously been opted out of coverages are cautioned to verify that existing dependents remain in place following a re-enrollment.

2.3.6 Due to an existing anomaly, in some cases, existing plan code XX (opt out) for medical, dental or vision, may not be replaced by the pending plan codes DM, DD, and DV when an employee has a BELI change. If this occurs, then the employee’s enrollment via AYSO will be rejected with an error message and enrollment transactions should instead be completed via the CICS screens. (See Functional Requirements R0014A, R0014B, and R0014C.)

2.4 Outstanding Items

2.4. 1 None

3 Business Rules

The current operative GIRs are dated June 30, 2017; their location is included in Section 6 External References. With at most minor exception, the business requirements in this document are aligned with the June 30, 2017 GIRs. If this BRD creates an exception to the GIRs, it is in the interest of streamlining the enrollment processes and reducing the opportunity for error. In that case, we anticipate that the succeeding version of GIRs will “catch up” with the requirement detail update described by this BRD.

The business rules related to auto enrollment can be found documented in the January 1, 2011 UC Health and Welfare Benefits Programs for Faculty & Staff Group Insurance Regulations (GIRs). An excerpted copy of the relevant language was provided in SR101029 for anyone seeking background information.

SR101029 (R2196) completely eliminated auto-enrollment by creating a PIE in PPS for employees changing to BELI 4 from BELI 1, 2, or 3, even if the employee was already enrolled in Core medical. This BRD requests that the specific process be modified to eliminate an unnecessary PIE in PPS for this case:

A default into Core medical or an opt out will be made by PPS based on whether or not the employee has existing coverage in any regular UC employee medical plan. However, an HR-administered PIE will be in effect allowing the employee to override the PPS default using a paper form.

The general new-hire default auto- enrollment as described in the 2011 GIRs will not be reinstated.

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4 Business Requirements

New Requirements Overview This BRD implements business requirements that modify the business requirements implemented in R2196 (SR101029). New-hire auto-enrollments are still prohibited. Some changes to how PPS handles auto enrollments for BELI changes are needed. Generally, BELI changes should not result in auto enrollments with some exceptions:

o Existing Core medical plan enrollments shall persist when eligible under the new BELI unless changed by the employee during their (PPS or HR administered) PIE (R0011).

o BELI changes downgrading regular employee benefits (Full and Mid-Level) to Core benefits shall automatically enroll employees having existing medical coverage to Core Medical; the employee may choose to opt out of automatic enrollment in Core medical via a “paper” enrollment election during the HR administered PIE. (R0008)

For BELI changes downgrading regular employee benefits (Full and Mid-Level) to Core benefits:

• There should be no automatic enrollment in Core Medical for employees who currently have no medical coverage plan; the employee may choose to enroll in Core Medical via a “paper” enrollment election during the HR administered PIE (R0010)

The business requirements stated in this section are intended to be those that are new, modified, or clarified since R2196 (SR101029). Existing related business requirements that are unchanged are not generally stated in this section.

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BELI-Change and Medical Plan Transition Table The “BELI-Change and Medical Plan Transition Table” includes some of the existing business requirements and the new/modified requirements to provide an overview of the related medical plan business functionality in context. The table focuses on the medical plan because the medical plans apply to the greatest number of BELI codes and represents the largest and most complex set of plan transitions.

How to Interpret the BELI-Change and Medical Plan Transition Table

The table outlines the BELI change driven PPS business requirements that affect medical plan enrollments for each of 11 types of BELI transitions. To adhere to the rules defined in the GIRs, each case takes into account whether there is an existing medical plan, and whether the BELI change derives from the 1000-hr rule.

The first five columns of the table define the requirements case in the following terms:

• A case number for reference • The current BELI • The new BELI • Whether the 1000-hour rule is the cause of the BELI transition • The current medical plan type: none, Core Medical, full/mid-level medical, or Postdoc medical

The sixth column describes how PPS should respond to the BELI change prior to any input from the EE.

The next column summarizes the type/s of medical plan that are available for the EE to elect

The following three columns define outcomes for up to three subcases depending on when an EE makes a medical plan election or does not do so. In some cases, there are fewer than three different outcomes,

• Column A describes the required outcome if an EE makes a medical plan election by the end of the month when the EE’s BELI has changed.

• Column B describes the required outcome if an EE makes a medical plan election after the end of the month when the EE’s BELI has changed but by the end of the PIE.

• Column C describes the required outcome if an EE does not make a medical plan election by the end of the PIE.

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PPS Medical6 Plan Requirements Arising from BELI Changes and Employee Elections

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New or Clarified Business Requirements

o This BRD partially restores some pre-R2196 PPS behaviors when an employee’s BELI changes from 1, 2, or 3 to BELI 4. In some BELI change cases, if an employee had existing medical enrollment prior to the BELI change, he may be automatically enrolled into Core Medical to maintain coverage if he takes no action.

As was the case prior to R2196, a PIE date should not be set in PPS when an employee’s benefit level is reduced to Core. For this case, an EE will have an HR-administered PIE during which he may use a paper form to override an undesired default. (R0007)

If the employee is enrolled in Core medical when the BELI 4 becomes effective (R0009) The Core medical plan should not be changed or term dated. If the employee does not wish to continue in Core Medical, he may opt out via paper

form. If the employee is not enrolled in any medical plan when BELI 4 becomes effective (R0010)

Her medical plan code (blank or opt out) and her opt out code should not be changed If the employee wishes to enroll in Core Medical, she may do so via paper form during

her PIE If the employee is enrolled in any regular employee medical plan other than Core when the BELI

4 becomes effective (R0008) The regular medical plan will be term-dated to month end (existing behavior) If the employee does not make a positive choice to Opt Out to XX (via paper form) by

the end of the month, the employee is enrolled in Core medical as of the first of the following month:

o the medical plan code is set to ‘AC’ with no termination date, o the Opt Out code (if any) is cleared

If the employee wishes to Opt Out of medical, he may do so via paper form.

o When an employee is changed from BELI 4 to BELI 1, 2, or 3, he is given a new PIE (existing behavior – Regression testing) (R0013)

If the employee is not enrolled in medical when the BELI 1, 2, or 3 becomes effective, his medical plan code is set to DM. The behavior of the opt out code varies; see the Functional Requirements for detail. (This bullet is prior behavior.) (R0014)

If the employee’s BELI change is to BELI 1, his dental plan and vision plan codes are set to DD and DV, respectively, and his dental and vision Opt Out codes are cleared (R0014A, R0014B)

If the employee selects a plan or plans during his PIE, his plan codes are entered with the effective date of his BELI change

If the employee doesn’t make a selection for an eligible medical, dental, or vision plan by the end of her PIE, the opt out code XX with reason ‘Z’ will be entered for each such plan (as specified in R2196) (R0014, R0014A, R0014B)

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If the employee is already enrolled in Core medical when the BELI 1, 2, or 3 becomes effective (R0015B)

The Core medical plan should not be changed or term dated when the BELI change becomes effective

If the employee re-enrolls in the Core medical plan during her PIE, no further action is required for her medical plan selection

If the employee does not enroll in a medical plan (or make a positive choice to Opt Out) by the end of her PIE,

o The employee remains enrolled in Core medical o The medical plan code remains unchanged as ‘AC’ with no change in effective

date

If the employee enrolls in a medical plan other than Core (or she makes a positive choice to Opt Out) after the end of the month but before her PIE ends, (R0015) Regression testing

o The new plan code is entered immediately

o If the employee’s BELI change was not due to the “1000/750 hour rule,” the effective date is retroactive to the first of the month following the BELI change

o If the employee’s BELI change was due to the “1000/750 hour rule,” the effective date is retroactive to the first of the month when the BELI was changed

4.1 User Requirements N/A

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4.2 Functional Requirements

Reqt. ID

Requirement Type

Requirement Description Priority [L/M/H]

Comments

R0001 Communicate requirements to LBNL. H BIS: inform LBNL (non-PPS) of the functional requirements. (This comment applies to all of the functional requirements in this table.)

R0002 New hire For new hires, there shall be no auto enrollment into any medical, dental, or vision plans for employees who do not take action to enroll during their PIEs.

H Regression testing requirement

R0003 New Hire For new hires, when an employee does not take action to enroll in a medical plan during his PIE:

• Medical Plan Code (EDB0292) shall be set to ‘XX’.

• Medical Insurance Opt Out Code (EDB0377) shall be set to ‘Z’, the code that indicates that the reason for opt out was expiration of the employee’s PIE with no medical election.

H Regression testing requirement (Spreadsheet cases 2, 10)

R0003A

New Hire For new hires, when an employee makes a positive choice to opt out of medical during his PIE:

• Medical Plan Code (EDB0292) shall be set to ‘XX’.

• Medical Insurance Opt Out Code (EDB0377) shall be set to ‘X’, the code that indicates that the reason for opt out was a positive choice.


R0004 New Hire For new hire employees who are eligible for full benefits and do not take action to enroll in a dental plan during their PIE:

• Dental Plan Code (EDB0272) shall be set to ‘XX’. • Dental Insurance Opt Out Code (EDB0378) shall

be set to ‘Z’ to indicate the reason for opt out was due to run out of PIE with no dental election.


R0004A

New Hire For new hires, when an employee makes a positive choice to opt out of dental insurance during his PIE:

• Dental Plan Code (EDB0272) shall be set to ‘XX’. • Dental Insurance Opt Out Code (EDB0378) shall

then be set to ‘X’, the code that indicates that the reason for opt out was a positive choice.


R0005 New Hire For new hire employees who are eligible for full benefits and do not take action to enroll in a vision


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plan during their PIE: • Vision Plan Code (EDB0347) shall be set to ‘XX’. • Vision Insurance Opt Out Code (EDB0379) shall

be set to ‘Z’ to indicate the reason for opt out was due to run out of her PIE with no vision election.

R0005A

New Hires For new hires, when an employee makes a positive choice to opt out of vision insurance during his PIE:

• Vision Plan Code (EDB0347) shall be set to ‘XX’. • Vision Insurance Opt Out Code (EDB0379) shall

then be set to ‘X’, the code that indicates that the reason for opt out was a positive choice.


R0007 BELI change from 1, 2, or 3 to 4

Change from BELI 1, 2, or 3 to BELI 4: When an employee’s BELI changes from 1, 2, or 3 to 4, PPS should not establish a PIE. PPS should not set a PIE date when an employee’s benefit level is reduced to Core.

H Currently the employee is receiving a PPS PIE. The EE will have an HR-administered PIE during which he may use a paper form to override an undesired default. Spreadsheet cases 7, 8, 9


BELI changes from Full or Mid-Level (BELI 1, 2, or 3) to Core benefits (BELI 4):

• If the employee was previously enrolled in a full benefit medical plan, the employee should be automatically enrolled in Core Medical.

o The regular medical plan will be term-dated to the end of the month when the BELI change was entered (existing behavior). Reason code “BE”

o If the employee does not make a positive choice to Opt Out to XX (via paper form) by the end of the month when the BELI change was entered, the employee is enrolled in Core medical as of the first of the following month: Medical Plan Code should be set to

‘AC’ with no termination date. Medical Insurance Opt Out code (if

any) should be cleared. The existing Medical Plan Coverage

Code (EDB0293) and dependents should be maintained.

o If the employee wishes to opt out of medical coverage, he may do so via paper

H Opt out via paper form should be tested using CICS screen EINS. Note that the “AC” (Core) plan code, rather than the “DM” code, should be queued. Spreadsheet case 7

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form during the HR administered PIE.


BELI changes from Full and Mid-Level (BELI 1, 2, or 3) to Core benefits (BELI 4):

• If the employee was already enrolled in the Core Medical plan, Core Medical enrollment should be maintained.

o The Core medical plan is not changed or term dated.

o DM plan code should NOT be established.

o The existing Medical Plan Coverage Code (EDB0293) and dependents should be maintained.

o If the employee does not wish to continue in Core Medical, he may opt out via paper form during the HR administered PIE.

H Opt out via paper form should be tested using CICS screen EINS. Spreadsheet Case 8

R0010 BELI change from 1, 2, or 3 to 4 No existing medical plan

When an employee transitions from BELI 1, 2, or 3 to BELI 4:

• If the employee was not enrolled in any medical plan, their default is to remain without a medical plan. They should not be auto-enrolled in Core medical.

o Medical Plan Code (blank or opt out) and Medical Insurance Opt Out Code should not be changed. The DM plan code should not be established. If Plan Code XX exists, it should not be end dated.

o If the employee wishes to enroll in Core Medical, she may do so via paper form during her (HR administered) PIE.

H Paper form enrollment in Core should be tested using CICS screen EINS. Spreadsheet case 9

R0011 BELI change, when enrolled in any medical plan (not Postdoc) Employee did not make a change during PIE

BELI change: When the employee is currently enrolled in a medical plan (excluding Postdoc) and they are eligible for the same plan under the new BELI, the plan coverage should be maintained if they do not make a choice during their PIE. The medical plan code remains unchanged with no change in effective date.

H Note: where the employee changed from BELI 4 to 1 due to reaching 1,000 hours, testing showed that the process already appears to work correctly. (case 3) Spreadsheet cases 1

June 21, 2018 10:42 AM 19

R0012 BELI change from any BELI to BELI 1

If the employee changes from any BELI to BELI 1, and he reaches the PIE end date without either enrolling in a dental plan or making a positive choice to opt out, the Dental Plan Code is set to XX with Opt Out code ‘Z’.


R0012A

BELI change from any BELI to BELI 1

If the employee changes from any BELI to BELI 1, and he reaches the PIE end date without either enrolling in a vision plan or making a positive choice to opt out, the Vision Plan Code is set to XX with Opt Out code ‘Z’.


R0013 BELI change from 4 to 1, 2 or 3

When an employee changes from BELI 4 to BELI 1, 2, or 3, he is given a new PIE in PPS.

H Regression testing Spreadsheet cases 1, 2, 3, 4

R0014

BELI change not due to 1,000 hours, no current plan

When an employee who is not enrolled in medical changes to a BELI that has medical eligibility:

o When PIE begins, his Medical Plan Code is set to DM.

o If the employee selects a plan during his PIE, his plan code is entered with the effective date of his BELI change (BELI Effective Date).

o If the employee does not select an eligible medical plan by the PIE end date, the Medical Insurance Opt Out Code XX with reason ‘Z’ will be entered.

o If the employee changes from BELI 2, 3 or 4 to BELI 1 and currently has opt out code XX with reason code Z, then the dependents are cleared out. (pre-existing anomaly)

H Regression testing Spreadsheet cases 2, 10 If there is an existing opt out code of “Z,” the “Z” will remain until it is cleared by a subsequent action.

Other opt out codes (“X,” “D,” or “C”) will be cleared when the “DM” code is set.

R0014A

BELI change from 2, 3, or 4 to 1 – dental

For an employee who changes from BELI 2, 3, or 4 to BELI 1:

• Dental Plan Code is set to DD, and Dental Insurance Opt Out Code is cleared, if present.

• If the employee selects a plan during his PIE, his plan code is entered with the effective date of his BELI change (BELI effective date).

• If the employee does not select an eligible dental plan by the PIE end date, the opt out code XX with reason ‘Z’ will be entered for the dental plan.

H Regression testing If there is an existing XX/Z with dental or vision when the employee is assigned BELI 1, the XX/Z will not be cleared out unless the employee makes a choice during their PIE. If the employee has an existing dental plan code XX (opt out), then transactions from AYSO (other than OE) will be rejected, and the enrollment will need to be completed using the CICS screens.

R0014B

BELI change from 2, 3, or 4 to 1 – vision

For an employee who changes from BELI 2, 3, or 4 to BELI 1:

• Vision plan code is set to DV and Vision Insurance Opt Out Code is cleared, if present.

H Regression testing If there is an existing XX/Z with dental or vision when

June 21, 2018 10:42 AM 20

• If the employee selects a plan during his PIE, his plan code is entered with the effective date of his BELI change (BELI Effective Date).

• If the employee does not select an eligible vision plan by the PIE end date, the opt out code XX with reason ‘Z’ will be entered for the vision plan.

the employee is assigned BELI 1, the XX/Z will not be cleared out unless the employee makes a choice during their PIE. If the employee has an existing vision plan code XX (opt out), then transactions from AYSO (other than OE) will be rejected, and the enrollment will need to be completed using the CICS screens.

R0014C

BELI change from 4 to 1 due to 1,000 hours, currently opted out

If employee changes from BELI 4 to BELI 1 and is currently opted out, then they should follow the logic in R0014. Exception: The employee does get a PIE, but the DM plan code is not set. This applies in the case of both Opt out code XX/Reason X and Opt out code XX/Reason Z.

Regression testing Note that, when there was a BELI change from 4 to 1 due to reaching 1,000 hours, testing revealed that current processing did not yield the expected results. PPS appears to be leaving the previous XX opt out code in place, although, since the employee has a PIE they can still enroll. If the employee has an existing medical plan code XX (opt out), then transactions from AYSO (other than OE) will be rejected, and the enrollment will need to be completed using the CICS screens. Spreadsheet case 4

R0014D

BELI change from 5 to 1 due to 1,000 hours

See requirement R0014 Regression testing Spreadsheet case 4

R0015 BELI change from 4 to 1, 2, or 3, not due to 1,000 hours, currently enrolled in

For an employee who changes from BELI 4 to BELI 1, 2, or 3 not due to 1,000 hours, and is enrolled in Core medical when the BELI 1, 2, or 3 becomes effective:

o If the employee enrolls in a medical plan other than Core (or makes a positive choice to Opt Out) by the end of the month when BELI change was entered, the new plan will come into effect

H Regression testing Spreadsheet case 1

June 21, 2018 10:42 AM 21

Core medical

on the first of the following month. The Core medical plan is term-dated to

the end of the month when the BELI change was entered.

The new plan code is queued with an effective date the day after the Core is term dated.

The ‘AC’ plan code is replaced by the queued plan code (including ‘XX’ if opted out).

• If the employee enrolls in a medical plan other than Core (or makes a positive choice to Opt Out) after the end of the month but before her PIE ends: The effective date is retroactive to the

first of the month after the BELI change was entered.

R0015A

BELI change from 4 to 1 due to 1,000 hours, currently enrolled in Core

For an employee who changes from BELI 4 to BELI 1 due to 1,000 hours and is enrolled in Core medical when the BELI 1 becomes effective:

• If the employee enrolls in a medical plan other than Core (or she makes a positive choice to Opt Out) The new plan code is entered

immediately The effective date is retroactive to the

first of the month when the BELI effective date


R0015B

BELI change from 4 to 1, 2, or 3, not due to 1,000 hours, currently enrolled in Core medical

If the employee is already enrolled in Core medical when the BELI 1, 2, or 3 becomes effective: If the employee takes no action, or re-enrolls in Core medical, the employee should remain in the Core medical plan.

• The Core medical plan should not be changed or term dated when the BELI change becomes effective

• If the employee re-enrolls in the Core medical plan during her PIE, no further action is required for her medical plan selection

• If the employee does not enroll in a medical plan (or make a positive choice to Opt Out) by the end of her PIE,

o The employee remains enrolled in Core medical

o The medical plan code remains unchanged as ‘AC’ with no change in

H

June 21, 2018 10:42 AM 22

effective date R0016 BELI change

from 1 to any other

When the BELI changes from 1 to any other BELI, the current dental and vision plans are set to end the last day of the month when the BELI is changed.

H Regression testing - Employee no longer eligible for vision or dental

R0017 BELI change from 2 or 3 to 1

When an employee changes from BELI 2 or 3 to BELI 1, she is given a new PIE.

H Regression testing Spreadsheet cases 1, 2

R0018 BELI change from 2 or 3 to 1 Enrolled in med plan (not Core)

When an employee changes from BELI 2 or 3 to BELI 1, if the employee is enrolled in a medical plan other than Core when the BELI 1 becomes effective, no action is taken on her enrollment code unless she makes a selection of a new medical plan.


R0018A

BELI change from 2 or 3 to 1 Enrolled in Core

When an employee changes from BELI 2 or 3 to BELI 1, if the employee is enrolled in Core when the BELI 1 becomes effective, no action is taken on her enrollment code unless she makes a selection of a new medical plan. The Core enrollment should persist.

H Spreadsheet case 1 This falls under R0011, but is a more specific case.

R0019 BELI change from 2 or 3 to 1, not enrolled in med plan

When an employee changes from BELI 2 or 3, to BELI 1, if the employee is not enrolled in a medical plan when the BELI 1 becomes effective, her medical plan code is initially set to DM.

If she does not enroll in a medical plan (or make a positive choice to Opt Out) by the end of her PIE, her DM plan code is changed to XX and the Opt Out code is set to ‘Z.’

H Regression testing Spreadsheet case 2 The opt out code Z will remain until it is cleared by a subsequent action.

R0020 BELI change to BELI 5

When employee changes from BELI 1, 2, 3, or 4 to 5, and they currently have Core or an existing full plan, the current medical plan should be set to end the last day of the month when the BELI is changed; no PPS PIE is set.


R0021 Postdoc No changes shall be made to current PPS behavior when an employee is assigned BELI P due to new hire or a change into a BELI P position. Currently, when an employee’s BELI changes from 1 to P, a PPS PIE is established, and any medical, dental and vision plans that the employee is enrolled in are end dated to the end of the month when the BELI change was entered. When an employee moves from BELI 2 (or 3) or 4 to BELI P, a PPS PIE end date is set, and their existing medical plan is end dated to the end of the month when the BELI change was entered.

H Regression testing requirement Postdocs are covered under collective bargaining and unilateral changes are not permitted.

June 21, 2018 10:42 AM 23

When a new hire is placed in BELI P, a PPS PIE is established, and the DM, DD and DV plan codes are established with an effective date equal to the hire date.

R0022 Maintenance item

Requirement Removed


Daily Maintenance: PPS should look for employees with default plans (DM, DV, DD) with old PIE dates (outside the existing processing window that are not initial values) and treat them as an expired PIE case (give them plan code XX – with opt out reason code Z).

H Issue: pending premiums are being added to the PPA table with each compute for these employees, creating abend when the number of rows exceeds the limit.


Requirement Removed

R0025 BELI P to BELI 1, 2, or 3

When an employee’s BELI changes from P to 1, 2, or 3, PPS should:

• establish a PIE • If the employee had postdoc insurance, then

set current medical, dental and vision plans to end last day of month when the BELI change was entered.

H Spreadsheet cases 5, 5A Regression testing Note: if the employee does not make an election during their PIE, then the end-dated Postdoc plans will remain in the system and no opt out code will appear.

R0025A

BELI P to BELI 4

If an employee changes from BELI P to BELI 4: • Any existing Postdoc plans should be end-

dated. • The employee should get a PIE • Plan code DM should be queued.

H Spreadsheet cases 6, 6A Regression testing

R0026 IDOC If an employee has a PIE from new hire or a BELI change and does not enroll in an eligible medical, dental, or vision plan during the PIE, she will be coded as being “Opt Out” with a reason code of ‘Z’. As specified in R2196, PPS will provide an IDOC message when a ‘Z’ opt-out code is generated for an end of PIE without enrollment.

H Regression testing

5 Non-Functional Requirements N/A

June 21, 2018 10:42 AM 24

6 External References Document Location Author SR100177_PPS_Stop_Default_Enrollment_in_H_W_Plans_BRD.docx

https://sp2010.ucop.edu/sites/its/apptech/ppers/basepps/PPSBusSpnc/2013/Cancelled%20-%202013/SR100177%20-%20PPS%20Stop%20Default%20Enrollment

Ken Smith

SR101029_RemoveAutoEnrollToMedicalDentalVision_BRD.pdf

http://payroll.ucop.edu/REL2016/R2196/SR101029_RemoveAutoEnrollToMedicalDentalVision_BRD.pdf

Joe Cutter

UC Health & Welfare Benefits Programs For Faculty and Staff , GROUP INSURANCE REGULATIONS (Jun 30, 2017)

http://ucnet.universityofcalifornia.edu/tools-and-services/administrators/docs/girs.pdf

UCOP HR Benefit Programs and Strategy

7 Attachments N/A










Documents

Business Requirements Document - payroll.ucop.edupayroll.ucop.edu/.../SR101377_Core_Enrollment_for_BELI_Changes_BRD.pdf · This BRD includes a new “BELI-Change and Medical Plan