Reconciliation of Benefit Data Updates in HRS
Overview of the steps taken to update HRS upon identification of benefit enrollment mismatches that may result in a financial reconciliation to collect/refund premiums to employees, triggered by the Reconciliation Team (Recon), Benefit Enrollment Recovery Team (BERT), Campus, or Vendors.
The following are typical enrollment issues identified:
State Group Health
- Generated from Recon through a comparison of current month ETF Invoice
to HRS enrollments. Variances are communicated to UWSC Benefits or UW Madison
Benefits thru an emailed spreadsheet. There are 4 types of mismatches (these will likely lesson with the ETF Interface):
Reconciliation Process Mismatches
- Plan: differences between plans elected in each system
- Program: differences in programs Grad or Reg (WRS)
- Coverage: differences in the coverage levels (Single/Family)
- Enrollment: differences in the enrollments (Active/Not Active)
State Group Life
- Coverage End Dates: ETF end date does not match HRS
- Full - Part Time: employee had a backdated change and per policy depending upon when the employee was counseled they may not owe the additional premiums for Part-Time
- Benefit Program Participation: Employee was discovered during WRS look back and the employee is not responsible for the increase in premium until the application is received, but the benefit program needs to reflect the date changed so WRS deductions are correct.
- Coverage Dates
- Securian currently invoices us for monthly premiums, Reconciliation Team identifies the following:
Dental and Vision
- Premium deducted from employee Securian does not have covered: untimely app, SSN incorrect, WRS entry is missing, no application received, prior period adjustment from missed premium
- Premium not deducted, Securian has active: LOA, missed payroll, terminated, refund for prior period over payment
- Premiums not what expected: ABBR differences, enrolled in different coverage
- Delta Dental currently invoices us for monthly premiums, Reconciliation Team identifies the following:
Premium not deducted from employee but covered at vendor: LOA, missed payroll, terminated, refund for prior period over deductionPremium deducted from employee and invoiced different:Coverage enrollments do not match, wait one billing cycle and send to Benefits to investigate and take corrective actionAll Other Plans
- Premium deducted from employee but not covered at vendor: timing of enrollment file to invoice (held for one month before sending to Benefits to investigate and take corrective action
- We do not receive enrollment files from all the vendors. These issues are brought to our attention by the vendors based on the Self-Bill invoices generated monthly by Reconciliation:
- Reinstatements into wrong plan or coverage
- Requested a refund from the vendor, due to an erroneous waive row
Benefit Enrollment errors occur when the data entered into HRS does not match the data entered into the vendors system. These data discrepancies are discovered in various ways depending on the benefit plan. In most situations the steps to correct are similar:
- Data error is identified by Recon, BERT Campus, or Vendor.
- UWSC Benefits is notified of the issue through a Recon report (ETF Term List), WISCIT, or email.
- UWSC Benefits contacts the campus to determine the correct data.
- UWSC Benefits uses ADM (Administrative) Event to correct HRS. If the ADM cannot fix the issue, they use Correct History (last resort) or works with the vendor to correct their system.
- If the data error created a financial impact, UWSC Benefits creates a ticket, if not previously created, and assigns to BERT or Madison Benefit Services for any financial corrections.
In a few situations the Benefit Enrollments are correct, however the Benefit Reconciliation Table shows variances due to Benefits Program Participation (BPP). Many times the BPP cannot be updated to reflect what the employee paid:
Grad - Reg Changes
- Employee was discovered during WRS Lookback - the employee is not responsible for the increase in SGH premium until the new app is approved.
- Benefit Program needs to reflect the date the employee is eligible so WRS deductions are taken.
- Ideally a WISCIT should be created to explain the data difference, for Holistic Review purposes.
- Benefit Reconciliation Adjustment should be entered to reflect "Late Grad - Reg Change" and the Benefit Reconciliation Table would reflect the expected based on the application date. All of these requests should be sent to BERT.
- Employee had an FTE change that occurred retroactively.
- Employee was not counseled timely: due to Federal Health Laws, the employee is not expected to pay the part-time premiums until they are counseled regarding the increase in premiums.
- Ideally a WISCIT should be created attaching the documentation of counseling that would be used for Holistic Review.
- Benefit Reconciliation Adjustment should be entered to reflect "Late Counsel of Employee" and the Benefit Reconciliation Table would reflect the expected based on the counseling date. All of these requests should be sent to BERT.
Additional ResourcesRelated KBs: