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: http://mn.gov/mmb/segip/humanresources/insurance-eligibility.jsp
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:
http://www.mn.gov/mmb/segip/humanresources/insurance-eligibility.jsp
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.
Contacts
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: http://mn.gov/mmb/segip/humanresources/insurance-eligibility.jsp
 Photo by: Gary Huschle
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