Presentation Public Service Health Care Plan (PSHCP) Eligibility Feed Transformation Project - April 2011

Associated Changes

Currently: 22 remittance files
- Coverage level is interpreted by Sun Life based on contribution reported
- Organizational file production schedules vary
- All 22 files are required before Sun Life systems can update
The new eligibility file will be sent every Tuesday by 1 PM
Sun Life will, in turn, update Telus system Wednesday night
Tuesday changes will be known to all partners by Thursday

Over 600K members from all participating organizations and a record for each is required every month to maintain coverage
For Regional Pay System (RPS) departments, eligibility reporting is dependant on a contribution deduction and there is a potential 48hr lag between Compensation Web Application (CWA) & RPS
It is anticipated that all weekly eligibility files will result in approximately 10K change records (if no change reported then no record is sent)
Only those members where an eligibility field is added/amended will be reported

Sun Life will no longer make manual updates. Reporting of changes will be through source system(s) amendments.
If a claim is rejected as a result of eligibility, Sun Life will advise the member to contact his/her Compensation Advisor (CA) or Insurance Specialist (IS)

The weekly SL system load may result in an entire file or just a record being rejected
File reject will be a Corporate responsibility – in the case of RPS that is PWGSC
Record reject corrections will be a Dept. responsibility
The first weekly error reports will be sent to Dept. within 48 hrs of the May 17 eligibility file transfer
An automated email message advising of the error report will be sent to a Dept., where applicable
A full file annual reconciliation will be conducted at least once a year

Administration Authority (AA) approval in situations of retroactive coverage greater than 6 months was introduced to monitor departmental performance
The Sun Life error reporting functionality provides the ability to generate performance monitoring functionality to replace the current AA pre-approval process
Retroactive coverage amendments will be automatically updated if both the following conditions exist:
- The change does not precede a member's ability to submit a claim; and
- The change does not precede the last change on file with Sun Life.
All other backdated amendments will be investigated by Sun Life prior to system update

Managed Secure File Transfer (MSFT) is a PWGSC service used to transmit Protected B files
Both eligibility files and error reports will use the MSFT service and be routed based on a file naming convention
TBS will be working with departments to establish the necessary MSFT link
Set-up and service costs will be initially absorbed by TBS and re-evaluated once fully implemented
It is strongly recommended that departments establish a generic PSHCP email account for use in PSHCP operations

Contributions and eligibility are now separate; if no change in coverage, then no file will be sent to Sun Life
PWGSC form 2278 process is still required for pre-payments and Quebec residents (taxable benefit)
Minimal coverage disruptions to/from LWOP, since no file will be sent unless coverage changes

Department code, Pay Office and Pay List changes will generate a change record for transmittal to Sun Life
If the Pay Office does not change, the CWA tool will automatically generate the transfer record
If the Pay Office changes, CA coordination will be essential to minimize coverage disruptions
Disruption can occur if a Coverage End Date is reported without a new Coverage Start Date (i.e. timing issue)
A system solution is under review in order to prevent reporting of coverage termination when form 1422 is received
Interim process:
- A communication strategy has been implemented at the Public Service Pension Centre;
- A member can request the 100 day supply limit be temporarily suspended in order to purchase an additional 3 month supply (TBS FAQ 28).