Termination Never Effective

Scenario description and support for ending benefits "as if they were not effective" i.e. no days of coverage

Checklist

• Send Coverage

• Identify Correction

• Formulate Correction Request(s)

• Send Coverage End Date

Components

1. Member Coverage Sent

2. Correction Identified

3. Member End Date Sent

4. Carrier Transmission

Member Coverage Sent

Description

Given a previously created subscriber, the platform user would send the initial coverage.

In this example. the member is electing Basic Life/AD&D and Disability coverages.

• subscriber_id -this refers to the id of the created subscriber

• coverage_period_id - this refers to the id of the created coverage period

  • This is the link between the carrier and the subscriber

• basic_life_add_plan_id - this refers to the id of the created plan, in this case a Basic Life Add Plan

• std_plan_id - this refers to the id of the created plan, in this case a Short Term Disability Plan

• ltd_plan_id - this refers to the id of the created plan, in this case a Long Term Disability Plan

• today - is the date that the Platform system is generating the event

• first_of_current_month - this refers to a placeholder, The first of day of the current calendar month. This is commonly First of this month, Same Day, or First of the Next Month for new hires.

This would be created by sending a POST request to subscriber/{{id}}/qualifying_life_events

Request

POST subscribers/{{subscriber_id}}/qualifying_life_events
{
    "qualifying_life_event": {
        "event": "new_hire",
        "date": "{{today}}",
        "eligibility_start_date": "{{first_of_current_month}}",
        "coverage_period_id": "{{coverage_period_id}}",
        "plan_elections": {
            "life_accidental_death_dismemberment": {
                "plan_id": "{{basic_life_add_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "{{first_of_current_month}}",
                        "volume": 10000000
                    }
                ]
            },
            "short_term_disability": {
                "plan_id": "{{std_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "{{first_of_current_month}}",
                        "volume": 34500
                    }
                ]
            },
            "long_term_disability": {
                "plan_id": "{{ltd_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_1_id}}",
                        "status": "employer_sponsored",
                        "start_date": "{{first_of_current_month}}"
                    }
                ]
            }
        }
    }
}

Correction Identified

Description

In the Platform system, a user or process has identified that this coverage is no longer valid.

Example

• A member is hired and elects benefits, starting the first of the next month.

• This election is sent to Ideon in real-time.

• The member's employment is terminated, and now the member is not eligible for the coverage.

Then, your system should determine that the coverage must be "cancelled" - The platform users can send a Termination Never Effective, which will communicate that there are zero days covered for the member.

Member End Date Sent

Description

After a correction is identified, you need to understand the current state of the member and send a termination to Ideon.

1. If you don't have the current member data and coverages for the subscriber, use a GET call to retrieve the latest qualifying_life_events for the member

2. Once you know the current state (for which Carriers should I cancel coverage?), prepare a QLE request that has an End Date, which is one day before the Start Date

   1.  "start_date": "2024-10-01",
       "end_date": "2024-09-30",   <---- one day before the start date 

3. Send the QLEs to Ideon, one for each coverage period (carrier) that the member was active and needs cancellation.

Request

{
    "qualifying_life_event": {
        "event": "termination_of_employment",
        "date": "{{today}}",
        "eligibility_start_date": "{{first_of_current_month}}",
        "coverage_period_id": "{{coverage_period_id}}",
        "plan_elections": {
            "life_accidental_death_dismemberment": {
                "plan_id": "{{basic_life_add_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "2024-10-01",
                        "end_date": "2024-09-30",
                        "volume": 10000000
                    }
                ]
            },
            "short_term_disability": {
                "plan_id": "{{std_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "2024-10-01",
                        "end_date": "2024-09-30",
                        "volume": 34500
                    }
                ]
            },
            "long_term_disability": {
                "plan_id": "{{ltd_plan_id}}",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "{{subscriber_id}}",
                        "status": "employer_sponsored",
                        "start_date": "2024-10-01",
                        "end_date": "2024-09-30"
                    }
                ]
            }
        }
    }
}

Carrier Transmission

Description

• When Ideon receives this Termination of Employment, we identify whether the member was previously enrolled by our system. If we have transmitted the member on a file or API as active, we send a termination to the Carrier in their preferred format. The result of this should be Zero Days of coverage.

  • If we haven't yet transmitted the coverage, we take in the end date and as a result, we don't start sending coverages for the member

• In Test: Transmit the end date to Ideon as well as in your current administration method. This is to ensure that both systems know the member's status and won't reinstate the member. We will:

  • take in the end date

  • ensure we don't start sending coverages for the member.

• In Production: Transmit the end date to Ideon. Based on the member's current state, and whether they have been transmitted to the Carrier, we will:

  • send a correction,

  • or take-in the end date, which cancels the member.