Attachment_3_Roles_and_Responsibilities_Matrix_2022.pdf

This file is Appendix O, a BENEFEDS Contractor Roles and Responsibilities Matrix that defines task allocation across four key parties: the BENEFEDS Contractor, Carriers, Enrollees, and the Office of Personnel Management (OPM).

The matrix comprehensively delineates responsibilities across five operational categories: Enrollment, Customer Service, Premium Administration (post-enrollment), Correspondence, Reporting, and Carrier Feeds. Under Enrollment, the BENEFEDS Contractor manages online and telephonic enrollment, demographic changes, paper processing, missing information, program education, and application functions, while Carriers and Enrollees share responsibility for missing information processing and program education. For Customer Service, the BENEFEDS Contractor handles password/login questions, benefit inquiries (premium and enrollment only), single rate quotes, qualifying life event questions, requests for plan information, and eligibility questions. Carriers and Enrollees assist with general benefit questions, multiple rate quote comparisons, specific plan questions, website navigation, and eligibility inquiries. The Premium Administration section assigns the BENEFEDS Contractor primary responsibility for payroll processing, bill file creation, overdue premium calculations, payment processing, refund handling, and retirement process management, with specific support functions distributed among other parties. Correspondence responsibilities include enrollment confirmations, ID card creation, benefit correspondence, ineligibility notifications, and termination notifications. The Reporting section assigns the BENEFEDS Contractor primary responsibility for enrollment reporting, web trend reporting, literature request reporting, call center metrics, premium reporting, payroll activity reporting, and OPM reporting. Carrier Feeds designate the BENEFEDS Contractor for managing enrollment and premium feeds to carriers, while Enrollees handle termination feeds back to BENEFEDS.