ESR Review and Updates April, 2015

ESR Review and Updates April, 2015

ESR Review and Updates April, 2015. Image of sunset on a Minnesota lake.

Photo by: Flickr user Audubon Center of the North Woods

Inaugural Edition

We are pleased to introduce our first newsletter dedicated to all that is employee insurance benefits eligibility. Its specifically for HR and DDIR staff to help ease the transition to the integration of ESR into our everyday work life. Look here for short articles that will help you keep on track and learn about new developments. We expect to publish it roughly once a month through next year.

Monthly Administrative Period Duties

Don’t forget about the Initial Look Back! Each and every month a new Initial Measurement Period begins and an Initial Stability Period ends. Agencies have about one week to conduct the Administrative Period duties. 

During administrative periods, agencies must:

  • Review the Initial Look Back report (HP4011E) to determine which employees are full-time for insurance eligibility purposes.
  • Offer the full employer contribution level coverage to all employees newly identified as full-time (averaged 30 or more hours per week during the Initial Measurement Period).
  • Determine if the level of coverage will change for an employee who averages less than 30 hours per week.  
  • Review HP6609 (in Document Direct) to ensure all hours are counted for employees with more than one appointment.

Agencies enter the applicable update to the Special Eligibility code in SEMA4 during the administrative period and notify employees of any changes to their insurance eligibility.

Employee Notification

Agencies must inform employees when their insurance eligibility status changes. This includes a change to an employee’s insurance eligibility status that occurs at any point other than at the time of appointment – for example, when an employee is found to be full-time at the conclusion of an Administrative Period.

Without a notification from the agency, some employees do not respond to the packet because they believe they are ineligible. When employees do not respond, SEGIP automatically enrolls them in medical coverage and they lose the ability to enroll in dental coverage until the next dental enrollment period. Those employees also lose access to optional coverages without evidence of insurability.

We have posted a notice template on the Insurance Eligibility webpage:

AF12 to MF12 = Nope.

Changing an employee’s Special Eligibility Code in such a manner that the employer contribution level does not change does not create the opportunity for the employee to change coverage elections. Examples:

  • MF12 to AF12 or MF9 to AF9 will not allow a change in the employee’s benefits. (AF12 to MF12 = Nope.)
  • MP12 to MF12 is a change in contribution levels and the employee may make benefit election changes. (MP12 to MF12 = Yes.)

The ability to make elections only occurs when an employee moves between one of the three eligibility levels of full, partial or none (F, P or X). Even then, the changes may be limited.

Remember: the only purpose of “AFs” is to help agencies remember that an employee is receiving that level of coverage due to their place in a Stability Period. Consequently, benefits-wise, AF12 and MF12 have exactly the same meaning.

New Report

Yearly Summary Total Report (HP4013E) is now available in DocumentDirect. This report will help agencies during the Standard Administrative Period (which occurs each year from late October through December). The Yearly Summary Total Report complements the Ongoing Employee Hours Measurement Report (HP4010E).

The two biggest differences between the these reports are that:

  • The 4010 is an exception report including only employees whose hours fall within a certain range. The Yearly Summary includes all employees who were employed by the agency during the Standard Measurement Period.
  • The 4010 provides more detail; each employee is covered in one page. The 4013 provides less information; each employee is covered in only one line.

        Employees are usually listed once for each appointment.

The Yearly Summary Total Report (4013):

  • Available annually in late October, it is a summary of the just completed Standard Measurement Period.
  • Includes every employee measured in the Standard Measurement Period.
  • Every employee has one line and it lists their weekly hour average for the Measurement Period.
  • Will be run once each year at the conclusion of the Standard Measurement Period (each October).
  • Will be available for at least two years.

The Yearly Summary Total Report will help agencies be clear on exactly who was measured and the number of hours each measured employee averaged.

Web-Based Training

A webinar discussing employee Eligibility at Appointment is available on the MMB web site:

This webinar is much like the training MMB presented last summer and is a verbal explanation of the Eligibility at Appointment Procedure also available on the same website.



For questions about SEMA4 coding, please contact your SEMA4 HR Specialist. For questions about an employee’s eligibility, please contact your Account Representative.

You can find them at:


Minnesota sunset viewed from shore of a lake with ducks in the water.

Photo by: Gary Huschle