Attachment 5 - Voluntary Beneftis Portal - BENEFEDS.doc

Voluntary Benefits Portal – BENEFEDS Section 1. BENEFEDS Overview

Section 2. Roles and Responsibilities

Section 3. Interfaces (including transfer of funds to the carrier)

Section 4. Security

Section 5. Fee Structure Arrangement

Section 1. BENEFEDS Overview

OPM utilizes a voluntary benefits portal, currently known as BENEFEDS, for its Federal Employees Dental and Vision Insurance Program (FEDVIP) and its Federal Flexible Spending Account Program (FSAFEDS). There are two major components to this system: an enrollment web site and a payroll/billing administration system. BENEFEDS operates a customer service center that processes enrollments/enrollment changes via phone and assists enrollees with billing issues. The BENEFEDS web site also has a component that allows the FEDVIP and FSAFEDS Contractors’ customer service representatives to view BENEFEDS data on their particular enrollees.

For the upcoming contract term, FLTCIP premiums will be collected by the BENEFEDS payroll/billing administration system. The Contractor must pass enrollment and reconciliation files and other information to BENEFEDS for it to administer the payroll/billing system.

We do not expect to initially use BENEFEDS in the FLTCIP application/enrollment process, but we reserve the right during the contract term to incorporate BENEFEDS into this process.

Section 2. Roles and Responsibilities

BENEFEDS will be responsible for all functions related to FLTCIP premium administration, including:

· requesting payroll or annuity deductions of premiums from agency payroll offices and retirement systems for enrollees choosing this payment method;

· interpreting data returned by payroll and annuity providers to appropriately update employee and annuitant status and taking action as necessary (i.e., switching payroll providers);

· validating enrollee payroll/annuity status with applicable payroll/annuity providers;

· working with intelligence agencies to ensure their particular security needs are met;

· holding periodic on-site meetings with major payroll and annuity providers;

· sending direct bills to enrollees choosing this payment method and in other circumstances as appropriate;

· performing automatic bank withdrawal of premiums for enrollees choosing this payment method;

· processing and reconciling payments;

· remitting premium payments and enrollee identifying information to the FLTCIP Contractor;

· taking action with payroll and annuity providers and enrollees as appropriate to resolve instances in which BENEFEDS does not receive premium payments as expected;

· processing changes in billing location or method due to employment status changes and/or enrollee requests; and

· staffing a customer service center to answer billing questions and refer benefit questions to the FLTCIP Contractor.

Payroll/Annuity Billing Process BENEFEDS will integrate with the agency payroll/annuity providers (APOs) to process payroll/annuity deductions for enrollees who choose this billing method. Currently, 59 percent of FLTCIP enrollees pay premiums via payroll/annuity deduction. BENEFEDS will be the primary liaison between the FLTCIP Contractor and the APOs. BENEFEDS will calculate the amount due based on the premium for coverage as communicated by the FLTCIP Contractor, pay frequency, arrears processing rules, and premium paid to date. Payroll/annuity deductions will only be taken if there is enough pay/annuity to cover the entire deduction. There will be no partial deductions taken from pay/annuity; in these instances, premiums will be collected through other means.

Billing Errors:

As part of the billing process a majority of the APOs will send BENEFEDS billing error files containing information on enrollees who could not be loaded to their payroll/annuity system. BENEFEDS will be responsible for researching and resolving these errors. The lack of eligibility files creates an environment where billing errors that would not normally occur for most group programs occur with some frequency. Some key examples of these billing errors are incorrect social security numbers and incorrect employing agencies. BENEFEDS will attempt to resolve these errors by communicating with their APO contacts (pre-noting, phone, email), contacting the enrollees (phone, email, letters), and using any other sources of information to correct the errors. If an error goes unresolved for a certain number of pay periods (to be defined), BENEFEDS will change the enrollee’s billing method to direct bill.

Payment Process:

When the APOs process payroll/annuity they will send the payment detail files directly to BENEFEDS and the funds to a BENEFEDS bank account (most APOs send via Electronic Funds Transfer). BENEFEDS will reconcile the detail and funds and compare against the billing records generated for that particular pay period. Once reconciled, the payments will post to BENEFEDS system and BENEFEDS will send the Contractor the premium and premium detail via batch premium feeds (see Section 3). In addition, the feed will contain “no deduction reason” codes for all payroll/annuity posted premium equal to zero dollars. Depending on the reason given, BENEFEDS and/or the Contractor may need to act on this information. If BENEFEDS encounters a variance during the reconciliation process, BENEFEDS will resolve the variance by working directly with the appropriate APO.

Employment Status Changes:

A majority of the APOs provide codes on the payment detail file that inform BENEFEDS why the deduction did not occur or that the employment status has changed. BENEFEDS takes various actions based on the code received to resolve the missed deduction or to change the employment status. For example, when BENEFEDS receives a “Retired” code, it will change the enrollee’s premium request to the appropriate Annuity Payroll Provider.

Direct Bill Process BENEFEDS will send bills to enrollees who choose to pay premiums by direct bill on a schedule determined by the Contractor and as approved by OPM. This process also will be used to collect premiums in some instances when an enrollee’s scheduled payroll/annuity deduction is unsuccessful, as noted in the billing errors section above. Once reconciled, the payments will post to BENEFEDS system and BENEFEDS will send the Contractor the premium and premium detail via the batch premium feeds (see Section 3). In addition, the feed will contain reason codes for all premiums equal to zero dollars. Currently, 22 percent of FLTCIP enrollees pay premiums via direct bill.

Automatic Bank Withdrawal Process BENEFEDS will process automatic bank withdrawal payments on a schedule determined by the Contractor and as approved by OPM. Once reconciled, the payments will post to BENEFEDS system and BENEFEDS will send the Contractor the premium and premium detail via the batch premium feeds (see Section 3). In addition, the feed will contain reason codes for all automatic bank withdrawal premiums equal to zero dollars. Currently, 19 percent of FLTCIP enrollees pay premiums via automatic bank withdrawal.

BENEFEDS will process enrollee requests to change payment methods in accordance with rules set by the Contractor and approved by OPM.

Other Payment Methods

The Contractor and BENEFEDS may propose and discuss other payment methods, which will be subject to OPM approval.

FLTCIP Contractor- Roles and Responsibility Matrix The table below demonstrates some of the high-level areas that involve an intersection of responsibilities and/or shared responsibilities of BENEFEDS and the FLTCIP Contractor. This table is not intended to be a comprehensive list of all responsibilities expected from the Contractor.

Contractor Enrollee**

Payroll/annuity processing

Payroll/annuity billing errors

Resolving billing errors

· Emailing/calling enrollees

· Mailing letters

· Working w/ APOs

· Leveraging research tools X

Payroll status changes

Customer service**

X

X

* BENEFEDS refers to the entity, including the system, website, and the people resources (e.g., website administrators, customer service representatives, business analysts, etc.)

** Enrollees will be able to resolve many of the Customer Service questions listed by accessing an online help system available on the BENEFEDS website.

Contractor Enrollees

X

X

Claims questions

X

Benefit questions

X

X

X

Application/Enrollment status questions

Correspondence

Protection Against Unintended Lapse notice

X

Official termination notification to enrollees

X Contractor must notify BENEFEDS that the Contractor terminated the enrollee’s coverage

Claims letters

X

Explanation of benefits

X

Benefit specific correspondence

X

Claims administration

X

Reporting

BENEFEDS/Contractor Feeds

Enrollment feed from Contractor to BENEFEDS

X

Termination feed from Contractor to BENEFEDS

X

* BENEFEDS refers to the entity, including the system, website, and the people resources (e.g., website administrators, customer service representatives, business analysts, etc.)

** Enrollees will be able to resolve many of the Customer Service questions listed by accessing an online help system available on the BENEFEDS website.

Section 3. Interfaces

Enrollment Transfer Process:

The FLTCIP Contractor will transmit all new enrollments and enrollment changes to BENEFEDS in a batch enrollment feed.

The feeds will likely contain the following data elements:

· Identifying information for enrollee

· Payee, if different

· Monthly premium

· Payment type chosen (payroll/annuity deduction, direct bill or automatic bank withdrawal)

· Payee’s employing agency, if payroll deduct

· Payee’s annuity office, if annuity deduct

· Enrollment Status (Active, Termination)

· Coverage Effective Date

· Termination Effective Date Premium Transfer Process:

BENEFEDS will generate and transmit a premium feed to the FLTCIP Contractor as part of the batch cycle. This feed will contain the premium posted to BENEFEDS system as well as any premium reversals and “no deduction reason” codes. BENEFEDS will review the premium feed detail and transfer the funds to the FLTCIP Contractor. The fund transfer amount will match the premium total on the premium feed.

The premium feed will likely contain the following data elements:

· Identifying information for enrollee/payee

· Premium Amount

· Debit or Credit Indicator

· No Deduction Reason Code (Insufficient Funds, Leave Without Pay, etc.)

Transmission Methods:

The above mentioned enrollment and premium files will be transmitted via a secure FTP (FTP/S) transmission method.

Section 4. Security

BENEFEDS makes extensive use of Information Technology (computers, applications, communication mechanism etc.) and is required to maintain the security and confidentiality of all systems and files in accordance with Federal directives.

Section 5. Fee Structure Arrangement

The administrative fee for BENEFEDS is separate from OPM’s administrative costs and will be paid by the Contractor to BENEFEDS from the Experience Fund. While the amount of the fee and the basis on which it will be charged is not determined at this time, it is likely that the fee will be comprised of both a fixed and variable component. The fixed component may include such things as the Program-specific allocation portion of the cost of maintaining and upgrading the Portal website, an allocation of overhead costs, and allocations of other fixed expenses. Additionally, there will likely also be a per enrollee variable component which will include the costs associated with those functions that generally vary with enrollment volume. These include billing, premium collection, customer service, and other variable expenses. There may be different classes of enrollees with separate per enrollee fees, depending on the premium collection method.

The final fees and fee structure for BENEFEDS will be communicated to the Contractor after contract award.

Please note that the functions BENEFEDS performs on your behalf should be included in your premium rate development.

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