Employee Central Global Benefits Support for Affordable Care Act Reporting - Functionality & Config

[nehasharma05]

As the Product Manager for Total Rewards - SAP SuccessFactors, I am excited to share that with the H2 2022 release, SAP SuccessFactors has introduced two enhancements to support United States Affordable Care Act Reporting.

The system will now be able to:

1. Store additional configurations regarding an insurance plan:
   Minimum Essential Coverage,
   Minimum Value,
   Plan Type (Fully Insured, Self-Insured)
2. Capture & Update the offer of Minimum Essential Coverage Plans for employees in various scenarios.

Let's first learn about the new elements of this enhancement and then delve into how each of these play together in various scenarios.

• New Fields - Fields in Insurance Plan Object

New Fields in Insurance Plan Object

 The above fields progressively appear when the Country/Region field is set as United States.

1. Minimum Essential Coverage: This is Yes/No field and can be set accordingly by the admin when a plan meets the MEC criteria as per the ACA guidelines.
2. Evaluate Offer of Coverage: This is a Yes/No field which shall be chosen to create offer records for the MEC plan. Only plans with a ‘yes’ value will be considered for offer record creation.
3. Coverage for Employee Required Contribution: This field needs to be set with the coverage name that is for the Enrollment For Option related to Employee only providing coverage to the employee only.
4. Enrolling for Employee Required Contribution: This field needs to be set with the Enrollment For option related to Employee only.
5. Plan Type: Configurability between Self-Insured & Fully Insured.
6. Minimum Value: This is a Yes/No field capturing whether a plan meets the standard insurance coverage requirement.

• New Job - Evaluate Offer for Affordable Care Act Reporting

This job can be configured in Admin Centre under Manage Data. This job creates offer records for the employees for the Insurance benefits with MEC plans. Admin needs to fill in the fields - Benefit, Insurance Plan (MEC Insurance Plan) and Job Owner.  On click of save, the job runs and can be monitored in Execution Manager Dashboard.

Evaluate Offer for Affordable Care Act Reporting Job Setup

• New Object - Benefit Offer Details for Employee

This object captures the details of the MEC plan offer that is made to an employee. It gets updated in various scenarios which is detailed further.

Benefit Offer Details for Employee Object

 The Date of Offer is the date when the MEC Insurance Plan is offered to the employee. Best practice to get this field captured correctly is to run the job the same day when the Open Enrollment Window Opens.
Employee Required Contribution is the minimum cost value which the employee contributes for a MEC plan that provides coverage only to the employee.

Now that the new elements are understood, let's look at the various situations of an employee cycle and the update in data captured in the ‘Benefit Offer Details for Employee’ object.

Scenario 1: Open Enrollment Window

Open enrollment is from 1 Jan 2023 to 28 Feb 2023. Benefits are effective from 1 March 2023 until 29 Feb 2024. To capture the offer details of the employees, admin should perform the below steps.

Step 1: Configure the fields for the MEC relevant insurance plan.
Step 2: Set up the ‘Evaluate Offer for Affordable Care Act Reporting’ job in the admin center for the required benefit & plan and monitor in Execution Manager Dashboard.
Step 3: Once the job is completed, you can see in Manage Data that ‘Benefit Offer Details for Employee’ record for the employees got created.

Below is a screenshot showing the offer record of Employee Oliver Perez.

Scenario - Open Enrollment

 Scenario 2: Enrollment

Open enrollment is from 1 Jan 2023 to 28 Feb 2023. The Benefit Offer Details for Employee record is already in place in the ‘Offered’ status due to the job that was run by admin on 1 Jan 2023.  Employee Oliver Perez chooses to enroll into the Benefit and MEC Plan on 23 Jan 2023. The existing offer record gets updated with further details. In the below screenshot we can see that the details got updated – Status of Offer changed to Enrolled; Request date, Effective from date, Enrollment End Date got captured.

Evaluate Offer for Affordable Care Act Reporting job is not needed to be run as this is an automatic update.

Scenario - Employee Enrolls

 Scenario 3: Opt-Out

1. Opt-out when OE window is open
   Open enrollment is from 1 Jan 2023 to 28 Feb 2023. Employee Oliver Perez chooses to enroll into the benefit Medical Insurance on 23 Jan 2023, but on 24 Jan 2023 he opt-outs of the benefit. The opt-out is effective from 1 March 2023. In this case, where the open enrollment period is going on and enrollment is yet to become active, his existing offer record gets updated with the date when the opt-out is effective from i.e. 1 March 2023.
2. Opt-out when the enrollment is active
   Open enrollment is from 1 Jan 2023 to 28 Feb 2023. Employee Olivia Gracia chooses to enroll into the benefit Medical Insurance on 23 Jan 2023. On 2 March 2023 Olivia opt-outs of the benefit. In this case, where the enrollment is active, the existing offer record gets updated with the opt-out date as effective from the current date when Olivia opts-out i.e. 2 March 2023.

Evaluate Offer for Affordable Care Act Reporting is not needed to be run to capture the opt-out details as this is an automatic update to the offer object.

In the next set off scenarios, the update will happen automatically in the offer record. For that, pre-requisite setup of tracker rules is required. Evaluate Offer for Affordable Care Act Reporting job is then not needed to be run.

Scenario 4: New Hire

Employee Emma Smith is a newly hired on 19 Jan 2023 and open enrollment window is going on. She is eligible for the MEC Plan Bronze Health US of Medical Insurance Benefit. When she gets hired the offer object gets created with the details for her.

Scenario - New Hire

Scenario 5: Employee Newly Eligible For The Plan

1. Newly Eligible when OE window is open
   Open Enrollment window for benefit ‘Health Insurance’ is from 1 Jan 2023 to 20 Jan 2023. Enrollment is active from 21 Jan 2023. Employees in the ‘Sales’ Department are eligible for the benefit ‘Health Insurance’ with MEC plan ‘Plan A’. Employee Michael Tremblay becomes newly eligible when he moves from ‘Corporate Services’ Department to ‘Sales’ Department on 19 Jan 2023. When this eligibility change happened the offer object gets created capturing the employee offer details.
2. Newly Eligible when OE window is closed
   Employee Sara Jones moves from ‘Corporate Services’ Department to ‘Sales’ on 22 Jan 2023. She is eligible for the ‘Health Insurance’ Benefit, but the OE window has closed on 20 Jan 2023. Now when an exception window is opened for this benefit for Sara, automatically the offer object gets created for Sara.

Scenario 6: Eligibility Loss or Termination

Employees in the ‘Sales’ Department are eligible for the benefit ‘Health Insurance’ with MEC plan ‘Plan A’. Employee Janet Wise chooses to enroll into the benefit Health Insurance on 20 Jan 2023 but on 21 Jan 2023 she loses eligibility as her department gets changed. When this happens, her offer record gets updated – the enrollment end date gets updated to 21 Jan 2023.

Similarly in case of termination scenario same update occurs. The benefit should be listed in the ‘Benefit Work/Life Event Configuration’ template for this termination automatic update.

Scenario 7: Exceptions For Events

1. Exception for enrollment
   Open enrollment is from 1 Jan 2023 to 28 Feb 2023. Employee Ben Shervin was offered Medical Insurance, but he didn't enroll during the Open Enrollment window. The system will have an offer record for Ben in the ‘Offered State’ for the Open Enrollment window. In June 2023, Ben has a life event and gets an exception for enrollment on Medical Insurance. A new offer record gets created with the Date of Offer field having the exception start date value.
2. Exception for edit/opt-out of enrollment
   Open enrollment is from 1 Jan 2023 to 28 Feb 2023. Employee Geoff Hill was offered Medical Insurance, and he enrolled during the Open Enrollment window. The system will have an offer record for Geoff. On 25 June 2023 Geoff has a life event and gets an exception for edit of enrollment on Medical Insurance. In this case, the existing offer record gets updated with details and no new offer record gets created. The Date of Offer stays as 1 Jan 2023.

Scenario 8: Dependent Age-out

The Medical Insurance benefit enrollment is active for employee Trevor Scott and covers his son Tim Scott. The offer record has details for his enrolled dependent as well.
The below benefit covers dependents below the age of 20. Tim is turning 20 on 8 March 2023, which would make him ineligible for the benefit. Now in this case, automatic update to offer record will happen if the settings are configured to automatically update the insurance enrollment due to dependent eligibility changes. If it’s not configured and admin manually removes the dependent from employee’s enrollment record, then the offer record will get updated. In this example, Tim’s (dependents) benefit enrollment end date will be updated to 8 March 2023.

Scenario - Dependent Age Out

Frequently Asked Questions

1. What are the scenarios for which Evaluate Offer for Affordable Care Act Reporting is needed to be run?
   Following are the scenario which require the job to be run: Open Enrollment, Benefit Changes & Plan Changes.
   For other scenarios related to changes in employee data, tracker rules setup for Job Information, Personal Information etc is a prerequisite for automatic updates without the need of Evaluate Offer for Affordable Care Act Reporting job to be run.
2. Why does the status show as Enrolled in the ‘Benefit Offer Details for Employee’ object when the employee has opted out/terminated?
   The statuses captured are– Offered and Enrolled. In case of opt-out/termination the opt-out date/enrollment end date gets captured which helps in knowing that the employee is no longer enrolled in the MEC plan.
3. What happens when employee enrolls into a Non-MEC plan of the same benefit?
   If the Evaluate Offer for Affordable Care Act Reporting job is run for the MEC plan and employee enrolls for the Non-MEC plan then the Benefit Offer Details for Employee object for the employee for the MEC plan will have the status as Offered as employee did not enroll into the MEC plan.
4. What value is captured in the Employee Required Contribution field?
   Employee Required contribution is the Employee only cost for Employee only coverage. The rate chart considered for filling this field is the one wherein smoking field is set to ‘No’.

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I hope this blog is helpful. You may reach out to me for any queries on this topic.

Thank You,
Neha Sharma 
Product Management
Total Rewards