Guardian s Proprietary Electronic Enrollment and Maintenance User Guide Version 9.0 Last Updated 09/10/2015

Transcription

1 Guardian s Proprietary Electronic Enrollment and Maintenance User Guide.0 Last Updated 09/10/2015 The Guardian Life Insurance Company of America, New York, NY Electronic Data Interchange Proprietary File 1

2 The Guardian Life Insurance Company of America (Guardian) is pleased to provide you with this User Guide; however it is a work in progress and may change from time to time. Therefore, Guardian reserves the right to change this document at any time without notice. The most current version of the document will be posted to the Guardian web site as updates are made. Table of Contents ection 1: Introduction to Guardians proprietary enrollment and maintenance Overview What is in this Guide? Questions hared Expectations Paper ubmissions File s Requirements/Guidelines ection 2: File specifications for the proprietary file Group Header Record Group Detail Record Group Trailer Record The Guardian Life Insurance Company of America, New York, NY Electronic Data Interchange Proprietary File 2

3 ection 1: Introduction to Electronic Data Interchange (EDI) Proprietary File Enrollment and Maintenance Overview This User Guide will assist you with your implementation of the electronic transfer of enrollment and maintenance eligibility using Guardian s standard proprietary file format. This format covers the transmission of eligibility data for group life, voluntary life, medical, dental, vision, prescription drug, critical illness, and disability coverages. If you prefer not to use this file format, other electronic methods we offer are HIPAA834, Guardian Anytime, and excel spreadsheet. At this time, there is no cost to participate in submitting enrollment/eligibility via one of our EDI processes. To ensure privacy and security, you also need to be able to send files via ecure File Transfer Protocol (FTP) or FTP with Guardian PGP encryption. What is in this Guide? This Electronic Enrollment and Maintenance guide outlines the criteria for establishing an electronic enrollment relationship with Guardian Life Insurance Company via our proprietary file format, including: File s (i.e. Full vs. Change files) File pecifications Questions We want you to feel at ease using Electronic Enrollment submissions. If you have questions, please call Guardian s Group Client Administration department at and immediately enter 1 then extension 7311 Monday through Friday between 8 a.m. and 5:00 p.m. ET to be connected with an EDI Team representative. hared Expectations Telephone inquires between our businesses should generally be acknowledged within one business day. Guardian has the right to suspend submission of EDI files based on your inability to comply with the accepted format, processes, expectations and requirements/guidelines. To help ensure a smooth EDI submission process, Guardian will: Process your file within one to two business days of the date received or we will notify you of our inability to use the file as submitted. Note: some of our EDI transactions/changes are uploaded into our system real-time however some need manual intervention prior to updating our system. Within one business day, identify and communicate errors that need to be resolved by the client. The Guardian Life Insurance Company of America, New York, NY Electronic Data Interchange Proprietary File 3

4 In return, we ask clients to: ubmit files accurately and according to the agreed-upon submission schedule. Correct actionable errors within two business days from the date the errors are communicated. ubmit any file specification changes to Guardian for approval before implementing the changes, as it may result in Guardian not being able to code changes appropriately. Required Paper ubmissions The following eligibility events require paper form submissions: GUL (Group Universal Life) enrollments/changes tate-specific Disability (DBL) enrollments/changes Medical/Prescription drug for NJ dependents over the child/student age limit covered until the age of 30 Virginia Continued Health Benefits for tudents Pennsylvania-Coverage for Military under Parent s policy EOI Evidence of Insurability Domestic Partner documentation Conditional Underwriting documentation Certification of Prior Coverage Loss of Group Coverage tudent tatus, unless otherwise arranged with the client U Homeland ecurity Form I-9, Employment Verification Form Dependent Eligibility Form for Connecticut. Dependent Eligibility Form for Massachusetts tate ARRA Election Form DD214 Certificate of Release or Discharge from Active Duty New York Dependent Eligibility Certification Form Ohio Dependent Eligibility Certification Form Pennsylvania Dependent Eligibility Certification Form File s Guardian accepts the following two types of files: Full files (preferred type) must contain one record for each subscriber and any associated dependents. Change files contain records for a specific add, change, termination. A change file may also be needed if all coverage elections are going to be submitted electronically. For each new file you send to Guardian, a compare process is run against our enrollment system to determine the specific add, change, or termination transactions included in the file. Preference is given to full file transmissions because they provide an inherent audit benefit, allowing all systems to remain synchronous. The Guardian Life Insurance Company of America, New York, NY Electronic Data Interchange Proprietary File 4

5 Requirements/Guidelines The requirements for electronic enrollment/eligibility transactions are as follows: Generate the data elements that include effective and termination dates coinciding with each transaction. Provide employees and eligible dependents data o In order for dependents to have coverage, they need to be reflected on the electronic file transmission) end the files to Guardian on a mutually agreed upon schedule end the files to Guardian utilizing one of the below methods: o FTP (ecure File Transfer Protocol) o FTP with Guardian PGP encryption An FTP questionnaire is available via the URL link below. This questionnaire needs to be completed and submitted back to Guardian in order to send your production files. Click on the Electronic Enrollment Link and then the FTP Questionnaire link. Linking a dependent to an employee: Employees and dependents are sent as separate occurrences. In order to capture dependent enrollment/eligibility accurately, the dependent(s) record needs to follow directly after the employee record for which they belong to. Volume and alary Amounts: Benefits that require volume and salary amounts need to include the decimal value of the volume/salary amount. (Example: Elected volume amount is $150, File should reflect ) Employment termination: If a date is present in the employment termination date on the employees record, all coverage s for that employee and for all dependents linked to that employee will be terminated effective on that date. Note: if the plan has a termination policy that carries the coverage through the end of the month in which their employment ended (1 st of the month termination rule), a date needs to be present in each of the applicable coverage end date fields representing the last day of the month in which their employment terminated. Coverage Termination: If a date is passed in a coverage end date field, then the coverage for that specific insurance product for that member and/or dependent will be terminated effective on that date. Coverage for other insurance products for that member and/or dependent will not be affected. Note: Once a termination (employment and/or coverage) is transmitted on a file, the change can be dropped from future files. The Guardian Life Insurance Company of America, New York, NY Electronic Data Interchange Proprietary File 5

6 Electronic Proprietary File Enrollment and Maintenance File specifications Effective Guardian Proprietary File Record Layout 07/01/2013 Primary Contact: EDI Administration (800) , ext 7311 Last Updated: 09/10/15 = ituational R = if coverage Group Header Record A Record Identifier H=Header R Group Name AN Name of the Group/Employer Guardian Group Number N Group Number R ender Identification ender Tax ID N number R File Date N File create date CCYYMMDD format Time of File N Time file was created HHMM format Usage Indicator A Code indicating interchange is Test or Production P = Production T = Test R File A Code indicating type of action F=Full file C=Change File R Filler R 6

7 Group Detail Record A Record Identifier D = Detail Employee/Dependent Employee/Dependent Identifier A identifier E = Employee D = Dependent = ituational R = if coverage R Employee N N ocial ecurity Number of the Employee Employee N R Guardian Group Number N Group Number Employment tatus A Code indicating employee's employment status FT=Fulltime RT=Retired tatus of coverage A of coverage under which benefits are paid A=Active C=COBRA Reason Code A Class Code N Class Effective Date N BR=Birth AD=Adoption MR=Marriage DE=Death RT=Retirement TE=Termination of Employment LA=Leave of Absense LO=Layoff DI = Divorce Code identifying the reason for the change Code identifying a group of employees R Date employee became effective in the specified class code CCYYMMDD format 7

8 = ituational R = if coverage Division Code N Code identifying branch/affiliated company employee is employed for R Division Effective Date N Date employee became effective in the specified division code CCYYMMDD format Department Code AN Code identifying a break down of employees on the plan by planholder defined categories Date of Hire N Date of employment Full time date if applicable CCYYMMDD format R Retirement Date N Date employee retires CCYYMMDD format Employment Term Date N Employees Last Day Worked CCYYMMDD format COBRA Indicator A Cobra identification Y=COBRA Last Name A Employee or Dependent Last Name R* First Name A Employee or Dependent First Name R* Middle Initial A Employee or Dependent Middle Initial Home Phone Number N Telephone number of the employee or dependent *Dependent first name and last name is not when dependent is only electing a coverage that requires minimum dependent data. Please refer to your individual group plan structure for requirements. 8

9 = ituational R = if coverage Address AN address of the employee or dependent Address1 AN Mailing address of the employee or dependent R Address2 AN Additional mailing address of the employee or dependent if necessary City A City Name R tate A tate Code R Zip AN Postal Code R Country Code A Code identifying country Date of Birth N The date of birth of the employee or dependent CCYYMMDD format R Gender A A code designating the gender M=Male F=Female R* A code designating the relationship P=pouse CH= AC=Adopted FC=Foster DP=Domestic Partner CA= Court Appointed Guardian C=tepson or tepdaughter EX = Ex-spouse E = elf Relationship Code A R *Gender is not for dependents when dependent is only electing a coverage that requires minimum dependent data. Please refer to your individual group plan structure for requirements. 9

10 M=Married =ingle U=Unreported W = Widowed D = Divorced = ituational R = if coverage Marital tatus A The marital status of the employee or dependent ocial ecurity Number of Dependent N N the dependent A code indicating the dependent is pursuing an academic or vocational course of training in a F=Full Time tudent tudent tatus A college setting N=Not a tudent A code indicating the dependent is Handicap tatus A handicapped/disabled H=Handicapped alary N Employees wage alary Mode/Frequency A H=Hourly W=Weekly BI=BiWeekly M=emimonthly M=Monthly A=Annual Code indicating frequency or type of payment Date specified alary alary Effective Date N became effective CCYYMMDD format Hours Worked N Hours worked per week moker Code A Code indicating a specific health situation T=Tobacco Use N=None 10

11 Medical Coverage Election A Medical Coverage Description AN Medical Coverage Level A Medical Coverage Effective Date N Medical Coverage End Date N Dental Coverage Election A Dental Coverage Description AN = ituational R = if coverage enrolled MM Description that describes the coverage being elected for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled DEN Description that describes the coverage being elected R 11

12 Dental Coverage Level A Dental Coverage Effective Date N Dental Coverage End Date N Primary Care Dentist election AN Prescription Drug Coverage Election A for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format Code identifying the Primary Care Dentist the employee or dependent has elected enrolled RX R 12

13 Prescription Drug Coverage Description AN Prescription Drug Coverage Level A Prescription Drug Coverage Effective Date N Prescription Drug Coverage End Date N Vision Coverage Election A Vision Coverage Description AN Description that describes the coverage being elected for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled VI Description that describes the coverage being elected R 13

14 Vision Coverage Level A Vision Coverage Effective Date N Vision Coverage End Date N LTD Coverage Election A LTD Coverage Description AN LTD Volume Election N LTD Coverage Level A for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled LTD Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based for the employee/dependent EMP=Employee Only R R 14

15 LTD Coverage Effective Date N LTD Coverage End Date N TD Coverage Election A TD Coverage Description AN TD Volume Election N TD Coverage Level A TD Coverage Effective Date N TD Coverage End Date N = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled TD Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based for the employee/dependent EMP=Employee Only coverage begins CCYYMMDD format R coverage ends CCYYMMDD format R 15

16 Basic Life Coverage Election A Basic Life Coverage Description AN Basic Life Volume Election N Basic Life Coverage Level A Basic Life Coverage Effective Date N Basic Life Coverage End Date N Basic AD&D Coverage Election A Basic AD&D Coverage Description AN Basic AD&D Volume Election N = ituational R = if coverage enrolled LIFE Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based for the employee/dependent EMP=Employee Only coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled ADD Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based R 16

17 Basic AD&D Coverage Level A Basic AD&D Coverage Effective Date N Basic AD&D Coverage End Date N Dependent Life Coverage Election A Dependent Life Coverage Description AN Dependent Life Volume Election N Dependent Life Coverage Level A Dependent Life Coverage Effective Date N Dependent Life Coverage End Date N for the employee/dependent EMP=Employee Only = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled DEPLIF Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based for the dependent dependents coverage PO=pouse Only CHD= Only PC = pouse + begins CCYYMMDD format R dependents coverage ends CCYYMMDD format R R 17

18 Voluntary Life Coverage Election A Voluntary Life Coverage Description AN Voluntary Life Volume Election N Voluntary Life Coverage Level A Voluntary Life Coverage Effective Date N Voluntary Life Coverage End Date N Voluntary AD&D Coverage Election A *Volumes may be, please refer to plan structure = ituational R = if coverage enrolled VOLLIF Description that describes the coverage being elected Amount of coverage being elected for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + R* coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled VOLADD R 18

19 Voluntary AD&D Coverage Description AN Voluntary AD&D Volume Election N Voluntary AD&D Coverage Level A Voluntary AD&D Coverage Effective Date N Voluntary AD&D Coverage End Date N Voluntary LTD Coverage Election A Voluntary LTD Coverage Description AN Voluntary LTD Volume Election N *Volumes may be, please refer to plan structure Description that describes the coverage being elected Amount of coverage being elected for the employee/dependent employee or dependents coverage EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage R* begins CCYYMMDD format R employee or dependents coverage ends CCYYMMDD format enrolled VOLLTD Description that describes the coverage being elected Amount of coverage being elected R 19

20 Version 9 Voluntary LTD Coverage Level A Voluntary LTD Coverage Effective Date N Voluntary LTD Coverage End Date N Critical Illness/pecified Disease Coverage Election A Critical Illness/pecified Disease Coverage Description AN Critical Illness/pecified Disease Volume Election N Critical Illness/pecified Disease Coverage Level A * Volumes may be, please refer to plan structure for the employee/dependent EMP=Employee Only = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled CRITIL Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + R R* R 20

21 Critical Illness/pecified Disease Coverage Effective Date N Critical Illness/pecified Disease Coverage End Date N Voluntary Critical Illness/pecified Disease Coverage Election A Voluntary Critical Illness/pecified Disease Coverage Description AN Voluntary Critical Illness/pecified Disease Volume Election N * Volumes may be, please refer to plan structure = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled VOLCRIT Description that describes the coverage being elected Amount of coverage being elected when coverage is not salary based R* 21

22 Voluntary Critical Illness/pecified Disease Coverage Level A Voluntary Critical Illness/pecified Disease Coverage Effective Date N Voluntary Critical Illness/pecified Disease Coverage End Date N Accident Coverage Election A Accident Coverage Description AN for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled ACC Description that describes the coverage being elected R 22

23 Accident Coverage Level A Accident Coverage Effective Date N Accident Coverage End Date N Cancer Coverage Election A Cancer Coverage Description AN for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format enrolled CAN Description that describes the coverage being elected R 23

24 Cancer Coverage Level A Cancer Coverage Effective Date N Cancer Coverage End Date N Employee Total Hours Worked Last 12 Months N for the employee/dependent EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + = ituational R = if coverage coverage begins CCYYMMDD format R coverage ends CCYYMMDD format Total hours worked last 12 months of employment Employee Rehire Date N Rehire Date CCYYMMDD format Employment tatus Eff Date N Date on which employment status is effective CCYYMMDD format R 24

25 Employee's Employer Name AN Employer Name Employer Contact First Name A Employer Contact Last Name A Employer Contact Relationship AN Employers Contact First Name Employers Contact Last Name Employer Contact Relationship with the Employee UPR = upervisor HMR = Human resources OHN = Occupational Health Nurse HRBP = HR Management BEN = Benefits & Payroll = ituational R = if coverage 25

26 Employer Address AN Employer address Employer Phone Number AN Employer Phone Number Employer Address 1 AN Employer Address Employer Address 2 AN Employer Address Employer City A Employer City Employer tate A Employer tate Employer Zip AN Employer Zip Code = ituational R = if coverage 26

27 = ituational R = if coverage Employer Country A Employer Country Code Reporting Division AN Experience Reporting Division Reporting Location AN Experience Reporting Location Reporting Department AN Experience Reporting Department Dental Reporting Class AN Experience Dental Reporting Class TD Reporting Class AN Experience TD Reporting Class LTD Reporting Class AN Experience LTD Reporting Class Life Reporting Class AN Experience Life Reporting Class AD&D Reporting Class AN Experience AD&D Reporting Class Vision Reporting Class AN Experience Vision Reporting Class Voluntary Life Reporting Class AN Experience Voluntary Life Reporting Class Voluntary AD&D Reporting Class AN Experience Voluntary AD&D Reporting Class Voluntary LTD Reporting Class AN Experience Voluntary LTD Reporting Class Hospital Indemnity Coverage Election A enrolled HOP 27

28 N = Numeric only AN = Alpha/Numeric Length Position Description Value Hospital Indemnity Coverage Description AN Hospital Indemnity Coverage Level A Hospital Indemnity Coverage Effective date N Description that describes the coverage being elected coverage being requested for the employee/dependent employee or dependents coverage begins EMP=Employee Only EP=Employee + pouse ECH=Employee + FAM=Family PO=pouse Only CHD= Only PC = pouse + CCYYMMDD format Hospital Indemnity Coverage End date N employee or dependents coverage ends CCYYMMDD format Dependent Life # of Dependents N # of children electing Dependent Life Voluntary Life # of Dependents N # of children electing Voluntary Life Voluntary AD&D # of Dependents N # of children electing Voluntary AD&D Critical Illness # of Dependents N # of children electing Critical Illness Voluntary Critical Illness # of Dependents N # of children electing Voluntary Critical Illness Accident # of Dependents N # of children electing Accident Cancer # of Dependents N # of children electing Cancer Hospital Indemnity # of Dependents N # of children electing Hospital Indemnity Filler Group Trailer Record A Record Identifier T=Trailer R Record Count N Total of all records R Filler A R=Require d = ituational R = if coverage is elected, data is 28

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