Using the Invoice Report
The Data
The Bill Reconciliation Report is generated based on enrollments at a particular time. The report also considers enrollment changes between the date of the previously generated report and the next scheduled report.
Ex. A report generated on 4/17/2019 will include enrollments as of 5/1/2019. Therefore, the report will include enrollment changes made between 3/18/2019 and 4/17/2019 that are effective 5/1/2019.
Note: Future-dated enrollments that are effective later will be captured in the subsequent month's report.
The Excel File
The excel file includes the following tabs
| Summary |
All enrollments for the billing period |
| Current Membership Details |
Details of the enrollments at the beginning of the billing period |
| Membership Changes |
Any changes in membership since the prior billing period |
Summary
The summary sheet summarizes the enrollments and premium dollars for each plan by coverage level. Report details at the top indicate the Company Name, Plan type, the billing period, and the date and time the report was generated.
| Plan Name | Plan Name |
| Coverage Level | Coverage tiers for each plan |
| Billing Rate | The per employee per month rate for each plan and coverage combination Note: If the Billing rate is based on age banded rates or eligibility fields (ex. class, location, smoker/non-smoker) then the rates column will appear blank. |
| Units | The total count of enrolled employees for each plan and coverage Note: Employees who have declined enrollment or have not enrolled into this plan type will not be counted here. |
| Premium | The product of units and corresponding rate, expressed as a dollar amount, for each plan and coverage. |
| Retro Charges | The sum of the retro charges for each plan and coverage tier, sourced from the "Membership Changes" sheet |
| Total | The sum of Premium and Retro Charges |
| Subtotal | Column totals for Premium, Retro Charges, and Total |
| Grand Total | Plan totals |
Current Membership Details
This sheet lists all members who are enrolled under the selected plan type, as of the 1st of the following month of the date the report is generated.
Note: Contents of Tier Coverage Plans will differ from Voluntary Based Plans
Tier Coverage Plans
| Member ID | Employee's ID on Benefits Junction |
| Member Name | Employee's first and last name |
| SSN | Employee's SSN |
| Plan Name | Name of the plan |
| Coverage Level | Coverage tier |
| Coverage Effective Date | Date plan coverage is effective |
| Enrollees | Total number of individuals coverage |
| Premium | Monthly premium based on the plan and coverage |
| Notes | Comments are provided in this column for records that require manual review. Please refer to the list of exceptions. |
Voluntary Based Plans
| Member ID | Employee's ID on Benefits Junction Note: The EE ID will be listed 1, 2 or 3 times depending on the employee, spouse and children that are covered. |
| Member Name | Employee's first and last name |
| SSN | Employee's SSN |
| Premium Age | Age at which the premium is calculated |
| Plan Name | Name of the plan |
| Coverage Level | Approved volume |
| Coverage Effective Date | Date plan coverage is effective |
| Enrollees | Indication of EE (Employee), SP (Spouse) and CH (Child) |
| Premium | Monthly premium based on the plan and coverage |
| Class/Location/Division/Department | Indicates the employees class, location, division, department |
| Notes | Comments are provided in this column for records that require manual review. Please refer to the list of exceptions. |
Membership Changes
This sheet lists all retroactive enrollment changes and corresponding premium and adjustments. It captures new enrollments (additions), enrollment terminations, and enrollment changes since the prior billing period.
Tier Coverage Plans
| Member ID | Employee's ID on Benefits Junction |
| Member Name | Employee's first and last name |
| SSN | Employee's SSN |
| Plan Name | Name of the plan |
| Coverage Level | Coverage tier |
| Coverage Effective Date | Date plan coverage is effective |
| Enrollees | Total number of individuals coverage |
| Add/Term | Indicates whether each entry is an addition (Start Coverage) or a termination (End Coverage) of enrollment, comparing the current and previous enrollments from the prior report |
| Premium | Monthly premium based on the plan and coverage |
| Notes | Comments are provided in this column for records that require manual review. Please refer to the list of exceptions. |
Voluntary Based Plans
| Member ID | Employee's ID on Benefits Junction Note: For volume-based coverage, the EE ID will be listed 1, 2 or 3 times depending on the employee, spouse and children that are covered. |
| Member Name | Employee's first and last name or Spouse's first and last name. Will be blank for children. |
| SSN | Employee's SSN |
| Premium Age | Age at which the premium is calculated |
| Plan Name | Name of the plan |
| Coverage Level | The approved volume is indicated |
| Coverage Effective Date | Date plan coverage is effective |
| Enrollees | Indicates Employee (EE), Spouse (SP) and Child (CH). |
| Add/Term | Indicates whether each entry is an addition (Start Coverage) or a termination (End Coverage) of enrollment, comparing the current and previous enrollments from the prior report |
| Premium | Monthly premium based on the plan and coverage |
| Class/Location/Division/Department | Indicates the employees class, location, division, department |
| Notes | Comments are provided in this column for records that require manual review. Please refer to the list of exceptions. |
Important Considerations
- When the first report is generated, enrollments for all employees will appear as ‘Adds’ in this sheet.
- Subsequent reports generated will compare the enrollment on the current report and the enrollments captured on the previous report generated, to indicate the ‘Adds’ and ‘Terms’, as applicable.
- There will be multiple entries per member, to represent changes from one plan (and/or coverage). These entries will indicate the termination of the previous plan/coverage, and the addition of the new plan/coverage elected. The retroactive premium applicable for each of these entries will be indicated in the corresponding rows.
- When an employee changes enrollment from Carrier A to Carrier B, there will be only one ‘Term’ entry on this sheet, for a report generated for Carrier A. The report generated for Carrier B will list one ‘Add’ entry in that report’s Membership Changes sheet.
Exceptions
Certain scenarios will be highlighted as exceptions, and premium adjustments will not be calculated and presented in this report. They will be identified and listed as exceptions to assist in reviewing these changes and calculating the adjustments manually to confirm against the carrier invoice. If the following scenarios are applicable for the period of review, they would be highlighted with notes in the ‘Notes’ column of the Current Membership Details and Membership Changes sheets.
- Multiple enrollment changes within the period from the date of the previous report and the date of the current report.
- Changes made to enrollments with a back date.
- Changes made to employee records that trigger a change in the billing premium.
Example: The medical premium for Plan A for employees in Division A and Division B are $100 and $150 respectively. An employee was in the Division A when the April 2019 invoice was generated but changed to Division B effective 3/1/2019. The invoice generated for May 2019 will not calculate the retro-activity in this scenario but will list it as an exception.
- For plans with age banded rates, the Bill Reconciliation Report considers the enrollment premium available in the system, as on the date the report is generated and not the age applicable based on the billing month.
- Retro adjustments based on a prorated basis are calculated with 31 days for all the months.
- A Retro Cap is not applied by the system if the adjustments are based on a prorated basis.