Open Enrollment
Frequently Asked Questions
· How does Open Enrollment work for plan sponsors utilizing EDI for eligibility maintenance?
A. When an EDI connection is in place, the plan sponsor and TPA Ben Admin can select one of three options to provide open enrollment information to Guardian:
1. Continue as is: The existing EDI file will be used to process eligibility changes as employees are added or removed. No change in business process. This is the preferred option.
2. Full Open Enrollment File: Includes all employee open and waived enrollments. This does not require upfront communication to Guardian to elect this option.
3. Term by Omission File: Employees that were covered in 2016 and have declined coverage for 2017 are not sent on the file. This requires at least three business days notification to Guardian to elect this option. Please contact us at edi . Include the Guardian group number and the date the Term by Omission File will be sent.
Please note term by omission cannot be used in the following situations:
-- Critical Illness Riders on the group.
-- Change files are being utilized
-- Files received after new plan year effective date
-- Group does not have open enrollment benefits.
Within two business days you will receive a reconciliation report via secure send email that will have three sections for you to review:
Section 1: Any missing information identified in the file that needs follow up
Section 2: Information about updates Guardian is making
Section 3: Employees that were removed from coverage (termed by omission)
· Q: What format should be used for the OE file?
A: The preferred OE file format is the same as your HIPPA 834 or Proprietary format.
· Q: Does Guardian require a test file for open enrollment?
A: No, Guardian does not require a test file.
· Q: How should we transmit the OE file to Guardian?
A: The transmission process does not change for open enrollment. Continue to send the file by the SFTP process.
· Q: Should we use a different naming convention for the open enrollment file?
A: Do not change the naming convention for an open enrollment file. The system uses the naming convention to determine how a file is loaded. If you change the naming convention, Guardian’s system will not recognize and will not be able to retrieve the file once it has been sent to the SFTP server.
· Q: Should we send new start dates (equal to the first day of the new plan year) for every employee on the OE file?
A: It is not necessary for you to send a new start date for every employee and dependent on the open enrollment file but will not create any issues if they are changed. We only require a new start date if the employee/family is changing coverages in the new plan year.
· Q: Should we send waiver dates for those records that are not continuing coverage?
A: Yes. Please send a waiver date for each member that is discontinuing coverage. However, it is not necessary if using term by omission.
· Q: When will we receive the reconciliation reports email for the Open Enrollment file?
A: You should receive the reports email via secure email within 2 business days of when the file is successfully applied on Guardian’s system.
· Q: Does Guardian require the open enrollment file to be sent on a specific date?
A: Guardian recommends you send an OE file at least two weeks prior to the open enrollment effective date to ensure ID cards are generated timely. If you cannot send the file within this time frame, it must arrive PRIOR to the open enrollment effective date. Once the open enrollment file has been sent, you cannot send another EDI file feed until the open enrollment date has passed. Changes after the OE file has been sent may be processed via Guardian Anytime or submitted to . Once the open enrollment effective date has passed, Guardian can then begin accepting changes from the prior year on the EDI file feed.
· Q: How should we communicate updates to Guardian for current plan year data once the OE file has been submitted?
A: Once the OE file has been loaded, any updates to the current plan year data will need to be submitted using another method. Updates can be made via www.GuardianAnytime.com, our online portal. If you would like more information on this tool, please reach out to your account manager. Updates may also be sent to our eligibility team at . Please note that our Eligibility team is not able to accept full population files.
· Q: Once the OE file is submitted to Guardian, when should we send our first production file for the new plan year?
A: Once the open enrollment effective date has passed, Guardian can begin accepting changes from the prior year on the EDI file feed.
· Q: If using term by omission for open enrollment files, what information should be sent in advance to inform us of your intentions?
A: Please send an email to with the following information:
1. Date of receipt for last file containing prior year updates
2. Date of receipt for Open Enrollment file
· Q: Who can help me if I have questions about this process?
A: Please contact Guardian EDI Administration at:
Email:
Phone: 800-433-5982, press 1 / dial ext 7311#
Please include Guardian Group Number/ Name with your communication