Open Enrollment Questionnaire
Customer Name:
Customer #:
Vendor:
Completed on (date): by*:
*please include name, email address, and phone number
Please complete the following questions:
1. Renewal Date:
2. When is your Open Enrollment Election period?
Open Enrollment Begins: Open Enrollment Ends:
3. Will there be any change to the source of your electronic file submissions (new broker/vendor)? If Yes, please explain.
Yes No
Explain
***NOTE: We have a 10-12 week implementation period for setting up a new file. If there will be a change in how the electronic eligibility file will be created, or who will be sending it to us, please let us know as soon as possible.
(include the new broker/vendor’s contact information if applicable.)
4. Has there been, or will there be, any changes to the contact(s) we work with regarding the electronic eligibility file updates?
Yes No
Explain
***NOTE: Please discuss any changes with your Electronic Eligibility Analyst and provide him/her with an updated contact list whenever there is a change.
5. Which file layout will you be using to send your open enrollment file?
UHC GSF FORMAT Is this a change from your current layout?
HIPAA 834 4010 Yes No .
HIPAA 834 5010
***NOTE: Please allow a 10-12 week implementation period for a layout change.
6. Are there any projected structure changes? Structure changes would consist of new Plan Variation/Reporting Codes being added or removed.
Yes No
Explain
***NOTE: All new structure plans must be approved and added to our system prior to testing. If a HSA /Narrow Network (Flex, Alliance or Signature Value Advantage) product is being added, please discuss this with your Electronic Eligibility Analyst as there could be additional fields required to be sent on the electronic eligibility file.
7. Will any coverage types (i.e. Medical, Rx, Dental, etc.) be added to and/or removed from your current electronic file?
Yes No
Explain
8. Will any populations (i.e. Retirees, Cobra, etc.) be added to and/or removed from your current electronic file?
Yes No
Explain
9. Do you have any plans that require a Primary Care Provider?
Yes No
Not Applicable (by checking his box you are indicating there are no plans requiring PCP information)
If Yes was marked above, how will Provider information be transmitted? And, if not sent, or missing/invalid do you allow for randomization? (check all appropriate boxes)
Sent via the Electronic File Randomization allowed if PCP data is missing or invalid
IVR (Interactive Voice Response – via telephone) Randomization is NOT allowed
10. Will the file contain any new deductible or out-of-pocket amounts for the new year?
Yes No
Not Applicable (by checking his box you are indicating there are no plans requiring Deductible or OOP information)
11. Will all members sent on the OE file be submitted with a new coverage effective date for the new plan year?
Yes - all members will have a new coverage effective date
No - a new coverage effective date will be sent only for those members making a change to their elections
12. SSN’s are required for all members on your Open Enrollment file. If SSNs are missing for a member do you have a process to acquire it in a timely manner? (This is to comply with the government mandate to have SSN’s for all employees and dependents.)
Yes No - a No response requires discussion with the UHC Account Management Team
13. UHG prefers you send a termination date for any member’s coverage(s) not continuing in the new plan year. Will you submit a coverage termination date for members who do not elect coverage for the new plan year?
Yes No
***NOTE: If a member has elected multiple coverage types, and elects not to continue one type of coverage for the new year, a termination date should be sent for the terminating coverage(s).
If “No” was selected above, or if a member is dropped from your file without a termination date being transmitted on the previous file, when your OE file updates to our system it will generate an auto-cancel date equal to the last day of the current plan year.
14. How will ID cards be managed for the Open Enrollment file?
Full Population Extract (New ID Cards for ALL members)
Maintenance cards for new adds and changes only
***NOTE: Maintenance cards will be generated only for the following reasons: Adding a new member; Changing a member’s name; Product type changes; or Reinstatements.
15. Test files are required for electronic Open Enrollment files for all new and existing business with structure/layout changes. All test files need to be Full Population files and should be received 6-8 weeks prior to sending your OE file.
Test File #1 Date: Test File #2 Date:
***NOTE 1: Test files MUST be sent to UnitedHealthcare’s Testing Platform. If you have a question, please discuss with your analyst how to send your test files. If there will be a different contact during file testing, please provide that person’s contact information. (Name, email address and work phone number.)
***NOTE 2: If test files contain ‘dummy’ data, the first production file will be treated as a test file.
***NOTE 3: Please review Quality Reports and return approval or comments within 24 hours.
16. When is/are your Open Enrollment Production file(s) scheduled to be sent to us?
“Live” Production File #1 Date:
(if applicable) “Live” Production File #2 Date:
***NOTE 1: Please discuss with your analyst how to send your production file.
***NOTE 2: If known, please inform your Electronic Eligibility Analyst the date when your last current year file will be transmitted. Often this isn’t known until there is a successful test file, however it is important for us to be informed when we will stop receiving “old plan year” data.
(if known) Last ‘Current Year’ File Date:
NEW THIS YEAR: ***NOTE 3: The production eligibility file for January 2015 membership is due to UHC on or before November 17, 2014 if your portfolio of products includes the Optum Health Wellness portal. The accuracy and timeliness of this file is required for your membership to be properly serviced.
17. Please specify how remaining ‘current year’ changes will be submitted once your Open Enrollment file has been applied to our system. (check only one box)
Manually via eServices
“CHANGES ONLY” FILE (Current-old plan year-Data Only)
Full File (Current-old plan year-Data Only) ß If you are choosing this option, please discuss it with your
Electronic Eligibility Analyst.
Full File (Mixed - Current-old plan year-Data and New Plan Year Data) ß If you are choosing this option, please
discuss it with your Electronic Eligibility Analyst.
If sending Electronic files list file dates/frequency. Also note if your business closes more than one business day.
Please list the dates and/or frequency of any ‘current year’ files that will be sent after your OE file has been processed.
18. Please list a minimum of one contact who is authorized to give their approval to the final test results, and can give the okay to load the tested file into our live production system:
Please include name, email address and phone number.
***NOTE: It is very important that this person be available at the time the ‘live’ production file is sent to us to load. Once the file has completed testing your Electronic Eligibility Analyst will send out a report that will compare current year membership (if applicable) with new year membership numbers, and request a reply with their approval to load that eligibility file into our live production system. It is imperative that we receive this approval to load the OE file within 24 hours – any delays will effect how quickly membership is loaded to our system, and may also effect when ID cards are sent out.
Thank you for taking the time to complete this questionnaire. Your answers to these questions will be instrumental in helping us process your Open Enrollment file(s).
NOTE: You may be receiving multiple questionnaires if you send in multiple files to us or if you have a multi-platform business (i.e. HMO, Medicare & Retirement, and/or Commercial business). It is important to address and respond and possibly speak with your UHG representative(s) to each Open Enrollment Questionnaire as it pertains to the specific file it relates to.