Eligibility and Vendor Management

Eligibility information, expressed simply, is essentially "who is on the plan, as of which date and who is off the plan, as of which date." The on and off date are first a function of employer eligibility rules, as agreed with each carrier or vendor. Waiting periods for benefits may vary - even between benefits. Different classes may be subject to different rules. A benefit may end at midnight on the date of termination or the last day of the month. Dependents may reach majority age at 23 or at other ages. (The rules for billing and payroll can further vary, but more on that in the appropriate section.) Eligibility management systems apply and enforce the rules based on the plan structure and life event rules built into the system for the employer.

Obviously, this can get complex. The role of the eligibility management function is to make sure that employee eligibility information, as maintained on our systems, corresponds directly to eligibility on benefit carrier and vendors' systems.

Eligibility management takes the data that results from the rules-based enrollment and change functions (including self-serve functions), after the data has been processed according to carrier/vendor rules and distributes the data to all carriers/vendors via a HIPAA 834 file or other means as required for the health or ancillary benefit provider. Files are transmitted securely via FTP or via the automated data management functions of our secure portal. The Benesyst BeneSmart system automatically integrates with our FSA and Continuation Services systems.