Benefit Spousal and Smoker Surcharges

We are preparing for our fall Benefit Enrollment and I have a question about surcharges and plan set-up.
Last year we started a spousal surcharge based on questions answered by employees via a paper form. Benefits managed employee groups based on their responses and I used the emp group to upload the deduction. In hind sight, I think we could have done better.
This year we are implementing a smoker surcharge and a spouse smoker surcharge in addition to the spousal coverage surcharge.

For this year, we have created a custom online form that employees are required to complete prior to doing their enrollment. The answers are stored on a custom table as a flag or Y/N.

I am looking for some information or insight for including the surcharge amounts within the benefit plan/deduction set-up using flags to define employee groups. So here are my questions:
1. If your employees complete benefits online through ESS and do you use an online form to include questions regarding spousal benefit coverage and/or smoker as part of enrollment (new hire and/or annual)?
2. If so, do you use a flag or field that is updated, either manually or by a process flow, as a result of their answers?
3. How do you process the surcharges, manually on the PR14 or through BN plan set-up?
4. If using BN plan set-up, do you define a separate surcharge plan, separate coverage levels within your health plan or just separate contribution records based on the employee groups within the health plan?
5. Do you use any process flows to handle the process?

Any information that is offered is appreciated!

[Updated on 7/9/2014 10:15 AM]

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Comments

unknown

2014 is the first year that we implemented surcharges, and we have three of them: Working Spouse, Tobacco Use and Wellness. We currenly have 4 medical plans and the rates are different for full time/part time status. I had to create 18 different employee groups, and set up 48 different rate option on the BN setup, and they all work beautifully!

I first created 3 user fields that are populated with "Y" or "N" for the three surchages. I also created 3 personnel actions (PA52) that are used to enter or change these fields during the year. (If we were to just change these fields directly on HR11 our automation rules would not work to change premiums.)

To alleviate having to key 2500 (x2) verifcation forms during Open Enrollment for the "Working Spouse" and "Tobacco Use" fields, an online CBL was created in the system that is used for our Mandatory Education. I was able to export the answers to the CBL and then upload them to the user fields using addins.

We put a message on the "welcome screen" during Open Enrollment that told Associates the rates they were seeing were the rates with no surcharges added. We also built .htm documents that Associates would see when they clicked the link for each medical plan. These .htm documents showed what the rate would be with each combination of surcharges added.

We use ESS for Open Enrollment and for new hires, but changes/enrollments due to life events during the year are still done using paper enrollment forms. (I'm hoping to automate these during the next year, but have not had time to work on that yet!) So, I also created a two paper verification forms (for Working Spouse and Tobacco Use) that we use on an on-going basis. These are completed during orientation by new hires and are given to Associates during the year when they are changing benefits due to life events.

I'll try to answer your questions as you have them listed:

1. Open enrollment and new hires complete benefit elections online through ESS. New hires are given a paper verification forms for "Working Spouse" and "Tobacco Use" to complete in new hire orientation. Life events during the year are also given these forms to complete.

2. I created 3 user fields to have to be updated with the "Y" or "N" indicator. This is done through a personnel action (PA52).

3. We use automation rules, so the changes in premiums are processed done automatically by running the PA100 and BN100 jobs.

4. Yes, as I said above, I had to set up 48 different Options Amounts (BN18) and Option Rates (BN19)

5. No, we do not have process flow so I cannot use it :-(

We have learned a few things during the year. I have created specific reasons to use with each personnel action. The reasons help us determine why the flag is "y" or "n". The one that has caused us the most problem is the "Tobacco Use" field. For a member that is covering a spouse on medical, if the member and/or the spouse have used tobacco in the last 12 months, the surcharge is assessed. We found that we needed to know if one or both of them were the smoker. So, I create 3 reasons Smoker-A, Smoker-A&S, Smoker-S (A stands for Associate and S stands for Spouse).

This is a pretty complex setup, but it does work. I'd be happy to talk off line if you have more questions.

Good luck!

hidehiro-nagase

Cyndie,
I'm running into an error .. More than one premuim record setup for employee. What am I missing?

Here is what I did (in test, of course ) I took a full-time employee, moved her to part-time, then did a PA adding her to the smoker-ap group. Then i went to BN32.1, stopped her 2014 full-time benefit effective 7/31/2014, then re-added her part-time rate 8/1/2014, then stopped the 8/1/2014 rate and tried to re-add using 1/1/2015 and that's where the message came in... help!

0712050808501819.doc

hidehiro-nagase

Cyndie - still thinking. Is it because my employee is part of the "full-time and smoker"- group I created ? I my thoughts are correct, then yes that would be the issue.

Now, I have other benefits based on the "full-time" group. I can't exclude the employee from the full-time group because it would affect other benefits.

I inherreted the group/benefit setup a long time ago and so for there were really no issue, but now that our facility is changing rules, it seems to be an issue.

Do I need to re-create the wheel?

unknown

Yes Danielle, your thoughts are correct. That is the error you will receive if the employee falls into two of the groups at the same time.

When we began implementing surcharges, I encountered the same issue with other benefits being based on our "full time" group. I did have to re-create the wheel by creating new employee groups.

You may need to consider creating a new medial plan(s) for the new plan year. It may make it easier for your to define your groups without having overlap.

I'd be happy to talk to you off line if you need to.

0811130630195911.xls

hidehiro-nagase

Cyndie!
You have been so helpful! I'm leaving for vacation and will be back next week. I'd love to touch base then!

thanks again!

unknown

Danielle, my email is cyndie.imler@mwhc.com .

ggrooteman

Danielle, Have a SUPER nice vacation! Thank you so much Cyndie for helping our wonderful Benefits specialist!

unknown

Hi Cyndie
We are implementing a working spouse surcharge for our 2015 open enrollment period. I came across your communication with Danielle on this topic. The information provided is very helpful. Would you be willing to elaborate on the use of the PA52. Are you using the effective date to drive employee groups? We currently use the PA52 to maintain our wellness surcharge and I am running into challenges when employees are qualified in the current year and not for the 2015 plan year. My email is dwildman@everettclinic.com if you prefer to contact me directly. Thank you.

unknown

Hi dwildman, I am going to send you an email.

unknown

Thank you, Cyndie.

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