BA0101 – Benefits Administration for Open Enrollment€¦ · tellite, Pass-Through Employee) Modify Participant 3 Profile 4 Go To BA0203 Benefit Participant Portal Start 2 Want

BA0101 – Benefits Administration for Open EnrollmentD

BM

Sup

er

Use

rD

BM

Mgm

tB

oard

of P

ublic

W

orks

(BP

W)

DM

B EB

D M

gmt

DB

M E

BD

D

irect

or Start

1November

Benefit Planning for Upcoming Fiscal Year

2January

Review/Modify Benefit Program/

Rate Changes

4Review/Modify

Benefit Program/Rate Changes

3February

Finalize Proposed Benefit Program/

Rate Changes

5February

Review/Approve Benefit Program/

Rate Changes

6March

Finalize Open Enrollment Materials

7March

Configure Program/Rate

Changes in SPS

8March

Modify Web Enroll Page to Reflect

Changes

9Mail OE

Announcement Postcard

BA0201 – Benefit Participant Account B

enef

it P

artic

ipan

t (A

ctiv

e S

tate

, Ret

iree,

Sat

ellit

e an

d P

ass-

Thro

ugh

Em

ploy

ee)

Start Yes

10Validate if Email Address is New/

Unique

9Participant Enters

Email Address

14Participant

Completes Profile

2New

Participant?

1Benefit Participant

Accesses “Benefits Portal”

5BA0203Benefit

Participant Portal

7Forget PW?

8Reset Login Information

11Email Addr

Unique?

12Participant

Receives Message Indicating Account

Exists

13Want to

Continue?

3Enter Login/Password

4Login/PW

Valid?

6Message: Account

Credentials Not Valid

End

15Validate Profile

Info Against List of Eligible

Participants

16Eligible for

Profile?

17Message: Account Profile Not Valid

Yes

No

No

Yes

End No

Yes

No

Yes

No

Yes

End

No

BA0202 – Benefit Participant Profile B

enef

it P

artic

ipan

t (A

ctiv

e S

tate

, Ret

iree,

Sat

ellit

e, P

ass-

Thro

ugh

Em

ploy

ee)

3Modify Participant

Profile

4Go To

BA0203Benefit

Participant Portal

Start

2Want to Change Profile?

1View Participant

Profile

No

Yes

4Other Ben

Portal Options

?

Yes

End

No

BA0203 – Benefit Participant Portal B

enef

it P

artic

ipan

t (A

ctiv

e S

tate

, Ret

iree,

Sat

ellit

e, P

ass-

Thro

ugh

Em

ploy

ee)

3Benefit Participant

Decides What They Want to Do

10Open

Enrollment?

16Mark Dep Disabled?

4Benefit

Materials?

Start

8Model Benefit Costs?

9Go To

BA0204Model Benefit

Costs

End

5View/Print

Benefit Materials

11Go To

BA0301Open

Enrollment-Web

14Add SSN

?

12Event Maint

Enrollment?

13Go To

Event Maint Enrollment-

Web

7Go To

BA0202Ben Partic

Profile

6Acct Profile Change?

15Go To

BA0205Modify Dep

No

Yes

Yes

YesYes

Yes

Yes

1Is

Participant Elig for Ben?

2Message: Not

Eligible for Benefits & All Links Inactive

No

No

Yes

No

No

17Benefits FAQ?

18View/Print

Benefits FAQ

No

Yes

19Question/Problem?

20Go To

BA0701Customer

Svc Call Ctr

No

Yes

BA0204 – Model Benefit Costs (This feature will not be available for Satellite participants since State does not track employee benefit costs for these Agencies)

SPS

Ben

efit

Par

ticip

ant

5Select Prescription

8Select FSA

6Select Dental

7Select AD&D

End

10Calculate Cost

4Select Medical

12Make

Changes?

Start9

Select Life

11View Model Cost

Online

17Optional:

Print Model Costs

2Want to

Model Diff Yrs of Svc?

1Display Current

EE Demographic & Benefit

Information

3Enter Years to

Service to Model Online

No

Yes

13Apply

Model to OE?

14Go To

BA0701Customer

Svc Call Ctr

Yes

No

16Go To

BA0701Customer

Svc Call Ctr

15Apply

Model to EM?

No

No

Yes

BA0205 – Modify DependentD

BM

EB

D E

nrol

lmen

tSP

SE

xter

nal R

evie

wB

enef

it Pa

rtici

pant

Start1

Acces Benefits Portal

2Select Dependent/

Beneficiary Link

3Display Current

Dependents

4Select Dependent

to EDIT

21Optional:

Print Dependents

5Update

Dependent Info

9Dependent Data Updated in SPS

6Dependent Data Updated in SPS

as ‘Pending’

11Mail Addtl Required

Paperwork to Benefit Participant

12Receive Addtl

Paperwork Requested

13Complete/Return

Required Paperwork

14Receive

Completed Paperwork

16Submit Paperwork

for External Review

17Disability Review

Conducted

18Disability

Approved?

19Change ‘Pending’ Disability Request

to ‘Denied’

20Receive Confirm

of Disability Denial

End

Yes

No

Yes

22AdHoc Report:Blank SSN’s

23AdHoc Report:

Pending Requests

24AdHoc Report:

Disabled Dependents

8Addt’l

Documentation?

No

Yes

No B

B

15Disability?

7Worklist

Dependent Data Updated

A

A

10Receive Confirm

Requested Update

Completed

25AdHoc Report:

Audit Dependents Data Update

2/1/2010 - 2/15/2010Benefit Period 1

2/16/2010 - 2/28/2010Benefit Period 2

3/1/2010 - 3/15/2010Benefit Period 3

2/9/2010Pay Period = 1/27/10-2/9/10

2/23/2010Pay Period = 2/10/10-2/23/10

3/9/2010Pay Period = 2/24/10-3/9/10

New Hire = 3/7/10Coverage EFFDT = 4/1/10

Any retro enrollment costs will be distributed across remaining benefit deduction periods in benefit year

Anne is investigating if the EE has 60 days from 4/1 or 60 days from 3/7 to enroll

Termination = 2/16/10Benefit Term Date = 2/28/10

EE Pays Full Benefit Period in Last Check Even Though Only Worked 1 Day in Benefit

Period

Termination = 2/15/10Benefit Term Date = 2/15/10

EE Pays Full Benefit Period in Last Check

Newborn* on 2/10/10Modify Coverage from Ind + Spouse to

Ind + 2 or MoreCoverage EFFDT = 2/10/10

Prorate Cost of Coverage from 2/10/10

Marriage on 2/26/10Modify Coverage from Ind to Ind + Spouse

Coverage EFFDT = 3/1/10

Leave of Absence on 3/13/10Modify Coverage from Ind + Spouse to Ind

Coverage EFFDT = 4/1/10EE Moves to Direct Pay as of 3/13/10

Anne is investigating if the EE has 60 days from 4/1 or 60 days from 3/13 to enroll

* Adoptions will follow the same coverage rule; all other dependent additions will be eligible for coverage

on the 1st of the month following the event date

Return from Leave of Absence on 3/15/10Modify Coverage from Ind to Ind + Spouse

Coverage EFFDT = 4/1/10Since Direct Payment is Monthly Payments, the EE has

paid for coverage thru 3/31/10Anne is investigating if the EE has 60 days from 4/1 or 60

days from 3/15 to enroll

State of Maryland – SPS ProjectBenefits Administration Future State Process DesignEvent Date vs Effective Date of Coverage

BA0301 – Open Enrollment - WebD

BM

EB

DE

nrol

lmen

tSP

SA

genc

y B

enef

its

Coo

rdin

ator

Ben

efit

Par

ticip

ant

Yes

Yes

(1)

Yes

2Login to Benefits

Portal

15OE Validated(Ben Admin Processing/

PSPBARUN)

12Submit OE Selections

6Select Open

Enrollment Link

3Want to Model

Costs?

14SPS Updated w/

Selection w/EFFDT = 7/1/YY

9Enter/Modify OE Selections Online

11Ready to Submit?

16Issues w/

Enrollment?

31SPS Updated w/

Working Data

Start

4Go To

BA0204Model Costs

32Optional:

Print Statement w/Disclaimer

29Want to Save

for Later?

5Ready to Enroll?

30Save OE Working

Data

24AdHoc Reports:

OE Status

17Receive Email Confirmation of

OE

18Optional

Print Enrollment Confirm Stmt

1Receive Postcard

Announcing OE

21Change in

Marital Status?

23Go To

BA0402Review

Marital Status or DP Chg

20Change in

Deps?

22Go To

BA0401Review Dep Add/Change

7Modify Employee

Demographic Data

8Add/Modify Dependent/

Beneficiary Data

Yes

No

10Indicate Addtil

Health Coverage

19AdHoc Reports:OE Requiring

Follow Up

No

No

No

Yes

YesYes

No

No

19AdHoc Reports:OE Requiring

Follow Up

25AdHoc Reports:Enrollment Date

26AdHoc Reports:Newly Enrolled

End

A

A

27AdHoc Reports:General Notice

BA0302 – Open Enrollment – Paper EnrollmentD

BM

EB

D E

nrol

lmen

tSP

SA

genc

y B

enef

its C

oord

inat

orBe

nefit

Par

ticip

ant

17OE ValidatedBen Admin

Process (PSPBARUN)

5Complete

Enrollment Form

18Issues w/

Enrollment?

3Contact Agency

Benefit Coordinator

4Mail/Email

Enrollment Form to Benefit Participant 28

AdHoc Reports:OE Status

Start

16SPS Updated w/


End

2Have a Paper

Enrollment Form?

No6

Mail Enrollment Form to Agency

Benefit Coordinator

7Receive/Review Paper Enrollment

Form

20Mail/Email

Confirmation Statement to

Benefit Participant

21Receive

Confirmation of OE

1Receive OE

Postcard Announcing OE

8Questions/Issues w/

Paper Enrollment?

11Work w/Agency

Benefits Coordinator to Resolve Issues

10Work w/Benefit Participant to

Resolve Issues

(2)

Yes

(1)

29Change in

Deps?

30Go To


31Change in

Marital Status?

32Go To

BA0402Review


No

9Received Required

Documentation?

No

NoA

Yes

12Modify Employee

Demographics Data

13Modify/Add Dependent/Beneficiary

Info

14Enter/Modify OE

Elections

Yes

15Enter Addtl Health

Coverage

22Optional:

Print Enrollment Confirmation

Yes

28AdHoc Reports:

OE Status No

Yes Yes

BNo

B




A

BA0303 – Event Maintenance (EM) Enrollment - WebD

BM

EB

D E

nrol

lmen

tSP

SA

genc

y B

enef

its

Coo

rdin

ator

Bene

fit P

artic

ipan

t

Yes No

Yes

(1)

No

Yes

No


Resolve Issues

19OE Validated(Ben Admin Processing/

PSPBARUN))

13Want to Save

for Later?

5Select EM

Enrollment Link

2Want to Model

Costs?

26Email

Confirmation of EM Enrollment

20Work w/Agency


27Optional:

Print Enrollment Confirmation Stmt

14Save EM Working

Data

28AdHoc Report:

Enrollment Date

6Select Reason for

EM Enrollment

12Ready to Submit?

15SPS Updated w/

Working Data

20Issues w/

Enrollment?

1Login to Benefits

Portal

4Ready to Enroll?

3Go To

BA0204Model Costs

End

18SPS Updated w/

Selection w/EFFDT =

MM/DD/YY

16Submit Enrollment

Selections

Start

7Validate Event

Date Qualifies for EM Enrollment

10Enter EM

Enrollment Selections Online

8Event Date

Eligible?

9Message: Event

Date Doesn’t Qualify for

OnGoing Enroll

Yes

No

No

17Optional:

Print Statement w/Disclaimer

(2)

Yes

22Change in

Deps?

Yes

24Change in

Marital Status?

25Go To

BA0402Review


No

Yes

No

11Enter Dependent & Marital Status

Information Online (if required)

21Changes

Required?

21AdHoc Report:

EM Event Status Report

Yes

21AdHoc Report:

EM Event Status Report

23Go To


A

A

A

Yes

No

30AdHoc Report:Initial COBRA

Notice

29AdHoc Report:Newly Enrolled

A

BA0304 – Event Maintenance (EM) Enrollment – PaperS

PSD

BM E

BD

Enr

ollm

ent

Age

ncy

Ben

efits

Coo

rdin

ator

Ben

efit

Par

ticip

ant

No

(2)

Yes No

No

No Yes

Yes

Yes

No

Yes Yes

No

7Receive/Review Paper Enrollment

Form

A

15SPS Updated w/


10Questions/Issues w/

Paper Enrollment?

25Optional:

Print Enrollment Confirmation

24Receive

Confirmation of EM


17Issues w/

Enrollment?

End

18AdHoc Reports:

OE Status

19Change in

Deps?

18AdHoc Reports:

OE Status

21Change in

Marital Status?

22Go To

BA0402Review


3Mail/Email

Enrollment Form to Benefit Participant

6Mail Enrollment Form to Agency

Benefit Coordinator



Resolve Issues

20Go To



2Contact Agency

Benefit Coordinator

A

23Mail/Email

Confirmation Statement to

Benefit Participant

14Trigger Event to

Enter EM Election

16OE ValidatedBen Admin

Process (PSPBARUN)

13Work w/Agency


11Received Required

Documentation?

1Have a Paper

Enrollment Form?

Start

4Complete

Employee Status on Form

5Complete

Enrollment/Change Action

Requested

8Event

Qualify?

Yes

(1)

10Receive

Notification Event Does not Qualify

No

9Notify EE event Does not Qualify

BB

BA0401 – Review Dependent Add/Change/Remove RequestBe

nefit

Par

ticip

ant

DB

M E

BD

Enr

ollm

ent

Age

ncy

Ben

efits

Coo

rdin

ator

No

Start

13Report:Dep A/C

Confirmation

1Worklist:

Participant Dep Change Request

4Meet w/Participant

to Get Proof

7Contact

Participant for Proof

Documentation

5Scan/Send Proof Documentation to

DBM

3Did EE Submit Backup Doc?

9Designate Dep

Add/Chg as Confirmed or

Denied

6Doc Meets Proof Req?

2Worklist:

Participant Dep Change Request

8Provide Proof

Documentation

14Email Marked

on Profile?

16Mail Dep A/C

Confirmation to Participant

17Receive Dep & Coverage Confirmation

15Email Dep A/C Confirmation to

Participant

No

Yes

Yes

10Approved?

11Contact

Participant to Explain Denial

12Explanation of

Dependent Denial

No

Yes

No

Yes

End

BA0402– Review Marital Status Change RequestD

BM

EBD

Enr

ollm

ent

Agen

cy B

enef

its C

oord

inat

orB

enef

it P

artic

ipan

t

No

No

Yes

Yes

No

Yes

No

Yes

8Provide Proof

Documentation

7Contact

Participant for Proof

Documentation

17Receive Marital

Status Chg Confirmation

12Explanation of

Marital Status Chg Denial

1Worklist:

Marital Status Change Request

9Designate Marital

Status Chg as Confirmed or

Denied

5Scan/Send Proof Documentation to

DBM

11Contact

Participant to Explain Denial

15Email Marital Status Chg

Confirmation to Participant

14Email Marked

on Profile?

16Mail Marital Status Chg Confirmation

to Participant

4Meet w/Participant

to Get Proof

2Worklist:

Marital Status Change Request

Start

10Approved?

6Doc Meets Proof Req?

3Did EE Submit Backup Doc?

13Report:

Marital Status Chg Confirmation

End

BA0403 – Dependent Turns 26D

BM

M

anag

emen

tAg

ency

Ben

efits

C

oord

inat

orB

enef

it P

artic

ipan

tD

BM

EBD

Enro

llmen

tS

PS

Start

17Mail COBRA

Materials

23AdHoc Report:COBRA Eligible

6Receive ’26 + Not Disabled’ Notice

22AdHoc Report:

Auto Dependent Cancellations

A

End

20Worklist:

Dep Benefits Cancelled

15Does Dep Qualify for COBRA?

19Go To

BA0201Benefit

Participant Acct

18Receive COBRA

Materials(if applicable)

13 Mos Before 26:Identify Affected

Deps Not Marked Disabled

2Generate Notice:26 + Not Disabled

5Mail ’26 + Not

Disabled’ Notice

91st of Mos After 26

Cancel Non-Disabled

Dependent

7Is Dep

Disabled?

8Go To

BA0202Benefits Portal

10Generate Notice:Dep CancelledCoverage Adj

13Mail

Dep CancelledCoverage Adj

Notice

14Receive


Notice

End No Yes

21Send Coverage Chg to Benefit Providers in Interface File

Yes/No (2)

A

22AdHoc Report:

Auto Dependent Cancellations


11Email Marked

on Profile?

12Email


Notice

Yes

No

16Print COBRA Cover Letter

Yes (1)

Before enrollment, the dependent will need to establish a benefit portal account.

3Email Marked

on Profile?

4Email ’26 + Not Disabled’ Notice

No

Yes

BA0404 – Leave of Absence (This process would be used to capture Leaves of Absence for SPS Agencies)

Bene

fit P

artic

ipan

tAg

ency

Ben

efits

C

oord

inat

orD

BM

EBD

D

irect

Pay

/Sat

ellit

eA

genc

y H

R C

oord

inat

or

1Enter/Modify

Employee Status Change to Put on Leave of Absence

20AdHoc Report:EE’s on LAW

14Go To

BA0303EM-Web

Enrollment

9Worklist:

EE on Leave

Start

11Contact EE to

Discuss Benefit Implications

12 Discuss Benefit Implications w/

Agency Ben Coordinator

13Does EE Want

to Remove Coverage?

10Worklist:

EE on Leave

15Leave Type =

Military?

16Go To

BA0405LAW – PAD &

Life

2Does EE

Participate in Ben?

Yes End

No

Yes



3Go To

BA0407Return from

Leave

No

Yes (2)

17Leave Type =

FMLA?

18Go To

BA0406LAW - FMLA

No No

Yes

19Go To

BA0603Direct Pay

4Reason = OJI

or Military?

5Worklist:

OJI or Military Leave Requires

Approval

6Review Military Orders or OJI

Documentation

8ApprovedReason?

7Enter Leave

Reason Approval or Denial Online

4Worklist:

Leave Reason Denied

No

Yes

Yes (1)

A

A

Yes

No

BA0405 – LAW – AD&D & Life Insurance Coverage (This process would be used to capture Leaves of Absence for SPS Agencies)

SP

S

Start

1Is EE Enrolled in AD&D* or

Life?

4Go To

BA0603Direct Pay

For AD&D and/or Life Coverage

End

3PAD* and/or Life Coverage Marked

as Direct Pay

Yes

2EE Benefits Fully

Paid by State

No

5All Other Benefits

Fully Paid by State

* AD&D = Accidental Death & Dismemberment Plan

BA0406 – LAW - FMLA S

PS

No

4Reassess Next Pay Period Until

FMLA Ends

1Is EE Using

Leave for Pay?Start

2Go To

BA0603Direct Pay

3Does Pay

Cover Deductions?

Personal Leave Accrual or Leave Bank

Yes Yes

No

BA0407 – Return from Leave of Absence D

BM

EB

DD

irect

Pay

/Sat

ellit

eB

enef

it P

artic

ipan

tAg

ency

Ben

efits

C

oord

inat

orA

genc

y H

R C

oord

inat

or

Yes

No

18Does EE Want to Chg Ben?

Start




17 Discuss Benefit Implications w/

Agency Ben Coordinator

20Worklist:

EE Returning from Leave

1Monitor LAW &

Anticipated Return Date

16Contact EE to

Discuss Benefit Implications

End

19Go To

BA0303EM

Enrollment

2Is EE

Returning as Scheduled?

15Worklist:

EE Returning from Leave

6Update

Anticipated Return Date

8Enter Status

Change for Return from Leave

9Does EE

Participate in Ben?

End

5Is EE

Terminating?

Yes

7Go To

PS0706LAW – Med/

Pers/Mil

Yes

21Cancel All Future

Direct Pay Invoices

22Determine if

Employee is Due a Refund

10Is Leave Reason = Military?

3Has EE

Exhausted FMLA?

4Go To

BA0404Leave of Absence

No No No

Agency HR Coordinator needs to modify the Leave Reason from FMLA to either Leave of Absence – Personal or Leave of Absence - Medical

No

11Worklist:

Military Rtn from LV Requires

Approval

12Review Military

Return Documents

13Enter Approval or

Denial Online

14Return

Approved?

Yes

23Worklist:

Leave Reason Denied

A

A

No

Yes

No

24Discuss Leave

Return w/Employee

BA0408 – Determine ORP Eligibility D

BM E

BD

SPS

DB

M E

BD

R

etire

esO

RP

Ret

iree

Ret

irem

ent A

genc

y

In additon, DBM EBD Retiree should be able to attach scanned application paperwork

11Determine

Combined State Subsidy

3Send Claims to

Institution HR/Ben Reps for

Verification

19Go To

BA0303EM

Enrollment-Web

14Is ORP Eligible

for Benefits Subsidy?

15Notification:

Eligible + Susidy %

Start

22AdHoc Report:

ORP Application Metrics

5Complete Claim of Non-ORP Service

End

10Enter Retirement

Info Online

21AdHoc Report:Eligible ORP

Retirees

B C

16Notification:

Not Eligible for Subsidy

9Receive

Application for ORP Benefits

12Flag ORP as

Eligible or Ineligible

2Complete Claim of

ORP ServiceC

8Consolidate

Application Packet & Send to DBM EBD Retirees

A1

Complete Checklist for ORP Retiree Enrollment

13Store Calculated Subsidy Amounts

20AdHoc Report:

Elig & State Subsidy WS

B

18Is ORP Eligible

for Benefits Subsidy?

6Send Claims to Agency HR/Ben

Reps for Verification

17Notification:

Subsidy Eligibility

7Receive &

Complete Claim of Non-ORP Service

4Receive &

Complete Claim of ORP Service

AA

BA0501 – Non-SPS Employee Maintenance(This process will support the entry/maintenance of Satellite, University System and MDOT employees into SPS for benefits)

DB

MSP

SC

PB

Age

ncy

Ben

efits

Coo

rdin

ator

or

Age

ncy

HR

Coo

rdin

ator

Start

3Enter New EE

Online

2Setup New

EE?

4Status

Change?

8Terminate

an EE?

1Select EE

Maintenance Action

6DemographicChange?

9Terminate EE

Online

5Enter EE Status Change Online

7Enter EE

Demographic Change Online

10Submit Add/

Change

12SPS Updated w/

Non-SPS EE Information

No No No No

YesYesYesYes

11More to

Add/Change?

Yes

No

15AdHoc:

EM Event Status

20Does EE

Need to Go to CPB?

21Send EE

Information to CPB

13Benefits

Administration(Events Triggered)

14Validate Ben Eligibility via

Ben Admin Process (PSPBARUN)

A

15Ben EligChange?

16Notify Agency Benefits

Coordinator

Yes

18Go To

BA0303EM

Enrollment-Web

17Review EM Event and Reach out to Benefit

Participant 19

Go ToBA0304

EM Enrollment-

Paper

Yes No A

A

No

End

A

15AdHoc:

EM Event Status

20Go To

BA0802Benefits

Termination

Yes

BA0601 – Satellite Agency Invoicing & Lockbox ReceivablesD

BM

EB

D

Dire

ct P

ay/S

atel

lites

DBM

Man

agem

ent

Lock

box

SPS

Sat

ellit

e A

genc

y

11Receive Satellite Agency Payment

7Create Detailed Satellite Agency

Invoice

14Relieve

Receivables

18Receive Overdue

Notice

13Receive & Load

Lockbox Interface File

9Pull Detailed

Satellite Agency Invoice

6Identify All

Satellite EE’s to Include on Invoice

20AdHoc Report:

Invoicing Details

19AdHoc Report:

Receivable Aging

12Include Payment on Daily Lockbox

Interface File

16Generate Overdue

Notice & Apply Late Fee

10Pay Invoice via

Lockbox

15Receivables Outstanding?

Start

21AdHoc Report:Lockbox Details

End

2By 2nd Sunday: Enter Monthly Surcharge %

Online

FTP

No

Yes

Processed on the 21st of the month for the current month

Evaluated on the 16th of the month

17Mail/Email

Overdue Notice to Satellite Agency

B

B

11st of the Month:

Send Email Requesting

Surcharge %

8Post Invoice to

Website for Satellite Agency to

Retrieve

4Notification:

Agencies w/o Surcharge Entry

32nd Sun – 3

Days:Agencies w/o Surcharge?

Yes

5Follow-Up w/Sats

to Ensure All Surcharges

Entered

22Any Point in Mos:

Enter Invoice Adjustment

A

ANo

BA0602 – Monthly Surcharge Entry(This process will support the Satellite invoicing process)

DB

MS

PSA

genc

y B

enef

its

Coo

rdin

ator

1Enter Monthly

Surcharge OnlineStart End

3SPS Updated w/

Satellite Surcharge

2Submit Surcharge

4AdHoc Report:

Satellite Surcharges

BA0603 – Direct Pay Invoicing & Lockbox Receivables(This process covers workers on COBRA, military leave, leave without pay (LAW), Contractual and PT who are directly paying for their benefits)

DB

M E

BD

D

irect

Pay

DBM

Man

agem

ent

Lock

box

Dire

ct P

ay B

enef

it P

artic

ipan

tSP

S

FTP

No

Yes

End13

Receivables Past Due?

3Create Direct Pay Payment Cover

Letter

8Make Monthly Payment via

Lockbox

21AdHoc Report:

Receivable Aging

7Receive Coupons

& Cover Letter

1Identify Direct Pay Participants Who Need Payment

Coupons


Interface File

Start

9Receive Direct Pay Payment

11Receive & Load


18Receive Overdue

Notice


6Mail Coupons & Cover Letter to

Participant

14Generate Overdue

Notice

22AdHoc Report:

Invoicing Details

12Relieve

Receivables

22AdHoc Report:

Invoicing Details


21AdHoc Report:

Receivable Aging

2Create Direct Pay Payment Coupons

Past Due = Due Date + 15 Days

19Receivables Past Due?

Past Due = Due Date + 30 Days

(2) No

20Go To

BA0801Benefits

Cancellation

Yes

A

A

17Mail Overdue

Notice to Participant

4Email Marked

on Profile?

5Email Coupons & Cover Letter to

Participant

Yes

No

Daily Process

15Email Marked

on Profile?

16Email Overdue

Notice to Participant

(1)

Yes

No

BA0604 – Special Retiree Invoicing & Lockbox Receivables(This process covers retirees whose retirement checks do not cover all of their benefit premiums)

DBM

M

anag

emen

tD

BM

EBD

R

etire

men

tLo

ckbo

xR

etire

e B

enef

it Pa

rtici

pant

SP

S

FTP

No

Yes

Evaluated on the 15th of the month

Evaluated on the 1st day of the following month

No

7Receive Special Retiree Payment

6Make Monthly Payment via

Lockbox


Interface File

11Obligation

Outstanding?

23AdHoc Report:

Invoicing Details

15Obligation

Outstanding?

A

1Identify Retirees

Who Require Payment Coupons


10Relieve Obligation

22AdHoc Report:

Receivable Aging

2Create Special

Retiree Payment Coupons

3Create Special

Retiree Payment Cover Letter

21Go To

BA0801Benefits

Cancellation

12Generate Overdue

Notice

5Receive Coupons

& Cover Letter

4Mail/Email

Coupons & Cover Letter to Retiree

22AdHoc Report:

Receivable Aging

End

9Receive & Load



Start

14Receive Overdue

Notice

23AdHoc Report:

Invoicing Details

A

16Worklist:

Retiree Payment Overdue

17Investigate

Non-Payment

18Issues w/Non-

Payment?

20Did Retiree

Pay?

19Hold Benefits

Cancellation for 30 Days

Yes

End

YesNo

No

13Mail/Email

Overdue Notice to Retiree

Yes

BA0701 – Customer Service Call CenterD

BM

Man

agem

ent

3rd

Leve

l Sup

port

(DBM

Sup

ervi

sor/M

gr)

DB

M E

BD

Cus

tom

er S

ervi

ce2nd

Lev

el S

uppo

rt(A

genc

y B

enef

it C

oord

inat

ors)

Ben

efit

Par

ticip

ant

13Ticket Forwarded

to 2nd Level Support

Start

End

7Work w/

Participant to Resolve Issue

28AdHoc Report:

Ticket Resolution Time

4Phone Tree

Routes Call & Customer Svc Rep Answers

1EE Has a

Question or Needs Benefit

Assistance

2EE Calls Cust Svc

Phone Number(8:30-4:30)

8Work w/Cust Svc to Resolve Issue

14Notification:

Assigned Cust Svc Ticket

6Can You

Assist Participant?

5Create Customer Svc Ticket Online

9Update Ticket Status Online

10Is EE

Satisfied?

11Enter Final

Resolution Online

12Close Ticket

Online

29AdHoc Report:

Cust Svc Metrics

21Notification:

Assigned Cust Svc Ticket

15Work w/



18Enter Final

Resolution Online

19Close Ticket

Online

Yes - 1st Level Support

No

1st Level Support

2nd Level Support

End

Yes – 2nd Level Support

16Does Ticket

Need to Go to 3rd Level?

Yes

20Ticket Forwarded

to 3rd Level Support

No – Requires 2nd Level Assistance

No – Requires 3rd Level Assistance

22Work w/


NoYes


24Is EE

Satisfied?

25Enter Final

Resolution Online

26Close Ticket

OnlineEnd

No

Yes

27AdHoc Report:

Open Ticket Aging

3EE Enters

Question via Benefit Portal

(24x7)

(1) or (2)

BA0801 – Benefits CancellationD

BM M

anag

emen

tAg

ency

Ben

efits

C

oord

inat

orB

enef

it P

artic

ipan

tD

BM

EB

DD

irect

Pay

SP

S

This will be a daily process and will be the result of lack of payment.

(1)

(1)

(2)

5Generate Benefits

Cancellation Notice

End

A

A

Start

2Auto-Cancel Participant

Benefits w/Proper EFFDT

12AdHoc Report:

Automatic Benefit Cancellations

7Send Cancellation

to Benefit Providers in Interface File

10Receive Benefits

Cancellation Notice

11Worklist:

Participant Benefits

Cancelled

A

3Decision to

Cancel Participant Benefits

1Identify

Participants Who Qualify for Ben Cancellation

4Manually Cancel

Participant Benefits w/Proper

EFFDT

Start

9Mail Benefits Cancellation

Notice

12AdHoc Report:


6Email Marked

on Profile?

8Email Benefits Cancellation

Notice

(1)

Yes

No

(2)

12AdHoc Report:


BA0802 – Benefits TerminationA

genc

y B

enef

its

Coo

rdin

ator

Bene

fit P

artic

ipan

tD

BM

M

anag

emen

tD

BM E

BD

D

irect

Pay

/Sat

ellit

eSP

S

1Identify

Participants Require Benefits

Termination

A

5Does EE

Qualify for COBRA?

End

12AdHoc Report:

Benefit Terminations

11Go To

BA0303EM

Enrollment-Web

12Worklist:

Participant Benefits

Terminated

Start

Start

3Decision to Manually Terminate

Benefits Coverage

These will be the result of Personnel Transactions

2Terminate Benefit

Coverage w/Proper EFFDT

9Mail COBRA

Notice + Materials

4Terminate Benefit

Coverage w/Proper EFFDT

10Receive COBRA

Materials(if applicable)


A

A

(1)

(1)

(2)

6Send Termination

to Benefit Providers in Interface File

No

Yes (2)

12AdHoc Report:

Benefit Terminations


Employee or Dependents have 63 days from COBRA notification date to enroll

7Flag Participant as COBRA Eligible + Expiration Date

8Print COBRA

Notice

BA0803 – Deduction Reconciliation Ag

ency

HR

C

oord

inat

orD

BM

EBD

Ret

irem

ent A

genc

yC

PBS

PS

End

14Go To

BA0604Special Retiree

Invoicing

Start

1Interface:

Send New/Chg’d Deduction Amts to

CPB

6Interface:

Send New/Chg’d Deduction Amts to

Retirement

2Receive & Load

New/Chg’d Deduction Amts

7Receive & Load

New/Chg’d Deduction Amts

4Process Payroll

5Every Week

Generate File of Deductions Taken

9Process

Retirement Checks

10Monthly

Generate File of Deductions Taken

11Receive and LoadDeductions Taken

12Compare

Deductions Scheduled Ded vs. Actual Ded

19Report:

Deduction Differences

3Verifies Check

Totals

8Verifies Check

Totals

13Is Indiv w Ded Diff a Retiree

?

Yes

No

15Invoice:

Create Invoice for Difference

18Report:

EE’s w/3+ No Pay

17Work List

Notification of No Pay

18Report:

EE’s w/3+ No Pay

16Compare

Designate Invoice as No Pay

BA0804 – Claims Eligibility Audit D

BM

EBD

Inte

rnal

Aud

itSP

SB

enef

it P

rovi

der

Yes

No

Need to Validate:1) Does Claim SSN Match SPS SSN2) Does Claim SSN Have Coverage 3) Did Claim SSN Have Coverage at the Time of the Claim4) Match Coverage Level at Time of Service with Claim Coverage Level5) Verify Dates of Service Covered if Retro Payment

This process will occur for every benefit provider. The timing will depend on the benefit provider agreements; for example: weekly, bi-weekly, monthly

End

1Generate File of Actual Claims

Start

5Excel File:

Claim Recon Error

3Compare Claim to Benefit Enrollment

2Receive & Load

Claims File

7Excel File:

Update the Claim Recon Error

6Investigate Claims

with Issues

4Claims w/Issues?

BA0805 – Benefit Provider Payments B

enef

it P

rovi

ders

Com

ptro

ller’s

Offi

ceD

BM E

BD

Acc

ount

ing

2AdHoc Report

Payroll Deduction Report

3AdHoc Report

EE Enroll by Plan & Coverage

1AdHoc Report

Satellite Receipts by Health Plan

4AdHoc Report

Enroll w/Premium & Capitation Fee

Request Check

Issue Check

Receive Payment

End

BA0806 – Terminate Portal Accounts S

PS

1Did EE

Terminate?

6Terminate Benefit

Portal Account

EndStart2

Is EE Eligible for COBRA?

3Has EE Elected

COBRA?

4Did EE End COBRA?

5Did COBRA

Expire?Yes

No

No

Yes Yes Yes No

No No

Yes

BA0807 – Retro Processing C

PB

SP

S

The receivable shall be recorded by benefit period and include:1. The EE portion of the premium2. The State subsidy portion of the premium3. The imputed income portion of the premium4. The coverage effective dates for the premium

No

Total Retro $ Amount/$50 = N Periods

Yes

The receivable shall be recorded by benefit period and include:1. The EE portion of the premium2. The State subsidy portion of the premium3. The imputed income portion of the premium4. The Retro portion of the premium5. The coverage effective dates for the premium

Yes

NoTotal Retro $ Amount/Benefit Periods Remaining =

Retro $ Per Period

Ideally, this file will contain:1. The EE portion of the premium2. The State subsidy portion of the premium3. The imputed income portion of the premium4. The Retro portion of the premium5. The Prorated portion of the premium

The check/advice shows the benefit deduction detail (premium, susidy, retro, proation).

4Determine the Total Retro $ Amount Due

8Record the

Receivable that is the Result of the

Event

1An Event is

Entered into the System

10Load

Deduction Detail

Start

3Record the

Receivable that is the Result of the

Event

12Employee Pay Check/Advice

A

5Determine the # of Benefit Periods if $50 per Benefit

Period

7Determine the

Retro $ Per Benefit Period

Remaining

A

2Is EFFDT <

Today’s Date?

11Produce Payroll

9Create

Deduction File for CPB

6N Periods Remain in

Benefit Year?