List of Functional Requirements for Enrollment / Eligibility / Extracts module:

• 1. Ability to enroll member and his or her Dependents in Benefit Funds
• 2. Add/change/delete functionality with respect to Dependents’ names, SS#’s, and other demographic information.
• 3. Store eligibility rules and regulations for all benefits, which in conjunction with the Union’s entry of members’ hours and wages each month, will be used to calculate eligibility for all members and their dependents.
• 4. File Extracts and File Transfers – communicate the eligibility data to Health Center’s practice management system, as well as produce eligibility files for dental, optical, and pharmacy benefit providers:
  • a. Cerner
  • b. Opus
  • c. GVS
  • d. Empire
  • e. Per Se
  • f. QSI
• 5. Capable of listing any dependents the employee may have. Show dependent’s name, SS#, sex, relationship, birth date, eligibility date, and whether a dependent is a full-time student or permanently disabled.
• 6. Provides alpha search name capability if the employee or dependent’s Social Security Number is missing or incorrect.
• 7. Eligibility for the entire population is re-calculated every month (or any other schedule) to ensure eligibility data remains current.
• 8. Eligibility for the certain group of people is calculated by event (e.g., CRF Upload, COBRA Event, Date of Death Entered, Termination from Employment) to ensure eligibility data remains current.
• 9. Cobra module interacts with the eligibility module to extend eligibility as payments are received.
• 10. When Member Special Conditions (e.g., Arbitration, Short Term Disability) are entered, Eligibility Status is extended for a specified period of time
• 11. Expand the current eligibility beyond medical benefits to include benefits such as Pension (eligibility rules for 6 HTC pension types and 5 Club pension types), Pre-Paid Legal Aid, ITP and Scholarship.
• 12. Allows for Domestic Partner tracking.
• 13. Eligibility is tied into the Contracts database, which contains, among other things, when specific benefits begin (Benefit Coverage, Opt-In/Out Information)
• 14. Upon inquiry, the system not only displays whether or not an enrollee is eligible, but if they are not eligible, the reason(s) why they are not eligible.
• 15. Automatic FTP transmission (by pre-set schedule) of Eligibility Extracts to Third Party Health Center Internet servers
• 16. Provides for screen inquiry of an employee’s eligibility and eligibility history, as well as the employee’s employment history.
• 17. Extend eligibility for Student Dependents
• 18. Handle Students taking off a semester between the age of 19 and 23, then coming back onto parents coverage
• 19. Ability to generate a list of all New Hires added to the system by the Union.
• 20. The system must be able to show “Eligible” people who are in arbitration for as long as they are in arbitration.