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HR-XML's US Benefits Enrollment schema supports enrollment in "tier-based" benefit coverages (such as medical, dental, and vision) and in spending accounts (for example, flexible spending accounts or "FSAs"). As the name implies, the schema is designed around requirements principally found within the U.S. market.
Version 3.0 of HR-XML's US Enrollment noun is based on a new architectural foundation and is not backwardly compatible with previous versions. The scope of the specification also has been revised based on implementation experience with the prior version of specifications. Note that two new messages have been designed to support Savings Plan and Stock Plan enrollments.
The most common way HR-XML's benefits enrollment specification has been implemented is in supporting the exchange of enrollment data between third party benefits administrators and insurance carriers. The specification may also may be useful is supporting other scenarios, such as the communication of employee enrollment data from an employer core HR system to a benefits administrator's system.
Benefits Plan Administrator. A benefits plan administrator (or sometimes "third-party administrator" or "TPA") serves as recordkeeper for a benefits program, administers new enrollments and changes in plan elections, updates participant data to reflect businsess and life events, and administers legal compliance on behalf of an employer. The administrator also may provide on-line facilities for employees/participants to use in making elections, enrollments, and in gaining information with respect to their benefit programs.
Health Plan. A group health plan offers health care coverage for employers, student organizations, professional associations, religious organizations, and other groups. Many employers offer group health plans to employees and their dependents as a benefit of working with that particular employer (medical benefits).
Carrier. Insurance carriers underwrite group health plans and/or provide administrative services related to the processing of benefits claims. The phrase "administrative services only" (ASO) is used to refer to a carrier that administers claims and provides related services to a health plan that is self-funded by an employer. In the context of HR-XML specifications, the terms "carrier" and "health plan" sometimes are used interchangably though the concepts are slightly different.
Examples of event categories that could trigger the collaboration, include:
Hire. A "hire event" coincides with the point in time at which a person who has been a candidate becomes associated with an employer as an employee. Sometimes systems are pre-provisioned with information about an individual after he or she has accepted the offer, but before the employee enters-on-duty.
Open Enrollment. A period designated for plan participants to change plans and/or their elections of options under those plans. Typically, a period of a week or weeks occurring once a year.
Enrollment Upon Eligibility. Enrollment upon meeting application requirements, such as satisfying waiting periods upon new hire or entry on duty.
Employee Promotion or Position Transfer. The promotion or transfer of an employee to a new position obviously triggers a variety of associated changes (reporting relationships, pay and benefit changes, work location changes, etc.).
Life Events. This broad category of events covers such happenings in the lives of employees or plan participants as marriage, divorce, legal separation, marriage annulment, birth or adoption of dependent children, gain/loss of guardianship, death, disability, leave of absence, etc.
Pay and Benefit Election Changes. A wide variety of financial and life events can in turn trigger the need for employers to make changes to benefit elections, payroll withholding, tax allowances claimed, beneficiaries change, benefit providers, changes in contribution/allocations, etc.
Personal Data Changes. These include events such as changes in personal information, such as government identifier, person name, home address, direct deposit account, etc.
Benefit Plan Changes and Transfers. A transfer of a plan to a new carrier or plan administrator can trigger a variety of updates or the need to synchronize data from a core HR system with the system of the new carrier or administrator.