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

Associated Changes

  1. Increased frequency: Monthly to weekly
  2. Reduced file transfer: Full file to changes only
  3. System of record: Source systems
  4. Error/discrepancy reports: Weekly / Annual
  5. Backdated coverage: Elimination of 6 month rule
  6. Method of data transmission: Managed Secure File Transfer (MSFT)
  7. Leave Without Pay: Coverage disruption
  8. Transfers including active to retired

1. Increased frequency: Monthly to weekly

  • 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

2. Reduced file transfer: Full file to changes only

  • 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

3. System of record: Source systems

  • 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)

4. Error/discrepancy reports: Weekly / Annual

  • 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
Figure 1: Error/discrepancy reports: Weekly
Error/discrepancy reports: Weekly. Text version below:
Figure 1 - Text version

The slide contains a sample of the discrepancy report Compensation Advisors will receive from Sun Life when a problem with a member's reported eligibility information is encountered. Refer to the document Public Service Health Care Plan (PSHCP) - New Eligibility Feed Transition and Future Administration Process for field details.

5. Backdated Coverage: Elimination of 6 month practice

  • 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

6. Method of data transmission: MSFT

  • 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

7. Leave Without Pay (LWOP): Coverage Disruption

  • 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

8. Transfers including active to retired

  • 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).


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