The need for separate Open Enrollment COBRA Files

COBRA files are unlike standard benefit files, as there is the need for an open enrollment COBRA file and the regular plan year COBRA files, both of which will be set on a schedule. The reasoning for this is to ensure retro terminations are captured and sent to the client’s COBRA administrator.

For example, if a subscriber has terminated employment in December, but the administrator did not terminate the employee until January, they will not be caught on the COBRA file for the new plan year. This employee’s benefits did not reach into the new plan year (January), therefore, is not captured on the COBRA file.

This will be rectified by including both plan years on the open enrollment COBRA files. There will then be a second set of files that run for the duration of the plan year, with only the current benefit plan year included in the file

Copying Files - Open Enrollment COBRA

1. Begin by locating the COBRA files for the current plan year under Data > Exports > Manage.
2. At the far right of the listed COBRA files, select the open check box.
3. With all of the current COBRA files selected, click “Duplicate Selected Exports” from the selection of action buttons above your listed EDI files.
4. Once the files have been duplicated, the duplicate files will have the name "- Copy" appended to title.

Configuring Open Enrollment COBRA Files

1. Open the duplicate file by clicking on the export name.
2. Update the file name as desired, indicating that this is a designated open enrollment file.
3. From Category drop-down, select the open enrollment category for the upcoming plan year.
4. Update the effective date of the file to reflect the first day of the new plan year
5. Save Properties
6. Navigate to the Benefits tab of the file. 
7. Select the applicable COBRA eligible benefits for the current plan year and the new plan year, ensuring to be mindful of any Group By Codes being used. Click "Save Benefits"
8. On the Schedule tab, enter in a schedule for the first thirty days of the new benefit plan year. The schedule should align with the regular weekly file schedules.
   • Example: the new plan year begins January first. The schedule entered should reflect a weekly cycle, ending on January thirty-first.
   • ProTip: the qualifying beneficiary (QB), also called qualifying event (QE), the file should always be configured first when rolling over files. The schedule should be entered for the qualifying beneficiary file first. The new plan member (NPM), also called new hire (NH), should be configured second. When setting the schedule for the NPM file, a schedule dependency should be set against the QB file. This means the NPM file will not run until the QB file has executed successfully.

Copying Files - Regular Production COBRA

1. Begin by locating the COBRA files for the current plan year under Data > Exports > Manage.
2. At the far right of the listed COBRA files, select the open check box.
3. With all of the current COBRA files selected, click “Duplicate Selected Exports” from the selection of action buttons above your listed EDI files.
4. Once the files have been duplicated, the duplicate files will have the name "- Copy" appended to title.

Configuring Regular Production COBRA Files

1. Open the duplicate file by clicking on the export name.
2. Update the file name as desired, indicating that the file is for the new plan year.
3. From Category drop-down, select the new plan year category.
4. Update the effective date of the file to reflect the first day of the second month of the new plan year
   • Example: the new plan year begins January first. The effective date entered should be February first.
5. Save Properties
6. Navigate to the Benefits tab of the file. 
7. Select the applicable COBRA eligible benefits for the current plan year, ensuring to be mindful of any Group By Codes being used. Click "Save Benefits"
8. On the Schedule tab, enter in a schedule for the remainder of the plan year, beginning in the second month of the plan year and ending on the last day of the plan year.
   • Example: the new plan year begins January first. The schedule entered should reflect a weekly cycle, beginning on February first and ending on December thirty-first.
   • ProTip: the qualifying beneficiary (QB), also called qualifying event (QE), the file should always be configured first when rolling over files. The schedule should be entered for the qualifying beneficiary file first. The new plan member (NPM), also called new hire (NH), should be configured second. When setting the schedule for the NPM file, a schedule dependency should be set against the QB file. This means the NPM file will not run until the QB file has executed successfully.