**See the EDI File Rollover Toolkit for full details and videos
Explicit terms are the employees that elected to end coverage, move to Waive, during the open enrollment period. Some carriers will term these employees by omission when they are not sent on the OE file, other carriers need to have these employees sent in the OE file with the end date of the last day of the Current package to end their coverage. To include explicit terms in an OE file follow the steps below.
Directions for sending explicit terms to carriers – Example going from 2012 to 2013:
Make sure the New package has the Default Mapping selected that was used to create the benefit records for Open Enrollment. This selection is done on the Package Properties screen. Confirm the Rollover Mapping includes mapping for the benefits that need explicit terms (this can be done via the Print link for the Rollover Mapping). If there are multiple Rollover Mappings for the package, make sure the mapping assigned includes the benefits that require the explicit terms. The system uses the Default Mapping to determine if the employee would have rolled over into coverage but is now in Waive.
Take a look at the change log. Go to System > Export Logs > Benefit Change Log > select the Current package (in this example 2012).
Note the number of Employees in Export for each benefit that needs to have explicit terms. This number should increase after the utility has run if there are explicit terms.
- Run the utility to pull in the terms from the current package and benefit(s).
- Click Settings
- Click Benefit Management
- Click Plan Utilities
- Select Add Previous Year’s Terms to Benefit Change Log and enter the New package effective date
Select the benefits needed for the New Benefit Package (in this example 2013) that require explicit terms. Select Save & Continue.
Review the details and if correct, Run Utility.
Make sure the Effective date is the start date for the New package. And the Package named is the New package.
Go back to the Benefit Change Log and select the Current package (2012). If the number of employees in export has increased there are explicit terms. Select a benefit and search for an Expiration Date equal to the start date of the New package (in this example 1/1/2013).
The employee will be sent in the file with the actual Effective Date and Expiration Date for the Current package. The system needs to put the effective date of the 1/1/2013 date in the change log so that the record will be included when the export is run with a 1/1/2013 effective date. The Current package must be included in the export. (*see comment below)
For the Benefit Expiration Date field, update the mapping to be: Benefit - Expiration Date equal to Benefit - Package Expiration Date AND Benefit - Expiration Date equal to the New package expiration date (in this example 12/31/2013, enter the date is the format shown here). Depending on the file, the action is either, Do Not Include Field or map to a blank, whichever the mapping is currently set to.
Note: Make a note of the Mapped Value option selected in the mapping before making any changes to the mapping as the Mapped Value option is set to the first option (Blank) when a new line is added to the mapping group**.
This mapping will only send the termination dates for employees whose coverage ended 12/31/2012 (the Current package year). Employees with a New package Expiration Date (12/31/2013), will not have this date sent in the file.
Open Export file. Select Do Not Reset Change Log. Set the Export Effective date to the new package Effective date, 1/1/2013.
Note: Include the previous package and benefits on the Benefits tab. Run the export to Export History Only to review and check for explicit terms and make sure other employees are correct in the file as well. Search for the end date in the format used in the file, e.g., 20131231.