Business Requirements Document

Transcription

1 Business Requirements Dcument SR Allw Cre Enrllment t Persist fr Cmpatible BELI Changes (Lean versin) 1

2 Dcument Infrmatin Dcument Attributes ID Owner Authr(s) Cntributr(s) Infrmatin SR Esther Cheung-Hill, Benefits Infrmatin Systems Je Cutter, Benefits Infrmatin Systems Kenneth Smith, Benefits Infrmatin Systems Revisin Histry Versin Issue Date Changes 1.0 6/23/17 Initial Versin 1.1 7/17/17 B. Burkart Added questins and suggested changes 1.2 7/18/17 B. Burkart wrked n functinal requirements and ther suggested changes 1.3 7/18/17 Updated in meeting with Je, Maria, Mary, Alex /19/17 Updated in meeting with Je, Maria, Mary, Alex /19/17 B. Burkart added sme regressin testing requirements /24/17 B. Burkart updated in meeting with Je, Mary, Alex and Maria /25/17 B. Burkart wrked n functinal requirements fr regressin testing. Updated in meeting with team 1.8 8/1/17- B. Burkart wrked n functinal requirements. 8/2/ /3/17 B. Burkart wrked n requ 23 re: pstdcs /3/17 B. Burkart updated with team 8/ /7/17 B. Burkart updated based n 8/2 ntes frm team meeting. Updated in team meeting 8/7. Replaced chart with revised chart /8/17 J. Cutter replaced chart with Excel bject /8/17 B. Burkart wrking n functinal requirements and updating references /9/17 Updated during team meeting 8/9, then a few updates after meeting /10/17 B. Burkart updated during meeting with team /16/17 Updated during team meetings 8/16, and updated after meeting /17/17 B. Burkart cmbined assumptins 19 and /22/17 B. Burkart cmmented R0018A /20/18 B. Burkart Started creating LEAN versin f BRD. Highlighted Functinal Requirements that will be remved /26/18 B. Burkart reviewed BRD t see if it is cnsistent with the selectin f requirements we will wrk n in Phase I /10/18 B. Burkart we will include requirements 7 and 10 in the lean versin f the prject. Reviewed the BRD t make sure it is cnsistent with including requ 7, 8, 9, 10, 11, 18A, 23, and all regressin testing /10/18 B. Burkart deleted assumptins that are duplicated in the functinal requirements /14/18 B. Burkart added t requirement #15. Als made sme mdificatins per the kickff meeting /15/18 B. Burkart made sme revisins in preparatin fr the cntinuatin f the kickff /16/18 B. Burkart mved sme items t the Out f Scpe sectin /21/18 B. Burkart updated during team meeting /22/18 B. Burkart updated spreadsheet case numbers assciated with 25 and 25A /24/18 B. Burkart updated assumptins 2

3 1.29 5/24/18 J. Cutter Updated Overview, Backgrund, Excluded frm Scpe, Business Rules, Business Requirements, External Reference /6/18 B. Burkart wrding change n Requ 14 and /7/18 B. Burkart finalized fr psting /13/18 B. Burkart updated with team regressin testing requirements /19/18-6/20/18 B. Burkart updated with team. Dcument Apprvals Rle Name Signature Date Prject Directr Esther Cheung-Hill 3

4 Table f Cntents 1 Overview Prduct/Slutin Scpe Business Rules Business Requirements Nn-Functinal Requirements External References Attachments

5 1 Overview This BRD riginally cmbined business requirement updates t Payrll and Persnnel System (PPS) that refine the requirements f R2196 (SR101029) alng with several ptential maintenance fixes t reslve technical issues that arse in R2196 develpment as well as pre-existing maintenance issues. Given the relatively limited service life remaining fr PPS, business needed infrmatin t weigh what maintenance issues shuld still be cnsidered fr inclusin in this prject. ITS prvided an estimate f the develpment and test resurces required fr each f the maintenance requirements; then business cnsidered the required resurces as well as the impact f including r excluding each business/maintenance requirement. Business gave high pririty t allw fr cmprehensive testing f all BRD requirements, including thrugh regressin testing fr the related existing functinal requirements. Fllwing sme iteratin, a scaled dwn lean prject plan was apprved including ne maintenance requirement, and the BRD was revised t its present Lean versin. The resulting mdificatins t PPS are cnsidered Urgent, but are nt date-mandated mdificatins t PPS. Sme maintenance items that are nt in scpe, and thus are nt included in the Base prject release can be cnsidered fr implementatin at the discretin f hsted systems r individual PPS lcatins after the install frm this BRD. This BRD includes a new BELI-Change and Medical Plan Transitin Table t summarize medical plan enrllment and effective date updates as a result f BELI change and subsequent emplyee enrllment actin. The table shws the dependency n the reasn that BELI changed (1000-hr rule), the type f medical plan enrlled (r nt) prir t the BELI change, and when and hw the emplyee respnds (r des nt) t the PIE created by the BELI change. The business requirement updates will simplify requirements and reduce the need fr emplyees t re-enrll in an eligible health plan when they are currently enrlled in a plan and their BELI has changed. The business refinements will nt change the cessatin f autmatic enrllment f new hires t default Medical, Dental and Visin plans that was intrduced in R2196. Business requirements that maintain existing enrllments thrugh sme BELI changes, and thse that default int Cre medical when BELI is changed frm Full r Mid-Level benefits t Cre Benefits will be restred clser t the behavir prir t Release R Backgrund Origin f Autmatic Enrllment in UC s PPS Prcesses in PPS that autmatically enrll emplyees in medical, dental, and visin cverage were implemented in the late 1980 s as part f the UC s strategy fr cmpliance with Internal Revenue Cde Sectin 89 which was enacted as part f the Tax Refrm Act f Althugh Sectin 89 was repealed in late 1989, the assciated PPS changes were left intact Perid f Initial Enrllment (PIE) A PIE is a 31-day perid, mst cmmnly cmmencing when a new emplyee is hired int a benefit-eligible appintment. During the PIE, the emplyee can enrll herself and her family in a selectin f ptinal UC benefits withut any waiting perids r qualifying examinatins. 5

6 1.1.3 Autmatic Enrllment Up t 2016, if a benefit-eligible emplyee reached end f PIE, had nt enrlled in a medical plan, a dental plan, r the visin plan, and had nt explicitly pted ut f cverage, PPS wuld enrll the emplyee in the respective plan type/s fr which he was eligible but nt enrlled. The autmatically assignable plans are Cre Medical, Dental PPO, and Visin. In additin t the end f PIE, ther circumstances prir t 2016 wuld cause PPS t enrll an emplyee int a default plan autmatically. Fr example, if an emplyee had been re-assigned t Cre Benefits (BELI 4), she wuld have autmatically be enrlled in default medical cverage withut a PPS-managed PIE Behavir R2196 (SR101029) After R2196, new hire aut-enrllment was effectively discntinued. Transitins between BELI that ffered a chice f additinal benefits cntinued t create a PIE. We wanted t reduce the number f unintentinal Cre level benefit members frm previus aut-enrllments, s we de-enrlled existing Cre members that were transitining BELI s they culd re-enrll intentinally if they wanted t keep Cre plans. Fr emplyees changing t BELI 4, we created a PIE in PPS t facilitate their chice f Cre Medical, r an explicit Opt ut via AYSO Benefits enrllment. The Opt ut culd als be accmplished by default at the end f the emplyee s PIE. After R2196 was released, we fund that sme emplyees wh were enrlled in Cre medical and had a change in BELI frm BELI 1, 2, r 3 t BELI 4 were being surprised by the discntinuance f their existing Cre medical plan althugh they remained eligible fr their existing plan with their new BELI. As a practical matter, we culd nt be sure that existing Cre members making a BELI transitin wuld always be made aware that they needed t re-enrll if they chse t maintain their existing plan. This BRD mdifies sme BELI change transitin rules t allw Cre enrllments t cntinue withut interventin fr cmpatible BELI changes Replacing the PIE That R2196 Added fr BELI Transitins t BELI 4 Prir t R2196, a BELI change t BELI 4 did nt result in a PIE date being created in PPS. This BRD restres sme f the prir behavir fr BELI changes frm BELI 1, 2, r 3 t BELI 4 by eliminating the creatin f a PPS-aware PIE and instead prviding sme rules t determine cntinued medical enrllment. Fr exceptins where these rules d nt crrectly anticipate an emplyee s desired medical enrllment, a paper enrllment during the PIE can prvide the desired verride Causes fr a PIE and Effect n Aut-Enrllment Varius events ther than a new hire will cause an emplyee t receive a PIE. If PPS is cgnizant f an emplyee s PIE, it sets a PIE end date fr the emplyee; then there is a ptential fr PPS t perfrm sme actins at varius stages f the PIE. If a PIE end date is nt set in PPS, HR administers the PIE, and there is n autmatic mechanism t take actin with respect t the PIE. The fllwing exemplifies PIE events that fall int these tw main categries with respect t PPS: PPS-aware PIE Events-- these cause PPS t enter a new PIE End date in the Emplyee Database (EDB). These are bth current prcess, and prcessing shuld remain as is: 1. The emplyee receives a new appintment that changes his BELI (t 1, 2, r 3 frm any BELI). 2. The emplyee wh was nt previusly full-benefit eligible accumulates 1000 r mre hurs f service during 12 successive mnths. (Check fr 1,000 hurs is included in mnthly maintenance prcess. A UCRS stred prcedure determines benefits eligibility.) PPS-unaware, HR-administered PIE Events these are generally paper frm initiated changes that DO NOT cause a new PIE End date t be entered fr the emplyee in PPS : 6

7 1. The emplyee presents a paper frm fr a change in enrllment due t a life change such as marriage r a new child added t the family. HR validates that the frm was submitted within 31 days f the qualifying event 2. The emplyee returns frm a leave f absence which exceeds 120 days 3. The emplyee mves t a new zip cde ut f cverage area fr his current medical prvider. Frmerly, a PPS-aware PIE culd trigger an aut enrllment if end f PIE circumstances dictate ne r mre aut enrllments. R2196 halted all aut-enrllment. Regardless f R2196, if PPS is unaware f the PIE, the PIE culd never cause an aut enrllment. 1.2 Objectives Cntinue t prevent New Hire aut-enrllment in default medical, dental, and/r visin benefits. T avid r minimize the need t re-enrll in medical benefits when the BELI changes t 4: If an emplyee is cvered under the Cre plan they shuld retain the Cre plan. If an emplyee is cvered under full/mid-level benefit medical plan, they shuld be autmatically enrlled in the Cre plan. Perfrm maintenance crrectins fr sme technical issues that arse frm the implementatin f SR (R2196) 1.3 Stakehlders Acrnym Descriptin Rle * Authrize Has ultimate signing authrity fr any changes t the dcument R Respnsible Respnsible fr creating this dcument A Accuntable Accuntable fr accuracy f this dcument (e.g. prject manager) S Supprts Prvides supprting services in the prductin f this dcument C Cnsulted Prvides input I Infrmed Must be infrmed f any changes Name Psitin * R A S C I Esther Cheung Hill Directr, HR-BIS X Je Cutter Business Systems Analyst X Ken Smith Business Systems Analyst X X Jaime Espinza Principal Analyst X Shaun Ruiz Payrll Crdinatr X Christy Thmpsn Manager, HR-BIS X X X Alex Tayag Prgrammer-Analyst X X Beth Burkart Business Analyst X X X Santhsh Katakam QA Analyst X X 1.4 Prpsed Strategy N/A 7

8 1.5 Glssary Term BELI BRD EDB EE ER GIR ITS LBNL OE PATH PPS PIE UC UCOP UCRS Descriptin Benefit Eligibility Level Indicatr Business Requirements Dcument Emplyee Database prefix t data element number Emplyee Emplyer Grup Insurance Regulatin Infrmatin Technlgy Services Lawrence Berkeley Natinal Labratry Open Enrllment Payrll, Academic Persnnel, Timekeeping and Human Resurces Payrll and Persnnel System Perid f Initial Enrllment University f Califrnia University f Califrnia Office f the President University f Califrnia Retirement System 2 Prduct/Slutin Scpe 2.1 Included in Scpe Updates t PPS t implement the requirements dcumented in this BRD. Mdify benefits aut-enrllment behavir in PPS when an emplyee s BELI changes Related maintenance fixes 2.2 Excluded frm Scpe Changes t nn-pps payrll systems such as at LBNL Changes t the business rules dcumented in the UC Health and Welfare Benefits Prgrams fr Faculty & Staff Grup Insurance Regulatins (GIRs) and ther explanatry cmmunicatin media Changes t PPS test interfaces used fr PATH and PATH-related infrmatin systems Any changes t the PPS Web Interface Retractive hires r BELI changes, where the date f the hire r BELI change precedes the entry date by mre than the length f a PIE, are nt defined under R2196 r this BRD. (The persn respnsible fr such an entry shuld verify the PPS respnse t the retractive change, make manual crrectins if needed, and verify that a new PIE is prvided either within PPS r via manual enrllment if the emplyee qualifies fr a new PIE.) The limited remaining service life fr PPS was a significant factr in the decisin t exclude the issues listed belw. Cntributing factrs in the decisin t exclude these issues frm scpe were: The resurces required t reslve the issues are culd nt be justified There are manual wrkarunds t avid r crrect adverse results The issues culd nt be reliably reprduced fr testing 8

9 The ccurrence f an issue is infrequent When an eligible emplyee wh is nt enrlled in a medical plan receives a PIE, but des nt enrll in a plan during their PIE, they are crrectly given an pt-ut medical cde ( XX ) with an pt-ut reasn cde f Z t indicate that their PIE ran ut withut enrllment in the medical plan. The mechanism is similar fr dental and visin if they are eligible fr Full benefit. The Opt ut cde Z des nt appear t be cnsistently applied when an emplyee has a PIE date in PPS and des nt make an electin f a plan. When there has been an errr in establishing the Z pt ut cde, r fr any reasn payrll r HR wants t remve it, the z cde is nt directly remvable. It cannt be changed nline and it will nt change with an X1 transactin. Re-derivatin t clear the Z will happen when the plan cde is changed. (csmetic n adverse impacts) PIE recalculates dates t the past when an emplyee s hire date is changed. This issue did nt riginate with SR101029, but is reprtedly wrse (ccurs mre frequently) since the R2196 release. This issue is relatively infrequent, and it can be fixed manually if it des ccur. It is lw impact, and a decisin was made t nt address it, due t the limited remaining life f PPS. DM in future plan: is it getting cleared ut when emplyee selects a new plan? There is an issue where smene selects a plan, but then it is end dated and replaced by the DM. (Daily Maintenance) Appears t be the plans that are ging straight int the current medical plan rather than ging int the future plan. Their new medical plan may be effective prir t the effective date f the future DM. Each mnth sme emplyees wh change BELI, but are nt changing t BELI 4 Cre benefits, have had their Medical Plan, r Medical, Dental, and Visin plans end-dated. Generally, they are ging t BELI 1. The exact sequence has nt been determined, as it culd nt be recreated in testing. Exceptins are being manually crrected at the lcatins. Fr emplyees wh are pted ut after reaching their PIE end date, all PPA rws fr the plan they are being pted ut f shuld be deleted. These PPA rws are pending premiums fr the default plans (DM, DD, DV) that are created during the cmpute. 2.3 Assumptins & Cnstraints ID Assumptin / Cnstraint Current Prcess: If an emplyee is still within her PIE and has a medical plan f DM, the CICS functins IFBC, IFDB and IINP and IINS use the Cre plan cde (AC) t lk up the emplyer and emplyee cntributins and display them. These cntributin indicatins fr the frmer default plan d nt reflect any enrllments, nr will they change any enrllments. This was unchanged by R2196 and their remval is nt a required change fr this BRD. Hwever if the implementatin f the requirements f this BRD caused these indicatins t be zered r remved, this wuld be a permissible unintended cnsequence Current Prcess: If an emplyee is still in PIE and has a medical plan f DM, the PPS Web interface will display emplyer and emplyee cntributins fr Cre medical. These indicatins d nt reflect any enrllments, nr will they change any enrllments. This display was ut f scpe and nt intentinally changed by R2196; it may r may nt be affected by this BRD as web interface changes and testing remain ut f scpe Dependent enrllment behavir shuld fllw the emplyee Regressin testing cmments were verified during QA testing. This is nt intended t 9

10 cver all pssible cases. Unspecified pre-existing anmalies are ut f scpe f the slimmed dwn prject There is an existing anmaly invlving drpped dependents in sme cases when the BELI changes and the emplyee had an existing XX pt ut with reasn cde Z. There may be ther cnditins in which this ccurs beside the nes we encuntered in testing. Users making nline updates t an emplyee that has previusly been pted ut f cverages are cautined t verify that existing dependents remain in place fllwing a re-enrllment Due t an existing anmaly, in sme cases, existing plan cde XX (pt ut) fr medical, dental r visin, may nt be replaced by the pending plan cdes DM, DD, and DV when an emplyee has a BELI change. If this ccurs, then the emplyee s enrllment via AYSO will be rejected with an errr message and enrllment transactins shuld instead be cmpleted via the CICS screens. (See Functinal Requirements R0014A, R0014B, and R0014C.) 2.4 Outstanding Items Nne 3 Business Rules The current perative GIRs are dated June 30, 2017; their lcatin is included in Sectin 6 External References. With at mst minr exceptin, the business requirements in this dcument are aligned with the June 30, 2017 GIRs. If this BRD creates an exceptin t the GIRs, it is in the interest f streamlining the enrllment prcesses and reducing the pprtunity fr errr. In that case, we anticipate that the succeeding versin f GIRs will catch up with the requirement detail update described by this BRD. The business rules related t aut enrllment can be fund dcumented in the January 1, 2011 UC Health and Welfare Benefits Prgrams fr Faculty & Staff Grup Insurance Regulatins (GIRs). An excerpted cpy f the relevant language was prvided in SR fr anyne seeking backgrund infrmatin. SR (R2196) cmpletely eliminated aut-enrllment by creating a PIE in PPS fr emplyees changing t BELI 4 frm BELI 1, 2, r 3, even if the emplyee was already enrlled in Cre medical. This BRD requests that the specific prcess be mdified t eliminate an unnecessary PIE in PPS fr this case: A default int Cre medical r an pt ut will be made by PPS based n whether r nt the emplyee has existing cverage in any regular UC emplyee medical plan. Hwever, an HR-administered PIE will be in effect allwing the emplyee t verride the PPS default using a paper frm. The general new-hire default aut- enrllment as described in the 2011 GIRs will nt be reinstated. 10

11 4 Business Requirements New Requirements Overview This BRD implements business requirements that mdify the business requirements implemented in R2196 (SR101029). New-hire aut-enrllments are still prhibited. Sme changes t hw PPS handles aut enrllments fr BELI changes are needed. Generally, BELI changes shuld nt result in aut enrllments with sme exceptins: Existing Cre medical plan enrllments shall persist when eligible under the new BELI unless changed by the emplyee during their (PPS r HR administered) PIE (R0011). BELI changes dwngrading regular emplyee benefits (Full and Mid-Level) t Cre benefits shall autmatically enrll emplyees having existing medical cverage t Cre Medical; the emplyee may chse t pt ut f autmatic enrllment in Cre medical via a paper enrllment electin during the HR administered PIE. (R0008) Fr BELI changes dwngrading regular emplyee benefits (Full and Mid-Level) t Cre benefits: There shuld be n autmatic enrllment in Cre Medical fr emplyees wh currently have n medical cverage plan; the emplyee may chse t enrll in Cre Medical via a paper enrllment electin during the HR administered PIE (R0010) The business requirements stated in this sectin are intended t be thse that are new, mdified, r clarified since R2196 (SR101029). Existing related business requirements that are unchanged are nt generally stated in this sectin. 11

12 BELI-Change and Medical Plan Transitin Table The BELI-Change and Medical Plan Transitin Table includes sme f the existing business requirements and the new/mdified requirements t prvide an verview f the related medical plan business functinality in cntext. The table fcuses n the medical plan because the medical plans apply t the greatest number f BELI cdes and represents the largest and mst cmplex set f plan transitins. Hw t Interpret the BELI-Change and Medical Plan Transitin Table The table utlines the BELI change driven PPS business requirements that affect medical plan enrllments fr each f 11 types f BELI transitins. T adhere t the rules defined in the GIRs, each case takes int accunt whether there is an existing medical plan, and whether the BELI change derives frm the 1000-hr rule. The first five clumns f the table define the requirements case in the fllwing terms: A case number fr reference The current BELI The new BELI Whether the 1000-hur rule is the cause f the BELI transitin The current medical plan type: nne, Cre Medical, full/mid-level medical, r Pstdc medical The sixth clumn describes hw PPS shuld respnd t the BELI change prir t any input frm the EE. The next clumn summarizes the type/s f medical plan that are available fr the EE t elect The fllwing three clumns define utcmes fr up t three subcases depending n when an EE makes a medical plan electin r des nt d s. In sme cases, there are fewer than three different utcmes, Clumn A describes the required utcme if an EE makes a medical plan electin by the end f the mnth when the EE s BELI has changed. Clumn B describes the required utcme if an EE makes a medical plan electin after the end f the mnth when the EE s BELI has changed but by the end f the PIE. Clumn C describes the required utcme if an EE des nt make a medical plan electin by the end f the PIE. 12

13 PPS Medical 6 Plan Requirements Arising frm BELI Changes and Emplyee Electins 13

14 New r Clarified Business Requirements This BRD partially restres sme pre-r2196 PPS behavirs when an emplyee s BELI changes frm 1, 2, r 3 t BELI 4. In sme BELI change cases, if an emplyee had existing medical enrllment prir t the BELI change, he may be autmatically enrlled int Cre Medical t maintain cverage if he takes n actin. As was the case prir t R2196, a PIE date shuld nt be set in PPS when an emplyee s benefit level is reduced t Cre. Fr this case, an EE will have an HR-administered PIE during which he may use a paper frm t verride an undesired default. (R0007) If the emplyee is enrlled in Cre medical when the BELI 4 becmes effective (R0009) The Cre medical plan shuld nt be changed r term dated. If the emplyee des nt wish t cntinue in Cre Medical, he may pt ut via paper frm. If the emplyee is nt enrlled in any medical plan when BELI 4 becmes effective (R0010) Her medical plan cde (blank r pt ut) and her pt ut cde shuld nt be changed If the emplyee wishes t enrll in Cre Medical, she may d s via paper frm during her PIE If the emplyee is enrlled in any regular emplyee medical plan ther than Cre when the BELI 4 becmes effective (R0008) The regular medical plan will be term-dated t mnth end (existing behavir) If the emplyee des nt make a psitive chice t Opt Out t XX (via paper frm) by the end f the mnth, the emplyee is enrlled in Cre medical as f the first f the fllwing mnth: the medical plan cde is set t AC with n terminatin date, the Opt Out cde (if any) is cleared If the emplyee wishes t Opt Out f medical, he may d s via paper frm. When an emplyee is changed frm BELI 4 t BELI 1, 2, r 3, he is given a new PIE (existing behavir Regressin testing) (R0013) If the emplyee is nt enrlled in medical when the BELI 1, 2, r 3 becmes effective, his medical plan cde is set t DM. The behavir f the pt ut cde varies; see the Functinal Requirements fr detail. (This bullet is prir behavir.) (R0014) If the emplyee s BELI change is t BELI 1, his dental plan and visin plan cdes are set t DD and DV, respectively, and his dental and visin Opt Out cdes are cleared (R0014A, R0014B) If the emplyee selects a plan r plans during his PIE, his plan cdes are entered with the effective date f his BELI change If the emplyee desn t make a selectin fr an eligible medical, dental, r visin plan by the end f her PIE, the pt ut cde XX with reasn Z will be entered fr each such plan (as specified in R2196) (R0014, R0014A, R0014B) 14

15 If the emplyee is already enrlled in Cre medical when the BELI 1, 2, r 3 becmes effective (R0015B) The Cre medical plan shuld nt be changed r term dated when the BELI change becmes effective If the emplyee re-enrlls in the Cre medical plan during her PIE, n further actin is required fr her medical plan selectin If the emplyee des nt enrll in a medical plan (r make a psitive chice t Opt Out) by the end f her PIE, The emplyee remains enrlled in Cre medical The medical plan cde remains unchanged as AC with n change in effective date If the emplyee enrlls in a medical plan ther than Cre (r she makes a psitive chice t Opt Out) after the end f the mnth but befre her PIE ends, (R0015) Regressin testing The new plan cde is entered immediately If the emplyee s BELI change was nt due t the 1000/750 hur rule, the effective date is retractive t the first f the mnth fllwing the BELI change If the emplyee s BELI change was due t the 1000/750 hur rule, the effective date is retractive t the first f the mnth when the BELI was changed 4.1 User Requirements N/A 15

16 4.2 Functinal Requirements Reqt. ID Requirement Type Requirement Descriptin Pririty [L/M/H] Cmments R0001 Cmmunicate requirements t LBNL. H BIS: infrm LBNL (nn-pps) f the functinal requirements. (This cmment applies t all f the functinal requirements in this table.) R0002 New hire Fr new hires, there shall be n aut enrllment int any medical, dental, r visin plans fr emplyees wh d nt take actin t enrll during their PIEs. requirement R0003 New Hire R0003 A New Hire R0004 New Hire R0004 A New Hire R0005 New Hire Fr new hires, when an emplyee des nt take actin t enrll in a medical plan during his PIE: Medical Plan Cde (EDB0292) shall be set t XX. Medical Insurance Opt Out Cde (EDB0377) shall be set t Z, the cde that indicates that the reasn fr pt ut was expiratin f the emplyee s PIE with n medical electin. Fr new hires, when an emplyee makes a psitive chice t pt ut f medical during his PIE: Medical Plan Cde (EDB0292) shall be set t XX. Medical Insurance Opt Out Cde (EDB0377) shall be set t X, the cde that indicates that the reasn fr pt ut was a psitive chice. Fr new hire emplyees wh are eligible fr full benefits and d nt take actin t enrll in a dental plan during their PIE: Dental Plan Cde (EDB0272) shall be set t XX. Dental Insurance Opt Out Cde (EDB0378) shall be set t Z t indicate the reasn fr pt ut was due t run ut f PIE with n dental electin. Fr new hires, when an emplyee makes a psitive chice t pt ut f dental insurance during his PIE: Dental Plan Cde (EDB0272) shall be set t XX. Dental Insurance Opt Out Cde (EDB0378) shall then be set t X, the cde that indicates that the reasn fr pt ut was a psitive chice. Fr new hire emplyees wh are eligible fr full benefits and d nt take actin t enrll in a visin requirement (Spreadsheet cases 2, 10) requirement requirement requirement requirement 16

17 R0005 A New Hires R0007 BELI change frm 1, 2, r 3 t 4 R0008 BELI change frm 1, 2, r 3 t 4 plan during their PIE: Visin Plan Cde (EDB0347) shall be set t XX. Visin Insurance Opt Out Cde (EDB0379) shall be set t Z t indicate the reasn fr pt ut was due t run ut f her PIE with n visin electin. Fr new hires, when an emplyee makes a psitive chice t pt ut f visin insurance during his PIE: Visin Plan Cde (EDB0347) shall be set t XX. Visin Insurance Opt Out Cde (EDB0379) shall then be set t X, the cde that indicates that the reasn fr pt ut was a psitive chice. Change frm BELI 1, 2, r 3 t BELI 4: When an emplyee s BELI changes frm 1, 2, r 3 t 4, PPS shuld nt establish a PIE. PPS shuld nt set a PIE date when an emplyee s benefit level is reduced t Cre. BELI changes frm Full r Mid-Level (BELI 1, 2, r 3) t Cre benefits (BELI 4): If the emplyee was previusly enrlled in a full benefit medical plan, the emplyee shuld be autmatically enrlled in Cre Medical. The regular medical plan will be termdated t the end f the mnth when the BELI change was entered (existing behavir). Reasn cde BE If the emplyee des nt make a psitive chice t Opt Out t XX (via paper frm) by the end f the mnth when the BELI change was entered, the emplyee is enrlled in Cre medical as f the first f the fllwing mnth: Medical Plan Cde shuld be set t AC with n terminatin date. Medical Insurance Opt Out cde (if any) shuld be cleared. The existing Medical Plan Cverage Cde (EDB0293) and dependents shuld be maintained. If the emplyee wishes t pt ut f medical cverage, he may d s via paper requirement H Currently the emplyee is receiving a PPS PIE. The EE will have an HRadministered PIE during which he may use a paper frm t verride an undesired default. Spreadsheet cases 7, 8, 9 H Opt ut via paper frm shuld be tested using CICS screen EINS. Nte that the AC (Cre) plan cde, rather than the DM cde, shuld be queued. Spreadsheet case 7 17

18 R0009 BELI change frm 1, 2, r 3 t 4 R0010 BELI change frm 1, 2, r 3 t 4 N existing medical plan R0011 BELI change, when enrlled in any medical plan (nt Pstdc) Emplyee did nt make a change during PIE frm during the HR administered PIE. BELI changes frm Full and Mid-Level (BELI 1, 2, r 3) t Cre benefits (BELI 4): If the emplyee was already enrlled in the Cre Medical plan, Cre Medical enrllment shuld be maintained. The Cre medical plan is nt changed r term dated. DM plan cde shuld NOT be established. The existing Medical Plan Cverage Cde (EDB0293) and dependents shuld be maintained. If the emplyee des nt wish t cntinue in Cre Medical, he may pt ut via paper frm during the HR administered PIE. When an emplyee transitins frm BELI 1, 2, r 3 t BELI 4: If the emplyee was nt enrlled in any medical plan, their default is t remain withut a medical plan. They shuld nt be autenrlled in Cre medical. BELI change: Medical Plan Cde (blank r pt ut) and Medical Insurance Opt Out Cde shuld nt be changed. The DM plan cde shuld nt be established. If Plan Cde XX exists, it shuld nt be end dated. If the emplyee wishes t enrll in Cre Medical, she may d s via paper frm during her (HR administered) PIE. When the emplyee is currently enrlled in a medical plan (excluding Pstdc) and they are eligible fr the same plan under the new BELI, the plan cverage shuld be maintained if they d nt make a chice during their PIE. The medical plan cde remains unchanged with n change in effective date. H Opt ut via paper frm shuld be tested using CICS screen EINS. Spreadsheet Case 8 H Paper frm enrllment in Cre shuld be tested using CICS screen EINS. Spreadsheet case 9 H Nte: where the emplyee changed frm BELI 4 t 1 due t reaching 1,000 hurs, testing shwed that the prcess already appears t wrk crrectly. (case 3) Spreadsheet cases 1 18

19 R0012 BELI change frm any BELI t BELI 1 R0012 A BELI change frm any BELI t BELI 1 R0013 BELI change frm 4 t 1, 2 r 3 R0014 BELI change nt due t 1,000 hurs, n current plan R0014 A R0014 B BELI change frm 2, 3, r 4 t 1 dental BELI change frm 2, 3, r 4 t 1 visin If the emplyee changes frm any BELI t BELI 1, and he reaches the PIE end date withut either enrlling in a dental plan r making a psitive chice t pt ut, the Dental Plan Cde is set t XX with Opt Out cde Z. If the emplyee changes frm any BELI t BELI 1, and he reaches the PIE end date withut either enrlling in a visin plan r making a psitive chice t pt ut, the Visin Plan Cde is set t XX with Opt Out cde Z. When an emplyee changes frm BELI 4 t BELI 1, 2, r 3, he is given a new PIE in PPS. When an emplyee wh is nt enrlled in medical changes t a BELI that has medical eligibility: When PIE begins, his Medical Plan Cde is set t DM. If the emplyee selects a plan during his PIE, his plan cde is entered with the effective date f his BELI change (BELI Effective Date). If the emplyee des nt select an eligible medical plan by the PIE end date, the Medical Insurance Opt Out Cde XX with reasn Z will be entered. If the emplyee changes frm BELI 2, 3 r 4 t BELI 1 and currently has pt ut cde XX with reasn cde Z, then the dependents are cleared ut. (pre-existing anmaly) Fr an emplyee wh changes frm BELI 2, 3, r 4 t BELI 1: Dental Plan Cde is set t DD, and Dental Insurance Opt Out Cde is cleared, if present. If the emplyee selects a plan during his PIE, his plan cde is entered with the effective date f his BELI change (BELI effective date). If the emplyee des nt select an eligible dental plan by the PIE end date, the pt ut cde XX with reasn Z will be entered fr the dental plan. Fr an emplyee wh changes frm BELI 2, 3, r 4 t BELI 1: Visin plan cde is set t DV and Visin Insurance Opt Out Cde is cleared, if present. requirement requirement Spreadsheet cases 1, 2, 3, 4 Spreadsheet cases 2, 10 If there is an existing pt ut cde f Z, the Z will remain until it is cleared by a subsequent actin. Other pt ut cdes ( X, D, r C ) will be cleared when the DM cde is set. If there is an existing XX/Z with dental r visin when the emplyee is assigned BELI 1, the XX/Z will nt be cleared ut unless the emplyee makes a chice during their PIE. If the emplyee has an existing dental plan cde XX (pt ut), then transactins frm AYSO (ther than OE) will be rejected, and the enrllment will need t be cmpleted using the CICS screens. If there is an existing XX/Z with dental r visin when 19

20 R0014 C BELI change frm 4 t 1 due t 1,000 hurs, currently pted ut If the emplyee selects a plan during his PIE, his plan cde is entered with the effective date f his BELI change (BELI Effective Date). If the emplyee des nt select an eligible visin plan by the PIE end date, the pt ut cde XX with reasn Z will be entered fr the visin plan. If emplyee changes frm BELI 4 t BELI 1 and is currently pted ut, then they shuld fllw the lgic in R0014. Exceptin: The emplyee des get a PIE, but the DM plan cde is nt set. This applies in the case f bth Opt ut cde XX/Reasn X and Opt ut cde XX/Reasn Z. the emplyee is assigned BELI 1, the XX/Z will nt be cleared ut unless the emplyee makes a chice during their PIE. If the emplyee has an existing visin plan cde XX (pt ut), then transactins frm AYSO (ther than OE) will be rejected, and the enrllment will need t be cmpleted using the CICS screens. Regressin testing Nte that, when there was a BELI change frm 4 t 1 due t reaching 1,000 hurs, testing revealed that current prcessing did nt yield the expected results. PPS appears t be leaving the previus XX pt ut cde in place, althugh, since the emplyee has a PIE they can still enrll. If the emplyee has an existing medical plan cde XX (pt ut), then transactins frm AYSO (ther than OE) will be rejected, and the enrllment will need t be cmpleted using the CICS screens. R0014 D BELI change frm 5 t 1 due t 1,000 hurs R0015 BELI change frm 4 t 1, 2, r 3, nt due t 1,000 hurs, currently enrlled in Spreadsheet case 4 See requirement R0014 Regressin testing Fr an emplyee wh changes frm BELI 4 t BELI 1, 2, r 3 nt due t 1,000 hurs, and is enrlled in Cre medical when the BELI 1, 2, r 3 becmes effective: If the emplyee enrlls in a medical plan ther than Cre (r makes a psitive chice t Opt Out) by the end f the mnth when BELI change was entered, the new plan will cme int effect Spreadsheet case 4 Spreadsheet case 1 20

21 R0015 A R0015 B Cre medical BELI change frm 4 t 1 due t 1,000 hurs, currently enrlled in Cre BELI change frm 4 t 1, 2, r 3, nt due t 1,000 hurs, currently enrlled in Cre medical n the first f the fllwing mnth. The Cre medical plan is term-dated t the end f the mnth when the BELI change was entered. The new plan cde is queued with an effective date the day after the Cre is term dated. The AC plan cde is replaced by the queued plan cde (including XX if pted ut). If the emplyee enrlls in a medical plan ther than Cre (r makes a psitive chice t Opt Out) after the end f the mnth but befre her PIE ends: The effective date is retractive t the first f the mnth after the BELI change was entered. Fr an emplyee wh changes frm BELI 4 t BELI 1 due t 1,000 hurs and is enrlled in Cre medical when the BELI 1 becmes effective: If the emplyee enrlls in a medical plan ther than Cre (r she makes a psitive chice t Opt Out) The new plan cde is entered immediately The effective date is retractive t the first f the mnth when the BELI effective date If the emplyee is already enrlled in Cre medical when the BELI 1, 2, r 3 becmes effective: If the emplyee takes n actin, r re-enrlls in Cre medical, the emplyee shuld remain in the Cre medical plan. The Cre medical plan shuld nt be changed r term dated when the BELI change becmes effective If the emplyee re-enrlls in the Cre medical plan during her PIE, n further actin is required fr her medical plan selectin If the emplyee des nt enrll in a medical plan (r make a psitive chice t Opt Out) by the end f her PIE, The emplyee remains enrlled in Cre medical The medical plan cde remains unchanged as AC with n change in H Spreadsheet case 3 21

22 R0016 BELI change frm 1 t any ther R0017 BELI change frm 2 r 3 t 1 R0018 BELI change frm 2 r 3 t 1 R0018 A Enrlled in med plan (nt Cre) BELI change frm 2 r 3 t 1 Enrlled in Cre R0019 BELI change frm 2 r 3 t 1, nt enrlled in med plan R0020 BELI change t BELI 5 R0021 Pstdc effective date When the BELI changes frm 1 t any ther BELI, the current dental and visin plans are set t end the last day f the mnth when the BELI is changed. When an emplyee changes frm BELI 2 r 3 t BELI 1, she is given a new PIE. When an emplyee changes frm BELI 2 r 3 t BELI 1, if the emplyee is enrlled in a medical plan ther than Cre when the BELI 1 becmes effective, n actin is taken n her enrllment cde unless she makes a selectin f a new medical plan. When an emplyee changes frm BELI 2 r 3 t BELI 1, if the emplyee is enrlled in Cre when the BELI 1 becmes effective, n actin is taken n her enrllment cde unless she makes a selectin f a new medical plan. The Cre enrllment shuld persist. When an emplyee changes frm BELI 2 r 3, t BELI 1, if the emplyee is nt enrlled in a medical plan when the BELI 1 becmes effective, her medical plan cde is initially set t DM. If she des nt enrll in a medical plan (r make a psitive chice t Opt Out) by the end f her PIE, her DM plan cde is changed t XX and the Opt Out cde is set t Z. When emplyee changes frm BELI 1, 2, 3, r 4 t 5, and they currently have Cre r an existing full plan, the current medical plan shuld be set t end the last day f the mnth when the BELI is changed; n PPS PIE is set. N changes shall be made t current PPS behavir when an emplyee is assigned BELI P due t new hire r a change int a BELI P psitin. Currently, when an emplyee s BELI changes frm 1 t P, a PPS PIE is established, and any medical, dental and visin plans that the emplyee is enrlled in are end dated t the end f the mnth when the BELI change was entered. When an emplyee mves frm BELI 2 (r 3) r 4 t BELI P, a PPS PIE end date is set, and their existing medical plan is end dated t the end f the mnth when the BELI change was entered. - Emplyee n lnger eligible fr visin r dental Spreadsheet cases 1, 2 Spreadsheet case 1 H Spreadsheet case 1 This falls under R0011, but is a mre specific case. Spreadsheet case 2 The pt ut cde Z will remain until it is cleared by a subsequent actin. H Regressin testing Spreadsheet case 11 requirement Pstdcs are cvered under cllective bargaining and unilateral changes are nt permitted. 22

23 R0022 Maintenance item R0023 Maintenance item When a new hire is placed in BELI P, a PPS PIE is established, and the DM, DD and DV plan cdes are established with an effective date equal t the hire date. Requirement Remved Daily Maintenance: PPS shuld lk fr emplyees with default plans (DM, DV, DD) with ld PIE dates (utside the existing prcessing windw that are nt initial values) and treat them as an expired PIE case (give them plan cde XX with pt ut reasn cde Z). H Issue: pending premiums are being added t the PPA table with each cmpute fr these emplyees, creating abend when the number f rws exceeds the limit. R0024 Maintenance item R0025 BELI P t BELI 1, 2, r 3 R0025 A R0026 IDOC BELI P t BELI 4 Requirement Remved When an emplyee s BELI changes frm P t 1, 2, r 3, PPS shuld: establish a PIE If the emplyee had pstdc insurance, then set current medical, dental and visin plans t end last day f mnth when the BELI change was entered. If an emplyee changes frm BELI P t BELI 4: Any existing Pstdc plans shuld be enddated. The emplyee shuld get a PIE Plan cde DM shuld be queued. If an emplyee has a PIE frm new hire r a BELI change and des nt enrll in an eligible medical, dental, r visin plan during the PIE, she will be cded as being Opt Out with a reasn cde f Z. As specified in R2196, PPS will prvide an IDOC message when a Z pt-ut cde is generated fr an end f PIE withut enrllment. H H H Spreadsheet cases 5, 5A Regressin testing Nte: if the emplyee des nt make an electin during their PIE, then the enddated Pstdc plans will remain in the system and n pt ut cde will appear. Spreadsheet cases 6, 6A Regressin testing Regressin testing 5 Nn-Functinal Requirements N/A 23

24 6 External References SR101029_RemveAutEnrllTMedi caldentalvisin_brd.pdf UC Health & Welfare Benefits Prgrams Fr Faculty and Staff, GROUP INSURANCE REGULATIONS (Jun 30, 2017) %20PPS%20Stp%20Default%20Enrllment _RemveAutEnrllTMedicalDentalVisi n_brd.pdf Dcument Lcatin Authr SR100177_PPS_Stp_Default_Enrll ment_in_h_w_plans_brd.dcx ers/basepps/ppsbusspnc/2013/cancelled%20- %202013/SR100177%20- Ken Smith Je Cutter UCOP HR Benefit Prgrams and Strategy 7 Attachments N/A 24