Overage Dependent With Active Coverage is Not Showing As Covered In HIPAA Output (Doc ID 2286693.1)

Last updated on JULY 14, 2017

Applies to:

PeopleSoft Enterprise HCM Benefits Administration - Version 9.2 and later
Information in this document applies to any platform.

Symptoms

The coverage code that includes the soon-to-be overage dependent is being changed to exclude the overage dependent, before the overage dependent's coverage has ended. 


STEPS
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1. Test employee has Family coverage eff 01/01/2016 - ee + sp + child with DOB 11/05/1990 (Nov 5/90) who is a student
2. Org's business rules permit overage dep to have coverage until Dec 31 of the year they turn 26. EE is on semi-monthly payroll
3. Queried the system for dependents who became overage by Dec 31/16.
4. Confirmed the FSC event rules for health plans
Coverage begins Month-Begin After Event Dt
Deduction begins Pay Pd Preceding Covg BegDt

Coverage ends On Pay Pd End after Event Dt
Deduction ends Pay Pd Containing Event Dage

5. Created a FSC event through BAS Activity page, eff date 12/31/2016
6. Processed the FSC event
New coverage code EE+Sp starts 01/01/2017, Deduction starts 12/01/2016
7. HIPAA run results - all HIPAA runs were Full File Audit:
a. Ran the Ben100a-HIPAA combination on Dec 5/16, File eff date Dec 12/16
Result is ESP for ee and sp. child is showing as covered with HLT but is not included in the employee's coverage code.
b. Ran the Ben100a-HIPAA combination on Dec 12/16, File eff date Dec 19/16
Result is ESP for ee and sp. child is showing as covered with HLT but is not included in the employee's coverage code.
c. Ran the Ben100a-HIPAA combination on Dec 19/16, File eff date Dec 26/16
Result is ESP for ee and sp. child is showing as covered with HLT but is not included in the employee's coverage code.
d. Ran the Ben100a-HIPAA combination on Dec 26/16, File eff date Jan 1/17.
Result is ESP for ee and sp. child is showing as covered with HLT but is not included in the employee's coverage code.
e. Ran the Ben100a-HIPAA combination on Jan 1/17, File eff date Jan 9/17. (first Monday in Jan/17)
Result is ESP for ee and sp. child has DTP*349 record for health benefit, eff Dec 31/16.



Cause

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