An employee finishes open enrollment and submits their benefit elections. Those elections still need to reach the carriers administering coverage and payroll processing deductions.
When that information moves between systems reliably, HR has less to enter manually and fewer discrepancies to investigate. But new plans, updated rates and carrier changes can affect those connections, making them an important part of open enrollment preparation.
Understanding a few technical terms can help employers and brokers ask the right questions before the new plan year.
Understand how enrollment data reaches carriers
BenAdmin platforms can send enrollment information to carriers through several types of connections. Two you may encounter are 834 EDI feeds and carrier data exchange integrations.
An 834 EDI feed is a standardized electronic file used to exchange health plan enrollment information. It can communicate who is enrolling, which coverage they elected and when that coverage takes effect. Setting up a feed involves configuring and testing it to meet the receiving carrier’s requirements.
Carrier data exchange integrations provide another way to transfer enrollment information through established platform and carrier connections. The supported benefits and delivery schedule depend on the connection.
For OE planning, confirm how each carrier will receive elections, when the information is due and whether upcoming changes require configuration or testing. A connection already in place deserves a review when the plans or information it carries change.
Confirm fourth-quarter cutoff dates early. BenAdmin partners should let employers know the applicable cutoff dates for OE file transmissions, along with any earlier deadlines for submitting final elections or corrections. These dates can vary by carrier and connection, so employers need a clear schedule that leaves time to review and resolve issues before the new plan year.
Know what your APIs actually exchange
An Application Programming Interface, or API, allows software systems to exchange defined information. In benefits administration, APIs can support functions such as sharing information with payroll or connecting an employee to a carrier’s evidence of insurability process.
The useful question is what a particular connection does for your organization. Which information moves between systems? Where should HR enter a change? How frequently does the receiving system update?
For payroll, review how new benefit deductions will reach the system and when they should begin. Confirm how the connection handles changes so the team knows where an update belongs and avoids entering conflicting information.
Review plans, rates and effective dates
An integration depends on the information configured within it. Before new elections are transmitted, review the upcoming plan year’s plans, coverage options, rates and effective dates.
Plan mapping is part of this work. It links a plan in the BenAdmin platform to the corresponding plan or identifier in the receiving system. A new carrier or replacement plan may require updates to that mapping.
Some supported carrier integrations can also bring plan and rate information into the platform. Confirm what your specific connection supports and who is responsible for reviewing the setup before employees enroll.
That review gives the team an opportunity to catch an incorrect rate or plan association before it affects a larger group of employees.
Account for coverage that requires approval
Certain benefit elections may require Evidence Of Insurability, or EOI, which involves providing health information for the carrier’s review.
Supported EOI integrations can connect parts of that process with the enrollment platform. However, an employee’s requested coverage may still be awaiting a carrier decision.
During OE preparation, clarify how employees complete EOI, how pending elections are tracked and how approved coverage amounts reach the appropriate systems. Include payroll in that discussion so deductions reflect the applicable coverage and approval status.
Make error review part of the process
Build time into the OE schedule to review transmission results and resolve discrepancies. A file being sent is one step; confirming the receiving system processed the information is another.
Depending on the connection, the team may have access to error reports, discrepancy tools or carrier responses that identify records needing attention. Establish who reviews that information, who makes corrections and who confirms the issue is resolved.
Before the new plan year begins, everyone involved should know:
- When final OE elections must be submitted.
- Which connections require testing or updates.
- Who reviews carrier responses and payroll deductions.
- Where unresolved issues should be escalated.
Clear responsibilities help prevent an error from sitting unnoticed while each party assumes someone else is handling it.
Bring integration support into your OE planning
Benefits data connections affect the work that follows enrollment, from establishing coverage to updating deductions. Reviewing them as part of OE preparation gives employers and brokers time to address changes before the new plan year.
At ebm, we help employers and brokers connect benefits administration with their broader HR technology setup and provide ongoing support. If your team is preparing for new plans, carrier changes or a different payroll system, let’s talk about what those changes mean for your BenAdmin setup. Schedule a discovery call.
