This document provides an overview of Sentric's open enrollment services. It discusses the two types of open enrollment EDI requests: coordination service and full service. The full service includes coordination plus mapping/configuration changes. Requirements gathering and planning steps are outlined. A timeline example is shown. Common carrier questions, benefits to customers, and a test are also covered. The presentation concludes with questions from attendees.

1. Carrier Connection &
Open Enrollment
Training
5/1/2015
Sentric, Inc.

2. Introduction
Carolyn Vertula
Sentric Product Support
Specialist
7 years experience working with
HRIS systems
Questions?
Hang on until the end, we’ll
have 15 minutes of Q&A or
email me at
cvertula@sentrichr.com
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3. Webinar How To
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4. Agenda
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 Two types of Open Enrollment EDI Requests
1. Open Enrollment Coordination Service
2. Open Enrollment Full Service (Coordination Service and
Mapping/Configuration Change Service)
 Open Enrollment Services Tasks
1. Requirements Gathering
 Open Enrollment Services Planning
 Open Enrollment Services Timeline

5. Poll
Carrier Connections Poll
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6. Steps Needed to Start the Open Enrollment EDI Process
• Customer will need to contact their CSR and let them know
they would like to set up an Open Enrollment Carrier
Connection
• This needs to be done at least one month prior to
starting Open Enrollment
• The case will be assigned to a Sentric Product Support
Specialist who will place the order for Open Enrollment
Services with eBN
• eBN assigns an Analyst to the case
• Sentric Product Support sets up a meeting between the
Customer, the Carrier, eBN, and Sentric to review next steps
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7. Who is Ebn?
• eBN is a partner with Sentric for all Carrier Connections and EDI
processing
• eBN stands for Electronic Benefits Networking
• EDI stands for Electronic Data Interchange
• There is a fee associated with the 2 different types of Service
• OE Coordination Service fee is $150.00 per connection
• OE Full Service fee is $250.00 per connection
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8. Open Enrollment EDI Feed Facts
• eBN needs, at the very minimum, 1 month notice before your Open
Enrollment Process begins to prepare for the data feed
• Open Enrollment Services is a totally separate process than that of the
Standard Carrier Connection Production process
• A Standard Carrier Connection Production feed has to be active or live in order to
perform the Open Enrollment Services
• Production files will be stopped while sending Open Enrollment files to the
carrier
• It is highly recommended that you leave a 3-4 week window open for
Carrier/eBN testing after you have completed your OE, and before your
benefit effective date.
• It will be determined by the Carrier how “changes” get entered into their
system during Open Enrollment Processing (example: Life Event - Marriage,
Birth of a Child, Divorce), New Hires, Terminations. These changes are
usually made by the customer directly logging onto the Carrier’s website
portal and making those changes.
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9. Open Enrollment Services Partner
Service Description Order When …
Open Enrollment Coordination
Service
eBN will coordinate the scheduling and
handling of an in-production client-carrier
connection between the client and the
carrier, to include preparation and delivery
of client’s Open Enrollment elections file to
the carrier when there are no required
mapping changes
An Open Enrollment elections
file is required by carrier, and
there are no
mapping/configuration
changes required
Open Enrollment Full Service
(Bundled Open Enrollment
Coordination Plus
Mapping/Configuration Change
Service)
With this one convenient Open Enrollment
service, eBN will handle smoothly and
accurately all the required in-production file
coordination, scheduling and delivery of
Open Enrollment elections file. In addition
it includes all required mapping changes
and testing with the carrier on behalf of the
customer
There are
mapping/configuration
changes required to the carrier
connection mapping due to
Open Enrollment changes in
client’s plans, codes, etc.
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10. Open Enrollment Services Planning Survey
Q# Question Yes No
1 Does the carrier require that an electronic file of open enrollment elections be submitted prior to the new plan year start
date?
2 Will you be adding, changing or removing plans with this carrier?
3 Will you be making any structure changes with this carrier, such as division or location code changes?
4 Will you be making any changes to group numbers or plan numbers with this carrier?
5 Will you be creating new Year Plans in SentricWorkforce? (example: PPO-2014 changes to PPO-2015, etc.)
6 Will you be changing plan names in SentricWorkforce?
For each carrier connection in production, please complete the following survey to determine
which Open Enrollment service(s) you need to order.
• If the answer to Q1 is “Yes” then you need “Open Enrollment Coordination Service”
• If the answer to any Q2 – Q6 is “Yes” then you need “Open Enrollment Full Service (Coordination
Service and ‘Mapping/Configuration Change Service’)”
• Submit your Open Enrollment Services order at least 4 weeks ahead of your Open Enrollment start
date
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11. Common Questions Asked to the Carrier
What determines the end of one plan year and the beginning of
another?
• Benefit Termination Date?
• Benefit Termination Status?
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12. Benefits to HR Customer
 Only set-up the details once (in SentricWorkforce)
 One less set of tasks to coordinate with your carriers
 No manual Open Enrollment data manipulations
 New elections delivered on-time
 No “missed enrollments”
 No late insurance cards
 No enrollment errors
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13. Open
Enrollment
Coordination
Service
Open Enrollment
Full Service
(Mapping &
Configuration
Change Service)
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eBN Open Enrollment Services Timeline Examples

14. Test
Test Your Knowledge
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15. 15
Questions
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16. 16
Thank You!
Please take a moment to fill out the survey