Benefits administration system and methods of use and doing business

An automated benefit administration system and methods of use and doing business. The full system includes a wide range of features including application of business rules to enrollment, eligibility, and maintenance data input, making of business decisions based on the specific data entered, and issuing of notices based on business rule discrepancies including notices to third parties when deemed appropriate. The full system also is secure while providing remote access, including through the Internet, limits access based on user hierarchy, allows user customization of various features including communications vehicles (e-mail, letter correspondence, or facsimile) and of the format of certain communications, provides automatic enrollment in Cobra without re-entry of beneficiary data, accomplishes various types of financial reconciliation, accommodates differing organizational structures and groupings of entities, provides business rule over-ride capability for certain users, and provides robust information about carriers and their services.

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BACKGROUND

The present invention relates to benefits administration systems and methods of use and doing business. The present invention also relates to automated systems for administering benefits.

In business and industry, benefits plans are common. They often include health care, savings or retirement plan, insurance, and other funding or services for employees. Administration of benefits has long presented a substantial challenge for business and industry.

One prior art automated system designed for administration of benefits has been known as the “Phoenix” system. The Phoenix system automated certain benefits administration tasks and included features such as:a. enrollment of beneficiaries through a limited-access, private computer network such as an business's internal computer network;b. automated but limited application of certain basic business rules to inform the user, at the time of entry on-screen only, of certain limited missing information such as a beneficiary's address, birthdate dependents, or benefits plan choice;c. automated reconciliation of payments provided they exactly match the amount invoiced to the customer;d. limited automation of physical letter generation such as generation of a welcome letter to a new customer setting forth little more than the effective date of initiation of plan coverage for the customer;e. automated maintenance of certain limited carrier data, including certain carrier rates and rating areas;f. limited automation of Cobra enrollment by re-keying data for the Cobra enrollment into the system;g. limited automation of open enrollment and re-qualification by automated sending out of notices and issuance of failure to re-qualify reports, allowing manual entry of termination if desired by the administrator;h. automated termination and issuance of termination notice to the carrier upon first termination of a customer and thus well prior to conclusion of the re-instatement option period; andi. limited periodic reconciling of payments actually received in-house by receipt at the system administrator's mailroom, routing to the finance department for entry into the system; if the payments matched exactly the amount of their respective invoices, the finance department would initiate a program through that would reconcile the cash received against the invoice; non-matching payments would require substantial manual involvement in the reconciliation processj. The Phoenix system included numerous limitations and issues, however, including:k. limited carrier data such as not including data (only zip codes and rates);l. lack of automated creation of a Cobra record from information already in the system for a given beneficiary;m. with regard to issuance of notices for enrollment or re-qualification, lacked ability select sub-groups (e.g., groups under 5 employees) for issuance of notices only to them, and also lacked automatic termination of groups that do not re-qualify;n. providing notice of termination of a group to a carrier prior to expiration of a re-qualification period for the group including Cobra members of the group;o. lack of automatic changing of employee status upon change of employee coverage (e.g., by changing from employee-only coverage to employee and spouse coverage), along with lack of automated corrected billing as a result of the change;p. lack of automated reconciliation of cash upon closing of a batch of inputted premium checks, and automatic reconciling of premium notices with payments provided by multiple payments (e.g., multiple checks providing payment for a particular premium amount);q. limited application of business rules to ensure correct data entry and limiting of enrollment as allowed by the rules, and relatedly, no ability to issue notices other than on-screen notices of certain limited types of information that may be missing;r. limited ability to generate required notices, and limited or no ability to send notices through differing media (e-mail, mail, fax);s. no ability to allow system access through remote or separate networks, such as via the Internet;t. no ability to reconcile payments that do not exactly match invoice amounts, and no ability to issue notices based on matching discrepancies; andu. limited data handling capacity, requiring periodic purge data to run the system.

BRIEF SUMMARY OF CERTAIN ASPECTS OF THE INVENTION

In summary, the present invention relates to an automated benefit administration system and methods of use and doing business. In certain embodiments, a full system includes a wide range of features including application of business rules to enrollment, eligibility, and maintenance data input, making of business decisions based on the specific data entered, and issuing of notices based on business rule discrepancies including notices to third parties when deemed appropriate. The full system also is secure while providing remote access, including through the Internet, limits access based on user hierarchy, allows user customization of various features including communications vehicles (e-mail, letter correspondence, or facsimile) and of the format of certain communications, provides automatic enrollment in COBRA without re-entry of beneficiary data, accomplishes various types of financial reconciliation, accommodates differing organizational structures and groupings of entities, provides business rule over-ride capability for certain users, and provides robust information about carriers and their services.

There are many other novel aspects and aspects of embodiments of the present invention. They will become apparent as the specification proceeds. In this regard, it is to be understood that the scope of the invention is not be determined by whether given subject matter addresses all or particular issues in the prior art noted above or provides all or particular features identified in this brief summary.

DETAILED DESCRIPTION

Certain embodiments of the benefits administration system may (i) apply rules to enrollment, eligibility, and/or group maintenance data input, preferably all such input, and (ii) make business rule decisions based on the specific data entered, preferably including automatic actions related to correct business rules as well as issuance of notices for business rule discrepancies. These capabilities can, in certain embodiments, include business rule over-rides based on user authority level.

For example, in the insurance industry, an enrollment application is required for enrollment into any insurance plan. Enrollment rules may pertain to the input of data from this application into the benefits administration system. An example of an enrollment rule may include inputting a Social Security number (SSN) that has been assigned to another member previously. In certain embodiments, the benefits administration system can produce a notification of a duplicate SSN and may not allow the completion of the member's enrollment utilizing the duplicate SSN.

Another example of an enrollment business rule is the entry of information for a new member who requests family health coverage but does not list any dependents on the new member's enrollment application in the system. In certain embodiments, the business rules within and automatically applied by benefits administration system can require the data entry of one spouse and at least one child in order to comply with family coverage. Without this dependent information, the system may refrain from allowing finalization of the enrollment. In certain embodiments, the system can then automatically designate the member's application as pending and generate one or more notices (such as letters) advising of the need for, or requesting, the missing information.

Eligibility rules may pertain to the specific business rules set up by the insurance companies. For example, to be eligible for a certain type of insurance, an employer group may require at least two employees; or in order for an employee to be eligible, the employee may have to work at least thirty hours per week. In certain embodiments, the benefits administration system may implement these types of specific rules.

For example, if a user seeks to enter an employer group with only one employee, in certain embodiments the system can thus refuse to finalize the enrollment unless another employee's information is entered. As another example, if user enters hours-work-per week for an employee less than the business rule of 30 hours, in certain embodiments, the system will not allow finalization of the enrollment. In certain embodiments, the system may accommodate exceptions such as when a user with a pre-determined authority level, such as a manager, desires to over-ride the eligibility business rule. In certain embodiments, the system can allow the exception based on pre-arranged authority levels within the system.

Group maintenance may pertain to enrollment/eligibility activities that occur after the finalization of a group's enrollment. One example may be the addition a newly hired employee to the employer group's plan. In certain embodiments, once the new employee application is received and data is entered, the system may apply one or more business rules for the waiting period for the new hire within the group within which the new hire is hired. Based on this comparison, the system may either assign a correct effective date or deny the enrollment because the employee has not properly satisfied the waiting period. In additional embodiments, if the employee is enrolled, the system may automatically issue an enrollment letter; or if denied, the system may automatically issue a denial letter.

Yet another group maintenance example may be the receipt of monthly insurance premium payments. In certain embodiments, the system may automatically issue an invoice outlining activity affecting the premium for a given period of time, such as the past month. Such activity may include adding a newly hired employee or dis-enrolling a terminated employee. In certain embodiments, the system may implement business rules to provide automatic reconciliation of the premium to the amount of an invoice.

In certain embodiments, the system may also be flexible enough to take into consideration activity that occurred after the creation of the invoice in reconciling the premium. For example, the monthly invoice to a given customer may total a particular amount. By the due date of the invoice, the employer may have sent notification of an employee disenrollment. The employer may have only sent a payment that deducts the premium for the disenrolled employee. In certain embodiments, the system can automatically reconcile the received payment against the invoice amount and the termination credit for the disenrolled employee.

In certain embodiments, the benefits administration system may implement varying authority levels for data entry and system operation. For example, the system may provide that (i) a data entry position may have authority to enter data but not to finalize enrollment even if all business rules are met; (ii) yet another position may have authority to finalize enrollment if all business rules have been satisfied; (iii) a supervisor may have authority to finalize enrollment with, as possible examples, minor premium shortages or non-eligibility-related missing enrollment information; (iv) managers may have authority to finalize enrollments with significant premium shortages or non-eligibility issues; and (v) a system administrator may have authority to over-ride any business rule.

Certain embodiments may also provide remote access through disparate networks, such as, for example, through the Internet, for enrollment, eligibility, or group maintenance data input. In certain embodiments, the system may then make business rule decisions based on the specific data entered. In certain embodiments, the system also may automatically perform actions related to the business rules. In certain embodiments, the system also may automatically issue notices, including on-line notice in certain embodiments, for business rule discrepancies. In certain embodiments, the system may include business rule over-rides based on the authority level of user.

In certain embodiments, the system can allow an external business customer to process enrollment, eligibility, or group maintenance via the Internet. For example, in the insurance industry, an enrollment application typically is required for enrollment into an insurance plan. In certain embodiments, the benefits administration system may allow this application to be entered remotely through a, preferably secure, Web site.

For example, an employer may request enrollment in a health insurance plan. In certain embodiments, the employer then may access the Web site provided by the system and enter the employer's current employees' demographic and health carrier information. The employer also may pay the first month's premium on-line through the Web site.

Preferably, the system prompts the on-line user for information. While the data is being entertained, in certain embodiments the system may compare the data to the business rules associated with each field. Once the input is completed properly, in certain embodiments the system may present an enrollment summary sheet summarizing enrollment information for the on-line user. For example, in certain embodiments implementing the a wage and tax form requirement for new group enrollments, the system may present the on-line user with the completed form and instructions to return the form to, for example, the insurance company for further processing. In certain embodiments, once the insurer approves enrollment, the system may automatically e-mail or otherwise forward an enrollment acceptance form to the user.

In certain embodiments, business rules remain identical whether for in-network or remote on-line transactions such as, for example, through the Internet.

Group maintenance may involve enrollment/eligibility activity occurring after the finalization of a group's enrollment. For example, if an employer or designated contact person is attempting to enroll a newly hired employee on-line, the employee is hired to work twenty hours per week, and the business rule set up for this particular group is that all employee's must work forty hours per week, in certain embodiments the system may dis-allow the finalization of the enrollment. In certain embodiments, the system may automatically issue a notice informing the group of the non-enrollment and, preferably, the reason(s) for the non-enrollment.

Another group maintenance activity can be employee or dependent disenrollments. In certain embodiments, the employer or designated person may access the appropriate group information on-line and enter the requested termination date. If the requested termination date complies with the business rule, in certain embodiments the system may immediately process the termination, preferably including the sending of a termination notice and COBRA information to the disenrolled employee, adjusting the applicable premium invoice, and notifying the appropriate insurance carrier. If the requested termination date is not within the pertinent business rules, in certain embodiments the system may calculate the termination date and display the date to the on-line user. If the user were to accept this date, in certain embodiments the system may complete the termination and, preferably, issue a notification to the user, such as by e-mail. If the user were to decline the system's proposed termination date, in certain embodiments the system may place the requested employee termination on hold and, preferably automatically, issue a notice of the situation to an appropriate representative.

In certain embodiments, the system may limit the capability to over-ride business rules to in-house personnel (e.g., the personnel of the entity that administers the system).

In certain embodiments, the system can provide a security application or process in order to control access to the system. In certain embodiments, the security framework includes a security information database as well as an administrator login capability. In certain embodiments, the system can allow the administrator to create users, modules, groups, applications, and assign user roles and access control lists (ACLs), etc. Preferably, the system significantly restricts access to the core administrative system.

In certain embodiments, the system generates an ACL for each user at the time the user logs into the system. Access to any resource in the core administrative system may be determined by the ACL, and the determination may be stored in, e.g., a user profile object, which may be stored into the session. A user can include a person working in any of the departments in a company, Internet users, or persons accessing an in-house system from an external location. In certain embodiments, individual user permissions take precedence over group permissions. In certain embodiments, even if the group permission is less restrictive than the user permission, the user permission overrides the group permission.

For example, the agent/broker of a large association group may want to allow the members of the association to enroll through the Internet but to also provide for agent/broker review of applications prior to actual enrollment. In certain embodiments, the system, through its security system, can allow such members to enroll through the Internet (with the application being processed through the enrollment/eligibility business rules), then route the completed application to the agent/broker (versus directly into the system after passing all the business rules), in order to allow the agent/broker to review the application. In certain embodiments, upon completion of such review and approval by the agent/broker, the system can automatically finalize the enrollment.

In certain embodiments, the benefits administration system may also provide the automatic generation of documents and other communications, customizable to the desires of the users. In this regard, the system may provide a flexible mail merge system for handling external business correspondence. In certain embodiments, the merge templates are basically RTF files with placeholders for dynamic data to be merged into them. In certain embodiments, the output is either a RTF file or a PostScript or a PDF document.

In certain embodiments, the system can also maintain a log of mail merge letters generated. The log information may include the template identification, a timestamp, the triggering application, and identification of the user generating the letter and to whom the letter is addressed (i.e., which group or member or agent). In certain embodiments, the templates are readily available, and the system may accommodate a virtually unlimited number of templates.

For example, when the agent/broker provides final approval for association member enrollment, in certain embodiments the system may issue enrollment approval and related correspondence. In certain embodiments, such correspondence or other documentation may be customized through the system to issue on the agent/broker's letterhead.

In certain embodiments, the system may provide for customizable work groups. Workgroups may define the broad categorization of a group of agents, internal working personnel, external working personnel, and mailing groups. In certain embodiments, the workgroup customization process includes creating a hierarchy of one or more parent entities and defining other workgroups under the parent(s).

In this event, a parent may be the highest in the hierarchy of a workgroup. Examples of parent work groups may include agent work groups or internal work groups. Examples of workgroups under the parent group may include groups of agents of differing authority levels within a given agent work group. In certain embodiments, further sub-groups or child groups may be established within the system. An example may include may include agents in a given geographical area or a customer group that has been enrolled in the system. In certain embodiments, the system includes the ability to exchange workgroup members or duplicate workgroup members in whole or in part.

In certain embodiments, the benefits administration system provides automatic but flexible account reconciliation. Cash reconciliation can provide a process of reconciling the cash receipts to individual invoices and reconciling the amount paid by the group. In certain embodiments, the system may provide a rule for reconciliation such as, for example:a. determine if negative cash is available and reconcile it with the positive cash (e.g., for NSF checks); andb. identify the oldest unreconciled invoice and reconcile it with the oldest cash.c. The reconciliation process may include automatic review of all invoices that have not been reconciled for a specific group and reconciling the invoice that has the earliest date with the cash received. It also may match the cash receipt with the invoice amount.d. In certain embodiments, the reconciliation process can be started automatically when a cash receipt batch is closed to reconcile cash received with invoices.e. Other functions that may be automatically performed in cash reconciliation may include one or more of the following:f. Billed amounts and cash receipt: this reconciliation process may reconcile an invoice that has not yet been reconciled for a specific group, determine if the invoice is the earliest unreconciled invoice for the specific group, and reconcile the invoice with the cash received from the group/member;g. Cash to negative cash: this process may reconcile negative cash with the positive cash received from the group. This may arise from receipt of a NSF (Non-Sufficient Funds) check after the applicable group's invoice has been reconciled. Upon receipt of notification of the NSF check, the NSF cash receipt entry may be created in the system. Upon receipt of a replacement check for the NSF check, the NSF check may be automatically reconciled with the replacement check provided the amount of the replacement check is the same as the amount of the NSF check.

Adjustments to cash: this process may include reconciling a cash receipt with the adjustment that may be available in the next invoice. For example, if the group has received the invoice for the next month and an employee has been terminated during the month but after the generation of invoice, the generated invoice may not identify this adjustment for the termed employees. The applicable group may deduct the adjustments for the terminated employee and forward the cash that does not match the original invoice. In certain embodiments, the system can automatically identify the discrepancy and adjust the cash receipt for the invoice with the termination adjustment taken in to account. In certain embodiments, the next invoice may identify the cash receipt and the adjustment for employee termination.

Adjustment to billed amounts: this process can identify previously billed invoices for the group provide adjustment as needed to the next invoice.

Billed amount to itself if no payment is due: this process can identify if the group has been terminated after the invoice for the group has been created. In certain embodiments, the system automatically creates an invoice for the terminated group and adjusts the amount due based on the previous invoice. In certain embodiments, the system issues a final invoice for the terminated group showing net amount due, if any, or refunded.

Adjustment to adjustment: this process may reconcile invoice adjustments against each other. For example, if a payment late fee accrues but is later waived, in certain embodiments the system may automatically adjust (eliminate) the late fee. Another may involve reinstatement of an employer group termination and associated charging of a reinstatement fee. If such a fee were to then be waived, in certain embodiments the system may automatically reconcile the waived fee.

Certain embodiments of the benefits administration system provide a substantially improved ability to handle much larger data sets and to handle data more efficiently. In addition, certain embodiments utilize an independent platform and portable programming language such as Java. Preferably, the system components are built using object oriented programming concepts. Preferably, these object-oriented components can be reused in other applications with similar requirements or extended further with additional features when and wherever required. Preferably, the system is developed using scalable J2EE standards.

In certain embodiments, the system may allow a given user to work with the system in differing roles or capacities. For example, a manager may seek to perform the role of data entry as well as that of a manager or authorizing entity. In certain embodiments, the system allows modification or addition of user roles as desired. In certain embodiments, the CAS (Core Administration System) system is, however, pre-configured for a basic set of predefined roles.

In certain embodiments, the benefits administration may further provide one or more of the following aspects:a. selective issuance of notices to sub-groups meeting certain criteria;b. automated creation of a Cobra record from information in the system for a given beneficiary;c. automatic issuance of notice to a member prior to termination of the re-qualification period;d. automatic revision of employee status upon change of employee coverage;e. automatic issuance of notices when data is not entered correctly or completely, including issuance of other than on-screen notices to one or more system administrators or other entity;f. ability of a user to customize how the user may be provide notices or correspondence, such as by e-mail, mail, or facsimile; andg. enhanced carrier data maintenance within the system.

The system may be utilized by a benefits provider as part of it business and operation. Alternatively, the system may be utilized by a service provider, such as for or in connection with remuneration provided to the service provider by customers. For example, user fees may be provided by the users of the system, such as benefits providers or employers.

The system may also be utilized by an employer or group of employers, and their employees, to provide automated benefits administration for the employer or group of employers.

In certain embodiments, all features identified above may be provided by the system. The system may thereby provide an automated benefits administration and method of use of the system and doing business in conjunction with it.

The following sections include implementation details, detailed explanations and detailed illustrations of various aspects of embodiments of the present invention. These sections include:1. an architectural design specification, which proceeds with reference to FIGS. A-1to A-3;2. a user manual concerning carrier maintenance, which proceeds with reference to FIGS. B-1to B-88;3. a user manual concerning enrollment, which proceeds with reference to FIGS. C-1to C-399;4. a user manual concerning finance, which proceeds with reference to FIGS. D-1to D-62;5. a user manual concerning other features, which proceeds with reference to FIGS. E-1to E-26;6. a user manual concerning sales and marketing, which proceeds with reference to FIGS. F-1to F-106;7. a user manual concerning user administration, which proceeds with reference to FIGS. G-1to G-66;8. a process specification for various use cases, which proceeds with reference to FIGS. H-1to H-36;9. process specifications for COBRA enrollment, change management, ROE/OE processes, termination, reinstatement, appeals and grievances, association masters and carrier issues, which proceed with reference to FIGS. I-1to I-77;10. process specifications for billing, cash receipt and cash reconciliation, and risk adjustment, which proceed with reference to FIGS. J-1to J-8;11. a functional specification document concerning mail merge, which proceeds with reference to FIGS. K-1and K-2;12. a process specification for reports, which proceeds with reference to FIGS. L-1to L-3;13. process specifications for campaigns, sales masters, agent profiles and quote creation, which proceed with reference to FIGS. M-1to M-53;14. process specifications for supply requests, workgroups, associates and call tracking, which proceed with reference to FIGS. N-1to N-13;15. a process specification for security mechanisms, which proceeds with reference to FIGS. P-1to P-38; and16. a process specification for common functional features.

Benefit Partners Inc

Software Architecture Document

Architectural Design Specification Document

The Software Architecture Document will provide an overview of the entire “Software Architecture” that will be used to develop Web Interface Module for BPI.

This document provides a comprehensive architectural overview of the system, using a number of different architectural views to depict different aspects of the system. It is intended to capture and convey the significant architectural decisions that have been made on the system.

Some of the common acronyms used in this document are as follows:

This Software Architecture Document, at high level, will contain:a. Architectural representation of proposed systemb. Architectural goalsc. Software requirementd. Software selection for the proposed systeme. Standards and methodologies that will be adopted for the proposed system

2. Architectural Goals

These guidelines will lay a foundation for the design and implementation strategy, selection of development tools, application software, and testing tools. The basic goals of the architectural design are discussed below.

Java is a platform independent and portable language. Applications developed in Java are proven to be portable across popular platforms.

The J2EE Standards will be adopted to develop the new application. J2EE standards demonstrate consistency of distributed applications that access various data sources.

The components will be built using Object Oriented concepts. These object-oriented components can be reused in other applications with similar requirements or extended further with additional features when and wherever required.

Applications developed using the J2EE Standards are proven to be scalable. Therefore, the system will be built in conformance with the J2EE Standards.

Identifying the latencies within the system and outside the system boundaries enables us to increase the performance of the application. Since most of the threading issues that lower the performance of an application are well handled within the Websphere application server, Websphere server's features and resources will be effectively utilized to achieve performance.

3. Architectural Representation of the Proposed System

The System will be developed based on the J2EE specification and follow the N-tier MVC architecture.

A tier is a logical partition of the separation of concerns in the system. Each tier is assigned its unique responsibility in the system.

J2EE specifications are multi tiered consisting of the Client Tier, Middle Tier (Presentation Layer, Business Layer, and Integration Layer), and the Data source. The J2EE architecture diagram is described below. (See FIG. A-1)

3.1. Client Tier

This tier represents all devices or system clients accessing the system or the application. In this case, the client would be a web browser or other application.

3.2. Middle Tier

The middle tier can be classified into multiple logical layers depending upon the business requirements and programming model. Three basic classifications are discussed below.

3.2.1. Presentation Layer

This tier encapsulates all presentation logic required to service the clients that access the system. The presentation tier intercepts the client requests, provides single sign-on, session management and accesses business services, constructs the response, and delivers the response to the client. Servlets, JSP, HTML reside in this tier.

3.2.2. Business Layer

This tier provides the business services required by the application clients. The tier contains the business data and business logic. All business processing for the application is centralized into this tier. The enterprise bean components are the choice for implementing the business objects in the business tier.

3.2.3. Integration Layer

This tier is responsible for communicating with external resources and systems, such as data stores and legacy applications. The business tier is coupled with the integration tier whenever the business objects require data or services that reside in the resource tier. The components in this tier can use JDBC, J2EE connector technology, or some proprietary middleware to work with the resource tier.

3.3. Data Source

This is the tier that contains the database and external resources such as legacy systems, business-to-business (B2B) systems, and services, such as, credit card authorization and EFT.

The following figure depicts the interaction model of a typical Model View Controller or the JSP Model 2 Architecture that is adopted in the Framework. (See FIG. A-2)

Here, the servlet acts as the controller and is in charge of processing the request and creating any objects of the beans used by the JSP. It also redirects, to the respective JSP, based on the Browser's request. There will be very minimal logic present in the JSP regarding the presentation. All the database access and program business logic will be processed within the bean.

There will be different beans for data source access (database, enterprise systems, queue, XML, etc.), error handling, access logging, and module wise application business logic processing. This clearly separates the presentation from the content and enables easy maintenance and scalability.

This model is the widely used and accepted model for application development in Java. This model is also adopted by Apache Struts framework for Java application development.

4. Software Selection for the Proposed System

This section provides an insight on the software selection for the various tiers depicted in this document.

4.1. Software Selection

4.2. API Versions

5. Standards and Methodologies

The standards and methodologies that will be followed for the application development are discussed below.

5.1. Design Document

Detailed design document will be prepared based on the scope of the application prior to the development. This document will contain the details on graphic user interface, navigation, class diagrams, data dictionary, field validation criteria, and program logic.

The types of Java beans that will be used to perform different business logics will be decided during the design stage. The bean types will be classified based on the complexity of the business logic and the scalability.

A separate document will be prepared outlining the coding standards that will be adopted in the application development. The document will contain details on program naming conventions to be used while coding. All programs developed will follow this standard.

Test plan and test case documents will be prepared for unit and integration testing of the application. The test cases will be used to test the application modules and integration. JTest will be used for testing code construction (white-box testing), code functionality (black-box testing), and code integrity (regression testing).

5.5. Error Handling

All error messages and error codes for the application will be stored in the database. Run time errors will be logged to text files that will be generated periodically by the system. Input validations will occur in both the client tier and the middle tier. The input validation error messages captured in the client tier will be displayed using JavaScript alerts. The input validation error messages captured in the middle tier will be displayed in HTML format, on the same page on which the error has occurred, in a different color.

5.6. Page Design

A Page Design Guidelines document will be created by Mascon, and approved by BPI, prior to the development. All pages in the application will conform to the standards depicted in this document. This document will contain the specifications for fonts, layouts, images, and other relevant details.

Custom JSP tag libraries will be created for all initial values and parameters used in the application. JSP tag libraries define declarative, modular functionality that can be reused by any JSP page. Tag libraries reduce the necessity to embed large amounts of Java code in JSP pages by moving the functionality provided by the tags into tag implementation classes. In doing so, tag libraries make authoring JSP pages easier and modular.

6. System Architecture and Hardware Selection

This section provides the details of the system architecture with nodes, terminals and their placement within the respective zones.

6.2. Hardware Selection

7. Browser Client Application Limitations and Work Around Solutions

The limitations of the Web Browser (thin client) based application, when compared to thick clients, are as follows:a. Input field masking, such as automatic date formatting and phone number formatting, are not easily handled in this environment. The thin client user interface is not as easy and robust as the thick client user interface. A work around must be designed to force the user to enter values in the required format.b. Due to the limitations of different browsers, a common methodology will be adopted that will work for all indicated browsers. This narrows down the user interface implementation features in a browser.c. Because of the lower level on interactivity, some actions that are presented entirely on one screen in the thick client may span multiple screens. Since each screen presentation involves a round trip to the server, this will result in slightly slower screen response when compared to the single screen approach. This can be minimized with some re-design of the user interface workflow, but overall, thin clients require more “clicks” than thick clients.d. Hot-keys validation scripts are cumbersome and take longer to download. Thus, hot-key functionality will be limited.

PX2 User Manual

Carrier Maintenance

Carrier Maintenance is the master module that encompasses the process of creating and maintaining all master information that is required for the PX2 System like Master Plan, Carrier Master, Product Profile, Rate Administration and Carrier Maintenance operations like import and export utilities.

The Applications

The above-mentioned processes are accomplished in several applications embedded into the Carrier Maintenance Module. These applications steer the tasks of creating, and maintaining master information for the PX2 entities, thereby helping achieve the goals of the Carrier Maintenance.

Master Plan—Master plan is to setup high-level information from a broad spectrum of coverages, plan and benefits offered by PacAdvantage. This includes line of coverage like Medical, Dental Vision and Chiropractic, plan type like HMO, PPO, POS, indemnity etc. and benefit level like Standard, Preferred Plus etc.

Carrier Master—Carrier Master is to setup information on the carriers. This provides demographic information about the carrier.

Product Profile—Product Profile is the product or the plan offered by each carrier based on the broad spectrum of master plan provided by PacAdvantage. The product includes wide range of benefits provide by the carriers. For example Blue Shield—HMO, American Specialty Health Plan etc. This also includes information about premium and enrollment data transmission profiles of each carrier for the specific plan.

Rate Administration—Rate administration is to administer various rate and fees to calculate the premium amount. These different fees structures are classified as admin fees, agent fees, additional fees and differential factor.

Carrier Maintenance Operations—Various utility operations are performed for the maintenance of the Carrier Master Module. These utilities include import and export of data into or from the PX2 System. Various Carrier Maintenance operations are.

Import Zip Codes—is to upload all zip codes in the state of California or USA. This information would be used for rates calculation based on employee's zip code of residence.

Import and Export Rates—is to upload raw rates for all the plans and export the rates in the given formats.

Import and Export Plan Availability—is to upload the Plans available for the specific carrier in the specific service area/county/zip and export the plans available for the specific carrier in the specific Service area/county/zip in a given format.

2 Master Plan

MPlan (Master Plan) is to setup basic information like Line of Coverage, Plan Type, Benefit Level offered through PACAdvantage. All Benefit Level, Plan type and the line of coverage offered by PACAdvantage is available in the Master Plan.

Access

The application can be accessed from the main menu as follows:Carrier Maintenance→Master Plan→Line of Coverage.Carrier Maintenance→Master Plan→Plan Type.Carrier Maintenance→Master Plan→Benefit Level.

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:Line of Coverage—to create, edit and delete Line of Coverage.Plan Type—to create, edit and delete Plan Type.Benefit Level—to create, edit and delete Benefit Level.

Line of CoverageThe line of coverage screen is to enter the details of line of coverage (LOC). The screen provides functionality to add, modify, view, and delete line of coverage.The sequential steps involved in the creation of a line of coverage are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select Master Plan and then Line of Coverage. (See FIG. B-1)Step—2: Enter the values in the respective field, as per the format briefed in field's explanation section. (See FIG. B-2)Step—3: Click Add button to have a temporary storage.Step—4: Also Edit button can be clicked for any modifications.Step—5: Change the contents to be modified and click Update. (See FIG. B-3)Step—6: Click Save button to save the contents.

Fields Explanation

ElementDescriptionLine of coverageThe text for line of coverage. Accepts alphabets andnumeric values of length not exceeding 20characters. Entry to this field is mandatory. Line ofCoverage does not accept duplicate values

Button Functionality

ElementDescriptionAddAdd the name of line of coverage. It is only atemporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of line of coverage. It is only atemporary updation. Becomes permanent recordonly after savingDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Only the records that does not have referenceelsewhere can be deleted. Becomes permanentrecord only after savingPrintThe Print will pops up a screen displaying thecontent of the table created and enables the user tohave print out of the same.Check BoxCheck box will be disabled which has any referenceto other fields. Otherwise the checkbox will beenabled to have the utility of check all/clear all.Check AllThe “Check All” Link will check all the enabledrecords in the tableClear AllThe “Clear All” Link will uncheck all the enabledrecords in the table that are checked.SaveSaves the entered line of coverage in the database.The page gets refreshed and the contents entered inthe fields are cleared.CancelClears the contents entered in the fields and restoreto the previous state as was before saving thechanges.

Plan Type

The plan type screen is to enter the details of plan type. The screen provides functionality to add, modify, view, and delete plan type.

The sequential steps involved in the creation of a plan type are listed below.

Step—1: After successful logon, click the menu Carrier Maintenance. Select Master Plan and then Plan Type. (See FIG. B-4)Step—2: Enter the values in the respective fields, as per the format briefed in fields' explanation sectionStep—3: Click Add button to have a temporary storage. (See FIG. B-5)Step—4: Also Edit button can be clicked for any modifications.Step—5: Change the contents to be modified and click update. (See FIG. B-6)Step—6: Click Save button to save the contents

Fields Explanation

Element Description

The text for plan type. Accepts alphabets and numeric values of length not exceeding 25 characters. Entry to this field is mandatory. Does not accept duplicate values

Button Functionality

ElementDescriptionAddAdd the name of plan. It is only atemporary addition. Becomes permanentrecord only after savingEditEdit button will allow for editing aspecific record in the table.UpdateUpdate the contents of Plan Type. It isonly a temporary update. Becomes permanentrecord only after savingCheck BoxCheck box will be disabled which has anyreference to other fields. Otherwise thecheckbox will be enabled to have theutility of check all/clear all.DeleteDelete button will delete the records inthe table checked for deletion. It is onlya temporary deletion. Only the recordsthat does not have reference elsewhere canbe deleted. Becomes permanent record onlyafter savingPrintThe Print will pops up a screen displayingthe content of the table created andenables the user to have print out of thesame.Check AllThe “Check All” Link will check all theenabled records in the tableClear AllThe “Clear All” Link will uncheck all theenabled records in the table that arechecked.SaveSaves the entered plan type in thedatabase. The page gets refreshed and thecontents entered in the fields arecleared.CancelClears the contents entered in the fieldsand restore to the previous state as wasbefore saving the changes.

Benefit Level

The Benefit Level screen is to enter the details of benefit level. The screen provides functionality to add, modify, view, and delete benefit level.

The sequential steps involved in the creation of a benefit level are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select Master Plan and then Benefit Level. (See FIG. B-7)Step—2: Enter the values in the respective fields, as per the format briefed in fields' explanation section. (See FIG. B-8)Step—3: Click Add button to have a temporary storage.Step—4: Also Edit button can be clicked for any modifications.Step—5: Change the contents to be modified and click Update. (See FIG. B-9)Step—6: Click Save button to save the contents

Fields Explanation

ElementDescriptionBenefit levelThe text for benefit level. Accepts alphabets andnumeric values of length not exceeding 255 characters.Entry to this field is mandatory. Does not acceptduplicate values

Button Functionality

ElementDescriptionAddAdd the name of benefit level. It is only a temporaryaddition. Becomes permanent record only after savingSaveSaves the entered benefit level in the database. Thepage gets refreshed.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Benefit Level. It is only atemporary update. Becomes permanent record onlyafter savingDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Only the records that does not have referenceelsewhere can be deleted. Becomes permanent recordonly after savingPrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.Check BoxCheck box will be disabled which has any reference toother fields. Otherwise the checkbox will be enabled tohave the utility of check all/clear all.Check AllThe “Check All” Link will check all the enabled recordsin the tableClear AllThe “Clear All” Link will uncheck all the enabledrecords in the table that are checked.CancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.

Related Applications

There are no related applications.

3 Carrier Master

Carrier Master is to setup basic information about carriers who provide coverage to plans offered through PACAdvantage. This holds master record for the carriers alternatively called “Health Insurance Service provider” and provides facility to create/edit or modify/inactivate the Carrier Master records.

Access

The application can be accessed from the main menu as follows:Carrier Maintenance→Carrier Master→Create Carrier MasterCarrier Maintenance→Carrier Master→Search Carrier Master

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:Carrier Information—to input details of a carrierSearch Carrier—to search a specific carrier record

Create Carrier Master

The carrier information screen is to enter details of a carrier. The screen provides functionality to add, modify, view, and delete carrier details.

The sequential steps involved in the creation of a new module are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select Carrier Master and then Create Carrier Master. (See FIG. B-10)Step—2: Enter the values in the respective field, as per the format briefed in fields explanation section Field Explanation, and click Save button. (See FIG. B-11)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionGeneral InformationCompany NameThe text for company name. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 50 characters. Entry to thisfield is mandatory. Company Name does not acceptduplicate valuesAddressThe text for company address. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters. Entry to thisfield is mandatory.SuiteThe text for company suite. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters.CityThe text for city. Accepts alphabets not exceeding 30characters. Entry to this field is mandatory.StateChoose the name of the state from the drop down listof States available in United States of America Entryto this field is mandatory.ZipThe text for zip. Accepts numeric of exactly 5 digits.Entry to this field is mandatory.Department InformationContactChoose the name of the contact department from theDepartmentdrop down list of contact departments available. Entryto this field is mandatorySalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact first name. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact last name. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters.SuffixChoose the suffix from the drop down list of suffixesavailable.TitleThe text for title. Accepts alphabets, numeric, andspecial characters except double quotes with values notexceeding 255 characters.AddressThe text for company address. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters. Entry to thisfield is mandatory.SuiteThe text for company suite. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters.CityThe text for city. Accepts alphabets not exceeding 30characters. Entry to this field is mandatory.StateChoose the name of the state from the drop down listof States available in United States of America Entryto this field is mandatory.ZipThe text for zip. Accepts numeric of exactly 5 digits.Entry to this field is mandatory.Mode ofChoose the mode of communication from the dropCommunicationdown list of modes available. Based on the selection,the respective fields are mandatory.PhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999.FaxThe text for fax number of the contact person. Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999.E-mailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format with length not exceeding 100characters.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the carrier information, department informationif any that has been added to the table, into thedatabase. The page gets refreshed and the contentsentered in the general Information fields are shown.AddAdd the contents of department information. It is onlya temporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of department information. It isonly a temporary update. Becomes permanent recordonly after savingPrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.NewNew button will create a new carrier general info pagefor entering the new set of data for the carrier.CancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.

Search Carrier

The search carrier screen displays the available carrier names. The screen provides the option to view, edit and delete the contents of Carrier Information.

The sequential steps involved in searching an existing carrier are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select Carrier Master and then Search Carrier. (See FIG. B-12)Step—2: Company name has to be selected from the drop down list (See FIG. B-13)Step—3: Select either View/Delete or Edit to display the contents of selected company name. If the selected option is View/Delete, Displays the contents for viewing or deleting. (See FIG. B-14)Step—4: To go back again to search screen, click Back.Step—5: If the selected option is Edit, displays the contents and allows to modify.Step—6: Modifications can be made for both the general information, as well as department information. Also choosing a record by clicking Edit button can modify department information. (See FIG. B-15)Step—7: Change the contents to be modified and click Update.Step—8: Click Save button to save the contents.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionGeneral InformationCompany NameThe text for company name. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 50 characters. Entry to thisfield is mandatory. Company Name does not acceptduplicate valuesAddressThe text for company address. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters. Entry to thisfield is mandatory.SuiteThe text for company suite Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters.CityThe text for city. Accepts alphabets not exceeding 30characters. Entry to this field is mandatory.StateChoose the name of the state from the drop down listof States available in United States of America.ZipThe text for zip. Accepts numeric of exactly 5 digits.Entry to this field is mandatory.Department InformationContactChoose the name of the contact department from theDepartmentdrop down list of contact departments available.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact first name. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact last name. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters.SuffixChoose the suffix from the drop down list of suffixesavailable.TitleThe text for title. Accepts alphabets, numeric andspecial characters except double quotes with values notexceeding 255 characters.AddressThe text for company address. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters. Entry to thisfield is mandatory.SuiteThe text for company suite. Accepts alphabets,numeric and special characters except double quoteswith values not exceeding 35 characters.CityThe text for city. Accepts alphabets not exceeding 30characters. Entry to this field is mandatory.StateChoose the name of the state from the drop down listof States available in United States of America Entryto this field is mandatory.ZipThe text for zip. Accepts numeric of exactly 5 digits.Entry to this field is mandatory.Mode ofChoose the mode of communication from the dropCommunicationdown list of modes available.PhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999.FaxThe text for fax number of the contact person. Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999.E-mailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format with length not exceeding 100characters.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the carrier information, department informationif any that has been added to the table, into thedatabase. The page gets refreshed and the contentsentered in the general Information fields are shown.AddAdd the contents of department information. It is onlya temporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of department information. It isonly a temporary update. Becomes permanent recordonly after savingPrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.NewNew button will create a new carrier general info pagefor entering the new set of data for the carrier.CancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.

Related Applications

There are no related applications.

4 Product Profile

Product Profile is to create information on Product and Plan pertaining to a carrier. This is also used to create transmission profiles for Enrollment and Premium. It facilities to create/Edit or modify carrier product information.

Access

The application can be accessed from the main menu as follows:Carrier Maintenance→Product Profile→Create Product ProfileCarrier Maintenance→Product Profile→Search Product Profile

Pre-RequisitesMaster Plan records must be available in the system.Carrier Master records must be available in the system.

Application FunctionsThis application has the following functions:Create Product Profile—to enter the information pertaining to a product and planSearch Product—to search a product and plan

Create Product Profile

The carrier product info screen is to add the information pertaining to a product and plan.

The sequential steps involved in the creation of carrier product information are listed below.Step—1: After successful logon, click Carrier Maintenance. Select Product Profile and then Create Product Profile. (See FIG. B-16)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-17)Step—3: The enrollment transmission is mainly meant for entering information and schedule for a transmission for a plan. Also Premium Transmission can be navigated from this screen. (See FIG. B-18)Step—4: The premium transmission is mainly meant for entering information and schedule for a transmission for a plan. Also Enrollment Transmission can be navigated from this screen (See FIG. B-19)Step—5: Click Save button to save the contents

Fields Explanation

Button Functionality

ElementDescriptionSaveClick on save button to save contents of productinformation and plan information.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Product. It is only a temporaryupdate. Becomes permanent record only after savingDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Only the records that does not have referenceelsewhere can be deleted. Becomes permanent recordonly after savingCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.NewClick on new button to add a new product and planinformation.CancelClick on the cancel button to clear the data entered onthe screen and returns the same screen to proceed.Enrollment and Premium TransmissionsSaveClick on save button to save contents of transmissioninformation.BackClick on back button will navigate back to carrierproduct info screen.

Search Product

The search product screen is to view and edit/modify the information in an existing plan name. Choosing a plan name from the drop down list of plan names available can carry out the search.

The sequential steps involved in searching an existing product are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select Product Profile and then Search Product. (See FIG. B-20)Step—2: Plan name has to be selected from the drop down list (See FIG. B-21)Step—3: Select either View/Delete or Edit to display the contents of selected plan name.If the selected option is View/Delete, displays the contents for viewing and deleting. (SeeFIG. 22) (See FIG.Step—4: To go back again to search screen, click Back.Step—5: If the selected option is Edit, displays the contents and allows to have modifications. Click Save. (See FIG. B-23)

Fields Explanation

Refer field explanations provided for Create Product Profile

Button Functionality

Refer Button Functionality explanations provided for Create Product Profile

Related Applications

Related applications are:Carrier MasterMaster Plan

5 Rate Administration

Rate Master is to setup basic information about various types of rates offered through PACAdvantage. Rates are the rates for the products offered by each carrier and their classification into various fee structures. The rates are classified as Admin Fees, Agent fees, Additional Fees and Rate Differential. These classifications are applied to the raw rate to arrive to the actual premium payable by group/member.

Access

Pre requisites for Rate Administrations are following:Association Master—Association master must be created and available in the system for assigning the rate for association groups.Association Acronym—Association acronym is to display the association name in an abbreviated form inside the table for display. A mapping file has to be configured to ensure that each Association ID/Association name is mapped with the Acronym name in the mapping file as in PX2 system.

The mapping file can usually be located in the following path:<config_root>/bpicas/assacyronym.xmlSample mapping<asst id=“0000000001”> Here goes the acronym name as defined by user</asst>asst id=Should have a valid association ID from the PX2 System.Acronym name should be edited in area shown in bold not exceeding 25 characters.

Application Functions

This application has the following functions:Admin Fees—to create/edit details of Admin FeesAdmin Fees Search—to search the details of admin fee for view, modification or deletionAgent Fees—to create/edit details of Agent FeesAgent Fees Search—to search the details of Agent Fees for view, modification or deletionAdditional Fees—to create/edit details of Additional FeesAdditional Fees Search—to search the details of Additional Fees for view, modification or deletionRate Differential—to create/edit details of Rate DifferentialRate Differential Search—to search the details of Rate Differential for view, modification or deletion

Admin Fees

The admin fees screen is to enter the details of rate type, whether the rate classification is for enrollment or renewal, group type, association Ids for a chosen association only, Individual Member or Association Group for a guaranteed association, percentage premium, effective date, group level fees, and member level fees. The screen provides functionality to save, edit or add new admin fees. Admin fees is broadly defined for two types of rates, namely consolidated [blended] and unconsolidated [non-blended].

The sequential steps involved in the creation of admin fees are listed below.Step—1: After successful logon, click menu Carrier Maintenance. Select Rate Administration and then Admin Fees. (See FIG. B-24)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-25)Step—3: Click Save button to save the contents. (See FIG. B-26)

Fields Explanation

ElementDescriptionRate TypeChoose the rate type from the option button. Rate typecan be either blended or non-blended. Blended rateswill allow for entering only percent premium based oneffective date for a specific group type. Non-blendedrates will allow for entering group level fees whichincludes flat $ amount and member level fees whichincludes flat $ amount for medical and dental, percentpremium for vision and cam [lines of coverage].Enroll/RenewChoose this option to create the admin fee for groupsduring enrollment or renewal.Group TypeChoose the group type from the drop down list of grouptypes available. Only group type of guaranteedassociation would allow choosing individual member orassociation groups.AssociationChoose the association name from the drop down list ofNameids for the association available. Association namewould be enabled only if the group type hasguaranteed, endorsed, PEO's and chambers.Member typeChoose the member type from the option buttons. Onlygroup type of guaranteed association would allowchoosing individual member or association groups[member type].PercentageEnter the value for percentage premium. AcceptsPremiumnumeric value in the range of 0 to 100 with decimalpoints (example 99.99)Effective DateEnter the date or choose from the calendar icon. Dateaccepts the format in MM/DD/YYYY.Group LevelEnter the value for group level fees. Accepts value inFeesthe format of currency (example 999999999.99 or99999999999)Member LevelEnter the value for member level fees. Accepts value inFeesthe format of currency (example 999999999.99 or99999999999) for fees in $ and accepts numeric valuein the range of 0 to 100 for fees in percentage.

Button Functionality

ElementDescriptionSaveSaves the entered admin fees in the database andnavigates to the confirmation page.CancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.New Admin FeeNavigates to admin fee screen for creating a new one

Admin Fees Search

The admin fees search screen displays the available admin fees. The screen provides the option to view, edit and delete the contents of Admin Fee

The sequential steps involved in the Searching for admin fees are listed below.Step—1: After successful logon, click menu Carrier Maintenance. Select Rate Administration and then Admin Fees Search. (See FIG. B-27)Step—2: Choose a rate type, Enrolled/Renew Status, group type, association name and effective date to have a search option. (See FIG. B-28)Step—3: This displays a screen with search result. (See FIG. B-29)Step—4: Choose a Rate type either to Modify or View/Delete.Step—5: If the option is Modify the following will be the screen to have any modifications. (See FIG. B-30)Step—6: Update the contents and click Save. Navigates to confirmation Screen (See FIG. B-31)Step—7: If the option is View/Delete the contents are displayed to view and delete (See FIG. B-32)Step—8: Clicking Delete will have the confirmation screen as follows. (See FIG. B-33)

Fields Explanation

Refer field explanations provided for Admin Fees

Button Functionality

Refer button functionality provided for Admin Fees

Agent Fees

The agent fees screen is to enter the details of rate type, group type, percentage of premium, effective date, group size like lower limit and upper limit with Amount and member level fees. The screen provides functionality to save, edit or add new admin fees. Agent fees is broadly defined for two types of rates, namely consolidated [blended] and unconsolidated [non-blended].

The sequential steps involved in the creation of agent fees are listed below.Step—1: After successful logon, click Carrier Maintenance.

Select Rate Administration and then Agent Fees. (See FIG. B-34)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-35)Step—3: Click Save button to save the contents. (See FIG. B-36)

Fields Explanation

ElementDescriptionRate TypeChoose the rate type from the option button. Rate typecan be either blended or non-blended. Blended rateswill allow for entering only percent premium based oneffective date for a specific group type. Non-blendedrates will allow for entering group level fees whichincludes group size lower limit, group size upper limitflat $ amount and member level fees which includesflat $ amount for medical and dental, percent premiumfor vision and cam [lines of coverage]. Group sizelower limit should not be greater than the group sizeupper limit.Enroll/RenewChoose this option to create the admin fee for groupsduring enrollment or renewal.Enrolled beforeCheck this field if the agent fees is for the groups1997enrolled before 1997.Group TypeChoose the group type from the drop down list of grouptypes available. Only group type of guaranteedassociation would allow choosing individual member orassociation groups.AssociationChoose the association name from the drop down list ofNamenames for the association available. Association namewould be enabled only if the group type hasguaranteed, endorsed PEO's and chambers.Member typeChoose the member type from the option buttons. Onlygroup type of guaranteed association would allowchoosing individual member or association groups[member type].PercentageEnter the value for percentage premium. AcceptsPremiumnumeric value in the range of 0 to 100Effective DateEnter the date or choose from the calendar icon. Dateaccepts the format in MM/DD/YYYY.Group sizeEnter the value for group size lower limit. Acceptslower limitnumeric values of maximum 3 digits. Lower limitvalue should be less than the value of upper limit.Group sizeEnter the value for group size upper limit. Acceptsupper limitnumeric values of maximum 3 digits. Upper limitvalue should not be less than lower limit value.AmountEnter the value for group level fees. Enter the valuefor group level fees. Accepts value in the format ofcurrency (example 999999999.99 or 99999999999)Member LevelEnter the value for member level fees. Accepts value inFeesthe format of currency (example 999999999.99 or99999999999) for fees in $ and accepts numeric valuein the range of 0 to 100 for fees in percentage.

Button Functionality

ElementDescriptionSaveSaves the entered agent fees in the database andnavigates to confirmation screenCancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.New Agent FeeNavigates to agent fee screen for creating a new one

Agent Fees Search

The agent fees search screen displays the available agent fees. The screen provides the option to view, edit and delete the contents of agent fee

The sequential steps involved in the searching admin fees are listed below.Step—1: After successful logon, click menu Carrier Maintenance. Select Rate Administration and then Agent Fees Search. (See FIG. B-37)Step—2: Choose a rate type, enroll/renew option, group type, association name and effective date to have a search operation. (See FIG. B-38)Step—3: This displays a screen with search result. (See FIG. B-39)Step—4: Choose a Rate type either to Modify or View/Delete.Step—5: If the option is Modify the following will be the screen to have any modifications. (See FIG. B-40)Step—6: Update the contents and click Save. On saving displays the confirmation screen. (See FIG. B-41)Step—7: If the option is View/Delete the contents are displayed to view and delete (See FIG. B-42)Step—8: Clicking Delete will have the confirmation screen as follows. (See FIG. B-43)

Fields Explanation

Refer field explanations provided for Agent Fees

Button Functionality

Refer button functionality provided for Agent Fees

Additional Fees

The additional fees screen is to enter the details of COBRA type, percentage of additional fees, effective date. The screen provides functionality to save, edit or add new additional fees. Additional fees is broadly defined for two types namely Cal COBRA and Federal COBRA.

The sequential steps involved in the creation of additional fees are listed below.Step—1: After successful logon, click Carrier Maintenance. Select Rate Administration and then Additional Fees. (See FIG. B-44)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-45)Step—3: Click Save button to save the contents. (See FIG. B-46)

Fields Explanation

ElementDescriptionRate TypeChoose the rate type from the option button. Rate typecan be either Cal COBRA or Federal COBRA.Percentage ofEnter the value for percentage premium. AcceptsAdditional Feesnumeric value in the range 0 to 100.Effective DateEnter the date or choose from the calendar icon. Dateaccepts the format in MM/DD/YYYY.

Button Functionality

ElementDescriptionSaveSaves the entered additional fees in the database andnavigates to confirmation screen.CancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.New Additional FeeNavigates to additional fee screen for creating a newone

Additional Fees Search

The additional fees search screen displays the available additional fees. The screen provides the option to view, edit and delete the contents of additional fee

The sequential steps involved in the Searching additional fees are listed below.Step—1: After successful logon, click menu Carrier Maintenance. Select Rate Administration and then Additional Fees Search. (See FIG. B-47)Step—2: Choose Cal Cobra or Federal Cobra and enter Additional Fee % and Effective Date to have a search operation. (See FIG. B-48)Step—3: This displays a screen with search result. (See FIG. B-49)Step—4: Choose a Rate type either to have Modify or View/Delete.Step—5: If the option is Modify the following will be the screen to have any modifications. (See FIG. B-50)Step—6: Update the contents and click Save. Displays the confirmation screen (See FIG. B-51)Step—7: If the option is View/Delete the contents are displayed to view and delete (See FIG. B-52)Step—8: Clicking Delete will have the confirmation screen as follows. (See FIG. B-53)

Fields Explanation

Refer field explanations provided for Additional Fees

Button Functionality

Refer button functionality provided for Additional Fees

Rate Differential

The Rate Differential screen is to enter the details of New Business Enrollment or New Business Enrollment & Renewal, Group Size criteria, group size lower limit, group size upper limit, differential factor, and effective date. The screen provides functionality to save, edit or add new Rate Differential.

The sequential steps involved in the creation of Rate Differential are listed belowStep—1: After successful logon, click Carrier Maintenance. Select Rate Administration and then Rate Differential. (See FIG. B-54)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-55)Step—3: Click Save button to save the contents. (See FIG. B-56)

Fields Explanation

ElementDescriptionLine ofThe field is a read only and will always have the valuecoverageas Medical.Group sizeEnter the value for group size lower limit. Acceptslower limitnumeric values of maximum 3 digits. Lower limitvalue should be less than the value of upper limit.Entry to this field is mandatoryGroup sizeEnter the value for group size upper limit. Acceptsupper limitnumeric values of maximum 3 digits. Upper limitvalue should not be less than lower limit value. Entryto this field is mandatoryDifferentialEnter the value for differential factor. Accepts decimalfactorvalues of positive integer with max of 6 digits, example99.999. Differential factor cannot have zero ornegative values. Entry to this field is mandatoryEffective DateEnter the date or choose from the calendar icon. Dateaccepts the format in MM/DD/YYYY. Entry to thisfield is mandatoryApplied ForChoose the option as new business enrollment or newbusiness enrollment and renewalGroup SizeChoose the option as enrolled employee or eligibleCriteriaemployee

Button Functionality

ElementDescriptionSaveSaves the entered Rate Differential in the databaseand navigates to confirmation screenCancelClears the contents entered in the fields and restore tothe previous state as was before saving the changes.New RateNavigates to rate differential fee screen for creating aDifferential Feenew one

Rate Differential Search

The rate differential search screen displays the available Rate Differential. The screen provides the option to view, edit and delete the contents of Rate Differential

The sequential steps involved in the creation of Rate Differential are listed below.Step—1: After successful logon, click menu Carrier Maintenance. Select Rate Administration and then Rate Differential Search. (See FIG. B-57)Step—2: Choose the option for applicable for, group size criteria, group size lower and upper limit, differential factor and effective date to have a search operation. (See FIG. B-58)Step—3: This displays a screen with search result. (See FIG. B-59)Step—4: Choose a Rate type either to have Modify or View/Delete.Step—5: If the option is Modify the following will be the screen to have any modifications. (See FIG. B-60)Step—6: Update the contents and click Save. Displays confirmation screen (See FIG. B-61)Step—7: If the option is View/Delete the contents are displayed only to have view and delete can be done. (See FIG. B-62)Step—8: Clicking Delete will have the confirmation screen as follows. (See FIG. B-63)

Fields Explanation

Refer field explanations provided for Rate Differential

Button Functionality

Refer button functionality provided for Rate Differential

Related Applications

Related applications are as follows.Association Master—Refer User manual for Association Master.

6 Import Zip Codes

Import Zip Codes is the functionality to provide for import of zip code data and any updates of the same.

Access

The application can be accessed from the main menu as follows:Carrier Maintenance→CM Operations→Import Zip

The latest zip code and zip code with multiple counties database from TPS Products and Services, Inc should be available for import. The format of the database files has to be either Comma Delimited ASCII (CSV) or Fixed Column ASCII, the 2 formats currently supported by PX2.

Application Functions

This application has the following functions:Import Zip CodesCommit Import of Zip Codes

Import Zip

Zip import will enable to bring the zip codes and zip counties in a specified format namely CSV ASCI [comma separated value] and Fixed position ASCII, which will transform the data in other format to these formats and will ease to read and store the data in database.

The sequential steps involved in importing a zip code are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select CM Operations and then Import Zip. (See FIG. B-64)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-65)Step—3: Click Import button. (See FIG. B-66)Step—4: Click Commit button. (See FIG. B-67)

Fields Explanation

ElementDescriptionImport IdRead only field to display import id valueStatusRead only field to display the status of importImported ByRead only field to display the user who imported thefilesImport DateRead only field to display the import dateCommitted ByRead only field.Committed DateRead only field to display the commit date.Zip File PathEnter the file path of zip file or select the path byclicking browse button. The field is mandatory.Zip File FormatChoose a format from drop down list for zip fileformat, which should match with selection of zip file.The field is mandatory.Zip CountiesEnter the file path of zip county or select the path byFile Pathclicking browse button. The field is mandatory.Zip CountiesChoose a format from drop down list for zip countyFile Formatformat, which should match with selection of zipcounty. The field is mandatory

Button Functionality

ElementDescriptionNewClick on new button enables to have a new import offiles.ImportClick on import button will perform the action ofimporting the selected valid files temporally. Once animport action is carried out, will enable the commitbutton.SearchClick on search button navigates to a screen to have asearch on entering Import id.CommitInitially commit button will be in disabled state. Oncean import activity is carried out, commit button will beenabled to have a permanent storage in the selectedfile formats.View ImportClick on view import log to have a pop up displayLogshowing the status of imported filesHide ImportClick on hide import log to hide the pop up displayLogmessage.

Commit Import Zip Codes

Commit zip codes can also be done by searching an import id.

The sequential steps involved in committing an import id are listed below.Step—1: Click Search button to search an import id.Step—2: This opens up a new screen to displaying import id to search. (See FIG. B-68)Step—3: Import ids can be selected by either entering import id and clicking search button or Click an import id, which are imported and are not committed. Back button is to go back to search screen without selecting an import id for commit.Step—4: Screen navigates displaying the selected import id, enabling commit button. (See FIG. B-69)Step—5: Click Commit button.Step—6: Screen gets refreshed and displays the confirmation as committed in the status field. (See FIG. B-70)

Fields Explanation

ElementDescriptionImport IdRead only field to display import id valueStatusRead only field to display the status of importImported ByRead only field to display the user who imported thefilesImport DateRead only field to display the import dateCommitted ByRead only field.Committed DateRead only field to display the commit date.Zip File PathEnter the file path of zip file or select the path byclicking browse button. The field is mandatory.Zip File FormatChoose a format from drop down list for zip fileformat, which should match with selection of zip file.The field is mandatory.Zip CountiesEnter the file path of zip county or select the path byFile Pathclicking browse button. The field is mandatory.Zip CountiesChoose a format from drop down list for zip countyFile Formatformat, which should match with selection of zipcounty. The field is mandatory

Button Functionality

ElementDescriptionNewClick on new button enables to have a new import offiles.ImportClick on import button will perform the action ofimporting the selected valid files temporally. Once animport action is carried out, will enable the commitbutton.SearchClick on search button navigates to a screen to have asearch on entering Import id.CommitInitially commit button will be in disabled state. Oncean import activity is carried out, commit button will beenabled to have a permanent storage in the selectedfile formats.View Import LogClick on view import log to have a pop up displayshowing the status of imported filesHide Import LogClick on hide import log to hide the pop up displaymessage.BackClick back button to go back to the search screen.

Related Applications

There is no related application.

7 Rate Files

Import Rates provides for import of rates information received from PacAdvantage and export of rates information to carriers for verification.

Access

The application can be accessed from the main menu as follows:Carrier Maintenance→CM Operations→Import Rate FilesCarrier Maintenance→CM Operations→Export Rate Files

Before importing rate files, a mapping file has to be configured to ensure that each plan/product listed in the rate file has an entry in the mapping file and is mapped to the corresponding plan id/product id as in PX2 system.

The mapping file can usually be located in the following path:<config_root>/bpicas/ec/conf/DataMap.xmlHere <config_root> refers to the root directory where all configuration files required for PX2 system are placed. Ask for your System Administrator's assistance in locating the configuration root in the system in which PX2 is installed.Open the mapping file using any standard text editors (e.g. Notepad). In the file you will be able to locate entries like<productId keyName=“1,AETNA,HMO,PLUS” keyValue=“PL001-02,PL001”/>These are the entries that establish the mapping between plan/product listed in the rate file and the corresponding plan id/product id as in PX2 system.The entries have a format like this<productId keyName=“<LOC_CODE>,<PLAN_NAME,<PLAN_TYPE>,<COPAY>” keyValue=“<PX2_PRODUCT_ID>,PX2_PLAN_ID”/>whereLOC CODE is a codification for the line of coverage; 1 stands for Medical, 2 for Dental, 3 for Vision and 4 for CAMPLAN_NAME is the name of the plan as in the Excel file; this usually corresponds to the value of the 1st column in the Excel sheetPLAN_TYPE is the type of plan; whether HMO, PPO, POS etc; this usually corresponds to the value of the 2nd column in the Excel sheet; an exception is the worksheet for CAM which doesn't have a plan typeCOPAY is the copay option of the plan; whether Standard, Plus or Preferred; this usually corresponds to the value of the 3rd column in the Excel sheet; an exception is the worksheet for CAM which has this information in the 2nd columnPX2_PRODUCT_ID is the product id that corresponds to the product id in the excel sheetPX2_PLAN_ID is the plan id that corresponds to the plan id in the excel sheetIf required, suitably modify these entries to ensure that a correct mapping has been established between the plan/products in the Excel sheet to the plans/products in PX2 system. After modifying, save and close the mapping file.

Application FunctionsThis application has the following functions:Import RatesExport Rates

Import RateRate import will enable to import the files pertaining to medical, dental, vision, CAM with effective date. Rate export can also be navigated from this screen.The sequential steps involved in importing a rate are listed below.Step—1: Before start of importing, open the rates file (.xls) in Microsoft Excel. Rates for all the 4 line of coverage, namely Medical, Dental, Vision and CAM would be available in the Excel as 4 separate worksheets. Switch to Medical worksheet. Save the work sheet in “Comma-delimited” format using the File, Save As menu. Repeat this procedure for Dental, Vision and CAM worksheets. All these 4 CSV files will be used for rates import.Step—2: After successful logon, click the menu Carrier Maintenance. Select CM Operations and then Import Rate Files. (See FIG. B-71)Step—3: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-72)Step—4: Import ids can be either entered directly or can be chosen by clicking search button. Respective file paths can be selected by clicking browse button. Click import button. Following is the screen shot showing the status after entering all the fields (See FIG. B-73)

Fields Explanation

ElementDescriptionImport IdRead only field to display import id valueStatusRead only field to display the status of importImported ByRead only field to display the user who imported thefilesImport DateRead only field to display the import dateMedical file pathEnter the file path of medical file or select the path byclicking browse button. If the status is imported or notimported this fields would not be editable. At least onefile path is requiredDental file pathEnter the file path of dental file or select the path byclicking browse button. If the status is imported or notimported this fields would not be editable. At least onefile path is requiredCAM file pathEnter the file path of CAM file or select the path byclicking browse button. If the status is imported or notimported this fields would not be editable At least onefile path is required.Vision file pathEnter the file path of vision file or select the path byclicking browse button. If the status is imported or notimported this fields would not be editable. At least onefile path is requiredEffective DateEnter the date or choose from the calendar icon. Dateaccepts the format in MM/DD/YYYY. The field ismandatory

Button Functionality

ElementDescriptionNewClick on new button enables to have a new import offiles.ImportClick on import button will perform the action ofimporting the selected valid files to have a permanentstorage in the selected file formats.SearchClick on search button navigates to a screen to have asearch on entering Import id.View Import LogClick on view import log to have a pop up displayshowing the status of imported filesHide Import LogClick on hide import log to hide the pop up displaymessage.BackClick back button to go back to the import screen

Export Rate Files

Rate export will enable to export a product from selecting a product id by clicking product search icon. Rate import can also be navigated from this screen.

The sequential steps involved in rates export are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select CM Operations and then Export Rate Files (See FIG. B-74)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-75)Step—3: Export ids can be selected by either entering export id and clicking search button or Click an export id. Back button is to go back to export screen without selecting an export id for commit (See FIG. B-76)Step—4: Click Export button. (See FIG. B-77)Step—5: Click Ok to download the file. (See FIG. B-78)

Fields Explanation

ElementDescriptionExport IdRead only field to display export id valueStatusRead only field to display the status of exportExported ByRead only field to display the user who exported thefilesExport DateRead only field to display the export dateProduct IdRead only field. Choose a product id by clicking theproduct id search iconProduct NameRead only field. Displays the corresponding value ofthe product id selected.Effective DateEnter the date for effective date or select a date byclicking calendar icon. The field is mandatory. Dateaccepts the format in MM/DD/YYYY

Button Functionality

ElementDescriptionNewClick on new button enables to have a new export of aproduct id.ExportClick on export button will perform the action ofexporting the selected product id. Once it is exported,export button will be in a disabled state. For anyfurther export of files, click on new buttonView Export LogClick on view export log to have a pop up displayshowing the status of exported filesHide Export LogClick on hide export log to hide the pop up displaymessage.SearchClick on search button navigates to a screen to have asearch on entering product id.BackClick back button to go back to the search screen

Export Loaded Rate Files

Export loaded rate files will enable to know the status of the selected files for export.

The sequential steps involved in export loaded rate files are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select CM Operations and then Export Rate Files (See FIG. B-79)Step—2: Screen navigates to Export Loaded Rates. (See FIG. B-80)Step—3: Enter Effective date and other related fields as per the format briefed in fields' explanation tableStep—4: Click Export button.Step—5: Click Search to know the status of the export id generated. (See FIG. B-81)Step—6: Click back to go back to Export Imported Rate File screen.

Fields Explanation

ElementDescriptionExport IdRead only field to display export id valueStatusRead only field to display the status of exportExported ByRead only field to display the user who exported thefilesExport DateRead only field to display the export dateEffective DateEnter the date for effective date or select a date byclicking calendar icon. The field is mandatory. Dateaccepts the format in MM/DD/YYYYProduct IdRead only field. Choose a product id by clicking theproduct id search iconLine of CoverageChoose a line of coverage from the drop down listavailableRate TypeChoose a rate type either from the available option sayBlended or Non-BlendedRAFBased on the selected value, RAF will be enabled forentering. Accepts numeric value.Agent FeeText for agent fee. Accepts numeric values rangingfrom the values of 0-100Admin FeeText for admin fee. Accepts numeric values rangingfrom the values of 0-100CAL Cobra FeeText for CAL Cobra fee. Accepts numeric valuesranging from the values of 0-100Product NameRead only field. Displays the corresponding value ofthe product id selected.

Button Functionality

ElementDescriptionNewClick on new button enables to have a new export of aproduct id.ExportClick on export button will perform the action ofexporting the selected product id. Once it is exported,export button will be in a disabled state. For anyfurther export of files, click on new buttonView Export LogClick on view export log to have a pop up displayshowing the status of exported filesHide Export LogClick on hide export log to hide the pop up displaymessage.SearchClick on search button navigates to a screen to have asearch on entering product id.BackClick back button to go back to the search screen

Related Applications

Related applications are:Product Profile

8 Plan Availability Files

Plan Availability is to provide for export & import of existing plan availability data to carriers and import of plan availability data received from carriers.

Access

The application can be accessed from the main menu as follows:Carrier Maintenance→CM Operations→Import Plan AvailabilityCarrier Maintenance→CM Operations→Export Plan Availability

The plan for which data has to be imported/exported should have already been defined in the PX2 system.

The format for records in the import file is shown below:[00539]<COUNTY_NAME><TAB><COUNTY_CODE><TAB><ZIP_CODE><TAB><RATING_REGION><TAB><AVAILABLE_FLAG>whereTAB denotes a single TAB characterCOUNTY_NAME is county nameCOUNTY_CODE is the 5-character county code comprising 2-character state+3-character county code (FIPS code)ZIP_CODE is the 5-digit zip codeRATING_REGION is the 2-character rating regionAVAIL_FL indicates whether the plan is available at the specific zip code (and county) or not; a value of X indicates availability and a blank value indicates non-availability

Application Functions

This application has the following functions:Import Plan AvailabilityExport Plan Availability

Import Plan AvailabilityPlan availability import will enable to import a file under a plan type. Also Plan availability export can be navigated from this screen.The sequential steps involved in importing plan availability data are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select CM Operations and then Import Plan Availability. (See FIG. B-82)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-83)Step—3: Click Import buttonStep—4: Also import id for plan availability can be selected by clicking search button. This leads to a screen displaying import ids. Click it to select an id (See FIG. B-84)

Fields Explanation

ElementDescriptionImport IdRead only field to display import id valueStatusRead only field to display the status of importImported ByRead only field to display the user who imported thefilesImport DateRead only field to display the import datePlanChoose a plan from the drop down list from the planname availableImport FileEnter the file path or select the path by clickingbrowse button. The field is mandatoryEffective DateEnter the date for effective date or select a date byclicking calendar icon. The field is mandatory. Dateaccepts the format MM/DD/YYYY

Button Functionality

ElementDescriptionNewClick on new button enables to have a new import ofplan availability.ImportClick on import button will perform the action ofimporting the selected valid to have a permanentstorage in the selected file formats.SearchClick on search button navigates to a screen to have asearch on entering Import id.View Import LogClick on view import log to have a pop up displayshowing the status of imported filesHide Import LogClick on hide import log to hide the pop up displaymessage.BackClick back button to go back to the import screen

Export Plan AvailabilityPlan availability export will enable to import a file under a plan type. Also Plan availability import can be navigated from this screen.The sequential steps involved in exporting plan availability are listed below.Step—1: After successful logon, click the menu Carrier Maintenance. Select CM Operations and then Export Plan Availability (See FIG. B-85)Step—2: Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. B-86)Step—3 Also export id for plan availability can be selected by clicking search button. This leads to a screen displaying export ids. Click an id to select (See FIG. B-87)Step—4: Click Export button.Step—5: Click Ok to download the file. (See FIG. B-88)

Fields Explanation

ElementDescriptionExport IdRead only field to display export id valueStatusRead only field to display the status of exportExported ByRead only field to display the user who exported thefilesExport DateRead only field to display the export datePlanChoose a plan from the drop down list from the planname availableEffective DateEnter the date or choose from the calendar icon. Dateaccepts the format in MM/DD/YYYY.Field is mandatory

Button Functionality

ElementDescriptionNewClick on new button enables to have a new export ofplan availability.ExportClick on export button will perform the action ofimporting the selected valid plans. Once it is exported,export button will be in a disabled state. For anyfurther export of plans, click on new buttonView Export LogClick on view export log to have a pop up displayshowing the status of exported plansHide Export LogClick on hide export log to hide the pop up displaymessage.SearchClick on search button navigates to a screen to have asearch on entering export id.BackClick back button to go back to the search screen

Related Applications

Related applications are:Product Profile

PX2 User Manual

Enrollment

Enrollment is the transaction module that encompasses the process of creating and maintaining all information about the groups and Members who participate in the PacAdvantage program. The enrollment module within PX2 system is classified broadly into following transactions to accommodate the business rules. They are New Business Enrollment, COBRA enrollment, Add-On and Changes, ROE/OE, Termination and Reinstatement, Appeals and Grievance and Carrier Issues and Enrollment Operations.

The Applications

The above-mentioned processes are accomplished in several applications embedded into the Enrollment Module. These applications steer the tasks of creating, and maintaining operational information for the small employer groups, employee, dependent and members like individual association member, COBRA member etc in the PX2 entities, thereby helping achieve the goals of the Enrollment.

The basic process of enrollment can be sub divided into following applications.

Association—Association is to setup high-level information associations within the State of California who can participate in the PacAdvantage program. They are classified as Guaranteed, Endorsed, PEO's or Chambers with each association having a set of business rules to participate in the PacAdvantage program.

New Business Enrollment—New Business Enrollment is the process of Enrolling the Employer Group and members to the PacAdvantage program. The groups and members who can participate in the program are Small Employer Group with employees and dependent, Association Groups with employees and dependents and individual members with dependents. Each group and member must qualify the eligibility rules as applicable to participate in the PacAdvantage program.

COBRA Enrollment—COBRA enrollment is the process of enrolling the members for COBRA coverage. California State laws and federal laws govern COBRA Rules based on whether it is Cal COBRA or Federal COBRA. COBRA eligibility and the coverage are governed by set of California State laws and federal laws. COBRA enrollment can be further sub divided into two streams. Namely, Enrollment of New Business COBRA wherein the Group enrolling with the program bring in their COBRA members also to participate in the program. Existing COBRA Enrollment wherein the members terminated from the existing groups are enrolled as COBRA group/member.

Add-On—Add-On is the process of adding new members like employee and dependents to the existing groups and employees respectively. Add-On process has business rules attached based on which the Add-On process is either accepted or denied.

Changes—Changes are the process of accommodating the changes that the group and or member sought during their participation in the PacAdvantage program. Change process has business rules attached based on which the Change process is either accepted or denied.

ROE/OE—ROE (Re-qualification and open enrollment) is the process of Re-qualifying the Group and Members on their anniversary. Once a year, on the anniversary date of a group's enrollment in PacAdvantage, the group's participation, contribution and qualification is reviewed. This review is to ensure that the group meets the qualification requirement. The main objective of this process is to review these criteria and re qualify as needed, notify them of rate changes and provide an opportunity for employees of the group to make changes to their enrollment.

OE (Open Enrollment) is the process during the anniversary of the group wherein the group has the privilege to make the changes to the plan, waiting period etc that were earlier not open for changes.

Termination and Reinstatement—Termination is the process of terminating the Groups and or members from the PacAdvantage program due to various reasons governed by business rules. The reasons for termination can be non-payment of premium, group's request for termination etc. Reinstatement is the process of revoking the terminated groups and or members based on the reasons governed by business rules. The reasons for reinstatement can be Premium paid through, processing error etc.

Appeals and Grievances—Appeals and Grievance is the process of maintaining a status for all Appeals and Grievances received from the customer and follow up with the decision made either by PacAdvantage-Roseville or PacAdvantage-SF.

Carrier Issues—Carrier Issues is the process of maintaining a status for all Carrier Issues received from the customer and follow up with the carrier for resolution and inform the customer of resolution.

Enrollment Operation—Enrollment operation is the process of generating out data for transmission of enrollment date. This consists of Member Data Transmission, Enrollment Data Transmission, PacAdvantage Transmission, ROE/OE Transmission

Association is the master module that encompasses the process of creating and maintaining all master information that is required for maintaining the Association information in the PX2 System.

Associations are basically a body of groups/members representing certain types of associations within the State of California. Association Groups and Association Members can participate in the PacAdvantage program similar to small employer groups or members. Associations are classified as Guaranteed, Endorsed, PEO's or Chambers. Each of the associations classified have specific business rules when participating in PacAdvantage program

Access

The application can be accessed from the main menu as follows:Enrollment→Association→Create AssociationEnrollment→Association→Modify Association

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:Create Association—to input details of a associationModify Association—to search a specific association record

Create Association

The create association screen is to enter details of an association. The screen provides functionality to save, edit or add new association details.

The sequential steps involved in the creation of a new association are listed below.Step—1: After successful logon, click the menu Enrollment. Select Association and select the option Create Association. (See FIG. C-1)Step—2: Enter the values in the respective field, as per the format briefed in fields' explanation section Field Explanation, and click Continue button. (See FIG. C-2)Step—3: Screen navigates to coverage information with auto generated association id. Choose relevant information pertaining to coverage and click Continue button. (See FIG. C-3)Step—4: Screen navigates to other information. (See FIG. C-4)Step—5: For internal work group click search icon. This pops up a screen to select internal work group.Step—6: Click on any internal work group for selection. (See FIG. C-5)Step—7: After filling the relevant information for other information and special handling as per the format briefed in fields' explanation section, click Continue buttonStep—8: Screen navigates to confirming successful creation of an association. (See FIG. C-6)

Fields ExplanationThe following table provides explanations for each of the screen fields.

ElementDescriptionGeneral Info TabAssociationThe text for association name. Accepts alphanumericNameand special characters not exceeding 60 characters.Entry to this field is mandatory.AssociationChoose a type of association from the drop down list.TypeEntry to this field is mandatoryStreet AddressThe text for association address. Accepts alphanumericand special characters not exceeding 35 characters.Entry to this field is mandatorySuite #The text for suite #. Accepts alphanumeric and specialcharacters not exceeding 35 characters. Entry to thisfield is mandatoryCityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters. Entry to thisfield is mandatoryStateChoose the name of the state from the drop down listof States available in United States of America. Entryto this field is mandatoryZipThe text for zip. Accepts numeric of either 5 or 9digits. Entry to this field is mandatorySalutationChoose the salutation from the drop down list ofsalutations available. Entry to this field is mandatoryFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. Entry to this field is mandatoryMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for Last name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding35 characters. Entry to this field is mandatorySuffixChoose the suffix from the drop down list of suffixesavailable.PhoneThe text for telephone number of the contact name.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999. Entry to this field ismandatoryExtensionThe text for telephone extension number. Acceptsnumeric values not exceeding 5 digits. The format is9999FaxThe text for fax number of the contact name. Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999. Entry to this field is mandatoryE-mailThe text for email of the contact name. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters.Coverage Info TabAssociation IDText for association id. This is a read only fieldAssociationText for association name. This is a read only fieldNameLine ofChoose the line of coverage offered by the associationCoverageby checking the check box/boxes.DomesticChoose yes or no to state if domestic partner coveragePartneris offered.Coverage RateChoose yes or no to state the rate type (Blended or NonTypeBlended)Other InfoAssociation IDText for association id. This is a read only fieldAssociationText for association name. This is a read only fieldNameInternal WorkChoose a internal work group by clicking search iconGroupMembershipSelect a value for membership status from the dropStatusdown list Values can be active, closed, frozen.Contract DateChoose a date of contract by clicking calendar icon.The date can be in the format MM/DD/YYYYAssociation Re-The text for re-qualification period. Accepts numericqualificationvalues not exceeding 2 digits. The value states numberPeriodof months for Association Re-qualification PeriodBatch BillingChoose the option of batch billing if the association ifpreferred by association.DesiredChoose the option to have name of association on theAssociationbill if preferred by association.Name on the Bill

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the entered information and navigates to nextlevel. The flow screen is from general info to coverageinfo then to other info. Screen flow should start fromgeneral info. Switchover in between the screens ispossible only if clicking the Continue button saves thefirst screen “General Info”.CancelCancel the contents entered in the fields and restoreto the previous state as was before saving the changes.

Modify Association

The modify association enables to modify the contents of an existing association. Alternatively you can also modify the record for the association by clicking the “Search Icon” for selecting the Association name or ID for modification when in create mode.

The sequential steps involved in modifying an existing association are listed below.Step—1: After successful logon, click the menu Enrollment. Select Association and select the option Modify Association. (See FIG. C-7)Step—2: Association name has to be selected from the drop down list or association id has to be entered for selecting an association. (See FIG. C-8)Step—3: Modify the values in the respective field, as per the format briefed in fields explanation section Field Explanation, and click Continue button. (See FIG. C-9)Step—4: Screen navigates to coverage information for any modifications. Modify relevant information pertaining to coverage and click Continue button. (See FIG. C-10)Step—5: Screen navigates to other information. (See FIG. C-11)Step—6: For internal work group click search icon. This pops up a screen to select internal work group. (See FIG. C-12)Step—7: Click on any internal work group for selection.Step—8: After modifying the information of other information and special handling as per the format briefed in field's explanation section, click Continue buttonStep—9: Screen navigates to confirming successful creation of an association. (See FIG. C-13)Step—10: If the option is Inactivate and confirming the inactivation, the following screen appears. (See FIG. C-14)

Fields Explanation

Refer field explanation provided for create association. In case of modify association, either association id can be entered or association name can be selected from the drop down list. In case of association id, it accepts alphanumeric values. The difference in modify mode the data available is populated for making modifications, if required.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionModifyClicking the Modify Button navigates to the GeneralInfo screen populating the records for the associationname selected or association ID entered.InactivateClicking the Inactivate button would inactivate therecords for the association name selected or associationID entered.ContinueSaves the entered information and navigates to nextlevel. The flow from general info to coverage info thento other info. Screen flow should start from generalinfo. Switchover in between the screens is possible onlyif the first screen “General Info” is saved by clickingthe Continue button or if the mode is Modify.CancelCancel the contents entered in the fields or restore tothe previous state as was before saving the changes.

Related Applications

There is no related application.

3 New Business Enrollment

New Business Enrollment is the transaction module that encompasses the process of enrolling and maintaining all information that is required for various entities that are eligible to participate in the PacAdvantage program in the PX2 System. This module captures all the relevant information required to enroll a group and members to the program. The group and member must satisfy certain eligibility criteria to enroll themselves.

Various groups and members are classified as “Small Employer Group with employees and their dependents, Association Group (Groups affiliated to an associations) with employees and their dependents, Individual Member (Members affiliated to an association) with or without dependents.

Access

All master records must be available in the system for a successful enrollment. Master Records are as follows:Carrier Maintenance—Refer “User Manual for Carrier Maintenance” for further information on the master records.Agent/Agency—Refer “User Manual for Sales and Marketing” for further information on the Agent/Agency records.Work Group—Refer “User Manual for Sales and Marketing” for further information on the Work Group records.Internal Associates—Refer “User Manual for Sales and Marketing” for further information on the Internal Associates records.Association Master—Association Master must be available in the system. Refer Section 2 of this document on “Association Master”.Eligibility Criteria—Business rules identifies the eligibility criteria for the Groups and member for participating in the PacAdvantage Program. For a successful enrollment the business rules must be met with.For entering Employee records the group must be available in the system and the enrolled status must be “Enroll Pend”.For entering Dependent records the Employee must be available in the system and the enrolled status must be “Enroll Pend”.

Application Functions

This application can be sub divided into following major functions:Group Enrollment—Group Enrollment consist of the following operations:Create Small Employer Group—to input details of a Small Employer Group.Create Alternate Group—to input details of an Alternate GroupCreate Individual Association Member—to input details of an Individual Association Member.Modify Group—to search a specific group for modification prior to enrollment. This search feature would allow searching for Small Employer Group or Association Group.Inactivate Group—to search a specific Small Employer Group or Association Group and make inactive.Employee Enrollment—Employee Enrollment consist of the following operations:Create Employee—to input details of an Employee for a specific group.Modify Employee—to search a specific employee for modification prior to enrollment. This search feature would allow searching employees attached to Small Employer Group or Association Group.Inactivate Employee—to search a specific Employee attached to Small Employer Group or Association—Group and make inactive.Dependent Enrollment—Dependent Enrollment consist of the following operations:Create Dependent—to input details of a Dependent of a specific employee.Modify Dependent—to search a specific dependent for modification prior to enrollment. This search feature would allow searching for dependent attached to an employee of a Small Employer Group or Association Group.Inactivate Dependent—to search a specific Dependent attached to an employee of Small Employer Group or Association Group and make inactive.Individual Member Enrollment—Individual Member Enrollment consist of the following operations:Modify Individual member—to search a specific member for modification prior to enrollment. This search feature would allow searching only for individual member who are attached to a guaranteed association.Inactivate Individual Member—to search a specific member those attached to a guaranteed association and make inactive.Create Individual Member Dependent—to input details of a Dependent of a specific individual member.Modify Individual Member Dependent member—to search a dependent of a specific individual member for modification prior to enrollment. This search feature would allow searching only for dependent of an individual member who is attached to a guaranteed association.Inactivate Dependent of Individual Member—to search a dependent of a specific individual member who are attached to a guaranteed association and make inactive.

Create Group (Small Employer Group)

The create group screen is to enter details of a group. The screen provides functionality to save, edit or add new group details.

The sequential steps involved in the creation of a new group by selecting small employer group are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Group Enrollment and Create Group. (See FIG. C-15)Step—2: Screen displays with the option of selecting a group hierarchy. (See FIG. C-16)Step—3: On choosing Small Employer Group and Clicking continue button screen navigates to General Info. Enter the values in the respective field, as per the format briefed in fields explanation section Field Explanation, and click Continue. (See FIG. C-17)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionPost Mark DateText for post mark date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYReceived DateText for received date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYCompany InformationLegal NameThe text for name of the group. Accepts alphanumericand special characters not exceeding 60 characters.Field is mandatoryDoing BusinessThe text for business nature. Accepts alphanumericAsand special characters not exceeding 60 characters.Field is optionalType ofChoose the type of business from the drop down listBusinessavailableTaxThe text for tax identification. Accepts numeric valuesIdentificationof exactly 9 digitsAddress Information: Physical and Billing Address - Note: Enter BillingAddress if different from the Physical Address.Street AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 charactersSuiteThe text for company suite/apt # Acceptsalphanumeric and special characters not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key.CityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop down listof counties available for the ZIP Code entered.Contact InformationMode ofChoose the mode of correspondence from the dropCorrespondencedown list available.Contact 1 and Contact 2 - Fill in the relevant for Contact 1 and 2.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters.SuffixChoose the suffix from the drop down list of suffixesavailable.Phone NumberThe text for telephone number of the contact person.Accepts numeric values of exactly 10 digits. The formatis (999) 999-9999ExtensionThe text for extension number of the contact person.Accepts numeric values not exceeding 5 digits.FaxThe text for fax number of the contact person. Acceptsnumeric values of exactly 10 digits. The format is(999) 999-9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100charactersContactThe text for comments. Accepts alphabets, numericCommentsand special characters. Field is optional

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Billing Informationscreen and the system generates Group ID.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Agent Info, Coverage Infoand Add Employees are the tabs visible on this screen.The navigation between tabs is possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—4: Screen navigates to billing information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-18)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop down listavailable. Based on selection corresponding fields willenable to enter the values. For e.g. if the value selectedis card payment, EFT will be disabled and allows onlyentering card details and vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. Accepts alphabets andNamesspace between two words.Credit Card TypeChoose the type of credit card from the drop down listavailable.Credit Card NoThe text for credit card number. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expiration from the drop down listavailableExpiration YearThe text for expiration year. Accepts numeric valuesof exactly 4. Example 2002.Billing AddressAs it appears on the credit CardStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 characters.ZIPThe text for zip. Accepts numeric value of either 5 or 9digits.StateThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.CityChoose the name of the state from the drop down listof States available in United States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number. Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number. Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of account from the drop down listavailable.Depositor's NameThe text for depositor's name. Accepts alphabets andspace between two words.Initial Payment InformationAmount ReceivedThe text for amount received. Accepts only numericvalues in the format 999999999.99Date ReceiveThe text for date received. Choose from the calendaricon in the format MM/DD/YYYY.Check #The text for check number. Accepts numeric values notexceeding 9 digits.No Check ReceivedCheck the option of no checks received for any non-receipt of checks.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Agent Informationscreen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for group.MissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Agent Info, Coverage Infoand Add Employees are the tabs visible on this screen.The navigation between tabs is possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—5: Screen navigates to Agent Info screen. Agent/Agency ID is selected by clicking search icon. (See FIG. C-19)Step—6: This pops up a screen to select agent/agency id. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-20)Step—7: Click on agent/agency id for selection. (See FIG. C-21)Step—8: Add the Agent information to the table for temporary storage. After filling other relevant information in agent info screen, as per the format briefed in field's explanation section and click Continue

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionAgent IDChoose an agent id by clicking search iconAgent TypeChoose an agent type from the drop down listavailable. Based on the selection of the agent type thepercent commission split entry and the Receive ROEpackets option would be available.Percent commissionThe text for percent commission. Accepts numericsplitvalues in the range of 1-100 (Example 100.00). Thiswill be enabled only if the Agent type selected is“Agent Of Record”Sum of the percentage for all the Agent of Recordadded should be equal to 100.00.Receive ROE/OEClick the check box to receive ROE/OE packets forpacketsagent. This option will not be available for AgentType “General Agent”.Agent CommissionThe text for agent commission. Defaults the valuedefined in CM - rate Administration for AgentCommission. Accepts numeric values less than orequal to the defaulted value in the in the range of1-100 (Example 4.45)Check the box if theClick the check box for a group with out an agent.group is without anThis option will be available only for the Agent Type,agent“Agent of Record and Writing Agent”.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of agent information. It is only atemporary addition. Becomes permanent only onsaving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of agent information. It is only atemporary update. Becomes permanent only on savingthe recordDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the recordCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationContinueSaves the data and navigates to Coverage Informationscreen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Agent Info, Coverage Infoand Add Employees are the tabs visible on this screen.The navigation between tabs is possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screenStep—9: Screen navigates to coverage information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-22)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionWaiting Period InformationEmployee TypeChoose an Employee Type from the drop down listavailableWaiting PeriodChoose a waiting period from the drop down listavailableRAF DiscountingRAFList the RAF tier applicable for the group based on theRAF tier available on group's effective date.ContributionLine of CoverageChoose a line of coverage from the drop down listelectedavailableContribution ForChoose a contribution for from the drop down listavailable. Contribution can be for an employee ordependent.Contribution TypeChoose a contribution type from the drop down listavailable. List the contribution type “% Lowest CostHMO”, “% Lowest Cost Plan”, “% Specified Plan”,“Flat $ Amount”. On Selecting % Specified Plan thepage would get refreshed and the Plan Name for theSpecified LOC would be populated in the Drop DownList “Plan Name”ContributionThe text for contribution amount. Accepts numericAmountvalues in the format 99999999.99 for flat $ amountand for the rest of the option it accepts as % value say100.00Plan NameChoose a plan name from the drop down list availableif the Contribution Type selected is “% SpecifiedPlan”.Current GroupChoose a group insurer from the drop down listInsureravailableWhether groupClick the option yes or nolegally required toprovide workerscompensationcoverageWorkersChoose a compensation carrier name from the dropcompensationdown list availablecarrier nameNumber ofThe text for total number of employees including fullEmployees (Fulltime and part time. Accepts numeric valuestime and part time)Number of full timeThe text for number of full time employees at the timeemployees at theof applying. Accepts numeric valuestime of applicationNumber of eligibleThe text for number of eligible employees at the timeemployees at theof applying. Accepts numeric valuestime of applicationNumber ofThe text for number of employees at the time ofemployee applyingapplying. Accepts numeric valuesHave you employedClick the option yes or no20 or moreemployees for 20 ormore weeks duringthe current orpreceding year(TEFRA)Have you employedClick the option yes or no20 or moreemployees duringat least 50% of thepreceding calendaryear (COBRA)Are you offeringClick the option yes or nocoverage toemployees workingmore 20-29 hoursper weekAre you offeringClick the option yes or nocoverage todomestic partnersAre you offeringClick the option yes or nocoverage to 1099Employer'sCheck this Check box if Employer's signature isSignatureverified.Date SignedThe text for Date Signed. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAdd (WaitingAdd the contents of Waiting Period information. It isPeriod Information)only a temporary addition. Becomes permanent onlyon saving the record.Add (Contribution)Add the contents of Contribution and Coverageelected. It is only a temporary addition. Becomespermanent only on saving the record.Update (WaitingUpdates the contents of Waiting Period information. ItPeriod Information)is only a temporary update. Becomes permanent onlyon saving the record.UpdateUpdate the contents of Contribution and Coverage(Contribution)elected. It is only a temporary update. Becomespermanent only on saving the record.CancelCancels the operation that was currently performedprior to saving the record.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.EnrollmentClick enrollment summary refreshes the screen andSummary [Link]display the summary information entered for groupcreationMissingClick missing information refreshes the screen andInformation [Link]displays the missed information. For a successfulcreation of a group, there should be no missinginformationMissing InfoSaves the data and navigates to Missing InformationPageContinue/Add EESaves the data and navigates to Add Employee screen.Create New GroupSaves the data entered and navigates to the screenGroup Hierarchy for creating New Group.CancelClears or restores the content entered in the fields onlyprior to saving the records.TabGeneral Info, Billing Info, Agent Info, Coverage Infoand Add Employees are the tabs visible on this screen.The navigation between tabs is possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screenStep—10: Screen navigates to add employee general information. Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. C-23)

Field ExplanationThe following table provides explanation for each button in the screen.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to coverage informationfor employees.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's general infoscreen.TabGeneral Info, Coverage Info, Add Dependent are thetabs visible on this screen. The navigation between thetabs is possible only if there is a valid Employee IDgenerated and assigned to the employee. Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—11: Screen navigates to coverage information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-24)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationHours workedThe text for worked hours per week. Accepts numericper weekvalues not exceeding 2 digits.Date ofThe text for date of employment. Choose a date byemploymentclicking calendar icon. Date accepts the formatMM/DD/YYYY.Employee typeChoose an employee type from the drop down listavailablePlan InformationLine of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if the employeeis waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down list availablePCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.Are you anClick the check box if you are an existing patientexisting patientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down list availablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insuranceThe text for insurance end date. Choose a date byend dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverageThe text for other coverage. Accepts alphabets withkeptvalues not exceeding 50 characters.EmployeeClick the check box, to have employee signaturesignatureThe text for date signed. Choose a date by clickingDate signedcalendar icon. Date accepts the format MM/DD/YYYY.Date cannot accept future date.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information. Itis only a temporary addition. Becomes permanent onlyon saving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only on savingthe record.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.EnrollmentClick enrollment summary refreshes the screen andSummary [Link]display the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successful[Link]creation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's general infoscreen.ContinueSaves the data and navigates to Coverage Informationscreen.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, Add Dependent are thetabs visible on this screen. The navigation between thetabs are possible only if there is a valid Employee IDgenerated and assigned to the employee Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—12: Screen navigates to add dependent information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click anyone of the button shown for subsequent operation. (See FIG. C-25)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionDependent InformationFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory.SuffixChoose the suffix from the drop down list of suffixesavailable.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Birth date cannot be later than thecurrent date.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.RelationshipChoose the relationship from the drop down listavailable.Street AddressThe text for address. Accepts alphanumeric and specialcharacters with values not exceeding 35 charactersSuiteThe text for suite/apt # . . . Accepts alphanumeric andspecial characters with values not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or9 digits. City, and State are populated automaticallyon entering the correct zip code and entering the tabkey.CityThe text for city. Accepts alphabets not exceeding 30characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaLine of CoverageSelected carrierThe text for selected carrier. It is a read only fieldCoverage choiceThe text for coverage. It is a read only fieldService areaThe text for service area. It is a read only fieldPrior plan typeChoose a plan type from the drop down list availablePrior planThe text for plan name. Accepts alphabetsWaivedClick the check box if Line of Coverage is waived.Start dateThe text for insurance start date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY.End dateThe text for insurance end date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY.PCP ID/The text for PCP ID. Accepts alphabets and numericvalues not exceeding 10 characters.PCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.DisabledClick the option of temporary or permanent. This isdependentenable if the relationship opted is childDomestic partnerClick the option for domestic partner. It depends onthe value selected in relationshipLegal guardianClick the option for legal guardian. It depends on thevalue selected in relationshipSignatureClick the check box if the signature is opted

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAdd EmployeeSaves the data and navigates to the screen for addingemployees.Add DependentSaves the data and navigates to the screen for addingdependentEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, Add Dependent are thetabs visible on this screen. The navigation between thetabs are possible only if there is a valid Employee IDgenerated and assigned to the employee Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—13: Clicking enrollment summary button screen navigates to enrollment summary. This screen shows the overall information that is entered. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Pre Enrollment button for checking the eligibility criteria for the Group and Members. (See FIG. C-26)

Field ExplanationThe following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of theText for the Name of the GroupGroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupProposedThe text for Proposed Effective Date. Choose a date byEffective Dateclicking calendar icon. Date accepts the formatMM/DD/YYYY. Default effective date is first of thefollowing month. Effective date cannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internal workgroup attached to the Group. This is based on thewriting agent's work group.EnrollmentEnrollment Summary Information is broken down intoSummarytree structure. The tree can by expanded or collapsed.InformationThe level of the tree is as per the example given below:− Employee− Dependent− Dependent− Employee− Dependent− Employee+ Employee− Employee+ Dependent+− EmployeeWhere (−) signifies expanded view and (+) signifiescollapsed view.Employee IDText for Employee IDEmployee SSNText for Employee SSNEmployee NameText for employee Name (First Name and Last Name)Effective DateText for Employee Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of the Group.Effective date cannot be past dateStatusText to specify the status of the employee.Dependent IDText for Dependent IDDependent SSNText for Dependent SSNDependent NameText for Dependent Name (First Name and LastName)Effective DateText for Dependent Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of theEmployee. Effective date cannot be past dateStatusText to specify the status of the Dependent.EnrollmentThere are two part of this information:Information1) Entered based on verification2) Based on the information provide on theCoverage Info screenEntered based on verificationTotal Full TimeValue is shown based on the actual full time employeeApplied (A)applied (System Identified)Total part TimeValue is shown based on the actual part time employeeApplied (B)applied (System Identified)Employee WaivedText to enter Employee Waived. Contains only whole(C)number. Accepts numbers not exceeding 5 digits.Manually entered based on verification.EmployeeText to enter Employee Declined. Contains only wholeDeclined (D)number. Accepts numbers not exceeding 5 digits.Manually entered based on verification.Total EligibleText to display total eligible employee. EmployeeEmployee (E) =Applying is sum total of A + B + D.Total EmployeeText to display total employee applying. EmployeeApplying (F)Applying is sum total of A + B.% ParticipationTest to display % participation. Participation is % ofE/FBased on Info ProvidedTotal Full TimeText for Total Full Time Applied. Based on theApplied (A)information provide on the Coverage Info screenTotal part TimeText for Total Part Time Applied. Based on theApplied (B)information provide on the Coverage Info screenTotal EmployeesText to display total employee applied. EmployeeAppliedApplied is sum total of A + B

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment summary shows record for 5 employeeson single screen. If the employee size increases morethan 5. These buttons are used for navigating to thenext and previous records for viewing.<< - Show first record(s)< - Show previous record(s)> - Show next record(s)>> - Show last record(s)Group IDClick Group ID to navigates to the Group's general infoscreen.Step—14: Clicking pre enrollment navigates to missing info screen. Missing information screen provide information on the data that is required to complete an enrollment process. This also checks for the eligibility of the group and member for enrolling into PacAdvantage Program. For a successful creation of a group the missing information should be empty. The user role and authority can overrule certain missing information.Enter the values in the respective fields, as per the format briefed in field's explanation section and click Enroll button for enrolling the Group and Members. (See FIG. C-27)

Field ExplanationThe following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of theText for the Name of the GroupGroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupProposedThe text for Proposed Effective Date. Choose a date byEffective Dateclicking calendar icon. Date accepts the formatMM/DD/YYYY. Default effective date is first of thefollowing month. Effective date cannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internal workgroup attached to the Group. Internal is based on thewriting agent's work group.Tree StructureEnrollment Missing Information is broken down intotree structure. The tree can by expanded or collapsed.The level of the tree is as per the example given below:− Employee− Dependent− Dependent− Employee− Dependent− Employee+ Employee− Employee+ Dependent+− EmployeeWhere (−) signifies expanded view and (+) signifiescollapsed view.Group MissingThis identifies all the eligibility rules and theInfoinformation that are incomplete on Group level forcompleting the enrollment process.Missing EntitiesList the missing entities for the group. Provides a linkto go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EmployeeThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on Employee level forcompleting the enrollment process.Missing EntitiesList the missing entities for the employee. Provides alink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.DependentThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on dependent level forcompleting the enrollment process.Missing EntitiesList the missing entities for the dependent. Provides alink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EnrollmentChoose from the drop down list the action to beActionperformed for enrollment. Enroll/DeclineRemarksText for remarks if any.Reasons forChoose from the drop down list the reasons for decline.DeclineReasons forText for other reason. If the reason for decline is otherOtherthan the reasons available.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionSend mailClick this link to send missing information to theInternal Work Group (GMS representatives) attachedto this Group.Preview InvoiceClick this Link to preview the Invoice details prior togeneration of invoice.EnrollSaves the data if there are no missing information andnavigates to enrollment confirmation page.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment missing information shows record for 5employees on single screen. If the employee sizeincreases more than 5. These buttons are used fornavigating to the next and previous records forviewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)Group IDClick Group ID to navigates to the Group's general infoscreen.Preview InvoiceClick Preview Invoice to pop up a new browser windowto preview the invoice for the group

Missing InformationThe following table provides explanation for each missing information and what needs to be done to remove missing information from the screen

Missing EntityMessageReasons/RemedyGroup LevelGeneralThese are missing information pertains to theInformationGroup Level information required in the GroupGeneral Information ScreenEmployer Tax IDEmployer Tax ID is notFill in the Employer taxspecifiedID in the Group GeneralInfo ScreenType of BusinessType of Business is notChoose the Type ofspecifiedBusiness Listed from thelist in Group General InfoScreenAddressAddress information isFill in the addressnot specifiedinformation in the GroupGeneral Info ScreenZIPZIP Code is not specifiedFill in the zip code in theGroup General InfoScreenCityCity name is not specifiedFill in the City name inthe Group General InfoScreenCountyCounty is not specifiedChoose County for Groupfrom the list in groupgeneral info screenStateState name is notChoose the State from thespecifiedlist in group general infoscreenMode ofMode of CorrespondenceChoose the Mode ofCorrespondenceis not specifiedCorrespondence forContact 1 from the list ingroup general info screenContact FirstContact first name forFill in the Contact first inNameContact 1 is not specifiedthe Group General InfoScreenContact LastContact last name forFill in the Contact last innameContact 1 is not specifiedthe Group General InfoScreenPhonePhone for Contact 1 is notFill in the Contact Phonespecifiedin the Group General InfoScreenEmailEmail for Contact 1 is notThis is required if thespecifiedmode of correspondenceselected is Email. Fill inthe Contact Email in theGroup General InfoScreenBillingThese missing information pertains to the GroupInformationLevel information required in the BillingInformation ScreenMode ofMode of payment is notChoose the Mode ofpaymentspecifiedPayment for the groupfrom the list in GroupBilling Info ScreenCheck NumberCheck Number is notFill in the Check numberspecified.in the Group Billing InfoScreenCheck DateDate Check received isFill in the Date receivednot specifiedin the Group Billing InfoScreenCheck NumberCheck Number receivedFill in the Check Numberis not specifiedin the Group Billing InfoScreenInitial PaymentInitial payment notIf initial payment check isreceivedreceived then uncheck thebox “No Check Received”in the Group Billing InfoScreenInitial PaymentInitial Payment is notIf initial payment check issufficient to get enrolledreceived but there is ashortfall in the amountthis message would beshown. Check the shortfall by previewing theinvoice with the amountreceived.The variation in amountreceived by more than (−)$2 will allow user withlevel II and above only toenroll.The variation in amountreceived by more than (−)$50 will allowing userwith level III and aboveonly to enrollThe variation in amountreceived by more than (−)$100 will allow user withlevel IV and above only toenrollCardholder'sCardholder's name is notThis is required if theNamespecifiedmode of payment opted bygroup is Credit Card. Fillin the Cardholder's namein the Group Billing InfoScreen.Credit Card TypeCredit Card Type is notThis is required if thespecified.mode of payment opted bygroup is Credit CardChoose the Credit CardType for the group fromthe list in Group BillingInfo ScreenCredit CardCredit Card Number isThis is required if theNumbernot specifiedmode of payment opted bygroup is Credit Card. Fillin the Credit CardNumber in the GroupBilling Info Screen.Expiration DateCredit Card ExpirationThis is required if theDate is not specifiedmode of payment opted bygroup is Credit Card. Fillin the Credit CardExpiration Date in theGroup Billing Info Screen.Bank NameBank name is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theBank Name in the GroupBilling Info Screen.Routing NumberRouting Number is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theRouting Number in theGroup Billing Info Screen.Account TypeAccount Type is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theAccount Type in theGroup Billing Info ScreenDepositor'sDepositor's Name is notThis is required if theNamespecifiedmode of payment opted bygroup is EFT. Fill in theDepositor's Name in theGroup Billing Info ScreenAgentThese missing information pertains to the GroupInformationLevel information required in the AgentInformation ScreenWriting AgentWriting Agent is notChoose the Writing Agentspecifiedfor the Group in theGroup Agent Info ScreenAgent of RecordAgent of Record is notThis is required ifspecifiedcommission for the agentexists. Choose the Agentof Record for the Group inthe Group Agent InfoScreenAgent LicenseAgent License Number isGo to Agent/AgencyNumbernot specifiedMaster Screen, search forthe agent/agencyattached with group andfill in the Licenseinformation.License ExpiryLicense Expiry Date isGo to Agent/AgencyDatenot specifiedMaster Screen, search forthe agent/agencyattached with group andfill in the Licenseinformation.License ExpiryAgent License Number isGo to Agent/AgencyDateexpiredMaster Screen, search forthe agent/agencyattached with group andmodify the license expirydate.Commission% Commission split isCheck if the commissionnot specifiedsplit for the agent ofrecord exists. If not editthe corresponding agentof record and enter %commission split for theAgent of Record in theGroup Agent Info ScreenTotal% Split in commission isCheck if the total of theCommissionless than 100%commission split's for theSplitagent of record is 100. Ifnot edit the correspondingagent of record and makechanges to makecommission split total to100% in the Group AgentInfo ScreenCoverageThese missing information pertains to the GroupInformationLevel information required in the CoverageInformation ScreenRAFRate Differential factor isThis is required to arrivenot specifiedto the PremiumCalculation for the Group.Select the RAF from thelist in Group CoverageInfo ScreenWorkersIs your Group legallyChoose the Option Yes orcompensationrequired to provideNo in Group Coveragecoverageworkers compensationInfo Screencoverage?WorkerWorker CompensationThis is required if theCompensationCarrier Name is notWorkers compensationCarrier Namespecifiedcoverage opted is yes.Choose the WorkerCompensation CarrierName from the list inGroup Coverage InfoScreenTotal EmployeeHow many employeesFill in the “How many(full time and part time)employees (full time andavailable with the Grouppart time)” available withthe Group in the GroupCoverage Info ScreenFull TimeHow many full timeFill in the “How many fullEmployeeemployees available withtime employees” availablethe Groupwith the Group in theGroup Coverage InfoScreenEligibleHow many eligibleFill in the “How manyEmployeeemployees at the time ofeligible employees at theapplicationtime of application”available with the Groupin the Group CoverageInfo ScreenEmployeesHow many employeesFill in the “How manyApplyingapplyingemployees applying” inthe Group Coverage InfoScreenTEFRAHave you employed 20 orChoose the Option Yes ormore employees for 20 orNo in Group Coveragemore weeks during theInfo Screencurrent or preceding year(TEFRA)COBRAHave you employed 20 orChoose the Option Yes ormore employees during atNo in Group Coverageleast 50% of the precedingInfo Screencalendar year (COBRA)Part timeAre you offering coverageChoose the Option Yes orCoverageto permanent employeeNo in Group Coverageworking 20-29 hours perInfo Screenweek?Domestic PartnerAre you offering coverageChoose the Option Yes orCoverageto domestic partners?No in Group CoverageInfo ScreenWaiting PeriodWaiting Period for theAdd waiting period for theemployees is not specifiedemployee based on theemployee type in GroupCoverage Info ScreenWaiting PeriodManagerial EmployeeEdit the waiting periodWaiting period notinformation and updatespecifiedthe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodNon- ManagerialEdit the waiting periodEmployee Waiting periodinformation and updatenot specifiedthe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodExempt EmployeeEdit the waiting periodWaiting period notinformation and updatespecifiedthe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodNon - Exempt EmployeeEdit the waiting periodWaiting period notinformation and updatespecifiedthe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodUnion Employee WaitingEdit the waiting periodperiod not specifiedinformation and updatethe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodNon- Union EmployeeEdit the waiting periodWaiting period notinformation and updatespecifiedthe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodFull-Time EmployeeEdit the waiting periodWaiting period notinformation and updatespecifiedthe waiting period for theemployee type in GroupCoverage Info ScreenWaiting PeriodPart-Time EmployeeEdit the waiting periodWaiting period notinformation and updatespecifiedthe waiting period for theemployee type in GroupCoverage Info ScreenLine of CoverageLine of coverage notAdd Line of Coverage inspecifiedGroup Coverage InfoScreenContributionEmployee ContributionEdit the Line of coverageTypetype not specifiedwherein the ContributionType is not specified andupdate the ContributionType in Group CoverageInfo ScreenContributionEmployee ContributionEdit the Line of coverageAmountAmount not specifiedwherein the ContributionAmount is not specifiedand update theContribution Amount inGroup Coverage InfoScreenContributionDependent ContributionEdit the Line of coverageTypetype not specifiedwherein the ContributionType is not specified andupdate the ContributionType in Group CoverageInfo ScreenContributionDependent ContributionEdit the Line of coverageAmountAmount not specifiedwherein the ContributionAmount is not specifiedand update theContribution Amount inGroup Coverage InfoScreenContributionContribution Type forEmployee and DependentType VariationEmployee and Dependentmust have samediffers.Contribution Type.Edit the Line of coveragewherein the ContributionType varies and updatethe Contribution Type inGroup Coverage InfoScreenPlan NamePlan not selected forEdit the Line of coverageContribution Type “%wherein the Plan Name isSpecified Plan”not specified and updatethe Plan Name in GroupCoverage Info ScreenEmployeeThese missing information pertains to theGeneralEmployee Level information required in theInformationEmployee General Information ScreenAddressAddress information isFill in the addressnot specifiedinformation in theEmployee General InfoScreenCityCity is not specifiedFill in the City in theEmployee General InfoScreenStateState is not specifiedFill in the City in theEmployee General InfoScreenZIP CodeZIP Code is not specifiedFill in the ZIP Code in theEmployee General InfoScreenDate of BirthDate of Birth is notFill in the Date of Birth inspecifiedthe Employee GeneralInfo ScreenGenderGender is not specifiedChoose the Gender in theEmployee General InfoScreenSSNSSN is not specifiedFill in the SSN in theEmployee General InfoScreen. If the employeerefuse to provide SSNthen click auto generateSSN/Unique ID in theEmployee General InfoScreen. Auto generationof SSN/Unique ID will beavailable only for the userwith role as level II andaboveMode ofMode of CorrespondenceChoose the Mode ofCorrespondenceis not specifiedCorrespondence forEmployee from the list inEmployee general infoscreenEmailEmail for Employee is notThis is required if thespecifiedmode of correspondenceselected is Email. Fill inthe Email in theEmployee general infoscreenEmployeeThese missing information pertains to theCoverageEmployee Level information required in theInformationEmployee Coverage Information ScreenHours WorkedHours worked per weekFill in the Hours workednot specifiedper week in the EmployeeCoverage Info ScreenDate ofDate of employment notFill in the Date ofEmploymentspecifiedEmployment in theEmployee Coverage InfoScreenEmployeeEmployee signature isVerify employee'sSignaturemissingsignature and checkEmployee Signaturecheckbox in the EmployeeCoverage Info ScreenDate SignedDate Signed is missingVerify Date signed and fillin the Date Signed in theEmployee Coverage InfoScreenEmployee TypeEmployee Type notChoose the EmployeespecifiedType for Employee Typefrom list in EmployeeCoverage info screenEmployee Type -Variation in EmployeeCheck for the EmployeeWaiting PeriodType at Group andType specified in theEmployee LevelGroup Coverage Info andthe Employee CoverageInfo. Employee Typespecified in The GroupLevel and the EmployeeLevel can have variation.Either change theEmployee Type inEmployee Coverage Infoscreen or add theEmployee Type in theGroup Coverage Info.EmployeeEmployee's Line ofChoose the Line ofCoverageCoverage not specifiedCoverage for theEmployee in EmployeeCoverage info screenMedicalMedical Line of CoverageChoose the Line ofCoveragenot specifiedCoverage for theEmployee in EmployeeCoverage info screen. Ifthe employee waivesmedical coverage checkthe checkbox MedicalWaived.Dental CoverageDental Line of CoverageThis is required if thenot specifiedGroup offers optionalbenefits. Choose the Lineof Coverage for theEmployee in EmployeeCoverage info screenVision CoverageVision Line of CoverageThis is required if thenot specifiedGroup offers optionalbenefits. Choose the Lineof Coverage for theEmployee in EmployeeCoverage info screenCAM CoverageCAM Line of CoverageThis is required if thenot specifiedGroup offers optionalbenefits. Choose the Lineof Coverage for theEmployee in EmployeeCoverage info screenCoverage ChoiceCoverage Choice betweenChoose the appropriatethe Line of Coveragecoverage choices as perdiffersthe illustration providedin the column below andedit the coverage choicefor the specific Line ofCoverage and update inEmployee Coverage infoscreen. Or In dependentInfo Screen waive theOptional coverage choicefor dependent under 2 bychecking the check boxWaive.Coverage ChoiceCoverage choice for the Medical should have highestIllustrationprecedence. There are Four Coverage Choices1 - Employee Family2 - Employee Child3 - Employee Spouse4 - Employee OnlyCase 1:If coverage choice for medical is Employee Child,Optional benefit cannot have employee spouse. Itshould be Employee Child or Employee Only providedchild is under 2Case 2:If Coverage Choice for Medical is Employee Spouseoptional benefits cannot have employee child. It shouldalso be Employee SpouseCase 3:If Coverage Choice for Medical is Employee Childoptional benefits cannot have employee only if at leastone child is above 2 years of age. It should also beEmployee childDependentNumber of Dependents isThis would be the caseCountnot sufficient to satisfywhen the dependentCoverage Choice.information is not enteredinto the system. AddDependent.This can also occur if thenumber of dependent asspecified in coveragechoice does not matchwith the dependentsavailable. Add orInactivate dependent asapplicable.DependentDependent information isThis would occur if thenot specifiedCoverage choice specifiedis other than employeeonly and depended recordis not entered. AddDependentDependentThese missing information pertains to theInformationDependent Level information required in theDependent Information ScreenDate of BirthDate of Birth is notFill in the Date of Birth inspecifiedthe Dependent GeneralInfo ScreenGenderGender is not specifiedChoose the Gender in theDependent General InfoScreenSSNSSN is not specifiedFill in the SSN in theDependent General InfoScreen. If the dependentrefuse to provide SSNthen click auto generateSSN/Unique ID in theDependent General InfoScreen. Auto generationof SSN/Unique ID will beavailable only for the userwith role as level II andaboveRelationshipRelationship of theChoose the dependentdependent with therelationship from theemployee not specifiedDependent Info ScreenRelationship -Relationship, child isVerify if the child isChildspecified for child abovedisabled and choose if23 years of ageDisabled Permanent orTemporary.SignatureDependent signature isThis is required if themissingdependent age is above18. Verify the signaturefor the dependent andcheck the checkboxSignature in thedependent info screenRelationshipNumber of spouse is moreCheck for the relationshipthan onein the dependent infoscreen. There can only beone of the followingrelationship for thedependent:Spouse or Ex - Spouse ordomestic partner.Choose differentrelationship for the otherdependent in thedependent info screen orinactivate the otherdependentGeneral MissingThis missing information pertains to the AllInformation onLevel of information. This may be due to nonAll Levelavailability of sufficient master record toprocess enrollment or may require businessdecisions or administrative changes in thesystem to overcome this missing informationEmployeeEmployee Record DoesProbably the entries forRecordnot existthe employees are notmade. Add employees tosatisfy this eligibility rule.Group SizeGroup Size cannot be lessProbably the entries forthan 2 Employeesthe employees are notmade or less that twoemployee records onlyexist in the system. Addat least 2 employees tosatisfy this eligibility rule.Group SizeGroup Size cannot beProbably the entries forgreater than 50the employees are moreEmployeesthan 50 records. This doesnot satisfy eligibilitycriteria rule for SmallEmployer Group. Groupcannot be enrolled.ParticipationParticipation Rule is notParticipation rule statesRulesatisfiedthat 65% of the eligibleemployees need to enrollif the group size is >3 and100% of the eligibleemployees need to enrollif the group size is <=3.Check if this is met with.If not then the group doesnot satisfy the eligibilityrule. Group cannot beenrolled. Check this inGroup Summary Screen.ContributionContribution Rule forThe employerRuleMedical is not satisfiedcontribution for theMedical Line of Coverageis not satisfied. Check theContribution Amount.Edit the Line of coverageand change thecontribution Amount andupdate in the GroupCoverage Info Screen.ContributionContribution Rule forThe employerRuleDental is not satisfiedcontribution for the Lineof Coverage is notsatisfied. Check theContribution Amount.Edit the Line of coverageand change thecontribution Amount andupdate in the GroupCoverage Info Screen.ContributionContribution Rule forThe employerRuleVision is not satisfiedcontribution for the Lineof Coverage is notsatisfied. Check theContribution Amount.Edit the Line of coverageand change thecontribution Amount andupdate in the GroupCoverage Info Screen.ContributionContribution Rule forThe employerRuleCAM is not satisfiedcontribution for the Lineof Coverage is notsatisfied. Check theContribution Amount.Edit the Line of coverageand change thecontribution Amount andupdate in the GroupCoverage Info Screen.Rate AvailabilityRate is not available forThis is possible if thethe Plan opted by theRates are not loaded forEmployeethe Group's effective dateof enrollment. Load therates for the specific planfrom the CarrierMaintenance - RateImport utility.Admin FeesAdmin Fees for the SmallThis is possible if theEmployer Group is notAdmin Fees is notspecifiedspecified for the Group'sEffective date. Add Adminfees from the CarrierMaintenance - RateAdministrationAgentAgent Commission for theThis is possible if theCommissionSmall Employer Group isAgent Commission is notnot specifiedspecified for the Group'sEffective date. Add AgentCommission from theCarrier Maintenance -Rate AdministrationRate DifferentialRate Differential FactorThis is possible if the RateFactorfor the Small EmployerDifferential Factor is notGroup is not specifiedspecified for the Group'sEffective date. Add RateDifferential Factor fromthe Carrier Maintenance -Rate AdministrationPlan availabilityMedical Plan selected byNormally the Plan for thethe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Plan availabilityDental Plan selected byNormally the Plan for thethe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Plan availabilityVision Plan selected byNormally the Plan for thethe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are 'available for theEmployee in theEmployee Coverage Infoscreen.Plan availabilityCAM Plan selected by theNormally the Plan for theEmployees not availableemployee is listed basedin the service area.on the Plan available inthe employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Step—15: On completing all the relevant information that is required for a successful enrollment of a group, the following is the sample screen for a successful enrollment of a group. (See FIG. C-28)

The create group screen is to enter details of a group. The screen provides functionality to save, edit or add new group details.

The sequential steps involved in the creation of a new group by selecting group under alternate group are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Group Enrollment and Create Group. (See FIG. C-29)Step—2: Screen displays with the option of selecting a group hierarchy. (See FIG. C-30)Step—3: Screen navigates select an alternate group. Enter a 10-digit number or choose an association name. (See FIG. C-31)Step—4: Choose the option of individual member and click Continue. (See FIG. C-32)Step—5: Clicking continue button screen navigates to general info. Enter the values in the respective field, as per the format briefed in fields explanation section Field Explanation, and click Continue. (See FIG. C-33)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionPost Mark DateText for post mark date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYReceived DateText for received date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYEmployee InformationSalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters. Last name is mandatorySuffixChoose the suffix from the drop down list of suffixesavailable.Date of BirthThe text for date of birth. Choose a date by clickingcalendar iconSocial SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.Address Information; Physical and Alternate Address- Note: EnterAlternate Address if different from the Physical Address.Street AddressThe text for address. Accepts alphanumeric and specialcharacters not exceeding 35 charactersSuiteThe text for suite/apt # Accepts alphanumeric andspecial characters not exceeding 35 charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key.CityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop down listof counties available for the ZIP Code entered.Mode ofChoose the mode of correspondence from the dropCorrespondencedown list available.Phone NumberThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999ExtensionThe text for extension number of the contact person.Accepts numeric values not exceeding 5 digits.FaxThe text for fax number of the contact person Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueNavigates to Billing Information screen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Agent Info, Coverage Infoand Add Employees are the tabs visible on this screen.The navigation between tabs is possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—6: Screen navigates to billing information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-34)

Field Explanation

Refer field explanation provided for Small Employer Group—Billing Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Billing InfoStep—7: Screen navigates to Agent Info screen. Agent/Agency ID is selected by clicking search icon. (See FIG. C-35)Step—8: This pops up a screen to select agency id Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-36)Step—9: Click on agency id for selection. (See FIG. C-37)Step—10: After filling other relevant information in agent info screen, as per the format briefed in field's explanation section and click Continue

Field Explanation

Refer field explanation provided for Small Employer Group—Agent Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Agent Info.Step—11: Screen navigates to coverage information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-38)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionHours worked perThe text for worked hours per week. Accepts numericweekvalues.Date of hireThe text for date of employment. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY.Employee typeChoose an employee type from the drop down listavailablePay RollCheck box for Pay Roll verification. Check this if payroll is verified.RAFText to display the RAF applicable for the IndividualAssociation Member.Line of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if the employeeis waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down list availablePCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.Are you an existingClick the check box if you are an existing patientpatientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down list availablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insurance endThe text for insurance end date. Choose a date bydateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverage keptThe text for other coverage. Accepts alphabets withvalues not exceeding 50 characters.Employee signatureClick the check box, to have employee signatureAdditional coverageThe text for any additional coverage. Acceptsalphabets with values not exceeding 50 characters.Date signedThe text for date signed. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Date cannot accept future date.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information.It is only a temporary addition. Becomes permanentonly on saving.EditEdit button will allow for editing a specific recordin the table.UpdateUpdate the contents of Plan Information. It is onlya temporary update. Becomes permanent only onsaving.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the recordsin the table that are checked.EnrollmentClick enrollment summary refreshes the screenSummaryand display the summary of information enteredfor group creationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's generalinfo screen.ContinueSaves the data and navigates to CoverageInformation screen. .CancelClears the contents entered in the fields or restoreto the previous state as was before saving thechangesTabGeneral Info, Billing Info, Agent Info, CoverageInfo and Add Employees are the tabs visible onthis screen.The navigation between tabs is possibleonly if there is a valid group ID generated andassigned to the group. Also while navigatingthrough the tab the content that are changed onthe screen are not saved unless explicitly savedby other operations on the screenStep—12: Screen navigates to add dependent information. First name and last name fields are mandatory and other fields are optional. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-39)

Field Explanation

Refer field explanation provided for Small Employer Group—Add Dependent.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAdd DependentSaves the data and navigates to the screen foradding dependentEnrollmentClick enrollment summary refreshes the screenSummaryand display the summary of information enteredfor group creationMissingClick missing information refreshes the screenInformationand displays the missed information. For asuccessful creation of a group, there should beno missing informationCancelClears the contents entered in the fields or restoreto the previous state as was before saving thechangesTabsGeneral Info, Coverage Info, Add Dependent arethe tabs visible on this screen. The navigationbetween the tabs are possible only if there is a validEmployee ID generated and assigned to the employeeAlso while navigating through the tab the contentthat are changed on the screen are not saved unlessexplicitly saved by other operations on the screenStep—13: Clicking enrollment summary button screen navigates to enrollment summary. This screen shows the overall information that are entered will be shown. (See FIG. C-40)

Field ExplanationThe following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformation HeaderName of the GroupText for the Name of the GroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like SmallEmployer GroupProposed EffectiveThe text for Proposed Effective Date. Choose aDatedate by clicking calendar icon. Date accepts theformat MM/DD/YYYY. Default effective date isfirst of the following month. Effective date cannotbe past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internalwork group attached to the Group. Internal isbased on the writing agent's work group.Association IDText to specify the Association IDAssociation NameText to specify the Association NameEnrollmentEnrollment Summary Information is brokenSummarydown into tree structure. The tree can by expandedInformationor collapsed. The level of the tree is as per theexample given below:− Employee− Dependent− Dependent+ DependentWhere (−) signifies expanded view and (+)signifies collapsed view.Employee IDText for Employee IDEmployee SSNText for Employee SSNEmployee NameText for employee Name (First Name andLast Name)Effective DateText for Employee Effective date. Choose adate by clicking calendar icon. Date acceptsthe format MM/DD/YYYY. Defaults effectivedate of the Group. Effective date cannot bepast dateStatusText to specify the status of the employee.Dependent IDText for Dependent IDDependent SSNText for Dependent SSNDependent NameText for Dependent Name (First Name andLast Name)Effective DateText for Dependent Effective date. Choose adate by clicking calendar icon. Date acceptsthe format MM/DD/YYYY. Defaults effectivedate of the Employee. Effective date cannotbe past dateStatusText to specify the status of the Dependent.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesGroup IDClick Group ID to navigates to the Group's generalinfo screen.Step—14: Clicking pre enrollment navigates to missing info screen. It gives the information that is left out while entering input for creating a group. For a successful creation of a group the missing information should be empty. (See FIG. C-41)

Field ExplanationThe following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformation HeaderName of the GroupText for the Name of the GroupGroup IDText and Link for the Group ID to navigate tothe Group General Info screenGroup TypeSpecifies the Type of the Group like SmallEmployer GroupProposed EffectiveThe text for Proposed Effective Date. Choose aDatedate by clicking calendar icon. Date accepts theformat MM/DD/YYYY. Default effective dateis first of the following month. Effective datecannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internalwork group attached to the Group. Internal isbased on the writing agent's work group.Association IDText to specify the Association IDAssociation NameText to specify the Association NameTree StructureEnrollment Missing Information is brokendown into tree structure. The tree can byexpanded or collapsed. The level of the treeis as per the example given below:− Employee− Dependent− DependentWhere (−) signifies expanded view and (+)signifies collapsed view.Group Missing InfoThis identifies all the eligibility rules and theinformation that are incomplete on Group levelfor completing the enrollment process.Missing EntitiesList the missing entities for the group. Providesa link to go to the respective screen to fill in therelevant information to complete all the requiredentries.MessageList the message against each missing entities.EmployeeThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on Employeelevel for completing the enrollment process.Missing EntitiesList the missing entities for the employee.Provides a link to go to the respective screento fill in the relevant information to completeall the required entries.MessageList the message against each missing entities.DependentThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on dependentlevel for completing the enrollment process.Missing EntitiesList the missing entities for the dependent.Provides a link to go to the respective screento fill in the relevant information to completeall the required entries.MessageList the message against each missing entities.Enrollment ActionChoose from the drop down list the action to beperformed for enrollment. Enroll/DeclineRemarksText for remarks if any.Reasons for DeclineChoose from the drop down list the reasonsfor decline.Reasons for OtherText for other reason. If the reason for declineis other enter the reasons here.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionEnrollSaves the data if there are no missing information andnavigates to enrollment confirmation page.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesGroup IDClick Group ID to navigates to the Group's general infoscreen.
Missing Information

The following table provides explanation for each missing information and what needs to be done to remove missing information from the screen

Missing EntityMessageReasons/RemedyMember LevelEmployeeThese missing information pertains to theGeneralMember Level information required in theInformationGeneral Information ScreenAddressAddress information isFill in the addressnot specifiedinformation in theEmployee General InfoScreenCityCity is not specifiedFill in the City in theEmployee General InfoScreenStateState is not specifiedFill in the City in theEmployee General InfoScreenZIP CodeZIP Code is not specifiedFill in the ZIP Code in theEmployee General InfoScreenDate of BirthDate of Birth is notFill in the Date of Birthspecifiedin the Employee GeneralInfo ScreenGenderGender is not specifiedChoose the Gender in theEmployee General InfoScreenSSNSSN is not specifiedFill in the SSN in theEmployee General InfoScreen. If the employeerefuse to provide SSNthen click auto generateSSN/Unique ID in theEmployee General InfoScreen. Auto generationof SSN/Unique ID will beavailable only for the userwith role as level II andaboveMode ofMode of CorrespondenceChoose the Mode ofCorre-is not specifiedCorrespondence forspondenceEmployee from the listin Employee generalinfo screenEmailEmail for Employee is notThis is required if thespecifiedmode of correspondenceselected is Email. Fill inthe Email in theEmployee general infoscreenBillingThese missing information pertains to theInformationMember Level information required in theBilling Information ScreenMode ofMode of payment is notChoose the Mode ofpaymentspecifiedPayment for the groupfrom the list in GroupBilling Info ScreenCheck NumberCheck Number is notFill in the Check numberspecified.in the Group Billing InfoScreenCheck DateDate Check is received isFill in the Date receivednot specifiedin the Group Billing InfoScreenCheck NumberCheck Number is receivedFill in the Check Numberis not specifiedin the Group Billing InfoScreenInitialInitial payment notIf initial payment check isPaymentreceivedreceived then uncheck thebox “No Check Received”in the Group Billing InfoScreenInitialInitial Payment is notIf initial payment checkPaymentsufficient to get enrolledis received but there is ashortfall in the amountthis message would beshown. Check the shortfall by previewing theinvoice with the amountreceived.The variation in amountreceived by more than (-)$2 will allow user withlevel II and above only toenroll.The variation in amountreceived by more than (-)$50 will allowing userwith level III and aboveonly to enrollThe variation in amountreceived by more than (-)$100 will allow user withlevel IV and above only toenrollCardholder'sCardholder's name is notThis is required if theNamespecifiedmode of payment opted bygroup is Credit Card. Fillin the Cardholder's namein the Group Billing InfoScreen.Credit CardCredit Card Type is notThis is required if theTypespecified.mode of payment optedby group is Credit CardChoose the Credit CardType for the group fromthe list in Group BillingInfo ScreenCredit CardCredit Card Number isThis is required if theNumbernot specifiedmode of payment optedby group is Credit Card.Fill in the Credit CardNumber in the GroupBilling Info Screen.ExpirationCredit Card ExpirationThis is required if theDateDate is not specifiedmode of payment opted bygroup is Credit Card. Fillin the Credit CardExpiration Date in theGroup Billing Info Screen.Bank NameBank name is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theBank Name in the GroupBilling Info Screen.RoutingRouting Number is notThis is required if theNumberspecifiedmode of payment opted bygroup is EFT. Fill in theRouting Number in theGroup Billing Info Screen.Account TypeAccount Type is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theAccount Type in theGroup Billing Info ScreenDepositor'sDepositor's Name is notThis is required if theNamespecifiedmode of payment opted bygroup is EFT. Fill in theDepositor's Name in theGroup Billing Info ScreenAgentThese missing information pertains to theInformationMember Level information required in the AgentInformation ScreenWriting AgentWriting Agent is notChoose the Writing Agentspecifiedfor the Group in theGroup Agent Info ScreenAgent ofAgent of Record is notThis is required ifRecordspecifiedcommission for the agentexists. Choose the Agentof Record for the Group inthe Group Agent InfoScreenAgent LicenseAgent License Number isGo to Agent/AgencyNumbernot specifiedMaster Screen, search forthe agent/agencyattached with group andfill in the Licenseinformation.License ExpiryLicense Expiry Date isGo to Agent/AgencyDatenot specifiedMaster Screen, search forthe agent/agencyattached with group andfill in the Licenseinformation.License ExpiryAgent License Number isGo to Agent/AgencyDateexpiredMaster Screen, search forthe agent/agencyattached with group andmodify the license expirydate.Commission% Commission is split isCheck if the commissionnot specifiedsplit for the agent ofrecord exists. If not editthe corresponding agentof record and enter %commission split for theAgent of Record in theGroup Agent Info ScreenTotal Com-% Split in commission isCheck if the total of themission Splitless than 100%commission split's for theagent of record is 100. Ifnot edit the correspondingagent of record and makechanges to makecommission split total to100% in the Group AgentInfo ScreenCoverageThese missing information pertains to theInformationMember Level information required in theCoverage Information ScreenHours WorkedHours worked per weekFill in the Hours workednot specifiedper week in the EmployeeCoverage Info ScreenDate ofDate of employment notFill in the Date ofEmploymentspecifiedEmployment in theEmployee Coverage InfoScreenEmployeeEmployee signature isVerify employee'sSignaturemissingsignature and checkEmployee Signaturecheckbox in the EmployeeCoverage Info ScreenDate SignedDate Signed is missingVerify Date signed and fillin the Date Signed in theEmployee Coverage InfoScreenEmployeeEmployee Type notChoose the EmployeeTypespecifiedType for Employee Typefrom list in EmployeeCoverage info screenEmployeeEmployee's Line ofChoose the Line ofCoverageCoverage not specifiedCoverage for theEmployee in EmployeeCoverage info screenMedicalMedical Line of CoverageChoose the Line ofCoveragenot specifiedCoverage for theEmployee in EmployeeCoverage info screen. Ifthe employee waivesmedical coverage checkthe checkbox MedicalWaived.DentalDental Line of CoverageThis is required if theCoveragenot specifiedAssociation offers optionalbenefits. Choose the Lineof Coverage for theEmployee in EmployeeCoverage info screenVisionVision Line of CoverageThis is required if theCoveragenot specifiedAssociation offers optionalbenefits. Choose the Lineof Coverage for theEmployee in EmployeeCoverage info screenCAMCAM Line of Coverage notThis is required if theCoveragespecifiedAssociation offers optionalbenefits. Choose the Lineof Coverage for theEmployee in EmployeeCoverage info screenCoverageCoverage Choice betweenChoose the appropriateChoicethe Line of Coveragecoverage choices as perdiffersthe illustration providedin the column below andedit the coverage choicefor the specific Line ofCoverage and update inEmployee Coverage infoscreen. Or In dependentInfo Screen waive theOptional coverage choicefor dependent under 2 bychecking the check boxWaive.CoverageCoverage choice for the Medical should have highestChoiceprecedence. There are Four Coverage ChoicesIllustration1- Employee Family2 - Employee Child3- Employee Spouse4 - Employee OnlyCase 1:If coverage choice for medical is Employee Child,Optional benefit cannot have employee spouse. Itshould be Employee Child or Employee Only providedchild is under 2Case 2:If Coverage Choice for Medical is Employee Spouseoptional benefits cannot have employee child. It shouldalso be Employee SpouseCase 3:If Coverage Choice for Medical is Employee Childoptional benefits cannot have employee only if at leastone child his above 2. It should also be Employee childDependentNumber of Dependents isThis would be the caseCountnot sufficient to satisfywhen the dependentCoverage Choice.information is not enteredinto the system. AddDependent.This can also occur if thenumber of dependent asspecified in coveragechoice does not matchwith the dependentsavailable. Add Dependent.DependentDependent information isThis would occur if thenot specifiedCoverage choice specifiedis other than employeeand depended record isnot entered. AddDependent1099's1099 not provided forManually verify 1099 forverificationthe employee and checkthe 1099's Flag in the .Enrollment summary forthe specific employee.DE6DE6 not provided forManually verify DE6 forverificationthe employee and checkthe DE6 Flag in theEnrollment summary forthe specific employee.DependentThese missing information pertains to theInformationDependent Level information required in theDependent Information ScreenDate of BirthDate of Birth is notFill in the Date of Birth inspecifiedthe Dependent GeneralInfo ScreenGenderGender is not specifiedChoose the Gender in theDependent General InfoScreenSSNSSN is not specifiedFill in the SSN in theDependent General InfoScreen. If the dependentrefuse to provide SSNthen click auto generateSSN/Unique ID in theDependent General InfoScreen. Auto generationof SSN/Unique ID will beavailable only for the userwith role as level II andaboveRelationshipRelationship of theChoose the dependentdependent with therelationship from theemployee not specifiedDependent Info ScreenRelationship -Relationship, child isVerify if the child isChildspecified for child abovedisabled and choose if23 years of ageDisabled Permanent orTemporary.SignatureDependent signature isThis is required if themissingdependent age is above18. Verify the signaturefor the dependent andcheck the checkboxSignature in thedependent info screenRelationshipNumber of spouse is moreCheck for the relationshipthan onein the dependent infoscreen. There can only beone of the followingrelationship for thedependent:Spouse or Ex - Spouse ordomestic partner.Choose differentrelationship for the otherdependent in thedependent info screenGeneralThese are missing information pertains to the allMissinglevel of information. This may be due to nonInformationavailability of sufficient master record toon All Levelprocess enrollment or may require businessdecisions or administrative changes in thesystem to overcome this missing informationEmployeeEmployee Record DoesProbably the entries forRecordnot existthe employees are notmade. Add employees tosatisfy this eligibility rule.RateRate is not available forThis is possible if theAvailabilitythe Plan opted by theRates are not loaded forEmployeethe Individual Member'seffective date ofenrollment. Load therates for the specific planfrom the CarrierMaintenance - RateImport utility.Admin FeesAdmin Fees for the SmallThis is possible if theEmployer Group is notAdmin Fees is notspecifiedspecified for theIndividual Member'sEffective date. Add Adminfees from the CarrierMaintenance - RateAdministrationAgentAgent Commission for theThis is possible if theCommissionSmall Employer Group isAgent Commission is notnot specifiedspecified for theIndividual Member'sEffective date. Add AgentCommission from theCarrier Maintenance -Rate AdministrationRateRate Differential FactorThis is possible if the RateDifferentialfor the Small EmployerDifferential Factor is notFactorGroup is not specifiedspecified for the AgentCommission Effectivedate. Add RateDifferential Factor fromthe Carrier Maintenance -Rate AdministrationPlanMedical Plan selected byNormally the Plan for theavailabilitythe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.PlanDental Plan selected byNormally the Plan for theavailabilitythe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.PlanVision Plan selected byNormally the Plan for theavailabilitythe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.PlanCAM Plan selected by theNormally the Plan for theavailabilityEmployees not availableemployee is listed basedin the service area.on the Plan available inthe employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Step—15: On completing all the relevant information that is required for a successful enrollment of a group, the following is the sample screen for a successful enrollment of an individual association member. (See FIG. C-42)

The create group screen is to enter details of a group The screen provides functionality to save, edit or add new group details.

There are three different ways of creation, namely creating a group, through small employer group, alternate group that has again two methods namely individual member and group.

The sequential steps involved in the creation of a new group by selecting group under alternate group are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Group Enrollment and Create Group. (See FIG. C-43)Step—2: Screen displays with the option of selecting a group hierarchy. (See FIG. C-44)Step—3: Screen navigates select an alternate group. Enter a 10 digit number or choose an association. (See FIG. C-45)Step—4: Choose the option of group and click Continue. (See FIG. C-46)Step—5: Clicking continue button screen navigates to general info. Enter the values in the respective field, as per the format briefed in fields explanation section Field Explanation, and click Continue. (See FIG. C-47)

Field Explanation

Refer field explanation provided for Small Employer Group—General Info.

Button Functionality

Refer button functionality provided for Small Employer Group—General Info.Step—6: Screen navigates to billing information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-48)

Field Explanation

Refer field explanation provided for Small Employer Group—Billing Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Billing Info.Step—7: Screen navigates to Agent Info screen. Agent/Agency ID is selected by clicking search icon. (See FIG. C-49)Step—8: This pops up a screen to select agency id Enter the first letter of agent name or first digit of agent id to perform search operation. (See FIG. C-50)Step—9: Click on agency id for selection. (See FIG. C-51)Step—10: After filling other relevant information in agent info screen, as per the format briefed in field's explanation section and click Continue

Field Explanation

Refer field explanation provided for Small Employer Group—Agent Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Agent Info.Step—11: Screen navigates to coverage information. Even though the fields are optional, enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-52)

Field Explanation

Refer field explanation provided for Small Employer Group—Coverage Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Coverage Info.Step—12: Screen navigates to add employee general information. First and Last name are mandatory other fields are optional. Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. C-53)

Field Explanation

Refer field explanation provided for Small Employer Group—Add Employee General Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Add Employee General Info.Step—13: Screen navigates to coverage information. Even though the fields are optional, enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-54)

Field Explanation

Refer field explanation provided for Small Employer Group—Add Employee Coverage Info.

Button Functionality

Refer button functionality provided for Small Employer Group—Add Employee Coverage Info.Step—14: Screen navigates to add dependent information. Enter the values in the respective fields, as per the format briefed in field's explanation section and click anyone of the button shown for subsequent operation. (See FIG. C-55)

Field Explanation

Refer field explanation provided for Small Employer Group—Add Dependent

Button Functionality

Refer button functionality provided for Small Employer Group—Add Employee Add Dependent.Step—15: Clicking enrollment summary button screen navigates to enrollment summary. This screen shows the overall information that is entered. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Pre Enrollment button for checking the eligibility criteria for the Group and Members. (See FIG. C-56)

Field Explanation

Refer field explanation provided for Small Employer Group—Enrollment Summary.

Button Functionality

Refer button functionality provided for Small Employer Group—Enrollment Summary.Step—16: Clicking pre enrollment navigates to missing info screen. Missing information screen provide information on the data that is required to complete an enrollment process. This also checks for the eligibility of the group and member for enrolling into PacAdvantage Program. For a successful creation of a group the missing information should be empty. The user role and authority can overrule certain missing information.Enter the values in the respective fields, as per the format briefed in field's explanation section and click Enroll button for enrolling the Group and Members. (See FIG. C-57)

Field Explanation

Refer field explanation provided for Small Employer Group—Enrollment Missing Info

Button Functionality

Refer button functionality provided for Small Employer Group—Enrollment Missing Info

Missing Information

Refer missing information provided for Small Employer Group—Missing InformationStep—17: On completing all the relevant information that is required for a successful enrollment of a group, the following is the sample screen for a successful enrollment of a group. (See FIG. C-58)

Modify Group (Small Employer Group)

The modify group screen is to modify details of a group for the existing groups. The screen provides functionality to save, edit or add new group details.

The sequential steps involved in the modify group are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Group Enrollment and Modify Group. (See FIG. C-59)Step—2: Navigates to search screen. Enter value in any one of the field or simply click search button to perform search operation. (See FIG. C-60)Step—3: This pop ups a screen with the search result. (See FIG. C-61)Step—4: Click on any group id for selection This navigates to general information of the group. The process of modification is similar to the process of flow as explained in Creation of Group. Refer Section Create Group (Small Employer Group)

Inactivate Group

The inactivate group screen is to make a group from activate state to inactivate.

The sequential steps involved in the inactivate group are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Group Enrollment and Inactivate Group. (See FIG. C-62)Step—2: Navigates to search screen. Enter value in any one of the fields or simply click search button to perform search operation. (See FIG. C-63)Step—3: This pop ups a screen with the search result. (See FIG. C-64)Step—4: Click on any group id for selection. This navigates to a screen confirming for the selected group to make inactivate. Click Inactivate button. (See FIG. C-65)Step—5: Confirms the status Click Search to navigate back to Group Search screen. (See FIG. C-66)

Create Employee

The create employee screen is to enter details of a employee The screen provides functionality to save, edit or add new employee details.

The sequential steps involved in the creation of an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Employee Enrollment and Create Employee. (See FIG. C-67)Step—2: This navigates to group search screen, to create an employee for an employer Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-68)Step—3: This pops up a screen with the search result. (See FIG. C-69)Step—4: Click on any employer/group id for selection.Step—5: This navigates to general information screen pertaining to an employee. The process of creating an employee is similar to the process explained for Small Employer Group

Modify Employee

The modify employee screen is to modify details of a employee The screen provides functionality to save, edit or add new employee details.

The sequential steps involved for modifying an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Employee Enrollment and Modify Employee. (See FIG. C-70)Step—2: This navigates to employee search screen. (See FIG. C-71)Step—3: Enter value in any one of the fields or simply click search button to perform search operation. Navigates to Search result screen. (See FIG. C-72)Step—4: Click on any employee id for selectionStep—5: This displays General Info screen of an employee with contents ready for any modification. The procedure and flow of modification are similar to the procedures explained for Small Employer Group

Inactivate Employee

The inactivate employee screen is to make a employee from activate state to inactivate.

The sequential steps involved in the inactivate employee are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Employee Enrollment and Inactivate Employee. (See FIG. C-73)Step—2: Navigates to search screen for employees. Either enters the id or first letter of employee name to perform search. Click search button. (See FIG. C-74)Step—3: This pop ups a screen with the search result. (See FIG. C-75a)Step—4: Click on any employee id for selection. This navigates to a screen confirming for the selected employee to make inactivate. Click Inactivate button. (See FIG. C-75b)Step—5: Confirms the status Click Search to navigate back to Employee search screen. (See FIG. C-76)

Create Dependent

The create dependent screen is to enter details of a employee The screen provides functionality to save, edit or add new dependent details.

The sequential steps involved in the creation of an dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Dependent Enrollment and Create Dependent. (See FIG. C-77)Step—2: Navigates to search screen for employees. Either enters the id or first letter of employee name to perform search operation. Click search button. (See FIG. C-78)Step—3: This pops up a screen with the search result. (See FIG. C-79)Step—4: Click on any employee id for selectionStep—5: This navigates to add dependent screen pertaining to an employee. The process of creating a dependent is similar to the process explained for Small Employer Group

Modify Dependent

The modify dependent screen is to modify details of a dependent.

The screen provides functionality to save, edit or add new dependent details.

The sequential steps involved in the modify dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Dependent Enrollment and Modify Dependent. (See FIG. C-80)Step—2: This navigates to dependent search screen. (See FIG. C-81)Step—3: Enter value in any one of the fields or simply click search button to perform search operation. (See FIG. C-82)Step—4: Click on any dependent id for selectionStep—5: This displays a screen with contents ready for any modification. The procedure and flow of modification are similar to the procedures explained for Small Employer Group

Inactivate Dependent

The inactivate dependent screen is to make a employee from activate state to inactivate.

The sequential steps involved in the inactivate dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Then select the option Dependent Enrollment and Inactivate Dependent. (See FIG. C-83)Step—2: This navigates to dependent search screen. (See FIG. C-84)Step—3: This pop ups a screen with the search result. (See FIG. C-85)Step—4: Click on any dependent id for selection. This navigates to a screen confirming for the selected employee to make inactivate. Click Inactivate button. (See FIG. C-86)Step—5: Confirms the status Click search button navigates to Dependent search screen. (See FIG. C-87)

Modify Individual Member

The screen is to have modification of details pertaining to an individual member. The screen provides functionality to save, edit or add new individual member details.

The sequential steps involved in modify individual member are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option Individual Member. Then Select Individual member and modify individual member. (See FIG. C-88)Step—2: Navigates to search screen individual employee. Either enters the id or first letter of employee name to perform search operation. Click search button. (See FIG. C-89)Step—3: This pops up a screen with the search result. (See FIG. C-90)Step—4: Click on any employee id for selectionStep—5: This navigates to general information pertaining to individual employee screen. The process of modifying individual member is similar to the process explained for Individual Member.

Inactivate Individual Member

The screen is to inactivate individual member from active state.

The sequential steps involved in inactivate individual member are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option Individual Member. Then Select Individual member and inactivate individual member. (See FIG. C-91)Step—2: Navigates to search screen individual employee. Enter value in any one of the fields or simply click search button to perform search operation.Step—3: This pops up a screen with the search result. (See FIG. C-92)Step—4: Click on any employee id for selection. This navigates to a screen confirming for the selected employee to make inactivate. Click Inactivate button. (See FIG. C-93)Step—5: Confirms the status. Click search to navigate back to Group search screen. (See FIG. C-94)

Create Dependent

The screen is to create a dependent for an individual employee member.

The sequential steps involved in creating a dependent for an individual member are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option Individual Member. Then Select Individual member dependent and create dependent. (See FIG. C-95)Step—2: Navigates to search screen individual employee. Enter value in any one of the field. (See FIG. C-96)Step—3: This pops up a screen with the search result. (See FIG. C-97)Step—4: Click on any employee id for selection. This navigates to add dependent screen. The process of creating a dependent is similar to the process explained for Individual Member creating a group by alternate with option.

Modify Dependent

The screen is to create a dependent for an individual member.

The sequential steps involved in creating a dependent for an individual member are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option Individual Member. Then Select Individual member dependent and modify dependent. (See FIG. C-98)Step—2: Navigates to search screen individual dependent. Either enters the id or first letter of employee name to perform search operation. Click search button. (See FIG. C-99)Step—3: This pops up a screen with the search result. (See FIG. C-100)Step—4: Click on any dependent id for selection. This navigates to add dependent screen. The process of creating a dependent is similar to the process explained for Individual Member creating a group by alternate with option

Inactivate Dependent

The screen is to inactivate a dependent for an individual member.

The sequential steps involved in creating a dependent for an individual member are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option Individual Member. Then Select Individual member dependent and inactivate dependent. (See FIG. C-101)Step—2: Navigates to search screen individual dependent. Either enters the id or first letter of employee name to perform search operation. Click search button. (See FIG. C-102)Step—3: This pops up a screen with the search result. (See FIG. C-103)Step—4: Click on any employee id for selection. This navigates to a screen confirming for the selected employee to make inactivate. Click Inactivate button. (See FIG. C-104)Step—5: Confirms the status of inactivation. Click search button to navigate back to dependent search. (See FIG. C-105)

Access

The application can be accessed from the main menu as follows:Enrollment→COBRA Enrollment→New COBRA to Existing COBRA

All master records must be available in the system for a successful enrollment. Master Records are as follows:Carrier Maintenance—Refer “User Manual for Carrier Maintenance” for further information on the master records.Work Group—Refer “User Manual for Sales and Marketing” for further information on the Work Group records.Internal Associates—Refer “User Manual for Sales and Marketing” for further information on the Internal Associates records.Association Master—Refer Section 2 of this document on “Association”.Eligibility Criteria (New Business COBRA)—members must satisfy eligibility rule for COBRA.Member for existing COBRA Enrollment must be in termed status.

Application Functions

This application can be sub divided into following major functions:New COBRA Enrollment—New COBRA Enrollment for the Group who bring in their existing COBRA members into the PacAdvantage consist of the following operations:Create New COBRA—to input details of a COBRA members is for a specific group.Modify New COBRA—to search a COBRA prior to enrollment for making modifications.Inactivate New COBRA—to search a COBRA prior to enrollment for making inactive.Existing COBRA Enrollment—Existing COBRA Enrollment is for those employee and or dependents that have terminated from the existing group due to various reasons. This consist of the following operations:Create Existing COBRA—to input details of a COBRA members for a specific group wherein the members are terminated.Modify Existing COBRA—to search a COBRA Group of the termed members for making modifications prior to enrollment.Inactivate Existing COBRA—to search a COBRA Group of the termed members for inactivating prior to enrollment.

The screen is to create new COBRA. The screen provides functionality to save, edit or add new COBRA.

The sequential steps involved in create new COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select COBRA Enrollment. Select the New COBRA and then select Create COBRA. (See FIG. C-106)Step—2: The screen navigates to group search for adding COBRA. Enter value in any one of the fields, or simply click Search to perform search operation. (See FIG. C-107)Step—3: The screen displays the search result. (See FIG. C-108)Step—4: Choose a group id.Step—5: Choose the option of enrolling as single or member with dependents. If the option is with dependents, enter number of dependents.Step—6: Click continue buttonStep—7: Screen navigates to general info for new business COBRA group. First name and last name are mandatory and other fields are optional. Enter the values in the respective field as per the format briefed in field's explanation section. Click continue button. (See FIG. C-109)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionParent Group IDText to display the Parent Group ID.Parent GroupText to display the Parent Group Name.NameCOBRA Group IDText to display the COBRA Group ID.COBRA TypeText to display the COBRA Group Typewhether Cal COBRA or Federal COBRA.Group EffectiveText to display effective date of the parentDategroup.Work GroupText to Display the internal Work groupassociated with the Parent GroupStatusText to display status of the group.Post Mark DateText for post mark date. Choose a date byclicking calendar icon. Accepts in theformat MM/DD/YYYYReceived DateText for received date. Choose a date byclicking calendar icon. Accepts in theformat MM/DD/YYYYSalutationChoose the salutation from the drop downlist of salutations available.First NameThe text for first name. Accepts alphabets andspecial character like hyphen and single quotesnot exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabetsnot exceeding 1 character.Last NameThe text for last name. Accepts alphabets andspecial characters like hyphen and singlequotes not exceeding35 characters. Last name is mandatory.SuffixChoose the Suffix from the drop down list ofsalutations available.Date of BirthThe text for date of birth. Choose a date byclicking calendar iconSocial SecurityThe text for social security number for everyNumberindividual. This can also be auto generated byclicking auto generate link. Accepts numericvalue of exactly 9 digits. Users with UserRole as Level 2 and above can only autogenerate SSN.GenderChoose a gender from the drop down listavailable.Address Information: Physical Home Address or Mailing AddressAddressThe text for company address. Acceptsalphabets and numeric values not exceeding35 charactersAptThe text for company suite/apt # Acceptsalphabets and numeric values of not exceeding35 charactersZipThe text for zip. Accepts numeric of either 5or 9 digits. City, State and County are populatedautomatically for the correct zip code.CityThe text for city. Accepts alphabets of notexceeding 30 characters.StateChoose the name of the state from the dropdown list of States available in United Statesof AmericaCountyChoose the name of the county from the dropdown list of States available in United Statesof AmericaMode ofChoose the mode of correspondence fromCorrespondencethe drop down list availablePhone NumberThe text for telephone number of the contactperson. Accepts numeric values of notexceeding 10 digits.The format is (999) 999-9999ExtensionThe text for telephone number of the contactperson. Accepts numeric values of notexceeding 5 digits.The format is (999) 999-9999FaxThe text for fax number of the contactperson. Accepts numeric values of notexceeding 10 digits. The format is 9999EmailThe text for email of the contact person.Accepts alphabets, numeric and specialcharacters in the standard email formatof length not exceeding 100 characters

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Billing Informationscreen and the system generates Group ID.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—8: Screen navigates billing info of group. Enter the values in the respective field as per the format briefed in field's explanation section. Click continue. (See FIG. C-110)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the dropdown list available. Based on selectioncorresponding fields will enable to enterthe values. For e.g. if the value selected iscard payment, EFT will be disabled andallows only entering card details andvice versa.Credit Card InformationCardholder'sThe text for cardholder's name. AcceptsNamesalphabets and space between two words.Credit Card TypeChoose the type of credit card from thedrop down list available.Credit Card NoThe text for credit card number. Acceptsnumeric values not exceeding 30 digitsExpiration DateChoose a month of expiration from thedrop down list availableExpiration YearThe text for expiration year. Acceptsnumeric values of exactly 4. Example2002.Billing Address As it appears on the credit CardStreet AddressThe text for company address. Acceptsalphanumeric and special characters notexceeding 35 characters.ZIPThe text for zip. Accepts numeric valueof either 5 or 9 digits.StateThe text for city. Accepts alphabets andspace between two words not exceeding30 characters.CityChoose the name of the state from thedrop down list of States available inUnited States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabetsand space between two words.Routing NumberThe text for routing number. Acceptsnumeric values not exceeding 9 digits.Account NumberThe text for account number. Acceptsnumeric values not exceeding 9 digits.Account TypeChoose the type of account from the dropdown list available.Depositor's NameThe text for depositor's name. Acceptsalphabets and space between two words.Initial Payment InformationAmount ReceivedThe text for amount received. Acceptsonly numeric values in the format999999999.99Date ReceiveThe text for date received. Choose fromthe calendar icon in the formatMM/DD/YYYY.Check #The text for check number. Acceptsnumeric values not exceeding 9 digits.No Check ReceivedCheck the option of no checks receivedfor any non-receipt of checks.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to coverage Informationscreen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—9: Screen navigates coverage info of group. Enter the values in the respective field as per the format briefed in field's explanation section. Click continue. (See FIG. C-111)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionCOBRA effectiveThe text for COBRA effective date. Choose a datedateby clicking calendar iconQualifying eventChoose a qualifying even from the drop down listavailableCOBRA end dateThe text for COBRA end date. Choose a date byclicking calendar iconSend bill toChoose the option of sending the bills either togroup or self (individual)Plan InformationLine of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if theemployee is waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down listavailablePCP ID/MedicalThe text for PCP ID. Accepts alphabets andgroup IDnumeric values not exceeding 10 characters.Are you an existingClick the check box if you are an existing patientpatientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down listavailablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insuranceThe text for insurance end date. Choose a date byend dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverage keptThe text for other coverage. Accepts alphabets withvalues not exceeding 50 characters.RAFThe text to display RAF applicable for the PrimaryGroup.Employee signatureClick the check box, to have employee signatureDate signedThe text for date signed. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Date cannot accept future date.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information.It is only a temporary addition. Becomes permanentonly on saving the record.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the recordsin the table that are checked.COBRA SummaryClick COBRA summary refreshes the screen anddisplay the summary of information entered forCOBRA creationContinueNavigates add dependent screen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the contentthat are changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—10: Screen navigates to add dependent screen. Enter the values in the respective field as per the format briefed in field's explanation section. Click Continue. (See FIG. C-113)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceed-ing 35 characters. Last name is mandatory.SuffixChoose the suffix from the drop down list of suffixesavailable.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Birth date cannot be later than thecurrent date.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by click-ing auto generate link. Accepts numeric value ofexactly 9 digits. Users with User Role as Level 2 andabove can only auto generate SSN.GenderChoose a gender from the drop down list available.RelationshipChoose the relationship from the drop down listavailable.Street AddressThe text for address. Accepts alphanumeric andspecial characters with values not exceeding 35charactersSuiteThe text for suite/apt #. Accepts alphanumeric andspecial characters with values not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or9 digits. City, and State are populated automaticallyon entering the correct zip code and entering the tabkey.CityThe text for city. Accepts alphabets not exceeding 30characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaSelected carrierThe text for selected carrier. It is a read only fieldCoverage choiceThe text for coverage. It is a read only fieldService areaThe text for service area. It is a read only fieldPrior plan typeChoose a plan type from the drop down list availablePrior planThe text for plan name. Accepts alphabetsWaivedClick the check box if medical is waivedStart dateThe text for start date. Choose a date by clickingcalendar iconEnd dateThe text for end date. Choose a date by clickingcalendar iconPCP ID/The text for PCP ID. Accepts alphabetsPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotesPCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotesDisabled dependentClick the option of temporary or permanent. This isenable if the relationship opted is childDomestic partnerClick the option for domestic partner. It depends onthe value selected in relationshipLegal guardianClick the option for legal guardian. It depends on thevalue selected in relationshipSignatureClick the check box if the signature is opted

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of dependent information. It is only atemporary addition.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesContinueScreen navigates to Missing info.TabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—11: Missing info screen displays the information that is left out while creating a COBRA. Enter the values in the respective field as per the format briefed in field's explanation section. Click Enroll. (See FIG. C-114)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of theText for the Name of the GroupGroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupProposedThe text for Proposed Effective Date. Choose a date byEffectiveclicking calendar icon. Date accepts the formatDateMM/DD/YYYY. Default effective date is first of thefollowing month. Effective date cannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internal workgroup attached to the Group. Internal is based on thewriting agent's work group.Tree StructureEnrollment Missing Information is broken down intotree structure. The tree can by expanded or collapsed.The level of the tree is as per the example given below:− Employee− Dependent− DependentWhere (−) signifies expanded view and (+) signifiescollapsed view.Group MissingThis identifies all the eligibility rules and theInfoinformation that are incomplete on Group level forcompleting the enrollment process.Missing EntitiesList the missing entities for the group. Provides a linkto go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EmployeeThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on Employee level forcompleting the enrollment process.Missing EntitiesList the missing entities for the employee. Provides alink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.DependentThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on dependent level forcompleting the enrollment process.Missing EntitiesList the missing entities for the dependent. Provides alink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EnrollmentChoose from the drop down list the action to beActionperformed for enrollment. Enroll/DeclineRemarksText for remarks if any.Reasons forChoose from the drop down list the reasons for decline.DeclineReasons forText for other reason. If the reason for decline is otherOtherthan the reasons available.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionEnrollSaves the data if there are no missing information andnavigates to enrollment confirmation page.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment missing information shows record for 5employees on single screen. If the employee sizeincreases more than 5. These buttons are used fornavigating to the next and previous records forviewing.<< - Show first record(s)< - Show previous record(s)> - Show next record(s)>> - Show last record(s)Group IDClick Group ID to navigates to the Group's general infoscreen.Preview InvoiceClick Preview Invoice to pop up a new browser windowto preview the invoice for the group

Missing InformationThe following table provides explanation for each missing information and what needs to be done to remove missing information from the screen

Missing EntityMessageReasons/RemedyMember LevelGeneralThese are missing information pertains to theInformationMember Level information required in theCOBRA Member General Information ScreenAddressAddress information isFill in the addressnot specifiedinformation in theEmployee General InfoScreenCityCity is not specifiedFill in the City in theEmployee General InfoScreenStateState is not specifiedFill in the City in theEmployee General InfoScreenZIP CodeZIP Code is not specifiedFill in the ZIP Code in theEmployee General InfoScreenDate of BirthDate of Birth is notFill in the Date of Birth inspecifiedthe Employee GeneralInfo ScreenGenderGender is not specifiedChoose the Gender in theEmployee General InfoScreenSSNSSN is not specifiedFill in the SSN in theEmployee General InfoScreen. If the employeerefuse to provide SSNthen click auto generateSSN/Unique ID in theEmployee General InfoScreen. Auto generationof SSN/Unique ID will beavailable only for the userwith role as level II andaboveMode ofMode of CorrespondenceChoose the Mode ofCorrespondenceis not specifiedCorrespondence forEmployee from the list inEmployee general infoscreenEmailEmail for Employee is notThis is required if thespecifiedmode of correspondenceselected is Email. Fill inthe Email in theEmployee general infoscreenBillingThese missing information pertains to the GroupInformationLevel information required in the BillingInformation ScreenMode of paymentMode of payment is notChoose the Mode ofspecifiedPayment for the groupfrom the list in GroupBilling Info ScreenCheck NumberCheck Number is notFill in the Check numberspecified.in the Group Billing InfoScreenCheck DateDate Check received isFill in the Date receivednot specifiedin the Group Billing InfoScreenCheck NumberCheck Number received isFill in the Check Numbernot specifiedin the Group Billing InfoScreenCardholder'sCardholder's name is notThis is required if theNamespecifiedmode of payment opted bygroup is Credit Card. Fillin the Cardholder's namein the Group Billing InfoScreen.Credit Card TypeCredit Card Type is notThis is required if thespecified.mode of payment opted bygroup is Credit CardChoose the Credit CardType for the group fromthe list in Group BillingInfo ScreenCredit CardCredit Card Number isThis is required if theNumbernot specifiedmode of payment opted bygroup is Credit Card. Fillin the Credit CardNumber in the GroupBilling Info Screen.Expiration DateCredit Card ExpirationThis is required if theDate is not specifiedmode of payment opted bygroup is Credit Card. Fillin the Credit CardExpiration Date in theGroup Billing Info Screen.Bank NameBank name is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theBank Name in the GroupBilling Info Screen.Routing NumberRouting Number is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theRouting Number in theGroup Billing Info Screen.Account TypeAccount Type is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theAccount Type in theGroup Billing Info ScreenDepositor's NameDepositor's Name is notThis is required if thespecifiedmode of payment opted bygroup is EFT. Fill in theDepositor's Name in theGroup Billing Info ScreenCoverageThese missing information pertains to the GroupInformationLevel information required in the CoverageInformation ScreenCOBRAQualifying Event is notChoose the QualifyingQualifyingspecifiedEvent for the group fromEventthe list in CoverageInformation ScreenCOBRA EndCOBRA End Date notChoose the QualifyingDatespecifiedEvent for the group fromthe list in CoverageInformation Screen toautomatically calculatethe COBRA end datebased on the QualifyingeventSend Bill ToWhere COBRA bill needsChoose one of the optionto be sent is not specifiedspecified (Group or Self)in Coverage InformationScreenLine of CoverageNo line of Coverage isChoose one of the line ofopted by the membercoverage in CoverageInformation ScreenPlan SelectionNo Plan is elected by theChoose one of the plan inmemberCoverage InformationScreenMedical LOCMedical Line of coverageMedical line of coverage isnot elected by Memberrequired to decide theCoverage Choice. ChooseMedical line of coveragein Coverage InformationScreenCoverage ChoiceNo coverage choiceMedical line of coverage isspecified for Medical Linerequired to decide theof coverageCoverage Choice. Choosecoverage choice inCoverage InformationScreenCoverageNo coverage choiceThis is required if theChoice - Dentalspecified for Dental Linemember opts for Dentalof coveragePlan. Choose coveragechoice in CoverageInformation ScreenCoverageNo coverage choiceThis is required if theChoice - Visionspecified for Vision Linemember opts for Visionof coveragePlan. Choose coveragechoice in CoverageInformation ScreenCoverageNo coverage choiceThis is required if theChoice - CAMspecified for CAM Line ofmember opts for CAMcoveragePlan. Choose coveragechoice in CoverageInformation ScreenDependent CountNumber of Dependents isThis would be the casenot sufficient to satisfywhen the dependentCoverage Choice.information is not enteredinto the system. AddDependent.This can also occur if thenumber of dependent asspecified in coveragechoice does not matchwith the dependentsavailable. Add Dependent.EmployeeEmployee signature isVerify employee'sSignaturemissingsignature and checkEmployee Signaturecheckbox in the EmployeeCoverage Info ScreenDate SignedDate Signed is missingVerify Date signed and fillin the Date Signed in theEmployee Coverage InfoScreenPlan availabilityMedical Plan selected byNormally the Plan for thethe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Plan availabilityDental Plan selected byNormally the Plan for thethe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Plan availabilityVision Plan selected byNormally the Plan for thethe Employees notemployee is listed basedavailable in the serviceon the Plan available inarea.the employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.Plan availabilityCAM Plan selected by theNormally the Plan for theEmployees not availableemployee is listed basedin the service area.on the Plan available inthe employees ServiceArea. Rare cases if theUser Modifies the ZIPCode in the EmployeeGeneral Info Screen andfails to update the Planfor the specific ZIP code,Service Area combinationthis message would beshown. Pick the plansthat are available for theEmployee in theEmployee Coverage Infoscreen.DependentThese missing information pertains to theInformationDependent Level information required in theDependent Information ScreenDate of BirthDate of Birth is notFill in the Date of Birth inspecifiedthe Dependent GeneralInfo ScreenGenderGender is not specifiedChoose the Gender in theDependent General InfoScreenSSNSSN is not specifiedFill in the SSN in theDependent General InfoScreen. If the dependentrefuse to provide SSNthen click auto generateSSN/Unique ID in theDependent General InfoScreen. Auto generationof SSN/Unique ID will beavailable only for the userwith role as level II andaboveRelationshipRelationship of theChoose the dependentdependent with therelationship from theemployee not specifiedDependent Info ScreenRelationship -Relationship, child isVerify if the child isChildspecified for child abovedisabled and choose if23 years of ageDisabled Permanent orTemporary.SignatureDependent signature isThis is required if themissingdependent age is above18. Verify the signaturefor the dependent andcheck the checkboxSignature in thedependent info screenRelationshipNumber of spouse is moreCheck for the relationshipthan onein the dependent infoscreen. There can only beone of the followingrelationship for thedependent:Spouse or Ex - Spouse ordomestic partner.Choose differentrelationship for the otherdependent in thedependent info screenStep—12: On clicking enroll button, screen navigates to confirmation screen, for having created a group under COBRA Enrollment. Click search button to navigate back to Group Search screen. (See FIG. C-115)

Modify COBRA

The screen is to have modification of details pertaining to a COBRA member. The screen provides functionality to save, edit or add new member details.

The sequential steps involved in modify COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option COBRA Enrollment. Then New COBRA and modify COBRA. (See FIG. C-116)Step—2: Navigates to group COBRA search screen. Enter value in any one of the fields, or simply click Search to perform search operation. (See FIG. C-117)Step—3: This pops up a screen with the search result. (See FIG. C-118)Step—4: Click on any group id for selectionStep—5: This navigates to general information pertaining to group screen. The process of modifying group is similar to the process explained vide from step 7 through step 12 of creating a COBRA group

Inactivate COBRA

The screen is to inactivate a COBRA from the active status.

The sequential steps involved in inactivate a COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the option COBRA Enrollment. Then select New COBRA and inactivate COBRA. (See FIG. C-119)Step—2: Navigates to group COBRA screen. Enter value in any one of the fields, or simply click Search to perform search operation. (See FIG. C-120)Step—3: This pops up a screen with the search result. (See FIG. C-121)Step—4: Click on any group id for selection. This navigates to a screen confirming for the selected group to make inactivate. Click Inactivate button. (See FIG. C-122)Step—5: Confirms the status. (See FIG. C-123)

The screen is to create COBRA for existing type. The screen provides functionality to save, edit or add new COBRA.

The sequential steps involved in create new COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select COBRA Enrollment. Select the Existing COBRA and then select Create COBRA. (See FIG. C-124)Step—2: The screen navigates to employee search for adding COBRA. Enter employee id or enter first letter of employee name for search. Click Search button. (See FIG. C-125)Step—3: The screen displays the search result. (See FIG. C-126)Step—4: Click on employee id.Step—5: Choose the option of sending bill either to group or self. Enter the date by clicking calendar icon, provided if the check box is clicked for verified member signature. (See FIG. C-127)Step—6: Choose the Member and state COBRA Election options for each member from the table and clicks continue.Step—7: Screen navigates to general info of group. First name and last name are mandatory and other fields are optional. Enter the values in the respective field, as per the format briefed in field's explanation section. (See FIG. C-128)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionParent Group IDText to display the Parent Group ID.Parent GroupText to display the Parent Group Name.NameCOBRA Group IDText to display the COBRA Group ID.COBRA TypeText to display the COBRA Group Type whether CalCOBRA or Federal COBRA.Group EffectiveText to display effective date of the parent group.DateWork GroupText to Display the internal Work group associatedwith the Parent GroupStatusText to display status of the group.Post Mark DateText for post mark date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYReceived DateText for received date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYSalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceed-ing 35 characters. Last name is mandatory.SuffixChoose the Suffix from the drop down list ofsalutations available.Date of BirthThe text for date of birth. Choose a date by clickingcalendar iconSocial SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.Address Information: Physical Home Address or Mailing AddressAddressThe text for company address. Accepts alphabets andnumeric values not exceeding 35 charactersAptThe text for company suite/apt # Accepts alphabetsand numeric values of not exceeding 35 charactersZipThe text for zip. Accepts numeric of either 5 or 9digits. City, State and County are populatedautomatically for the correct zip code.CityThe text for city. Accepts alphabets of not exceeding30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop downlist of States available in United States of AmericaMode ofChoose the mode of correspondence from the dropCorrespondencedown list availablePhone NumberThe text for telephone number of the contact person.Accepts numeric values of not exceeding 10 digits.The format is (999) 999-9999ExtensionThe text for telephone number of the contact person.Accepts numeric values of not exceeding 5 digits. Theformat is (999) 999-9999FaxThe text for fax number of the contact person. Acceptsnumeric values of not exceeding 10 digits. The formatis 9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Billing Informationscreen and the system generates Group ID.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—8: Enter the values in the respective field, as per the format briefed in field's explanation section. Screen can be navigated to Billing Info by either clicking continue button or through other respective tabs. (See FIG. C-129)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop down listavailable. Based on selection corresponding fieldswill enable to enter the values. For e.g. if the valueselected is card payment, EFT will be disabled andallows only entering card details and vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. Accepts alphabetsNamesand space between two words.Credit Card TypeChoose the type of credit card from the drop downlist available.Credit Card NoThe text for credit card number. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expiration from the drop downlist availableExpiration YearThe text for expiration year. Accepts numeric valuesof exactly 4. Example 2002.Billing AddressAs it appears on the credit CardStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 characters.ZIPThe text for zip. Accepts numeric value of either 5or 9 digits.StateThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.CityChoose the name of the state from the drop down listof States available in United States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number. Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number. Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of account from the drop down listavailable.Depositor's NameThe text for depositor's name. Accepts alphabets andspace between two words.Initial Payment InformationAmount ReceivedThe text for amount received. Accepts only numericvalues in the format 999999999.99Date ReceiveThe text for date received. Choose from the calendaricon in the format MM/DD/YYYY.Check #The text for check number. Accepts numeric valuesnot exceeding 9 digits.No Check ReceivedCheck the option of no checks received for any non-receipt of checks.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to coverage Informationscreen.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—9: Screen can be navigated to Coverage Info by either clicking continue button or through other respective tabs. Enter the values in the respective field, as per the format briefed in field's explanation section. (See FIG. C-130)

Fields ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionPlan ElectionChoose PlanClick on the check box to select the plan.Send bills toChoose the Option Group or Self for “Send bill to”.Member SignatureCheck this if member signature is verifiedDate SignedThe text for Date Signed. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to either Dependent InfoScreen or COBRA Summary screen.Cobra SummarySaves the data and Navigates COBRA Summaryscreen.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—10: Screen can be navigated to Dependent Info by either clicking continue button or through other respective tabs. (See FIG. C-131)Step—11: Dependent Screen for COBRA is Display only screen. Click continue to navigate to COBRA Missing Info screen. (See FIG. C-132)

Field ExplanationThe following table provides explanation for each button in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of theText for the Name of the GroupGroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupProposedThe text for Proposed Effective Date. Choose a date byEffectiveclicking calendar icon. Date accepts the formatDateMM/DD/YYYY. Default effective date is first of thefollowing month. Effective date cannot be past dateStatusText to specify the status of the group.Pend DateDate FinalizedWork GroupText for Work Group. This specifies the internal workgroup attached to the Group. Internal is based on thewriting agent's work group.Tree StructureEnrollment Missing Information is broken down intotree structure. The tree can by expanded or collapsed.The level of the tree is as per the example given below:− Employee− Dependent− DependentWhere (−) signifies expanded view and (+) signifiescollapsed view.Group MissingThis identifies all the eligibility rules and theInfoinformation that are incomplete on Group level forcompleting the enrollment process.Missing EntitiesList the missing entities for the group. Provides a linkto go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EmployeeThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on Employee level forcompleting the enrollment process.Missing EntitiesList the missing entities for the employee. Provides alink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.DependentThis identifies all the eligibility rules and theMissing Infoinformation that are incomplete on dependent level forcompleting the enrollment process.Missing EntitiesList the missing entities for the dependent. Provides alink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EnrollmentChoose from the drop down list the action to beActionperformed for enrollment. Enroll/DeclineRemarksText for remarks if any.Reasons forChoose from the drop down list the reasons for decline.DeclineReasons forText for other reason. If the reason for decline is otherOtherthan the reasons available.

Button FunctionalityThe following table provides explanation for each button in the screen.

ElementDescriptionEnrollSaves the data if there are no missing information andnavigates to enrollment confirmation page.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment missing information shows record for 5employees on single screen. If the employee sizeincreases more than 5. These buttons are used fornavigating to the next and previous records forviewing.<< - Show first record(s)< - Show previous record(s)> - Show next record(s)>> - Show last record(s)Group IDClick Group ID to navigates to the Group's general infoscreen.Preview InvoiceClick Preview Invoice to pop up a new browser windowto preview the invoice for the groupStep—12: On clicking enroll button, screen navigates to confirmation screen, for having created a group under COBRA Enrollment. Click search button to navigate back to Group Search screen. (See FIG. C-133)

Modify COBRA

The screen is to modify COBRA details for existing type. The screen provides functionality to save, edit or add new COBRA.

The sequential steps involved in modify COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the Existing COBRA and then select New COBRA. (See FIG. C-134)Step—2: The screen navigates to group search for adding COBRA. Enter group id or enter first letter of group name for search. Click Search button. (See FIG. C-135)Step—3: This pops up a screen with the search result.Step—4: Click on any group id for selection. Screen navigates to general info screen pertaining to group. The process and flow for modification are similar to that of creating a group, which are explained vide step 7 through step 11

Inactivate COBRA

The screen is to inactivate a COBRA details from its active in existing type. (See FIG. C-136)

The sequential steps involved in inactivating COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select New Business Enrollment. Select the Existing COBRA and then select Inactivate COBRA. (See FIG. C-137)Step—2: The screen navigates to group search for COBRA. Enter group id or enter first letter of group name for search. Click Search button. (See FIG. C-138)Step—3: This pops up a screen with the search result.Step—4: Click on any group id for selection. This navigates to a screen confirming for the selected group to make inactivate. Click Inactivate button. (See FIG. C-139)Step—5: Confirms the status. Click Search navigates employee search screen. (See FIG. C-140)

Termination is the transaction module that encompasses the process of terminating the group and member enrolled with PacAdvantage in the PX2 System. This process allows terminating Groups, Members and dependent from the PacAdvantage program.

Access

The application can be accessed from the main menu as follows:Enrollment→Termination→Group Termination→Employee Termination→Dependent Termination→Multiple Group Termination

The groups and member must exist in the system for the termination process to occur.

Application Functions

This application has the following functions for termination:Group Termination—to terminate a groupEmployee Termination—to terminate an employeeDependent Termination—to terminate a dependentMultiple Group Termination—to terminate multiple groups

Group Termination

The screen is to terminate a group.

The sequential steps involved in terminating a group are listed below.Step—1: After successful logon, click the menu Enrollment and select Termination. Then select Group Termination. (See FIG. C-141)Step—2: The screen navigates to group search to select a group. Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-142)Step—3: This pops up a screen with search result. (See FIG. C-143)Step—4: Click on any group id for selection. The screen navigates to term request (See FIG. C-144)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continue.Step—6: Screen navigates to process term. Enter the details of effective term date and change term status and click Continue. (See FIG. C-145)Step—7: Confirms the termination of a group. (See FIG. C-146)Step—8: Click Search button to go back to Group Search screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionRequest for TermMode ofChoose a mode of request from the drop down listRequestavailable. The field is mandatory.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.Date ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The receiveddate cannot be greater than system date. The field ismandatory.Request TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon. Therequest term date should be the last day of thatparticular month except in case of death. The field ismandatory.Reason forChoose a reason from the drop down list The field isTermmandatory.OthersThe text for narrating other info, provided the optionfor reason for terms is othersAuthorizedChoose Authorized contact from the list. The field iscontactmandatory.Process TermEffective TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon.Change TermChoose a status from the drop down list for changeStatusterm

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in theflow of termination.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Employee Termination

The screen is to terminate an employee.

The sequential steps involved in terminating an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select Termination. Then select Employee Termination. (See FIG. C-147)Step—2: The screen navigates to employee search to select a group. Enter value in any of the field or simply click Search button to perform. search operation. (See FIG. C-148)Step—3: This pops a screen with search result.Step—4: Click on any employee id for selection. The screen navigates to term request. (See FIG. C-149)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continue.Step—6: Screen navigates to process term. Enter the details of effective term date and change term status and click Continue. (See FIG. C-150)Step—7: Confirms the termination of a employee. (See FIG. C-151)Step—8: Clicking Search button leads to Employee search screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionRequest for TermMode of RequestChoose a mode of request from the drop down listavailable. This field is mandatory.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system dateThis field is mandatory.Date ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The Datereceived cannot be greater than system date. This fieldis mandatory.Request TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon. Therequest term date should be the last day of thatparticular month. This field is mandatory.Reason for TermChoose a reason from the drop down listOthersThe text for narrating other info, provided the optionfor reason for terms is othersAuthorizedThe text for authorized contact. The field iscontactmandatory.Process TermEffective TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon.Change TermChoose a status from the drop down list for changeStatusterm

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in the flowof termination.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Dependent Termination

The screen is to terminate a dependent.

The sequential steps involved in terminating a dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Termination. Then select Dependent Termination. (See FIG. C-152)Step—2: The screen navigates to dependent search to select a group. Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-153)Step—3: This pops a screen with search result. (See FIG. C-154)Step—4: Click on any dependent id for selection. The screen navigates to term request. (See FIG. C-155)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continue.Step—6: Screen navigates to process term. Enter the details of effective term date and change term status and click Continue. (See FIG. C-156)Step—7: Confirms the termination of a dependent. (See FIG. C-157)Step—8: Click Search button to navigate back to Dependent Search screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionRequest for TermMode of RequestChoose a mode of request from the drop down listavailable. The field is mandatory.Post Mark DateThe text for postmark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.Date ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The DateReceived cannot be greater than system date. The fieldis mandatory.Request TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon. Therequest term date should be the last day of thatparticular month. The field is mandatory.Reason for TermChoose a reason from the drop down list. The field ismandatory.OthersThe text for narrating other info, provided if the optionfor reason for terms is othersAuthorizedThe text for authorized contact. The field iscontactmandatory.Process TermEffective TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon.Change TermChoose a status from the drop down list for changeStatusterm

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in the flowof termination.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Multiple Group Termination

The screen is to terminate multiple groups.

The sequential steps involved in terminating multiple groups are listed below.Step—1: After successful logon, click the menu Enrollment and select Termination. Then select Multiple Group Termination. (See FIG. C-158)Step—2: The screen navigates to term request Enter the fields with appropriate values as per the format briefed in field's explanation. Click continue. (See FIG. C-159)Step—3: Confirms the termination of a groups. (See FIG. C-160)Step—4: Click search button to navigate back to Group Termination screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionRequest for TermMode of RequestChoose a mode of request from the drop down listavailablePost Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepost mark date cannot be greater than system dateDate ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The postmark date cannot be greater than system dateRequest TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon. Therequest term date should be the last day of thatparticular monthReason for TermChoose a reason from the drop down listOthersThe text for narrating other info, provided if the optionfor reason for terms is others

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in the flowof termination.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Reinstatement is the transaction module that encompasses the process of reinstating the group and member enrolled with PacAdvantage in the PX2 System. This process allows reinstating Groups, Members and dependent to the PacAdvantage program.

Access

The application can be accessed from the main menu as follows:Enrollment→Reinstatement→Group Reinstatement→Employee Reinstatement→Dependent Reinstatement

The groups and member must exist in the system and also terminated for processing reinstatement.

Application Functions

This application has the following functions for reinstatement:Group Reinstatement—to reinstate a groupEmployee Reinstatement—to reinstate an employeeDependent Reinstatement—to reinstate a dependent

Group Reinstatement

The screen is to reinstate a group.

The sequential steps involved in reinstating a group are listed below.Step—1: After successful logon, click the menu Enrollment and select Reinstatement. Then select Group Reinstatement. (See FIG. C-161)Step—2: The screen navigates to group search to select a group. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-162)Step—3: This pops up a screen with search result. (See FIG. C-163)Step—4: Click on any group id for selection. The screen navigates to reinstate request. (See FIG. C-164)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continueStep—6: Screen navigates to process reinstate. Enter the details of effective term date and change term status and click Continue. (See FIG. C-165)Step—7: Confirms the reinstatement of a group. (See FIG. C-166)Step—8: Click Search button to go back to Group Search screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionInitiate Group ReinstatementMode of RequestChoose a mode of request from the drop down listavailable. The field is mandatory.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.Date ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The DateReceived cannot be greater than system date. The fieldis mandatory.RequestThe text for request term date. Choose a date in theReinstateformat MM/DD/YYYY by clicking calendar icon. TheDaterequest reinstate date should be the first day of nextmonth. The field is mandatory.Reason forChoose a reason from the drop down list. The field isReinstatemandatory.OthersThe text for narrating other info, provided the optionfor reason for reinstate is othersAuthorizedThe text for authorized contact. The field iscontactmandatory.Process ReinstatementEffective TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon.Change ReinstateChoose a status from the drop down list for changeStatusreinstate

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in the flowof reinstatement.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Employee Reinstatement

The screen is to reinstate an employee.

The sequential steps involved in reinstating an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select Reinstatement. Then select Employee Reinstatement. (See FIG. C-167)Step—2: The screen navigates to employee search to select a group. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-168)Step—3: This pops a screen with search result. (See FIG. C-169)Step—4: Click on any employee id for selection. The screen navigates to reinstate request. (See FIG. C-170)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continue.Step—6: Screen navigates to process reinstate. Enter the details of effective term date and change status and click Continue. (See FIG. C-171)Step—7: Confirms the reinstate of an employee. (See FIG. C-172)Step—8: Click Search button to navigate back to Employee Search screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionInitiate Employee ReinstatementReason for TermText for reason for term. The field is read onlyTerm DateText for termination date. Field is read only.Mode of RequestChoose a mode of request from the drop down listavailable. The field is mandatory.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.Date ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The DateReceived cannot be greater than system date. The fieldis mandatory.Request ReinstateThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon. Therequest reinstate date should be the first day of nextmonth. The field is mandatory.Reason forChoose a reason from the drop down list. The field isReinstatemandatory.OthersThe text for narrating other info, provided the optionfor reason for reinstate is othersAuthorizedThe text for authorized contact. The field iscontactmandatory.Process ReinstatementEffective TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon.Change ReinstateChoose a status from the drop down list for changeStatusreinstate

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in the flowof termination.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Dependent Reinstatement

The screen is to reinstate a dependent.

The sequential steps involved in reinstating a dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Reinstatement. Then select Dependent Reinstatement. (See FIG. C-173)Step—2: The screen navigates to dependent search to select a group. Enter dependent id or enter first letter of dependent name for search. Click Search button. (See FIG. C-174)Step—3: This pops a screen with search result. (SeeFIG. 175)Step—4: Click on any dependent id for selection. The screen navigates to reinstate request. (See FIG. C-176)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continue.Step—6: Screen navigates to process reinstate. Enter the details of effective term date and change term status and click Continue. (See FIG. C-177)Step—7: Confirms the reinstatement of a dependent. (See FIG. C-178)Step—8: Click search button to go back to Dependent Search screen.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionInitiate Dependent ReinstatementMode of RequestChoose a mode of request from the drop down listavailable. The field is mandatory.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.Date ReceivedThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon. The DateReceived cannot be greater than system date. The fieldis mandatory.Request ReinstateThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon. Therequest reinstate date should be the first day of nextmonth. The field is mandatory.Reason forChoose a reason from the drop down list. The field isReinstatemandatory.OthersThe text for narrating other info, provided the optionfor reason for reinstate is othersAuthorizedThe text for authorized contact. The field iscontactmandatory.Process ReinstatementEffective TermThe text for request term date. Choose a date in theDateformat MM/DD/YYYY by clicking calendar icon.Change ReinstateChoose a status from the drop down list for changeStatusreinstate

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputContinueSaves the data and navigates to next screen in the flowof termination.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Appeals and grievance is the transaction module that encompasses the process for the groups and members enrolled with PacAdvantage in the PX2 System to raise appeals and grievance. Appeals and Grievance is the process of maintaining a status for all Appeals and Grievances received from the customer and follow up with the decision made either by PacAdvantage-Roseville or PacAdvantage-SF.

Access

The application can be accessed from the main menu as follows:Enrollment→Appeals and Grievances→Create→Modify→Close

Group and member information must be available in the system for making an appeal or grievance.

Application Functions

This application has the following functions for reinstatement:Create—to create an appeal & grievanceModify—to modify an appeal & grievanceClose—to close an appeal & grievance

Create

The screen is to create an appeal and grievance.

The sequential steps involved in creating an appeal & grievance are listed below.Step—1: After successful logon, click the menu Enrollment and select Appeals & Grievances. Then select Create. (See FIG. C-179)Step—2: The screen navigates search to select a group or member. Based on the selection the information of group/member will be displayed. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-180)Step—3: This pops a screen with search result. (See FIG. C-181)Step—4: Click on any group/member id for selection. The screen navigates to create grievance. (See FIG. C-182)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation. Click continueStep—6: Screen navigates to confirming create grievance. (See FIG. C-183)

Field Explanation

The following table provides explanation for each button in the screen.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputSaveSaves the data and navigates to next screen in the flowof creating a grievanceCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Modify

The screen is to modify an appeal and grievance.

The sequential steps involved in modifying an appeal & grievance are listed below.Step—1: After successful logon, click the menu Enrollment and select Appeals & Grievances. Then select Modify. (See FIG. C-184)Step—2: The screen navigates search to select either by complainant or by grievance. Based on the selection the information of group/member with grievance details will be displayed. Enter group/member/grievance id o for search. Click Search button. (See FIG. C-185)Step—3: The screen navigates to process grievance Enter the fields with appropriate values as per the format briefed in field's explanation. (See FIG. C-186)Step—4: Click Save.Step—5: The screen confirms the modification of grievance. (See FIG. C-187)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionProcess GrievanceSearch byChoose the option to search by complainant or searchby grievance. Based on this option the EitherGrievance ID or Complainant ID field will be enabled.ComplainantChoose a type of complainant from either group orTypememberComplainant IDThe text for complainant id. Accepts numeric values.Forward forClick this option to have approvalapprovalForward ToThe text for the person to whom it has to be forwardedForward DateThe text for forward date. Choose a date in the formatMM/DD/YYYY by clicking calendar iconBatch DateThe text for batch date. Choose a date in the formatMM/DD/YYYY by clicking calendar iconAdditionalThe text for additional remarks. Accepts alphabets,Remarksnumeric and special characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputSaveSaves the data and navigates to next screen in the flowof creating a grievanceCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Close

The screen is to close an appeal and grievance.

The sequential steps involved in closing an appeal & grievance are listed below.Step—1: After successful logon, click the menu Enrollment and select Appeals & Grievances. Then select Close. (See FIG. C-188)Step—2: The screen navigates search to select either by complainant or by grievance. Based on the selection the information of group/member with grievance details will be displayed. Enter group/member/grievance id o or enter first letter of group/member's name for search. Click Search. (See FIG. C-189)Step—3: The screen navigates to close grievance Enter the fields with appropriate values as per the format briefed in field's explanation. (See FIG. C-190)Step—4: Click Save.Step—5: The screen confirms the close of grievance. (See FIG. C-191)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionComplainant TypeChoose a type of complainant from either group ormemberComplainant IDThe text for complainant id. Accepts numeric valuesConclusionChoose a conclusion from the drop down list availableReasonThe text for reason. If the reason is others, it willenable the field other reason for entryOther ReasonThe text for other reason. Field is enabled only if theoption under reasons is othersBatch DateThe text for batch date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputSaveSaves the data and navigates to next screen in the flowof creating a grievanceCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes

8 Carrier Issues

Carrier Issues is the transaction module that encompasses the process for the groups and members enrolled with PacAdvantage in the PX2 System to raise issues with the carriers. Carrier Issues is the process of maintaining a status for all Carrier Issues received from the customer and follow up with the carrier for resolution and inform the customer of resolution.

Access

The application can be accessed from the main menu as follows:Enrollment→Carrier Issues→Create→Modify→Close

There are no pre-requisites for using this application.

Application Functions

This application has the following functions for reinstatement:Create—to create carrier issueModify—to modify carrier issueClose—to close carrier issue

Create

The screen is to create carrier issue.

The sequential steps involved in creating carrier issue are listed below.Step—1: After successful logon, click the menu Enrollment and select Carrier Issues. Then select Create. (See FIG. C-192)Step—2: The screen navigates search to select a group or member. Based on the selection the information of group/member will be displayed. Enter value in any one of the field or simply click search button to perform search operation. (See FIG. C-193)Step—3: This pops a screen with search result. (See FIG. C-194)Step—4: Click on any group/member id for selection. The screen navigates to create carrier issue. (See FIG. C-195)Step—5: Enter the fields with appropriate values as per the format briefed in field's explanation.Step—6: Click SaveStep—7: Screen navigates to confirming create carrier issues. (See FIG. C-196)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionCarrier Issue InformationReceived DateThe text for received date. Choose a date in the formatMM/DD/YYYY by clicking calendar icon.UrgentClick the check box, if it is urgentCarrierChoose a carrier from the drop down list availableReported IssueChoose a reported issue from the drop down listavailableRemarksThe text for remarks. Accepts alphabets, numeric andspecial characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputSaveSaves the data and navigates to next screen in the flowof creating carrier issueCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Modify

The screen is to modify carrier issue.

The sequential steps involved in modifying a carrier issue are listed below.Step—1: After successful logon, click the menu Enrollment and select Carrier Issues. Then select Modify. (See FIG. C-197)Step—2: The screen navigates search to select either by complainant or by carrier issue. Based on the selection the information of group/member with grievance details will be displayed. Enter the value for either customer id or carrier issue id. The field is mandatory. (See FIG. C-198)Step—3: Click search. The screen navigates to process carrier issue to modify. (See FIG. C-199)Step—4: Enter the fields with appropriate values as per the format briefed in field's explanationStep—5: Click Save.Step—6: The screen confirms the modification of carrier issues. (See FIG. C-200)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionSearch bySelect search either by client type or by carrier issuetypeCustomer TypeChoose a Customer Type from either group or member.The field is enabled only if the search is selected asclient typeCustomer IDThe text for customer id. Accepts numeric valuesCarrier Issue IDThe text for carrier issue id. Accepts numeric values.The field is enabled only if the selected type is carrierissue typeNotify carrierChoose an option as yes or no for notifying a carrierMode ofChoose a mode from the drop down list availableNotificationDate NotifiedThe text for notification date. Choose a date in theformat MM/DD/YYYY by clicking calendar iconBatch DateThe text for batch date. Choose a date in the formatMM/DD/YYYY by clicking calendar iconAdditionalThe text for remarks. Accepts alphabets, numeric andRemarksspecial characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputSaveSaves the data and navigates to next screen in the flowof creating a grievanceCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes

Close

The screen is to close carrier issue.

The sequential steps involved in closing carrier issue are listed below.Step—1: After successful logon, click the menu Enrollment and select Carrier Issues. Then select Close. (See FIG. C-201)Step—2: The screen navigates search to select either by customer or by carrier issue. Based on the selection the information of group/member with carrier issue details will be displayed. Enter group/member/carrier issue id for search. The field is mandatory. Click Search. (See FIG. C-202)Step—3: The screen navigates to close carrier issue Enter the fields with appropriate values as per the format briefed in field's explanation. (See FIG. C-203)Step—4: Click Save.Step—5: The screen confirms the close of carrier issue. (See FIG. C-204)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionSearch bySelect search either by client type or by carrier issuetypeCustomerChoose a Customer Type from either group or member.TypeThe field is enabled only if the search is selected asclient typeCustomer IDThe text for customer id. Accepts numeric values withexactly 9 digitsCarrier IssueThe text for carrier issue id. Accepts numeric valuesIDwith exactly 9 digits. The field is enabled only if theselected type is carrier issue typeActual IssueChoose an issue for actual issue from the drop downlist availableResolutionChoose a resolution from the drop down list availableRetransmissionClick yes or no for retransmissionDate CarrierThe text for carrier received date. Choose a date in theReceivedformat MM/DD/YYYY by clicking calendar iconNotifyClick yes or no for notifying originatorOriginatorBatch DateThe text for batch date. Choose a date in the formatMM/DD/YYYY by clicking calendar iconResolutionThe text for resolution comments. Accepts alphabets,commentsnumeric and special characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchSearch is performed based on the inputSaveSaves the data and navigates to next screen in the flowof creating a grievanceCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes

9 Add On

Add On is the transaction module that encompasses the process of Adding New Employee or Dependent to the group and or member enrolled with PacAdvantage in the PX2 System.

Access

The application can be accessed from the main menu as follows:Enrollment→Add On→Employee Add On→Dependent Add On

Group and the member must be enroll and all their relevant information must be available in the system to Add On Employee and or dependent.

Application Functions

This application has the following functions for reinstatement:Add Employee—to add employeeAdd Dependent—to add dependentModify Dependent—to modify employeeModify Dependent—to modify dependent

Add Employee

The screen is to add an employee.

The sequential steps involved in adding an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select Add On. Select Employee Add On. Then click Add Employee. (See FIG. C-205)Step—2: The screen navigates search to select a group. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-206)Step—3: This pops up a screen with search result. (See FIG. C-207)Step—4: Click on any group id for selection. Screen navigates to change request screen for adding an employee.

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of theText for the Name of the Group. Read Only fieldgroupEffective DateText for Employee Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of the Group.Effective date cannot be past date Read only fieldGroup IDText for Group ID. Read only field.StatusText for status. Read only fieldGroup TypeText for group type. Read only field.Work GroupText for work group. Read only field.Mode ofChoose a mode of request from the drop down listRequestavailablePost Mark DateText for post mark date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYEntry to this field is mandatoryReceived DateText for received date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYY.Entry to this field is mandatory.Reasons forChoose a reason for add on from the drop down listAdd OnavailableOthersText for others. This field is enabled only if the optionfor reasons for add on is others

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the entered information and navigates to nextscreen Employee General Info.CancelClears or restores the content entered in the fields onlyprior to saving the recordsStep—5: Enter the fields with appropriate values as per the format briefed in field's explanationStep—6: Screen navigates to add employee general information. First and Last name are mandatory other fields are optional. Enter the values in the respective fields, as per the format briefed in field's explanation section. (See FIG. C-209)

Field Explanation

The following table provides explanation for each button in the screen.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to coverage informationfor employees.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's general infoscreen.TabGeneral Info, Coverage Info, Add Dependent are thetabs visible on this screen. The navigation between thetabs is possible only if there is a valid Employee IDgenerated and assigned to the employee. Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—7: Screen navigates to coverage information. Even though the fields are optional, enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-210)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationHours workedThe text for worked hours per week. Accepts numericper weekvalues not exceeding 2 digits.Date ofThe text for date of employment. Choose a date byemploymentclicking calendar icon. Date accepts the formatMM/DD/YYYY.Employee typeChoose an employee type from the drop down listavailablePay RollCheck box for Pay Roll verification. Check this if payroll is verifiedPlan InformationLine of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if the employeeis waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down list availablePCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.Are you anClick the check box if you are an existing patientexisting patientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down list availablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insuranceThe text for insurance end date. Choose a date byend dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverageThe text for other coverage. Accepts alphabets withkeptvalues not exceeding 50 characters.EmployeeClick the check box, to have employee signaturesignatureDate signedThe text for date signed. Choose a date by clickingcalendar icon. Date accepts the format MM/DD/YYYY.Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information. Itis only a temporary addition. Becomes permanent onlyon saving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only on savingthe record.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's general infoscreen.ContinueSaves the data and navigates to Coverage Informationscreen.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, Add Dependent are thetabs visible on this screen. The navigation between thetabs are possible only if there is a valid Employee IDgenerated and assigned to the employee Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—8: Screen navigates to add dependent information. First name and last name fields are mandatory and other fields are optional. Enter the values in the respective fields, as per the format briefed in field's explanation section and click either Enrollment Summary or Add dependent. (See FIG. C-211)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionDependent InformationFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.MiddleThe text for middle initial. Accepts alphabets notInitialexceeding 1 character.Last NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory.SuffixChoose the suffix from the drop down list of suffixesavailable.Date ofThe text for date of birth. Choose a date by clickingBirthcalendar icon. Date accepts the formatMM/DD/YYYY. Birth date cannot be later than thecurrent date.SocialThe text for social security number for everySecurityindividual. This can also be auto generated by clickingNumberauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.RelationshipChoose the relationship from the drop down listavailable.StreetThe text for address. Accepts alphanumeric and specialAddresscharacters with values not exceeding 35 charactersSuiteThe text for suite/apt # . . . Accepts alphanumeric andspecial characters with values not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, and State are populated automatically onentering the correct zip code and entering the tab key.CityThe text for city. Accepts alphabets not exceeding 30characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaLine of CoverageSelectedThe text for selected carrier. It is a read only fieldcarrierCoverageThe text for coverage. It is a read only fieldchoiceService areaThe text for service area. It is a read only fieldPrior planChoose a plan type from the drop down list availabletypePrior planThe text for plan name. Accepts alphabetsWaivedClick the check box if Line of Coverage is waived.Start dateThe text for insurance start date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY.End dateThe text for insurance end date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY.PCP ID/The text for PCP ID. Accepts alphabets and numericvalues not exceeding 10 characters.PCP lastThe text for PCP last name. Accepts alphabets andnamespecial character like hyphen and single quotes notexceeding 35 characters.PCP firstThe text for PCP first name. Accepts alphabets andnamespecial character like hyphen and single quotes notexceeding 25 characters.DisabledClick the option of temporary or permanent. This isdependentenable if the relationship opted is childDomesticClick the option for domestic partner. It depends onpartnerthe value selected in relationshipLegalClick the option for legal guardian. It depends on theguardianvalue selected in relationshipSignatureClick the check box if the signature is opted

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddSaves the data and navigates to the screen for addingEmployeeemployees.AddSaves the data and navigates to the screen for addingDependentdependentEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, Add Dependent are thetabs visible on this screen. The navigation between thetabs are possible only if there is a valid Employee IDgenerated and assigned to the employee Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—9: Clicking enrollment summary button screen navigates to enrollment summary. This screen shows the overall information that is entered will be shown. (See FIG. C-212)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of the GroupText for the Name of the GroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internal workgroup attached to the Group. This is based on thewriting agent's work group.EnrollmentEnrollment Summary Information is broken down intoSummarytree structure. The tree can by expanded or collapsed.InformationThe level of the tree is as per the example given below:− Employee− Dependent− DependentWhere (−) signifies expanded view and (+) signifiescollapsed view.Employee IDText for Employee IDEmployee SSNText for Employee SSNEmployee NameText for employee Name (First Name and Last Name)Effective DateText for Employee Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of theEmployee. Effective date cannot be past dateStatusText to specify the status of the employee.ElementDescriptionDependent IDText for Dependent IDDependent SSNText for Dependent SSNDependent NameText for Dependent Name (First Name and LastName)Effective DateText for Dependent Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of theEmployee. Effective date cannot be past dateStatusText to specify the status of the Dependent.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionPreSaves the data and performs validation and eligibilityEnrollmentchecks against the information required for enrollmentand navigates to the screen Missing Information.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—10: Clicking pre enrollment navigates to missing info screen. It gives the information that is left out while entering input for creating a group. For a successful creation of a group the missing information should be empty. (See FIG. C-213)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName ofText for the Name of the Groupthe GroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupEffectiveThe text for Effective Date.DateStatusText to specify the status of the group.WorkText for Work Group. This specifies the internal workGroupgroup attached to the Group. Internal is based on thewriting agent's work group.TreeEnrollment Missing Information is broken down intoStructuretree structure. The tree can by expanded or collapsed.The level of the tree is as per the example given below:− Employee− Dependent− DependentWhere (−) signifies expanded view and (+) signifiescollapsed view.EmployeeThis identifies all the eligibility rules and theMissinginformation that are incomplete on Employee level forInfocompleting the enrollment process.MissingList the missing entities for the employee. Provides aEntitieslink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.DependentThis identifies all the eligibility rules and theMissinginformation that are incomplete on dependent level forInfocompleting the enrollment process.MissingList the missing entities for the dependent. Provides aEntitieslink to go to the respective screen to fill in the relevantinformation to complete all the required entries.MessageList the message against each missing entities.EnrollmentChoose from the drop down list the action to beActionperformed for enrollment. Enroll/DeclineRemarksText for remarks if any.ReasonsChoose from the drop down list the reasons for decline.for DeclineReasonsText for other reason. If the reason for decline is otherfor Otherthan the reasons available.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSendClick this link to send missing information to themailInternal Work Group (GMS representatives) attachedto this Group.PreviewClick this Link to preview the Invoice details prior toInvoicegeneration of invoice.EnrollSaves the data if there are no missing information andnavigates to enrollment confirmation page.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment missing information shows record for 5employees on single screen. If the employee sizeincreases more than 5. These buttons are used fornavigating to the next and previous records forviewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)EmployeeClick Employee ID to navigates to the Employee'sIDgeneral info screen.PreviewClick Preview Invoice to pop up a new browser windowInvoiceto preview the invoice for the groupStep—11: On completing all the relevant information that is required for a successful addition of an employee, the following is the sample screen for a successful creation. (See FIG. C-214)Step—12: Click Search employee to navigate back to Search Employee screen.

Modify Employee

The screen is to modify an employee.

The sequential steps involved in modifying an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select Add On. Select Employee Add On. Then click Modify Employee. (See FIG. C-215)Step—2: The screen navigates search to select a group. Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-216)Step—3: This pops up a screen with search result. (See FIG. C-217)Step—4: Click on any employee id for selection. This navigates to General info of employees. The flow and method of modifying are similar to that of creation, which is explained in Add Employee, vide step 6 through step 11.

Modify Dependent

The screen is to modify a dependent. Here an employee can be added to a group and a dependent to that employee can be modified.

The sequential steps involved in modifying dependent are listed below.

Step—1: After successful logon, click the menu Enrollment and select Add On. Select Employee Add On. Then click Modify Dependent. (See FIG. C-218)Step—2: The screen navigates search to select a dependent Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-219)Step—3: This pops up a screen with search result. (See FIG. C-220)Step—4: Click on any employee id for selection. This navigates to Add Dependent of an employee. The flow and method of modifying are similar to that of creation, which is explained in Add Employee, vide step 8 through step 11.

Inactivate Dependent

The screen is to inactivate a dependent.

The sequential steps involved in inactivating dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Add On. Select Employee Add On. Then click Inactivate Dependent. (See FIG. C-221)Step—2: The screen navigates search to select a dependent. Enter value in any one of the field or simply click search button to perform search operation. (See FIG. C-222)Step—3: This pops up a screen with search result. (See FIG. C-223)Step—4: Click on any Dependent ID for selection. Screen navigates to Inactivate. (See FIG. C-224)Step—5 Click Inactivate button, leads to confirmation screen. (See FIG. C-225)

Add Dependent

The screen is to add a dependent.

The sequential steps involved in adding a dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Add On. Select Dependent Add On. Then click Add Dependent. (See FIG. C-226)Step—2: The screen navigates search to select a group/employee Enter value in any one of the field, or simply click search button, to perform search operation. (See FIG. C-227)Step—3: This pops up a screen with search result. (See FIG. C-228)Step—4: Click on any employee id for selection. This navigates to change request for add on dependent screen. Enter the fields with appropriate values as per the format briefed in field's explanation. Click Continue. (See FIG. C-229)Step—5: Screen navigates to Add on Dependent screen. Enter the fields with appropriate values as per the format briefed in field's explanation. Click Enrollment summary. Enrollment summary and missing information are similar to Add Dependent and it is explained under Add Employee vide step 8 through step 11. (See FIG. C-230)

Field Explanation

Refer for field explanations explained in Add Employee

Button Functionality

Refer for field explanations explained in Add Employee

Modify Dependent

The screen is to modify a dependent, where a dependent is added to an already enrolled employee. The process and flow are similar to that of modify dependent under Employee Add on.

The sequential steps involved in modifying dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Add On. Select Employee Add On. Then click Modify Dependent. (See FIG. C-231)Step—2: The screen navigates search to select a dependent Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-232)Step—3: This pops up a screen with search result. (See FIG. C-233)Step—4: Click on any employee id for selection. This navigates to Add Dependent of an employee. The flow and method of modifying are similar to that of creation, which is explained in Add Employee, vide step 8 through step 11.

Enrollment Operation is a utility process for generation various file in the specified output format for transmission to the Carrier, PacAdvantage and Mail House. These operations are Export Membership Data, Export PacAdvantage Data, Export Transmission Data, ROE Process, and ROE Packet Generation.

Access

The application can be accessed from the main menu as follows:Enrollment→En-Operations→Export Membership Data→Export PacAdvantage Data→Export Transmission Data→ROE Process→ROE Packet Generation

All master and transaction records must be available in the system for Enrollment Operation.

Output file format and information for each carrier must be available in the system. Refer “User Manual for Carrier Maintenance” for further information on the output file formats for Carriers (Enrollment Transmission)

Application Functions

This application has the following functions for reinstatement:Export Membership DataExport PacAdvantage DataExport Transmission DataROE ProcessROE Packet Generation

Export Membership Data

The screen is to export membership data.

The sequential steps involved in exporting membership data are listed below.Step—1: After successful logon, click the menu Enrollment and select EN-Operations. Select Export Membership Data. (See FIG. C-234)Step—2: The screen navigates to Export Membership Data. (See FIG. C-235)Step—3: Choose the option of carrier or plan, member status, term effective date and file format and click ExportStep—4: Initially the status will be not exported. Once the export button is clicked after filling necessary fields, a new browser window open for downloading the file. (See FIG. C-236)Step—5: Click “Click here to download” link and then click Ok to download the fileStep—6: Click on the Search button navigates to the screen shown below. Enter Export ID and search for the export status. Click on the Export ID link to show the screen with export details or Click back to go back to the export screen. (See FIG. C-237)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionExport IDRead only field to display export id valueStatusRead only field to display the status of export.ExportedRead only field to display the user who exported theByfilesExportRead only field to display the export dateDateCarrierChoose this option and select from the list if the dataexport is based on the CarrierPlanChoose this option and select from the list if the dataexport is based on the PlanMemberChoose from the List the Member status. MemberStatusStatus can be Active, Termed or Both. The field ismandatoryTermEnter the date for Term Effective Date or select a dateEffectiveby clicking calendar icon. The field is mandatory if theDateMember status option is Termed or Both.File FormatChoose a format from drop down list for output formatthat should be generated. The field is mandatory

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on new button enables to have a new Export offiles.ExportClick on Export button will perform the action ofexporting the files based on selection criteriaSearchClick on search button navigates to a screen to have asearch on entering Export ID.ViewClick on view export log to have a pop up displayExport Logshowing the status of exported filesHideClick on hide export log to hide the pop up displayExport Logmessage.ClearClears the content and restore the operation that wascurrently performed prior to saving the recordBackGoes back to Export screen.

Export PacAdvantage Data

The screen is to export PacAdvantage Data.

The sequential steps involved in exporting PacAdvantage data are listed below.Step—1: After successful logon, click the menu Enrollment and select EN-Operations. Select Export PacAdvantage Data. (See FIG. C-238)Step—2: The screen navigates to Export PacAdvantage Data. (See FIG. C-239)Step—3: Click ExportStep—4: Initially the status will be not exported. Once the export button is clicked, the user has an option to view the status of export process by clicking Search.Step—5: Click back button to go back to Export. PacAdvantage Data Screen. (See FIG. C-240)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionExport IDRead only field to display export id valueStatusRead only field to display the status of export.ExportedRead only field to display the user whoByexported the filesExportRead only field to display the export dateDate

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on new button enables to have a new Export offiles.ExportClick on Export button will perform the action ofexporting the files based on selection criteriaSearchClick on search button navigates to a screen to have asearch on entering Export ID.ViewClick on view export log to have a pop up displayExport Logshowing the status of exported filesHideClick on hide export log to hide the pop up displayExport Logmessage.ClearClears the content and restore the operation that wascurrently performed prior to saving the recordBackGoes back to Export PacAdvantage Data screen.

Export Transmission Data

The screen is to export transmission data.

The sequential steps involved in exporting transmission data are listed below.Step—1: After successful logon, click the menu Enrollment and select EN-Operations. Select Export Transmission Data. (See FIG. C-241)Step—2: The screen navigates to Export Transmission Data. (See FIG. C-242)Step—3: Click ExportStep—4: Initially the status will be not exported. Once the export button is clicked after filling necessary fields, the user has an option to view the status of export process by clicking Search. (See FIG. C-243)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionExport IDRead only field to display export id valueStatusRead only field to display the status of export.Exported ByRead only field to display the user who exported thefilesExport DateRead only field to display the export dateTransmit for theEnter the date for Transmit for the following Datefollowing DateFrom or select a date by clicking calendar icon. TheFromfield is mandatory.Transmit for theEnter the date for Transmit for the following Date Tofollowing Dateor select a date by clicking calendar icon. The field isTomandatory.CommentsText to enter Comments if any.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on new button enables to have a new Export offiles.ExportClick on Export button will perform the action ofexporting the files based on selection criteriaSearchClick on search button navigates to a screen to have asearch on entering Export ID.BackGoes back to Export Transmission Data screen.

ROE Process

The screen is to process ROE data.

The sequential steps involved in processing ROE are listed below.Step—1: After successful logon, click the menu Enrollment and select EN-Operations. Select ROE Process. (See FIG. C-244)Step—2: The screen navigates to ROE Process. (See FIG. C-245)Step—3: Click Generate

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionRun IDThe text for sequential number of Run ID. It is a readonly field and is auto generatedRenewal DateThe text for Renewal Date during which the ROE/OEprocess is to be initiated.Run ByThe text for name of the user who initiates ROEprocess. It is a read only field.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on New button to start new ROE Process.GenerateClick Generate to Initiate ROE Process. ROE processonce initiated for a specific period cannot be reinitiated once again.CancelClick cancel to reset the fields.

ROE Packet Generation

The screen is to process ROE Packet Generation.

The sequential steps involved in generating ROE Packets are listed below.Step—1: After successful logon, click the menu Enrollment and select EN-Operations. Select ROE Packet Generation. (See FIG. C-246)Step—2: The screen navigates to ROE Packet Generation. Select ROE cycle period and apply filter conditions for Generating ROE/OE packets. (See FIG. C-247)Step—3: Click GenerateStep—4: Initially the status will be not imported. Once the export button is clicked after filling necessary fields, the user has an option to view the status of export process by clicking Search. (See FIG. C-248) Step 5: Click Back button to go back to ROE

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionExport IDThe text for Export ID. This is auto generated by thesystemStatusThe text for Export Status. This is a read only field.The system shows the Export status based on dataexportedExported ByThe text for Exported By. This is a read only field.Export DateThe text for Export date. This is a read only field.ROE CycleChoose the ROE Cycle period for which the ROE/OEpacket are to be generated.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.CommentsText to specify comments if any.Selected GroupsThe text displays the selected group count based onthe ROE Cycle period. Example 0 to 100. It is aread only fieldGroup IDThe text for Group ID. Accepts numeric values only.Group NameThe text for group name. Accepts any characters.Group TypeChoose the group type from the list.Group Size FromThe text for group size and specifies the startingrange. Accepts numeric values only.Group Size ToThe text for group size and specifies the ending range.Accepts numeric values only.View SelectedCheck the View Selected Check Box to view onlyselected groups.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFilterClick the Filter to display the Group based on thesearch criteria/filter conditions provided.Clear FilterClear the Content of the fields.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.Check All on thisThe “Check All on this Page” Link will check all thePagerecords in the table on this PageClear All on thisThe “Clear All on this Page” Link will uncheck all thePagerecords in the table that are checked on this Page.Invert SelectionThe Invert Selection Link will invert the selectioncriteria for the check boxes. I.e. All Check Groupswould be unchecked and vice versa.<<, <, >, >>These buttons are used for navigating to the next andprevious records for viewing.<< - Show first record(s)< - Show previous record(s)> - Show next record(s)>> - Show last record(s)NewClick New to start new operation on this screenGenerateClick Generate to generate ROE/OE packets for MailHouse Transmission.SearchClick Search Button to search the Status of theROE/OE Packet generationCancelCancels the operation that was currently performedprior to saving the record.BackGoes back to ROE Transmission screen.

Changes is the transaction module that encompasses the process of accommodating and maintaining all information that is required for Groups ad Members. Change can be done for Groups, COBRA Members, Individual Member, Employee and Dependent.

Access

The application can be accessed from the main menu as follows:Enrollment→En-Operations→Group Change→COBRA Change→Individual Employee Change→Employee Change→Dependent Change

Groups and Members must be enrolled and all the relevant information must be available in the system for making changes.

Application Functions

This application has the following functions for reinstatement:

Create New Change Request

Modify Change Request

Group Change Create New Request

The screen is to have an request for any change in Group

The sequential steps involved in change request for group are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Group change and Create Change Request. (See FIG. C-249)Step—2: The screen navigates to Group Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-250)Step—3: This pops up a screen with search result. (See FIG. C-251)Step—4: Click on any group id for selection the screen navigates to Group Change Request. (See FIG. C-252)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of theText for the Name of the Group. This is read only field.groupEffective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field..StatusText for status. This is read only field.Group TypeText for group type. This is read only field..Work GroupText for work group. This is read only field..General InformationMode of RequestChoose a mode of request from the drop down listavailablePost Mark DateText for post mark date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYEntry to this field is mandatoryReceived DateText for received date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYY.Entry to this field is mandatory.Reasons forChoose a reason for change from the drop down listChangeavailableOthersText for others. This field is enabled only if theoption for reasons for change is others

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the entered information and navigates to nextlevel, which show the pick list for the changes that aresought.ClearClears or restores the content entered in the fields aswas prior to saving the records.Step—5: Choose mode of request, Post mark date, date received and reason for change. Clicks continue. This screen would be available only if there are no change requests pending for the group.Step—6: Navigates to group changes, which allows the option to pick the changes sought. Check the items that need to be change and click on continue button. This screen is dynamically built to display only those changes that can be performed on the specific group selected. (See FIG. C-253)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group. Read Only fieldEffective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.General InformationContactSelecting this option will enable to allowInformation1for any modificationsContactSelecting this option will enable to allowInformation2for any modificationsPhysical AddressSelecting this option will enable to allowfor any modificationsBilling AddressSelecting this option will enable to allowfor any modificationsTax IdentificationSelecting this option will enable to allowfor any modificationsBilling AddressSelecting this option will enable to allowfor any modificationsBilling InformationPaymentSelecting this option will enable to allowinformationfor any modificationsAgent InformationWriting AgentSelecting this option will enable to allowfor any modificationsAgent of RecordSelecting this option will enable to allowfor any modificationsGeneral AgencySelecting this option will enable to allowfor any modificationsCoverage InformationRAFSelecting this option will enable to allowfor any modificationsWaiting PeriodSelecting this option will enable to allowfor any modificationsMedical LOCSelecting this option will enable to allowfor any modificationsVision LOCSelecting this option will enable to allowfor any modificationsDental LOCSelecting this option will enable to allowfor any modificationsCAM LOCSelecting this option will enable to allowfor any modificationsOthersSelecting this option will enable to allowfor any modifications

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to General information for groups.ClearClears the contents entered in the fields or restore to theprevious state as was before saving the changesStep—7: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-254)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionCompany InformationLegal NameThe text for name of the group. Accepts alphanumericand special characters not exceeding 60 characters.Field is mandatoryDoing BusinessThe text for business nature. Accepts alphanumericAsand special characters not exceeding 60 characters.Field is optionalType of BusinessChoose the type of business from the drop down listavailableTax IdentificationThe text for tax identification. Accepts numeric valuesof exactly 9 digitsAddress Information: Physical and Billing Address - Note: Enter BillingAddress if different from the Physical Address.Street AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 charactersSuiteThe text for company suite/apt # Acceptsalphanumeric and special characters not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key.CityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop down listof counties available for the ZIP Code entered.Contact InformationMode ofChoose the mode of correspondence from the dropCorrespondencedown list available.Contact 1 and Contact 2 - Fill in the relevant for Contact 1 and 2.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters.SuffixChoose the suffix from the drop down list of suffixesavailable.Phone NumberThe text for telephone number of the contact person.Accepts numeric values of exactly 10 digits. The formatis (999) 999-9999ExtensionThe text for extension number of the contact person.Accepts numeric values not exceeding 5 digits.FaxThe text for fax number of the contact person. Acceptsnumeric values of exactly 10 digits. The format is(999) 999-9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100charactersContactThe text for comments. Accepts alphabets, numericCommentsand special characters. Field is optional

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Billing Informationscreen and the system generates Group ID. This isenabled only if changes are sought on this screen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreen.Step—8: On clicking continue, navigates to Billing Information Respective tabs can also clicked to navigate corresponding screens. (See FIG. C-255)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop down listavailable. Based on selection corresponding fields willenable to enter the values. For e.g. if the value selectedis card payment, EFT will be disabled and allows onlyentering card details and vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. Accepts alphabets andNamesspace between two words.Credit Card TypeChoose the type of credit card from the drop down listavailable.Credit Card NoThe text for credit card number. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expiration from the drop down listavailableExpiration YearThe text for expiration year. Accepts numeric valuesof exactly 4. Example 2002.Billing AddressAs it appears on the credit CardStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 characters.ZIPThe text for zip. Accepts numeric value of either 5 or 9digits.StateThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.CityChoose the name of the state from the drop down listof States available in United States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number. Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number. Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of account from the drop down listavailable.Depositor's NameThe text for depositor's name. Accepts alphabets andspace between two words.Initial Payment InformationAmount ReceivedThe text for amount received. Accepts only numericvalues in the format 999999999.99Date ReceiveThe text for date received. Choose from the calendaricon in the format MM/DD/YYYY.Check #The text for check number. Accepts numeric values notexceeding 9 digits.No CheckCheck the option of no checks received for any non-Receivedreceipt of checks.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Agent Informationscreen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreen.Step—9: On clicking continue, navigates to Agent Information. Respective tabs can also clicked to navigate corresponding screens. (See FIG. C-256)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionAgent IDChoose an agent id by clicking search iconAgent TypeChoose an agent type from the drop down listavailable. Based on the selection of the agent type thepercent commission split entry and the Receive ROEpackets option would be available.PercentThe text for percent commission. Accepts numericcommissionvalues in the range of 1-100 (Example 100.00). Thissplitwill be enabled only if the Agent type selected is “AgentOf Record”Sum of the percentage for all the Agent of Recordadded should be equal to 100.00.ReceiveClick the check box to receive ROE/OE packets forROE/OEagent. This option will not be available for Agent Typepackets“General Agent”.AgentThe text for agent commission. Defaults the valueCommissiondefined in CM - rate Administration for AgentCommission. Accepts numeric values less than orequal to the defaulted value in the in the range of1-100 (Example 4.45)Check the boxClick the check box for a group with out an agent. Thisif the groupoption will be available only for the Agent Type, “Agentis without anof Record and Writing Agent”.agent

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of agent information. It is only atemporary addition. Becomes permanent only onsaving the record.EditEdit button will allow for editing a specific record inthe table.ClearClears the contents entered in the fieldsUpdateUpdate the contents of agent information. It is only atemporary update. Becomes permanent only on savingthe recordDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the recordCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.MissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationContinueSaves the data and navigates to Coverage Informationscreen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreenStep—10: On clicking continue, navigates to Coverage Information. Respective tabs can also clicked to navigate corresponding screens. (See FIG. C-257)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionHours workedThe text for worked hours per week. Accepts numericper weekvalues.Date ofThe text for date of employment. Choose a date byemploymentclicking calendar icon. Date accepts the formatMM/DD/YYYY.Employee typeChoose an employee type from the drop down listavailableLine of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if the employeeis waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down list availablePCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.Are you anClick the check box if you are an existing patientexisting patientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down list availablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insuranceThe text for insurance end date. Choose a date byend dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverageThe text for other coverage. Accepts alphabets withkeptvalues not exceeding 50 characters.RAFText to display the RAF applicable for the IndividualAssociation Member.EmployeeClick the check box, to have employee signaturesignatureDate signedThe text for date signed. Choose a date by clickingcalendar icon. Date accepts the format MM/DD/YYYY.Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information.It is only a temporary addition. Becomes permanentonly on saving.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only on saving.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.MissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's generalinfo screen.ContinueSaves the data and navigates to Missing Informationscreen.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreenStep—11: Clicking change summary button screen navigates to missing info screen. This screen shows the overall information that is entered will be shown. (See FIG. C-258)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup Missing InformationMissing EntityList the missing entities for the groupchangeMessageProvides a message for the missing entitiesChange InformationChange RuleSpecifies the pick list for the changesChange statusShow the change status as incomplete,completeChangeChoose from the list change statusconfirmationChange ActionChoose from the list of change actionRemarksText for briefing the change action

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionConfirmNavigates to confirmation screen by incorporating allthe changes madeClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—12: Confirms the changes incorporated in-group request. Click Group Change Search to go back to Group Search screen. (See FIG. C-259)

Group Modify Pending Change

The screen is to have an request for any change in Group

The sequential steps involved in change request for group are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Group change and Modify Pending Change. (See FIG. C-260)Step—2: The screen navigates to Group Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-261)Step—3: This pops up a screen with search result. (See FIG. C-262)Step—4: Navigates to group changes, which allows the option to have changes required. If no option is selected the continue button in respective pages will be disabled and changes cannot be performed. (See FIG. C-263)

Field Explanation

Refer field explanations explained in Create New Change Request under Group Change

Button Functionality

Refer button functionality explained in Create New Change Request under Group Change.Step—5: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. The process and flow for modifying change request is similar to that of create new change request. (See FIG. C-264)

Field Explanation

Refer field explanations explained in Create New Change Request.

Button Functionality

Refer button functionality explained in Create New Change Request.

COBRA Change Create New Request

The screen is to have an request for any change in COBRA

The sequential steps involved in change request for COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select COBRA change and Create Change Request. (See FIG. C-265)Step—2: The screen navigates to Employee Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-266)Step—3: This pops up a screen with search result. (See FIG. C-267)Step—4: Click on any employee id for selection the screen navigates to Employee change Request. (See FIG. C-268)

Field Explanation

Refer field explanations explained in Create New Change Request

Button Functionality

Refer button functionality explained in Create New Change Request.Step—5: Screen navigates to employee change (pick list). Select the options to have any modifications, so that the selected screen will enable the continue button. This screen is dynamically built to display only those changes that can be performed on the specific group selected. (See FIG. C-269)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group. This is readonly field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is readonly fieldGeneral InformationChange in employeeSelecting this option will enable to allowaddressfor any modificationsChange SSNSelecting this option will enable to allow forinformationany modificationsEmployee DateSelecting this option will enable to allow forof birthany modificationsChange in employeeSelecting this option will enable to allow fordemographicany modificationslocationBilling InformationPaymentSelecting this option will enable to allow forInstructionany modificationsCoverage InformationMedical LOCSelecting this option will enable to allow forany modificationsVision LOCSelecting this option will enable to allow forany modificationsDental LOCSelecting this option will enable to allow forany modificationsCAM LOCSelecting this option will enable to allow forany modificationsHours workedSelecting this option will enable to allow forany modificationsEmployee TypeSelecting this option will enable to allow forany modificationsDate of employmentSelecting this option will enable to allow forany modificationsStep—6: On clicking continue, screen navigates to General Info screen. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-270)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformation HeaderName of the groupText for the Name of the Group. This is readonly field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is read only fieldEmployee InformationSalutationChoose the salutation from the drop down list ofsalutations available. This is read only fieldFirst NameThe text for first name. Accepts alphabets andspecial character like hyphen and single quotesnot exceeding 25 characters. First name ismandatory. This is read only fieldMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character. This is read only fieldLast NameThe text for last name. Accepts alphabets andspecial characters like hyphen and single quotesnot exceeding 35 characters. Last name ismandatory. This is read only fieldSuffixChoose the Suffix from the drop down list ofsalutations available This is read only field.Date of BirthThe text for date of birth. Choose a date byclicking calendar icon Allows for modification,as it has been opted for change from the pickup list.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated byclicking auto generate link. Accepts numericvalue of exactly 9 digits. Users with User Role asLevel 2 and above can only auto generate SSN.This is read only fieldGenderChoose a gender from the drop down listavailable. This is read only fieldAddress InformationStreet AddressThe text for address. Accepts alphanumeric andspecial characters with values not exceeding 35charactersAptThe text for suite/apt #. Accepts alphanumeric andspecial characters with values not exceeding 35characters This is read only fieldZipThe text for zip. Accepts numeric value of either5 or 9 digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key. This is read only fieldCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.This is read only fieldStateChoose the name of the state from the dropdown list of States available in United States ofAmerica This is read only fieldCountyChoose the name of the county from the dropdown list of States available in United States ofAmerica This is read only fieldMode ofChoose the mode of correspondence from theCorrespondencedrop down list available This is read only fieldPhone NumberThe text for telephone number of the employee.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999 This is readonly fieldExtensionThe text for extension number of the employee.Accepts numeric values not exceeding 5 digitsThis is read only fieldFaxThe text for fax number of the employee.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999 This is readonly fieldEmailThe text for email of the employee. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding100 characters This is read only field

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Billing Informationscreen. This is enabled only if changes are sought onthis screenClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Coverage Info are the tabsvisible on this screen. Navigation to the next screenis also possible by using tabs If continue button isdisabled use this tab to navigate to the next screen.Also while navigating through the tab the contentthat are changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—7: On clicking continue, screen navigates to Billing Info. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-271)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop downlist available. Based on selection correspondingfields will enable to enter the values. For e.g. ifthe value selected is card payment, EFT will bedisabled and allows only entering card detailsand vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. AcceptsNamesalphabets and space between two words.This is read only fieldCredit Card TypeChoose the type of credit card from the dropdown list available.Credit Card NoThe text for credit card number. Acceptsnumeric values not exceeding 30 digitsExpiration DateChoose a month of expiration from the dropdown list availableExpiration YearThe text for expiration year. Accepts numericvalues of exactly 4. Example 2002.Billing AddressAs it appears on the credit CardStreet AddressThe text for company address. Acceptsalphanumeric and special characters notexceeding 35 characters.ZIPThe text for zip. Accepts numeric value ofeither 5 or 9 digits.StateThe text for city. Accepts alphabets andspace between two words not exceeding 30characters.CityChoose the name of the state from the dropdown list of States available in United Statesof AmericaEFT InformationBank NameThe text for bank name Accepts alphabetsand space between two words.Routing NumberThe text for routing number. Accepts numericvalues not exceeding 9 digits.Account NumberThe text for account number. Accepts numericvalues not exceeding 9 digits.Account TypeChoose the type of account from the drop downlist available.Depositor's NameThe text for depositor's name. Accepts alphabetsand space between two words.COBRA Billing InformationSend Bills toChoose the option to send the bills to Group or Sel.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Coverage Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Coverage Info are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screen.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—8: On clicking continue, screen navigates to Coverage Info. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-272)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionPlan InformationLine of coverageChoose a line of coverage from the drop downlist availableMedical waivedClick the check box for medical waive if theemployee is waiving medical.Carrier selectionChoose a carrier selection from the drop down(Benefit level)list availableCoverage choiceChoose a coverage from the drop down listavailablePCP ID/MedicalThe text for PCP ID. Accepts alphabets andgroup IDnumeric values not exceeding 10 characters.Are you anClick the check box if you are an existing patientexisting patientPCP last nameThe text for PCP last name. Accepts alphabetsand special character like hyphen and singlequotes not exceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabetsand special character like hyphen and singlequotes not exceeding 25 characters.Prior plan typeChoose a plan type from the drop down listavailablePrior plan nameChoose a plan name from the drop down listavailablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insuranceThe text for insurance end date. Choose a date byend dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.AdditionalThe text for additional coverage. AcceptsCoveragealphabets with values not exceeding 50characters.Date signedThe text for date signed. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information. Itis only a temporary addition. Becomes permanent onlyon saving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only on savingthe record.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.MissingClick missing information refreshes the screen andInformationdisplays the missed information. For asuccessful creation of a group, there should be nomissing informationGroup IDClick Group ID to navigates to the Group's generalinfo screen.ContinueSaves the data and navigates to Missing Informationscreen, if it is enabled . . .ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Coverage Info, are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screenAlso while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screenStep—9: On clicking continue, screen navigates to Missing Info. (See FIG. C-273)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationChange RuleSpecifies the pick list for the changesChange statusShow the change status as incomplete,completeChangeChoose from the list change statusconfirmationChange ActionChoose from the list of change actionRemarksText for briefing the change action

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionConfirmNavigates to confirmation screen by incorporatingall the corrections madeClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—10: After entering the respective fields, click continues, which navigates to confirmation screen. (See FIG. C-274)

COBRA Modify Pending Change

The screen is to have an request for any change in COBRA

The sequential steps involved in change request for COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select COBRA change and Modify Pending Change. (See FIG. C-275)Step—2: The screen navigates to Employee Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-276)Step—3: This pops up a screen with search result. (See FIG. C-277)Step—4: Navigates to employee changes, which allows the option to have changes required. If no option is selected the continue button in respective pages will be disabled and changes cannot be performed. (See FIG. C-278)

Field Explanation

Refer field explanations explained in Create New Change Request under COBRA Change

Button Functionality

Refer button functionality explained in Create New Change Request under COBRA ChangeStep—5: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. The process and flow for modifying change request is similar to that of create new change request. (See FIG. C-279)

Field Explanation

Refer field explanations explained in Create New Change Request, under COBRA Change

Button Functionality

Refer button functionality explained in Create New Change Request, under COBRA Change.

Individual Member Change Create New Request

The screen is to have a request for any change in Individual Member

The sequential steps involved in change request for Individual Member are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Individual Member change and Create Change Request. (See FIG. C-280)Step—2: The screen navigates to Employee Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-281)Step—3: This pops up a screen with search result. (See FIG. C-282)Step—4: Click on any employee id for selection the screen navigates to Employee change Request. (See FIG. C-283)

Field Explanation

Refer field explanations explained in Create New Change Request

Button Functionality

Refer button functionality explained in Create New Change Request.Step—5: Screen navigates to employee change (pick list). Select the options to have any modifications, so that the selected screen will enable the continue button. (See FIG. C-284)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group. This isread only field.Effective DateText for Effective date. This is read onlyfield.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is read onlyfieldGeneral InformationChange in employeeSelecting this option will enable to allowaddressfor any modificationsChange SSNSelecting this option will enable to allowinformationfor any modificationsEmployee Date ofSelecting this option will enable to allowbirthfor any modificationsChange in employeeSelecting this option will enable to allowdemographicfor any modificationslocationBilling InformationPaymentSelecting this option will enable to allowInstructionfor any modificationsCoverage InformationMedical LOCSelecting this option will enable to allowfor any modificationsVision LOCSelecting this option will enable to allowfor any modificationsDental LOCSelecting this option will enable to allowfor any modificationsCAM LOCSelecting this option will enable to allowfor any modificationsHours workedSelecting this option will enable to allowfor any modificationsEmployee TypeSelecting this option will enable to allowfor any modificationsDate of employmentSelecting this option will enable to allowfor any modificationsStep—6: On clicking continue, screen navigates to General Info screen. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-285)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of theText for the Name of the Group. This is readgrouponly field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is read only fieldEmployee InformationSalutationChoose the salutation from the drop down list ofsalutations available. This is read only fieldFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory. This is readonly fieldMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character. This is read only fieldLast NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory. This is readonly fieldSuffixChoose the Suffix from the drop down list ofsalutations available This is read only field.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon Allows for modification, as it hasbeen opted for change from the pick up list.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN. This is read only fieldGenderChoose a gender from the drop down list available.This is read only fieldAddress InformationStreet AddressThe text for address. Accepts alphanumeric and specialcharacters with values not exceeding 35 charactersAptThe text for suite/apt #. Accept alphanumeric andspecial characters with values not exceeding 35characters This is read only fieldZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key. This is read only fieldCityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters. This is readonly fieldStateChoose the name of the state from the drop down listof States available in United States of America This isread only fieldCountyChoose the name of the county from the drop downlist of States available in United States of AmericaThis is read only fieldMode ofChoose the mode of correspondence from the dropCorrespondencedown list available This is read only fieldPhone NumberThe text for telephone number of the employee.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999 This is read only fieldExtensionThe text for extension number of the employee.Accepts numeric values not exceeding 5 digits This isread only fieldFaxThe text for fax number of the employee. Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999 This is read only fieldEmailThe text for email of the employee. Accepts alphabets,numeric and special characters in the standard emailformat of length not exceeding 100 characters This isread only field

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Billing Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Coverage Info are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screen.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—7: On clicking continue, screen navigates to Billing Info. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-286)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of paymentfrom the drop down listavailable. Based on selectioncorresponding fields willenable to enter the values. Fore.g. if the value selectedis card payment, EFT will bedisabled and allows onlyentering card details andvice versa.Credit Card InformationCardholder'sThe text for cardholder's name.NamesAccepts alphabets andspace between two words.This is read only fieldCredit Card TypeChoose the type of creditcard from the drop down listavailable.Credit Card NoThe text for credit cardnumber. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expirationfrom the drop down listavailableExpiration YearThe text for expiration year.Accepts numeric valuesof exactly 4. Example 2002.Billing AddressAs it appears on the credit CardStreet AddressThe text for company address.Accepts alphanumericand special characters notexceeding 35 characters.ZIPThe text for zip. Acceptsnumeric value of either 5 or 9digits.StateThe text for city. Acceptsalphabets and space betweentwo words not exceeding30 characters.CityChoose the name of thestate from the drop down listof States available in UnitedStates of AmericaEFT InformationBank NameThe text for bank name.Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number.Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number.Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of accountfrom the drop down listavailable.Depositor's NameThe text for depositor's name.Accepts alphabets andspace between two words.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Coverage Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Coverage Info are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screen.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—8: On clicking continue, screen navigates to Coverage Info. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-287)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationHours worked perThe text for worked hoursweekper week. Accepts numericvalues not exceeding 2 digits.Date of employmentThe text for date of employment.Choose a date byclicking calendar icon.Date accepts the formatMM/DD/YYYY.Employee TypeChoose an Employee Typefrom the drop down listavailableRAF DiscountingRAFList the RAF tier applicablefor the group based on theRAF tier available ongroup's effective date.Plan InformationLine of coverageChoose a line of coveragefrom the drop down listavailableMedical waivedClick the check box formedical waive if the employeeis waiving medical.ElementDescriptionCarrier selectionChoose a carrier selection(Benefit level)from the drop down listavailableCoverage choiceChoose a coverage fromthe drop down list availablePCP ID/MedicalThe text for PCP ID.group IDAccepts alphabets and numericvalues not exceeding10 characters.Are you an existingClick the check box if youpatientare an existing patientPCP last nameThe text for PCP last name.Accepts alphabets andspecial character like hyphenand single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name.Accepts alphabets andspecial character likehyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from thedrop down list availablePrior plan nameChoose a plan name from thedrop down list availablePrior insuranceThe text for insurancestart datestart date. Choose a date byclicking calendar icon.Date accepts the formatMM/DD/YYYY.PriorThe text for insurance endinsurance enddate. Choose a date bydateclicking calendar icon.Date accepts the formatMM/DD/YYYY.AdditionalThe text for additionalCoveragecoverage. Accepts alphabetswith values notexceeding 50 characters.Date signedThe text for date signed.Choose a date by clickingcalendar icon. Date acceptsthe format MM/DD/YYYY.Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information. Itis only a temporary addition. Becomes permanent onlyon saving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only on savingthe record.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.MissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's general infoscreen.ContinueSaves the data and navigates to Missing Informationscreen, if it is enabled . . .ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Coverage Info, are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screenAlso while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screenStep—9: On clicking continue, screen navigates to Missing Info. (See FIG. C-288)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationChange RuleSpecifies the pick list for the changesChange statusShow the change status as incomplete, completeElementDescriptionChangeChoose from the list change statusconfirmationChange ActionChoose from the list of change actionRemarksText for briefing the change action

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionConfirmNavigates to confirmation screen by incorporating allthe corrections madeClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—10: After entering the respective fields, click continues, which navigates to confirmation screen. (See FIG. C-289)

Individual Member Modify Pending Change

The screen is to have a request for any change in Individual Member

The sequential steps involved in change request for Individual Member are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Individual Member change and Modify Pending Change. (See FIG. C-290)Step—2: The screen navigates to Employee Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-291)Step—3: This pops up a screen with search result. (See FIG. C-292)Step—4: Navigates to employee changes, which allows the option to have changes required. If no option is selected the continue button in respective pages will be disabled and changes cannot be performed. (See FIG. C-293)

Field Explanation

Refer field explanations explained in Create New Change Request under Individual Change

Button Functionality

Refer button functionality explained in Create New Change Request under Individual ChangeStep—5: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. The process and flow for modifying change request is similar to that of create new change request. (See FIG. C-294)

Field Explanation

Refer field explanations explained in Create New Change Request, under Individual Member Change

Button Functionality

Refer button functionality explained in Create New Change Request, under Individual Member Change.

Employee Change Create New Request

The screen is to have a request for any change in Employee

The sequential steps involved in change request for Employee are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Employee change and Create Change Request. (See FIG. C-295)Step—2: The screen navigates to Employee Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-296)Step—3: This pops up a screen with search result. (See FIG. C-297)Step—4: Click on any employee id for selection screen navigates to Employee change Request. (See FIG. C-298)

Field Explanation

Refer field explanations explained in Create New Change Request

Button Functionality

Refer button functionality explained in Create New Change Request.Step—5: Screen navigates to employee change (pick list). Select the options to have any modifications, so that the selected screen will enable the continue button. (See FIG. C-299)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group.This is read only field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is read only fieldGeneral InformationChange in employeeSelecting this option will enable to allow for anyaddressmodificationsChange SSNSelecting this option will enable to allowinformationfor any modificationsEmployee Date ofSelecting this option will enable to allowbirthfor any modificationsChange in employeeSelecting this option will enable to allowdemographicfor any modificationslocationBilling InformationPaymentSelecting this option will enable to allow for anyInstructionmodificationsCoverage InformationMedical LOCSelecting this option will enableto allow for any modificationsVision LOCSelecting this option will enableto allow for any modificationsDental LOCSelecting this option will enableto allow for any modificationsCAM LOCSelecting this option will enableto allow for any modificationsHours workedSelecting this option will enableto allow for any modificationsEmployee TypeSelecting this option will enableto allow for any modificationsDate of employmentSelecting this option will enableto allow for any modificationsStep—6: On clicking continue, screen navigates to General Info screen. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-300)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName ofText for the Name of the Group. This is read only field.the groupEffectiveText for Effective date. This is read only field.DateGroup IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.EmployeeText for employee name. This is read only fieldNameEmployee InformationSalutationChoose the salutation from the drop down list ofsalutations available. This is read only fieldFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory. This is readonly fieldMiddleThe text for middle initial. Accepts alphabets notInitialexceeding 1 character. This is read only fieldLastThe text for last name. Accepts alphabets and specialNamecharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory. This is readonly fieldSuffixChoose the Suffix from the drop down list ofsalutations available This is read only field.Date ofThe text for date of birth. Choose a date by clickingBirthcalendar icon Allows for modification, as it hasbeen opted for change from the pick up list.SocialThe text for social security number for everySecurityindividual. This can also be auto generated by clickingNumberauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN. This is read only fieldGenderChoose a gender from the drop down list available.This is read only fieldAddress InformationStreetThe text for address. Accepts alphanumeric and specialAddresscharacters with values not exceeding 35 charactersAptThe text for suite/apt # . . . Accepts alphanumeric andspecial characters with values not exceeding 35characters This is read only fieldZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key. This is read only fieldCityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters. This is readonly fieldStateChoose the name of the state from the drop down listof States available in United States of America This isread only fieldCountyChoose the name of the county from the drop down listof States available in United States of America This isread only fieldMode ofChoose the mode of correspondence from the dropCorre-down list available This is read only fieldspondencePhoneThe text for telephone number of the employee.NumberAccepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999 This is read only fieldExtensionThe text for extension number of the employee.Accepts numeric values not exceeding 5 digits This isread only fieldFaxThe text for fax number of the employee. Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999 This is read only fieldEmailThe text for email of the employee. Accepts alphabets,numeric and special characters in the standard emailformat of length not exceeding 100 characters This isread only field

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Coverage Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Coverage Info are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screen.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—7: On clicking continue, screen navigates to Coverage Info. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-301)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationHours worked perThe text for worked hoursweekper week. Accepts numericvalues not exceeding 2 digits.Date of employmentThe text for date ofemployment. Choose a date byclicking calendar icon.Date accepts the formatMM/DD/YYYY.Employee TypeChoose an Employee Type fromthe drop down list availablePlan InformationLine of coverageChoose a line of coveragefrom the drop down list availableMedical waivedClick the check box formedical waive if the employeeis waiving medical.Carrier selectionChoose a carrier selection(Benefit level)from the drop down list availableCoverage choiceChoose a coverage from thedrop down list availablePCP ID/MedicalThe text for PCP ID.group IDAccepts alphabets and numericvalues not exceeding 10 characters.Are you an existingClick the check box ifpatientyou are an existing patientPCP last nameThe text for PCP last name.Accepts alphabets andspecial character likehyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name.Accepts alphabets andspecial character likehyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type fromthe drop down list availablePrior plan nameChoose a plan name fromthe drop down list availablePrior insuranceThe text for insurancestart datestart date. Choose a date byclicking calendar icon.Date accepts the formatMM/DD/YYYY.Prior insurance endThe text for insurance enddatedate. Choose a date byclicking calendar icon.Date accepts the formatMM/DD/YYYY.AdditionalThe text for additionalCoveragecoverage. Accepts alphabetswith values notexceeding 50 characters.Date signedThe text for date signed.Choose a date by clickingcalendar icon. Date acceptsthe format MM/DD/YYYY.Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information. Itis only a temporary addition. Becomes permanent onlyon saving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only on savingthe record.CancelCancels the operation that was currently performedprior to saving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.MissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's general infoscreen.ContinueSaves the data and navigates to Missing Informationscreen, if it is enabled . . .ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Coverage Info, are the tabsvisible on this screen. Navigation to the next screen isalso possible by using tabs If continue button isdisabled use this tab to navigate to the next screenAlso while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screenStep—8: On clicking continue, screen navigates to Missing Info. (See FIG. C-302)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationChange RuleSpecifies the pick list for the changesChange statusShow the change status as incomplete, completeChangeChoose from the list change statusconfirmationChange ActionChoose from the list of change actionRemarksText for briefing the change action

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionConfirmNavigates to confirmation screen by incorporating allthe corrections madeClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—9: After entering the respective fields, click continues, which navigates to confirmation screen. (See FIG. C-303)

Employee Modify Pending Change

The screen is to have a request for any change in Employee

The sequential steps involved in change request for Employee are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Employee change and Modify Pending Change. (See FIG. C-304)Step—2: The screen navigates to Employee Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-305)Step—3: This pops up a screen with search result. (See FIG. C-306)Step—4: Navigates to employee changes, which allows the option to have changes required. If no option is selected the continue button in respective pages will be disabled and changes cannot be performed. (See FIG. C-307)

Field Explanation

Refer field explanations explained in Create New Change Request under Employee Change

Button Functionality

Refer button functionality explained in Create New Change Request under Employee ChangeStep—5: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. The process and flow for modifying change request is similar to that of create new change request. (See FIG. C-308)

Field Explanation

Refer field explanations explained in Create New Change Request, under Employee Change

Button Functionality

Refer button functionality explained in Create New Change Request, under Employee Change.

Dependent Change Create New Request

The screen is to have a request for any change in Dependent

The sequential steps involved in change request for Dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Dependent change and Create Change Request. (See FIG. C-309)Step—2: The screen navigates to Dependent Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-310)Step—3: This pops up a screen with search result. (See FIG. C-311)Step—4: Click on any dependent id for selection the screen navigates to Dependent change Request. (See FIG. C-312)

Field Explanation

Refer field explanations explained in Create New Change Request

Button Functionality

Refer button functionality explained in Create New Change Request.Step—5: Screen navigates to employee change (pick list). Select the options to have any modifications, so that the selected screen will enable the continue button. (See FIG. C-313)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group.This is read only field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field..StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Dependent IDText for Dependent ID This is read only field.Dependent NameText for Dependent name. This is read only fieldGeneral InformationChange inSelecting this option will enable to allow for anyDependent addressmodificationsChange SSNSelecting this option will enableinformationto allow for any modificationsDependent Date ofSelecting this option will enablebirthto allow for any modificationsChange inSelecting this option will enableDependentto allow for any modificationsdemographiclocationDependentSelecting this option will enableRelationshipto allow for any modificationsCoverage InformationChange in PlanSelecting this option will enable to allowinformationfor any modificationsStep—6: On clicking continue, screen navigates to Dependent Change screen. Make any corrections if previously opted in change request, then only continue button will be enabled. Otherwise navigate screens through tabs. (See FIG. C-314)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of the groupText for the Name of the Group. This is read only field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field..StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Dependent IDText for Dependent ID This is read only field.Dependent NameText for Dependent name. This is read only fieldDependent InformationFirst NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory. This is readonly fieldMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character. This is read only fieldLast NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory. This is readonly fieldSuffixChoose the Suffix from the drop down list ofsalutations available This is read only field.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon Allows for modification, as it hasbeen opted for change from the pick up list.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN. This is read only fieldGenderChoose a gender from the drop down list available.This is read only fieldStreet AddressThe text for address. Accepts alphanumeric and specialcharacters with values not exceeding 35 charactersAptThe text for suite/apt # . . . Accepts alphanumeric andspecial characters with values not exceeding 35characters This is read only fieldZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key. This is read only fieldCityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters. This is readonly fieldStateChoose the name of the state from the drop down listof States available in United States of America This isread only fieldRelationshipChoose the relationship from the drop down listavailable. This is read only field

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionChange SummarySaves the data and Navigates to Change SummaryInformation screen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesMissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.Step—7: On clicking continue, screen navigates to Missing Info. (See FIG. C-315)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionDependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationChange RuleSpecifies the pick list for the changesChange statusShow the change status as incomplete, completeChangeChoose from the list change statusconfirmationChange ActionChoose from the list of change actionRemarksText for briefing the change action

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionConfirmNavigates to confirmation screen by incorporating allthe corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—8: after entering the respective fields, click continues, which navigates to confirmation screen. (See FIG. C-316)Step—9: Click Dependent Search to navigate back to Dependent Search screen.

Dependent Modify Request Change

The screen is to have a request for any change in Dependent

The sequential steps involved in change request for Dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select Change. Select Dependent change and Modify Change Request. (See FIG. C-317)Step—2: The screen navigates to Dependent Search screen. Enter any value in one of the field to perform search operation. (See FIG. C-318)Step—3: This pops up a screen with search result. (See FIG. C-319)Step—4: Navigates to Dependent changes, which allows the option to have changes required. If no option is selected the continue button in respective pages will be disabled and changes cannot be performed. (See FIG. C-320)Step—5: On clicking continue, navigates to Dependent Change. The process and flow for modifying change request is similar to that of create new change request. (See FIG. C-321)Step—6: On clicking continue, screen navigates to Missing Info. (See FIG. C-322)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionDependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationChange RuleSpecifies the pick list for the changesChange statusShow the change status as incomplete, completeChangeChoose from the list change statusconfirmationChange ActionChoose from the list of change actionRemarksText for briefing the change action

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionConfirmNavigates to confirmation screen by incorporating allthe corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—7: After entering the respective fields, click continues, which navigates to confirmation screen. (See FIG. C-323)Step—8: Click Dependent Search to navigate back to Dependent Search screen.

Field Explanation

Refer field explanations explained in Create New Change Request, under Dependent Change

Button Functionality

Refer button functionality explained in Create New Change Request, under Dependent Change

ROE is the transaction module that encompasses the process of Re-qualification and open enrollment for Group and Members enrolled with PacAdvantage in the PX2 System. ROE (Re-qualification and open enrollment) is the process of Re-qualifying the Group and Members on their anniversary. Once a year, on the anniversary date of a group's enrollment in PacAdvantage, the group's participation, contribution and qualification is reviewed. This review is to ensure that the group meets the qualification requirement.

OE (Open Enrollment) is the process during the anniversary of the group wherein the group has the privilege to make the changes to the plan, waiting period etc that were earlier not open for changes.

Access

The application can be accessed from the main menu as follows:Enrollment→ROE→Group Enrollment→Employee Enrollment→Dependent Enrollment→Individual Member→COBRA→Manual ROE

The Process ROE operation should be initiated prior to making the ROE/OE changes to the Groups and Members.

Group and the member must be enroll and all their relevant information must be available in the system in order to accomplish the task for ROE/OE.

Application Functions

This application has the following functions for reinstatement:Modify—to modify group, employee, dependent, individual enrollment entries

Group Enrollment

The screen is to modify group enrollment

The sequential steps involved in modifying group enrollment are listed below.Step—1: After successful logon, click the menu Enrollment and select ROE. Select Group Enrollment. Then click Process Group. (See FIG. C-324)Step—2: The screen navigates search to select a group. Enter value in any one of the field, or simply click search button to perform search operation. (See FIG. C-325)Step—3: This pops up a screen with search result. (See FIG. C-326)Step—4: Click on any Group ID for selection. Screen navigates to change request screen for making ROE/OE changes for a group. (See FIG. C-327)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup General InformationContactSelecting this option will enable toInformationallow for any modificationsAddressSelecting this option will enable toInformationallow for any modificationsTax IdentificationSelecting this option will enable toallow for any modificationsDemographicSelecting this option will enable tolocationallow for any modificationsBilling InformationBilling InformationSelecting this option will enable toallow for any modificationsAgent InformationAgent InformationSelecting this option will enable toallow for any modificationsCoverage InformationRAF DiscountingSelecting this option will enable toallow for any modificationsWorkersSelecting this option will enable toCompensation Flagallow for any modificationsTEFRA flagSelecting this option will enable toallow for any modifications1099 FlagSelecting this option will enable toallow for any modificationsDomestic PartnerSelecting this option will enable toSupport flagallow for any modificationsCOBRA SupportSelecting this option will enable toflagallow for any modificationsPart time supportSelecting this option will enable toflagallow for any modificationsWaiting periodSelecting this option will enable toinformationallow for any modificationsMedical LOCSelecting this option will enable toallow for any modificationsVision LOCSelecting this option will enable toallow for any modificationsDental LOCSelecting this option will enable toallow for any modificationsCAM LOCSelecting this option will enable toallow for any modifications

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to General informationfor groups.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—5: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-328)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionCompany InformationLegal NameThe text for name of the group. Accepts alphanumericand special characters not exceeding 60 characters.Field is mandatoryDoing Business AsThe text for business nature. Accepts alphanumericand special characters not exceeding 60 characters.Field is optionalType of BusinessChoose the type of business from the drop down listavailableTax IdentificationThe text for tax identification. Accepts numeric valuesof exactly 9 digitsAddress Information: Physical and Billing Address - Note: Enter BillingAddress if different from the Physical Address.Street AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 charactersSuiteThe text for company suite/apt # Acceptsalphanumeric and special characters not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key.CityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop down listof counties available for the ZIP Code entered.Contact InformationMode ofChoose the mode of correspondence from the dropCorrespondencedown list available.Contact 1 and Contact 2 - Fill in the relevant for Contact 1 and 2.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters.SuffixChoose the suffix from the drop down list of suffixesavailable.Phone NumberThe text for telephone number of the contact person.Accepts numeric values of exactly 10 digits. The formatis (999) 999-9999ExtensionThe text for extension number of the contact person.Accepts numeric values not exceeding 5 digits.FaxThe text for fax number of the contact person. Acceptsnumeric values of exactly 10 digits. The format is(999) 999 - 9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100charactersContact CommentsThe text for comments. Accepts alphabets, numericand special characters. Field is optional

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Billing Informationscreen and the system generates Group ID. This isenabled only if changes are sought on this screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreen.Step—6: On clicking continue, navigates to Group Billing Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-329)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop down listavailable. Based on selection corresponding fields willenable to enter the values. For e.g. if the value selectedis card payment, EFT will be disabled and allows onlyentering card details and vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. Accepts alphabets andNamesspace between two words.Credit Card TypeChoose the type of credit card from the drop down listavailable.Credit Card NoThe text for credit card number. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expiration from the drop down listavailableExpiration YearThe text for expiration year. Accepts numeric valuesof exactly 4. Example 2002.Billing Address As it appears on the credit CardStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 characters.ZIPThe text for zip. Accepts numeric value of either 5 or 9digits.StateThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.CityChoose the name of the state from the drop down listof States available in United States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number. Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number. Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of account from the drop down listavailable.Depositor's NameThe text for depositor's name. Accepts alphabets andspace between two words.Initial Payment InformationAmount ReceivedThe text for amount received. Accepts only numericvalues in the format 999999999.99Date ReceiveThe text for date received. Choose from the calendaricon in the format MM/DD/YYYY.Check #The text for check number. Accepts numericvalues not exceeding 9 digits.No Check ReceivedCheck the option of no checks received for any non-receipt of checks.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Agent Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for group.MissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreen.Step—7: On clicking continue, navigates to Group Agent Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-330)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionAgent IDChoose an agent id by clicking search iconAgent TypeChoose an agent type from the drop down listavailable. Based on the selection of the agent type thepercent commission split entry and the Receive ROEpackets option would be available.Percent commissionThe text for percent commission. Accepts numericsplitvalues in the range of 1-100 (Example 100.00). Thiswill be enabled only if the Agent type selected is“Agent Of Record”Sum of the percentage for all the Agent of Recordadded should be equal to 100.00.Receive ROE/OEClick the check box to receive ROE/OE packets forpacketsagent. This option will not be available for Agent Type“General Agent”.Agent CommissionThe text for agent commission. Defaults the valuedefined in CM − rate Administration for AgentCommission. Accepts numeric values less than orequal to the defaulted value in the in the range of 1-100(Example 4.45)Check the box if theClick the check box for a group with out an agent.group is without anThis option will be available only for the AgentagentType, “Agent of Record and Writing Agent”.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of agent information. It is only atemporary addition. Becomes permanent only onsaving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of agent information. It is only atemporary update. Becomes permanent only on savingthe recordDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the recordCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationContinueSaves the data and navigates to Coverage Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen.. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreenStep—8: On clicking continue, navigates to Group Coverage Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-331)

Field Explanation

The following table provides explanation for each button in the screen

ElementDescriptionWaiting Period InformationEmployee TypeChoose an Employee Type from the drop down listavailableWaiting PeriodChoose a waiting period from the drop down listavailableRAF DiscountingRAFList the RAF tier applicable for the group based on theRAF tier available on group's effective date.ContributionLine of CoverageChoose a line of coverage from the drop down listelectedavailableContribution ForChoose a contribution for from the drop down listavailable. Contribution can be for an employee ordependent.Contribution TypeChoose a contribution type from the drop down listavailable. List the contribution type “% Lowest CostHMO”, “% Lowest Cost Plan”, “% Specified Plan”,“Flat $ Amount”. On Selecting % Specified Planthe page would get refreshed and the Plan Namefor the Specified LOC would be populated inthe Drop Down List “Plan Name”ContributionThe text for contribution amount. Accepts numericAmountvalues in the format 99999999.99 for flat $ amountand for the rest of the option it accepts as % value say100.00Plan NameChoose a plan name from the drop down list availableif the Contribution Type selected is “% Specified Plan”.Current GroupChoose a group insurer from the drop down listInsureravailableWhether groupClick the option yes or nolegally required toprovide workerscompensationcoverageWorkersChoose a compensation carrier name from the dropcompensationdown list availablecarrier nameNumber ofThe text for total number of employees including fullEmployees (Fulltime and part time. Accepts numeric valuestime and part time)Number of full timeThe text for number of full time employees at the timeemployees at theof applying. Accepts numeric valuestime of applicationNumber of eligibleThe text for number of eligible employees at the timeemployees at theof applying. Accepts numeric valuestime of applicationNumber ofThe text for number of employees at the time ofemployee applyingapplying. Accepts numeric valuesHave you employedClick the option yes or no20 or moreemployees for 20 ormore weeks duringthe current orpreceding year(TEFRA)Have you employedClick the option yes or no20 or moreemployees duringat least 50% of thepreceding calendaryear (COBRA)Are you offeringClick the option yes or nocoverage toemployees workingmore 20-29 hoursper weekAre you offeringClick the option yes or nocoverage todomestic partners

Button Functionality

The following table provides explanation for each button in the screen

ElementDescriptionAdd (WaitingAdd the contents of Waiting Period information. It isPeriod Information)only a temporary addition. Becomes permanent onlyon saving the record.Add (Contribution)Add the contents of Contribution and Coverageelected. It is only a temporary addition. Becomespermanent only on saving the record.Update (WaitingUpdates the contents of Waiting Period information. ItPeriod Information)is only a temporary update. Becomes permanent onlyon saving the record.UpdateUpdate the contents of Contribution and Coverage(Contribution)elected. It is only a temporary update. Becomespermanent only on saving the record.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the recordsin the table that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationView Missing InfoSaves the data and navigates to Missing InformationPageSave & Create NewSaves the data entered and navigates to the screenGroupGroup Hierarchy for creating New Group.CancelClears or restores the content entered in the fields onlyprior to saving the records.TabGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. The navigationbetween tabs is possible only if there is a valid groupID generated and assigned to the group. Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—9: On clicking Enrollment Summary, screen navigates to Summary screen. (See FIG. C-332)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionTotal Full TimeValue is shown based on the actual full timeApplied (A)employee applied (System Identified)Total part TimeValue is shown based on the actual part timeApplied (B)employee applied (System Identified)Employee WaivedText to enter Employee Waived. Contains(C)only whole number. Accepts numbers notexceeding 5 digits. Manually entered basedon verification.Employee DeclinedText to enter Employee Declined. Contains(D)only whole number. Accepts numbers notexceeding 5 digits. Manually entered basedon verification.Total EligibleText to display total eligible employee.Employee (E) =Employee Applying is sum total of A + B + D.Total EmployeeText to display total employee applying.Applying (F)Employee Applying is sum total of A + B.% ParticipationTest to display % participation. ParticipationBased on Info Providedis % of E/FTotal Full TimeText for Total Full Time Applied. Based onApplied (A)the information provide on the Coverage InfoscreenTotal part TimeText for Total Part Time Applied. Based onApplied (B)the information provide on the Coverage InfoscreenTotal EmployeesText to display total employee applied.AppliedEmployee Applied is sum total of A + BTotal Full TimeValue is shown based on the actual full timeApplied (A)employee applied (System Identified)Step—10: On clicking continue, navigates to Missing Info screen. (See FIG. C-333)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Dependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationROE/OE StatusSpecifies the pick list for the changesRemarksText for briefing the change actionReason for DeclineChoose from the list of reasons for decline.This field is enabled only if the status ofROE/OE is opted as declineOthersText for briefing the other status anddescription

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFinalizeNavigates to confirmation screen by incorporatingall the corrections madeClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—11: On clicking Finalize, navigates to confirmation screen. (See FIG. C-334)

Employee Enrollment

The screen is to modify employee enrollment

The sequential steps involved in modifying employee enrollment are listed below.Step—1: After successful logon, click the menu Enrollment and select ROE/OE Select Employee Enrollment. Then click Process Employee. (See FIG. C-335)Step—2: The screen navigates search to select an employee. Enter value in any one of the field or simply click Search button to perform search operation. (See FIG. C-336)Step—3: This pops up a screen with search result. (See FIG. C-337)Step—4: Click on any Employee ID for selection. Screen navigates to change request screen for making ROE/OE changes for an employee. (See FIG. C-338)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group. ReadOnly fieldEffective DateText for Employee Effective date.This is read only field.Group IDText for Group ID. This is readonly field.StatusText for status. This is read only field.Group TypeText for group type. This is read onlyfield.Work GroupText for work group. This is read onlyfield.Employee IDText for Employee ID. This is read onlyfield.Employee NameText for Employee Name. This is readonly field.Employee General Information ChangesEmployee DateSelecting this option will enable to allowof Birthfor any modifications.Employee AddressSelecting this option will enable to allowfor any modificationsEmployee SSNSelecting this option will enable to allowfor any modificationsEmployeeSelecting this option will enable to allowDemographicfor any modificationsInformationEmployee Coverage Information ChangesPayrollSelecting this option will enable to allowfor any modificationsEmployee TypeSelecting this option will enable to allowfor any modificationsMedical LOCSelecting this option will enable to allowfor any modificationsVision LOCSelecting this option will enable to allowfor any modificationsDental LOCSelecting this option will enable to allowfor any modificationsCAM LOCSelecting this option will enable to allowfor any modifications

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to General informationfor employees. This is enabled only if changes aresought on this screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—5: On selecting the options for changes click Continue. Screen navigates to Employee General Information screen. (See FIG. C-339)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationSalutationChoose the salutation from the drop downlist of salutations available.First NameThe text for contact name. Accepts alphabetsand special characters like hyphen and singlequotes not exceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabetsnot exceeding 1 character.Last NameThe text for contact name. Accepts alphabetsand special characters like hyphen and singlequotes not exceeding 35 characters.SuffixChoose the suffix from the drop down list ofsuffixes available.Date of BirthThe text for date of birth. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Birth date cannot be laterthan the current date.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated byclicking auto generate link. Accepts numericvalue of exactly 9 digits. Users with User Roleas Level 2 and above can only auto generateSSN.GenderChoose a gender from the drop down listavailable.Address InformationStreet AddressThe text for address. Accepts alphanumericand special characters with values not exceeding35 charactersAptThe text for suite/apt #. Accepts alphanumericand special characters with values not exceeding35 charactersZipThe text for zip. Accepts numeric value ofeither 5 or 9 digits. City, State and County arepopulated automatically on entering the correctzip code and entering the tab key.CityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the dropdown list of States available in United Statesof AmericaCountyChoose the name of the county from the dropdown list of States available in United Statesof AmericaMode ofChoose the mode of correspondence from theCorrespondencedrop down list availablePhone NumberThe text for telephone number of the employee.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999ExtensionThe text for extension number of the employee.Accepts numeric values not exceeding 5 digitsFaxThe text for fax number of the employee.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999EmailThe text for email of the employee. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding100 characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Coverage informationfor employees. This is enabled only if changes aresought on this screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, are the tabs visible onthis screen. Navigation to the next screen is alsopossible by using tabs If continue button is disableduse this tab to navigate to the next screen. Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—6: After making any changes in the fields as explained in the field explanation, click Continue. Screen navigates to employee Coverage Info screen. (See FIG. C-340)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationHours worked perThe text for worked hours per week.weekAccepts numeric values not exceeding2 digits.Date of employmentThe text for date of employment. Choosea date by clicking calendar icon. Dateaccepts the format MM/DD/YYYY.Employee typeChoose an employee type from the dropdown list availablePlan InformationLine of coverageChoose a line of coverage from the dropdown list availableMedical waivedClick the check box for medical waive ifthe employee is waiving medical.Carrier selectionChoose a carrier selection from the drop(Benefit level)down list availableCoverage choiceChoose a coverage from the drop downlist availablePCP ID/MedicalThe text for PCP ID. Accepts alphabetsgroup IDand numeric values not exceeding 10characters.Are you an existingClick the check box if you are an existingpatientpatientPCP last nameThe text for PCP last name. Acceptsalphabets and special character like hyphenand single quotes not exceeding 35characters.PCP first nameThe text for PCP first name. Acceptsalphabets and special character like hyphenand single quotes not exceeding 25characters.Prior plan typeChoose a plan type from the drop downlist availablePrior plan nameChoose a plan name from the drop downlist availablePrior insuranceThe text for insurance start date. Choose astart datedate by clicking calendar icon. Date acceptsthe format MM/DD/YYYY.Prior insurance endThe text for insurance end date. Choose adatedate by clicking calendar icon. Date acceptsthe format MM/DD/YYYY.Other coverage keptThe text for other coverage. Accepts alphabetswith values not exceeding 50 characters.Employee signatureClick the check box, to have employeesignatureDate signedThe text for date signed. Choose a date byclicking calendar icon. Date accepts theformat MM/DD/YYYY.Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information.It is only a temporary addition. Becomes permanentonly on saving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of Plan Information. It is only atemporary update. Becomes permanent only onsaving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered forgroup creationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationGroup IDClick Group ID to navigates to the Group's generalinfo screen.ContinueSaves the data and navigates to Missing Informationscreen, if it is enabled.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, are the tabs visible onthis screen. Navigation to the next screen is alsopossible by using tabs If continue button is disableduse this tab to navigate to the next screen. Also whilenavigating through the tab the content that arechanged on the screen are not saved unless explicitlysaved by other operations on the screenStep—7: After entering the fields as per the field details explained in field explanation. Click Continue. Screen navigates to Enrollment Summary. (See FIG. C-341)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformation HeaderName of the GroupText for the Name of the GroupGroup IDText and Link for the Group ID to navigateto the Group General Info screenGroup TypeSpecifies the Type of the Group like SmallEmployer GroupProposed EffectiveThe text for Proposed Effective Date. ChooseDatea date by clicking calendar icon. Date acceptsthe format MM/DD/YYYY. Default effectivedate is first of the following month. Effectivedate cannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies theinternal work group attached to the Group.This is based on the writing agent's workgroup.EnrollmentEnrollment Summary Information is brokenSummarydown into tree structure. The tree can byInformationexpanded or collapsed. The level of the treeis as per the example given below:− Employee− Dependent− Dependent− Employee− Dependent− Employee+ Employee− Employee+ Dependent+− EmployeeWhere (−) signifies expanded view and(+) signifies collapsed view.Employee IDText for Employee IDEmployee SSNText for Employee SSNEmployee NameText for employee Name (First Nameand Last Name)Effective DateText for Employee Effective date. Choose adate by clicking calendar icon. Date acceptsthe format MM/DD/YYYY. Defaults effectivedate of the Group. Effective date cannot bepast dateStatusText to specify the status of the employee.EnrollmentThere are two part of this information:Information3) Entered based on verificationEntered4) Based on the information provide on thebased on verificationCoverage Info screenTotal Full TimeValue is shown based on the actual fullApplied (A)time employee applied (System Identified)Total part TimeValue is shown based on the actual part timeApplied (B)employee applied (System Identified)Employee WaivedText to enter Employee Waived. Contains(C)only whole number. Accepts numbers notexceeding 5 digits. Manually entered basedon verification.Employee DeclinedText to enter Employee Declined. Contains(D)only whole number. Accepts numbers notexceeding 5 digits. Manually entered basedon verification.Total EligibleText to display total eligible employee.Employee (E) =Employee Applying is sum total of A + B + D.Total EmployeeText to display total employee applying.Applying (F)Employee Applying is sum total of A + B.% ParticipationTest to display % participation. ParticipationBased on Infois % of E/FProvidedTotal Full TimeText for Total Full Time Applied. Based onApplied (A)the information provide on the CoverageInfo screenTotal part TimeText for Total Part Time Applied. Based onApplied (B)the information provide on the CoverageInfo screenTotal EmployeesText to display total employee applied.AppliedEmployee Applied is sum total of A + B

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionPre EnrollmentSaves the data and performs validation andeligibility checks against the informationrequired for enrollment and navigates to thescreen Missing Information.ClearClears the contents entered in the fields orrestore to the previous state as was before savingthe changes<<, <. >, >>The enrollment summary shows record for 5employees on single screen. If the employee sizeincreases more than 5. These buttons are used fornavigating to the next and previous records forviewing.<< - Show first record(s)< - Show previous record(s)> - Show next record(s)>> - Show last record(s)Group IDClick Group ID to navigates to the Group'sgeneral info screen.Step—8: On clicking Pre-Enrollment, screen navigates to missing info. (See FIG. C-342)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Dependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationROE/OE StatusSpecifies the pick list for the changesRemarksText for briefing the change actionReason for DeclineChoose from the list of reasons for decline.This field is enabled only if the status ofROE/OE is opted as declineOthersText for briefing the other status anddescription

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFinalizeNavigates to confirmation screen by incorporatingall the corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—9: On clicking Finalize, navigates to confirmation screen. Click continue to navigate back to Group search irrespective of process, as the process is being carried out for a group. (See FIG. C-343)

Dependent Enrollment

The screen is to modify dependent enrollment

The sequential steps involved in modifying dependent enrollment are listed below.Step—1: After successful logon, click the menu Enrollment and select ROE. Select Dependent Enrollment. Then click Modify. (See FIG. C-344)Step—2: The screen navigates search to select an dependent. Enter the search criteria for Searching for the dependent. (See FIG. C-345)Step—3: This pops up a screen with search result. (See FIG. C-346)Step—4: Click on any Dependent ID for selection. Screen navigates to change request screen for making ROE/OE changes for an employee. (See FIG. C-347)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group.Read Only fieldEffective DateText for Employee Effective date.This is read only field.Group IDText for Group ID. This is readonly field.StatusText for status. This is read onlyfield.Group TypeText for group type. This is read onlyfield.Work GroupText for work group. This is read onlyfield.Employee IDText for Employee ID. This is readonly field.Employee NameText for Employee Name. This is readonly field.Dependent IDText for Dependent ID. This is readonly field.Dependent NameText for Dependent Name. This is readonly field.Dependent General Information ChangesDependent to waiveSelecting this option will enable to allowVision Planfor any modifications.InformationDependent to waiveSelecting this option will enable to allowDental Planfor any modificationsInformationDependent to waiveSelecting this option will enable to allowMedical Planfor any modificationsInformationPrior PlanSelecting this option will enable to allowInformationfor any modificationsDependent AddressSelecting this option will enable to allowInformationfor any modificationsDependent SSNSelecting this option will enable to allowfor any modificationsDependentSelecting this option will enable to allowRelationshipfor any modificationsDependent DateSelecting this option will enable to allowof Birthfor any modificationsDependentSelecting this option will enable to allowPersonalfor any modificationsInformation

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Dependent Generalinformation for employees.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—5: On clicking continue, navigates to Dependent General Information screen. Respective tabs can also clicked to navigate to corresponding screens. If any other tabs like Coverage or General Info, or if Enrollment summary, Cancel is disabled, due to non-selection of changes sought, use missing information link to navigate to the missing info screen. (See FIG. C-348)

Field Explanation

The following table provides explanation for each button in the screen.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionEnrollmentSaves the data and navigates to Summary screen. ThisSummaryis enabled only if changes are sought on this screen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, are the tabs visible onthis screen. If any other tabs like Coverage or GeneralInfo, or if Enrollment summary, Cancel is disabled,due to non-selection of changes sought, use missinginformation link to navigate to the missing info screen.Step—6: After entering the fields as per the field details explained in field explanation. Click Continue. Screen navigates to Enrollment Summary. (See FIG. C-349)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformation HeaderName of the GroupText for the Name of the GroupGroup IDText and Link for the Group ID to navigateto the Group General Info screenGroup TypeSpecifies the Type of the Group like SmallEmployer GroupProposed EffectiveThe text for Proposed Effective Date. ChooseDatea date by clicking calendar icon. Date acceptsthe format MM/DD/YYYY. Default effectivedate is first of the following month. Effectivedate cannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies theinternal work group attached to the Group.This is based on the writing agent's workgroup.EnrollmentEnrollment Summary Information is brokenSummarydown into tree structure. The tree can byInformationexpanded or collapsed. The level of the treeis as per the example given below:− Employee− Dependent− Dependent− Employee− Dependent− Employee+ Employee− Employee+ Dependent+− EmployeeWhere (−) signifies expanded view and(+) signifies collapsed view.Employee IDText for Employee IDEmployee SSNText for Employee SSNEmployee NameText for employee Name (First Nameand Last Name)Effective DateText for Employee Effective date. Choose adate by clicking calendar icon. Date acceptsthe format MM/DD/YYYY. Defaults effectivedate of the Group. Effective date cannot bepast dateStatusText to specify the status of the employee.EnrollmentThere are two part of this information:Information5) Entered based on verification6) Based on the information provide on theCoverage Info screenEntered based on verificationTotal Full TimeValue is shown based on the actual fullApplied (A)time employee applied (System Identified)Total part TimeValue is shown based on the actual part timeApplied (B)employee applied (System Identified)Employee WaivedText to enter Employee Waived. Contains(C)only whole number. Accepts numbers notexceeding 5 digits. Manually entered basedon verification.Employee DeclinedText to enter Employee Declined. Contains(D)only whole number. Accepts numbers notexceeding 5 digits. Manually entered basedon verification.Total EligibleText to display total eligible employee.Employee (E) =Employee Applying is sum total of A + B + D.Total EmployeeText to display total employee applying.Applying (F)Employee Applying is sum total of A + B.% ParticipationTest to display % participation. Participationis % of E/FBased on Info ProvidedTotal Full TimeText for Total Full Time Applied. Based onApplied (A)the information provide on the CoverageInfo screenTotal part TimeText for Total Part Time Applied. Based onApplied (B)the information provide on the CoverageInfo screenTotal EmployeesText to display total employee applied.AppliedEmployee Applied is sum total of A + B

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionPre EnrollmentSaves the data and performs validation and eligibilitychecks against the information required for enrollmentand navigates to the screen Missing Information.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment summary shows record for 5 employeeson single screen. If the employee size increases morethan 5. These buttons are used for navigating to thenext and previous records for viewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)Group IDClick Group ID to navigates to the Group's general infoscreen.Step—7: On clicking Pre-Enrollment, screen navigates to missing info. (See FIG. C-350)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Dependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationROE/OE StatusSpecifies the pick list for the changesRemarksText for briefing the change actionReason for DeclineChoose from the list of reasons for decline. Thisfield is enabled only if the status of ROE/OEis opted as declineOthersText for briefing the other status and description

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFinalizeNavigates to confirmation screen by incorporating allthe corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—8: On clicking Finalize, navigates to confirmation screen. Click continue to go back to Group search. (See FIG. C-351)

COBRA

The screen is to modify COBRA

The sequential steps involved in modifying COBRA are listed below.Step—1: After successful logon, click the menu Enrollment and select ROE. Select COBRA. (See FIG. C-352)Step—2: he screen navigates search to select a group. Enter the search criteria for Searching for the group. (See FIG. C-353)Step—3: his pops up a screen with search result. (See FIG. C-354)Step—4: lick on any Group ID for selection. Screen navigates to change request screen for making ROE/OE changes for a group. (See FIG. C-355)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationParent Group IDText to display the Parent Group ID. This is a readonly fieldParent GroupText to display the Parent Group Name. This is aNameread only fieldCOBRA Group IDText to display the COBRA Group ID. This is a readonly fieldCOBRA TypeText to display the COBRA Group Type whether CalCOBRA or Federal COBRA. This is a read only fieldGroup EffectiveText to display effective date of the parent group. ThisDateis a read only fieldWork GroupText to Display the internal Work group associatedwith the Parent Group This is a read only fieldStatusText to display status of the group. This is a read onlyfieldMode of RequestChoose a mode of request from the drop down listavailable. The field is mandatory.Post Mark DateThe text for post mark date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon. Thepostmark date cannot be greater than system date.The field is mandatory.Date ReceivedThe text for received date. Choose a date in theformat MM/DD/YYYY by clicking calendar icon.The received date cannot be greater than systemdate. The field is mandatory.Reason for ChangeChoose a reason from the drop down list The field ismandatory.OthersThe text for narrating other info, provided the optionfor reason for terms is others

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to General informationfor groups.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—5: On clicking continue, navigates to Group General Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-356)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionParent Group IDText to display the Parent Group ID.Parent GroupText to display the Parent Group Name.NameCOBRAText to display the COBRA Group ID.Group IDCOBRA TypeText to display the COBRA Group Type whether CalCOBRA or Federal COBRA.Group EffectiveText to display effective date of the parent group.DateWork GroupText to Display the internal Work group associatedwith the Parent GroupStatusText to display status of the group.Post Mark DateText for post mark date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYReceived DateText for received date. Choose a date by clickingcalendar icon. Accepts in the format MM/DD/YYYYSalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory.SuffixChoose the Suffix from the drop down list ofsalutations available.Date of BirthThe text for date of birth. Choose a date by clickingcalendar iconSocial SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.Address Information: Physical Home Address or Mailing AddressAddressThe text for company address. Accepts alphabets andnumeric values not exceeding 35 charactersAptThe text for company suite/apt # Accepts alphabetsand numeric values of not exceeding 35 charactersZipThe text for zip. Accepts numeric of either 5 or 9digits. City, State and County are populatedautomatically for the correct zip code.CityThe text for city. Accepts alphabets of not exceeding30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop down listof States available in United States of AmericaMode ofChoose the mode of correspondence from the dropCorrespondencedown list availablePhone NumberThe text for telephone number of the contact person.Accepts numeric values of not exceeding 10 digits. Theformat is (999) 999-9999ExtensionThe text for telephone number of the contact person.Accepts numeric values of not exceeding 5 digits. Theformat is (999) 999-9999FaxThe text for fax number of the contact person. Acceptsnumeric values of not exceeding 10 digits. The formatis 9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Billing Informationscreen and the system generates Group ID. This isenabled only if changes are sought on this screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen.Navigation to the next screen is also possible by usingtabs If continue button is disabled use this tab tonavigate to the next screen Also while navigatingthrough the tab the content that are changed on thescreen are not saved unless explicitly saved by otheroperations on the screen.Step—6: On clicking continue, navigates to Group Billing Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. Enter the values in the respective fields, as per the format briefed in field's explanation section and click Continue. (See FIG. C-357)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop down listavailable. Based on selection corresponding fields willenable to enter the values. For e.g. if the value selectedis card payment, EFT will be disabled and allows onlyentering card details and vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. Accepts alphabets andNamesspace between two words.Credit Card TypeChoose the type of credit card from the drop down listavailable.Credit Card NoThe text for credit card number. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expiration from the drop down listavailableExpiration YearThe text for expiration year. Accepts numeric valuesof exactly 4. Example 2002.Billing AddressAs itappears on the credit CardStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 characters.ZIPThe text for zip. Accepts numeric value of either 5 or 9digits.StateThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.CityChoose the name of the state from the drop down listof States available in United States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number. Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number. Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of account from the drop down listavailable.Depositor's NameThe text for depositor's name. Accepts alphabets andspace between two words.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to coverage Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen.Navigation to the next screen is also possible by usingtabs If continue button is disabled use this tab tonavigate to the next screen. Also while navigatingthrough the tab the content that are changed on thescreen are not saved unless explicitly saved by otheroperations on the screen.Step—7: On clicking continue, navigates to Group Coverage Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-358)

Field Explanation

The following table provides explanation for each button in the screen

ElementDescriptionCOBRA effectiveThe text for COBRA effective date. Choose a datedateby clicking calendar iconQualifying eventChoose a qualifying even from the drop down listavailableCOBRA end dateThe text for COBRA end date. Choose a date byclicking calendar iconSend bill toChoose the option of sending the bills either to groupor self (individual)Plan InformationLine of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if theemployee is waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down list availablePCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.Are you an existingClick the check box if you are an existing patientpatientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down list availablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insurance endThe text for insurance end date. Choose a date bydateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverage keptThe text for other coverage. Accepts alphabets withvalues not exceeding 50 characters.RAFThe text to display RAF applicable for the PrimaryGroup.Employee signatureClick the check box, to have employee signatureDate signedThe text for date signed. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of employee coverage information.It is only a temporary addition. Becomes permanentonly on saving the record.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.COBRA SummaryClick COBRA summary refreshes the screen anddisplay the summary of information entered forCOBRA creationContinueNavigates add dependent screen.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—8: On clicking continue, navigates to Dependent Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-359)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionFirst NameThe text for first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for last name. Accepts alphabets and specialcharacters like hyphen and single quotes not exceeding35 characters. Last name is mandatory.SuffixChoose the suffix from the drop down list of suffixesavailable.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Birth date cannot be later than thecurrent date.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.RelationshipChoose the relationship from the drop down listavailable.Street AddressThe text for address. Accepts alphanumeric andspecial characters with values not exceeding 35charactersSuiteThe text for suite/apt #. Accepts alphanumeric andspecial characters with values not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, and State are populated automatically onentering the correct zip code and entering the tab key.CityThe text for city. Accepts alphabets not exceeding 30characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaSelected carrierThe text for selected carrier. It is a read only fieldCoverage choiceThe text for coverage. It is a read only fieldService areaThe text for service area. It is a read only fieldPrior plan typeChoose a plan type from the drop down list availablePrior planThe text for plan name. Accepts alphabetsWaivedClick the check box if medical is waivedStart dateThe text for start date. Choose a date by clickingcalendar iconEnd dateThe text for end date. Choose a date by clickingcalendar iconPCP ID/The text for PCP ID. Accepts alphabetsPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotesPCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotesDisabled dependentClick the option of temporary or permanent. This isenable if the relationship opted is childDomestic partnerClick the option for domestic partner. It depends onthe value selected in relationshipLegal guardianClick the option for legal guardian. It depends on thevalue selected in relationshipSignatureClick the check box if the signature is opted

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of dependent information. It is only atemporary addition.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changesContinueScreen navigates to Missing info.TabsGeneral Info, Billing Info, Coverage Info and AddEmployees are the tabs visible on this screen. Thenavigation between is tabs are possible only if there isa valid group ID generated and assigned to the group.Also while navigating through the tab the content thatare changed on the screen are not saved unlessexplicitly saved by other operations on the screen.Step—9: On clicking continue, navigates to Missing Info screen. (See FIG. C-360)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeElementDescriptionMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Dependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationROE/OE StatusSpecifies the pick list for the changesRemarksText for briefing the change actionReason for DeclineChoose from the list of reasons for decline. This fieldis enabled only if the status of ROE/OE is opted asdeclineOthersText for briefing the other status and description

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFinalizeNavigates to confirmation screen by incorporating allthe corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—10: On clicking Finalize, navigates to confirmation screen. (See FIG. C-361)

Manual ROE

The screen is to have manual ROE

The sequential steps involved in having manual ROE are listed below.Step—1: After successful logon, click the menu Enrollment and select ROE. Select Manual ROE. (See FIG. C-362)Step—2: The screen navigates search to select a process. Entries to the fields are mandatory. Click Search. (See FIG. C-363)Step—3: This pops up a screen with search result. (See FIG. C-364)Step—4: Choose a employee id and click Process Manual. Click Search to navigate back to group search screen. (See FIG. C-365)

Individual Member Modify

The screen is to modify Individual Member

The sequential steps involved in modifying Individual Member are listed below.

Step—1: After successful logon, click the menu Enrollment and select ROE. Select Individual Member and then Modify Individual Member. (See FIG. C-366)Step—2: The screen navigates search to select an employee. Enter the search criteria for Searching for the Employee. (See FIG. C-367)Step—3: This pops up a screen with search result. (See FIG. C-368)Step—4: Click on any employee id for selection the screen navigates to Individual Employee Change (pick list). (See FIG. C-369)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group.This is read only field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.ElementDescriptionStatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is read only fieldAssociation IDText for Association ID This is read only field.Association NameText for Association name. This is read only fieldEmployee General InformationEmployee addressSelecting this option will enable to allow for anymodificationsSSN informationSelecting this option will enable to allow forany modificationsEmployee Date ofSelecting this option will enable to allow forbirthany modificationsEmployeeSelecting this option will enable to allow fordemographicany modificationslocationEmployee Billing InformationBilling InformationSelecting this option will enable toallow for any modificationsEmployee Agent InformationAgent InformationSelecting this option will enable to allow for anymodificationsCoverage InformationRAF DiscountingSelecting this option will enable to allowfor any modificationsEmployee TypeSelecting this option will enable to allowfor any modificationsPayrollSelecting this option will enable to allowfor any modificationsMedical LOCSelecting this option will enable to allowfor any modificationsVision LOCSelecting this option will enable to allowfor any modificationsDental LOCSelecting this option will enable to allowfor any modificationsCAM LOCSelecting this option will enable to allowfor any modificationsHours workedSelecting this option will enable to allowfor any modificationsEmployee TypeSelecting this option will enable to allowfor any modificationsDate of employmentSelecting this option will enable to allowfor any modifications

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to General informationfor groups.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—5: On clicking continue, navigates to General Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-370)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group. This is read only field.Effective DateText for Effective date. This is read only field.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for employee ID This is read only field.Employee NameText for employee name. This is read only fieldAssociation IDText for Association ID This is read only field.Association NameText for Association name. This is read only fieldEmployee InformationSalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for first name. Accepts alphabets and specialcharacter like hyphen and single quotes not exceeding25 characters. First name is mandatory.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters. Last name is mandatorySuffixChoose the suffix from the drop down list of suffixesavailable.Date of BirthThe text for date of birth. Choose a date by clickingcalendar iconSocial SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.Address Information; Physical and Alternate Address - Note: EnterAlternate Address if different from the Physical Address.Street AddressThe text for address. Accepts alphanumeric and specialcharacters not exceeding 35 charactersSuiteThe text for suite/apt # Accepts alphanumeric andspecial characters not exceeding 35 charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key.CityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaCountyChoose the name of the county from the drop down listof counties available for the ZIP Code entered.Mode ofChoose the mode of correspondence from the dropCorrespondencedown list available.Phone NumberThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999ExtensionThe text for extension number of the contact person.Accepts numeric values not exceeding 5 digits.FaxThe text for fax number of the contact person Acceptsnumeric values not exceeding 10 digits. The format is(999) 999-9999EmailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueNavigates to Billing Information screen. This isenabled only if changes are sought on this screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabsGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreen.Step—6: On clicking continue, navigates to Billing Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-371)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionMode of paymentChoose a mode of payment from the drop down listavailable. Based on selection corresponding fields willenable to enter the values. For e.g. if the value selectedis card payment, EFT will be disabled and allows onlyentering card details and vice versa.Credit Card InformationCardholder'sThe text for cardholder's name. Accepts alphabets andNamesspace between two words.Credit Card TypeChoose the type of credit card from the drop down listavailable.Credit Card NoThe text for credit card number. Accepts numericvalues not exceeding 30 digitsExpiration DateChoose a month of expiration from the drop down listavailableExpiration YearThe text for expiration year. Accepts numeric valuesof exactly 4. Example 2002.Billing AddressAs it appears on the credit CardStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 characters.ZIPThe text for zip. Accepts numeric value of either 5 or9 digits.StateThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.CityChoose the name of the state from the drop down listof States available in United States of AmericaEFT InformationBank NameThe text for bank name. Accepts alphabets and spacebetween two words.Routing NumberThe text for routing number. Accepts numeric valuesnot exceeding 9 digits.Account NumberThe text for account number. Accepts numeric valuesnot exceeding 9 digits.Account TypeChoose the type of account from the drop down listavailable.Depositor's NameThe text for depositor's name. Accepts alphabets andspace between two words.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and Navigates to Agent Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesEnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for group.MissingClick missing information refreshes the screen andInformationdisplays the missed information for the group.TabsGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreen.Step—7: On clicking continue, navigates to Agent Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-372)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionAgent IDChoose an agent id by clicking search iconAgent TypeChoose an agent type from the drop down listavailable. Based on the selection of the agent type thepercent commission split entry and the Receive ROEpackets option would be available.PercentThe text for percent commission. Accepts numericcommissionvalues in the range of 1-100 (Example 100.00). Thissplitwill be enabled only if the Agent type selected is“Agent Of Record”Sum of the percentage for all the Agent of Recordadded should be equal to 100.00.Receive ROE/OEClick the check box to receive ROE/OE packets forpacketsagent. This option will not be available for AgentType “General Agent”.Agent CommissionThe text for agent commission. Defaults the valuedefined in CM - rate Administration for AgentCommission. Accepts numeric values less than orequal to the defaulted value in the in the range of1-100 (Example 4.45)Check the box ifClick the check box for a group with out an agent.the group isThis option will be available only for the Agentwithout an agentType, “Agent of Record and Writing Agent”.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of agent information. It is only atemporary addition. Becomes permanent only onsaving the record.EditEdit button will allow for editing a specific record inthe table.UpdateUpdate the contents of agent information. It is only atemporary update. Becomes permanent only on savingthe recordDeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the recordCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary of information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationContinueSaves the data and navigates to Coverage Informationscreen. This is enabled only if changes are sought onthis screenCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreenStep—8: On clicking continue, navigates to Coverage Information of group Respective tabs can also clicked to navigate to corresponding screens. Continue would be enabled only if the changes are sought on this screen, else use tab to navigate to the next screen. (See FIG. C-373)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee InformationHours worked perThe text for worked hours per week. Acceptsweeknumeric values not exceeding 2 digits.Date of hireThe text for date of hire. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY.Employee typeChoose an employee type from the drop down listavailablePay RollCheck box for Pay Roll verification. Check this if payroll is verified.RAF DiscountingRAFList the RAF tier applicable for the group based on theRAF tier available on group's effective date.Plan InformationLine of coverageChoose a line of coverage from the drop down listavailableMedical waivedClick the check box for medical waive if the employeeis waiving medical.Carrier selectionChoose a carrier selection from the drop down list(Benefit level)availableCoverage choiceChoose a coverage from the drop down list availablePCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.Are you an existingClick the check box if you are an existing patientpatientPCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior plan typeChoose a plan type from the drop down list availablePrior plan nameChoose a plan name from the drop down list availablePrior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insurance endThe text for insurance end date. Choose a date bydateclicking calendar icon. Date accepts the formatMM/DD/YYYY.AdditionalThe text for additional coverage. Accepts alphabetsCoveragewith values not exceeding 50 characters.Date signedThe text for date signed. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY. Date cannot accept future date.

Button Functionality

The following table provides explanation for each button in the screen

ElementDescriptionAdd (WaitingAdd the contents of Waiting Period information. It isPeriodonly a temporary addition. Becomes permanent onlyInformation)on saving the record.AddAdd the contents of Contribution and Coverage elected.(Contribution)It is only a temporary addition. Becomes permanentonly on saving the record.UpdateUpdates the contents of Waiting Period information. It(Waitingis only a temporary update. Becomes permanent onlyPeriodon saving the record.Information)UpdateUpdate the contents of Contribution and Coverage(Contribution)elected. It is only a temporary update. Becomespermanent only on saving the record.CancelCancels the operation that was currently performedprior to saving the record.EditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.EnrollmentClick enrollment summary refreshes the screen andSummarydisplay the summary information entered for groupcreationMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationViewSaves the data and navigates to Missing InformationMissing InfoPageSave & CreateSaves the data entered and navigates to the screenNew GroupGroup Hierarchy for creating New Group.CancelClears or restores the content entered in the fields onlyprior to saving the records.TabGeneral Info, Billing Info, Agent Info, Coverage Infoare the tabs visible on this screen. Navigation to thenext screen is also possible by using tabs If continuebutton is disabled use this tab to navigate to the nextscreen. Also while navigating through the tab thecontent that are changed on the screen are not savedunless explicitly saved by other operations on thescreenStep—9: Click Enrollment Summary link to have a summary detail. Click Pre Enrollment, which also leads to Missing Info screen. (See FIG. C-374)Step—10: Clicking change summary button screen navigates to missing info screen. This screen shows the overall information that are entered will be shown. (See FIG. C-375)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationROE/OE StatusSpecifies the pick list for the changesRemarksText for briefing the change actionReason for DeclineChoose from the list of reasons for decline. Thisfield is enabled only if the status of ROE/OE isopted as declineOthersText for briefing the other status and description

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFinalizeNavigates to confirmation screen by incorporating allthe corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—11: On clicking Finalize, navigates to confirmation screen. Click Continue to go back to Group search screen. (See FIG. C-376)

Individual Dependent Modify

The screen is to modify Individual Member Dependent

The sequential steps involved in modifying Individual Member Dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select ROE. Select Individual Member and then Modify Dependent. (See FIG. C-377)Step—2: The screen navigates search to select an dependent. Enter the search criteria for Searching for the Dependent. (See FIG. C-378)Step—3: This pops up a screen with search result. (See FIG. C-379)Step—4: Click on any employee id for selection the screen navigates to Individual Employee Change (pick list). (See FIG. C-380)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionGroup InformationName of the groupText for the Name of the Group. Read Only fieldEffective DateText for Employee Effective date. This is read onlyfield.Group IDText for Group ID. This is read only field.StatusText for status. This is read only field.Group TypeText for group type. This is read only field.Work GroupText for work group. This is read only field.Employee IDText for Employee ID. This is read only field.Employee NameText for Employee Name. This is read only field.Dependent IDText for Dependent ID. This is read only field.Dependent NameText for Dependent Name. This is read only field.Dependent General Information ChangesDependent to waiveSelecting this option will enable to allow for anyVision Planmodifications.InformationDependent to waiveSelecting this option will enable to allow for anyDental PlanmodificationsInformationDependent to waiveSelecting this option will enable to allow for anyCAM PlanmodificationsInformationDependent to waiveSelecting this option will enable to allow for anyMedical PlanmodificationsInformationPrior PlanSelecting this option will enable to allow for anyInformationmodificationsDependent AddressSelecting this option will enable to allow for anyInformationmodificationsDependent SSNSelecting this option will enable to allow for anymodificationsDependentSelecting this option will enable to allow for anyRelationshipmodificationsDependent Date ofSelecting this option will enable to allow for anyBirthmodificationsDependentSelecting this option will enable to allow for anyPersonalmodificationsInformation

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionContinueSaves the data and navigates to Dependent Generalinformation for employees.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—5: n clicking continue, navigates to Dependent General Information screen. Respective tabs can also clicked to navigate to corresponding screens. If any other tabs like Coverage or General Info, or if Enrollment summary, Cancel is disabled, due to non-selection of changes sought, use missing information link to navigate to the missing info screen. (See FIG. C-381)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionDependent InformationFirst NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters.SuffixChoose the suffix from the drop down list of suffixesavailable.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon. Date accepts the format MM/DD/YYYY.Birth date cannot be later than the current date.Social SecurityThe text for social security number for everyNumberindividual. This can also be auto generated by clickingauto generate link. Accepts numeric value of exactly 9digits. Users with User Role as Level 2 and above canonly auto generate SSN.GenderChoose a gender from the drop down list available.Address InformationStreet AddressThe text for address. Accepts alphanumeric and specialcharacters with values not exceeding 35 charactersAptThe text for suite/apt #. Accepts alphanumeric andspecial characters with values not exceeding 35charactersZipThe text for zip. Accepts numeric value of either 5 or 9digits. City, State and County are populatedautomatically on entering the correct zip code andentering the tab key.CityThe text for city. Accepts alphabets and space betweentwo words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaLine of Coverage Information [For Medical, Vision, Dental]Selected ProductText for the product selected. It is a read only field.Coverage ChoiceChoose a coverage from the drop down list availableWaivedClick the check box for any waive.Service AreaThe text for service area.PCP ID/MedicalThe text for PCP ID. Accepts alphabets and numericgroup IDvalues not exceeding 10 characters.PCP last nameThe text for PCP last name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 35 characters.PCP first nameThe text for PCP first name. Accepts alphabets andspecial character like hyphen and single quotes notexceeding 25 characters.Prior insuranceThe text for insurance start date. Choose a date bystart dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Prior insuranceThe text for insurance end date. Choose a date byend dateclicking calendar icon. Date accepts the formatMM/DD/YYYY.Other coverageThe text for other coverage. Accepts alphabets withkeptvalues not exceeding 50 characters.AdditionalThe text for additional coverage. Accepts alphabetsCoveragewith values not exceeding 50 characters.DisabledClick the option of temporary or permanent. This isdependentenable if the relationship opted is childDomestic partnerClick the option for domestic partner. It depends onthe value selected in relationshipLegal guardianClick the option for legal guardian. It depends on thevalue selected in relationshipSignatureClick the check box if the signature is opted

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionEnrollmentSaves the data and navigates to Summary screen. ThisSummaryis enabled only if changes are sought on this screen.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesTabGeneral Info, Coverage Info, are the tabs visible onthis screen. If any other tabs like Coverage or GeneralInfo, or if Enrollment summary, Cancel is disabled,due to non-selection of changes sought, use missinginformation link to navigate to the missing info screen.Step—6: After entering the fields as per the field details explained in field explanation. Click Continue. Screen navigates to Enrollment Summary. (See FIG. C-382)

Field Explanation

The following table provides explanation for each element in the screen.

ElementDescriptionGroupContains header information of the GroupInformationHeaderName of the GroupText for the Name of the GroupGroup IDText and Link for the Group ID to navigate to theGroup General Info screenGroup TypeSpecifies the Type of the Group like Small EmployerGroupProposed EffectiveThe text for Proposed Effective Date. Choose a date byDateclicking calendar icon. Date accepts the formatMM/DD/YYYY. Default effective date is first of thefollowing month. Effective date cannot be past dateStatusText to specify the status of the group.Work GroupText for Work Group. This specifies the internal workgroup attached to the Group. This is based on thewriting agent's work group.EnrollmentEnrollment Summary Information is broken down intoSummarytree structure. The tree can by expanded or collapsed.InformationThe level of the tree is as per the example given below:− Employee− Dependent− Dependent− Employee− Dependent− Employee+ Employee− Employee+ Dependent+− EmployeeWhere (−) signifies expanded view and (+) signifiescollapsed view.Employee IDText for Employee IDEmployee SSNText for Employee SSNEmployee NameText for employee Name (First Name and Last Name)Effective DateText for Employee Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of the Group.Effective date cannot be past dateStatusText to specify the status of the employee.Dependent IDText for Dependent IDDependent SSNText for Dependent SSNDependent NameText for Dependent Name (First Name and LastName)Effective DateText for Dependent Effective date. Choose a date byclicking calendar icon. Date accepts the formatMM/DD/YYYY. Defaults effective date of the Group.Effective date cannot be past dateStatusText to specify the status of the Dependent.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionMissingClick missing information refreshes the screen andInformationdisplays the missed information. For a successfulcreation of a group, there should be no missinginformationCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes<<, <, >, >>The enrollment summary shows record for 5 employeeson single screen. If the employee size increases morethan 5. These buttons are used for navigating to thenext and previous records for viewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)Group IDClick Group ID to navigates to the Group's general infoscreen.Step—7: On clicking Pre-Enrollment, screen navigates to missing info. (See FIG. C-383)

Field Explanation

The following table provides explanation for each button in the screen.

ElementDescriptionEmployee Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Dependent Missing InformationMissing EntityList the missing entities for the group changeMessageProvides a message for the missing entitiesEnrollmentLists all the changes sought in the pick listInformationStatusDisplaying the status of change.Change InformationROE/OE StatusSpecifies the pick list for the changesRemarksText for briefing the change actionReason for DeclineChoose from the list of reasons for decline. This field isenabled only if the status of ROE/OE is opted asdeclineOthersText for briefing the other status and description

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionFinalizeNavigates to confirmation screen by incorporating allthe corrections madeCancelClears the contents entered in the fields or restore tothe previous state as was before saving the changesStep—8: On clicking Finalize, navigates to confirmation screen. (See FIG. C-384)

13 View

View option is to facilitate to have any change, or to view the contents of Group, Employee and Dependent.

Access

The application can be accessed from the main menu as follows:Enrollment→View→View GroupEnrollment→View→View EmployeeEnrollment→View→View Dependent

The groups, employees and dependents must exist in the system.

Application Functions

This application has the following functions for reinstatement:View Group—to view the contents of groupView Employee—to view the contents of employeeView Dependent—to view the contents of dependents

View Group

The screen is to view the contents of a group, for further process like to change, only to view the contents or to create a new group.

The sequential steps involved in viewing the details of a group are listed below.Step—1: After successful logon, click the menu Enrollment and select View. Then select View Group. (See FIG. C-385)Step—2: The screen navigates to group search to select a group. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-386)Step—3: This pops up a screen with search result. (See FIG. C-387)Step—4: Choose a group id for selection. On clicking Change button, screen navigates to group change request screen, which is similar to change request for Group explained under CHANGE. The flow and process are same based on the type of group selected. (See FIG. C-388)

On clicking View button, screen navigates to group view screen. The screen is to only to have view option. Click Search Group to navigate back to Group search screen (See FIG. C-389)

On clicking Create New button, screen navigates to group hierarchy screen which is explained under NEW BUSINESS, to create a new group.

View Employee

The screen is to view the contents of an employee, for further process like to change, only to view the contents or to create a new employee

The sequential steps involved in viewing details of an employee are listed below.Step—1: After successful logon, click the menu Enrollment and select View. Then select View Employee. (See FIG. C-390)Step—2: The screen navigates to employee search to select an employee. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-391)Step—3: This pops up a screen with search result. (See FIG. C-392)Step—4: Choose an employee id for selection.

On clicking Change button, screen navigates to employee change request screen, which is similar to change request for Employee explained under CHANGE. The flow and process are same as explained under CHANGE. (See FIG. C-FIG. 393)

On clicking View button, screen navigates to employee view screen. The screen is to only to have view option. Click Search employee to navigate back to Employee search screen. (See FIG. C-394)

On clicking Create New button, screen navigates to Change request for employee add on screen to add new employees.

View Dependent

The screen is to view the contents of an dependent, for further process like to change, only to view the contents or to create a new dependent

The sequential steps involved in viewing details of a dependent are listed below.Step—1: After successful logon, click the menu Enrollment and select View. Then select View Dependent. (See FIG. C-395)Step—2: The screen navigates to employee search to select an employee. Enter value in any one of the fields, or simply click search button to perform search operation. (See FIG. C-396)Step—3: This pops up a screen with search result. (See FIG. C-397)Step—4: Choose an dependent id for selection.

On clicking Change button, screen navigates to dependent change request screen, which is similar to change request for Dependent explained under CHANGE. The flow and process are same as explained under CHANGE. (See FIG. C-398)

On clicking View button, screen navigates to dependent view screen. The screen is to only to have view option. Click Search employee to navigate back to Dependent search screen. (See FIG. C-399)

On clicking Create New button, screen navigates to Change request for dependent add on screen to add new dependents.

PX2 User Manual

Finance

Finance is the transaction module that encompasses the process of Billing, Cash Receipts, Cash Reconciliation and other Finance Operations like Premium Transmission Data Output, Mail House Billing Data Output, Lockbox and EFT Imports, Credit Card Import and export, Commission Check Run and Import Risk Adjustment Factors. These operations are for the various group and members participating in the PacAdvantage program.

The Applications

The above-mentioned processes are accomplished in several applications embedded into the Finance Module. These applications steer the tasks of creating, and maintaining operational information relevant for financial transactions within PX2 entities, thereby helping achieve the goals of the Finance Module.Billing—Billing is the process of creating invoice for the customers enrolled in the PacAdvantage program. The Invoice on a broad base is classified into two types—First Time Invoice (invoice to the group/member that has enrolled as new business) and Running invoice or periodic invoice (To the existing Group/Members).Cash Receipts—Cash Receipt is the process of entering the cash received by BPI into the system. The cash receipt can be received in various modes as defined by the business process. Cash Receipt includes Lock Box receipts, Check, Credit Card, EFT and Transfer.Cash Reconciliation—Cash Reconciliation is the process of reconciling the cash receipts and adjustments to individual invoices and reconciling the amount paid by the group.Cash Disbursement—Cash Disbursement is the process of handling commission. It deals with both commission disbursement as well as commission adjustments.Finance Operations—Finance Operation consists of the utility operations within the finance module for various processes like Premium Transmission Data Output, Mail House Billing Data Output, Lockbox and EFT Imports, Credit Card Import and export, Commission Check Run and Import Risk Adjustment Factors.

Billing is the transaction module that encompasses the process of creating and maintaining invoices for the group and member enrolled with PacAdvantage in the PX2 System. Billing mainly can be categorized in to two.

First Time invoice, generate first time invoice for the groups/members who have enrolled as new business and Periodic invoice.

Generate running invoice to the existing groups/members.

Billing also has other utility as a support to the billing process viz. Suppress Batch Billing, Batch Bill, Batch Billing Adjustments, Manual Bill and Dynamic Text.

AccessThe application can be accessed from the main menu as follows:Finance→Billing→Suppress Batch Billing→Batch Billing→Manual Billing→Billing Adjustments→Dynamic Text

All relevant master and transaction records must be available in the system for a successful billing. Master and transaction records are as follows:Carrier Maintenance—Refer “User Manual for Carrier Maintenance” for further information on the master records.Agent/Agency—Refer “User Manual for Sales and Marketing” for further information on the Agent/Agency records.Enrollment—“User Manual for Enrollment” for further information on the enrolled group and member records. All the information about the existing group/members and their real time transaction details are required to invoice correctly.When bill run is in process there should be no other activities performed on the PX2 System. Bill generation process requires considerable overheads. Probable the best time to start batch billing process is at the end of the day when there would be no user accessing the system.

Application Functions

This application has the following functions:Suppress Batch Billing—Suppress Batch Billing is the process of suppressing periodic bill for a specific Group/Member or collective group and membersBatch Billing—Batch billing is the process of generating running invoice for the existing groups/members. To run this process, scheduler must be started.Manual Billing—Manual billing is the process of creating the invoice manually for a specific group of members where in some special adjustments needs to be made.Billing Adjustments—Billing adjustment is the process of adjusting the bill amount either in full or in part against its value, for a specific group of members where in some special adjustments needs to be made.Dynamic Text—This process provides a feature to add dynamic content on the bills sent to the for a specific Group/Member or collective groups and members

Suppress Batch Billing

The sequential steps involved in Suppress Batch Billing are listed below.Step—1: After successful logon, click the menu Finance and select Billing. Then select Suppress Batch Billing. (See FIG. D-1)Step—2: The screen navigates to Suppress Batch Billing screen. (See FIG. D-2)Step—3: Choose the group ids to suppress and click save button. This will disable save, filter and clear filter buttons and will have only new button enabled to proceed further.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionBill PeriodThe text for bill period. Choose from the list theinvoice period for suppressing the bill.Selected GroupThe text displays the selected group count based onthe invoice period. Example 0 to 100. It is a readonly fieldGroup IdThe text for group Id. Accepts numeric values notexceeding 7 digits.Group NameThe text for group name. Accepts alphanumeric andspecial characters.Group TypeChoose a group type from the drop down listavailableROE Cycle DateThe text for ROE Cycle Date From. Choose from theFromcalendar icon in the format MM/DD/YYYY.ROE Cycle DateThe text for ROE cycle end date. Choose from theTocalendar icon in the format MM/DD/YYYYEffective DateThe text for effective start date. Choose from theFromcalendar icon in the format MM/DD/YYYYEffective Date ToThe text for effective end date. Choose from thecalendar icon in the format MM/DD/YYYYGroup Size FromThe text for group size and specifies the startingrange. Accepts numeric values not exceeding 3digits.Group Size ToThe text for group size and specifies the endingrange. Accepts numeric values not exceeding 3digits.Rate TypeChoose the rate type option from either Blended orNon-Blended RateViewChoose view option from the available options likeAll/Suppressed groups/Un-suppressed groupsView SelectedCheck the View Selected Check Box to view onlyselected groups.TableTable displays the Groups selected based on theSearch and filter conditions.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionBill PeriodOn Selecting the bill period, shows all the groups/members available for the specific invoice periodCheck All(At Suppress Bill Header) Check All link Checks allthe groups from database.Clear All(At Suppress Bill Header). Clear All link uncheck allthe groups that are checked from database.FilterClick the Filter to display the Group based on thesearch criteria / filter conditions provided.Clear FilterClear the Content of the fields.NewClick New to start new operation on this screenSuppressClick Suppress to Suppress billing for the groupsselectedSaveClick Save to save the content of suppress billingUn-SuppressClick Un-Suppress to Un-Suppress billing for thegroups selected.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.Check All on thisThe “Check All on this Page” Link will check all thePagerecords in the table on this PageInvert SelectionThe Invert Selection Link will invert the selectioncriteria for the check boxes. I.e. All Check Groupswould be unchecked and vice versa.<<, <, >, >>These buttons are used for navigating to the next andprevious records for viewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)

Batch Billing

The sequential steps involved in Batch Billing are listed below.Step—1: After successful logon, click the menu Finance and select Billing. Then select Batch Billing. (See FIG. D-3)Step—2: The screen navigates to batch billing screen. (See FIG. D-4)Step—3: Select the bill period and click process button to create invoice for all the groups that are un-suppressed for that bill run period.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionRun IdThe text for sequential number of Run Id. It is a readonly field and is auto generatedBill PeriodChoose month and year for bill period from the dropdown list available, during which bills are to begenerated.Run ByThe text for name of the user who generated the bill.It is a read only field.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionProcessClick Process to start the bill run process for the allthe groups and member for the specified billingperiod selected.NewClick New to start new operation for the Bill Run.View StatusClick view status to navigate to Auto Billing StatusSearchStep—4: On clicking view status button the screen navigates to auto billing status search screen. {See FIG. D-5}Step—5: Enter the value of any one field or simply click search button to perform Search operationStep—6: This pops up a search result screen. (See FIG. D-6)

Fields Explanation

The following table provides explanations for each of the screen fields.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClick Search to search for the Billing Status basedon the search criteria entered.CancelClears the contents entered in the editable field.BackNavigates back to Auto Billing screen.

Manual Billing

The sequential steps involved in Manual BillingStep—1: After successful logon, click the menu Finance and select Billing. Then select Manual Billing. (See FIG. D-7)Step—2: The screen navigates to Manual Invoice screen. (See FIG. D-8)Step—3: Choose period and group id. If the bill for the group id is already generated for the selected month, will display the contents and create button will be disabled. Otherwise, create button will be enabled to generate a bill.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionInvoice DetailsBill #Shows the Bill #. This is auto generated by thesystem.Bill DateShows the Bill Date. Show the date when this billwas generated in the format MM/DD/YYYYPeriodThe text for invoice period. Choose from the list theinvoice period for creating the bill.Due DateShows the Due Date. Show the date when this bill isdue in the format MM/DD/YYYYStatusShows the status of the Bill.Reconciled DateShows the Reconciled Date. Show the date whenthis bill is reconciled in the format MM/DD/YYYYGroup InformationGroup IdText for Group ID. Accepts numeric values notexceeding 7 digits.Group TypeText for Group Type. It is a read only field.Group NameText for Group Name. It is a read only fieldStatusText for Status. It is a read only fieldAssociation NameText for Association Name. It is a read only fieldRate TypeText for Rate Type. It is a read only fieldGroup Level AdjustmentTypeChoose a type of adjustment from the drop down listavailableAmountThe text for adjustment amount. Accepts value in theformat of currency (example 999999999.99)PeriodThe text for the period of adjustment. Choose monthand year from the drop down list.Billing SummaryDisplays the bill summary.Prior period billedText for Prior period billed amount. It is a read onlyamountfieldAdjustments sinceText for Adjustments since prior period. It is a readprior periodonly fieldPaymentsText for Payments Received. It is a read only fieldReceivedPast Due AmountText for Past Due Amount. It is a read only fieldCurrent billText for Current bill amount. It is a read only fieldamountTotal DueText for Total Due. It is a read only fieldEmployee LevelDisplays Employee Level Adjustments. This can beAdjustmentsdue to Add On or Termed Employee/Members.Current PremiumDisplays current premium due for each employeesDueBill SummaryDisplays the bill summarySub Total -Text for Sub Total - Medical Premium. It is a readMedical Premiumonly fieldSub Total - DentalText for Sub Total - Dental Premium. It is a readPremiumonly fieldSub Total - VisionText for Sub Total - Vision Premium. It is a readPremiumonly fieldSub Total - CAMText for Sub Total - CAM Premium. It is a read onlyPremiumfieldAdministrationText for Administration member Fees. It is a readmember Feesonly fieldAgent memberText for Agent member Fees. It is a read only fieldFeesAdministration flatText for Administration flat Fee. It is a read onlyFeefieldAgent flat FeeText for Agent flat Fee. It is a read only fieldTotal due currentText for Total due current period. It is a read onlyperiodfieldAdd Past DueText for Add Past Due Amount. It is a read onlyAmountfieldTotal DueText for Total Due. It is a read only field

Button Functionality

The following table provides explanations for each button in the screen.

ElementDescriptionNewClick New to create a new manual bill.CreateClick Create to Creates bill based on the informationprovidedAddAdd the contents of adjustments into the tablebelow. It is only a temporary addition. Becomespermanent only on saving the record.CalculateClick calculate button to calculate the adjustmentsbased on the adjustment period selected.UpdateUpdate the contents of adjustments. It is only atemporary update. Becomes permanent only onsaving the record.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent only on saving the record.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.

Billing Adjustments

The sequential steps involved in Dynamic Text are listed below.Step—1: After successful logon, click the menu Finance and select Billing. Then select Billing Adjustments. (See FIG. D-9)Step—2: The screen navigates to Adjustment Screen. (See FIG. D-10)Step—3: Enter adjustment date.Step—4: Choose a group id by clicking search icon. Corresponding fields are read only and selecting a group id populates the data.Step—5: Choose Type of group level adjustment and period. Only if the value of type is Late Fee, Calculate button is enabled to calculate and fetch the value in amount field otherwise calculate button is disabled.Step—6: Click Search button lead to have details of adjustment ids, generated. (See FIG. D-11)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionAdjustment DetailsAdjustment IdThis field is a read only and system generated id ofexactly 10 digits.Adjustment DateText for Adjustment Date. Choose a date byclicking calendar icon to have a date in theMM/DD/YYYY format.StatusShows the status of the adjustment.Group InformationGroup IDChoose a group ID by clicking search icon. Field ismandatory.Group TypeField is read only. Populates data based on theselected group IDGroup NameField is read only. Populates data based on theselected group IDAssociation NameField is read only. Populates data based on theselected group IDStatusField is read only. Populates data based on theselected group IDRate TypeField is read only. Populates data based on theselected group IDGroup Level AdjustmentsTypeChoose a type of group level adjustment from thedrop down list available. Field is mandatoryAmountAmount is calculated based on the inputs of type andperiod. Value gets populated by clicking calculatebuttonPeriodChoose a period for which group level adjustment issought. Field is mandatory.

Button Functionality

ElementDescriptionCalculateClick calculate button to calculate the adjustmentsbased on the adjustment period selected.NewClick New to create a new group level adjustmentSaveClick Save to save the content of billing adjustmentSearchClick Search to search for the group level adjustmentstatus based on the search criteria entered.

Dynamic Text

The sequential steps involved in Dynamic Text are listed below.Step—1: After successful logon, click the menu Finance and select Billing. Then select Dynamic Text. (See FIG. D-12)Step—2: The screen navigates to dynamic text screen. (See FIG. D-13)Step—3: Enter the text for dynamic text. This field is mandatory.Step—4: Enter the values in the fields as per the format briefed in fields' explanation table. Choose a group id.Step—5: On clicking Save button, the assigned dynamic text will be made available for the selected group and disable all the fields except New to continue the flow.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionDynamic TextThe text for dynamic text. Accepts all characters.Invoice PeriodThe text for invoice period. Choose from the list theinvoice period for embedding dynamic text on thebill.Selected GroupThe text displays the selected group count based onthe invoice period. Example 0 to 100. It is a readonly fieldGroup IdThe text for group Id. Accepts numeric values notexceeding 7 digits.Group NameThe text for group name. Accepts alphanumeric andspecial characters.Group TypeChoose a group type from the drop down listavailableROE Cycle DateThe text for ROE Cycle Date From. Choose from theFromcalendar icon in the format MM/DD/YYYY.ROE Cycle DateThe text for ROE cycle end date. Choose from theTocalendar icon in the format MM/DD/YYYYEffective DateThe text for effective start date. Choose from theFromcalendar icon in the format MM/DD/YYYYEffective Date ToThe text for effective end date. Choose from thecalendar icon in the format MM/DD/YYYYGroup Size FromThe text for group size and specifies the startingrange. Accepts numeric values not exceeding 3digits.Group Size ToThe text for group size and specifies the endingrange. Accepts numeric values not exceeding 3digits.View SelectedCheck the View Selected Check Box to view onlyselected groups.TableTable displays the Groups selected based on theSearch and filter conditions.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionInvoice PeriodOn Selecting the invoice period, shows all thegroups/members available for the specific invoiceperiodCheck All(At Dynamic Text Header) Check All link Checksall the groups displayed.Clear All(At Dynamic Text Header). Clear All link uncheckall the groups that are checkedFilterClick the Filter to display the Group based on thesearch criteria/filter conditions provided.Clear FilterClear the Content of the fields.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.Check All on thisThe “Check All on this Page” Link will check all thePagerecords in the table on this PageInvert SelectionThe Invert Selection Link will invert the selectioncriteria for the check boxes. I.e. All Check Groupswould be unchecked and vice versa.<<, <, >, >>These buttons are used for navigating to the next andprevious records for viewing.<< - Show first record(s)< - Show previous record(s)> - Show next record(s)>> - Show last record(s)NewClick New to start new operation on this screenSaveClick Save to save the Content of the dynamic text

3 Cash Receipts

Cash Receipt is the transaction module that encompasses the process of creating and maintaining Cash receipts for the group and member enrolled and invoiced in the PX2 System. Cash Receipt is the process of entering the cash received by BPI into the system. The cash receipt can be received in various modes as defined by the business process. Cash Receipt includes Lock Box receipts, Check, Credit Card, EFT and Transfer. Cash Receipts here identifies the Manual Cash batch and Credit Card over phone.

Access

The application can be accessed from the main menu as follows:Finance→Cash Receipts→Manual Batch→Credit Card over Phone

All relevant transactional data pertaining to the group and member must be available for the Cash receipt process.Invoice should be generated and available for the Group/Member for cash receipts for existing groups and members.For new business enrollment the group information must be available in the system to enter the cash batchAll billing information and the mode of payments must be available in the system.For credit card over phone process, Internet connection is a mandatory.

Application Functions

This application has the following functions:Manual Batch: Manual batch is the process of entering the payments and receipts into the system manually. The payments and receipts are identified based on the batch type that can be Manual Batch, NSF Batch, Returns Batch, Positive Transfer, Negative Transfer, Direct Deposit and Wire Transfer.Credit Card over Phone: Credit Card over phone is a interface built for processing credit card transactions over phone for the Group/Member who opts to pay be credit card.

Manual Batch

The sequential steps involved in Manual Batch are listed below.Step—1: After successful logon, click the menu Finance and select Cash Receipts. Then select Manual Batch (See FIG. D-14)Step—2: The screen navigates to Manual Batch screen. (See FIG. D-15)Step—3: Choose Batch type and enter tape total.Step—4: Enter the values in the respective fields as per the format briefed in fields' explanation table.Step—5: On clicking add will do the temporary storage and clicking Save will have a permanent storage.Step—6: Clicking Search button navigates to search screen to have the details of Batch Ids generated. In the search screen, either value can be entered or simply click search button to perform the search operation.Step—7: Following is the search result screen. Click back, to go back to Manual Batch screen. (See FIG. D-16)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionBatch InformationBatch IdThe text for Batch ID. This is auto generated by thesystemBatch DateThe text for batch date. Batch Date defaults to thecurrent date. Choose a date by clicking calendaricon. Date accepts the format M/DD/YYYY.Batch TotalThe text for Batch Total. This is dynamicallycalculated by the system based on the batch entriesBatch TypeChoose the batch type from the list provided. Batchtype can be Manual Batch, NSF Batch, ReturnsBatch, Positive Transfer, Negative Transfer, DirectDeposit and Wire Transfer.Tape TotalThe text for Tape Total. Accepts value in the formatof currency (example 9999999999.99). This field ismandatory.Tape BalanceThe text for Tape Balance. This is dynamicallycalculated by the system based on the batch entries.Batch StatusThe text for Batch Status. Displays the status of thebatch. Batch can be Open or ClosedCheck InformationPost Mark DateThe text for Post Mark date. Choose a date byclicking calendar icon. Date accepts the formatM/DD/YYYY. Post Mark Date cannot be greaterthan Received date.Received DateThe text for Received date. Choose a date byclicking calendar icon. Date accepts the formatM/DD/YYYY. Received Date cannot be future date.This field is mandatory.Check #The text for Check #. Accepts numeric values notexceeding 10 digits. This field is mandatory.Check AmountThe text for amount received. Accepts value in theformat of currency (example 9999999999.99). Thisfield is mandatory. Check amount should be equalGroup Amount Total.Check DistributionGroup IdText for Group ID. Group ID accepts numeric valueof exactly 7 digits. This field is mandatory.Group NameText for Group name. It is a read only fieldAmountThe text for amount received. Accepts value in theformat of currency (example 9999999999.99)CommentsChoose the comments from the list providedOthersText for others. If the Comments is Others specifyother commentTableDisplay the Check distribution added for the batch.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddClick the Add Link to add additional row for theCheck DistributionAddClick add button to add the content of checkdistribution to the table. The Check distributionamount should be equal to the check amount to add.This is only a temporary addition. Becomespermanent only on saving the record.NewClick New to Create a new Batch entrySaveClick Save to save the batch entry data.DeleteClick Delete to delete the batch entry record checkedfor deletion. Becomes permanent only on saving therecord.CloseClick Close button to close the batch data andprocess auto reconciliation. Closing the batch ispossible only if Tape Balance is equal to zero.SearchClick search for searching the existing status ofBatch Data.

Credit Card Over Phone

The sequential steps involved in Credit card over phone are listed below.Step—1: After successful logon, click the menu Finance and select Cash Receipts. Then select Credit Card Over Phone. (See FIG. D-17)Step—2: The screen navigates to Credit Card over phone screen to have transaction, credit card information and amount distribution details. (See FIG. D-18)Step—3: Enter the values in the fields as per the format briefed in fields' explanation table.Step—4: Click Save to save the content. Initially Process button will be disabled. Once the contents are saved, Process button is enabled to process the contents.Step—5: Click Process button to process the transaction. Once Process is click, both Save and Process buttons are disabled.Step—6: Click Search button to have the list of all transactions ids This pops up a search screen. (See FIG. D-19)Step—7: Enter the value in any one of the field or simply click search to perform search operation.Step—8: This navigates to a screen with search results. (See FIG. D-20)Step—9: Click a transaction id for selection to view/modify the content or otherwise click back to credit card over phone screen.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionTransaction InformationTransaction IdThe text for Transaction ID. This is auto generatedby the systemTransaction DateThe text for Transaction date. Choose a date byclicking calendar icon. Date accepts the formatM/DD/YYYY.Transaction StatusThe text for Transaction Status. This is a read onlyfield. The system shows the transaction status basedon credit card authorizationCredit Card InformationCard Holder'sThe text for cardholder's name. Accepts alphabetsNameand space between two words.Credit CardThe text for credit card number. Accepts numericNumbervalues not exceeding 30 digitsCredit Card TypeChoose the type of credit card from the drop downlist available.Expiration DateChoose a month and year of expiration from the dropdown list availableFirst NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters.Middle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters.Street AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaZipText for ZIP Code. Accepts numeric value of exactly5 digits.Payment AmountText for Payment Amount. Displays the amount due.Amount DistributionGroup IdText for Group ID. Group ID accepts numeric valueof exactly 7 digits.Group NameText for Group name. It is a read only fieldAmount DueText for Amount Due. It is a read only fieldPayment AmountThe text for amount received. Accepts value in theformat of currency (example 9999999999.99)RemarksText for Remarks. Accepts 50 characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddClick the Add Link to add additional row for theCheck DistributionNewClick new to Create a new Credit Card over phoneentrySaveClick Save to save the Credit Card over phone entry.ProcessClick Process to process the credit card transactionSearchClick search for searching the existing Credit CardInformation entered.BackClick Back Button to go back to the Credit card overphone screen.

4 Cash Reconciliation

Cash Reconciliation is the transaction module that encompasses the process of reconciling the invoices, cash receipts and adjustments for a specific group and member enrolled and invoiced in the PX2 System. Reconciled Cash can be disbursed to the Carriers, Agents, PacAdvantage and Benefit Partners. Normally cash reconciliation is an automated process. But under special circumstances when the Cash Receipts, Invoices and Adjustments do not match the reconciliation can be done manually using the Cash reconciliation Process.

Also it encompasses the history of billing and payment details.

Access

The application can be accessed from the main menu as follows:Finance→Cash Reconciliation→Manual Reconciliation→Billing & Payment History

Billing, Cash Receipts entries should have occurred for reconciliation.

Enrollment—Refer User Manual for Enrollment for further information on the enrollment process. Real time information and the transaction on the Group and member is required for Reconciliation.

Application Functions

This application has the following functions:Manual Reconciliation.Billing & Payment History

Manual Reconciliation

The sequential steps involved in Manual Reconciliation are listed below.Step—1: After successful logon, click the menu Finance and select Cash Reconciliation. Then select Manual Reconciliation (See FIG. D-21)Step—2: The screen navigates to Group Search screen. (See FIG. D-22)Step—3: Enter value in any one of the field or simply click Search button to perform search operation.Step—4: This pops up a screen with search result (See FIG. D-23)Step—5: Click on any group id for selectionStep—6: Screen navigates to Cash Reconciliation. (See FIG. D-24)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionGroup IdText to display the Group ID, This is a read onlyfieldGroup NameText to display the Group Name, This is a read onlyfieldAssociation NameText for Association Name. It is a read only fieldRate TypeText for Rate Type. It is a read only fieldGroup TypeText for Group Type It is a read only fieldLeft to BalanceText to display the Left to Balance, This is a readonly field. This field is dynamically populated basedon the Check box selected for the reconciliation.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClick Search to search for a new group forprocessing reconciliationClearClick Clear to Cancel and restore to the state as wason loading the pagePostClick Post Reconciliation to Post Reconciliation. IfReconciliationthe Amount Left To Balance is within (+/−2) anyuser can post reconciliation. If the Amount isbetween $3.00 to $50.00 User with Level IIauthorization only can post reconciliation. AmountBetween $51.00 to $100.00 User with Level IIIauthorization only can post reconciliation. Foramount greater than $100.00 User with Level IVauthorization only can post reconciliation.

Billing & Payments History

The sequential steps involved in billing and payment history are listed belowStep—1: After successful logon, click the menu Finance and select Cash Reconciliation. Then Billing & Payments History. (See FIG. D-25)Step—2: Screen navigates group search. (See FIG. D-26)Step—3: Enter value in any one of the field or simply click search button to perform search operation.Step—4: This pops up a search result screen. (See FIG. D-27)Step—5: Click a group id for selection.Step—6: Navigates to history screen. (See FIG. D-28)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionGroup InformationGroup IdText for Group ID. It is a read only field.Group TypeText for Group Type. It is a read only field.Group NameText for Group Name. It is a read only fieldStatusText for Status. It is a read only fieldAssociation NameText for Association Name. It is a read only fieldRate TypeText for Rate Type. It is a read only field

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClick Search to search for billing and paymentshistory

Cash disbursement consists of utility operations like commission disbursement and commission adjustment.

Access

The application can be accessed from the main menu as follows:Finance→Cash Disbursement→Commission disbursement→Commission adjustmentsAll relevant transactional data pertaining to the group and member must be available for the cash disbursement.

Application Functions

This application has the following functions:Commission disbursementCommission adjustments

Commission Disbursement

The sequential steps involved in Agent Commission run are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Disbursement and then select Commission Disbursement. (See FIG. D-29)Step—2: The screen navigates to Commission Disbursement Screen. (See FIG. D-30)Step—3: Choose Bill period from the drop down list. Click ProcessStep—4: Click View Status to have the details of Run ids generated. Search screen pops up. Enter value in any of the fields, or simply click Search button to perform search operation. (See FIG. D-31)Step—5: This pops up a screen with search result. Click any Run Id for selection to view the status of a particular run id. (See FIG. D-32)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionRun IdThe text for Export ID. This is auto generated by thesystemBill PeriodThe text for Export date. This is a read only field.Run ByThe text for Export Status. This is a read only field.The system shows the Export status based onpremium transmission data export

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionProcessClick Process to start the bill run process for the allthe groups and member for the specified billingperiod selected.NewClick New to start new operation for the Bill Run.SearchClick Search to navigate to Commission Billing RunStatus Search

Commission Adjustments

The sequential steps involved in Commission Adjustments are listed below.Step—1: After successful logon, click the menu Finance and select Cash disbursement. Then select Commission AdjustmentsStep—2: The screen navigates to commission adjustment. (See FIG. D-33)Step—3: Choose a type of adjustment. (See FIG. D-34)Step—4: Choose an agent/agency id by clicking search icon. Agent name gets populated based on the selected value.Step—5: Enter adjustment amount. Then click save.Step—6: Click on search button yields the details of the adjustment ids created. (See FIG. D-35)

6 Finance Operations

Finance Operation consists of the utility operations within the finance module for various processes like Premium Transmission Data Output, Mail House Billing Data Output, Lockbox and EFT Exports, Credit Card Import and export, and Import Risk Adjustment Factors.

Access

The application can be accessed from the main menu as follows:Finance→Finance Operations→Premium Transmission→Billing→Cash Receipts→Risk Adjustment

All relevant transactional data pertaining to the group and member must be available for the Finance Operations. To run this process, scheduler must be started.

Application Functions

This application has the following functions:Premium TransmissionMail House BillingLock BoxEFT Data ExportCredit Card ExportCredit Card ImportMail house Commission Data ExportRisk Adjustment Import

Premium Transmission

The sequential steps involved in Premium Transmission are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Then select Premium Transmission (See FIG. D-36)Step—2: The screen navigates to Transmission screen. (See FIG. D-37)Step—3: Choose the dates for transmit and comments if any. Click Export. Immediately, the export status will display the status as “In Progress”.Step—4: Click Search to know the status of the export ids generated. (See FIG. D-38)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionExport IdThe text for Export ID. This is auto generated by thesystemExport StatusThe text for Export Status. This is a read only field.The system shows the Export status based onpremium transmission data exportExported ByThe text for Exported By. This is a read only field.Export DateThe text for Export date. This is a read only field.Transmit for theChoose “Transmit for the following Dates From” byfollowing Datesclicking calendar icon. The date can be in the formatFrom:MM/DD/YYYYTransmit for theChoose “Transmit for the following Dates To” byfollowingclicking calendar icon. The date can be in the formatDates ToMM/DD/YYYYTableDisplay the Transmission ID for the Carrier andCarrier NameCommentsThe text for Comments.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick New button to Create new Premium DataTransmissionExportClick Export button to Export the Premium DataTransmission based on the selection criteriaSearchClick Search Button to Search for the Premium DataTransmission and view the Export Status

Mail House Billing Data Export

The sequential steps involved in Mail House Billing Export Data are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Billing and then select Mail House Billing Data Export. (See FIG. D-39)Step—2: The screen navigates to Mail House Billing screen. (See FIG. D-40)Step—3: Choose Export date and a group id for export. Click Export.Step—4: Click view status to know the status of export ids generated. Search screen pops up. Enter value in any of the field, or simply click search button to perform search operation. (See FIG. D-41)Step—5: Click back to navigate back to Mail House Billing screen. (See FIG. D-42)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionMail House Billing DataExport IdThe text for Export ID. This is auto generated by thesystemStatusThe text for Export Status. This is a read only field.The system shows the Export status based on dataexportedExported ByThe text for Exported By. This is a read only field.Export DateThe text for Export date. This is a read only field.Export Date as ofChoose “Export Date as of” from the list of billingperiodSelected GroupsThe text displays the selected group count based onthe invoice period. Example 0 to 100. It is a readonly fieldCommentsThe text for Comments.FilterGroup IdThe text for group Id. Accepts numeric values only.Group NameThe text for group name. Accepts any characters.Group TypeChoose a group type from the drop down listavailableROE Cycle DateThe text for ROE Cycle Date From. Choose from theFromcalendar icon in the format MM/DD/YYYY.ROE Cycle DateThe text for ROE cycle end date. Choose from theTocalendar icon in the format MM/DD/YYYYEffective DateThe text for effective start date. Choose from theFromcalendar icon in the format MM/DD/YYYYEffective Date ToThe text for effective end date. Choose from thecalendar icon in the format MM/DD/YYYYGroup Size FromThe text for group size and specifies the startingrange. Accepts numeric values only.Group Size ToThe text for group size and specifies the endingrange. Accepts numeric values only.View SelectedCheck the View Selected Check Box to view onlyselected groups.TableTable displays the Groups selected based on theSearch and filter conditions.

Button Functionality

The following table provides explanation for each button in the screen.

Process Lock Box

The sequential steps involved in Lock Box are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Cash Receipts and then select Lock Box. (See FIG. D-43)Step—2: The screen navigates to Import Lock Box screen. (See FIG. D-44)Step—3: On clicking Search Button enables to have a list of Import Ids. This pops up a search screen. (See FIG. D-45)Step—4: Enter value in any of the field or simply click search button to perform search operation. This navigates to a screen with search result. (See FIG. D-46)Step—5: Choose an Import ID for selection to alter the content or simply click back button to navigate back to Lockbox screen.Step—6: Enter the values in the respective fields, as per the formats specified in the field explanation table and click Import.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionImport IdRead only field to display import id valueStatusRead only field to display the status of importImport DateRead only field to display the import dateImported ByRead only field to display the user who imported thefilesImport FileEnter the file path or select the path by clickingbrowse button. The field is mandatoryBatch DateEnter the date for Batch date or select a date byclicking calendar icon. The field is mandatory.Tape TotalText for tape Total. Enter the tape total. Acceptsnumeric values in the format 9999999.99CommentText for comments.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on new button enables to have a new import ofLockbox File.ImportClick on import button will perform the action ofimporting the file selected.SearchClick on the Search button to search for the Lockboxfile import status.BrowseClick on the Browse button will enable to choose afile to import

EFT Data Export

The sequential steps involved in EFT Data Export are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Cash Receipts and then select EFT Data Export. (See FIG. D-47)Step—2: The screen navigates to EFT Data Export screen. (See FIG. D-48)Step—3: On clicking Search button leads to EFT Data Search screen to have all the Export Ids. (See FIG. D-49)Step—4: Enter the value in any one of the field or simply click search button to perform search operation. This pops up a screen with search results. (See FIG. D-50)Step—5: Choose an Export ID for selection, otherwise click Back button to navigate back to EFT Data Export.Step—6: Enter the values in the respective fields as per the format briefed under Fields' Explanation and click Export.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionExport EFT DataExport IdThe text for Export ID. This is auto generated by thesystemStatusThe text for Export Status. This is a read only field.The system shows the Export status based on dataexportedExported ByThe text for Exported By. This is a read only field.Export DateThe text for Export date. This is a read only field.Export Date as ofChoose “Export Date as of” from the list of billingperiodSelected GroupsThe text displays the selected group count based onthe invoice period. Example 0 to 100. It is a readonly fieldTotal BillText to display the total bill amount. This is readAmountonly fieldCommentsThe text for Comments.FilterGroup IdThe text for group Id. Accepts numeric values only.Group NameThe text for group name. Accepts any characters.Group TypeChoose a group type from the drop down listavailableROE Cycle DateThe text for ROE Cycle Date From. Choose from theFromcalendar icon in the format MM/DD/YYYY.ROE Cycle DateThe text for ROE cycle end date. Choose from theTocalendar icon in the format MM/DD/YYYYEffective DateThe text for effective start date. Choose from theFromcalendar icon in the format MM/DD/YYYYEffective Date ToThe text for effective end date. Choose from thecalendar icon in the format MM/DD/YYYYGroup Size FromThe text for group size and specifies the startingrange. Accepts numeric values only.Group Size ToThe text for group size and specifies the endingrange. Accepts numeric values only.View SelectedCheck the View Selected Check Box to view onlyselected groups.TableTable displays the Groups selected based on theSearch and filter conditions.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionExported date AsOn Selecting the Exported date As on, shows all theongroups/members available for the specific periodCheck All(At Text Header) Check All link Checks all thegroups displayed.Clear All(At Text Header). Clear All link uncheck all thegroups that are checkedFilterClick the Filter to display the Group based on thesearch criteria/filter conditions provided.Clear FilterClear the Content of the fields.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.Check All on thisThe “Check All on this Page” Link will check all thePagerecords in the table on this PageInvert SelectionThe Invert Selection Link will invert the selectioncriteria for the check boxes. I.e. All Check Groupswould be unchecked and vice versa.<<, <, >, >>These buttons are used for navigating to the next andprevious records for viewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)NewClick New to start new operation on this screenExportClick Save to save the Content of the EFT ExportCommitClick Commit to effect the EFT PaymentSearchClick on Search navigates to have EFT searchBackClick Back navigates back to EFT payment screen

Credit Card Export

The sequential steps involved in Credit Card Export are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Cash Receipts and then select Credit Card Export. (See FIG. D-51)Step—2: The screen navigates to Credit Card Export Screen (See FIG. D-52)Step—3: Choose export date and a group id. Click Export. This pops up a screen for confirmation to download. Click Ok. (See FIG. D-53)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCredit Card ExportExport IdThe text for Export ID. This is auto generated by thesystemStatusThe text for Export Status. This is a read only field.The system shows the Export status based on dataexportedExported ByThe text for Exported By. This is a read only field.Export DateThe text for Export date. This is a read only field.Export Date asChoose “Export Date as of” from the list of billingofperiodSelected GroupsThe text displays the selected group count based onthe invoice period. Example 0 to 100. It is a readonly fieldCommentsThe text for Comments.FilterGroup IdThe text for group Id. Accepts numeric values only.Group NameThe text for group name. Accepts any characters.Group TypeChoose a group type from the drop down listavailableROE Cycle DateThe text for ROE Cycle Date From. Choose from theFromcalendar icon in the format MM/DD/YYYY.ROE Cycle DateThe text for ROE cycle end date. Choose from theTocalendar icon in the format MM/DD/YYYYEffective DateThe text for effective start date. Choose from theFromcalendar icon in the format MM/DD/YYYYEffective DateThe text for effective end date. Choose from theTocalendar icon in the format MM/DD/YYYYGroup Size FromThe text for group size and specifies the startingrange. Accepts numeric values only.Group Size ToThe text for group size and specifies the endingrange. Accepts numeric values only.View SelectedCheck the View Selected Check Box to view onlyselected groups.TableTable displays the Groups selected based on theSearch and filter conditions.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionExported date AsOn Selecting the Exported date As on, shows all theongroups/members available for the specific periodCheck All(At Text Header) Check All link Checks all thegroups displayed.Clear All(At Text Header). Clear All link uncheck all thegroups that are checkedFilterClick the Filter to display the Group based on thesearch criteria/filter conditions provided.Clear FilterClear the Content of the fields.Check AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.Check All onThe “Check All on this Page” Link will check all thethis Pagerecords in the table on this PageInvert SelectionThe Invert Selection Link will invert the selectioncriteria for the check boxes. I.e. All Check Groupswould be unchecked and vice versa.<<, <, >, >>These buttons are used for navigating to the next andprevious records for viewing.<< - Show first record (s)< - Show previous record (s)> - Show next record (s)>> - Show last record (s)NewClick New to start new operation on this screenSaveClick Save to save the Content of the Credit CardExport

Credit Card Import

The sequential steps involved in Credit Card Import are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Cash Receipts and then select Credit Card Import. (See FIG. D-54)Step—2: The screen navigates to Credit Card Import Screen. (See FIG. D-55)Step—3: Choose a file to import by clicking Browse button. The file should be in the format of .txtStep—4: Click Import button to import the selected file. If the file selected is imported successfully, status will show imported.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionImport IdRead only field to display import id valueStatusRead only field to display the status of importImport DateRead only field to display the import dateImported ByRead only field to display the user whoimported the filesImport FileEnter the file path or select the path by clickingbrowse button. The field is mandatoryCommentsText for Comments

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on new button enables to have a new import ofCredit Card File.ImportClick on import button will perform the action ofimporting the file selected.

Mail House Commission Data Export

The sequential steps involved in Agent Commission run are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Cash Receipts and then select Mail house Commission data export. (See FIG. D-56)Step—2: The screen navigates to Mail House Commission Data Export Screen (See FIG. D-57)Step—3: Choose export date and group id to be exported. Click Export.Step—4: Click view status to have the status details of export ids generated. Search screen pops up. Enter value in any of the field or simply click search button to perform search operation. (See FIG. D-58)Step—5: This pops up a screen with search result. Click Back to navigate back to Mail house commission data export screen. (See FIG. D-59)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCheque BillingExport IdThe text for Export ID. This is auto generated by thesystemStatusThe text for Status. This is a read only field. Thesystem shows the Export status based on premiumtransmission data exportExported ByThe text for Exported By. This is a read only field.Export DateThe text for Export date. This is a read only field.Exported date AsOn Selecting the Exported date As on, shows all theongroups/members available for the specific periodSelected GroupsDisplays the number of groups selected from theOftotal number of available groupsCommentsThe text for Comments.FilterAgent/Agency IdText for agent/agency id. Accepts numeric values ofnot exceeding 10 digitsAgent/AgencyChoose either agent or agency to incorporate namesAgent First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters. Field is mandatoryAgent Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters. Field is mandatoryAgency LegalNameView SelectedCheck the View Selected Check Box to view onlyselected groups.Effective DateThe text for effective start date. Choose from theFromcalendar icon in the format MM/DD/YYYYEffective Date ToThe text for effective end date. Choose from thecalendar icon in the format MM/DD/YYYYCheck AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.Check All on thisThe “Check All on this Page” Link will check all thePagerecords in the table on this PageInvert SelectionThe Invert Selection Link will invert the selectioncriteria for the check boxes. I.e. All Check Groupswould be unchecked and vice versa.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick New to start new operation on this screenExportClick Export button to Export the check billing databased on the selection criteriaSearchClick Search Button to Search for the check billingdata and view the Export StatusFilterClick the Filter to display the Group based on thesearch criteria/filter conditions provided.Clear FilterClear the Content of the fields.

Risk Adjustment

The sequential steps involved in Risk Adjustment Import are listed below.Step—1: After successful logon, click the menu Finance and select Finance Operations. Select Risk Adjustment and then select Risk Adjustment Import. (See FIG. D-60)Step—2: The screen navigates to Import Risk Adjustment Factor. (See FIG. D-61)Step—3: Choose a file to import by clicking Browse button. The file format should be of .txt Click Import to import the selected file.Step—4: Click search button to know the status of import ids generated. This pops up a search screen, where the enter any value in one of the field or simply click search to perform search operation.Step—5: This pops up a screen with search result. Click on any import id to view the contents or otherwise click Back button to navigate back to Import Risk Adjustment Factor screen. (See FIG. D-62)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionImport IdRead only field to display import id valueImport StatusRead only field to display the status of importImported ByRead only field to display the user who imported thefilesImport DateRead only field to display the import dateImport FileEnter the file path or select the path by clickingbrowse button. The field is mandatoryEffective DateEnter the date for Effective date or select a date byclicking calendar icon. The field is mandatory.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNewClick on new button enables to have a new importof Risk Adjustment Factor File.ImportClick on import button will perform the action ofimporting the file selected.SearchClick on the Search button to search for the RiskAdjustment file import status.

PX2 User Manual

Others

Others encompass the modules like Search Zip, Call Tracking, Manual Mail Merge, Report and Letter Regeneration.

The Applications

Search Zip—. Search Zip provides basically two types of searches. First it analyses the zip codes provided namely zip1 and zip2 and provides the distance between the two locations. Another one is search can be made either by entering zip code, county or city

Call Tracking—. Call Tracking is used to track the calls that are made or received with specific business intension. It can be inbound (calls received) or outbound (calls made). It also has a feature for identifying task on hand for the calls as “To do List”

Manual Mail Merge—. The Mail Merge module addresses the functionality of the system where it needs to generate business correspondences using predefined templates. The templates are basically RTF files with placeholders for dynamic data in them. The output is usually a RTF file, but at times this could be a PostScript or a PDF document

Letter Regeneration—. The Letter Regeneration is mainly to generate letters as per the templates provided. The templates can be selected based on the selected criteria, namely Group, Employee, Agent and Dependent.

Reports—. Report Module encompasses the process of displaying the business information to the viewers. The objective of the Reports is to provide information captured in the system to the user in a presentable manner. The reports can be single, two-dimensional and multi dimensional providing the information to the decision-maker

2 Search Zip

Search Zip provides basically two types of searches. First it analyses the zip codes provided namely zip1 and zip2 and provides the distance between the two locations. Entering zip code, county or city can make another one is search.

Access

The application can be accessed from the main menu as follows:Others→Search Zip

Zip search provides the distance between the two zip codes and also search can be made by either on zip code, county or city.

Application Functions

The application consists of only one screen.Zip Search—to arrive the distance of two zip codes and also to have a search either on zip code, county or city.

Search Zip

Zip search provides the distance between the two zip codes and also either on zip code, county or city can make search.Step—1: After successful logon, click the menu Others and Search Zip. (See FIG. E-1)Step—2: Choose any one from the options [City, County, Zip] and enter corresponding value in the text field. Entry to this field is mandatory, before clicking Search button.Step—3: This pops up a screen with search results. (See FIG. E-2)Step—4: Enter zip code1 and zip code2, as per field explanation provided in Fields Explanation table. Also choose the search option from City/County/Zip. Click Search. (See FIG. E-3)

Fields Explanation

The following table provides explanations for each of the screen fields

Button Functionality

The following table provides explanation for each button in the screen

ElementDescriptionSearchClick on the search button will search based on theselection of the radio button value for the text enteredin the search box. Search box should not be empty.CancelClick on the cancel button to clear the data entered onthe screen and focus on the same screen to proceed.PrintClick on Print will print the contents of the tablegenerated based on the search criteria.Go buttonClick on the go button to analyze the zip codesentered for their availability and displays the resultfor the valid zip codes.

3 Call Tracking

Call Tracking is used to track the calls that are made or received with specific business intension. It can be inbound (calls received) or outbound (calls made). It also has a feature for identifying task on hand for the calls as “To do List”.

Access

The application can be accessed from the main menu as follows:Others→Call Tracking→To Do List

Group & Agent information must be available in the system. as a pre-requisite

Application Functions

This application has the following functions:Call Tracking—to keep track of information received from group/agentTo Do List—gives a list of task to be performed

Call TrackingStep—1: After successful logon, click the menu Sales & Marketing and select Call Tracking. Then select call tracking. (See FIG. E-4)Step—2: Screen navigates to Call Tracking screen. (See FIG. E-5)Step—3: Select a value for call type from the list available Choose. Group/Agent Id by clicking search icon. (See FIG. E-6)Step—4: On clicking search icon, a search screen pops up. Search operation can be performed either based on the inputs or even if the fields are empty. (See FIG. E-7)Step—5: Click on group id for selectionStep—6: Enter the value of the fields, as per the format briefed in field's explanation sectionStep—7: Click save button.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCall TypeChoose a type of call from the drop down listavailableReferenced EntityChoose an entity from either Group or Agent.Group is the default selected valueGroup IdThe text for group id. Choose a group id byclicking search icon. It is valid only if theoption of referenced entity is group.The field is mandatoryAgent IdThe text for agent id. Choose an agent id byclicking search icon. It is valid only if theoption of referenced entity is agent.The field is mandatoryCaller NameThe text for caller name Accepts alphabetsand special characters like hyphen and singlequotes not exceeding 35 characters.Field is mandatoryNature of CallChoose a nature of call from the drop downlist available. Field is mandatoryOtherThe text for others. It accepts alphanumericvalues. The field is active only if the value ofnature of call is otherDate & TimeThe text for date and time. It is a systemgenerated value and it is read onlyFollow-up requiredClick the check box, if the follow-up isrequiredFollow-up DateThe text for follow-up date. Choose a date inthe format MM/DD/YYYY by clickingcalendar icon. It is mandatory only if thefollow-up value is clicked.CommentThe text for comments. Accepts alphanumericand special characters except double quotes ofmaximum length 255 characters

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the entered information not only for thepresent screen.SearchClears the screen and perform search operationbased on the input value for group/agent.CancelClears the contents entered in the fields or restoreto the previous state as was before saving thechanges.

To do ListStep—1: After successful logon, click the menu Others and select Call Tracking. Then select To Do List. (See FIG. E-8)Step—2: Screen navigates to “To Do” List screen.Step—3: Choose call type. Enter date for either follow-up date or called date. Click Search. (See FIG. E-9)Step—4: This pops up a screen with search result. (See FIG. E-10)Step—5: On selecting an entity by clicking the check box, it means that the status is going to be changed.Step—6: On clicking save it will ask for confirming the change in status. Once it is confirmed the task is completed and get removed from the list.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCall TypeChoose a type of call from the option ofinbound and outbound. The default valueselected is inboundFollow-up DateThe text for follow-up date. Choose a datein the format MM/DD/YYYY by clickingcalendar icon. provided the option offollow-up-date is selectedCalled DateThe text for called date. Choose a date inthe format MM/DD/YYYY by clickingcalendar icon, provided called date is selected

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the entered information not only for thepresent screen.SearchClears the screen and perform search operationbased on the input value for group/agent.CancelClears the contents entered in the fields orrestore to the previous state as was beforesaving the changes.CloseClose the window.

4 Manual Mail Merge

The Mail Merge module addresses the functionality of the system where it needs to generate business correspondences using predefined templates. The templates are basically RTF files with placeholders for dynamic data in them. The output is usually a RTF file, but at times this could be a PostScript or a PDF document

Access

The application can be accessed from the main menu as follows:Others→Manual Mail Merge

All the pre-defined templates for generating business correspondence must be available for generating the same.

Application Functions

This application has the following functions:Mail Merge—to generate business correspondence as per the available templates.

Manual Mail Merge

The screen is to generate business correspondence.

The sequential steps involved in manual mail merge are listed below.Step—1: After successful logon, click the menu others select Manual Mail Merge. (See FIG. E-11)Step—2: Navigates to a screen wherein a category has to be selected. Based on the selected category, the templates pertaining to that category will be displayed for generating business correspondence. (See FIG. E-12)Step—3: Choose a template id for generating the business correspondence. (See FIG. E-13)Step—4: This navigates to a screen, which has mainly three headings stating about the details of Template information, the category selected and the output option. The header that contains the fields based on the selected category, are all dynamically generated. to have search operation. (See FIG. E-14)Step—5: The content of the fields based on the category selected, has to be selected by search icon. Enter any value or first letter in any one of the fields to perform search operation. Click search icon. (See FIG. E-15)Step—6: This pops up a screen with search result. (See FIG. E-16)Step—7: Click on any hyperlink for selection.Step—8: Choose the output option. If the option is View the user can a view of the business letter generated from the chosen template or otherwise if the option is Print to Mailroom will queue the business correspondence generated to printer. A pop up screen will appear stating the status of mail merge. (See FIG. E-17)Step—9: On clicking Ok button, screen navigates to word document as follows: (See FIG. E-18)

Letter Regeneration is used to generate letters for a specific period with specific type of letter say Add On, Termination etc., with specific addressee say Employee, Group, Dependent etc.,

Access

The application can be accessed from the main menu as follows:Others→Letter Regeneration

Relevant information must be available in the system as a pre-requisite

Application Functions

This application has the following functions:Letter Regeneration—to generate letters with specific request

Letter RegenerationStep—1: After successful logon, click the menu Others and then Letter Regeneration. (See FIG. E-19)Step—2: Screen navigates to Letter Regeneration screen.Step—3: Enter the values in the respective field as per the format explained in fields' explanation table.Step—4: Based on the selected value in Address Type, will allow to have search operation for address, by clicking the search icon. (See FIG. E-20)Step—5: By clicking the search icon for addressee, search screen displays, for the selected value in address type.Step—6: Select an employee id. The selected employee name gets reflected in Letter Regeneration screen. (See FIG. E-21)Step—7: According to the inputs, the templates will be displayed by clicking Search button to generate a letter. If no option is selected and simply clicking search button will display all the templates.Step—8: Click on any template for selection to generate a letter.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionLetter generatedThe text for From date to generate a letter.betweenChoose a date in the format MM/DD/YYYY byclicking calendar icon providedAndThe text for To date to generate a letter. Choosea date in the format MM/DD/YYYY by clickingcalendar icon providedType of letterChoose a type of letter from the drop down listavailable namely, Add On, Termination, MissingInfo, OthersAddressee typeChoose a type of addressee from the drop downlist available namely, Group, Employee,Dependent, Agent. This field is mandatory.AddresseeBased on the selected value of addressee type,will restrict to choose a addressee by clicking thesearch icon.Addressee nameText for addressee name. This is a read only field.Data is populated by selecting an addressee byclicking search icon.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClears the screen and perform search operationbased on the input value.ClearClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Reports Module encompasses the process of displaying the business information to the viewers. The objective of the Reports is to provide information captured in the system to the user in a presentable manner. The reports can be single, two-dimensional and multi dimensional providing the information to the decision-maker.

Reports are categorized based on the modules and the purpose of the reports.

Access

The application can be accessed from the main menu as follows:Others→Reports

All the master and transactional data must be available in the system to display the real time reporting feature.

Application Functions

This application has the following functions:Generate—to generate reports

Report

The screen is to generate report

The sequential steps involved in generating a report are listed below.Step—1: After successful logon, click the menu Others select Report. (See FIG. E-22)Step—2: The screen navigates to report heading, which are identified as major headings to cover all the information. (See FIG. E-23)Step—3: Choose any heading. Click (+) to expand and (−) to collapse. Screen displays the sub-headings under each major heading. (See FIG. E-24)Step—4: Choose any sub-heading to have report.Step—5: Navigates to a screen for entering the query criteria. These fields are built dynamically based on the report sought. (See FIG. E-25)Step—6: Enter the search criteria as available on the screen and Click Generate Report. Click on the back button to navigated back to the Report Screen.Step—7: Opens up a new browser window and displays the report in the crystal viewer. (See FIG. E-26)

PX2 User Manual

Sales & Marketing

Sales and Marketing is the master and transaction module that encompasses the process of creating and maintaining master and transaction information that is required for the PX2 System like Agent, Agency, Lead, Quotes, Work Group, Associates, Supplier request, Lead and Agent Tracking and Campaign.

The Applications

The above-mentioned processes are accomplished in several applications embedded into the Sales and Marketing Module. These applications steer the tasks of creating, and maintaining master and transaction information for the PX2 entities, thereby helping achieve the goals of the Sales and Marketing.

Supply Request—A Supply Request is the process of ordering the handbooks, rate books, forms and application, complementary, super directories that are sent to the employer groups and its members through the mailroom. Supplier Request basically consists of Internal Supplier request to cater to the internal needs of the BPI and External Supplier request to cater to the external needs of the BPI.

Work Groups—Workgroups is the process of categorization of a group of agents, internal working personnel of BPI, external working personnel associated with BPI into a subset of work groups.

Associates—The Associated is the process of identifying and managing the personnel who are employed by BPI and work with BPI.

Campaign—A campaign is the process of identifying a segment of potential employer groups targeted through the media like the radio, newspaper, mailers etc. Benefit Partners organizes for the marketing campaigns through third parties or by itself periodically.

Sales Master—Sales Master is the process of maintaining the entire master records relevant to the Sales. This includes operations like creation and maintenance of Agent, Agency, Lead Masters, Lead Tracking, and Agent Profiles.

Quotes—Quotes are the processes of providing Quotes for potential business entities as well as existing business entities. Quotes can be requested for small Employer Groups or Alternate Groups (Individual Association Member, Association Group, COBRA etc.) as well as for employees of those groups.

2 Supply Request

Supplier request is to setup basic information for ordering various Handbooks, stationeries and other materials needs by BPI for their day to day business in the PX2 system Supplier Request are of two types, Internal and External

Access

Pre-RequisitesBoth internal and external supplier request contains header and the items (As Stock # in the header and Items below). The data for the Stock # and the Items are available in the tables TBL_BPICAS_CODE_CTRL and TBL_BPICAS_UTIL.Table TBL_BPICAS_CODE_CTRL has CODE_ID, CODE_VALUE and CODE_DESC

The table needs to be populated to have the Stock # on the screen

Example Data

The table needs to be populated to have the Items on the screen

Example Data

Application Functionality

The application consists of two screens.

Internal Supply Request—to have internal supply request

External Supply Request—to have external supply request

Internal Supply RequestStep—1: After successful login, click Supply Request then select Internal Supply Request. (See FIG. F-1)Step—2: Navigates to Internal Supply Request screen. Entry in one quantity field is mandatory. Also confirmation can be accessed by clicking confirmation tab. (See FIG. F-2)Step—3: On clicking Save navigates Confirmation screen. (See FIG. F-3)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionQtyEnter the value for quantity. Accepts only numericvalues. At least one value for quantity is mandatory.SpecialEnter the text for special instructions. AcceptsInstructionsalphanumeric and special characters not exceeding255 characters. The field is optional.

Button Functionality

The following table provides explanations for each of the screen fields.

ElementDescriptionSave buttonClick on save button to the save the content keyedin and navigates to confirmation screen displayingthe Confirmation ID.Cancel buttonClick on clear button clears the content and appearsagain for fresh entries

External Supply RequestStep—1: After successful login, click Supply Request then select External Supply Request. (See FIG. F-4)Step—2: Navigates to External Supply Request screen. Entry in one quantity field is mandatory. Also confirmation can be accessed by clicking confirmation tab. (See FIG. F-5)Step—3: On clicking Save navigates to Confirmation screen. (See FIG. F-6)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionQtyEnter the value for quantity. Accepts only numericvalues. At least one value for quantity is mandatory.Customer RequestEnter a date or click calendar icon to select a date.DateThe field is mandatory.Confirm fulfillmentChoose the option by ticking the checkbox to haveby Emaila confirmation of request made by email.Agent/EmployerEnter the value for agent/employer group id. TheGroup Idfield is mandatory. Or Choose the Agent or Groupby clicking the Search IconCompany NameEnter the text for company name. The field ismandatoryAddressThe text for company address. Acceptsalphanumeric and special characters notexceeding 35 charactersSuiteThe text for company suite Accepts alphanumericand special characters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.The field is mandatoryStateChoose a state from the drop down list. The fieldis mandatoryReferenced EntityChoose the option either Group or AgentZipThe text for zip. Accepts numeric value of exactly5 digits.Ship viaChoose the option of delivery from the availablemodes like Mailroom, Will Call,Special InstructionsEnter the text for special instructions. Acceptsalphanumeric and special characters not exceeding255 characters.

Button Functionality

The following table provides explanations for each of the screen fields.

ElementDescriptionSave buttonClick on save button to the save the content keyed inand navigates to confirmation screen displaying theConfirmation ID.Cancel buttonClick on clear button clears the content and appearsagain for fresh entries

3 Work Groups

Work Group is to setup basic information like Category, Work Group and Child Work Group. Workgroups is the concept of categorization of a group of agents, internal working personnel of BPI, external-working personnel associated with BPI into a subset of work groups. Also this provides a feature of swapping the members within the work group.

Access

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:Category—To Create, Modify and view CategoryMain Workgroup—To Create, Modify and view Main WorkgroupChild Workgroup—To Create, Modify and view Child WorkgroupMail Members—To Create, Modify and view Mail MembersSwap Members—To Swap members between source and destination work groups

CategoryStep—1: After successful logon, click the menu Sales & Marketing and select Work Groups. Then select Category. (See FIG. F-7)Step—2: Screen navigates to category screen. Enter the category name with its description as per the format briefed in field's explanation section. (See FIG. F-8)Step—3: Click Add button to have a temporary storage.Step—4: Select a category name by clicking Edit button to modify a category name. (See FIG. F-9)Step—5: Change any modifications and click UpdateStep—6: Click Save button to save the contents

Fields Explanation

The following table provides explanations for each of the screen fields.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of category. It is only a temporaryaddition. Becomes permanent record only after savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of category. It is only a temporaryupdate. Becomes permanent record only after savingCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered category in the database. The pagegets refreshed and the contents entered in the fieldsare shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Main WorkgroupStep—1: After successful logon, click the menu Sales & Marketing and select Work Groups. Then select Main Workgroup. (See FIG. F-10)Step—2: Screen navigates to main workgroup screen. Choose a category name. Enter the main workgroup name with its description and also select the option whether it is a child work group or main work group, as per the format briefed in field's explanation section. (See FIG. F-11)Step—3: Click Add button to have a temporary storage.Step—4: Select a main workgroup name by clicking Edit button to modify a main workgroup name. (See FIG. F-12)Step—5: Change any modifications and click UpdateStep—6: Click Save button to save the contents

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCategoryChoose a category from the drop down list availableNameThe text for main workgroup name. Accepts alphabetsand numeric values not exceeding 30 characters.Entry to this field is mandatory.DescriptionThe text for main workgroup description. Acceptsalphabets and numeric and all special charactersexcept double quotes with values not exceeding 255characters. Field is optionalIs this a childChoose this option, if the main work group is also aworkgroupchild work group

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of main workgroup. It is only atemporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of main workgroup. It is only atemporary update. Becomes permanent record onlyafter savingCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered main workgroup in the database.The page gets refreshed and the contents entered inthe fields are shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Child WorkgroupStep—1: After successful logon, click the menu Sales & Marketing and select Work Groups. Then select Child Workgroup. (See FIG. F-13)Step—2: Screen navigates to child workgroup screen. Choose a main workgroup. Enter the child workgroup name with its description, as per the format briefed in field's explanation section. (See FIG. F-14)Step—3: Click Add button to have a temporary storage.Step—4: Select a child workgroup name by clicking Edit button to modify a child workgroup name. (See FIG. F-15)Step—5: Change any modifications and click UpdateStep—6: Click Save button to save the contents

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionMain workgroupChoose a main workgroup from the drop downlist availableNameThe text for child workgroup name. Acceptsalphabets and numeric values not exceeding 30characters.Entry to this field is mandatory.DescriptionThe text for child workgroup description. Acceptsalphabets, numeric and special character exceptdouble quotes not exceeding 255 characters.Field is optional

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of child workgroup. It is only atemporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of child workgroup. It is only atemporary update. Becomes permanent record onlyafter savingCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records in thetable that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered Child Workgroup in the database.The page gets refreshed and the contents entered inthe fields are shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Mail MembersStep—1: After successful logon, click the menu Sales & Marketing and select Work Groups. Then select Mail Members. (See FIG. F-16)Step—2: Screen navigates to mail member's screen. Choose a child workgroup Enter the mail id, as per the format briefed in field's explanation section. (See FIG. F-17)Step—3: Click Add button to have a temporary storage.Step—4: Selecting a mail member and clicking Edit button to modify a mail member name. (See FIG. F-18)Step—5: Change any modifications and click UpdateStep—6: Click Save button to save the contents

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionChild workgroupChoose a child workgroup from the drop downlist availableMail IdThe text for mail id. Accepts alphabets, numericand special characters in the standard emailformat of length not exceeding 100 charactersEntry to this field are mandatory.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of mail member. It is only atemporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of mail member. It is only atemporary update. Becomes permanent record onlyafter savingCheck AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered Mail Members in the database. Thepage gets refreshed and the contents entered in thefields are shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Swap MembersStep—1: After successful logon, click the menu Sales & Marketing and select Work Groups. Then select Swap Members. (See FIG. F-19)Step—2: Screen navigates to swap members screen. Choose a category, source child group and destination child group to swap members. Also select from the options, whether swap is to be full, partial or duplicate. (See FIG. F-20)Step—3: Click Search to list the members for swapping from the Source work group to the destination work group.Step—4: Select the members for swapping and click Swap to swap the members from Source Work group to the destination Work Group.Step—5: Change any modifications and click UpdateStep—6: Click Save button to save the contents

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionChoose CategoryChoose the Category from the list. List allthe Child Work Group for the specificCategory selected.Choose SourceChoose the Source Child Work group fromChild Work groupthe listChoose DestinationChoose the Destination Child Work groupChild Work groupfrom the listDo you want to doChoose the Option Full, Partial or Duplicatea full swap or aDefault value of selection is Fullpartial swap?

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClick the search button to list the Member belongingto the Source Work Group for swapping. Based onthe Option, Full, Partial or Duplicate the Check boxis enabled or disabled. Say for Full the Check box isdisabled and the others the check box is enabled.SwapClick Swap to swap the member from Source toDestination Child Work GroupCheck AllThe “Check All” Link will check all the records inthe tableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.

An associate is to setup basic information of associates working with BPI in the PX2 System. Associates can be of two types, Internal and External.

Access

The application can be accessed from the main menu as follows:Sales & Marketing→Associates

Work of Category Internal or External must be available in the system for Assigning associated work group.

Application Functions

This application has the following functions:Associate—To Create, Modify and Delete Associates

AssociateStep—1: After successful logon, click the menu Sales & Marketing and select Associates. (See FIG. F-21)Step—2: Screen navigates general information. Choose associate type as either internal or external. (See FIG. F-22)Step—3: Enter the values in the respective fields, as per the format briefed in field's explanation section.Step—4: Choose an available workgroup and assign it by clicking>>button. Then enter the value of license number if applicable.Step—5: Click Add button to have a temporary storageStep—6: Select an associate and click Edit button to modify an associate name. (See FIG. F-23)Step—7: Change any modifications and click UpdateStep—8: Click Save button to save the contents

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionAssociate TypeChoose a type from either Internal or External.Default value selected is ExternalSalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for associate first name. Accepts alphabetsand special characters like hyphen and single quotesnot exceeding 25 characters. This field is mandatoryMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for associate last name. Accepts alphabetsand special characters like hyphen and single quotesnot exceeding 35 characters.SuffixChoose the suffix from the drop down list ofsuffixes available.TitleThe text for title. Accepts alphabets, numeric andspecial characters except single quotes notexceeding 255 characters.AddressThe text for associate address. Accepts alphanumericand special characters not exceeding 35 charactersSuiteThe text for associate suite Accepts alphanumericand special characters except double quotes notexceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of associates. It is only a temporaryaddition. Becomes permanent record only after savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of associate. It is only a temporaryupdate. Becomes permanent record only after savingCheck AllThe “Check All” Link will check all the records in thetableClear AllThe “Clear All” Link will uncheck all the records inthe table that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered associate in the database. The pagegets refreshed and the contents entered in the fieldsare shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

A marketing campaign is an initiative where an identifiable segment of potential employer groups are targeted and organizes for the marketing campaigns through third parties or by BPI PacAdvantage periodically.

The details of a campaign initiative are captured in the system through the campaign master the campaign master provides information on the campaign, duration and the personnel associated with the campaign. The media through which a campaign is done is captured in the system using the source type and source subtype.

Access

The application can be accessed from the main menu as follows:Sales & Marketing→Campaign→Source TypeSales & Marketing→Campaign→Source Sub TypeSales & Marketing→Campaign→CampaignSales & Marketing→Campaign→Campaign Search

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:

Source Type

Source Sub Type

Campaign

Campaign Search

Source Type

The source type defines the media through which a campaign can be conducted. The screen provides functionality to save, edit or add new source type.

The sequential steps involved in the creation of a source type are listed belowStep—1: After successful logon, click the menu Sales & Marketing. Select Campaign and then Source Type. (See FIG. F-24)Step—2: Enter the value of source type and select the option of input source as per the format briefed in field's explanation section. (See FIG. F-25)Step—3: Click Add button to have a temporary storage.Step—4: Selecting a source type and clicking Edit button to modify/a source type.Step—5: Change any modifications and click Update. (See FIG. F-26)Step—6: Click Save button to save the contents.

Fields Explanation

The following table provides explanations for each of the screen fields.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of source type. It is only a temporaryaddition. Becomes permanent record only after savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of source type. It is only atemporary update. Becomes permanent record onlyafter savingCheck BoxCheck box will be disabled which has any reference toother fields. Otherwise the checkbox will be enabled tohave the utility of check all/clear all.Check AllThe “Check All” Link will check all the enabled recordsin the tableClear AllThe “Clear All” Link will uncheck all the enabledrecords in the table that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered source type in the database. Thepage gets refreshed and the contents entered in thefields are shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Source Sub Type

Source sub type provides the information on the subcategory that may come under the source type. The screen provides functionality to save, edit or add new source sub type.

The sequential steps involved in the creation of a source sub type are listed below.Step—1: After successful logon, click the menu Sales & Marketing. Select Campaign and then Source Sub Type. (See FIG. F-27)Step—2: Select a source sub type. Enter the value of source sub type with its description as per the format briefed in field's explanation section. (See FIG. F-28)Step—3: Click Add button to have a temporary storage.Step—4: Selecting a source sub type and clicking Edit button to modify a source sub type.Step—5: Change any modifications and click UpdateStep—6: Click Save button to save the contents. (See FIG. F-29)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionSource TypeChoose a source type from the available drop down list.This field is mandatory.Source subThe text for source sub type name. Accepts alphabetsTypeand numeric values of maximum length 40. Entry tothis field is mandatory. Source Sub Type Name doesnot accept duplicate valuesDescriptionThe text for description of source sub type. Acceptsalphabets, numeric and special characters exceptdouble quote with values not exceeding 255 characters.Field is optional.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionAddAdd the contents of source sub type. It is only atemporary addition. Becomes permanent record onlyafter savingEditEdit button will allow for editing a specific record inthe table.DeleteDelete button will delete the records in the tablechecked for deletion. It is only a temporary deletion.Becomes permanent record only after savingUpdateUpdate the contents of source sub type. It is only atemporary addition. Becomes permanent record onlyafter savingCheck BoxCheck box will be disabled which has any reference toother fields. Otherwise the checkbox will be enabled tohave the utility of check all/clear all.Check AllThe “Check All” Link will check all the enabled recordsin the tableClear AllThe “Clear All” Link will uncheck all the enabledrecords in the table that are checked.PrintThe Print will pops up a screen displaying the contentof the table created and enables the user to have printout of the same.SaveSaves the entered source sub type in the database. Thepage gets refreshed and the contents entered in thefields are shown.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.

Campaign

The campaign master provides information on the campaign, duration and the personnel associated with the campaign. The media through which a campaign is done is captured in the system using the source type and source subtype.

The source type defines the media through which a campaign can be conducted and the source sub type provides the information on the subcategory that may come under the source type. The screen provides functionality to save, edit or add new source type The sequential steps involved in the creation of a Campaign are listed below.Step—1: After successful logon, click the menu Sales & Marketing. Select Campaign and then Campaign. (See FIG. F-30)Step—2: Enter the text for campaign name and its description. (See FIG. F-31)Step—3: Choose source type and source sub type from drop down list. Based on the selection of Source Type the page gets refreshed to list the corresponding Source Sub Type.Step—4: Choose an associated workgroup. Make it assigned workgroup by clicking>>button.Step—5: Choose from and to dates of duration by clicking calendar iconStep—6: Click Save button. Screen gets refreshed with auto generated Campaign Id. The save button is now in update mode. (See FIG. F-32)Step—7: Click Import button to import files. It pop up a new window. (See FIG. F-33)Step—8: Choose the file to be imported and click import button.Step—9: Confirms the status of imported files. Click Back to Import Screen to navigates back for further importing of files. (See FIG. F-34)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCampaign MasterCampaign NameThe text for campaign name. Accepts alphabetsand numeric values not exceeding 40 characters.Field is mandatory.Campaign IDText to Display Campaign ID. This is a read onlyfield.DescriptionThe text for description of campaign name. Acceptsalphabets, numeric and special characters exceptdouble quotes not exceeding 50 characters. Field isoptional.Source TypeChoose a source type from drop down list. Field ismandatory.Source Sub TypeChoose a source sub type from the drop down list.Source sub type depends on the selection of sourcetype. Field is mandatory.AssociatedWork groups are listed.WorkgroupAssignedAssign a work group. Field is mandatoryWorkgroupDuration FromChoose a valid date by clicking calendar icon. Dateaccepts the format in MM/DD/YYYY. Field ismandatory.Duration ToChoose a valid date by clicking calendar icon. Todate cannot be greater than from date. Date acceptsthe format in MM/DD/YYYY. Field is mandatoryImport Campaign DataCampaign IDText to Display Campaign ID. This is a read onlyfield.File PathEnter the file path or select the path by clickingbrowse button. The field is mandatoryFile FormatChoose a format from drop down list for FileFormat, which should match with selection of file.The field is mandatoryCommentsText to enter comments. Accepts alphabets, numericand special characters except double quotes notexceeding 250 characters. This field is optional

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionCampaign MasterNewCreates a new campaign.SaveSaves the entered campaign information. Thepage gets refreshed with auto generatedcampaign id. The save button is now shownas Update Button and Import button is enabledImportClick import to display a pop up screen toimport the campaign data.UpdateUpdates the contents modifiedCancelClears the contents entered in the fields or restoreto the previous state as was before saving thechanges.Import Campaign DataNewClick new button to Import new CampaigndataView PreviousNavigates to a screen displaying imported filesImportfor the particular campaign id.Back to CampaignNavigates back to import screen for furtherImportimport of files.ImportClick import to import the campaign data inthe database

Campaign Search

Campaign search is to search campaign based on either campaign id or campaign name. Campaign search is to have view, delete or modify the campaigns already created

The sequential steps involved in the campaign search are listed below.Step—1: After successful logon, click the menu Sales & Marketing. Select Campaign and then Campaign Search. (See FIG. F-35)Step—2: Search operation can be performed by clicking the search button either by entering the values in the fields or even with empty fields. Campaign id or a first letter of campaign name to have search operation. (See FIG. F-36)Step—3: Displays the results of search. (See FIG. F-37)Step—4: Select a campaign and choose the option of modify or view. If the option is modify the following screen appears for modification. (See FIG. F-38)Step—5: Change the contents and click Update.Step—6: If the option is view, the following screen appears only to have a view. Campaigns that are not referred elsewhere can also be deleted. (See FIG. F-39)Step—7: Click New Campaign button to go back to campaign create screen.

Fields Explanation

Refer field explanations provided for Create Campaign

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClears the screen and perform search operationbased on the input value for group/agent.CancelClears the contents entered in the fields or restoreto the previous state as was before saving thechanges.

6 Sales Master

Sales Master is to setup basic information for Agent, Agency and Lead in the PX2 System. Sales Master also has functionality of Lead tracking, maintenance of Agent profile and Campaign to Lead conversion.

Access

Pre-Requisites for using this application are as follows:

Work Group must be defined and available in the system Campaign data must be available to convert Campaign to lead

Associates data must be available for assigning BSS representatives.

Application Functions

This application has the following functions:Create Agency—to create/edit details of AgencySearch Agency—to search the details of Agency for view modification or deletionCreate Agent—to create/edit details of AgentSearch Agent—to search the details of Agent for view modification or deletionCreate Lead—to create/edit details of leadSearch Lead—to search the details of lead for view modification or deletionCampaign to Lead—to convert campaign data to leadLead Tracking—to track the information on leadLead Tracking to do List—to track and follow up on leadCreate Agent Profile—to create/edit details of Agent ProfileSearch Agent Profile—to search the details of Agent Profile for view modification or deletion

Create AgencyStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Create Agency. (See FIG. F-40)Step—2: Screen navigates to Agency Master screen. (See FIG. F-41)Step—3: Enter the values for the respective fields, as per the format briefed in field's explanation section. Click Next.Step—4: Navigates to second part of the agency master's screen for filling in further information. (See FIG. F-42)Step—5: Enter the values for the respective fields, as per the format briefed in field's explanation section. For agency work group, it should be selected by clicking search icon.Step—6: This pops up a screen for workgroup search. (See FIG. F-43)Step—7: Choose category, Main workgroup and child workgroup from the respective drop down list and Click Add.Step—8: This displays a screen with the selected workgroup. (See FIG. F-44)Step—9: After filling all the fields in agency master, click save to create agency master. Following is the sample confirmation screen for a successful creation of agency master. (See FIG. F-45)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCompany NameThe text for company name. Accepts alphanumericand special characters. Field is mandatoryDBAThe text for business nature. Accepts alphanumericand special characters. Field is optionalStreet AddressThe text for company address. Accepts alpha-numeric and special characters not exceeding 35charactersSuiteThe text for company suite. Accepts alphanumericand special characters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop downlist of States available in United States of AmericaZipThe text for zip. Accepts numeric value of exactly5 digits. Field is mandatoryPhoneThe text for telephone number of the contactperson. Accepts numeric values not exceeding10 digits. The format is (999) 999-9999.FaxThe text for fax number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.Mode ofChoose a mode of communication from the dropCommunicationdown list available. Based on the selected value,related fields are mandatory.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters. Field is mandatoryMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotesnot exceeding 35 characters. Field is mandatoryStreet AddressThe text for company address. Acceptsalphanumeric and special characters not exceeding35 charactersSuiteThe text for company suite Accepts alphanumericand special characters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop downlist of States available in United States of AmericaZipThe text for zip. Accepts numeric value of exactly5 digits. Field is mandatoryPhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.ExtensionThe text for extension of telephone numberAccepts numeric values not exceeding 4 digits.The format is 9999.FaxThe text for fax number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.E-mailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters.Broker TypeChoose an option for broker type from eitherStatewide, Regional or unknownExclude fromClick this option to have exclusion of broadcast faxBroadcast FaxExclude fromClick this option to have exclusion ofEmployee/Memberemployee/member term letterTerm LetterExclude fromClick this option to have exclusion of overdueoverdue premiumpremium noticenoticeExclude fromClick this option to have exclusion ofEmployee/Memberemployee/member add on letterAdd on LetterAgency WorkgroupChoose a agency work group by clicking searchiconInternal WorkgroupChoose an internal workgroup from the drop downlist available. The field is mandatory.BSS RepChoose a value for BSS Rep from the drop downlist availableTax ID/SSNThe text for Tax ID/SSN. Accepts numeric valuesof exactly 9 digitsLicense NumberThe text for License number. Accepts numericvalues not exceeding 15 digitsLicense TypeChoose a type for license from the drop down listavailableLicense ExpirationThe text for License expiration date. Choose adate in the format MM/DD/YYYY by clickingcalendar icon.E&O NumberThe text for E&O number. Accepts numeric valuesnot exceeding 15 digitsE&O ExpirationThe text for E&O Expiration date. Choose a datein the format MM/DD/YYYY by clicking calendaricon.Preferred Mode ofChoose an option for mode of payment eitherpaymentCheck or ACHBank NameThe text for bank name. Accepts alphabets, numericand special characters except double quotes withvalues not exceeding 50 characters.Account NumberThe text for accounts number. Accepts numericvalues not exceeding 9 digitsAccount TypeChoose a type of account from the drop down listavailableRouting NumberThe text for routing number. Accepts numericvalues not exceeding 10 digits.Name of theThe text for name of the account holder. AcceptsAccountalphabets and numeric values not exceeding 50characters.Payee NameThe text for payee name. Accepts alphabets notexceeding 60 characters.Requires specialClick this option for any special handling ishandlingrequired

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNextClick Next to move to the next screen for entering theAgency information.SaveSaves the entered information entered for the Agencyin the screen one and two.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.CloseCloses the window and go back to agency masterscreenPreviousNavigates to the previous screen. If any data is enteredon this screen it validate the data prior to moving tothe previous screen.

Search AgencyStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Search Agency. (See FIG. F-46)Step—2: Screen navigates to Search Agency Master screen. (See FIG. F-47)Step—3: Either enter the value in any one of the field or simply click Search.Step—4: This pops up a screen with the search result. (See FIG. F-48)Step—5: Choose an Agency Id for selection. The selected agency id can be modified or view and delete. If modify button is clicked details with the contents will be displayed for any modification or otherwise clicking view/delete button will enabled to view or deleted.Step—6: If the modify button is clicked following will be screen. Enter the text at the respective fields for modification, if any. The flow and procedure for modifying an agency master is similar to create agency master. (See FIG. F-49)Step—7: If the view/delete button is clicked, following is the screen, which allows to view and delete. (See FIG. F-50)Step—8: After viewing the contents, if the new agency is clicked will enable to add new agency master or if the delete button is clicked will delete the agency master that is currently in view. (See FIG. F-51)Step—9: On clicking delete, navigates to confirming the deletion of agency record. From here clicking new agency button can create also new agency. (See FIG. F-52)

Fields Explanation

Refer Field explanation provided for Create New Agency

Button Functionality

Refer Button Functionality provided for Create New Agency.

Create AgentStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Create Agent. (See FIG. F-53)Step—2: Screen navigates to Agent Master screen. (See FIG. F-54)Step—3: Enter the values for the respective fields, as per the format briefed in field's explanation section. Click Next.Step—4: Navigates to second part of the agent master screen for entering further information. (See FIG. F-55)Step—5: Enter the values for the respective fields, as per the format briefed in field's explanation section. For agent work group, it should be selected by clicking search icon.Step—6: The selection procedure for Work group search is similar to that of workgroup search explained in Create Agency. For Associated agencies the procedure is same but the sample screen is as follows. (See FIG. F-56)Step—7: Enter the first letter of agency id or agency name to perform search operationStep—8: This displays a screen with the selected workgroup. (See FIG. F-57)Step—9: After filling all the fields in agent master, click save to create agent master. Following is the sample confirmation screen for a successful creation of agent master. (See FIG. F-58)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionFirst NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotesnot exceeding 25 characters. Field is mandatoryMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters. Field is mandatoryCompany NameThe text for company name. Accepts alphanumericand special characters. Field is mandatoryDBAThe text for business nature. Accepts alphanumericand special characters. Field is optionalStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 charactersSuiteThe text for company suite Accepts alphanumericand special characters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop downlist of States available in United States of AmericaZipThe text for zip. Accepts numeric value of exactly 5digits. Field is mandatoryPhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.FaxThe text for fax number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.Mode ofChoose a mode of communication from the dropCommunicationdown list available. Based on the selected value,related fields are mandatory.E-mailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters.GenderChoose a gender from the drop down list available.Date of BirthThe text for date of birth. Choose a date by clickingcalendar icon. Date accepts the formatMM/DD/YYYY.Birth date cannot be later than the current date.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters. Field is mandatoryMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters. Field is mandatoryStreet AddressThe text for address. Accepts alphanumeric andspecial characters not exceeding 35 charactersSuiteThe text for suite Accepts alphanumeric and specialcharacters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop downlist of States available in United States of AmericaZipThe text for zip. Accepts numeric value of exactly 5digits. Field is mandatoryPhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.ExtensionThe text for extension number of the employee.Accepts numeric values not exceeding 4 digitsFaxThe text for fax number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.E-mailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters.Broker TypeChoose an option for broker type from eitherStatewide, Regional or unknownExclude fromClick this option to have exclusion of broadcast faxBroadcast FaxExclude fromClick this option to have exclusion ofEmployee/MemberTerm Letteremployee/member term letterExclude fromClick this option to have exclusion of overdueoverdue premiumpremium noticenoticeExclude fromClick this option to have exclusion ofEmployee/Memberemployee/member add on letterAdd on LetterAgent WorkgroupChoose a agent work group by clicking searchiconInternal WorkgroupChoose an internal workgroup from the drop downlist available. The field is mandatory.BSS RepChoose a value for BSS Rep from the drop downlist availableAssociated AgencyChoose a Associated Agency by clicking searchiconTax ID/SSNThe text for Tax ID/SSN. Accepts numeric valuesof exactly 9 digitsLicense NumberThe text for License number. Accepts numericvalues not exceeding 15 digitsLicense TypeChoose a type for license from the drop down listavailableLicense ExpirationThe text for License expiration date. Choose a datein the format MMJDD/YYYY by clickingcalendar icon.E&O NumberThe text for E&O number. Accepts numeric valuesnot exceeding 15 digitsE&O ExpirationThe text for E&O Expiration date. Choose a date inthe format MM/DDIYYYY by clicking calendaricon.Preferred Mode ofChoose an option for mode of payment either Checkpaymentor ACHBank NameThe text for bank name. Accepts alphabets, numericand special characters except double quotes withvalues not exceeding 50 characters.Account NumberThe text for accounts number. Accepts numericvalues not exceeding 9 digitsAccount TypeChoose a type of account from the drop down listavailableRouting NumberThe text for routing number. Accepts numericvalues not exceeding 10 digits.Name of theThe text for name of the account holder. AcceptsAccountalphabets and numeric values not exceeding 50characters.Payee NameThe text for payee name. Accepts alphabets notexceeding 60 charactersRequires specialClick this option for any special handling ishandlingrequired

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionNextClick Next to move to the next screen for entering theAgency information.SaveSaves the entered information entered for the Agencyin the screen one and two.CancelClears the contents entered in the fields or restore tothe previous state as was before saving the changes.CloseCloses the window and go back to agency masterscreenPreviousNavigates to the previous screen. If any data is enteredon this screen it validate the data prior to moving tothe previous screen.

Search AgentStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Search Agent. (See FIG. F-59)Step—2: Screen navigates to Search Agent Master screen. (See FIG. F-60)Step—3: Either enter the value in any one of the field or simply click Search.Step—4: This pops up a screen with the search result. (See FIG. F-61)Step—5: Choose an Agent Id for selection. The selected agent id can be modified or view and delete. If modify button is clicked details with the contents will be displayed for any modification or otherwise clicking view/delete button will enabled to view or deleted.Step—6: If the modify button is clicked following will be screen. (See FIG. F-62)Step—7: Enter the text at the respective fields for modification, if any. The flow and procedure for modifying an agency master is similar to create agency master.Step—8: If the view/delete button is clicked, following is the screen that can have view or delete. (See FIG. F-63)Step—9: After viewing the contents, if the new agency is clicked will enable to add new agency master or if the delete button is clicked it will delete the agent master which is currently in view.Step—10: On clicking delete, navigates to confirming the deletion of agency record. From here clicking new agency button can create new agency. (See FIG. F-64)

Fields Explanation

Refer field explanation provided for Create Agent.

Button Functionality

Refer button functionality provided in Create Agent

Create LeadStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Create Lead. (See FIG. F-65)Step—2: Screen navigates to Lead Master screen. (See FIG. F-66)Step—3: Enter the values for the respective fields, as per the format briefed in field's explanation section. Click Next.Step—4: Navigates to second part of the lead master screen for entering further information. (See FIG. F-67)Step—5: Enter the values for the respective fields, as per the format briefed in field's explanation section. Based on the selection of name as either agent/agency the corresponding value for agency/agent is selected by clicking search icon.Step—6: After filling all the fields in lead master, click save to create lead master. Following is the sample confirmation screen for a successful creation of lead master. (See FIG. F-68)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionGroup TypeChoose the Group Type from the list.Association IdChoose the association id from the list. If the Grouptype is Guaranteed, Endorsed, PEO or Chambercorresponding association name will be listed.Member TypeChoose the member type as Individual Member orAssociation Group. This option will be available ifthe Association selected is Guaranteed.Source Sub TypeChoose sub source type from the list.Company NameThe text for company name. Accepts alphanumericand special characters. Field is mandatoryDBAThe text for business nature. Accepts alphanumericand special characters. Field is optionalStreet AddressThe text for company address. Accepts alphanumericand special characters not exceeding 35 charactersSuiteThe text for company suite Accepts alphanumericand special characters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaZipThe text for zip. Accepts numeric value of exactly 5digits. Field is mandatoryPhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999.FaxThe text for fax number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.SalutationChoose the salutation from the drop down list ofsalutations available.First NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 25 characters. Field is mandatoryMiddle InitialThe text for middle initial. Accepts alphabets notexceeding 1 character.Last NameThe text for contact name. Accepts alphabets andspecial characters like hyphen and single quotes notexceeding 35 characters. Field is mandatoryStreet AddressThe text for address. Accepts alphanumeric andspecial characters not exceeding 35 charactersSuiteThe text for suite Accepts alphanumeric and specialcharacters not exceeding 35 charactersCityThe text for city. Accepts alphabets and spacebetween two words not exceeding 30 characters.StateChoose the name of the state from the drop down listof States available in United States of AmericaZipThe text for zip. Accepts numeric value of exactly 5digits. Field is mandatoryPhoneThe text for telephone number of the contact person.Accepts numeric values not exceeding 10 digits. Theformat is (999) 999-9999.ExtensionThe text for extension of telephone number Acceptsnumeric values not exceeding 4 digits. The format is9999.FaxThe text for fax number of the contact person.Accepts numeric values not exceeding 10 digits.The format is (999) 999-9999.E-mailThe text for email of the contact person. Acceptsalphabets, numeric and special characters in thestandard email format of length not exceeding 100characters.NoneChoose the option as none if applicable.AgentChoose an agent by clicking search icon. The optionis enabled only if the value is selected as agent forname.AgencyChoose an agency by clicking search icon. Theoption is enabled only if the value is selected asagency for name.InternalChoose an internal workgroup from the drop downWorkgrouplist available. The field is mandatory.BSS RepChoose a value for BSS Rep from the drop down listavailableNo. Of employeesThe text for number of employees. Accepts numericvalues not exceeding 4 digits.Plan TypeChoose a plan type from the drop down listavailableCurrent CarrierChoose a current carrier from the drop down listavailableDeductibleThe text for deductible. Accepts numeric values notexceeding 12 digits.Co PayThe text for co pay. Accepts numeric values notexceeding 12 digits.Benefit level inThe text for benefit level in networkNetworkBenefit level outThe text for benefit level out of networkof NetworkEmployerThe text for employer contribution.Contribution in %ApproximateThe text for approximate monthly premium.monthly premiumRenewal DateThe text for renewal date. Accepts date in theformat MM/DD/YYYY by clicking calendar icon.Best time to callThe text for best to call.CommentsThe text for comments.Mode ofSelect a mode of communication from the dropcommunicationsdown list available

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the entered information not only for thepresent screen.SearchClears the screen and perform search operationbased on the input value for group/agent.CancelClears the contents entered in the fields orrestore to the previous state as was before savingthe changes.CloseCloses the window and go back to agency masterscreenPreviousNavigates to the screen earlier to this.

Search LeadStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Search Lead. (See FIG. F-69)Step—2: Screen navigates to Search Lead screen. (See FIG. F-70)Step—3: Either enter value in any of the field or simply click Search.Step—4: This pops up a screen with the search result. (See FIG. F-71)Step—5: Choose an Lead Id for selection. The selected lead id can be modified or view and delete. If modify button is clicked details with the contents will be displayed for any modification or otherwise clicking view/delete button will enabled to view or deleted.Step—6: If the modify button is clicked following will be screen. (See FIG. F-72)Step—7: Enter the text at the respective fields for modification, if any. The flow and procedure for modifying a lead master is similar to create lead master.Step—8: If the view/delete button is clicked, following is the screen that can have view or delete. (See FIG. F-73)Step—9: After viewing the contents, if the new lead is clicked, will enable to add new lead master or if the delete button is clicked it will delete the lead master, which is currently in view.Step—10: On clicking delete, navigates to confirming the deletion of lead record. From here clicking new lead button can create new lead. (See FIG. F-74)

Fields Explanation

Refer field explanation provided for Create Lead

Button Functionality

Refer button functionality provided for Create Lead

Campaign to LeadStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Campaign to Lead. (See FIG. F-75)Step—2: Screen navigates to Campaign to Lead screen. (See FIG. F-76)Step—3: Enter the value of a campaign id or choose a campaign id by clicking search iconStep—4: Either enter value in any of the field or simply click Search. (See FIG. F-77)Step—5: Click on any campaign id for selection (See FIG. F-78)Step—6: By clicking Search Campaign Data the following screen gets displayed. (See FIG. F-79)Step—7: Choose Campaign id. Click Convert to lead This converts campaign to lead and the selected campaign gets

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionCampaign IdText for Campaign ID. Enter the CampaignID or click the search icon.Campaign NameText for Campaign IDFrom DateThe text for From Date. Choose a date byclicking calendar icon. Date accepts theformat MM/DD/YYYY.To DateThe text for To Date. Choose a date byclicking calendar icon. Date accepts theformat MM/DD/YYYY.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSearchClick search to display the Campaign IDbased on the search criteria.CloseCloses the window and go back to campaignto lead screenSearch CampaignDisplays the content of selected campaign idDataConvert to LeadConverts campaign to lead and the item getsremoved from the campaign id list table.Check AllThe “Check All” Link will check all therecords in the tableClear AllThe “Clear All” Link will uncheck all therecords in the table that are checked.CancelClears the contents entered in the field.

Lead TrackingStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Lead Tracking. (See FIG. F-80)Step—2: Screen navigates to Lead Tracking screen. (See FIG. F-81)Step—3: Enter the value of a lead id and Click Get Status to display the current status of the lead or choose a lead id by clicking search icon. (See FIG. F-82)Step—4: Either enter value in any one of the field or simply click Search.Step—5: This pops up a screen with search result. (See FIG. F-83)Step—6: Click on any lead id for selection. The status of the lead is displayed.Step—7: Choose the respective values and click save. (See FIG. F-84)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionLead IdText for Lead ID. Enter lead id of chooseLead ID by clicking the Search Icon.Company NameRead only field to display Company NamePhoneRead only field to display Company PhoneFirst NameRead only field to display First NameLast NameRead only field to display Last NameCall StatusChoose from the Call Status provided.Contact ResultChoose from the Contact Result provided.Only if the “Call Status” option is “MadeContact” this will be enabled.Qualified LeadChoose from the Qualified Lead ResultResultprovided. Only if the “Contact Result” optionis “Qualified Lead” this will be enabled.Non-QualifiedChoose from the Non-Qualified Lead ReasonsLead Reasonsprovided. Only if the “Contact Result” optionis “Non-Qualified Lead” this will be enabled.Not InterestedChoose from the Not Interested ReasonsReasonsprovided. Only if the “Qualified Lead Result”option is “Not Interested” this will be enabled.Post Quote ResultChoose from the Post Quote Result provided.Only if the “Qualified Lead Result” option is“Produced Quotes” this will be enabled.StatusDisplays the status dynamically based on thecombination of the options selected.NotesText area to enter brief notes on the leadtrackingFollow up DateThe text for Follow up Date. Choose a dateby clicking calendar icon. Date accepts theformat MM/DD/YYYY.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the entered information not only for thepresent screen.Get StatusShow the status of the Lead being Tracked.CancelClears the contents entered in the fields orrestore to the previous state as was before savingthe changes.

Lead Tracking—To Do ListStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Lead Tracking—To Do List.Step—2: Screen pops up a new window Lead Tracking To Do List screen. The screen can have only view option. The contents of this screen are the inputs of lead tracking screen. This screen displays the follow up on the Lead tracking. (See FIG. F-85)Step—3: Click close.

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionUser IdRead only field for User id.Lead IdRead only field for Lead Id.Lead NameRead only field Lead Name.PhoneRead only field for Phone.Follow up DateRead only field for follow up date.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionCloseCloses the pop up window.

Create Agent ProfileStep—1: After successful logon, click the menu Sales & Marketing and select Create Agent Profile (See FIG. F-86)Step—2: Screen navigates to Agent Profile (See FIG. F-87)Step—3: Click Save. Confirms the creation of agent profile. (See FIG. F-88)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionAgent DetailsWorkgroup NameChoose a work group name from the available list.List all child workgroup for the selected workgroupAgent IDChoose a agent id from the available listAgent NameText for agent name. Field is read onlyCompany NameText for agent name. Field is read onlyPresent RatingText for present rating accepts numeric valuesProfile InformationDo you currentlyChoose the option from Yes or Nosell HealthInsuranceDo you currentlyChoose the option from Yes/No/Unknownsell PacAdvantageTypes of InsuranceSelect the check box of insurance from the availablesold by Agentcheck box list.Percentage of timeText for percentage of time focussed on healthfocused on Healthinsurance. Accepts numeric values.InsuranceAverage GroupText for average group size [within Pac Advantage].Size (withinAccepts numeric values.PacAdvantage)Average GroupText for average group size [outside Pac Advantage].Size (outsideAccepts numeric values.PacAdvantage)Percentage of staffText for percentage of staff concentrating on Healthconcentrating onInsurance. Accepts numeric values.Health InsuranceYears in BusinessText for years in business. Accepts numeric values.Subjective RatingsBroker knowledgeChoose a rating from 0 to 4of PacAdvantageBroker PotentialChoose a rating from 0 to 4Broker loyalty andChoose a rating from 0 to 4confidence withPacAdvantageSubjective RatingChoose a rating from 0 to 4Other InformationMarketing PlansChoose a marketing plan from the available drop list.No. 1 Selling PlanChoose a plan for selling plan [plan-1] from theavailable drop down listNo. 2 Selling PlanChoose a plan for selling plan [plan-2] from theavailable drop down list

Button Functionality

The following table provides explanations for each of the screen fields.

ElementDescriptionSave buttonClick on save button to the save the content keyed inand navigates to confirmation screen displaying theConfirmation ID.Cancel buttonClick on clear button clears the content and appearsagain for fresh entries

Search Agent ProfileStep—1: After successful logon, click the menu Sales & Marketing and select Sales Master. Then select Search Agent Profile. (See FIG. F-89)Step—2: Screen navigates to Search Agent Profile screen (See FIG. F-90)Step—3: Either enter value in any of the field or simply click Search.Step—4: This pops up a screen with the search result. (See FIG. F-91)Step—5: Choose an Agent Id for selection. The selected agent id can be modified or viewed. If modify button is clicked details with the contents will be displayed for any modification or otherwise clicking view button will enabled to view the contents and prevents any modificationStep—6: If the modify button is clicked following will be screen. (See FIG. F-92)Step—7: Enter the text at the respective fields for modification, if any. The flow and procedure for modifying an agency profile is similar to create agency profile. On any change, and clicking Update will pop up a screen. (See FIG. F-93)Step—8: If the view button is clicked, following is the screen, which can have only to view the contents, and no modification is allowed. (See FIG. F-94)Step—9: After viewing the contents, if the new agency is clicked will enable to add new agency profile.

Fields Explanation

Refer field explanation referred in Create Agent Profile

Button Functionality

The following table provides explanations for each of the screen fields.

ElementDescriptionSaveClick on save button to the save the content keyed inand navigates to confirmation screen displaying theConfirmation ID.CancelClick on clear button clears the content and appearsagain for fresh entriesModifyModify enables to edit and modifications is possibleViewView enables to edit the content and modification isnot possibleUpdateUpdate the contents of source sub type. It is only atemporary addition. Becomes permanent record onlyafter savingNew Agent ProfileCreates a new agent profile

Quotes are provided for potential business entities as well as existing business entities. Quotes can be requested for small Employer Groups or Alternate Groups (Individual Association Member, Association Group, COBRA etc.) as well as for employees of those groups.

Access

The application can be accessed from the main menu as follows:Sales & Marketing→Quotes

All master data must be available in the system for generation of Quotes. Pre-requisites for using this application are as follows:Carrier Maintenance—Refer “User Manual for Carrier Maintenance” for further information on the master records.Agent/Agency—Refer “User Manual for Sales and Marketing” for further information on the Agent/Agency records.Work Group—Refer “User Manual for Sales and Marketing” for further information on the Work Group records.Internal Associates—Refer “User Manual for Sales and Marketing” for further information on the Internal Associates records.Enrollment—Refer “User Manual for Enrollment” for further information on the Group and Member records.

Application Functions

This application has the following functions:Create QuotesModify Quote/Create Quote RevisionGenerate QuoteGenerate Interim QuoteView Missing Information

Create Quotes

This function enables the user to input necessary input information/parameters for quotes and save the information for retrieval at a later point in time.

A quote is unique for each Group and Lead; any changes to the quote will result in a new revision. To modify an existing quote or create a new quote revision, please refer to next section “Modify Quote/Create Quote Revision”.Step—1: After successful logon, click menu Sales & Marketing and select the option Quotes. (See FIG. F-95)Step—2: Browser navigates to Group/Lead Info screen. Choose whether the quote is for a Lead or an Existing Group. Select the Lead/Group by clicking Lookup icon, found next to the lead/group Id field. Alternately, if the lead/group id is known, it can be entered directly into the field. (See FIG. F-96)Step—3: On clicking the Lookup icon, based on whether the quote is for a lead or group, the browser navigates to either lead search or to group search screen. (See FIG. F-97)A lead can be searched using first few characters of lead name, contact first/last name or contact phone number.A group can be searched using first few characters of its legal name, contact first/last name or tax id/SSN or group's effective date or phone number. (See FIG. F-98)Step—4: Click on the group/lead, for which the quote is being created, to return to the main screen.Step—5: On selecting a lead/group, either using the lookup option or entering directly into the field, lead/group details and agent details get populated on the screen.If quoting for a group, an additional option, “Populate Current Enrollment” is enabled. Clicking the option populates additional group information like coverage and contribution option, agent fee, current employee information with their plans.Step—6: Choose the coverage and contribution options selected by the lead/group.Alternately, the “Default Coverage and Contribution” option can be used. Default coverage and contribution is Medical coverage alone selected with an employer contribution of 50% of lowest cost HMO plan towards employee premium and none towards dependent premium.Note: This section is enabled only if the lead/group is an employer group.Step—7: Click on the “Employee Info” tab on the top or the link at the bottom to navigate to employee information screen. If “Populate Current Enrollment” option was selected earlier, the screen comes populated with current employee information.Use “Set Size” option to set the number of employees on the quote; the screen inserts specified number of blank employee rows. Enter employee name, employee age/date of birth, coverage option, number of persons covered under the employee (including the employee), and the employee's zip code of residence. (See FIG. F-99)Note: If zip code is not specified for an employee, the lead's/group's zip code is used for rates calculation.Alternately, employee information can be uploaded from a flat file. (See FIG. F-100)Specify the file format, whether CSV ASCII or Fixed Position ASCII, browse and locate the file to be uploaded. Click Upload to upload employee information from the file.Step—8: Click on the “Quote Output” tab on the top or the link at the bottom to navigate to quote output screen. (See FIG. F-101)Choose whether Standard quote or Interim quote is required. (Interim quote is explained in a subsequent section).Use “Exclude Plans” option to exclude any plans that should not appear on the quote. Select the plan(s) that need to be excluded (Hold ‘Control’ key to select multiple plans) and click Add button.Enter other information required for quotes like quote for, mode of output and addressee information.Step—9: Click Save button to save quote input information.

Fields Explanation

The following table provides explanations for each of the screen fields.

Common

ElementDescriptionQuote #The id with which the quote is uniquely identifiedalong with the revision. The field is read only. Quote idis auto generated.Quote DateDate on the quote. The field is read only and reflectsthe value entered in the quote date field on the“Group/Lead Info” tab.Lead/Group IdUnique id of lead/group being quoted. The field is read-only and reflects the value entered in the lead/group idfield on the “Group/Lead Info” tab.Lead/Group NameName of the lead/group being quoted. This field is readonly.TypeLead/Group's type; whether Small Employer Group,Individual Association Member, Cal-COBRA etc.

Group/Lead Info Tab

ElementDescriptionLead/Group InformationQuote forChoose the option to quote for either lead or group.Lead/Group IdUnique id of lead/group being quoted. Lead/Groupid can be selected by clicking Lookup icon.Other revisionsList all revisions for the quote and allows user toselect a specific revision.General InformationQuote DateDate on the quote. Entry in this field is mandatory.Mode of RequestChoose a type of mode of request from the dropdown list availablePost Mark DateDate on which request for quote was post-marked.Choose a date by clicking calendar icon. Entry inthis field is mandatory.Receive DateDate on which request for quote was received.Choose a date by clicking calendar icon. Entry inthis field is mandatory.Rate TypeChoose a rate type to be used for quoting.Agent CommissionAgent commission percentage to be used forblended rate calculation. Entry in this field is man-datory. The field is enabled only for the quotes onblended rate structure.Effective DateEffective date for the quote. Choose a date by click-ing calendar icon. Entry in this field is mandatory.Coverage &Contribution InformationUse defaultCheck to generate quote using default coverage andcoverage andcontribution options. Default coverage and con-contributiontribution is Medical coverage alone selected withan employer contribution of 50% of lowest costHMO plan towards employee premium and nonetowards dependent premiumContribution TypeFor the line of coverage, choose contribution typeopted by the lead/group. Leave as blank, when notquoting the line of coverage.Specify PlanWhen employer contribution is percentage ofspecified plan, choose specified plan.Value for EESpecify employer contribution towards employee'spremium.Value for DepSpecify employer contribution towards dependent'spremium.

Employee Info Tab.

ElementDescriptionEmployee InformationQuote Spec EECheck to indicate employees to be quoted, when using“Employee Rate Illustration”, “Cal-COBRA” or “Fed-COBRA” options.Employee NameName of employee. Entry in this field is mandatory.Age/DOBAge or date of birth of employee. Date of birth has tospecify in MM/dd/yyyy format. Entry in this field ismandatory.TierCoverage choice opted by the employee. Entry in thisfield is mandatory.#Count of members covered under the employee'scoverage including the employee. System defaultsvalue in this field based on the coverage type selectedbut is editable by the user.ZipZip code of employee's residence. If no value isprovided, employer's zip code is used for ratecalculation.CountyCounty of employee's residence. This is normally aread-only field except in cases where employee's zipcode spans multiple counties. In such cases, when theuser tries to generate a quote, the system prompts theuser to select the county.Medical PlanMedical plan to be used when quoting using “Quote forspecified plans only” option.Dental PlanDental plan to be used when quoting using “Quote forspecified plans only” option.Vision PlanVision plan to be used when quoting using “Quote forspecified plans only” option.CAM PlanCAM plan to be used when quoting using “Quote forspecified plans only” option.Total EmployeesTotal number of employees on the quote. This field isread only.Total WaivingTotal number of employees waiving medical coverage.Total DecliningTotal number of employees declining coverage throughPacAdvantage plans.Total COBRAsTotal number of COBRAs covered under the employer.Rate Differential FactorCalculated bySpecify whether differential factor has to be calculatedSystem/Enteredby the system or is entered by the user. Option forby userentry by user is allowed only when quoting for a leador doing a group renewal quote.DifferentialRate differential factor applicable for the lead/group.Factor

Interim Quote Tab

ElementDescriptionMedicalQuote MedicalCheck to include quote for medical coverage.ContributionCheck to include employer contribution summary inSummary?quote output.EmployerCheck to include employer rate summary in quotesSummaryoutput for each of the contribution options, namely, %of lowest cost HMO plan, % of lowest cost plan, % ofspecified plan and flat $ amount.Employee QuotesCheck to include individual employee quote sheets inquotes output for each of the contribution option.Value forSpecify contribution percentage or dollar amount ofEmployeeemployer (in case of flat dollar contribution) towardsemployee's premium for each of the contributionoption.Value forSpecify contribution percentage or dollar amount ofDependentemployer (in case of flat dollar contribution) towardsdependent's premium for each of the contributionoption.DentalQuote DentalCheck to include quote for dental coverage.ContributionCheck to include employer contribution summary inSummary?quote output.EmployerCheck to include employer rate summary in quotesSummaryoutput for each of the contribution options, namely, %of lowest cost plan, % of specified plan and flat $amount.Employee QuotesCheck to include individual employee quote sheets inquotes output for each of the contribution option.Value forSpecify contribution percentage or dollar amount ofEmployeeemployer (in case of flat dollar contribution) towardsemployee's premium for each of the contributionoption.Value forSpecify contribution percentage or dollar amount ofDependentemployer (in case of flat dollar contribution) towardsdependent's premium for each of the contributionoption.VisionQuote VisionCheck to include quote for vision coverage.ContributionCheck to include employer contribution summary inSummary?quote output.EmployerCheck to include employer rate summary in quotesSummaryoutput for each of the contribution options, namely, %of lowest cost plan, % of specified plan and flat $amount.Employee QuotesCheck to include individual employee quote sheets inquotes output for each of the contribution option.Value forSpecify contribution percentage or dollar amount ofEmployeeemployer (in case of flat dollar contribution) towardsemployee's premium for each of the contributionoption.Value forSpecify contribution percentage or dollar amount ofDependentemployer (in case of flat dollar contribution) towardsdependent's premium for each of the contributionoption.CAMQuote CAMCheck to include quote for CAM coverage.ContributionCheck to include employer contribution summary inSummary?quote output.EmployerCheck to include employer rate summary in quotesSummaryoutput for each of the contribution options, namely, %of lowest cost plan, % of specified plan and flat $amount.Employee QuotesCheck to include individual employee quote sheets inquotes output for each of the contribution option.Value forSpecify contribution percentage or dollar amount ofEmployeeemployer (in case of flat dollar contribution) towardsemployee's premium for each of the contributionoption.Value forSpecify contribution percentage or dollar amount ofDependentemployer (in case of flat dollar contribution) towardsdependent's premium for each of the contributionoption.

Quote Output

ElementDescriptionGenerateSpecify whether to generate a standard quote or aninterim quote. It is not sufficient to enter inputparameters for interim quotes; this field has to be setto “Interim Quote” to generate an interim quote.Quote for spec-Specify whether to quote only for plans specifiedified plans onlyagainst each employee.Exclude spec-Exclude plans from appearing in the quote output.ified planQuote forSpecify whether quote is for a group or selected set ofemployees within the group.When quotingWhen quoting for groups, specify whether the quotegroups, includeoutput should have employer rate summary alone oremployer rate summary and employee quote pages.Mode of OutputSpecify mode of quote output.Send to whoseSpecify whether the quote has to be sending to agent'sattentionattention or group's attention or other. If “other” isselected name and address or email or fax of addresseehas to be specified.Include programSpecify whether to include program brochure as part ofbrochurethe quote output or not.

Button Functionality

The following table provides explanation for each button in the screen.

Common

ElementDescriptionNewClears the screen to allow creation of a quote.SaveSaves quote input information to the database. Thesaved quote can be retrieved at a later point in time.SearchAllows searching for a saved quote.

Group/Lead Info Tab

ElementDescriptionPopulate CurrentPopulates quotes screen with additional groupEnrollmentinformation like coverage and contribution option,agent fee, current employee information with theirplans.

Employee Info Tab

ElementDescriptionSet SizeSets the size of the employee information entrytable based on the number entered in the fieldpreceding the button.Upload EmployeeAllows uploading employee information fromInformationtext files of specific format.DeleteDeletes selected (checked) employee rows fromthe entry table.

Quote Output Tab

ElementDescriptionGenerate quoteGenerates quotes output based on the quotes outputoptions specified.

Modify Quote/Create Quote Revision

This function enables the user to modify input information for an existing quote and save it as modification to current revision or as a new revision.Step—1: After successful logon, click menu Sales & Marketing and select the option Quotes.Step—2: Click Search button to search for an existing quote. The browser navigates to quotes search screen.A quote can be searched using quote number, quote date, first few characters of lead/group name. (See FIG. F-102)Click on quote to be modified to return to the main screen. (See FIG. F-103)Step—3: Existing revision available for the quote gets listed in next to lead/group id field in the “Lead/Group Information” section. Select the revision number to modify. The screen refreshes to load the selected revision.Step—4: Make necessary modifications to the quotes input information and click save button. The system prompts with a question “Do you want to save changes as a new revision? . . . ”. Click OK to save the modifications as a new revision; click Cancel to save the modifications to the same revision.

Generate Quote

This function enables the user to generate a quote and view, print, email or fax the quote output.Step—1: After successful logon, click menu Sales & Marketing and select the option Quotes. (See FIG. F-104)Step—2: Click Search button to search for an existing quote. The browser navigates to quotes search screen.A quote can be searched using quote number, quote date, first few characters of lead/group name.Click on the quote to be modified to return to the main screen.Step—3: Click on the “Quote Output” tab on the top or the link at the bottom to navigate to quotes output screen. Ensure that the mode of output and “attention to” information are as desired. Click Generate Quote button to generate the quote.If “View” option was selected, a popup window appears and the quote output opens up as a word document in the window.If “Email” or “Fax” option was selected, the quotes output is send via email or fax directly to “Group”, “Agent” or “Other” as specified in “attention to” information.If “Print in Mailroom” option was selected, the quote output is send to the mailroom queue.

Generate Interim Quote

This function enables the user to generate an interim quote and view, print, email or fax the quote output.

An interim quote is different from a standard quote, in that, parameters can be specified for all the 4 contribution options.Step—1: After successful logon, click menu Sales & Marketing and select the option Quotes.Step—2: Click Search button to search for an existing quote. The browser navigates to quotes search screen.A quote can be searched using quote number, quote date, first few characters of lead/group name.Click on the quote to be modified to return to the main screen.Step—3: Click on the “Interim Quote” tab on the top or the link at the bottom to navigate to employee information screen. Specify the line of coverage to be quoted and the contribution parameters for each line of coverage. (See FIG. F-105)Step—4: Click on the “Quote Output” tab on the top or the link at the bottom to navigate to quotes output screen. Choose Interim quote option. Ensure that other information required for quotes like quote for, mode of output and addressee information is entered as desired. Click Generate Quote button to generate the quote.

View Missing Information

This function enables the user to view any missing input information required for quote generation. The option would also list out any business rule that is not satisfied.

Step 1: After successful logon, click menu Sales & Marketing and select the option Quotes.Step—2: Please refer to previous sections on how to create a new quote or modify a saved quote. Before clicking on save button to the save the quote-input information to the database, click on the “Missing Info” tab on the top or the link at the bottom to navigate to missing information screen.Step—3: If the quote has any mission information or any business rule not satisfied, the screen would list out all such items. (See FIG. F-106)The missing information is grouped on how the input fields are grouped in the input screens. Click on the hyperlink at the top corner of each section to navigate to the specific area in the input screen where the missing information is located.

Related Applications

No related applications

PX2 User Manual

User Administration

User Administration is the administrative module that encompasses the processes of creating and maintaining the PX2 entities like Module, Application, Resource, Group, User, User Role, Group Access rights, User Role Group Mapping and Password Configuration.

The Applications

The above-mentioned processes are accomplished in several applications embedded into the User Administration system. These applications steer the tasks of creating, and administering the PX2 entities, thereby helping achieve the goals of the User Administration system.

Module Master—Modules are the encapsulation from a wider perspective, of the broad functionalities of the PX2 system. For e.g. Carrier Maintenance, Sales and Marketing, Enrollment, Finance etc. This module master application is used to manage modules within the PX2 system.

Application Master—An application represents a business use case or a set of related use cases. The organization of related resources or pages in sequence constitute an application. A module consists of many applications. For e.g. Carrier Maintenance module consists of following applications viz. Zip Master, Carrier Master, and M Plan etc. This application master application is used to manage applications within the PX2 system.

Resource Master—These are entities or pages that are organized in logical sequence to achieve the functionality of an application. An application can have one or more resources, access to which is administered by the User Administration module. This resource master application is used to manage resources within the PX2 system.

Group Master—A group is a functional or logical collection of users. The grouping is based on the nature of operations performed by the users. A user can belong to multiple groups. This group master application is used to manage groups within the PX2 system.

User Master—A user is an entity representing a person working in any of the departments in Benefit Partners Inc. The identity of the user is to be authenticated by the User Administration System in consideration of his/her group and role. A user can belong to multiple groups and can play multiple roles. This user master application is used to manage users within the PX2 system.

User Role Master—User role represents a job a particular person performs in the system. A user can play multiple roles in the system. For e.g., a manager can play the role of a data entry personnel as well as that of an authorizing body. When logged in as data entry personnel, he/she may not have the privileges what was available as a manager. This user role master application is used to manage user roles within the PX2 system.

Mapping—This crucial process involves the creation of modular combinations of the entities. This process of mapping the entities is three-fold as detailed below.

User Role Group Mapping—This bi-fold process assigns a selected role to a user and then assigns the user to a selected group.

Group Access Rights—This process assigns access rights to a group for an application. Subsequently the resources in the selected application could be allotted individual Read, Write or No Access rights to the group.

User Access Rights—This process assigns access rights to the user for an application's resources. This assignment over-rides the rights available to the group to which the user belongs.

Password Configuration—This process configures the various password-related parameters. These parameters include maximum & minimum password length, maximum & minimum expiry days, password repeat count etc.

Modules are the encapsulation from a wider perspective, of the functionalities associated with the PX2 system. For e.g. Carrier Maintenance, Sales and Marketing, Enrollment, Finance etc.The module comprises of a group of applications. The following modules form an integral part of the core administrative system viz. Carrier Maintenance, Enrollment, Sales and Marketing and Finance.

Access

The application can be accessed from the main menu as follows:Security→Module→Create/Modify→Delete Module

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:Create ModuleModify ModuleDelete Module

Create Module

This function enables the creation of a new module. This creates a module with a unique id, under which several applications could be organized.

The sequential steps involved in the creation of a new module are listed below.

Step—1: After successful logon, click the menu Module and select the option Create/Modify. (See FIG. G-G-1)Step—2: Enter the values in the respective field as per the format briefed in the Fields Explanation section, and click the Save button. (See FIG. G-2)

Fields Explanation

The following table provides explanations for each of the screen fields.

ElementDescriptionModule IdThe id with which the module is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.Module NameThe text for module name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the module beingcreated. Accepts alphabets and numeric values.Entry in this field is optional.

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionSaveSaves the entered module information in thedatabase. The page gets refreshed and the contentsentered in the fields are cleared.CancelClears the contents entered in the fields.

Modify Module

This function enables the modification of an existing module. After modification, the organization of applications under the module remains intact.

The sequential steps involved in the modification of an existing module are listed below.Step—1: After successful logon, click the menu Module and select the option Create/Modify (See FIG. G-3)Step—2: Module id has to be selected by clicking the lookup icon. (See FIG. G-4)This pops a window enlisting the existing module ids. (See FIG. G-5)Step—3: Choose a module id by double clicking on any of the listed module ids. The selected module id gets inserted in the module id field automatically. (See FIG. G-6)Step—4: Change the contents to be modified and click Update.

Fields Explanation

The following table provides explanation for each of the screen fields.

ElementDescriptionModule IdThe id with which the module is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.Module NameThe text for module name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the module beingmodified. Accepts alphabets and numeric values.Entry in this field is optional.

Button Functionality

The following table provides explanation for each button in the screen

ElementDescriptionModule IdThe id with which the module is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.Module NameThe text for module name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the module beingmodified. Accepts alphabets and numeric values.Entry in this field is optional.

Delete Module

This function enables the deletion of an existing module. Only the modules that are not associated with any other application are available for deletion.

The sequential steps involved in the deletion of an existing module are listed below.Step—1: After successful logon, click the menu Module and select the Delete option. (See FIG. G-7)Step—2: Check the ids of the modules to be deleted. Only modules that do not have any applications organized under them can be deleted.Step—3: Click the Delete button to perform delete operation on the selected modules. (See FIG. G-8)

Button Functionality

The following table provides explanation for each button in the screen.

ElementDescriptionCheck BoxCheck the modules to be deleted. Check box will bein disabled state for applications that have been usedin any of the higher-level entities of the UserAdministration system.DeleteDeletes the selected applications.

Related Applications

Related applications are:Application MasterResource Master

An application represents a business use case or a set of related use cases. The organization of related resources or pages in sequence constitute an application. A module consists of many applications. For e.g. Carrier Maintenance module consists of following applications viz. Zip Master, Carrier Master, and M Plan etc. Each application is constituted of several pages.

Access

The application can be accessed from the main menu as follows:Security→Application→Create/Modify→Delete Application

The Module, under which the application is to be organized, must have been created and available.

Application Functions

This application has the following functions:Create applicationModify applicationDelete application

Create Application

This function enables the creation of a new application. This creates an application with a unique id under which several resources could be organized.

The sequential steps involved in the creation of a new application are listed below.Step—1: After successful logon, click the menu Application and select the option Create/Modify. (See FIG. G-9)Step—2: Enter the values in the respective fields, as per the format briefed in Fields Explanation section. (See FIG. G-10)Step—3: To select an application, click the lookup icon. This pops a window enlisting the existing application ids. Choose an application id by double clicking on any application id for selection. Corresponding application name of the selected application id will be inserted automatically. (See FIG. G-11)Step—4: Enter the application name directly.Step—5: Enter the comments directly.Step—6: To select a module, click the lookup icon. This pops a window enlisting the existing module ids. Choose a module id by double clicking on any module id for selection. The module name of the selected module id will be inserted automatically (See FIG. G-12)Step—7: Click Save button to save the contents.

Fields Explanation

ElementDescriptionApplication IdThe id with which the application is uniquelyidentified. Accepts alphabets and numeric values.Entry in this field is mandatory. Selection could alsobe made, by clicking the lookup icon.Application NameThe text for application name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the Application beingcreated. Accepts alphabets and numeric values.Entry in this field is optional.Select the moduleClicking on the Lookup icon enlists the existingmodules, selecting which automatically makes anentry in the field. Entry in this field is mandatory.On this selection, modules selected will getassociated with the application being created.

Button Functionality

ElementDescriptionApplication IdThe id with which the application is uniquelyidentified. Accepts alphabets and numeric values.Entry in this field is mandatory. Selection could alsobe made, by clicking the lookup icon.Application NameThe text for application name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the Application beingcreated. Accepts alphabets and numeric values.Entry in this field is optional.Select the moduleClicking on the Lookup icon enlists the existingmodules, selecting which automatically makes anentry in the field. Entry in this field is mandatory.On this selection, modules selected will getassociated with the application being created.

Modify Application

This function enables the modification of an existing application. After modification, the organization of resources under the application remains intact.

The sequential steps involved in the modification of an existing application are listed below.Step—1: After successful logon, click the menu Application and select the option Create/Modify. (See FIG. G-13)Step—2: Application id could be directly entered or selected by clicking the lookup icon. (See FIG. G-14)This pops a window enlisting the existing application ids. (See FIG. G-15)Step—3: Choose an application id by double clicking on any application id. The selected application id gets automatically inserted in the application id field with its corresponding application name.Step—4: Module has to be selected by clicking the lookup icon. [See step—3 of create application] (See FIG. G-16)Step—5: Change the contents to be modified and click Update.

Fields Explanation

ElementDescriptionApplication IdThe id with which the application is uniquelyidentified. Accepts alphabets and numeric values.Entry in this field is mandatory.Application NameThe text for Application name. Accepts alphabetsand numeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the application beingmodified. Accepts alphabets and numeric values.Entry in this field is optional.Selected theClicking on the lookup icon enlists the existingmoduleModules, selecting which automatically makes anentry in the field. Entry in this field is mandatory.Upon this selection, the selected modules will getassociated with the application being modified.

Button Functionality

ElementDescriptionUpdateSaves the entered Application information in thedatabase. The page gets refreshed and the contentsentered in the fields are cleared.CancelClears the contents entered in the fields.

Delete Application

This function enables the deletion of an existing application. Only the applications that are not associated with any other resource or module are available for deletion.

The sequential steps involved in the deletion of an existing application are listed below.Step—1: After successful logon, click the menu Application and select the Delete option. (See FIG. G-17)Step—2: Check the application ids to be deleted. Only applications that don't have any resources under them can be deleted.Step—3: Click Delete button to perform delete operation on the selected application ids. (See FIG. G-18)

Button Functionality

ElementDescriptionCheck BoxCheck the applications to be deleted. Check box willbe in disabled state for applications that have beenused in any other User Administration levels ofhigher than it.DeleteDeletes the selected applications.

Related Applications

Related applications are:Module MasterResource Master

These are entities or pages that are organized in logical sequence to achieve the functionality of an application. An application can have one or more resources, access to which is administered by the User Administration module.

The resources accessible from the system can be protected using a single access control (ACL). The ACL specifies the nature of access rights available for a page. For e.g. Read or Write or None.

Access

The application can be accessed from the main menu as follows:Security→Resource→Create/Modify→Delete Resource

An application is constituted of resources. The application, to which the resources are to be attached, must be available in the system.

Application Functions

This application has the following functions:Create resourceModify resourceDelete resource

Create Resource

This function enables the creation of a new resource. This creates a resource with a unique id.

The sequential steps involved in the creation of a new resource are listed below.Step—1: After successful logon, click menu Resource and select the option of Create/Modify. (See FIG. G-19)Step—2: Enter the values in the respective fields, as per the format briefed in Fields Explanation section. (See FIG. G-20)Step—3: For selecting an application, click the lookup icon. This pops a window enlisting the existing application ids. Choose an application id by double clicking on any application id for selection. The name of the selected application id will be inserted automatically. (See FIG. G-21)Step—4: Enter the resource name directly.Step—5: Enter screen URL directly.Step—6: Enter comments directly.Step—7: Click the Save button to save the contents.

Fields Explanation

ElementDescriptionResource IdThe id with which the resource is uniquelyidentified. Accepts alphabets and numeric values.Entry in this field is mandatory.Resource NameThe text for resource name. Accepts alphabets andnumeric values. Entry in this field is mandatory.Screen URLThe path URL for accessing the resource. Acceptsalphabets and numeric values. Entry in this field ismandatory.CommentsThe comments pertinent to the resource beingcreated. Accepts alphabets and numeric values.Entry in this field is optional.Select theClicking on the lookup icon enlists the existingApplicationapplications, selecting which automatically makes anentry in the field. Entry in this field is mandatory.Upon this selection, the application selected will getassociated with the resource being created.

Button Functionality

ElementDescriptionSaveSaves the entered resource information in thedatabase. The page gets refreshed and the contentsentered in the fields are cleared.CancelClears the contents entered in the fields.

Modify Resource

This function enables the modification of an existing resource.

The sequential steps involved in the modification of an existing module are listed below.Step—1: After successful logon, click Resource menu and select the option Create/Modify. (See FIG. G-22)Step—2: Resource id has to be selected by clicking the lookup icon. (See FIG. G-23)This pops a window enlisting the existing application ids. (See FIG. G-24)Step—3: Choose a resource id by double clicking on any resourced id. The selected resource id gets automatically inserted in the resource id field with its corresponding resource name.Step—4: Application has to be selected by clicking the lookup icon. [See step—3 of create resource] (See FIG. G-25)Step—5: Change the contents to be modified and click Update.

Fields Explanation

ElementDescriptionResource IdThe id with which the resource is uniquelyidentified. Entry in to this field is mandatory.Resource NameThe text for resource name. Accepts alphabets andnumeric values. Entry in this field is mandatory.Screen URLThe URL of the resource. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the resource beingmodified. Accepts alphabets and numeric valuesEntry in this field is optional.Selected theClicking on the lookup icon enlists the existingApplicationapplications selecting which automatically makes anentry in the field. Entry in this field is mandatory.On this selection, applications selected will getassociated with the resource being modified.

Button Functionality

ElementDescriptionUpdateSaves the entered resource information in thedatabase. The page gets refreshed and the contentsentered in the fields are cleared.CancelClears the contents entered in the fields.

Delete Resource

This function enables the deletion of an existing resource. Only the resources that are not associated with any application are available for deletion.

The sequential steps involved in the deletion of an existing resource are listed below.Step—1: After successful logon, click Resource menu and select the Delete option. (See FIG. G-26)Step—2: Select the values of resource ids to be deleted. The resources that are not associated with any application only are available for deletion.Step—3: Click Delete button to perform delete operation on the selected resources. (See FIG. G-27)

Button Functionality

ElementDescriptionCheck BoxCheck the resources to be deleted. Check box will bein disabled state for resources that have been used inany other User Administration levels of higher thanthis.DeleteDeletes the selected resources.

Related Applications

Related applications are:Module MasterApplication Master

A group is a functional or logical collection of users. The grouping is based on the nature of operations performed by the users. A user can belong to multiple groups. Groups provide an efficient way to manage large numbers of users because an administrator can specify permissions for an entire group at one time. The resources can be allocated to a group instead of assigning to an individual user. The user being a part of the group acquires access rights to those resources attached to the group.

Access

The application can be accessed from the main menu as follows:Security→Group→Create/Modify→Delete Group

There are no pre-requisites for using this application.

Application Functions

This application has the following functions:Create groupModify groupDelete group

Create Group

This function enables the creation of a new group. This creates a group with a unique id under which several users could be organized.

The sequential steps involved in the creation of a new group are listed below.Step—1: After successful logon, click the menu Group and select the option Create/Modify. (See FIG. G-28)Step—2: Enter the values in the respective fields as per the format briefed in the field's explanation section, and click the Save button. (See FIG. G-29)

Fields Explanation

ElementDescriptionGroup IdThe id with which the group is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.Group NameThe text for group name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the group being created.Accepts alphabets and numeric values. Entry in thisfield is optional.

Button Functionality

ElementDescriptionSaveSaves the entered group information in the database.The page gets refreshed and the contents entered inthe fields get cleared.ClearClears the contents entered in the fields.

Modify Group

This function enables the modification of an existing group. After modification, the organization of users under the group remains intact.

The sequential steps involved in the modification of an existing group are listed below.Step—1: After successful logon, click the menu Group and select the option Create/Modify. (See FIG. G-30)Step—2: Group id has to be selected by clicking the lookup icon. This pops a window enlisting the existing application ids. (See FIG. G-31)Step—3: Choose a group id by double clicking on any group id for selection. The selected group id gets automatically inserted in the group id field with its corresponding group name. (See FIG. G-32)Step—4: Change the contents to be modified and click the Update button. (See FIG. G-33)

Fields Explanation

ElementDescriptionGroup IdThe id with which the group is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.Group NameThe text for group name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the group beingmodified. Accepts alphabets and numeric valuesEntry in this field is optional.

Button Functionality

ElementDescriptionUpdateSaves the entered group information in the database.The page gets refreshed and the contents entered inthe fields are cleared.CancelClears the contents entered in the fields.

Delete Group

This function enables the deletion of an existing group. Only the groups that are not associated with any other application are available for deletion.

The sequential steps involved in the deletion of an existing group are listed below.Step—1: After successful logon, click the menu Group and select the Delete option. (See FIG. G-34)Step—2: Check the ids of the groups to be deleted. The disabled checkboxes represent the groups that are previously mapped to any users.Step—3: Click the Delete button to perform delete operation on the selected groups. (See FIG. G-35)

Button Functionality

ElementDescriptionCheck BoxCheck the groups to be deleted. Check box will be indisabled state for groups that have been previouslyassociated with users.DeleteDeletes the selected groups.

Related Applications

Related application is:Users

A user is an entity representing a person working in any of the departments in Benefit Partners Inc. The identity of the user is to be authenticated by the User Administration system in consideration of his/her group and role. A user can belong to multiple groups and can play multiple roles.

Access

The application can be accessed from the main menu as follows:Security→User→Create/Modify→Delete User

Groups must have been created and available to attach users to those groups. This attachment can be of any form like one user to one group or one user to many groups.

Application Functions

This application has the following functions:Create userModify userDelete user

Create User

This function enables the creation of a new user.

The sequential steps involved in the creation of a new user are listed below.Step—1: After successful logon, click the menu User and select the option Create/Modify. (See FIG. G-36)Step—2: Enter the values in the respective fields as per the format briefed in Fields Explanation section, and click the Save button. (See FIG. G-37)

Fields Explanation

ElementDescriptionFirst NameThe first name of the user. Accepts alphabets oflength not exceeding 25 characters. Entry in thisfield is mandatory.Middle InitialThe middle initial of the user. Accepts only 1alphabet character. Entry in this field is optional.Last NameThe last name of the user. Accepts alphabets oflength not exceeding 35 characters. Entry in thisfield is mandatory.User IdThe id with which the user is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.PasswordThe password to logon. Accepts alphabets, numericvalues and special characters. Entry in this field ismandatory.Display nameThe display name is the name by which a userwishes to display his/her name. Accepts alphabetsand numeric values. Entry in this field is mandatory.PhoneThe telephone number of a user. Accepts only 10digits of numeric and should be in the format 999999 9999. Entry in this field is mandatory.ExtensionThe extension number to access a user. Accepts only4 digits of numeric and should be in the format9999. Entry in this field is optional.FaxThe fax number of a user. Accepts only 10 digits ofnumeric and should be in the format 999 999 9999.Entry in this field is optional.E-mailThe email id of a user. Accepts alphabets, numericvalues and special characters of length not exceeding100 with a valid email format. Entry in this field ismandatory.LockLock the user access to the PX2 system. Onchecking the lock check box, the user is deniedaccess to the entire PX2 system.

Button Functionality

ElementDescriptionSaveSaves the entered user information in the database.The page gets refreshed and the contents entered inthe fields are cleared.CancelClears the contents entered in the fields.

Modify User

This function enables the modification of an existing user.

The sequential steps involved in the modification of an existing user are listed below.Step—1: After successful logon, click the menu User and select the option Create/Modify. (See FIG. G-38)Step—2: User id has to be selected by clicking the lookup icon. (See FIG. G-39)Step—3: This pops up a screen. Enter the user id. To run a search on existing user ids type a few letter(s) and click on the Search button. (See FIG. G-40)Step—4: Double click on any user-id for selection. Corresponding display name will get inserted in the field automatically. (See FIG. G-41)Step—5: Change the contents to be modified and click Update.

Field Explanation

ElementDescriptionFirst NameThe first name of the user. Accepts alphabets oflength not exceeding 25 characters. Entry in thisfield is mandatory.Middle InitialThe middle initial of the user. Accepts only 1alphabet character. Entry in this field is optional.Last NameThe last name of the user. Accepts alphabets oflength not exceeding 35 characters. Entry in thisfield is mandatory.User IdThe id with which the user is uniquely identified.Accepts alphabets and numeric values. Entry in thisfield is mandatory.PasswordThe password to logon. Accepts alphabets, numericvalues and special characters. Entry in this field ismandatory.Display nameThe display name is the name by which a userwishes to display his/her name. Accepts alphabetsand numeric values. Entry in this field is mandatory.PhoneThe telephone number of a user. Accepts only 10digits of numeric and should be in the format 999999 9999. Entry in this field is mandatory.ExtensionThe extension number to access a user. Accepts only4 digits of numeric and should be in the format9999. Entry in this field is optional.FaxThe fax number of a user. Accepts only 10 digits ofnumeric and should be in the format 999 999 9999.Entry in this field is optional. Entry in this field ismandatory.E-mailThe email id of a user. Accepts alphabets, numericvalues and special characters of length not exceeding100 with a valid email format. Entry in this field ismandatory.LockLock the user access to the PX2 system. Onchecking the lock check box the user is denied accessto the entire PX2 system.

Button Functionality

ElementDescriptionUpdateSaves the entered user information in the database.The page gets refreshed and the contents entered inthe fields are cleared.CancelClears the contents entered in the fields.

Delete User

This function enables the deletion of an existing user. Only the users that are not associated with any other groups are available for deletion.

The sequential steps involved in the deletion of an existing user are listed below.Step—1: After successful logon, click the menu User and select the Delete option. (See FIG. G-42)Step—2: Check the user ids to be deleted. Only the users that are not associated with any other groups are available for deletion.Step—3: Click Delete button to perform delete operation on the selected user ids. (See FIG. G-43)

Button Explanation

ElementDescriptionCheck BoxCheck the users to be deleted. Check box will be indisabled state for users that have been used in anyother User Administration levels of higher than it.DeleteDeletes the selected users.

Related Applications

Related application is:Group Master

7 User Role

User role represents a job a particular person performs in the system. A user can play multiple roles in the system. For e.g. a manager can play the role of data entry personnel as well as that of an authorizing body. When logged in as data entry personnel, he/she may not have the privileges what was available as a manager.

Access

The application can be accessed from the main menu as follows:Security→Application→Create/Modify→Delete User Role

There are no pre-requisites as such for using this application.

Application Functions

This application has the following functions:Create user roleModify user roleDelete user role

Create User Role

This function enables the creation of a new user role. This creates a user role with a unique id to which several users could be mapped.

The sequential steps involved in the creation of a new user role are listed below.Step—1: After successful login, click the menu User Role and select the option Create/Modify. (See FIG. G-44)Step—2: Enter the values in the respective fields as per the format briefed in fields explanation section, and click the Save button. (See FIG. G-45)

Field Explanation

ElementDescriptionUser Role IdThe id with which the user role is uniquelyidentified. Accepts alphabets and numeric values oflength not exceeding 35 characters. Entry in thisfield is mandatory.User Role NameThe text for user role name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the user role beingcreated. Accepts alphabets and numeric values.Entry in this field is optional.

Button Functionality

ElementDescriptionSaveSaves the entered user role information in thedatabase. The page gets refreshed and the contentsentered in the fields get cleared.CancelClears the contents entered in the fields.

Modify User Role

This function enables the modification of an existing user role. Many user roles can be assigned to a user but only one role can be exercised at a time.

The sequential steps involved in the modification of an existing user role are listed below.Step—1: After successful logon, click the menu User Role and select the option Create/Modify. (See FIG. G-46)Step—2: Enter the User role or select the user role id by clicking the lookup icon. (See FIG. G-47)This pops a window enlisting the existing application ids. (See FIG. G-48)Step—3: Double click on any user role id for selection. Corresponding display name will get inserted in the field automatically. (See FIG. G-49)Step—4: Change the contents to be modified and click the Update button.

Field Explanation

ElementDescriptionUser Role IdThe id with which the user role is uniquelyidentified. Accepts alphabets and numeric values oflength not exceeding 35 characters. Entry in thisfield is mandatory.User Role NameThe text for user role name. Accepts alphabets andnumeric values. Entry in this field is mandatory.CommentsThe comments pertinent to the user role beingcreated. Accepts alphabets and numeric values.Entry in this field is optional.

Button Functionality

ElementDescriptionUpdateSaves the entered user role information in thedatabase. The page gets refreshed and the contentsentered in the fields are cleared.CancelClears the contents entered in the fields.

Delete User Role

This function enables the deletion of an existing user role. Only he user roles that are not mapped to any users are only available for deletion.

The sequential steps involved in the deletion of an existing user role are listed below.Step—1: After successful logon, click the menu User Role and select the Delete option. (See FIG. G-50)Step—2: Check the user role ids to be deleted. The user roles that are not associated with any other higher-level hierarchy of users only are available for deletion.Step—3: Click Delete button to perform delete operation on the selected user role ids. (See FIG. G-51)

Button Explanation

ElementDescriptionCheck BoxCheck the user role to be deleted. Check box will bein disabled state for user roles that have been used inany other User Administration levels of higher thanit.DeleteDeletes the selected User roles.

Related Applications

Related applications are:UserMapping

The Mapping master is the application used to create mapping between Groups, User and User Roles. This crucial process involves the creation of modular combinations of these entities.

Access

The application can be accessed from the main menu as follows:Security→User Role→Group Access Rights→User Role Group→User Access Rights

Users, Groups, User Roles, Resources must be available in the system to establish mapping amongst them.

Application Functions

This application is to establish a relationship between Groups, User and User Roles.Create/Remove Group Access RightsCreate/Remove User Role GroupCreate/Remove User Access Rights

User Role Group

This bi-fold process assigns a selected role to a user and then assigns the user to a selected group.

The sequential steps involved in the creating user role group are listed below.Step—1: After successful logon, click the menu Mapping and select the User Role Group option. (See FIG. G-52)Step—2: User id has to be selected by clicking the lookup icon. (See FIG. G-53)This pops up a screen. Enter the user id. (See FIG. G-54)To run a search on existing user ids type a few letter(s) and click on the Search button.Step—3: Double click on any user-id for selection. User id and its corresponding display name will get inserted in the respective fields automatically.Step—4: To assign a role to the user, select an existing role by clicking the lookup icon. This pops a window enlisting the existing roles. Choose a role by double clicking on any role. The selected role name gets inserted in the role field automatically. (See FIG. G-55)Step—5: Click Select button to complete the mapping of user to role. The window gets refreshed displaying the list of available groups. (See FIG. G-56)Step—6: Now to associate the user with the assigned role to a group, check the group ids to be associated with.Step—7: Click on Save button to complete the process of mapping of the user to role to group.

Field Explanation

ElementDescriptionUser IdThe id with which the user is uniquely identified.Display NameThe display name is the name by which a userwishes to display his/her name.Select the RoleThe selection of a role is to assign a role to theselected user id.

Button Functionality

ElementDescriptionSelectSelect will map the selected user to the selected roleand enlist the existing groups.SaveSaves the entered user, role, and group informationin the database. The page gets refreshed and thecontents entered in the fields are cleared.Clear/CancelThe mapping process carried out up to that pointgets cancelled. Clears the contents entered in thefields.

Group Access Rights

This process assigns access rights to a group for an application. Subsequently the resources in the selected application could be allotted individual read, write or no access rights to the group.

The sequential steps involved in the creating group access rights are listed below.Step—1: After successful login, click the menu Mapping and select the Group Access Rights option. (See FIG. G-57)Step—2: Group id has to be selected by clicking the lookup icon. This pops a window enlisting the existing groups ids. Choose a group id by double clicking on any group id for selection. The selected group id gets inserted in the group id field automatically. (See FIG. G-58)Step—3: Now to assign applications to the selected group, select the application id by clicking the lookup icon. This pops a window enlisting the existing applications. Choose an application by double clicking on any application id for selection. The selected application id gets inserted in the application field automatically. (See FIG. G-59)Step—4: Click the Select button to complete the mapping of group to application. The window gets refreshed displaying the resources available under the application. (See FIG. G-60)Step—5: Now to assign resource-wise access rights to the assigned group and application, check the resource names to be associated with and set the desired access right from the adjoining access right list as read or write or no access.Step—6: Click on Save button to complete the process of creating group access rights.

Field Explanation

ElementDescriptionSelect the GroupThe id with which the group is uniquely identified.Select theThe id with which the application is uniquelyApplicationidentified.ACL [AccessLevel indicates the level of accessing methods saycontrol level]read, write and no access for the each of theresources.

Button Explanation

ElementDescriptionSelectSelect will map the selected group to the selectedApplication and enlist the resources under theselected application.SaveSaves the entered information in the database. Thepage gets refreshed and the contents entered in thefields are cleared.Clear/CancelThe group access rights carried out up to that pointgets cancelled. Clears the contents entered in thefields.

User Access Rights

User access rights represent the privileges required for accessing resources. An administrator protects resources by establishing access control lists to grant permissions to users and groups. Individual user permissions take precedence over group permissions. Individual user permission overrides the more restrictive group permission.

This process assigns access rights to the user for an application's resources. This assignment over-rides the rights available to the group to which the user belongs.

The sequential steps involved in the creating user access rights are listed below.Step—1: After successful logon, click the menu Mapping and select the User Access Rights (See FIG. G-61)Step—2: User id has to be selected by clicking the lookup icon. (See FIG. G-62)Enter the user id. To run a search on existing user ids type a few letter(s) and click on the Search button. The screen illustrated below pops up.Step—3: Double click on any user-id for selection. Corresponding display name will get inserted in the field automatically.Step—4: Application id has to be selected by clicking the lookup icon. This pops a window enlisting the existing application ids. Choose an application id by double clicking on any application id for selection. The selected application id gets inserted in the application id field automatically. (See FIG. G-63)Step—5: To assign a role to the user with assigned application, now select an existing role by clicking the lookup icon. This pops a window enlisting the existing roles. Choose a role by double clicking on any role for selection. The selected role name gets inserted in the role field automatically. (See FIG. G-64)Step—6: Click Select button to complete the process of user access rights. The window gets refreshed displaying the resources available under the selected application. (See FIG. G-65)Step—7: Now to assign resource-wise access rights to the assigned user, application and role, check the resource names to be associated with and set the desired access right from the adjoining access right list as read or write or no access.Step—8: Click on Save button to complete the process of creating user access rights.

Field Explanation

ElementDescriptionUser IdThe id with which the user is uniquely identified.Display NameThe display name is the name by which a userwishes to display his/her name.Select theThe id with which the application is uniquelyApplicationidentified.Select the RoleThe selection of a role is to assign a role to theselected user id, application.ACL [AccessLevel indicates the level of accessing methods saycontrol level]read, write and no access for the each of theresources.

Button Functionality

ElementDescriptionSelectSelect will map the selected User, Role to theselected Application and enlist the resources underthe selected Application.SaveSaves the entered information in the database. Thepage gets refreshed and the contents entered in thefields are cleared.Clear/CancelThe user access rights carried out up to that pointgets cancelled. Clears the contents entered in thefields.

Related Applications

9 Password Configuration

This process configures the various password-related parameters. These parameters include maximum & minimum password length, maximum & minimum expiry days, password repeat count etc.

Access

The application can be accessed from the main menu as follows:Security→Configure→Password Configuration

There are no pre-requisites as such for using this application.

Application Functions

This application is to administer the parameters related to password.

Configure Password

Password configuration is mainly to monitor and control the usage of password.

Following is the screen snapshot for password configuration. (See FIG. G-66)

Fields Explanation

ElementDescriptionMaximumMaximum allowed length in characters of thePassword lengthpassword. Entry in this field is mandatory.MinimumMinimum allowed length in characters of thepassword lengthpassword. Entry in this field is mandatory.Maximum ExpiryMaximum allowed date for password expiration inDaysdays. Entry in this field is mandatory.Minimum ExpiryMinimum allowed date for password expiration inDaysdays. Entry in this field is mandatory.Prompt ExpiryPrompt expiry date is to highlight as a reminder forPeriodpassword expiration in days. Entry in this field ismandatory.Password RepeatThis specifies the number of times the password hasCountto have a new entry with no repetition of previouspasswords. Entry in this field is mandatory.Invalid PasswordInvalid password count will have the count ofCountattempting with invalid passwords before the user islocked. Entry in this field is mandatory.Lock time forLock time for password in HH:MM:SS format topasswordhave session-out. Entry in this field is mandatory.

Button Functionality

ElementDescriptionSaveSaves the entered password information in thedatabase. The page gets refreshed and the contententered in the fields appear on the screen.

Related Applications

Benefit Partners Inc

Process Specification

1.1. PurposeThis purpose of this document is to identify the process associated with the business use case Create Carrier Master.

1.2. Business Use Case Specification Reference

Business Use Specification

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_CM_001Create Carrier Master

2. Process Identification

Create Carrier Master is user for creation of master record for the carrier which includes the general information about the carrier, Department Contact Information, Mode of Communications Line of Coverage, plan type and the benefit level offered by the carrier and the benefit description.

2.2. Process Description & FlowThis process describes the Use Case “Create Carrier Master”. This document is the amendment of BPI_CAS_FSD_CM—01 (Version 1.1).

2.2.1. Create Carrier MasterThe flow of the process is as described below.a. Input the general information about the carrier.b. Input the Department Contact Informationc. Validate if the department contact information has the right data type.d. If yes add the information to a temporary storage.e. If not re enter the information correctly and add again.f. Continue adding further department contact information.g. If yes follow steps from b) to e)h. Edit or delete the Department Contact Information.i. On edit remove the data from temporary storage and populate the department contact information data to the fields and change the data. Continue from c) to e).j. On delete remove the data from the temporary storage.k. Can continue from step b) onwards or go to step 1)l. If not then check if the data entered for the general carrier information is correct or erroneous.m. If erroneous re enter the correct data.n. If Correct then save the data to the repository.o. System auto generates a unique identification number for the carrier.p. Choose the Line of coverageq. For the line of coverage choose the system show the Plan type.r. Choose the Plan Types. For the plan type choose the system show the benefit levelt. Choose the benefit level and enter the benefit level name for the specific carrier and add.u. The Line of coverage, plan type, Benefit Level and the name is populated in and shown.v. Check if the data entered is correct or erroneous.w. If erroneous then edit or delete the benefit level name.x. Else continue adding the next line of coveragey. If the process is completed save the data.z. The data is saved into the repository and unique identification number is generated for the all the benefit level offered by the specific carrier aCarrierName_PlanType_BenefitLevel_UniqueID

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface ID: Create Carrier Master

3.1.2.1. Screen Name: Create Carrier Master

ElementElementNameTypeLabelPurposeMain HeaderTextMain HeaderTo give the heading for theCreateCreatescreen being navigatedCarrierCarrierMasterMasterSub HeaderTextSub HeaderProvide Content Area TextCarrierCarrierGeneralGeneralInformationInformationSub HeaderTextSub HeaderText for the Company AddressAddressAddressCompanyTextCompanyText for the entry fieldNameNameCompanyEntry FieldCompanyEntry Field for Company nameName (EntryName (EntryField)Field)AddressTextAddressText for the AddressAddressEntry FieldAddressEntry Field for Address(Entry Field)(Entry Field)Suite/Apt #TextSuite/Apt #Text for Suite/Apt #Suite/Apt #Entry FieldSuite/Apt #Entry Field for Suite/Apt #(Entry Field)(Entry Field)CityTextCityText for CityCity (EntryEntry FieldCity (EntryEntry Field for CityField)Field)StateTextStateText for stateState (EntryEntry FieldState (EntryEntry Field for StateField)Field)ZIPTextZIPText for ZIPZIP (EntryEntry FieldZIP (EntryEntry Field for ZIPField)Field)Sub HeaderTextSub HeaderText for the sub headingContactContactDepartmentDepartmentDepartmentDrop DownDepartmentList all the departments forListthe carrier for contactinformationContactTextContactText for Contact nameNameNameSalutationTextSalutationText for SalutationFirst NameTextFirst NameText for First nameMiddle nameTextMiddle nameText for middle nameLast nameTextLast nameText for last nameSuffixTextSuffixText for SuffixTitleTextTitleText for titleSalutationEntry FieldSalutationEntry Field for SalutationFirst NameEntry FieldFirst NameEntry field for first nameMiddle nameEntry FieldMiddle nameEntry field for middle nameLast nameEntry FieldLast nameEntry field for last nameSuffixEntry FieldSuffixEntry Field for SuffixTitleEntry FieldTitleEntry Field for titleAddressTextAddressText for the AddressAddressEntry FieldAddressEntry Field for Address(Entry Field)(Entry Field)Suite/Apt #TextSuite/Apt #Text for Suite/Apt #Suite/Apt #Entry FieldSuite/Apt #Entry Field for Suite/Apt #(Entry Field)(Entry Field)CityTextCityText for CityCity (EntryEntry FieldCity (EntryEntry Field for CityField)Field)StateTextStateText for stateState (EntryEntry FieldState (EntryEntry Field for StateField)Field)ZIPTextZIPText for ZIPZIP (EntryEntry FieldZIP (EntryEntry Field for ZIPField)Field)Mode ofDrop DownMode ofList various modes of contactCommuni-ListCommuni-preferredcationcationPhoneTextPhoneText for phoneFAXTextFAXText for FAXEmailTextEmailText for emailPhoneEntry FieldPhoneEntry Field for Phone numberFAXEntry FieldFAXEntry field for FAXEmailEntry FieldEmailEntry field for emailADDButtonADDTo add the above details on to(HTMLthe html table after validationSubmitcheck.button)TableHTMLTableTable for adding up the contactTableinformationDeleteButtonDeleteTo delete the contact(HTMLinformation checked forButton)deletionCheck AllText LinkCheck AllTo check all the check boxesin the tableClear AllText LinkClear AllTo un check all the check boxeschecked in the tableDeleteCheck boxDeleteTo check the items for deletionEditButtonEditTo edit the contact information(HTMLagainst the row selected forButton)editionDepartmentTextDepartmentShows the name of the depart-NameNamement. added For examplefinance, marketing etc.Last NameTextLast NameName of the contact personPhoneTextPhonePhone of the contact personFAXTextFAXFAX of the contact personEmailTextEmailEmail address of the contactpersonSAVEButtonSAVESave all the above information(HTMLto the repositorySubmitbutton)CANCELButtonCANCELTo reset the entries made in all(HTMLthe fieldsresetbutton)

3.1.2.3. Front End Validations

Validation DetailsThis section provides the front-end screen validations along with the associated message—Success/Error Message text

3.1.3. User Interface ID: Create Product

3.1.3.3. Front End Validations

Validation DetailsThis section provides the front-end screen validations along with the associated message—Success/Error Message text

Element#NameAction/Validation DetailsMessage1.Trans IdThis name should be brought from thePlan Id is requiredprevious screenPlanId acceptsBPI_CAS_SCR_CM_001_001.alphanumeric valuesonly2.Line ofShould list various types of Line ofNote: The ScreenCov-Coverage from the database.should not beerageDefault Line of Coverage should berefreshed when-- Choose One --choosing differentSubsequent line of coverage should beLine of Coverage.listed alphabetically.Line of Coverage isOn choosing the line of coveragerequiredcorresponding Plan Type should belisted.On choosing different Line ofCoverage the Plan Type List shouldbe refreshed and new set of plan typeshould be listed for the new line ofcoverage selected.3.PlanShould list various types of Plan TypeNote: The ScreenTypefrom the database.should not bePlan Type should be Listedrefreshed whenalphabeticallychoosing differentOn choosing the Plan TypePlan Type.Corresponding Benefit Level ShouldPlan Type is requiredbe listed.On choosing different Plan Type theBenefit Level List should be refreshedand new set of Benefit Level shouldbe listed of the new Plan Typeselected.4.CarrierShould be enteredCarrier Name isNamerequired5.PlanShould be enteredPlan Name is requiredName6.AddShould function with Enter KeyError Dialog BoxCursor Positioned on the “ADD”Text:button or Mouse Click.“The name entered forCheck if alternate Benefit Level namealternate Benefit Levelis valid.Name is incorrect.If not throw error message.Please enter theCheck if there is no duplicate entry forcorrect name.”the Combination of Line of Coverage,“The is no namePlan Type and Benefit level selected.entered for BenefitIf Duplicate Show Error MessageLevel Name. PleaseCheck if there is blank field if soenter the name.”throw error messageError Dialog BoxSuccess: The items selected with theText:benefit level name are added to the“The Benefit LevelHTML table below (temporary)Name for thecombination of Lineof Coverage, Plan typeand Benefit Level isalready entered. Pleaseselect othercombination.”7.TableShould have column header and eachsubsequent row should be identifiedby alternate color combinations. i.e.First row should have color ‘x’ andthe next row should have color‘y’.The next row should have color ‘x’again and so on. The size of any textinside any cell should be wrapped ifthe text becomes too long.8.DeleteShould function with Enter KeyError Message:Cursor Positioned on the “Delete”“Please choose thebutton or on Mouse Click.row or rows to beDelete Button should work ondeleted.”multiple deletes based on the checkbox or boxes selected. If the userclicks on the delete button withoutchecking any of the delete check boxshould throw error message.Success: Deletes the row or rows fromthe HTML table(temporary storage)9.CheckOn clicking the “Check All” Link allOn clicking theAllthe rows with the check box option are“Check All”Link allchecked.the rows with thecheck box option arechecked.10.ClearOn clicking the “Clear All” Link allOn clicking the “ClearAllthe rows with the check box optionAll” Link all the rowschecked are unchecked.with the check boxoption checked areunchecked.11.DeleteCheck box option with default“unchecked”12.EditShould function with Enter KeyNote: All edits that areCursor Positioned on the “Edit”done on the data frombutton or on Mouse Click.the repository orOn clicking the edit button the rowdatabase, history ofedited should be removed from thethe changes madetable and the data should be populatedmust be available.back on the editable entry field.13.SAVEShould function with Enter KeySystem Error:Cursor Positioned on the “SAVE”Common Text shall bebutton or on Mouse Click.followed for theValidation Check:System Error.Check if there is any data entered inDialog box :the alternate Benefit Level Name“Would you like tofield.Add the AlternateIf yes show a dialog box with messageBenefit Level name“Would you like to Add the Alternatebefore saving” Yes/Benefit Level name before saving”No.Yes/No.If yes allow the user to add the data.If no save the data without adding theAlternate Benefit Level Name to theHTML Table.On saving the data the data gets savedto the database.Success:On Successful saving the flow shouldbe automatically be navigated back tothe previous screen.(BPI_CAS_SCR_CM_001_001)14.CancelCancel Button should clear all thecontent filled on the entry fields.

3.1.4. User Interface ID: Search Carrier Master

3.1.4.1. Screen Name: Search Carrier Master

3.1.4.3. Front End Validations

Validation DetailsThis section provides the front-end screen validations along with the associated message—Success/Error Message text

Element#NameAction/Validation DetailsMessage1.CarrierDefault option on the list isname-- Choose One --Lists all the active carrier inalphabetical order2.ViewShould function with Enter KeyError Dialog BoxCursor Positioned on the “View”Text: “Please choosebutton or on Mouse Click.a carrier to viewOn clicking the View Button if noinformation”Carrier name is selected then throw anerror message.Else Success should navigate to theview pageBPI_CAS_SCR_CM_001_006 withthe data pertaining to the carrierselected.3.EditShould function with Enter KeyError Dialog BoxCursor Positioned on the “Edit”Text:button or on Mouse Click.“Please choose aOn clicking the Edit Button if nocarrier to EditCarrier name is choose then throw aninformation”error message.Else Success should navigate to theEdit pagesBPI_CAS_SCR_CM_001_004 withthe data pertaining to the carrierselected.

3.1.5. User Interface ID: Modify Carrier Master

3.1.5.1. Screen Name: Modify Carrier Master

3.1.6. User Interface ID: Modify Carrier Product

3.1.6.1. Screen Name: Modify Carrier Product

3.1.6.3. Front End Validations

Validation DetailsThis section provides the front-end screen validations along with the associated message—Success/Error Message text

#Element NameAction/Validation DetailsMessage1.Carrier nameThis name should be brought from theprevious screenBPI_CAS_SCR_CM_001_004.2.Line of CoverageShould list various types of Line ofNote: The ScreenCoverage from the database.should not beDefault Line of Coverage should berefreshed when— Choose One —choosing different lineSubsequent line of coverage should beof coverage.listed alphabetically.On choosing the line of coveragecorresponding Plan Type should belisted.On choosing different Line ofCoverage the Plan Type List shouldbe refreshed and new set of plan typeshould be listed for the new line ofcoverage selected.3.Plan TypeShould list various types of Plan TypeNote: The Screenfrom the database.should not bePlan Type should be Listedrefreshed whenalphabeticallychoosing differentOn choosing the Plan TypePlan Type.Corresponding Benefit Level Shouldbe listed.On choosing different Plan Type theBenefit Level List should be refreshedand new set of Benefit Level shouldbe listed of the new Plan Typeselected.4.Benefit LevelShould list various types of BenefitLevel from the database.Benefit Level should be listedalphabetically.5.Benefit LevelThe field is used for filling BenefitNameLevel Name6.Alternate nameThe field is used for enteringError Dialog Box Text:Alternate Benefit Level Name“The value entered forAlternate BenefitLevel Name isincorrect. Please enterthe correct value.”7.AddShould function with Enter KeyError Dialog Box Text:Cursor Positioned on the “ADD”“The value entered forbutton or Mouse Click.Benefit Level Name isCheck if Alternate Benefit Level nameincorrect. Please enteris valid.the correct value.”If not throw error message.Embedded ErrorCheck if there is no duplicate entry forMessage:the Combination of Line of Coverage,Show this message onPlan Type and Benefit level selected.space above theIf Duplicate Show Error MessageHTML table withSuccess: The items selected with theRED color.benefit level name are added to the“The Benefit LevelHTML table below (temporary)Name for thecombination of Lineof Coverage, Plan typeand Benefit Level isalready available.Please select otherbenefit level.”8.TableShould have column header and eachsubsequent row should be identifiedby alternate color combinations. i.e.First row should have color ‘x’ andthe next row should have color‘y’. The next row should have color ‘x’again and so on. The size of any textinside any cell should be wrapped ifthe text becomes too long.9.DeleteCheck box option with default“unchecked”10.DeleteShould function with Enter KeyError Message:Cursor Positioned on the “Delete”“Please choose the row orbutton or on Mouse Click.rows to be deleted.”Delete Button should work onmultiple deletes based on the checkbox or boxes selected. If the userclicks on the delete button withoutchecking any of the delete check boxshould throw error message.Note: the delete action should onlydelete the single or multiple rowsselected from the view inside thetable.However the data must not be deletedfrom the database on saving. It shouldonly inactivate the benefit level name/names selected for deletion.11.EditShould function with Enter KeyRepository DataCursor Positioned on the “Edit”should be green inbutton or on Mouse Click.color and theOn clicking the edit button the rowTemporary dataedited should be removed from theshould be red in color.table and the data should be populatedback on the editable entry field.12.SAVEShould function with Enter KeySystem Error:Cursor Positioned on the “SAVE”Common Text shall bebutton or on Mouse Click.followed for theValidation Check:System Error.Check if there is any data entered inDialog box:the Alternate Name field.“Would you like toIf yes show a dialog box with messageAdd the Alternate“Would you like to Add AlternateBenefit Level nameBenefit Level name before saving”before saving”Yes/No.Yes/No.If yes allow the user to add the data.Note: For all theIf no save the data without adding thechanges made historyBenefit Level Name to the HTMLof changes should beTable.available for viewingOn saving the data the data gets savedvia reports for theto the database.specific modules.Success:On Successful saving the flow shouldbe automatically be navigated back tothe Search Screen.(BPI_CAS_SCR_CM_001_003)Note: Data must not be deleted fromthe database on saving. It should onlyinactivate the benefit level name/names selected for deletion.13.CancelTo cancel the previous operation.

3.1.7. User Interface ID: View Carrier Master

3.1.8. User Interface ID: Search Product

3.1.8.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

Element#NameAction/Validation DetailsMessage1.CarrierDefault option on the list isname— Choose One —Lists all the active carrier inalphabetical order2.ViewShould function with Enter KeyError DialogCursor Positioned on the “View”Box Text:button or on Mouse Click.“PleaseOn clicking the View Button ifchoose ano Carrier name is selected thencarrier to viewthrow an error message.information”Else Success should navigate tothe view pageBPI_CAS_SCR_CM_001_006with the data pertaining to thecarrier selected.3.EditShould function with Enter KeyError DialogCursor Positioned on the “Edit”Box Text:button or on Mouse Click.“PleaseOn clicking the Edit Button if nochoose aCarrier name is choose thencarrier to Editthrow an error message.information”Else Success should navigate tothe Edit pagesBPI_CAS_SCR_CM_001_004with the data pertaining to thecarrier selected.

3.1.9. User Interface ID: View Product Info

Benefit Partners Inc

Process Specification

This purpose of this document is to identify the process associated with the business use case Create Plan. This document is the amendment of BPI_CAS_FSD_CM—02 (Version 1.0).

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_CM_002Create M Plan

2. Process Identification

This process identifies the functionality for creation of Line of Coverage, Plan Type and Benefit Level.

This process is used to create various Line of Coverage, Plan type and benefit level offered by PacAdvantage. Line of coverage includes the coverage offered by PacAdvantage e.g. Medical, Dental, Vision, Chiropractic, Voluntary Medical etc. These classify broad range of all the line of coverage offered.

Plan type includes plan type for specific line of coverage e.g. PPO, HMO, PSO etc.Benefit Level specifies the specific benefit level offered for the line of coverage and plan type e.g. Standard, Preferred, preferred plus etc.

2.2. Process Description & Flow

2.2.1. Create Line of Coverage

1. Input Line of Coverage name

2. Validate Line of Coverage name

3. If yes add the information to a temporary storage.

4. If not re enter the information correctly and add again.

5. Edit or delete Line of Coverage name

6. If erroneous re enter the correct data.

7. If Correct then save the data to the repository

8. System auto generates a unique identification number for Line of Coverage

Refer Process Flow Diagram

2.2.2. Create Plan Type

1. Input Plan Type name

2. Validate Plan Type name

3. If yes add the information to a temporary storage.

4. If not re enter the information correctly and add again.

5. Edit or delete Plan Type name

6. If erroneous re enter the correct data.

7. If Correct then save the data to the repository

8. System auto generates a unique identification number for Plan Type

Refer Process Flow Diagram

2.2.3. Create Benefit Level

1. Input Benefit Level name

2. Validate Benefit Level name

3. If yes add the information to a temporary storage.

4. If not re enter the information correctly and add again.

5. Edit or delete Benefit Level name

6. If erroneous re enter the correct data.

7. If Correct then save the data to the repository

8. System auto generates a unique identification number for Benefit Level

Refer Process Flow Diagram

2.2.4. Process Flow Diagrams

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface ID: Create Line of Coverage

ElementElementNameTypeLabelPurposeMainTextMain HeaderTo give the heading for theHeader LineLine ofscreen being navigatedof coveragecoverageLine ofTextLine ofProvide textCoverageCoverageLoc NameEntry FieldLoc NameEntering line of coverageAddHTMLAddButton for adding the Line ofButtoncoverage to the table belowTableHTML tableTableFor adding and displaying allthe names of the Line ofCoverageDeleteButtonDeleteTo delete the line of Coverage(HTMLcheckedButton)Check AllText LinkCheck AllTo check all the check boxesin the tableClear AllText LinkClear AllTo un check all the check boxeschecked in the tableDeleteCheck boxDeleteTo check the items for deletionEditButtonEditTo edit the Line of coverage(HTMLagainst the row selected forButton)editionSaveButtonSaveSave all the above information(HTMLto the repositorySubmitbutton)CancelButtonCancelTo reset the entries made in(HTML resetall the fieldsbutton)

3.1.2.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—

#Element NameAction/Validation DetailsMessage1.Line ofThis field is used for entering the“Line of Coverage - Is required.”coverage Entryline of coverage. The Line of“Line of Coverage -coverage should be alphanumericAccepts alphanumeric values only”only. The special characterpermitted is only space barbetween the two words. And canhave max length 20. Blank line ofcoverage not allowed2.AddOn Clicking add button or pressingOn click of Add buttonenter key field with the cursorchecks for the aboveposition on the Add button, Thementioned validations +data gets added to the table.“Line of Coverage - Already exists.”Validation checks are done to not(Occurs on duplicate record entry)allow null value on the entry fieldand the entry field should haveonly alphanumeric values.Duplicate name for the line ofcoverage should not be allowed.3.TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. i.e. First row shouldhave color ‘x’ and the next rowshould have color ‘y’. The next rowshould have color ‘x’ again and soon. The size of any text inside anycell should be wrapped if the textbecomes too long.4.DeleteShould function with Enter Key“! Select record(s) for deletion”Cursor Positioned on the “Delete”(If the operation is inbutton or on Mouse Click.Edit Mode & deleteDelete Button should work onoperation is invoked)multiple deletes based on thecheck box or boxes selected. If theuser clicks on the delete buttonwithout checking any of the deletecheck box should throw errormessage.Success: Deletes the row or rowsfrom the table (temporary storage)5.Check AllOn clicking the “Check All” linkshould check all the check boxesin the HTML table.6.Clear AllOn clicking the “Clear All” linkshould uncheck all the checkedcheck boxes in the HTML table.7.DeleteCheck box option with defaultDelete Check box is“unchecked”disabled and grayedout if the data in thecorresponding row/rows has child parentrelationship. (I.e. it hasreference somewhereelse in the database.)8.EditShould function with Enter Key“! Complete the update process”Cursor Positioned on the “Edit”(If the operation is alreadybutton or on Mouse Click.in Edit Mode & another EditOn clicking the edit button the rowoperation is invoked)edited should be disabled and thedata should be populated back onthe editable entry field.Note: All data that are from therepository should be in greencolor. The data that is added andnot saved should be in red. Thedata selected for editing should bedisplayed in gray. The “Add”button will be changed to “Update”button.9.SaveShould function with Enter KeyFor general scriptCursor Positioned on the “SAVE”validations for commonbutton or on Mouse Click.functionality referOn saving the data the data getsBPI_CAS_FSD_COMMONsaved to the database.System Error:Check if there is data populated forCommon Text shall beediting. If yes show a dialog boxfollowed for thewith message “Complete updateSystem Error.Process.”“! Do any operation to save.”(Displayed when invokedimmediately after thescreen is loaded).“! Complete the update process”(Displayed when Saveis invoked in EditMode).10.CancelShould reset all the entries toprevious status before saving. i.e.the fields should be blank. If any ofthe data has been selected forediting, the same data shouldappear when cancel button isclicked.

3.1.3. User Interface ID: Create Plan Type

ElementElementNameTypeLabelPurposeMainTextMainTo give the heading for theHeaderHeaderscreen being navigatedPlan TypePlan TypePlan TypeTextPlan TypeProvide textPlan typeEntry FieldPlan typeEntering Plan typeEntryEntryAddHTMLAddButton for adding the Plan TypeButtonto the table belowTableHTML tableTableFor adding and displaying all thenames of the Plan TypeDeleteButtonDeleteTo delete the Plan Type checked(HTMLButton)Check AllText LinkCheck AllTo check all the check boxes inthe tableClear AllText LinkClear AllTo un check all the check boxeschecked in the tableDeleteCheck boxDeleteTo check the items for deletionEditButtonEditTo edit the Plan Type against the(HTMLrow selected for editionButton)SAVEButtonSAVESave all the above information(HTMLto the repositorySubmitbutton)CANCELButtonCANCELTo reset the entries made in(HTML resetall the fieldsbutton)

3.1.3.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

#Element NameAction/Validation DetailsMessage1.Plan type EntryThis field is used for entering the PlanError Dialog Box:Type. The Plan Type should be“Plan Name - Isalphanumeric only. The special characterrequired”permitted is only space bar between the“Plan Name - Acceptstwo words. And can have max length 255.alphanumeric values only”Blank line of coverage not allowed2.AddOn Clicking add button or pressingError Dialog Box:enter key field with the cursorOn click of Add buttonposition on the button, The datachecks for the abovegets added to the table. Validationmentioned validations +checks are done to not allow null“Plan Name - alreadyvalue on the entry field and theexists.”entry field should have only(Occurs on duplicatealphanumeric values.record entry)3.TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. i.e. First row shouldhave color ‘x’ and the next rowshould have color ‘y’. The next rowshould have color ‘x’ again and soon. The size of any text inside anycell should be wrapped if the textbecomes too long.4.DeleteShould function with Enter KeyError Dialog Box:Cursor Positioned on the “Delete”“! Select record(s) forbutton or on Mouse Click.deletion”Delete Button should work on“! Complete the updatemultiple deletes based on theprocess”check box or boxes selected. If the(If the operation is inuser clicks on the delete buttonEdit Mode & deletewithout checking any of the deleteoperation is invoked)check box should throw errormessage.Success: Deletes the row or rowsfrom the table temporarily.5.Check AllOn clicking the “Check All” linkshould check all the check boxesin the HTML table.6.Clear AllOn clicking the “Clear All” linkshould uncheck all the checkedcheck boxes in the HTML table.7.DeleteCheck box option with defaultDelete Check box is“unchecked”disabled and grayed out ifthe data in thecorresponding row/rowshas child parentrelationship. (I.e. it hasreference somewhere elsein the database.)8.EditShould function with Enter Key“! Complete the updateCursor Positioned on the “Edit”process”button or on Mouse Click.(If the operation is alreadyOn clicking the edit button the rowin Edit Mode & another Editedited should be disabled in theoperation is invoked)table and the data should bepopulated back on the editableentry field.Note: All the data inside the tablethat are available from therepository should be green in colortext. The temporary data should bered in color text. The data selectedfor editing should be displayed ingray. The “Add” button will bechanged to “Update” button.9.SaveShould function with Enter KeyFor general scriptCursor Positioned on the “SAVE”validations for commonbutton or on Mouse Click.functionality referOn saving the data the data getsBPI_CAS_FSD_COMMONsaved to the database.System Error:Check if there is data populated forCommon Text shall beediting. If yes show a dialog boxfollowed for thewith message “Complete updateSystem Error.Process.”“! Do any operation tosave.”(Displayed when invokedimmediately after thescreen is loaded).“! Complete the updateprocess.”(Displayed when Save isinvoked in Edit Mode).10.CancelShould reset to the previous statuson clicking the cancel button. i.e.make all the entry field blank. Ifany of the data has been selectedfor editing, the same data shouldappear when cancel button isclicked.

3.1.4. User Interface ID: Create Benefit Level

ElementElementNameTypeLabelPurposeMainTextMainTo give the heading for theHeaderHeaderscreen being navigatedBenefitBenefitLevelLevelBenefitTextBenefitProvide textLevel NameLevel NameBenefitEntry FieldBenefitEntering the benefit levelLevel NameLevel NamenameEntryEntryAddHTMLAddButton for adding the BenefitButtonLevel to the table belowTableHTML tableTableFor adding and displaying allthe names of the Benefit LevelDeleteButtonDeleteTo delete the Benefit Level(HTMLcheckedButton)Check AllText LinkCheck AllTo check all the check boxesin the tableClear AllText LinkClear AllTo un check all the checkboxes checked in the tableDeleteCheck boxDeleteTo check the items for deletionEditButtonEditTo edit the Benefit Level(HTMLagainst the row selectedButton)for editionSaveButtonSaveSave all the above information(HTMLto the repositorySubmitbutton)CancelButtonCancelTo reset the entries made in(HTML resetall the fieldsbutton)

3.1.4.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

#Element NameAction/Validation DetailsMessage1.Benefit LevelThis field is used for entering theError Dialog Box:Benefit Level. The Benefit Level“Benefit Level - Is required”should be alphanumeric only. The“Benefit Level -special character permitted is onlyAccepts alphanumeric values only”space bar between the two words.And can have max length 255.Blank line of coverage not allowed2.AddOn Clicking add button or pressingError Dialog Box:enter key field with the cursorOn click of Add buttonposition on the button, The datachecks for the abovegets added to the table. Validationmentioned validations +checks are done to not allow null“Benefit Level - already exists.”value on the entry field and the(Occurs on duplicateentry field should have only alpharecord entry)values.Should check for duplicate entries3.TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. i.e. First row shouldhave color ‘x’ and the next rowshould have color ‘y’. The next rowshould have color ‘x’ again and soon. The size of any text inside anycell should be wrapped if the textbecomes too long.4.DeleteShould function with Enter KeyError Dialog Box:Cursor Positioned on the “Delete”“! Select the record(s) for deletion”button or on Mouse Click.“! Complete the update process”Delete Button should work on(If the operation is inmultiple deletes based on theEdit Mode & deletecheck box or boxes selected. If theoperation is invoked)user clicks on the delete buttonwithout checking any of the deletecheck box should throw errormessage.5.Check AllOn clicking the “Check All” linkshould check all the check boxesin the HTML table.6.Clear AllOn clicking the “Clear All” linkshould uncheck all the checkedcheck boxes in the HTML table.7.DeleteCheck box option with defaultDelete Check box is“unchecked”disabled and grayedout if the data in thecorresponding row/rows has child parentrelationship. (I.e. it hasreference somewhereelse in the database.)8.EditShould function with Enter Key“! Complete the update process”Cursor Positioned on the “Edit”(If the operation is alreadybutton or on Mouse Click.in Edit Mode & anotherOn clicking the edit button the rowEdit operation is invoked)edited should be removed from thetable and the data should bepopulated back on the editableentry field.If the data is from the repositoryshow it in green color text. If it istemporary data just added show itin red color text. The data selectedfor editing should be displayed ingray. The “Add” button will bechanged to “Update” button.9.SaveShould function with Enter KeyFor general scriptCursor Positioned on the “Save”validations for commonbutton or on Mouse Click. Onfunctionality refersaving the data the data getsBPI_CAS_FSD_COMMONsaved to the database.SystemError:Check if there is data populated forCommon Text shall beediting. If yes show a dialog boxfollowed for thewith message “Complete updateSystem Error.Process.”“! Do any operation to save.”(Displayed when invokedimmediately after thescreen is loaded).“! Complete the update process.”(Displayed when Saveis invoked in EditMode).10.CancelShould reset to the previous statuson clicking the cancel button. Ifany of the data has been selectedfor editing, the same data shouldappear when cancel button isclicked.

3.1.5. Screen Flow

The flow of the process is as described below. (See FIG. H-15)

Benefit Partners Inc

Process Specification

This purpose of this document is to identify the process associated with the business use case Create Rate Master. This document is the amendment of BPI_CAS_FSD_CM—03 (Version 1.1).

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_CM_003Create Rate Master

2. Process Identification

This process describes the Use Case “Rate Master”.

Rate Master is used to upload all the rates for the products (Benefits) provided by individual health insurance provider (Carrier). The individual rate files are provided by PacAdvantage with the rate for all the products offered by all the carriers in a specific file format. This Process for loading the rates would be covered in the Document Reference No: BPI_CAS_FSD_EC

The rates are normally classified as blended rates and raw rates.

Raw rates would include only the premium rates for the products offered.

Blended rate would include the sum total of the entire raw rate, admin fees, agent commission additional fees and Differential Fees. The rate classification would define the formula for calculating the blended rate for the product under offering. Using the administrative screens the classification of rates for arriving to these calculations is provided.

Admin Fees Further Admin fees can be of two types % of the premium or a fixed flat $ amount.

Agent Commission Agent commission can be a % of premium or a flat $ amount per member or a flat $ amount per group size.

Additional Fees Additional Fees can be a % premium or flat $ amount for the carrier.

Differential Fees The amount type for Differential Rate should include Flat $ amount as Flat $ amount per member and also Flat $ amount per Group. When the Flat $ amount is per group it should be able to specify group size.

The state is divided into several service areas based on the number of counties and their population. In the state of California there are presently 6 service areas. The Rate is based on the service area where the employees are residing. Also there are cases when the ZIP code has two or more Service Areas. Under these conditions the ZIP code should be attached to those services areas from where the rates are to be picked.

2.2. Process Description & Flow

2.2.1. Admin Fee

The flow of the process is as described below.

1. Input the rate type information.

2. Validate if the rate type information has the right data type.

3. If Correct then save the data to the repository.

4. Search admin fee records.

5. Select a record in modify mode

6. Edit the rate type information.

7. Validate if the rate type information has the right data type.

8. If Correct then save the data to the repository.

9. Search admin fee records.

10. Select a record in view/delete mode

11. View the selected admin fee

12. Delete the selected admin fee from the repository.

Refer Process Flow DiagramFIG. 1.

2.2.2. Agent FeeThe flow of the process is as described below.

1. Input the rate type information.

2. Validate if the rate type information has the right data type.

3. If Correct then save the data to the repository.

4. Search agent fee records.

5. Select a record in modify mode

6. Edit the rate type information.

7. Validate if the rate type information has the right data type.

8. If Correct then save the data to the repository.

9. Search agent fee records.

10. Select a record in view/delete mode

11. View the selected agent fee.

12. Delete the selected agent fee from the repository.

Refer Process Flow DiagramFIG. 2.

2.2.3. Additional FeeThe flow of the process is as described below.

1. Input the rate type information.

2. Validate if the rate type information has the right data type.

3. If Correct then save the data to the repository.

4. Search additional fee records.

5. Select a record in modify mode

6. Edit the rate type information.

7. Validate if the rate type information has the right data type.

8. If Correct then save the data to the repository.

9. Search additional fee records.

10. Select a record in view/delete mode

11. View the selected additional fee.

12. Delete the selected additional fee from the repository.

Refer Process Flow DiagramFIG. 3.

2.2.4. Rate DifferentialThe flow of the process is as described below.

1. Input the rate type information.

2. Validate if the rate type information has the right data type.

3. If Correct then save the data to the repository.

4. Search rate differential records.

5. Select a record in modify mode

6. Edit the rate type information.

7. Validate if the rate type information has the right data type.

8. If Correct then save the data to the repository.

9. Search rate differential records.

10. Select a record in view/delete mode

11. View the selected rate differential.

12. Delete the selected rate differential from the repository.

Refer Process Flow DiagramFIG. 4.

2.2.5. Process Flow Diagrams

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface ID: Rate Classification—Admin Fees

3.1.2.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

#Element NameAction/Validation DetailsMessage1.Rate TypeRate Type should be selected for“Rate Type - Is required”Adding Admin Fees(Either one ofBlended Rate or Non BlendedRate) and (Either one of Enroll orRenew).2.Group TypeShould list all the Group Type“Group Type - Is required”within the systemThe first option should be- Choose One -. SubsequentGroup Types should be listed inalphabetical order3.Association IdShould list all the Association Id“Association Id - Is required”within the system .The first optionshould be- Choose One -. SubsequentGroup Types should be listed inalphabetical4.Member TypeMember Type should be selected“Member Type - Is required.for Adding Admin Fees if GroupSelect either Individual MemberType is Guaranteed Association.or Association Group”5.Percentage PremiumPercentage Premium should be“Percentage Premium - Isentered if the rate type is BlendedRequired”“Percentage Premium - Acceptsnumeric value only (0 to 100)”6.Effective DateEffective Date should be selected“Effective Date - Is required ”from Calendar or entered“Effective Date - Accepts theFor valid Date Formatformat in MM/DD/YYYY”Refer BPI CAS FSD Common7.AmountAmount should be entered if the“Amount - Is required”rate type is Non Blended“Amount - Accepts currencyformat only (# # #. # #)8.MedicalMedical should be entered if the“Medical - Is required”rate type is Non Blended“Medical - Accepts currencyformat only (# # #. # #)9.DentalMedical should be entered if the“Dental - Is required”rate type is Non Blended“Dental - Accepts currencyformat only (# # #. # #)10.VisionMedical should be entered if the“Vision - Is required”rate type is Non Blended“Vision - Accepts numeric valueonly (0 to 100)”11.CAMMedical should be entered if the“CAM - Is required”rate type is Non Blended“CAM - Accepts numeric valueonly (0 to 100)”12.SaveShould function with Enter KeyFor general script validations forCursor Positioned on the “SAVE”common functionality referbutton or on Mouse Click.BPI_CAS_FSD_COMMONOn saving the data the data getsSystem Error:saved to the database.Common Text shall be followedShould there be any validationfor the System Error.error on any of the fields. Shouldshow the script error and place thecursor on the specific entry field.Check if the entries are notduplicate.On Successful saving the flow“! Do any operation to save.”should reside in the same screen.(Displayed when invokedException: If the data selected forimmediately after the screen isedition is from the repository retainloaded).its previous state. I.e. the datashould be visible in the table aftersaving.Also show different text color for“! Complete the update process.”the data added (temporary) and(Displayed when Save is invokedthe data picked from thein Edit Mode).repository.13.CancelShould reset to the previous stateon clicking the cancel button

3.1.3. User Interface ID: Rate Classification—Search Admin Fees

3.1.3.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

#Element NameAction/Validation DetailsMessage1Effective DateEffective Date should be selected“Effective Date -from Calendar or enteredAccepts theFor valid Date Formatformat inRefer BPI_CAS_FSD_CommonMM/DD/YYYY2SearchShould function with Enter KeyOn click of SearchCursor Positioned on the “Search”button checks forbutton or Mouse Click.the aboveAll the entries are valid. It fetchesmentionedthe records from repository basedvalidationson inputs and displays the recordsin the table below. Else throwserror dialog box.3TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. I.e. first row shouldhave color ‘x’ and the next rowshould have color ‘y’. The next rowshould have color ‘x’ again and soon. The size of the text inside anycell should be wrapped if the textbecomes too long.4View/DeleteShould function with Enter Key“! Select anyCursor Positioned on the “View/one ofDelete” button or on Mouse Click.the record”If the user clicks on the viewbutton without checking any of theview radio button should throwerror message.Success: View the current rowfrom the table.5ModifyShould function with Enter KeyCursor Positioned on the “Modify”button or on Mouse Click.On clicking the modify button therow is edited and the data shouldbe populated.5CancelShould reset to the previous stateon clicking the cancel button

3.1.4. User Interface ID: Rate Classification—View Admin Fees

3.1.4.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

#Element NameAction/Validation DetailsMessage1DeleteShould function with Enter Key“Do you want toCursor Positioned on the “Delete”delete the selectedbutton or on Mouse Click.record?”If the user clicks on the deletebutton throw message box.Success: Deletes the row from thedata base2New AdminShould go to the admin feesFeesscreen clicking the New AdminFees button

3.1.5. User Interface ID: Rate Classification—Agent Commission

ElementElementNameTypeLabelPurposeMainTextMain HeaderTo give heading for theHeader rateratescreen being navigatedClassificationClassificationfor Agentfor AgentFeesFeesRate TypeRadioRate TypeTo Select a rate type(Whether Blended orNon Blended)Rate TypeRadioRate TypeTo Select a rate type(Whether Enroll orRenew)EnrolledCheck BoxEnrolledTo be checked if enrolledbefore 1997before 1997before 1997.Group TypeDrop DownGroup TypeList all the Group TypeListAvailable in the systemAssociationDrop DownAssociationList all the AssociationIDListIDType Available in thesystemMemberRadioMemberTo Select a Member typeTypeType(Whether Individual orAssociation)PercentageEntry FieldPercentageEntry field for enteringPremiumPremium% premiumEffectiveEntry FieldEffectiveTo choose the date requiredDateDateby calendar or enteringGroup SizeEntry FieldGroup SizeEntry field for enteringLower LimitLower LimitGroup size Lower limit.Group SizeEntry FieldGroup SizeEntry field for enteringUpper LimitUpper LimitGroup size Upper limit.AmountEntry FieldAmountEntry field for enteringAmount in $MedicalEntry FieldMedicalEntry field for enteringthe Medical Fee in $DentalEntry FieldDentalEntry field for enteringthe Dental Fee in $VisionEntryField VisionEntry field for enteringthe Vision Fee in %CAMEntry FieldCAMEntry field for enteringthe CAM Fee in %SaveButtonSaveSave all the above(HTMLinformation to theButton)repositoryCancelButtonCancelTo reset the entries made(HTMLin all the fieldsButton)

3.1.5.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

•Element NameAction/Validation DetailsMessage1.Rate TypeRate Type should be selected for“Rate Type - Is Required”Adding Agent Fees (Either one ofBlended or Non Blended Rate andEither one of Enroll or Renew)2.Enrolled before 1997Should be selected if enrolledbefore 1997.3.Group TypeShould list all the Group Type“Group Type - Is required”within the systemThe first option should be- Choose One -.SubsequentGroup Types should be listed inalphabetical order4.Association IdShould list all the Association Id“Association Id - Is required”within the system. The first optionshould be- Choose One -. SubsequentGroup Types should be listed inalphabetical5.Member TypeMember Type should be selected“Member Type - Is required. Selectfor Adding Agent Fees if GroupIndividual Member or AssociationType is Guaranteed Association.Group.”6.Percentage PremiumPercentage Premium should be“Percentage Premium” - Is requiredentered if the rate type is Blended“Percentage Premium in - Acceptsnumeric values only (0 to 100)”7.Effective DateEffective Date should be selected“Effective Date - Is required”from Calendar or entered“Effective Date - Accepts theFor valid Date Formatformat in MM/DD/YYYY ”Refer BPI_CAS_FSD_Common8.Group Size Lower LimitGroup Size Lower Limit should be“Group Size Lower Limit - Is required”entered if the rate type is Non“Group Size Lower limit - AcceptsBlendednumeric values only (1-999)”9.Group Size Upper LimitGroup Size Upper Limit should be“Group Size Upper Limit - Is required”entered if the rate type is Non“Group Size Upper Limit - AcceptsBlendednumeric values only (1-999)”“Kindly enter Group Size Upper limitgreater than Lower Limit”10.AmountAmount should be entered if the“Amount - Is required”rate type is Non Blended“Amount - Accepts currency format only(# # #. # #)11.MedicalMedical should be entered if theMedical - Is required”rate type is Non Blended“Medical - Accepts currency format only(# # #. # #)12.DentalMedical should be entered if the“Dental - Is required”rate type is Non Blended“Dental - Accepts currency format only(# # #. # #)13.VisionMedical should be entered if the“Vision - Is required”rate type is Non Blended“Vision - Accepts numeric value only(0 to 100)”14.CAMMedical should be entered if the“CAM - Is required”rate type is Non Blended“CAM - Accepts numeric value only(0 to 100)”15.SaveShould function with Enter KeyFor general script validations forCursor Positioned on the “SAVE”common functionality referbutton or on Mouse Click.BPI_CAS_FSD_COMMONOn saving the data the data getsSystem Error: Common Text shall besaved to the database.followed for the System Error.Should there be any validation“! Do any operation to save.”error on any of the fields. Should(Displayed when invoked immediatelyshow the script error and place theafter the screen is loaded).cursor on the specific entry field.Check if the entries are notduplicate.On Successful saving the flowshould reside in the same screen.Exception: If the data selected foredition is from the repository retainits previous state. I.e. the datashould be visible in the table aftersaving.16.CancelShould reset to the previous stateon clicking the cancel button

3.1.6. User Interface ID: Rate Classification—Search Agent Commission

ElementElementNameTypeLabelPurposeMainTextMain HeaderTo give heading for theHeader rateratescreen being navigatedClassificationClassificationfor Agentfor AgentFeesFeesRate TypeRadioRate TypeTo Select a rate type(Whether Blended orNon Blended)Enroll/RadioEnroll/To Select a rate typeRenewRenew(Whether Enroll orRenew)Group TypeDrop DownGroup TypeList all the GroupListType Available in thesystemAssociationDrop DownAssociationList all the AssociationIDListIDType Available in thesystemEffectiveEntry FieldEffectiveTo choose the dateDateDaterequired by calendaror enteringGroup SizeEntry FieldGroup SizeEntry field for enteringLower LimitLower LimitGroup size Lower limit.Group SizeEntry FieldGroup SizeEntry field for enteringUpper LimitUpper LimitGroup size Upper limit.SearchHTML ButtonSearchButton to search thedata based on inputsand displays the resultsin HTML table belowTableHTML tableTableShows the all the datain the column formatView/Button (HTMLView/Button to view theDeleteButton)Deleteselected record dataCheckRadio ButtonCheck IndexTo check the items forIndexmodify, view anddeletionModifyButton (HTMLModifyTo edit the data againstButton)the row selected foreditionCancelButton (HTMLCancelTo reset the entries madeButton)in all the fields

3.1.6.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

•Element NameAction/Validation DetailsMessage1Effective DateEffective Date should be selected“Effective Date -from Calendar or enteredAccepts theFor valid Date Formatformat inRefer BPI_CAS_FSD_CommonMM/DD/YYYY ”2Group SizeGroup Size Lower Limit should be“Group SizeLower Limitentered if the rate type is NonLower limit -BlendedAcceptsnumericvalues only(1-999)”3Group SizeGroup Size Upper Limit should be“Group SizeUpper Limitentered if the rate type is NonUpper Limit -BlendedAcceptsnumeric valuesonly (1-999)”“Kindly enterGroup SizeUpper limitgreater thanLower Limit”4SearchShould function with Enter KeyOn click ofCursor Positioned on the “Search”Search buttonbutton or Mouse Click.checks for theAll the entries are valid. It fetchesabove mentionedthe records from repository basedvalidationson inputs and displays the recordsin the table below. Else throwserror dialog box.5TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. I.e. first row shouldhave color ‘x’ and the next rowshould have color ‘y’. The next rowshould have color ‘x’ again and soon. The size of the text inside anycell should be wrapped if the textbecomes too long.6View/DeleteShould function with Enter Key“! Select anyCursor Positioned on the “View/one ofDelete” button or on Mouse Click.the record”If the user clicks on the viewbutton without checking any of theview radio button should throwerror message.Success: View the current rowfrom the table.7ModifyShould function with Enter Key“! Select anyCursor Positioned on the “Modify”one ofbutton or on Mouse Click.the record”On clicking the modify button therow is edited and the data shouldbe populated.8CancelShould reset to the previous stateon clicking the cancel button

3.1.7. User Interface ID: Rate Classification—View Agent Commission

3.1.7.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

•Element NameAction/Validation DetailsMessage1DeleteShould function with Enter Key“Do you want toCursor Positioned on the “Delete”delete the selectedbutton or on Mouse Click.record?”If the user clicks on the deletebutton throw message box.Success: Deletes the row from thedata base2New AgentShould go to the agent fees screenFeesclicking the New Agent Feesbutton

3.1.8. User Interface ID: Rate Classification—Additional Fees

3.1.8.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

•Element NameAction/Validation DetailsMessage1.Cobra TypeCobra Type should be selected for“Kindly chooseAdding Additional FeesCobra”2.Additional FeeAdditional Fee Percentage should“% Of AdditionalPercentagebe entered.Fees—Is required”“% of AdditionalFees—Acceptsnumeric valueonly (0 to 100)3.Effective DateEffective Date should be selected“Effective Date—Isfrom Calendar or enteredrequired”For valid Date Format“Effective Date -—Refer BPI_CAS_FSD_CommonAccepts the formatin MM/DD/YYYY”4.SaveShould function with Enter KeyFor general scriptCursor Positioned on the “SAVE”validations forbutton or on Mouse Click.commonOn saving the data the data getsfunctionality refersaved to the database.BPI_CAS_FSD_Should there be any validationCOMMONerror on any of the fields. ShouldSystem Error:show the script error and placeCommon Text shallthe cursor on the specific entrybe followed for thefield.System Error.Check if the entries are not“! Do any operationduplicate.to save.”On Successful saving the flow(Displayed whenshould reside in the same screen.invoked immediatelyException: If the data selected forafteredition is from the repositorythe screen isretain its previous state.loaded).I.e. the data should be visiblein the table after saving.5.CancelShould reset to the previous stateon clicking the cancel button

3.1.9. User Interface ID: Rate Classification—Search Additional Fees

3.1.9.1. Screen Name: Rate Classification—Search Additional Fees

ElementElementNameTypeLabelPurposeMainTextMain HeaderTo give heading for theHeader rateratescreen being navigatedClassificationClassificationforforAdditionalAdditionalFeesFeesCobra TypeRadioCobra TypeTo Select a Cobra Type(Whether Cal Cobra orFederal Cobra)AdditionalEntry FieldAdditionalEntry field for entering %FeeFeeAdditional FeesPercentagePercentageEffectiveEntry FieldEffectiveTo choose the date required byDateDatecalendar or enteringSearchHTMLSearchButton to search the data basedButtonon inputs and displays theresults in HTML table belowTableHTML tableTableShows the all the data in thecolumn formatView/ButtonView/Button to view the selectedDelete(HTMLDeleterecord dataButton)CheckRadioCheck IndexTo check the items for modify,IndexButtonview and deletionModifyButtonModifyTo edit the data against the row(HTMLselected for editionButton)CancelButtonCancelTo reset the entries made in(HTMLall the fieldsButton)

3.1.9.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

•Element NameAction/Validation DetailsMessage1Additional FeeAdditional Fee Percentage should“% of AdditionalPercentagebe entered.Fees—Acceptsnumeric valueonly (0 to 100)2Effective DateEffective Date should be selected“Effective Date -—from Calendar or enteredAccepts the formatFor valid Date Formatin MM/DD/YYYY”Refer BPI_CAS_FSD_Common3SearchShould function with Enter KeyOn click of SearchCursor Positioned on the “Search”button checks forbutton or Mouse Click.the aboveAll the entries are valid. Itmentionedfetches the records fromvalidationsrepository based on inputsand displays the recordsin the table below. Elsethrows error dialog box.4TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. I.e. first row shouldhave color ‘x’ and the next rowshould have color ‘y’. The next rowshould have color ‘x’ again and soon. The size of the text inside anycell should be wrapped if the textbecomes too long.5View/DeleteShould function with Enter Key“! Select any oneCursor Positioned on the “View/of the record”Delete” button or on Mouse Click.If the user clicks on the viewbutton without checking any of theview radio button should throwerror message.Success: View the current rowfrom the table.6ModifyShould function with Enter Key“! Select any oneCursor Positioned on the “Modify”of the record”button or on Mouse Click.On clicking the modify button therow is edited and the data shouldbe populated.7CancelShould reset to the previous stateon clicking the cancel button

3.1.10. User Interface ID: Rate Classification—View Additional Fees

3.1.10.1. Screen Name: Rate Classification—View Additional Fees

3.1.10.3. Front End Validations

•Element NameAction/Validation DetailsMessage1DeleteShould function with Enter Key“Do you want toCursor Positioned on the “Delete”delete the selectedbutton or on Mouse Click.record?”If the user clicks on the deletebutton throw message box.Success: Deletes the row from thedata base2New AdditionalShould go to the additional feesFeesscreen clicking the New additionalFees button

3.1.11. User Interface ID: Rate Classification—Differential Fees

3.1.11.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

3.1.12. User Interface ID: Rate Classification—Search Differential Fees

ElementElementNameTypeLabelPurposeMainTextMain HeaderTo give heading for theHeader rateratescreen being navigatedClassificationClassificationforforDifferentialDifferentialFactorFactorGroup SizeEntry FieldGroup SizeEntry field for enteringLower LimitLower LimitGroup size Lower limit.Group SizeEntry FieldGroup SizeEntry field for enteringUpper LimitUpper LimitGroup size Upper limit.DifferentialEntry FieldDifferentialEntry field for enteringFactorFactorDifferential FactorEffectiveEntry FieldEffectiveTo choose the date requiredDateDateby calendar or enteringApplicableRadioApplicableTo Select a Applicable ForForFor(Whether New BusinessOnly or New Business orRenewal)Group SizeRadioGroup SizeTo Select a Group SizeCriteriaCriteriaCriteria (Whether EligibleEmployee or EnrolledEmployee)SearchHTMLSearchButton to search the dataButtonbased on inputs anddisplays the results inHTML table belowTableHTML tableTableShows the all the data inthe column formatView/ButtonView/Button to view the selectedDelete(HTMLDeleterecord dataButton)CheckRadio ButtonCheck IndexTo check the items forIndexmodify, view and deletionModifyButton (HTMLModifyTo edit the data against theButton)row selected for editionCancelButtonCancelTo reset the entries made in(HTMLall the fieldsButton)

3.1.12.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

Element•NameAction/Validation DetailsMessage1Group SizeGroup Size Lower Limit should“Group SizeLoweraccept numeric.Lower limit—LimitAcceptsnumeric valuesonly (1-999)”2Group SizeGroup Size Upper Limit should“Group SizeUpperaccept numeric.Upper Limit—LimitAcceptsnumeric valuesonly (1 -999)”“Kindly enterGroup SizeUpper limitgreater thanLower Limit”3DifferentialDifferential Factor should accept“DifferentialFactornumeric..Factor—Acceptsnumeric valuesonly.”4EffectiveEffective Date should be“EffectiveDateselected from Calendar orDate -—Acceptsentered For valid Date Formatthe format inRefer BPI_CAS_FSD_CommonMM/DD/YYYY”5SearchShould function with Enter KeyOn click ofCursor Positioned on theSearch button“Search” button or Mouse Click.checks for theAll the entries are valid. Itabove mentionedfetches the records fromvalidationsrepository based on inputsand displays the recordsin the table below. Else throwserror dialog box.6TableShould have column header andeach subsequent row should beidentified by alternate colorcombinations. I.e. first rowshould have color ‘x’ andthe next row should havecolor ‘y’. The next row shouldhave color ‘x’ again and so on.The size of the textinside any cell should bewrapped if the text becomes toolong.7View/Should function with Enter Key“! Select any oneDeleteCursor Positioned on the “View/of the record”Delete” button or on MouseClick. If the user clicks onthe view button withoutchecking any of the viewradio button should throwerror message.Success: View the current rowfrom the table.8ModifyShould function with Enter Key“! Select any oneCursor Positioned on theof the record”“Modify” button or onMouse Click.On clicking the modify buttonthe row is edited and thedata should be populated.9CancelShould reset to the previousstate on clicking the cancelbutton

3.1.13. User Interface ID: Rate Classification—View Differential Fees

3.1.13.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the associated message—Success/Error Message text

•Element NameAction/Validation DetailsMessage1DeleteShould function with Enter Key“Do you want toCursor Positioned on the “Delete”delete the selectedbutton or on Mouse Click.record?”If the user clicks on the deletebutton throw message box.Success: Deletes the row from thedata base2NewShould go to the agent fees screenDifferentialclicking the New Differential FeesFeesbutton

3.1.14. Screen Flow

Benefit Partners Inc

Process Specification

This purpose of this document is to identify the process associated with the business use case Create ZIP. This document is the amendment of BPI_CAS_FSD_CM—04 (Version 1.0).

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_CM_004Create ZIP

2. Process Identification

This process describes the Use Case “Create ZIP”. Standard ZIP is loaded into the system. Refer the document reference no. BPI_CAS_FSC_EC for process of loading ZIP Code. Also for the specific ZIP Codes the corresponding service areas are loaded. The state is divided into several service areas based on the number of counties and their population. In the state of California there are presently 6 service areas. The Rate is based on the service area where the employees are residing.

2.2. Process Description & Flow

2.2.1. Zip Code Search

The Screen described below has two features provided:

Zip code search feature is by which the user can search for zip based on any of the selection criteria. Search for zip is based on City name, County name or a Valid Zip code. When user enters the search value, search results are displayed on a table format.

There is also provision for canceling the search value. Numbers of records fetched are also displayed on the screen.

There is also a feature to print the records fetched. A separate page is invoked on clicking the printer icon. The print page has the fetched records with print button. Clicking on which will invoke the printer dialog.

User can view records in Normal as well as Expanded mode. Expanded mode can be invoked by clicking the gif in the table header.

2.2.2. Zip Distance

Zip Distance feature is by which user can get the distance of the zip codes entered. Zip distance is calculated based on the geographical distribution of the area by its latitudinal & longitudinal position. The result is displayed in miles.

The user interface for Zip is provided below. The two screenshots is the same screen shown to describe these two features.

2.2.3. Process Flow Diagrams

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface ID: Zip Search

3.1.2.3. Front End Validations

Validation Details

This section provides the front-end screen validations along with the

#Element NameAction/Validation DetailsMessage1.CityMax length of the searchfield is set.2.CountyMax length of the searchfield is set.3.ZipMax length of the searchfield is set.4.SearchOn click of the button,“Search Value - Isrecords are fetched fromrequired.”repository based on“City - Acceptsselection criteria.alphabetic charactersonly.”“County - Acceptsalphabetic charactersonly.”“ZIP - Accepts exactly5 digit numbers only.”5.CancelOn click of this button,entry field is cleared.6.GoOn click of the button,“Zip1 - Is required.”distance between the two“Zip2 - Is required.”zip codes is displayed.“ZIP - Accepts exactly5 digit numbers only.”7.CancelOn click of this button,entry field is cleared.

3.2. Screen Flow

This section describes the screen flow for the group enrollment process. (See FIG. H-36)

Benefit Partners Inc

Process Specification

Cobra Enrollment

The purpose of this document is to describe the process of COBRA Enrollment. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2 Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_ENEnrollmentBPI_SCOPE_EN_002COBRA EnrollmentBPI_SCOPE_EN_001Group Enrollment

1.3 Document Reference

2 Process Identification

California State laws and federal laws govern COBRA Rules based on whether it is Cal COBRA or Federal COBRA.

The decision whether the Group is a CAL COBRA or FEDERAL COBRA would be based on the Group size or the number of employee in the group. If the number of the employee were greater than or equal to 20 then it would be FEDERAL COBRA. If the group size were less than 20 employees then it would be Cal COBRA. This needs to be entered at the time of group enrollment. Based on applications received for group.

2.2 Process Description

The objective of the COBRA Enrollment is to:New Business COBRA EnrollmentExisting member converting to COBRA because of the qualifying rules.Add on for COBRA membersChanges to COBRA membersRequalification and Open enrollment and Open enrollment for the COBRA members.

2.3 Process Flow

Process for COBRA is based on the type of COBRA enrollmentNew Business COBRA EnrollmentExisting members converting into COBRA after termination

Process Flow for New Business COBRA Enrollment

1) Search for the group and select the SEG Group or Alternate Group with whom the COBRA members are to be added.

2) Specify if the Member is enrolling as COBRA member as an individual or with dependent

3) If the member is enrolling with dependent then specify the number of dependent

4) Enter member general information, which includes the personal information and address information.

5) Add the dependant/dependents if the option selected is with dependent and enter the dependent/dependents information.

6) Enter COBRA information for the member and dependents as applicable.

7) Select the Line of coverage options for the member and dependent as applicable.

8) List COBRA member summary and select the Benefit Level (Carrier Selection) based on the ZIP code and Service area provided.

9) Show missing information for the COBRA enrollment.

Process Flow for New Business COBRA (See FIG. I-1)

Process Flow for Existing Member COBRA Enrollment

1) Search for the group and employee who need to be converted into the COBRA members.

2) Check the term status and reasons for the Employee/dependent.

3) Process COBRA Eligibility checks. This checks the eligibility of the Employee if termed and the reasons for the term, which form the basic for the qualifying event. Of if the employee is not termed and the dependent/dependents are termed their reasons for terms and qualifying event. If none qualify then COBRA enrollment is declined based on ACL. If either qualifies then the COBRA enrollment information is shown with option to select line of coverage for the termed members.

4) Identify the primary member based on the criteria.

Employee is also termed and opts for COBRA then the employee becomes the primary member.

If spouse is termed with children and spouse opts for COBRA coverage then spouse becomes the primary member

If Children/child is termed and opts for COBRA coverage the oldest child becomes the primary member.

5) Check if the Plan is available in the Primary members ZIP/Service area.If so then the member should select the same plan as was before. If not, pend and send quote for plans available and then allow the member to select the plan that is available in the new ZIP service area.

6) Dependents should have the same plan as well. However they can waive any plan. (Refer the business rules for COBRA)

7) Show Summary and missing information.

Process Flow for Existing COBRA Conversion (See FIG. I-2)

3 User Interface

3.1 User Interface Screens

3.1.2.4 Help Menu

New Business enrollment can bring in the members as COBRA. This screen is used for adding the COBRA members to the new business groups based on the selection of the group.

3.1.3.4 Help Menu

This screen is used for filling up the primary COBRA member information. The information contained here is the personal information and the address information. The ZIP and the service are provided here governs the rate calculation for the COBRA member.

ElementElementNameTypeLabelPurposeSalutationTextSalutationTo provide textSalutationListSalutationList type of salutationDependentTextDependentTo provide textFirstFirst namenameFirstEntry FieldFirst NameEnter the first nameNameDependentTextDependentTo provide textLastLast namenameLastEntry fieldLast nameEnter the last namenameMITextMITo provide textMIEntry FieldMIEnter the middle initialSuffixTextSuffixTo provide textSuffixEntry FieldSuffixEnter the suffixDependentTextDependentTo provide textSocialSocialSecuritySecurityNumberNumberSSNTextSSNTo provide textSSNEntry fieldSSNEnter the SSN numberUniqueTextUnique IDTo provide textIDUniqueEntryUnique IDShow the unique IDIDfield (Ungeneratededitable).GenderTextGenderTo provide textGenderListGenderList the genderRelationshipTextRelationshipTo provide textRelationshipListRelationshipList all types of relationshiplike spouse, domesticpartner, child, step childothersBirthTextBirth DateTo provide textDateBirthCalendarBirth DateCalendar to choose the birthDatedateAddHTMLAddTo add the above dependentDependentSubmitDependentInformation to the html tableButtonbelowTableHTMLTableTable for adding up theTabledependent informationDeleteButtonDeleteTo delete the items checked(HTMLfor deletionButton)CheckText LinkCheck AllTo check all the check boxesAllin the tableClear AllText LinkClear AllTo un check all the checkboxes checked in the tableDeleteCheck boxDeleteTo check the items fordeletionEditButtonEditTo edit the items against the(HTMLrow selected for editionButton)DisabledTextDisabledTo provide textDisabledRadioDisabledTemporary or permanentRadioButtonRadio Buttondisability (Can be only one orButtonthe other) Default NONE.DomesticTextDomesticTo provide textPartnerPartnerDomesticCheck boxDomesticIs Form available if so check.PartnerPartnerLegalTextLegalTo provide textGuardianGuardianLegalCheck boxLegalIs Form available if so check.GuardianGuardianSignatureTextSignatureTo provide textSignatureCheck boxSignatureIs signature available if checkContinueHTMLContinueOn clicking the continueButtonbutton save the informationCancelHTMLCancelTo reset to the state as wasreset Buttonbefore loading the page

3.1.4.4 Help Menu

This screen is used for filling up the dependent COBRA member information. The information contained here is the personal information. If there are multiple dependent then you can add the dependent COBRA members here.

Element NameAction/Validation DetailsMessageDateDefaults to system date. UserError Dialog Box:can either enter the date of pick“Date cannot bethe date form the calendarfuture date” Pleaseenter past date”COBRADefaults to 18 months. Can beNoneeffectivechanged by the user.periodReasons forList the qualifying reasons forNoneelectingCOBRA.COBRAWhere wouldOption to bill either the group ofNoneyou like thethe COBRA member based onbills to be sentthe flag checkedIs memberCheck if the member signature isNonesignatureverifiedverifiedLine ofTable to show the Line ofNoneCoveragecoverage against each memberSelection Tablefor picking the option. The Line ofcoverage displayed is based onthe line of coverage selected bythe primary group.Note: The table would display theMember name in the followingpriority.Employee as primary memberSpouse as the next memberOther members would be listedbased on the age.CoverageCheck Box to pick anyNoneSelectioncombination of coverage's for allthe member for this specificCOBRA groupShow CoverageOn click of the Coverage choiceNoneChoicesystem should identify thecoverage choice based on theoptions checked. Whethermember only, member andspouse etc.ContinueOn clicking the continue buttonDialog Box:saves the data and leads to the“Are you surepageto continue”BPI_CAS_SCR_EN_002_005

3.1.5.4 Help Menu

This screen is used for filling up the COBRA qualifying events and the COBRA tenure for the members. Also there is an option to select the line of coverage opted for the various members.

ElementNameElement TypeLabelPurposeMemberTextMemberTo provide textMissingMissingInformationInformationEmployeeExpandableEmployeeShould be able to expand theTabTreeTabEmployee Tab to list theDetails for the EmployeeMissing and information andAlso show an expandable tabfor the Dependent MissingInformationEnrollmentDropEnrollmentList the status of enrollment.StatusDown ListStatusCan be Enroll or DeclineRemarksEntry FieldRemarksRemark for the status ofenrollmentReasonsDropReasons forList the reasons for declineforDown ListDeclineDeclineOtherEntry FieldOtherAny other reasons for declineReasonsReasonsor othersCancelHTMLCancelTo reset the operationButtonProcessHTMLProcessProcess the enrollment andEnrollmentButtonEnrollmentleads to the enrollmentconfirmation page.BPI_CAS_SCR_EN_001_011

Element NameAction/Validation DetailsMessageEnrollmentList the status of enrollment.The ErrorStatusdefault option should beDialog Box:- choose one -“Please chooseIf the option selected is Decline.enrollment statusShould list the list box containingbefore continuing.”reasons for the decline.If none is selected throw errormessage.RemarksCan accept any character.Reasons forList the reasons for the decline.Error Dialog Box:DeclineThe default option should be“Please choose- choose one -reasons for decliningIf none is selected throw errorbefore continuing.”message.Other ReasonsCan accept any character.NoneCancelResets to the status as was onNoneloading this page.ProcessShould function with Enter KeyError Dialog Box:EnrollmentCursor Positioned on the“Please choose“Process Enrollment” button or onenrollment statusMouse Click.before continuing.”On success leads to the“Please chooseconfirmation page.reasons for decliningBPI_CAS_SCR_EN_001_011before continuing.”It checks the eligibility rule for theCOBRA member once again.Process the post enrollmentactivity like sending emails,welcome letter. First monthinvoices and email alert to GMS,Sales and finance.

3.1.7 User Interface Id: BPI_SCR_EN—002—007—Existing COBRA Employee Search

ElementNameElement TypeLabelPurposeGroupTextGroup IDTo provide textIDGroup IdEntry fieldGroup IdEnter the group id forsearching the employeeEmployeeTextEmployee IDTo provide textIDEmployeeEntry fieldEmployee IDEnter the Employee ID forIDsearching the employeeEmployeeTextEmployeeTo provide textSSNSSNEmployeeEntry fieldEmployeeEnter the Employee SNN forSSNSSNsearching the employeePhoneTextPhoneTo provide textnumbernumberPhoneEntry fieldPhoneEnter the Employee Phonenumbernumbernumber for searching theemployeeListHTML TreeListTree to List the EmployeeEmployeeEmployeeand their dependentEmployeeHTML TableEmployeeTable to list employeeTableTableinformation and statusDependentHTML tableDependentTable to list dependentTableTableinformation and statusProcessHTML buttonProcessButton to check the COBRACOBRACOBRAeligibility and take to the nextpageBPI_CAS_SCR_EN_002_008if eligible. If not the showthe same page.

ElementNameAction/Validation DetailsMessageGroup IdEnter the Group ID or pick theGroup ID can be enteredgroup ID based on the Groupalong with any other validsearchfields for the employeeprovided below.EmployeeEnter the employee Id or pick theNote: At least on of theIDemployee based on thefield with the searchemployee search window.criteria for the employeemust be enteredEmployeeEnter the employee SSN or pickNote: At least on of theSSNthe employee based on thefield with the searchemployee search window.criteria for the employeemust be enteredPhoneEnter the employee Phone orNote: At least on of thenumberpick the employee based on thefield with the searchemployee search window.criteria for the employeemust be enteredListTree to open up if dependentNoneEmployeeexist for the employeeEmployeeList the employee with status andNoneTableeffective dateDependentList the dependent with statusNoneTableand effective dateProcessCheck the status and termEmbedded error if non-ofCOBRAreasons and process thethe member is termedeligibility check for the existingor not qualifies formember to COBRACOBRA.Note: It should check thefollowing status. Term Status,Term reasonsOnly the member termed alleligible for the COBRA. Thereasons for term can eitherdecline COBRA enrollment ordefine the COBRA period.

ElementElementNameTypeLabelPurposeCOBRAPage subCOBRATo provide textqualifyingHeaderqualifyingEventEventInitialTextInitial COBRATo provide textCOBRAeffective dateeffectivedateDateEntryDateEnter the initialfieldeffective dateCOBRATextCOBRATo provide textEndEnd DateDatePeriodEntryPeriodEnter the COBRA effectivefieldperiod Default to the periodbased on the qualifyingevent.ReasonsTextReasons for TermTo provide textfor TermReasonsDynamicReasons for TermReasons for Term based onfor TermTextthe term reasons providedTermTextTerm DateTo provide textDateTermDynamicTerm DateDisplay the term date of theDatetextmemberWhereTextWhere wouldTo provide textwouldyou like theyou likebills to be sentthe billsto besentWhereCheckWhere wouldCheck if the bill is to be sentwouldBoxyou like the billsto the group or the memberyou liketo be sentthe billsto besentIsTextIs memberTo provide textmembersignaturesignatureverifiedverifiedIsCheckIs memberCheck if signature is verifiedmemberboxsignaturesignatureverifiedverifiedLine ofHTMLLine of CoverageTable to display the MemberCoverageTableSelection Tablenames and the Line ofcoverage check boxes forSelectionpicking the line of coverageTablefor each COBRA membersCheck ifCheckCheck if memberCheck if the member is notmemberboxis not enrollingenrolling for COBRAis notfor COBRAenrollingforCOBRACoverageCheckCoverageCheck box to select the lineSelectionBoxSelectionof coverageShowHTMLShow CoverageButton to show the coverageCoveragebuttonChoicechoice for each line ofChoicecoverage based on the checkbox/boxes checked.ContinueHTMLContinueButton to save the data andButtonlead to the next screen forshowing the summary andselection of Benefit leveloffered by carriers (ScreenBPI_CAS_SCR_EN_002_009)

Element NameAction/Validation DetailsMessageDateDefault to the date next to theError Dialogterm date. Allow for makingBox:changes based on authorization“Date cannot beprior to the termdate. Please enterthe valid date”PeriodDefault to the period based onnonethe Qualifying events. Allow tochange based on authorizationWhere would youCheck the option for billing,nonelike the bills to beWhether to the group or thesentmemberIs memberCheck if signature is verifiednonesignature verifiedLine of CoverageTable to show the Line ofNoneSelection Tablecoverage against each memberfor picking the option. The Line ofcoverage displayed is based onthe line of coverage selected bythe primary group.Note: The table would display theMember name in the followingpriority.Employee as primary memberSpouse as the next memberOther members would be listedbased on the age.Check if memberThis is check if the member is notNoneis not enrolling foropting for the COBRACOBRACoverageCheck Box to pick anyNoneSelectioncombination of coverage's for allthe member for this specificCOBRA groupShow CoverageOn click of the Coverage choiceNoneChoicesystem should identify thecoverage choice based on theoptions checked. Whethermember only, member andspouse etc.ContinueOn clicking the continue buttonDialog Box:saves the data and leads to the“Are you surepageto continue”BPI_CAS_SCR_EN_002_009

3.1.9 User Interface Id: BPI_SCR_EN—002—009—Primary Member Information

Note: This screen is pre filled with the employee information available in the employee master for all the members and the dependents belonging to this employee. Changes can be made to the information as applicable.

3.1.10 User Interface Id: BPI_SCR_EN—002—010—Existing Coverage Information

ElementElementNameTypeLabelPurposeBenefitHTMLBenefit LevelTable to display all theLevelTable(carrierMembers in the row and The(carrierSelection)Benefit level selection optionSelection)in the Columns.MemberLinkMemberProvide feature to edit thenamenamemember information byclicking this linkCoverageHTMLCoverageThe row get pre populatedChoiceROWChoicebased on the choice made inthe screenBPI_CAS_SCR_EN_002_009BenefitLinkBenefit LevelLink to the carrier selectionLevelNamefor the specific line ofNamecoverage if not available inthe ZIP and service area ofthe Primary member.PCP infoLinkPCP infoLink to edit the PCP info of(Available)(Available)the individual members asapplicable.COBRAHTMLCOBRAButton to click for saving theSummaryButtonSummarydate and navigating to thenext page for displayingCOBRA summary/missinginformationCancelHTMLCancelButton to reset to the state asrest buttonwas on loading the page.

Element NameAction/Validation DetailsMessageBenefit LevelShould have column header andNone(carriereach subsequent row should beSelection)identified by alternate colorcombinations. I.e. First rowshould have color ‘x’ and the nextrow should have color ‘y’. Thenext row should have color ‘x’again and so on. The size of anytext inside any cell should bewrapped if the text becomes toolong.The Header and the Left Columnshould be distinguishable.MemberThis is a link to edit the memberNonenameinformation when on change oredit mode. ThisPCP InfoThis is a link to edit the PCPNoneinformation for the specificmember. If PCP information isnot available then on clicking thelink it allows to fill in the PCPinformation for the specific line ofcoverage.CoverageDisplays the dynamic text basedNoneChoiceon the choices checked in theprevious screenBPI_CAS_SCR_EN_002_004BenefitDefault benefit level would thatNoneLevelthe employee selected when theSelectionstatus was enrolled.On clicking the Link show aminimized window with option toselect the benefit level for thespecific line of coverage. Notethe line of coverage is displayedbased on the Group options. (i.eonly if the group has selected theline of coverage.Also the benefit level (carrier)displayed is based on the ZIPcode/Service area of theprimary COBRA member.Only if the prior Benefit level isnot available in the current ZIP/service are of the primarymember this is allowed to bechanged.COBRAOn clicking the COBRA SummaryDialog Box:Summarybutton save the content of this“Are you surepage into the repository andyou would likeleads to the COBRA summaryto continue”page to display the COBRAmissing information. ScreenBPI_CAS_SCR_EN_002_006This also does all the COBRAeligibility checks prior to thedisplay of summary page.CancelResets to the state as was onnoneloading the page.

Note: the rest of the flow is common for both new Business COBRA and the Existing member conversion to COBRA.

Screen BPI_CAS_SCR_EN—006 followed by COBRA enrollment.

Screen Flow Diagram for COBRA Enrollment (See FIG. I-12)

4 Business Rule Mapping

ActivityRulesNew BusinessNeed to know initial COBRA effective dateCOBRANeed to have system calculate COBRA end date(NB brings(18 mo, 36 mo, or other) based on Term Reasonin COBRA)(Qualifying events).For system to do this we need to have thefollowing data captured during the New BusinessCOBRA Enrollmenta) Initial Effective dateb) Qualifying eventsCOBRA coverageCOBRA coverage has no lapse of time from thedate of term & COBRA enrollmentException: DeathMain subscribers coverage is terminated date ofdeath and not the end of the month: qualifiedbeneficiaries (i.e. spouse/child) effective date ofCOBRA is the day after the members deathNote: Since the COBRA coverage has no lapse oftime it should be basically effective from the dayfollowing the term date what ever be the reasons.Normal terms are always done on the end of theMonth.Death is done on the day of the death.COBRA Election60 days to elect COBRA coverage from the timeof COBRA notification letter.60 days is based off the:Date that we are notified of the termination(Postmark date for termination)ORThe termination dateWHICHEVER IS LATER. The decision is to bemade based on manual review by GMS personnel.COBRA ElectionIf a FED COBRA group, we need to include anfor Federaladditional 14 days from termination notificationCOBRAdate because FED Employers have 14 days to no-tify their employees of their rights after whichthey notify the plan administrator/Pac Advan-tage). The decision is to be made based on man-ual review by GMS personnel.COBRA PremiumCOBRA members initial premium (all premiumsDuesfrom effective date to current) must be made/mailed/postmarked within 45 days from theCOBRA election date (the date the application ispostmarked)If payment is not MADE within this time frame,the COBRA coverage is termed flat (effectivedate). Any partial premium payments made willbe reimbursed.Provide over ride for 45th day rule (ACL)(This override needs to be available upon creatingthe COBRA)COBRA EmployeeIf main Employer group goes into possible termgoverned bystatus or is termed, the COBRA will need to beEmployer (Groups)notified and put in same status. Employee willhave the same coverage type, carrier & co-pay aswhen termed (continue with exact coverage asbefore)Cannot add dependents that were not previouslycovered (until o/e or qualifying event)Benefit LevelsBenefit level cannot change. Optional benefits andmedical offered by the group is not mandatory[Line of Coverage]PossibleSocial Security disability - coverage extended to aextension oftotal of 29 month (11 mo. Extension) (all otherCOBRA coverageterm reasons apply)The main subscriber does not have to elect toextend the coverage for himself, just hisdependents can elect to take the extensionAge 60 prior to loss of employment & worked forEmployer for 5 consecutive years - coverageextended until the Employee turns age 65 (all otherterm reasons apply)The main subscriber does not have to elect toextend the coverage for himself, just hisdependents can elect to take the extensionAlso there should be a facility to grant COBRAextension if applicable based on authority.QualifyingContinua-Qualifying EventsBeneficiariestion periodTERMINATION_OF_EMPLOY-Employee, Spouse18MENTand ChildrenREDUCTION_OF_WORK_HOURSEmployee, Spouse18and ChildrenCAN_ NO LONGER_AF-Employee, Spouse18FORD_COVERAGEand ChildrenOBTAINED_COVERAGE_ELSE-Employee, Spouse18WHEREand ChildrenDEATHSpouse and Children36ENTITLED_TO_MEDICAREEmployee, Spouse36and ChildrenFRAUD_OR_MISREPRESEN-Employee, Spouse36TATIONand ChildrenDPND OBTAINED_COVER-Employee, Spouse18AGE_ELSEWHEREand ChildrenDIVORCE_OR_LEGAL_SEP-Employee, Spouse36ARATIONand ChildrenEMPLOYEE_CANNOT_AF-Spouse36FORD_SPOUSE_COVERAGEDPND_DEATHNone18DPND_ENTITLED_TO_MED-Dependent Spouse36ICAREand ChildrenDPND_FRAUD_OR_MISREP-None36RESENTATIONOVER_AGE_23Dependent Child18NO_LONGER_AN_ELIGI-Dependent Spouse18BLE_DEPENDENTand ChildrenNO_LONGER_A_DISA-Dependent Child18BLED_CHILDEMPLOYEE_CAN_NO_LONG-Child18ER_AFFORD_CHILD_COVER-AGEOTHERSEmployee, Spouse36and ChildrenThere are other qualifying events, which are also considered while COBRA enrollment based on their Reason For Term.

5 User Role

The respective level of user role can over rule the following missing information.

User Role Level II, Level III, Level IV

S. No., Missing Information Condition

1 SSN already exists. Employee SSN already exists

2 SSN already exists. Dependent SSN already exists

Benefit Partners INC

Process Specification

Functional Design Process Specification

This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_ENEnrollmentBPI_SCOPE_EN_002Enrollment Add On

Other Document Reference

Document IDDocument nameBPI_CAS_FSD_ENFunctional Specification Document - EnrollmentBPI_CAS_FSD_EN_001Process Flow - New Business EnrollmentBPI_CAS_FSD_EN_003Process Flow - COBRA Enrollment/ChangesBPI_CAS_FSD_EN_005Process Flow - Termination/ReinstatementBPI_CAS_RULEBOXRULE BOX for Add on and change

2. Process Identification

Process Flow and Description

This process is used to make changes to the Existing groups/members or dependents or add a new member/dependent to the Group or employee based on the business rules associated with changes and “Add ON's”.

2.2. Process Description

The objective of the process

2.3. Process Flow

This process is used to make changes to the Existing groups/members or dependents or add a new member/dependent to the Group or employee based on the business rules associated with changes and “Add ON's”.

2.4. User Interface Screens

2.4.1.1.1.1 Screen Snap Shot

Refer 3.1.13.2 of BPI_CAS_FSD_EN—01 for the details.

2.4.1.1.2.1 Screen Snap Shot

2.4.1.1.3.1 Screen Snap Shot

Refer User Interface ID: BPI_CAS_SCR_EN—001—002—Group General of BPI_CAS_FSD_EN—01

Refer 3.1.3.2 of BPI_CAS_FSD_EN—01 for the details.

2.4.1.1.4.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—007—Employee Coverage of BPI_CAS_FSD_EN—01

Refer 3.1.8.2 of BPI_CAS_FSD_EN—01 for the details.

Refer 3.1.9.2 of BPI_CAS_FSD_EN—01 for the details

2.4.1.1.6.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—010—Missing Information of BPI_CAS_FSD_EN—01

2.4.1.1.7.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—009—Enrollment Summary of BPI_CAS_FSD_EN—01

2.4.1.1.8.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—011—Enrollment Confirmation of BPI_CAS_FSD_EN—01

2.4.1.1.11.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—013—Employee Search of BPI_CAS_FSD_EN—01

2.4.1.1.12.1 Screen Snap Shot

2.4.1.1.13.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—008—Dependent of BPI_CAS_FSD_EN—01

2.4.1.1.15.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—010—Missing Information of BPI_CAS_FSD_EN—01

2.4.1.1.16.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—011—Enrollment Confirmation of BPI_CAS_FSD_EN—01

2.4.1.1.17 Change Screen SID

2.4.1.1.17.1 Screen Snap ShotRefer to User Interface ID BPI_CAS_FSD_EN—01BPI_CAS_RULKEBOX

2.4.2. Screen Flow

Change: —Group Change New Request

Change: —Employee Change New Request

Change: —Dependent Change New Request

3. Business Rule Mapping

ActivityRulesEmployer Add OnThe rate for the employer is guaranteed for oneyear (One year from the date of enrollment) Hencethe entire rates that is effective for the employer/group needs to be effective for the new employeesas well. However the eligibility of the Employee isbase on the normal eligibility rules that is applicablefor the Employee at the time of enrollment. Countsfor the add-on employee can go more than 70 andup to 100 if Small Employer Group (override basedon ACL). If Guaranteed association then there is nolimit on the employee count at any time.Process Add onShows the missing information of the Add Onemployee and emails the missing information to theGMS rep.Process Add onOn successful Add On the welcome mail is sent tothe Employer/Employee and cc to Agent. Billingadjustment is made which would be handled in theFinance Module.Process Add OnAdding employee needs to check on the Waiting(waiting Period)Period. If the employee does not satisfy the waitingperiod then it should send email to the GMS rep.Also the employee effective date should default tothe date when the employee is actually eligible.If the Employee satisfied the waiting period and is60 days past the waiting period then it should flagthis as missing information as this becomes a lateapplication, which needs clarification from theemployer before enrolling the employee. Thisemployee can be enrolled only with authorization.The employee application form is not deemed as“Late” if it is postmarked within 60 days from theeligibility date. If it is postmarked more than 60days from the eligibility date, the application isdeclined as it is “Late”.Late application can be enrolled only on the nextROE.

Employee Add On (Adding Dependent)

ActivityRulesEmployee Add OnThe rate for the employer is guaranteed for oneyear (One year form the date of enrollment) Hencethe entire rate that is effective for the employer/group needs to be effective for the new dependentas well. However the eligibility of the Dependent isbase on the normal eligibility rules that is applicablefor the Dependent at the time of enrollment.Coverage Choice to be manipulated by Systemautomatically.Process Add onShows the missing information of the Add OnDependent and emails the missing information tothe GMS rep.Process Add onOn successful Add On the welcome mail is sent tothe Employer/Employee/Dependent and cc toAgent. Billing adjustment is made which would behandled in the Finance Module.General RulesIf the employee has selected the Employee onlyoption as coverage choice then it needs to bechanged for adding a dependent. System would notallow adding dependent with Employee only status.

Employer Change

ActivityRulesDemographicDemographic change can include change inchangesCompany Name, Contact name, Address, Phone,Fax, Email, Tax ID. All these change can be madeand does not affect the business rules except fortransmission of letter, email contactsBilling ChangesAll Billing changes are flag and email is sent toGMS rep and Finance for Information. Billingchanges would effect the billing frequency or themode of payment (EFT, Credit Card or Check)Waiting PeriodChange in the waiting period would affect theChangeEmployee Eligibility criteria for all add onemployees, going forward, as the change may be.Change in the Employee type for the waiting periodconsideration would also affect the EmployeeEligibility for the New Employees ‘Add-On’, goingforward.Waiting Period would be based on the EmployerEffective date.Effective date for changing the Waiting periodshould default to the 1stof the following month.Waiting period can be changed only once from thedate of enrollment (effective date) to one-year cyclefor the employer.If the waiting period changes are more than once inthe calendar year for the employer. This is to benotified to the GMS rep and only the authorizedperson can override this and allow for waitingperiod change beyond 1 in employer anniversarydate (one year cycle).EmployerContribution would be based on the EmployerContributionEffective date.Effective date for changing the Contribution shoulddefault to the 1stof the following month.Contribution can be changed only twice from thedate of enrollment (effective date) to one-year cyclefor the employer.If the Contribution changes are more than once inthe calendar year for the employer. This is to benotified to the GMS rep and only the authorizedperson can override this and allow for contributionchange beyond 1 in employer calendar year.Note: Effective dates for Contribution changesshould be 1stfollowing month if the billing cyclehas not completed.If the billing cycle is complete then it should beeffective the next billing cycle. I.e. 1stof themonth following the next month.Optional benefitsa)Medical: No change allowed.Changesb)Dental Can be added only during ROE cycle.Can be dropped any time. Note if dental isdropped then it can be added in the ROEfollowing 12 month from the date of droppingthe dental plan.c)Vision and CAM: Can be added and droppedany time. Note if an optional benefit is droppedthen it can be added in the ROE following 12month from the date of dropping the optionalbenefit.d)This is to be notified to the GMS rep and onlythe authorized person can override this.Employee CountsCan be changed only at next ROE cycle.(Number ofemployee)COBRACan Change any time but will effective from 1stofthe month onlyIf this changes then any existing COBRA with thisgroup will change accordingly and automatically, 1stof the month.Should trigger automatic transmissionTEFRACan be change any time but will be effective from1stof the month only.Transmit record to the carrier only if the employeeis 65+Part time coverage/Can be change only during open enrollment or ReDomestic partnerqualification and open enrollment. But should allowfor overriding this feature based on authority.Note: Any over riding function should trigger autoemail to the concerned GMS rep for making thechanges based on their authority.Agent ChangeThis triggers a new process flow. (Refer processflow diagram FIG. 4.)

Note: For all changes effective date will be defaulted based on POST MARK DATE, If POST MARK date is lesser than 15th Day of month then Effective date will be 1st day of next month else it will be 1st day of next of the next month

4. User Role

The respective level of user role can over rule the following missing information.

Employee, Group and Dependent Changes (w.r.t. Current Date)

User RoleConditionLevel IReinstatement date is with in 30 days prior or laterLevel IIReinstatement date is with in 30 days prior or laterLevel IIIReinstatement date is with in 60 days prior or later

Benefit Partners Inc

Process Specification

The purpose of this document is to describe the process of ROE/OE Process. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_ENEnrollmentBPI_SCOPE_EN_004Enrollment - ROE

1.4. Document Reference

2. Process Identification

Once a year, on the anniversary date of a group's enrollment in PacAdvantage (or for some, it's July 1st, not their anniversary date), the group's participation, contribution and qualification is reviewed. This review is to ensure that the group meets the qualification requirement. The main objective of this process is to review these criteria and re qualify as needed, notify them of rate changes and provide an opportunity for employees of the group to make changes to their enrollment.

This process is identified as Re-qualification and open enrollment. Also there is another process associated with this called as open enrollment where in the group has the privilege to make the changes to the plan, waiting period etc.

The difference between the two processes is that for re-qualification the Group has to under go the eligibility check to qualify for their next term.

For open enrollment the group need not re qualify and under go the eligibility checks.

The group should already have been enrolled with the PacAdvantage and have no termination date for the ROE to be done.

2.2. Process Description

The objective of the ROE/OE Process is to:Annual Re qualification or open enrollment form filled by the EmployerOpen Enrollment Change form completed by employee, if applicableEmployee Enrollment form(s) completed by employee, if applicableDependent Enrollment form(s) completed by employee, if applicable

The following are the other requirements that will be supported and constraints on the proposed system:1) The system has to initiate ROE/OE process 3 months prior to the actual anniversary date for the specific group. This process needs to be initiated by GMS personnel.2) System has to pick up the Groups for ROE based on the rules defined below:Group Size: less than or equal to 4—All the groups needs to be re-qualified.Group Size: 5 to 9—10% of the Group needs to be re-qualifiedGroup Size: greater than or equal to 10—1% of the group needs to be re-qualified.3) System has to randomly pick up the groups based on the above rules for ROE based on random generator algorithm.4) All other Group that is a part of ROE and OE needs to have their open enrollment processed.5) Also their needs to be a facility to have manual OE process wherein the Employee or Employees are manually picked for ROE or OE process. Manual OE is usually performed based on searching the Employee based on line of coverage and plan.6) There needs to be a feature to Finalize the ROE or OE for all the groups that have the same ROE/OE cycle.

2.3. Process Flow

Process for ROE/OE

The process starts after manual initiation1) Identify the group that has their anniversary date 3 months hence.2) Based on the group size identify if the group needs to be re-qualified.3) Randomly pick up the group for re-qualification4) If the group is not picked for re-qualification then the group only needs to have open enrollment.5) Send ROE/OE packets to mail house. The packet includes the Agent Packet and the group packet.6) Also sent the packets to the COBRA members of the existing group.7) Send reminder for the ROE/OE every month.8) Receive the ROE/OE packets completed by the Group and enter into the system.9) Follow up for missing information10) Convey the Group/Agent about the ROE status on completion of the process.

Note the screens for entry of data for the ROE/OE processes are similar to the Group/Employee/Dependent Changes screen. However for the ROW/OE process the status would be identified as ROE process.

3. User Interface

3.1. User Interface Screens

3.1.2.1.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—012—Group Search of BPI_CAS_FSD_EN—01

3.1.2.4.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—002—Group General of BPI_CAS_FSD_EN—01

3.1.2.5.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—003—Billing of BPI_CAS_FSD_EN—01

3.1.2.6.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—005—Agent of BPI_CAS_FSD_EN—01

3.1.2.7.1 Screen Snap Shot

3.1.2.8.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—004—Group Coverage of BPI_CAS_FSD_EN—01

3.1.2.9.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—013—Employee Search of BPI_CAS_FSD_EN—01

3.1.2.11.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—006—Employee Information of BPI_CAS_FSD_EN—01

3.1.2.12.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—007—Employee Coverage of BPI_CAS_FSD_EN—01

3.1.2.13.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—014—Dependent Search of BPI_CAS_FSD_EN—01

3.1.2.15.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—008—Dependent of BPI_CAS_FSD_EN—01

3.1.2.16.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—009—Enrollment Summary of BPI_CAS_FSD_EN—01

3.1.2.17.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—010—Missing Information of BPI_CAS_FSD_EN—01

3.1.2.18.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—011—Enrollment Confirmation of BPI_CAS_FSD_EN—01

3.1.2.19.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—013—Employee Search of BPI_CAS_FSD_EN—01

3.1.2.20.1 Screen Snap Shot

3.1.2.21.1 Screen Snap Shot

3.1.2.22.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—006—Employee Information of BPI_CAS_FSD_EN—01

3.1.2.23.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—003—Billing of BPI_CAS_FSD_EN—01

3.1.2.24.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—005—Agent of BPI_CAS_FSD_EN—01

3.1.2.25.1 Screen Snap Shot

3.1.2.26.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—007—Employee Coverage of BPI_CAS_FSD_EN—01

3.1.2.27.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—014—Dependent Search of BPI_CAS_FSD_EN—01

3.1.2.28.1 Screen Snap Shot

3.1.2.29.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—008—Dependent of BPI_CAS_FSD_EN—01

3.1.2.30.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—009—Enrollment Summary of BPI_CAS_FSD_EN—01

3.1.2.31.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—010—Missing Information of BPI_CAS_FSD_EN—01

3.1.2.32.1 Screen Snap Shot

Refer to 3.1.1 Screen Shot: BPI_SCR_EN—002—001 of BPI_CAS_FSD_EN—02

3.1.2.35.1 Screen Snap Shot

Refer to 3.8.1 Screen Shot: BPI_SCR_EN—002—009 of BPI_CAS_FSD_EN—02

3.1.2.36.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—003—Billing of BPI_CAS_FSD_EN—01

3.1.2.37.1 Screen Snap Shot

Refer to 3.9.1 Screen Shot: BPI_SCR_EN—002—010 of BPI_CAS_FSD_EN—02

3.1.2.38.1 Screen Snap Shot

Refer to 3.3.1 Screen Shot: BPI_SCR_EN—002—003 of BPI_CAS_FSD_EN—02

3.1.2.39.1 Screen Snap Shot

Refer to 3.5.1 Screen Shot: BPI_SCR_EN—002—006 of BPI_CAS_FSD_EN—02

3.1.2.40.1 Screen Snap ShotRefer to User Interface ID: BPI_CAS_SCR_EN—001—011—Enrollment Confirmation of BPI_CAS_FSD_EN—01

3.1.3. Screen Flow

4. Business Rule Mapping

ActivityRulesROE ProcessIdentify the group randomly based on the Groupsize for ROE.ROE validationAll the eligibility rules that are applicable as new bus-iness enrollment are applicable for the ROE as well.Open EnrollmentOpen enrollment allows for making the changes thatare normally not possible during the normal changes.BillingBill in a normal way if the ROE/OE has a completedstatus. Make the bill for the new effective date.If the ROE/OE has a status as pend then pend the billfor the new effective date.

5. User Role

The respective level of user role can over rule the following missing information.

Benefit Partners Inc

Process Specification

The purpose of this document is to identify the process associated with the business use case Termination and Reinstatement

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_ENEnrollmentBPI_SCOPE_EN_005Termination and Reinstatement

2. Process Identification

<Brief Description of the Process>

2.2. Process Description

Process Flow for Group Term

This process is used to terminate or reinstate the Group, Employee and or Dependent.

TheFIG. 1shows the process flow for the group termination. The group can be termed broadly based on two reasons; Non-payment of Premium or by group request for termination. Non-payment of premium is an automated process and starts and completes the term process automatically. The employer request is a manual term process and the Group is termed manually.

Automated Term process initiates the Term Process. Letter is sent to the Group with 15 days notice for reinstatement. The system holds the status as “Term Pending” although the group believes they are completely termed. The reason for this is to prevent the sending of termination then reinstatement transmissions to the carriers; which causes confusion. The finance department then processes the term to completion if the payment is not received. Finance also has ability to override the term pend status based on authority.

Manual Term process is based on the request received from the group. All manual term process is notified to finance for necessary action. If the Group has a shortfall then the system notifies the finance department and finance processes the term. Term letter is send to the Group for paying through the balance premium. If the balance premium is paid then the finance department completes the term. If the balance is not paid then finance terms the group retrospectively.

If the Group has a refund due them then the system notifies the finance department and finance processes the refund and completes the term process.

Process Flow for Employee Term

Employee term is based on the Employer request to terminate the employee based on certain reasons. Based on these reasons the employee is termed and all employees who are termed needs to be sent the COBRA packets for COBRA enrollment. Billing adjustments are made for the employee term in the next invoice generated.

Process Flow for Dependent Term

Dependent term is based on the Employer/Employee request to terminate the Dependent based on certain reasons. Based on these reasons the Dependent is termed and the termed Dependent are sent the COBRA packets for COBRA enrollment. Billing adjustments are made for the Dependent term in the next invoice generated for the Group.

2.3. Process Flow

3. User Interface

3.1. User Interface Screens

Element NameElement TypePurposeMode of RequestSelection BoxEntry Field for the Group Id.Postmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedAuthorized ContactSelection BoxEntry Field for the AuthorizedContactRequested TermEntry FieldEntry Field for the RequestDateTerm DateReason for TermSelection BoxSelect the Reason for TermOther ReasonEntry FieldEntry Field for the Other Reason

Element NameElement TypePurposePostmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedRequested TermEntry FieldEntry Field for the Request TermDateDateReason for TermSelection BoxSelect the Reason for TermOther ReasonEntry FieldEntry Field for the Other Reason

Element NameElement TypePurposeGroup NameEntry FieldEntry Field for the Group Name.Group IdEntry FieldEntry Field for the Group IDEmployee FirstEntry FieldEntry Field for theNameEmployee First NameEmployee LastEntry FieldEntry Field for the EmployeeNameLast NameEmployee PhoneEntry FieldEntry Field for the EmployeeNumberPhone NumberEmployee SSNEntry FieldEntry Field for the Employee SSNEmployee IDEntry FieldEntry Field for the Employee ID

Element NameElement TypePurposeMode of RequestSelection BoxEntry Field for the Group Id.Postmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedAuthorized ContactSelection BoxEntry Field for the AuthorizedContactRequested TermEntry FieldEntry Field for the RequestDateTerm DateReason for TermSelection BoxSelect the Reason for TermOther ReasonEntry FieldEntry Field for the Other Reason

Element NameElement TypePurposeEmployee FirstEntry FieldEntry Field for theNameEmployee First Name.Employee LastEntry FieldEntry Field for theNameEmployee Last NameEmployee SSNEntry FieldEntry Field for the Employee SSNEmployee IdEntry FieldEntry Field for the Employee IdDependent FirstEntry FieldEntry Field for theNameDependent First NameDependent LastEntry FieldEntry Field for theNameDependent Last NameDependent SSNEntry FieldEntry Field for the Dependent SSNDependent IdEntry FieldEntry Field for the Dependent Id

Element NameElement TypePurposeMode of RequestSelection BoxEntry Field for the Group Id.Postmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedAuthorized ContactSelection BoxEntry Field for theAuthorized ContactRequested TermEntry FieldEntry Field for the RequestDateTerm DateReason for TermSelection BoxSelect the Reason for TermOther ReasonEntry FieldEntry Field for the Other Reason

Element NameElement TypePurposeMode of RequestSelection BoxEntry Field for the Group Id.Postmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedAuthorized ContactSelection BoxEntry Field for the Authorized ContactReinstatement DateEntry FieldEntry Field for the Request Rein DateRequestedReason forSelection BoxSelect the Reason for ReinstatementReinstatementOther ReasonEntry FieldEntry Field for the Other Reason

Element NameElement TypePurposeGroup NameEntry FieldEntry Field for the Group Name.Group IdEntry FieldEntry Field for the Group IDEmployee FirstEntry FieldEntry Field for the Employee First NameNameEmployee LastEntry FieldEntry Field for the Employee Last NameNameEmployee PhoneEntry FieldEntry Field for the Employee PhoneNumberNumberEmployee SSNEntry FieldEntry Field for the Employee SSNEmployee IDEntry FieldEntry Field for the Employee ID

Element NameElement TypePurposeMode of RequestSelection BoxEntry Field for the Group Id.Postmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedAuthorized ContactSelection BoxEntry Field for the Authorized ContactReinstatement DateEntry FieldEntry Field for the Request Rein DateRequestedReason forSelection BoxSelect the Reason for ReinstatementReinstatementOther ReasonEntry FieldEntry Field for the Other Reason

Screen Snap Shot

Element NameElement TypePurposeEmployee FirstEntry FieldEntry Field for the Employee First Name.NameEmployee LastEntry FieldEntry Field for the Employee Last NameNameEmployee SSNEntry FieldEntry Field for the Employee SSNEmployee IdEntry FieldEntry Field for the Employee IdDependent FirstEntry FieldEntry Field for the Dependent First NameNameDependent LastEntry FieldEntry Field for the Dependent Last NameNameDependent SSNEntry FieldEntry Field for the Dependent SSNDependent IdEntry FieldEntry Field for the Dependent Id

Element NameElement TypePurposeMode of RequestSelection BoxEntry Field for the Group Id.Postmark DateEntry FieldEntry Field for the Group NameDate ReceivedEntry FieldEntry Field for the Date ReceivedAuthorized ContactSelection BoxEntry Field for the Authorized ContactReinstatement DateEntry FieldEntry Field for the Request Rein DateRequestedReason forSelection BoxSelect the Reason for ReinstatementReinstatementOther ReasonEntry FieldEntry Field for the Other Reason

4. Business Rule Mapping

ActivityRulesTerm ProcessThe person who requested the term should be the(requestdesignated contact person or agent assigned toreceived from)that group. Other persons are not authorized toinitiate the term request.Term ProcessOn employer request the term process is initiated.(Manual)The term process should check the billingstatus and the balance due or refund. If thegroup has paid through and there is noshortage or surplus then this process shouldauto initiate the term process. Send letters theGroup, Employee and dependent. Notify viamail to the GMS rep if the group size is lessthan 15 and if above 15 notify the Sales rep.If there is a shortage then send a mail to thefinance and put the term status as termpending. Finance should initiate follow up forcollecting the balance due and sent the termletter and payment letter. On receipt ofpayment term the Group. If the Payment is notreceived then retro terms the group.If there is refund due to the group the financeshould process the refund and initiate the termthere after.Note: GMS can process Term up to 30 days.(LEVEL I)Term beyond 30 days-60 days can beprocessed only by lead (LEVEL II)Term extended beyond 60 days is based onultimate authority to a specified user ((LEVEL IIIand IV)Term ProcessAutomated term process is initiated if the group(Automated)does not pay the premium or there is shortage ofpremium. Term letter is sent to the group on 32 dayof non-receipt of payment and the Group is given15-day notice to repay. If the Group does not paywithin 32 + 15 days the finance should finalize termbased on authority.General TermIf the group is termed then all the employees andrulesdependents for the group are termed. The COBRAMembers associated with the group should also betermed. The term letter should be sent to the entiremember for the Group including the COBRA group.EFT and auto credit card deductions should stopon term.Term ProcessDependent can be terminated based on variousreason provide for the employee terminationAll term should be effective end of the currentmonth or if the term is requested for the month afterthe current month.Dependent cannot be termed with past datebeyond 30 days.Exception:Death of the dependent. The dependent is termedthe on the day of the death.Term RulesAuto initiate Dependent terms if the age of thedependent is 23 and the dependent other thanspouse or domestic partner are no longer eligible.Also send the COBRA packet to the dependent iftermed.Billing AdjustmentMake adjustment to the billing for the termeddependent in the next billing cycle.Term ProcessThe person who requested the term should be the(requestdesignated contact person. Other persons are notreceived from)authorized to initiate the term request.Term ProcessOn employer request the term process is initiated.(Manual)The term process should check the billingstatus and the balance due or refund. If thegroup has paid through and there is noshortage or surplus then this process shouldauto initiate the term process. Send letters theGroup, Employee and dependent. Notify viamail to the GMS rep if the group size is lessthan 15 and if above 15 notify the Sales rep.If there is a shortage then send a mail to thefinance and put the term status as termpending. Finance should initiate follow up forcollecting the balance due and sent the termletter and payment letter. On receipt ofpayment term the Group. If the Payment is notreceived then retro terms the group.If there is refund due to the group the financeshould process the refund and initiate the termthere after.Note: GMS can process Term up to 30 days.(LEVEL I)Term beyond 30 days-60 days can beprocessed only by lead (LEVEL II)Term extended beyond 60 days is based onultimate authority to a specified user (LEVEL IIIand IV)Term ProcessAutomated term process is initiated if the group(Automated)does not pay the premium or there is shortage ofpremium. Term letter is sent to the group on 32 dayof non-receipt of payment and the Group is given15-day notice to repay. If the Group does not paywithin 32 + 15 days the finance should finalize termbased on authority.General TermIf the group is termed then all the employees andrulesdependents for the group are termed. The COBRAMembers associated with the group should also betermed. The term letter should be sent to the entiremember for the Group including the COBRA group.EFT and auto credit card deductions should stopon term.Term ProcessThis is to complete the term process where theterm status was term pend. All auto initiated termprocess has the term status as term pend. Itrequires user intervention to complete the termprocess based on authority.Term ProcessEmployee can be terminated based on variousreason provide for the employee terminationAll term should be effective end of the currentmonth or if the term is requested for the month afterthe current month.Employee cannot be termed with past date beyond30 days.Exception:Death of the employee. The employee is termedthe on the day of the death.ProcessAll employee terms should send term letter to theAssociatedemployee and group. The employee can opt forwith termCOBRA and hence the COBRE enrollment packetshould be sent to the employeeBillingThere should be billing adjustment in theAdjustmentsubsequent bill for the termed employee.Term ProcessDependent can be terminated based on variousreason provide for the employee terminationAll term should be effective end of the currentmonth or if the term is requested for the month afterthe current month.Dependent cannot be termed with past datebeyond 30 days.Exception:Death of the dependent. The dependent is termedthe on the day of the death.Term RulesAuto initiate Dependent terms if the age of thedependent is 23 and the dependent other thanspouse or domestic partner are no longer eligible.Also send the COBRA packet to the dependent iftermed.BillingMake adjustment to the billing for the termedAdjustmentdependent in the next billing cycle.ReinstatementThe person who requested the reinstatementProcessshould be the designated contact person. Otherpersons are not authorized to initiate thereinstatement request.If reinstatement cannot happen then send thedenial letter.If reinstated notify financeSystem should calculate the reinstatement fees.Finance will reinstate on receipt of payment.Note When the group is reinstated all the membersassociated with the group are also reinstated.Including COBRA group.GMS can reinstate within 30 days. Any periodabove this needs authorization.ReinstatementThe person who requested the reinstatementProcessshould be the designated contact person. Otherpersons are not authorized to initiate thereinstatement request.If reinstatement cannot happen then send thedenial letter.Note When the Employee is reinstated all thedependents of the Employee are also reinstated.ReinstatementThe person who requested the reinstatementProcessshould be the designated contact person. Otherpersons are not authorized to initiate thereinstatement request.If reinstatement cannot happen then send thedenial letter.If reinstated notify finance for reinstatement feescalculation if applicable.

5. User Role

The respective level user can terminate or reinstate the dependent, employee or group based on the criteria mention in the following table. The following validations are done with respect to the current date.

S.No., User RoleConditionDependent Termination1 Level ITermination date is with in 30 days prior or later2 Level IITermination date is with in 60 days prior or later3 Level III, Level IVTermination date is with in 90 days prior or laterEmployee Termination1 Level ITermination date is with in 30 days prior or later2 Level IITermination date is with in 60 days prior or later3 Level III, Level IVTermination date is with in 90 days prior or laterGroup Termination1 Level ITermination date is with in 30 days prior or later2 Level IITermination date is with in 60 days prior or later3 Level III, Level IVTermination date is with in 90 days prior or laterDependent Reinstatement1 Level IReinstatement date is with in 30 days prior or later2 Level IIReinstatement date is with in 60 days prior or later3 Level III, Level IVReinstatement date is with in 90 days prior or laterEmployee Reinstatement1 Level IReinstatement date is with in 30 days prior or later2 Level IIReinstatement date is with in 60 days prior or later3 Level III, Level IVReinstatement date is with in 90 days prior or laterGroup Reinstatement1 Level IReinstatement date is with in 30 days prior or later2 Level IIReinstatement date is with in 60 days prior or later3 Level III, Level IVReinstatement date is with in 90 days prior or later

Benefit Partners Inc

Process Specification

Appeals and Grievances

The purpose of this document is to describe the process of Appeals and Grievances. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_ENEnrollmentSCOPE_ADDAddendum to the Scope Document

2. Process Identification

Any process or transaction that is performed by PacAdvantage is subject to a review process. The rule for such is defined in the PacAdvantage handbook. There are cases when the Customer is not satisfied with some of the decisions made during the administration of the program. When a customer is not satisfied with the decision made they can submit a request for Program Review. Once a decision has been made to grant or deny the request, an Appeal can then be submitted to overturn the decision of the Program Review. Not all decisions are appealable. In any case, all grievances need to be sent to PacAdvantage-Roseville, along with other certain requirements, for making a decision whether to consider the Grievances or to reject them as the case may be.

PacAdvantage-Roseville makes the decision on the initial requests or “Program Reviews” and forwards the response to the customer. Upon receipt of a second request or “Appeal”, if the decision is appealable, Pac Advantage-Roseville forwards the information to PacAdvantage-SF to make a ruling. (If the decision is not appealable, PacAdvantage-Roseville sends a letter regarding such to the customer.) PacAdvantage-SF then returns a ruling and PacAdvantage-Roseville forwards the response to the customer.

This entire process needs to be captured and tracked by the system.

Any transaction within the system has a history. The personnel handling the grievance need to review the history and generate a report regarding the grievance for review.

2.2. Process Description

The objective of the Grievance process is to:1) Maintain a status for all Grievances received from the customer and follow up with the decision made either by PacAdvantage-Roseville or PacAdvantage-SF.

The following are the other requirements that will be supported and constraints on the proposed system:1) The system would track the initial request from open to close.2) The system would track subsequent requests, if a proper appeal, from re-open to close.3) Track subsequent requests, if not a proper appeal, for receive dates, remarks and any correspondence.4) The system would also have a history of all the transactions to get the report for the Nature of Grievance.

2.3. Process Flow

Process for Grievances—First Request (or “Program Review”)1) Receive the Grievance from Group and/or Member and/or Agent representing the Group and/or Member.2) Categorize the nature of the Grievance.3) Review the history and collect all the relevant documents for the Grievance.4) Make decision to approve/deny the Grievance.5) Close the Grievance.6) Send relevant letters.7) If the Grievance is in favor of the group or the employee, send notification to Finance and or GMS to take necessary action (Reinstate the Group/Member).

Process for Grievances—Second Request (or “Appeal”)1) Receive the Grievance from the Group and/or Member and/or Agent representing the Group and/or Member.2) Categorize the nature of the Grievance.3) Review the history and collect all the relevant documents for the Grievance.4) Forward the document with relevant information to PacAdvantage-SF.5) Follow up with PacAdvantage-SF regarding the decision on the Grievance.6) On receiving the decision convey the decision to the Group and or employee.7) Close the Grievance.8) Send relevant letters.9) If the Grievance is in favor of the group or the employee send notification to Finance and or GMS to take necessary action (Reinstate the Group/Member).

3. User Interface

3.1. User Interface Screens

Element Name

ElementElementNameTypeLabelPurposeComplainantTextComplainantTo display textTypeTypeComplainantTextComplainantTo display complainant typeTypeTypedynamicallyComplainantTextComplainantTo display textIDIDComplainantTextComplainantTo display complainant typeIDIDdynamicallyGroupHTMLGroupTo display company name,InformationTableInformationcontact name, address,phone, effective date,ROE date, statusPostmarkTextPostmark DateTo display textDatepostMarkDateCalendarPostmark DateTo enter the postmark dateReceived dateTextReceived dateTo display textreceivedDateCalendarReceived dateTo enter the received dateNature OfTextNature ofTo display textGrievanceGrievancenatureOf-ListNature ofTo list the Nature ofGrievanceGrievanceGrievance.Upon selection ofthe Nature ofGrievance, the correspondingGrievance Type is displayedon the screenSubject ofTextSubject ofTo display textGrievanceGrievancesubjectOf-ListSubject ofTo list the Subject ofGrievanceGrievanceGrievance for selectionUrgentTextUrgentTo display texturgentCheck-UrgentTo select the option of havingboxurgent.RemarksTextRemarksTo display textremarksTextRemarksTo enter remarks largerAreaarea is providedsaveHTMLSaveSubmit the data and savebuttonin the databasecancelHTMLCancelTo reset to previous status asbuttonwas on loading the page

Screen Validations

ElementAction/ValidationNameDetailsMessagePostmarkShould default to system date.Error Dialog Box:DatePostmark date can never be a future“Please choose thedate and can be one day older thancorrect date. Postmarkcurrent date only.date can be a future date.”ReceivedShould default to system date.Error Dialog Box:dateReceived date can never be a future“Please choose thedate and should be equal to ORcorrect date. Receivedgreater than current date.date can be a future date.”Nature ofDefault Option should be - ChooseError Dialog Box:GrievanceOne-- Should list all the types of“Please choose theNatures of Grievancesnature of grievance.Subject ofDefault Option should be - ChooseError Dialog Box:GrievanceOne-- Should list all the types of“Please choose thesubject of Grievancessubject of grievance.RemarksEntry Text Area to enter the remarksNonefor the Grievance. The text areashould have scrollbar if the contentwithin the text area grows.SaveShould function On clicking theError Dialog Box:Save Button or“The value enteredpressing the Enterfor ‘field name’ iskey with cursor on the “Saveincorrect. Please enterButton”the correct value.”Save the data to theNote: The “field name”repository withname should bethe status of the Grievance as open.dynamically pickedAuto generate the grievance IDbased on the name ofthe field for which theerror has occurred.CancelShould reset to the status as was onNoneloading the page on clicking thecancel button

Screen Validations

ElementNameAction/Validation DetailsMessageGrievanceEntry field to enter grievance ID andError Message:on tab should populate the Grievance“The grievance IDbased on the Grievance idnot available”ComplainantEntry fields to enter Complainant IDError Message:and on tab should populate all the“Complainant IDGrievances for the specific appellant.not available”SearchSearch for the Grievance ID orNoneAppellant IDGrievanceThe table gets populated based onNoneProcessthe search criteria. For Grievance IDTablethe table shows only one grievance.For Appellant search the table showsall the grievances for the specificAppellant.ProcessProcess the specific Row in the tableNONEselectedGrievanceTable to display Postmark Date,NoneReceived Date, Nature of Grievance,Subject of Grievance, AppellantType, Appellant ID, GrievanceStatus, Remarks.AdditionalEntry field for additional remarksNoneRemarksForward forCheck box to check if forward orNoneApprovalnot.Forward ToIf “Forward for Approval” isError Dialog Box:checked then this field must be“Please Enter thecompleted. To enter the name of theForwarded to personsperson to whom the Grievance is toname”be forwardedForwardAllow entering the date or pickingError Dialog Box:Dateup from the calendar“Please Enter theIf “Forward for Approval” isForwarded Date”checked then this field must becompleted. Enter the forward dateBatch DateAllow entering the batch date orNonepicking up from the calendarSaveShould function On clicking theError Dialog Box:Save Button or“The value enteredpressing the Enterfor ‘field name’ iskey with cursor on the “Saveincorrect. PleaseButton”enter the correctSave the data onvalue.”clicking the saveNote: The “fieldbutton.name”name should bedynamically pickedbased on the name ofthe field for whichthe error has occurred.CancelReset to the state as was on loadingNonethe page

Screen Validations

3.1.2. Screen Flow

4. Business Rule Mapping

ActivityRulesAppealsAppeals and grievance is the screen that needs to beand grievancehandled by personnel skilled with the operations of thePacAdvantage and the governing rules.All appeals are entered and followed up for the outcomeof the appeals. The turn around time for the appealsshould be 3 days at the BPI office for entering the recordand gathering the reports and summarizing the history.

Benefit Partners Inc

Process Specification

Association Master

The purpose of this document is to describe the process of Association Master. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business UseBusiness UseSpecification IDCase NameBPI_SCOPE_ENEnrollmentSCOPE_ADDAddendum to the Scope DocumentBPI_SCOPE_EN_01Business Use case specification- Group EnrollmentBPI_SCOPE_EN_03Business Use case specification- Create IndividualAssociation

2. Process Identification

Associations are basically a body of groups/members representing certain types of associations within the State of California. Association Groups and Association Members can participate in the PacAdvantage program similar to small employer groups or members. Associations are classified as Guaranteed, Endorsed, PEO's or Chambers. Each of the associations classified have specific business rules when participating in PacAdvantage program. This document identifies the rules and business governing the association groups and members.

2.2. Process Description

The objective of the Association Master is to:1) Create a master record for the association based on the classification of the association and specify the business rules associated with these classifications.2) The master record for association includesGeneral information about the associationContact informationCoverage InformationAgent informationOther information like internal work group, membership status etc.

2.3. Process Flow

Process for Association Master

Create, modify or inactivate an association master is the basic operations that can be performed on the association master.1) Enter general information about the association. The general information includesAssociation TypeAssociation NameAffiliation IDAddressSuiteCityStateZIP2) Enter contact information. The contact information includesSalutationFirst NameMiddle InitialLast NameSuffixContact PhoneContact FaxEmail Address3) Enter coverage information. Coverage information includesLine of coverage offeredDomestic Partner CoverageRate TypeAdmin Fees Type (Note: This are captured in Carrier Maintenance Module (Rate Classification)Agent Fees Type (Note: This are captured in Carrier Maintenance Module (Rate Classification)Additional Fees type (Note: This are captured in Carrier Maintenance Module (Rate Classification)4) Enter other information. Other information includesInternal Work groupMembership statusContract DateAssociation re qualification periodSpecial Handling

3. User Interface

3.1. User Interface Screens

ElementElementNameTypePurposeCoverageHeaderTo provide header for CoverageInformationTextLine ofTextTo provide textcoverageLine ofCheckCheck boxes to select multiple line of coverageCoverageboxesofferedDomesticTextTo provide textPartnerCoverageDomesticRadioTo choose yes or no for domestic partnerPartnerBoxescoverageCoverageCoverage RateTextTo provide textTypeCoverage RateRadioTo choose if the rate type is blended or nontypeBoxesblendedContinueHTMLSubmit button to save the data entered in to theButtonrepository and navigate to the next screenBPI_CAS_SCR_EN_007_003CancelHTMLTo reset to the status as was on loading the page.resetButton

3.1.2. Screen Flow

4. Business Rule Mapping

ActivityRulesAllow EmployerAre eligible to enroll at any time and follow businessGroups 2-50rules for Non-Association Small Employer Groups 2-50.This rules applies for Guaranteed, Endorsed, PEO's andChambersAllow IndividualMust have a membership number and apply after 60Membersdays (read as waiting period), but within 120 days, ofbecoming a member of the Association or of a groupsponsored for coverage. Effective date of coverage willbe within 45 days of receipt of a completed application.Declines must wait until Open Enrollment. Waives mayenroll within 30 days of losing other employer-sponsored coverage. The Individual Associationmember is required to enroll in all lines of coverageoffered by the Association Master. The IndividualAssociation member is not eligible for COBRA.This is applicable only to Guaranteed associationAllow EmployerAre eligible to enroll at any time and follow businessGroups >100rules for Small Employer Groups 2-50 EXCEPT for thesize of the group for Guaranteed association (Group sizecan be un limited for guaranteed association)RatesRate for each association for various rate classificationare defined in the carrier maintenance module.(AdminFees, Agent Commission, Additional Fees and Ratedifferential)AgentAll associations have an Agency and/or Agent(s).Commissions are applicable to both Group's andAssociation Member's. For both, the agent is attached atthe Group/Association member, but can only be chosenfrom the particular agents attached to the association.Agent is selected based on the internal work groupassigned to the agent/agency.Screen RulesSmall employer group after identifying the associationfor Groupwould follow the same navigation as applicable for theSmall employer group. The Group Affiliated to anassociation should also have the Membership Numberand the date of membership.Screen Rules forIndividual association would follow the same navigationIndividualas applicable to the employee after selecting theAssociationassociation and validating that the association ismembersguaranteed. The only additional things needed are a“Membership Number” and a “Date of Membership”.Essentially the “Date of Membership” replaces theemployee “Date of Hire” for an employee.

Benefit Partners Inc

Process Specification

Carrier Issues

The purpose of this document is to describe the process of Carrier Issues. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business UseSpecification IDBusiness Use Case NameBPI_SCOPE_ENEnrollmentSCOPE_ADDAddendum to the Scope Document

2. Process Identification

Various issues can arise for a member or group once enrolled with a carrier through PacAdvantage. These issues can vary from not receiving identification cards to incomplete transmission upload by the carrier. As PacAdvantage becomes aware of these issues it is their responsibility to resolve the issue in a timely manner acting as a liaison between the member and the carrier. All issues need to be tracked from start to finish by reason for issue and related carrier for reporting on performance standards as well providing information to PacAdvantage-SF regarding recurring issues within a carrier.

Issues can arise at the Group level, for all members on a group and/or all members on a line of coverage. Issues can also arise at the Employee level and/or Dependent level, by member and/or by plan.

Within PacAdvantage there are personnel who specifically handle all carrier related issues. Other representatives within PacAdvantage can receive the initial request, document it as needed and forward it to the Carrier Issue personnel. The Carrier Issue personnel contact the carrier to resolve the issue. They mark the documentation as needed and then close the issue and forward the resolutions back to the initial requestor (Originator). The Originator informs the member/group of resolution.

2.2. Process Description

The objective of the Carrier Issues process is to:1) Maintain a status for all Carrier Issues received from the customer and follow up with the carrier for resolution and inform the customer of resolution.

The following are the other requirements that will be supported and constraints on the proposed system:1) The system would track the initial request from open to close.2) The system would track both the reported issue and the actual issue.3) The system would track the final resolution.4) The system would also have a history of all the transactions to get the report for the Reported Issue.

2.3. Process Flow

Process for Carrier Issues1) Representative is notified of the issue by the customer and cannot resolve the issue alone.2) Representative initiates a request either from the Group level, Employee level, or Dependent level.3) The representative categorizes the reported issue and provides any supporting documentation.4) The issue is marked as “Open” for the Carrier Issue personnel to handle.5) The Carrier Issue personnel contact the carrier.6) The Carrier Issue personnel provide the carrier with necessary information to resolve the issue. (i.e. re-transmission, e-mail of information)7) The Carrier Issue personnel mark the issue as “Closed” and inform the Originator.8) The originator follows-up with the member.

3. User Interface

3.1. User Interface Screens

<List SID and the Screen Name and Corresponding HTML File for the Screen.>

ElementElement NameTypePurposeReceived dateTextTo display textReceived dateCalendarTo enter the received dateReported IssueTextTo display textReported IssueListTo list the Reported Issue.GroupEntryTo enter Group ID if Client Type isFieldGroup. Ability to search for Group,upon selection or entry of the Group,the group's general information isdisplayed (Company Name, ContactName, Address, Phone, EffectiveDate, ROE Date, Status)MemberEntryTo enter Member ID if Client Type isFieldMember. Ability to search for Member,upon selection or entry of the memberID, the member's general informationis displayed (Name, Address, Phone,Effective Date, ROE Date, Status,Benefit Level, Coverage Choice)RemarksTextTo display textRemarksEntryTo enter remarksFieldSubmitHTMLSubmit the data and save in thebuttondatabaseCancelHTMLTo reset to previous status as was onbuttonloading the pageCancelHTMLTo reset to previous status as was onbuttonloading the page

Screen Validations

Element NameAction/Validation DetailsMessageReceived dateShould default to system date.Error Dialog Box:Received date can never be a future“Please choose the correct date. Receiveddate.date can be a future date.”Reported IssueDefault Option should be - ChooseError Dialog Box:One - Should list all the types of“Please choose the reported issue.Reported IssuesClient TypeOption to choose Group or memberNonewith radio button group.ClientEntry field to enter the group ID orNonemember ID based on the Client typeselected. Based on the Clientselected Display the Group ormember information in the HTMLtable.SearchPop up window to search for theNoneGroup or Member based on theClient type selected.GroupHTML Table to display the GroupNoneInformationMemberHTML Table to display memberNoneinformationRemarksEntry Text Area to enter the remarksNonefor the Carrier Issue. The text areashould have scrollbar if the contentwithin the text area grows.SubmitShould function On clicking theError Dialog Box:Submit Button or pressing the Enter“The value entered for ‘field name’ iskey with cursor on the “Submitincorrect. Please enter the correct value.”Button”Note: The “field name” name should beSave the data to the repository withdynamically picked based on the name ofthe status of the Carrier Issue asthe field for which the error has occurred.open.Auto generate the Carrier Issue IDCancelShould reset to the status as was onNoneloading the page on clicking thecancel button

Element NameElement TypePurposeCarrier IssueTextTo display textIDCarrier IssueEntry FieldTo enter Carrier Issue ID. Ability toIDsearch for open Carrier IssuesClientTextTo display textClientEntry FieldTo enter client ID. Ability to searchfor open Issues for the specific clientSearchPop Up windowTo search for the Carrier Issue ID orthe Client ID (group or member id)with open issuesCarrier IssueHTML TableList the issues based on the searchProcess Tablecriteria.ProcessHTML ButtonTo show the issue selected for furtherprocessingCarrier IssueHTML TableTable to display Received Date,Reported Issue, Client Type,Client ID, Issue Status, Remarks.AdditionalTextTo display textRemarksAdditionalEntry FieldTo enter textRemarksNotify CarrierTextTo display textNotify CarrierRadio ButtonTo check if notifying to carrierMode ofTextTo display textNotificationMode ofList BoxIf “Notify Carrier” is checked thenNotificationthis field must be completed. Toenter the mode of notificationDate NotifiedTextTo display textDate NotifiedCalendarIf “Notify Carrier” is checked thenthis field must be completed.Enter the notified dateBatch DateTextTo display textBatch DateCalendarTo enter batch dateSubmitHTML buttonSubmit the data and save in thedatabaseCancelHTML buttonTo reset to previous status as was onloading the page

Screen Validations

Element NameAction/Validation DetailsMessageCarrier IssueEntry field to enter Carrier Issue IDError Message:and on tab should populate the“Carrier Issue ID is required”Carrier Issue based on the CarrierIssue idClientEntry fields to enter Client ID and onError Message:tab should populate all the Carrier“Client ID is required”Issues for the specific Client.Searchsearch for the Carrier Issue ID orNoneClient IDCarrier IssueThe table gets populated based onNoneProcess Tablethe search criteria. For Carrier IssueID the table shows only one CarrierIssue. For Client search the tableshows all the Carrier Issues for thespecific Client.ProcessProcess the specific Row in the tableNONEselectedCarrier IssueTable to display Received Date,NoneReported Issue, Client Type, ClientID, Issue Status, Remarks.AdditionalEntry field for additional remarksNoneRemarksNotify CarrierRadio button to select if notify or notNoneMode ofIf “Notify Carrier” is yes then thisError Dialog Box:Notificationfield must be completed. To enter“Please Enter the Mode of Notification”the Mode of Notification for whomthe Issue is to be forwardedDate NotifiedAllow entering the date or pickingError Dialog Box:up from the calendar“Please Enter the Notified Date”If “Notify Carrier” is yes then thisfield must be completed. Enter thenotified dateBatch DateAllow entering the batch date orNonepicking up from the calendarSubmitShould function On clicking theError Dialog Box:Submit Button or pressing the Enter“The value entered for ‘field name’ iskey with cursor on the “Submitincorrect. Please enter the correct value.”Button”Note: The “field name” name should beSave the data on clicking the submitdynamically picked based on the name ofbutton. If the Mode of Notification isthe field for which the error has occurred.Email, then open new message withappropriate information. If Mode ofNotification is Fax, then enterappropriate information for fax.CancelReset to the state as was on loadingNonethe page

Screen Validations

Element NameAction/Validation DetailsMessageCarrier IssueEntry field to enter Carrier Issue IDError Message:and on tab should populate the“Carrier Issue ID is required”Carrier Issue based on the CarrierIssue idCustomerEntry fields to enter Client ID and onError Message:tab should populate all the Carrier“Customer ID is required”Issues for the specific Client.Searchsearch for the Carrier Issue ID orNoneClient IDCarrier IssueThe table gets populated based onNoneProcess Tablethe search criteria. For Carrier IssueID the table shows only one CarrierIssue. For Client search the tableshows all the Carrier Issues for thespecific Client.CloseClose the specific Row in the tableNoneselectedCarrier IssueTable to display Received Date,NoneReported Issue, Client Type, ClientID, Issue Status, Remarks.Actual IssueDefault option should be the same asreported issue. List all issues.RetransmissionRadio button to select if retransmitNoneor notResolutionDefault option should be - chooseone -. List the resolutions for closingthe issue as Updated, Denied orcancelledResolutionEntry field for additional commentsNoneCommentsDate CarrierAllow entering the date or pickingNoneResolvedup from the calendarIf “Notify Carrier” is yes then thisfield must be completed. Enter thenotified dateBatch DateAllow entering the batch date orNonepicking up from the calendarNotify OriginatorRadio button to select if notify ornot. If yes send pre-formatted emailto Originator.SubmitShould function On clicking theError Dialog Box:Submit Button or pressing the Enter“The value entered for ‘field name’ iskey with cursor on the “Submitincorrect. Please enter the correct value.”Button”Note: The “field name” name should beSave the data on clicking the submitdynamically picked based on the name ofbutton. If the Mode of Notification isthe field for which the error has occurred.Email, then open new message withappropriate information. If Mode ofNotification is Fax, then enterappropriate information for fax.CancelReset to the state as was on loadingNonethe page

3.1.2. Screen Flow

4. Business Rule Mapping

ActivityRulesCarrier IssuesCarrier Issue is the screen that needs to behandled by personnel skilled with theoperations of the PacAdvantage and thecoordination of data with the Carriers.All issues are entered and followed up for theresolution of the issue.

Benefit Partners

Process Specification

Billing

The purpose of this document is to describe the process of Billing. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_FI_001Finance - Business use caseSpecification - Billing

2. Process Identification

Billing is the process of creating the invoice for the Customers enrolled in the PacAdvantage program. The Invoice is on broad base classified into two—First Time Invoice (invoice to the group/member that has enrolled as new business) and Running invoice or periodic invoice (To the existing Group/Members).

2.2. Process Description

The objective of the Billing process is to:

1) Generate first time invoice to the groups/members who have enrolled as new business. The invoice should get all the information about the group/member prior to invoicing. Generation of first time invoice is an automated process and should be triggered on completion of group/member enrollment.2) Generate running invoice or periodic invoice to the existing groups/members. All the information about the existing group/members and their real time transaction details are required to invoice correctly.

This billing sub module also needs to have a feature to incorporate the following.

Suppress periodic Bill for a specific Group/Member or collective group and members

Preview invoice prior to creation of actual invoice.

Suppress late fee for a specific Group/Member or collective group and members

Calculate Reinstatement Fee for a specific Group/Member or collective group and members

Include feature to add dynamic content on the bills sent to the for a specific Group/Member or collective groups and members

Calculate additional fee for Credit card transaction if applicable.Calculate adjustment when there is retrospective change in Benefit Level (for the Carrier Selected) for group/member and make adjustments in the subsequent bill.

Calculate adjustment if the group/members have termed.

Generate manual invoice and preview invoices before generating them.All billing transactions would be period specific (i.e. the bills would be associated with the month of coverage). Invoices would be run only on a monthly basis, whatever is the billing frequency. For example if the billing frequency opted is quarterly. The excess amount would be adjusted as credits in the subsequent month's invoices.Invoice view/preview prior to generation of invoice needs to be provided in the Enrollment module.

2.3. Process Flow

Process For Billing—First Time Invoice1) Enrollment is completed for the new business prior to generation of First Time Invoice.2) All information relevant for billing (Generation of Invoice is gathered) These information areGroup IDGroup Billing AddressBilling information for the group like billing frequency, mode of payment and relevant information for mode of payment like EFT or Credit Card.Employees and Dependents informationMember countEmployer ContributionEmployee ContributionRaw Rate for Each of the Benefit Level for the specific Carrier selected by the employee (for specific Age bracket, Service Area, Coverage Choice with effective date)Rate differential based on member count (Group size) with effective dateAdmin fees for the specific group type with effective date.Agent commission that is defined in the Agent Info tab for the group if defined. Otherwise the default agent commission specified in the Carrier Maintenance Module (Agent Commission Fees) with effective date.Additional fees if any for the specific group type with effective date.

Process for Billing—Running Invoice (Periodic Invoice)1) Monthly or periodic invoice is sent to the existing group/members based on the Frequency selected by the group/member and the mode of communication preferred.2) Existing billing also gathers all information relevant for billing.3) In addition to this it also needs the previous invoice history to calculate the additional fees, late fees, reinstatement fees or as applicable.4) The running invoice generated is for the coverage period following the previous invoice period. I.e if the previous invoice was generated in the month of Jan. 5 2002 and for the coverage period February 2002, The invoice generate on Feb. 5 2001 would be for the coverage period March 2002,5) Billing should also calculate the Fees required for Credit Card transaction if applicable.6) Adjustment for Add On employee/dependent or member.7) Adjustment for Termed employee/dependent or member.8) Reinstatement fees Termed Group, employee/dependent or member are reinstated.9) Invoice once created by the system cannot be cancelled.

An invoice is considered closed only if the invoice has been reconciled. Hence all open invoices should be considered for late fee calculation.

3. User Interface

3.1. User Interface Screens

3.1.1. Suppress Batch Billing

Element NameElement TypeLabelPurposeBill PeriodOption BoxBill PeriodBill period for which batch billing is suppressedSelectedDisplay TextSelectedDisplays count of groups selected out of totalGroupsGroupsgroupsFilterGroup IdText BoxGroup IdTo filter groups based on group idGroup NameText BoxGroup NameTo filter groups based on group nameGroup TypeOption BoxGroup TypeTo filter groups based on group typeGroup SizeText BoxGroup SizeTo filter groups based on group sizeROE DateText BoxROE Date - ToTo filter groups based on ROE date of groupsRangeEffective DateText BoxEffectiveTo filter groups based on effective date of groupsRangeDate - ToRate TypeOption BoxRate TypeTo filter groups based on rate typeViewOption BoxViewTo filter groups based on whether batch billing issuppressed or notFilterCommandFilterRefreshes group selection table based on the filterenteredClear FilterCommandClear FilterClears the filter and displays all groups in thegroup selection tableGroupsSelectionFor selecting groups for export. Options forSelectionTableselection all groups, all groups in a page,deselecting all and selection inversion areavailable to the user.NewCommandNewClears the screenSaveCommandSaveSaves the suppressed groups information to thedatabase

Element NameAction/Validation DetailsMessageBill PeriodCheck to see that billing“Please enter a validperiod is not nullbilling period”

3.1.2. Group Auto Bill Suppressing

Element NameAction/Validation DetailsMessageBill PeriodCheck to see that billing period is“Please enter a validnot nullbilling period”

3.1.3. Manual Bill

ElementNameAction/Validation DetailsMessageBill PeriodCheck to see if bill period is not“Please enter a valid billnull and is validperiod”Group IdCheck to see if group id is not“Please enter a valid groupnull and is validid”AdjustmentCheck to see that the value for“Please enter a validTypethe filed is not null and is validadjustment type”AmountCheck to see that the value for“Please enter a validthe filed is not null and is validadjustment amount”PeriodCheck to see that the value for“Please enter a validthe filed is not null and is validadjustment period”

ElementElementNameTypeLabelPurposeAdjustment IdDisplay TextAdjustment IdDisplays unique system generated id for theadjustmentAdjustmentText BoxAdjustment DateAdjustment DateDateStatusDisplay TextStatusStatus of the adjustment: Open or ReconciledGroup IdText BoxGroup IdId of group for which adjustment entry is madeGroup TypeDisplay TextGroup TypeDisplays group typeGroup NameDisplay TextGroup NameDisplays group nameAssociationDisplay TextAssociationDisplays name of association if group is enrolledNameNamethrough oneGroup StatusDisplay TextGroup StatusDisplays status of groupAdjustmentOption BoxAdjustment TypeType of adjustmentTypeAmountText BoxAmountAdjustment AmountPeriodOption BoxPeriodPeriod for which adjustment entry is postedNewCommandNewClears screen for a new adjustment entrySaveCommandSaveSaves the adjustment entry to the databaseSearchCommandSearchProvides search functionality for adjustments

ElementNameAction/Validation DetailsMessageGroup IdCheck to see that the value for“Please enter a valid groupthe filed is not null and is validid”AdjustmentCheck to see that the value for“Please enter a validTypethe filed is not null and is validadjustment type”AmountCheck to see that the value for“Please enter a validthe filed is not null and is validadjustment amount”PeriodCheck to see that the value for“Please enter a validthe filed is not null and is validadjustment period”

3.2. Interface Flow

4. Business Rule Mapping

ActivityRulesI - First Time InvoiceBlendedFor Small Employer Group(New Business) Note: All new business falls under blendedrate only1.Check All the member for Small Employer Group2.Check the Employee Raw Rate for the Specific Line of Coverage for the (CarrierSelected) Benefit Level.3.Apply formula on the entire employee for all the line of coverage provided by the groupfor the (Carrier Selected) Benefit Level (Age Bracket, Coverage Choice and ServiceArea for the specific Employee). Refer Formula4.The Admin Fees, Agent Commission and Rate Differential Factor are governed by theeffective date. Apply the effective date for these fees with the Effective date for theGroup in deriving the Blended rate for the employees and the total amount payable bythe Group. However the Agent commission is based on the one provided at the grouplevel in the Agent Information Tab. It overrides the fee provided in the carriermaintenance agent commission fees.5.Check if the initial payment made by the group equals the Total amount as derivedabove. If not then check the difference. Allow for Reconciliation up to $2 without andauthorized intervention. For amount between $50-$3 Allow reconciliation based onsecurity. For amount above $50 allow reconciliation based on ultimate authority. (Thisrule governs if the group can be enrolled or not. Hence there should be an invoicepreview that identifies the Cash received and the total amount due for the new business)This should be viewable by all.6.The rate should be picked up based on the rules specified below:Check the Effective date for the Group (Initial enrollment date)Check the rate from the rate table whose effective date is latest but less than theeffective date of the Group. (E.g.) Group Effective date Mar. 1, 2001. Rate effective datesJan. 1, 2001 and Jul. 1, 2001. In this example since the group effective date is Mar. 1, 2001 the Ratepicked should be Jan. 1, 2001 effective date rate.7.Show the Employer Contribution and the Employee Deduction in the invoice summary.Billing Address should be picked up based on the billing address provided by the group.If billing address is not provided, then business address should be considered for billing.Also check the mode of communication. If the group prefers to be mailed emailed orfaxed and accordingly transmit the invoice. Refer Sample Invoice 1 for the SmallEmployer Group (New Business)Note: Small employer may bring in the COBRA members. Bill the COBRA membersseparately or along with the Group based on the decision made for billing the COBRAGroup.If the COBRA members are billed separately. Generate a separate invoice for the eachsubscriber COBRA members. Refer Rule for COBRA Member InvoiceHowever the bill for the COBRA members can be sent to the primary group if thatoption is selected.All COBRA Invoices whether billed to the primary group or the COBRA Group shouldhave a separate invoice for all the COBRA groups.For COBRA Members(New Business) Note: All new business falls under blended rateonly even for COBRA members brought by new business.1.Check the entire subscriber COBRA member for Small Employer Group (primaryGroup).2.Check Coverage Choice for the Subscriber member for each lines of coverage and alsonote that these line of coverage are selected by the Primary group.3.Check what are the line of coverage picked up be each of the members including thesubscriber member and their dependent.Note: The rate for the COBRA member should be based on the following rule.Identify the subscriber member line of coverage selected. The age, service area and thecoverage choice provided by the subscriber member is the governing rate.If the subscriber does not select the line of coverage that the dependent member haveselected. Check if the dependent member have relation ship as spouse or child/children.If the Relationship is spouse then the Spouse Age should be the deciding factor for therate and the coverage choice opted.If the relationship is child/children then the eldest dependent member should be thedeciding factor for the rate based on the Age.Note however in all the above cases the Service Area is governed by the Service area ofthe Subscriber COBRA member.Note: If the Primary COBRA member is a child they have their own Group ID andtheir own line of coverage and benefit level.For Individual(New Business) Note: All new business falls under blended rateAssociation Membereven for the individual association member.1.Individual association member can have dependent attached to the member.2.The rate for the individual association member is governed by the rate applicable for theGuaranteed association based on the effective date for the Association.3.The individual members can have the same line of coverage as defined by theassociation.4.The Admin Fee, Agent Commission, Additional fees and rate differential factor is asapplicable for the Association with the effective date.5.The calculation formula is the same as applicable for the employee of Small employergroup.6.The dependents for the individual association members are governed by what has beenselected by the subscriber individual association member.Small employer GroupNew Business) Note: All new business falls under blended rateaffiliated to associationeven for the Small employer group affiliated to an association.1.Small employer groups affiliated with an association have the same rules as applicableto the Small employer group with exception for the rate.2.The Admin fees, Agent commission, additional fees and Differential factor for the smallemployer groups affiliated with an association are as defined for the Association witheffective date for the Association.3.However the Agent commission is based on the one provided at the group level in theAgent Information Tab. It overrides the fee provided in the carrier maintenance agentcommission feesII - First Time Invoice FormulaBlended for Small Employer GroupBlended Rate = (Raw Rate * Differential Factor)/(1 − Agent Commission % − AdminFee %)ExampleIII - First Time Invoice FormulaBlended for COBRA MembersExampleIV - Running InvoiceBlended1.For Running invoice all that is applicable for first time invoice is applicable. In additionto that the running invoice has the following as well:2.Late fee if applicable: Late fee charges are 5% on the Amount due in the priorinvoices. The late fee calculation rule is as follows:Due Date:Postmark date:Received date:If the post mark date for cash receipt is available it should fall on or before due date.If postmark date is not available then if should check 5 calendar days backward from thedate received and see if it falls within the due date.If the amount is received within the due date as per the above rules and is short late feeis still applied for the shortage of premium.If the above two conditions are not satisfied then late fee is charged for the Group ormember.Note: Late fee is charged on the prior month's current premium(e.g.) Due date is 1stof every month or the first business day of the month. Whichever isapplicable. For example Feb. 1, 2001Date payment received : Feb. 1, 2001 No late feeDate payment received is Feb. 2, 2001 and post marked Jan. 31, 2001 No late feeDate payment received is Feb. 3, 2001 and post marked Feb. 2, 2001 late fee applicableDate payment received is Feb. 6, 2001 and postmarked date not available. Look 5 days behind forthe date for receipt. I.e Feb. 1, 2001 hence no late feesDate payment received is Feb. 8, 2001 and postmarked date not available. Look 5 days behind forthe date for receipt. I.e Feb. 3, 2001 hence late fees applicable.3.Balance forward if applicable: Balance forward is the amount balance from theprevious invoice or shortage of premium.4.Billing Adjustment: Billing adjustments can have various categories: Note Theadjustment can be positive or negative based on the coverage period.Employee Coverage Choice ChangeEmployee/Dependent Benefit Level(Selected carrier) changeEmployee/Dependent TerminationEmployee/Dependent Add OnRate for the Benefit Level Offered by the carrier changes retrospectively. I.e overwriting the previous effective date that was applicable for the group.5.Credit Card Payment transaction fee if applicable: Credit card transaction fee is2.5% of the total amount due for the group/member6.NSF Check if applicable: $25 handling fees is charged for the NSF check.7.Reinstatement fees: (Reinstatement fees are on the following assumption that on thedate of term all the previous balances on the group are settled.) The group needs to bereinstated on the date next to the term date. The Amount due for the reinstatement fromthe date following the term dates to the current month when the group is reinstated.(e.g.) Group Term Date: Feb. 31, 2001Date when the group was reinstated May 10, 2001Effective reinstatement date is Mar. 1, 2001. Reinstatement fees is calculated for the Period Mar. 1, 2001I.e. the month when the reinstatement occurred. The invoice contains the premium due forthe next month as well i.e. Jun. 1, 2001. However the current amount due is based on the currentperiod i.e. from Mar. 1, 2001 to May 31, 2001, Next months period Jun. 31, 2001 and reinstatement feesPercentage on the premium due when reinstatement occurred (The amount on which thereinstatement fees is calculated.)Note: Subsequent billing cycle would contain the Reinstatement Adjustments andReinstatement fees on reinstatement for the group/member.A reinstatement fee is 10% of the premium due when reinstatement occurred.V - RunningNon- BlendedInvoiceNote: The difference in the rules for non-blended and blended is in the rate calculationrules. The rest of the processes are same as for the blended.FormulaFormula for Non - Blended RatesThe formula for the premium calculation for the invoice Non - Blended is asfollows(Non-Blended)a) Raw Rateb) Agent Commission per Memberc) Agent Commission per Group based on group sized) Admin fee per Membere) Admin fee per Group based on group sizef) Additional Feesg) Differential factorMember Level Fees = Raw Rate + Member Count * (Agent Commission PerMember + Admin Fee Per Member)Note (If differential factor is applicable then Raw rate should be factored i.eRaw Rate * Differential Factor)Group Level Fees = Agent Commission per Group Size + Admin Fees perGroup sizeTotal Non Blended Premium Billed to Group =Member Level Fees + Group Level FeesExampleRaw Rate = $100Agent Commission per Member = $10Agent Commission per Group based on group size = $50 for Group size =>15Admin fee per Member = $10Admin fee per Group based on group size = $50 for Group size =>15Additional Fees = 10 % on Raw RateDifferential factorEmployee1 Member count including employee = 3Employee2 Member count including employee = 2Employee3 Member count including employee = 4Employee4 Member count including employee = 5Employee5 Member count including employee = 1Total Member count = 15Group size (=>15) = 15Member Level FeeEmployee1 = 100 + 3 (10 + 10) = $160Employee2 = 100 + 2 (10 + 10) = $140Employee3 = 100 + 4 (10 + 10) = $180Employee4 = 100 + 5 (10 + 10) = $200Employee5 = 100 + 1 (10 + 10) = $120Member Level Fees = $800Group Level Fees = $50 + $50 + $100Total Non Blended Premium Billed to Group =Member Level Fees + Group Level Fees = $800 + $100 = $900This formula is for the specific Benefit Level (offered by carrier) for a specific line ofcoverage and a specific employee/member.The total amount billed to group should include all the Rates after applying this formulafor all the employees/members and their line of coverage.FormulaFormula for Non - Blended RatesExampleThe formula for the premium calculation for the invoice Non Blended for CalCOBRA is as follows:Member Premium for Cal COBRA = Raw Rate * (1 + Additional fee %)Example:Member Premium for Cal COBRA = 100 * (1 + 0.10) = $110Amount Billed to COBRA Group = $110This formula is for the specific Benefit Level (offered by carrier) for a specific line ofcoverage and a specific employee/member.The total amount billed to COBRA Subscriber member should include all the Rates afterapplying this formula for all the members and their line of coverage.

Benefit Partners Inc

Process Specification

Cash Receipt

The purpose of this document is to describe the process of Cash Receipt. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_FI_002Finance - Business use caseSpecification - Cash Receipt

TermExplanationEFTElectronic Fund Transfer

2. Process Identification

Cash Receipt is the process of entering the cash received by BPI into the system. The cash receipt can be received in various modes as defined by the business process. Cash Receipt includes Lock Box receipts, Check, Credit Card, EFT and Transfer.

2.2. Process Description

This Cash Receipt sub module also needs to incorporate the following.1) Enter the lock box payment received as a batch process into the system2) Enter EFT payment received as a batch process into the system3) EFT payment made directly to Wells Fargo Bank4) On line payment using the Credit Card and Check5) User interface to make payment over phone by Credit card or Check6) Credit Card payment with automatic pulling of the cash or manually on request7) Handle negative check i.e. NSF's, Refund and Transfer.8) Transfer of cash from one group to the other.

This Cash Receipt sub module also needs to have a feature to incorporate the following.Batch the cash receipt based on the batch number defined.There should be ability to batch each of the modes of the payment received into a separate batch.For EFT, Credit Card, On Line Check and Lockbox payments there should be ability to upload the files into the system as one batch. Reconciliation will follow once the batch is imported and closed.In addition, prior entry of Lock box total entry made needs to tally with the lock box total.

This document details only one mode of cash entry namely, Manual Batch. Lockbox, EFT and payments through credit cards are detailed in their respective process specification documents.

2.3. Process Flow

Cash receipts into the system can be from the following sources:EFTCheck received at BPILock Box fileOn line Credit CardCheck or Credit card over phone

The cash received by any of the above mode is batched and entered into the system. The batch number is identified based on the mode of payment receipts. All batches should be identified uniquely with batch number and timestamp.

The Payment received are either entered manually into the system or uploaded into the system from the files available. The batch total and sum of the entries made in each batch should tally before saving the batch.

Batch date should represent the deposit date.

3. User Interface

3.1. User Interface Screens

3.1.1. Manual Cash Batch

3.2. Interface Flow

4. Business Rule Mapping

ActivitiesRulesBatch EntryUnique id should be created for each batched. The batchtotal should be tallied to the individual sum before savingthe batch. The batch id should be uniquely generatedprior to creation of batch. Each cash receipt should havethe postmark date, date received and the system date (I.ethe date when the batch is created) and batch total. Theline items within each batch should have a feature toSplit the payment for multiple group ids if required.Batch date should be the deposit data.Any entries made to the batch can be saved prior tocompletion of the batch entries. However there would bea status for the batch which would indicate if the batch isclosed or not. Modification can be done only to the batchesthat are open. Any batch that is closed cannot be modified.If there is an erroneous entry for the batch and the batchis saved. Only Transfer can be done and it is not allowedto delete the batch that are closed. Only the batches that areclosed can be reconciled.Batch by FileThe batch that are created by uploading the files like forUploadsLockbox, EFT or Credit Card will have an identificationthat payment for this batch was made by Lockbox, EFTor Credit Card. These batches are always closed.NegativeNSF would be entered into the system and there wouldCheck (NSF)be an indicator indicating that this batch is a NSF batch.TransferCash transfer may be due to the reason that the Cash hasbeen wrongly enter for the group to which the cash doesnot belong. In such cased entering negative cash receiptfor the Group for whom the cash has been wrongly enteredand making positive cash to the group to whom the cashbelongs makes the cash adjustment. There should be apositive and negative cash adjustment.ReturnsRefund would be a batch and would be handled similar tothe NSF Check.

Benefit Partners Inc

Process Specification

Cash Reconciliation

The purpose of this document is to describe the process of Cash Reconciliation. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_FI_003Finance - Business use caseSpecification - Cash Reconciliation

TermExplanationEFTElectronic Fund Transfer

2. Process Identification

Cash Reconciliation is the process of reconciling the cash receipts to individual invoices and reconciling the amount paid by the group.

The objective of the Cash Reconciliation process is to reconcile:1) Billed amounts and cash receipt2) Cash to negative cash3) Adjustment to cash4) Adjustment to billed amounts5) Billed amount to itself if the total due results in zero6) Adjustment to Adjustment

2.2. Process Flow and Description

Process for Cash Reconciliation:Reconciliation is the process of matching one to one the cash received on hand and the invoices that are open. The cash are received by numerous ways as described in BPI_CAS_FSD_FI—02 (Cash Receipt). The invoice is generated for the various groups/members based on the premium due. These invoices are matched with the cash receipts and reconciled.

The rule for reconciliation should be as follows:1. Look for the Negative Cash available and reconcile it with the positive cash (for NSF checks).2. Look for the oldest unreconciled invoice and reconcile with the oldest cash.

The reconciliation process should look through all the invoices that have not been reconciled for a specific group and reconcile the invoice that has the earliest date with the cash received. It should also match the Cash receipt with the invoice amount.

Note: reconciliation process is started automatically when the cash receipt batch is closed and it reconciles the cash received with the invoices.Billed amounts and cash receipt: This reconciliation process is to reconcile the invoice that has not yet been reconciled for the specific group and check if the invoice is earliest un reconciled invoice for the specific group and reconcile the invoice with the cash received form the group/member.Cash to negative cash: This is the process of reconciling the negative cash with the positive cash received from the group. This case arises when there is a NSF check and the group's invoice has been reconciled. The bank usually notifies NSF check and then NSF Cash receipt entry is created in the system. Now on receipt of a replacement check against the NSF check the NSF check is reconciled with the replacement check provided the amount tallies.Adjustments to Cash: This is the process of reconciling the cash receipt with the adjustment that may be available in the next invoice. Example: If the group has received the invoice for the next month and they have an employee termed this month after the generation of invoice. The generated invoice would not identify this adjustment for the termed employees as the employee was termed after creation of invoice. But the Group may deduct the adjustments for the termed employee and send the cash that would be short as they would sent the check with the adjustments. Hence this process should identify such conditions and adjust the cash receipt for the invoice with adjustment taken in to account. The next invoice would show the cash receipt and the adjustment for the employees termed. This process can also be coined as “Reconciled but not billed”.Adjustment to billed amounts: This process identifies the invoices that are already billed to the group and any adjustments that are not made in the current invoice needs to be adjusted in the next invoice with the adjustments made.Billed amount to itself if the total due results in zero: This is process identifies if the group is termed and the invoice is already created for the group for the next month. Invoice would be created for the termed group on group termination and would adjust that with previous invoice. There would always be a final invoice for the termed groups showing adjustments that would include refund, or short fall or zero balance.Adjustment to Adjustment: This process is for adjusting the late fee with late fee is waived, Reinstatement fees with reinstatement fee waive as the case may be. If the Late fee is shown in the previous invoice that can be adjusted by waiving late fee or reinstatement fees as applicable. Example: Late fees may be $25.00 and waive late fees would be $−25.00. Here adjustment to adjustment would be $25 to $25. Also adjustment needs to be made on invoice with invoice.

3. User Interface

3.1. User Interface Screens

Note: Reconciliation can have any of the possible combination provided below:1) Invoice to Invoice2) Invoice to Cash receipt3) Invoice to Adjustment4) Cash receipt to cash receipt5) Cash receipt to adjustment6) Adjustment to adjustment

Hence, the validation for the amount left to balance is done based on any of the combination selected from the check boxes.

Note: Adjustments would be shown only under special conditions where term has been initiated after generation of invoices and the group pays short taking this adjustments into account.

3.2. Interface Flow

4. Business Rule Mapping

ActivitiesRulesAutomatedAutomatic Reconciliation would be done on closing the batch for the cash receipt. If theReconciliationcash receipt batch were closed then it would start the reconciliation process.The following process would be auto reconciled:Billed amounts and cash receiptAdjustment to cashBilled amount to itself if the total due results in zeroAdjustment to billed amountsReconciliationReconciliation process would look for the earliest un reconciled invoice and reconciles itfor the Existingprovided it is less than $+_2.00.GroupsReconciliation would be as per the following sequence.Look for the Negative Cash available and reconcile it with the positive cash (for NSFchecks).Look for the oldest unreconciled invoice and reconcile with the oldest un-reconciledcash and so on.On Reconciliation the entire invoice, cash receipts would have a status as reconciled.ManualThis process would trigger reconciliation manually based on authority or if the user is tryingReconciliationto reconcile and specific cash receipts with the invoice as the case may be. Manualreconciliation can be does only for those invoices that has not reconciled automaticallyManualCash to negative cashReconciliationAdjustment to AdjustmentAny reconciliation that is not completed by automatic reconciliation process would bereconciled manually.Formula forGeneral formula for reconciliation would be as follows:reconciliationBilled amounts and cash receipt = (Invoice Amount − Cash Receipt)Adjustment to cash = (Adjustment − Cash Receipts)Billed amount to itself if the total due results in zero = (Invoice Amount + Invoice Amount)Adjustment to billed amounts = (Adjustment Amount + Invoice Amount)Cash to negative cash = (Cash receipt + cash receipt)Adjustment to Adjustment = (Adjustment + adjustment)General formula = (Invoice Amount + Adjustment Amount − Cash Receipt Amount)ExampleInvoice = $1000.00, Cash receipt = $−100.00, Cash receipt = $918.00,Adjustment = $−100.00, Adjustment = $−80.00Amount that can be Reconciled = 1000 − (−100) − (800) + (−100) + (−80) = 1000 + 100 − 918−100 − 80 = $2.00 This $2.00 is balance forward for the subsequent invoice.New BusinessExcluding COBRA and Individual Association Members who follow the reconciliation rulesReconciliationas per the Existing Group, the new business groups is auto reconcile if within $ +−2.00. Ifthe amount is short by $100.00 the invoice and the cash receipt would be reconciled and theshort fall would be balance forward in the next invoice. PacAdvantage Fund (A CashReceipt Batch auto generated by the system) would adjust this short fall. This would bebased on authority (Finance/GMS).Also for the new business the auto reconciliation process would apply to reconcile theInvoice Generated on successful enrollment with the cash receipt as initial enrollmentpayment.

Benefit Partners Inc

Process Specification

Risk Adjustment

The purpose of this document is to describe the process of Risk Adjustment. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_FI_007Finance - Business use caseSpecification - Risk Adjustment

TermExplanationEFTElectronic Fund Transfer

2. Process Identification

Risk Adjustment is the process of accessing the risk borne by each of the Carrier in paying for the claims submitted to them by members.

Risk adjustment factor is assigned to the Carrier. Based on these factors the carrier may be classified as Payers, Receivers or None (if no factor is assigned).

Payers are the one who pays in the risk adjustment amount to the Pool. Receivers are the one who receives the Risk Adjustment amount from the pool.

These risk adjustment factors are pre-defined by PacAdvantage.

2.2. Process Description

The objective of the Risk Adjustment process is to:1) Provide for upload of Risk Adjustment (RA) factors in the form of text files into PX2 system

The uploaded data would subsequently be used in cash disbursement reports for suggesting the amount to be paid out to carriers after application of RA factors.

The following are the other requirements that will be supported and constraints on the proposed system:1) The system will maintain a log of all zip codes and service area imports. The log information will include the user, the day & time of import, the file path & format and the status of the import.

2.3. Process Flow

Process for Upload of Risk Adjustment Factors1) The import file and an effective date for import are all input from the user.2) The system checks to see if the file data is per the format expected. If not, an error is reported.3) If data already exists for an effective date, the system prompts to the user as to whether it should overwrite the data or cancel the import.4) The system imports Risk Adjustment factors to its database.

3. User Interface

3.1. User Interface Screens

3.1.1. Risk Adjustment Factors Import

ElementNameAction/Validation DetailsMessageImportCheck to see that the value“Please enter a validFile Namefor the field is not nullimport file name”EffectiveCheck to see that the value for“Please enter a validDatethe filed is not null and is valideffective date”

3.2. Interface Flow

4. Business Rule Mapping

ActivitiesRulesRiskThe formula for risk Adjustment factor is as given below:AssessmentRaw Rate = Premium Amount (Raw Rate for Medical LineFormulaof coverage and the benefit level for the specific carrieropted by the member)Adjustment Factor = Fixed dollar amount per member count(can be negative or positive based on whether the Carrieris receiver or payer)Positive is the receiver and negative is the payer.Risk Adjustment amount = Raw rate + (Risk Adjustmentfactor * member count for that plan)ExampleAdjustment Factor = $ + 5.00 for Aetna (receiver)Adjustment Factor = $ − 2.00 for Health Net (payer)Employee 1 = $400 with (4 member inclusive ofemployee) AetnaEmployee 2 = $300 with (2 member inclusive ofemployee) Health netEmployee 3 = $200 with (1 member inclusive ofemployee) Health netFor Health net300 + (−2 * 2) + 200 + (−2 * 1) = 304 + 202 = 494.00For Aetna400 + (5 * 4) = $420.00Note:the adjustment factor has an effective date attach to it. Normally it is loaded once in 6 months.

Benefit Partners Inc

Functional Specification Document

Mail Merge

The purpose of this document is to describe the functional requirements for the Mail Merge module. This document provides a brief description of the module functionality and identifies all the integration points with other modules.

This document is to be read in conjunction with the BPI Scope document, which identifies all the business use cases for the proposed system. For each business use case or a set of logically related use cases, a detailed process specification document is prepared. The process specification document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output for each business use case. This document consists of forward references to all the process specifications associated with the Mail Merge module.

1.2. Scope Document Reference

This section provides the scope document references for the module.

Scope DocumentReferenceDocument DescriptionVersionBPI_SCOPEScope Document for BPI1.0BPI_SCOPE_ADDAddendum to the BPI scope document1.0

1.3. Process Specification Document Reference

This section provides the forward references to the process specification document for the module.

TermExplanationMail MergeMail merge is the process of populating predefinedtemplates with dynamic data to extract businesscorrespondences like quotes, letters to groups, agents etc.

2. Module Functionality

2.1. Brief Description

The Mail Merge module addresses the functionality of the system where it needs to generate business correspondences using predefined templates. The templates are basically RTF files with placeholders for dynamic data in them. The output is usually a RTF file, but at times this could be a PostScript or a PDF document. The diagram below illustrates the mail merge process. (See FIG. K-1)

Benefit Partners, Inc uses a lot of mail merge templates for their business correspondences. There are around 150 templates that are in use today.

The proposed system will also maintain a log of mail merge letters generated. The log information includes the template id, timestamp, triggering application, user generating the letter, and to whom the letter is addressed (i.e., which group or member or agent).

3.1. Brief Description

Benefit Partners, Inc would like to have functionality where a letter can be reproduced exactly as the original at a later point in time without having to store a whole electronic copy of the original letter. This functionality would be achieved by storing just the dynamic text that goes into generation of the original letter and the template used for the original letter in a persistent medium. When a letter has to be reproduced the template used for the original letter and the dynamic text are retrieved from the persistent medium and merged to produce a copy of the original letter.

3.2. Storing the Template

The proposed functionality requires the template used for generation of the original letter, to be available at the time of reproducing the letter. This would be achieved by versioning the templates whenever there is a change to template. All the versions of a template would be maintained, as electronic copies, for achieving the proposed functionality. The current version to be used for each template would be specifiable in a configuration file (XML).

3.3. Storing the Dynamic Text

The dynamic that goes into generated letter would be stored as an entity (column) in a database table. The dynamic text would be stored as a key-value pair that maps each placeholder in the template with the data that goes in the placeholder. The likely database structure for the table that holds the dynamic data is shown in the “Data Structures” section.

3.3.1 Implementation Notes

Since the size of the dynamic text is relatively huge and varying for different letters, it would be stored as a long field in the database. Most of the database implementations (especially IBM DB2 UDB) suggest that a table containing long fields be placed on a separate storage disk in order to avoid a performance hit. With an idea on the average number of letters generated by Benefit Partners, Inc, it is estimated that the data size growth would be at the rate of 3.5-5 GB per year.

3.4. Reproducing a Letter

The proposed functionality would require a new application to reproduce a letter. The user would be able to search previously generated letters using different parameters like date and time of generation of original letter, type of letter (welcome, term, reinstate etc), intended addressee etc. The system would fetch the version of template used, retrieve the dynamic text from the database and reproduces the letter.

3.4.1.1 Screen Fields Explanation

4. Mail Merge Templates

The following table lists out the mail merge templates to be used in the proposed system.

Note: Unless specified otherwise, delivery mode is addressee's preferred mode of communication.

Benefit Partners Inc

Process Specification

Reports

The purpose of this document is to describe the process of Reports and reporting the information and the data available in the system. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_REPReports

2. Process Identification

2.2. Process Description

The objective of the Reports is to provide information captured in the system to the user in a presentable manner.

The reports can be single, two-dimensional and multi dimensional providing the information to the decision-maker.

The objective of reporting is to paint that picture by analyzing and interpreting vast quantities of data-customer demographics, cross-sales, service calls, Internet experiences and online transactions—turning information into insight and developing conclusive, fact-based strategies to gain that competitive edge.

Reports are categorized based on the modules and the purpose of the reports.

2.3. Process Flow

All reports can be classified based on the following criteria:Purpose of Report: Briefly outline the intended use and the purpose of the report and what information it is to provide.Intended Audience/Delivery To: This specifies the intended audience for the report and to whom the report is to be delivered. The can be ranging from President, Vice President Operations, Managers and CFO's and BPI Team.Frequency of reports (Monthly, Weekly daily etc.): The frequencies of reports are based on whether the reports are Automated or Manual. All automated reports would have the frequency for delivery (Monthly, Weekly etc.). Manual reports does not have any frequency and can also be called as adhoc report, which is reported on the screen in the form of HTML when, required by the user.Mode of Delivery: All automated reports are delivered via email to the users defined as the intended audience. Adhoc reports are viewable on the screen and can be printed in HTML format.Output Format (HTML, XL or RTF): Output Format can be XL, HTML or RTF. The formats are based on the report type. All reports that are automated are in XL format. The reports that are manual or Adhoc are in HTML format.User Interface required for the report or not: Adhoc Reports and manual reports require user interface to generate the report. These reports are generated in HTML format.Automated reports does not require User interface.Input to the system (Input parameters): This defines the input parameters required to generate the Report. Input can be based on single parameter, Multiple parameters with and/or Conditions.Expected Output of the report (Output Parameters): This defines the output of the report. The output can be single dimensional or multi dimensional.Output can also be based on certain logic's, calculation and comparative reports or derivative of two or more reports summarized.

The reports that are generated automatically should be delivered to the intended audience via email. Also all the generated reports should be store under some file path in a systematic manner (may be time stamp and report ID) and logged in file or Database (preferably in database) so that we can retrieve the reports retrospectively from this file path.

3. User Interface

3.1. User Interface Screens

3.1.1.1. Screen Snapshot

This is a generalized screen for all the reports. This screen can be split into two parts, one as an input parameter to obtain the desired report and the second part is the report itself. (See FIG. L-1)

ElementElement NameTypePurposeModule IDTextDescribes the name of the module thereport is extracted from.Report nameTextName of the reportReport IDTextID of the ReportParametersTextSpecifies the input parameters for the reportParameterEntry FieldSpecifies the entry fields for the parametersEntriesFetch reportHTMLButton to fetch the report based on theButtoninput criteria

3.1.2. Help Menu

3.2. User Interface Screens

This is a generalized screen for all the reports. This screen can be split into two parts, one as an input parameter to obtain the desired report and the second part is the report itself.

ElementElement NameTypePurposeModule NameTextDescribes the name of the modulethe report is extracted from.Report nameTextName of the reportReport IDTextID of the ReportReport DescriptionTextBrief Description of the reportReportHTMLHTML Table Containing the ReportTableBackHTMLButton to navigate back to the PreviousButtonPage. (INPUT for the Report)

Element NameAction/Validation DetailsMessageReportThe HTML Table for the report isNonedynamic and based on the report canbe single or multi dimensional.BackHTML Button to navigate to theNoneprevious screen (Input Screen)

3.2.2. Help Menu

Element NamePurposeValid ValuesReportShows theBased on the report the outputgenerated reportscan be single of multi dimensional.

4. Business Rule Mapping

Report IDBPI_CAS_REP_CM_001Report NameRates in different formatPurpose ofThis report is used to show the rates forReportthe various health products offered by CarrierDelivery ToCarriers and All BPI usersFrequencyNon periodicMode ofNoneDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to report1. Eff_Date2. Carrier_ID3. Plan_Type_ID4. Benefit_IDOutput of theProduct Name, Product Name, Rates for EmployeeReportOnly, Employee and Spouse, Employee andDependents, Employee, Spouse and Dependents.

Report IDBPI_CAS_REP_CM_002Report NameComparison on the current rates providedby the carrier with past rate.Purpose ofThis report is to compare the current rate offered byReportthe carrier with their previous rates based ona specified period.Delivery ToPacAdvantage and All BPI usersFrequencyNon periodicMode ofNoneDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to report1. Eff_Date2. Carrier_ID3. Plan_Type_ID4. Benefit_ID5. Eff_Date16. Carrier_ID17. Plan_Type_ID18. Benefit_ID1Output of theProduct Name, Product Name, Rates for EmployeeReportOnly, Employee and Spouse, Employee andDependents, Employee, Spouse and Dependents.

Report IDBPI_CAS_REP_CM_003Report NamePlan availabilityPurpose ofThis report is used to show the plan availabilityReportfor the specified carrier in a Zip's available inCalifornia.Delivery ToCarriers and All BPI usersFrequencyNon periodicMode ofNoneDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to report1. Eff_Date2. Plan IDOutput of theProduct Name, Carrier name,ReportZIP, Effective Date and Rating Region.

Report IDBPI_CAS_REP_CM_005Report NameZIP Codes with No CoveragePurpose ofThis report is used to show the Zip's inReportCalifornia where there is no coverage.Delivery ToCarriers and All BPI usersFrequencyNon periodicMode ofNoneDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportEFF_DATE,LOC_ID.Output of theZIP, Effective Date of Plan non-Availability.Report

Report IDBPI_CAS_REP_CM_006Report NamePlan Changes - Member EffectedPurpose ofWhen there is a change in the plan availabilityReportin a specific ZIP code and or County or whenevera plan ceases to exist report about the entire memberin the specific ZIP or County with that planshould be listed.Delivery ToCarriers and All BPI usersFrequencyNon periodicMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomated/Should be triggered by Plan changesManualInput to reportEFF_DATE,PLAN_IDOutput of theGroup name, Group ID, Member Name, MemberReportSSN or Unique ID, Member Benefit Level,Coverage Choice, ZIP, County, Service Area

Report IDBPI_CAS_REP_CM_007Report NameConsolidated report on Rate Classification sortedby Rate Type (Admin, Agent Commission,Additional fees and Differential Factor)Purpose ofTo report on the Fees structure for the rateReportClassification based on the Admin fees, AgentCommission Additional fees and differential factor.Delivery ToAdhocFrequencyNon periodicMode ofnoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportPARAMEFFDATEOutput of theRate Type - Blended:ReportGroup Type, Agent Commission, Admin Fee,Rate Type - Non Blended:LOC Type, Group Type, Group Size, PerMember Flat Amt, Per Group Flat Amt,Differential Factor:Group size down limit, Group size up limit,Differential factor.

4.2. Module Name: Sales and Marketing

Report IDBPI_CAS_REP_SM_001Report NameSold Group Details for Period SpecifiedPurpose ofThis report is used to show the Total GroupsReportsold for a specified effective date and also show thecumulative sales up to dateDelivery ToBSS Manager, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManual and AutomatedManualInput to reportEffective DateOutput of theGroup Name, Group ID, Writing Agent Name,ReportMarketing Source, Contact Date, ActiveSubscribers Count, Active Dependent Count

Report IDBPI_CAS_REP_SM_002Report NameSold Group Details for PeriodSpecified based on Group TypePurpose ofThis report is used to show the Total Groups soldReportfor a specified effective date and also show thecumulative sales up to date for a specific group typeDelivery ToBSS Manager, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManual and AutomatedManualInput to reportEffective Date, Group TypeOutput of theGroup Name, Group ID, Writing Agent Name,ReportMarketing Source, Contact Date, SubscribersCount, Dependent Count

Report IDBPI_CAS_REP_SM_004Report NameComparison between case sold CurrentMonths and Previous Year Current MonthPurpose ofThis report is used to compare the CaseReportsold in the current month with the cash sold in theprevious year current month.Delivery ToBSS Manager, Vice President Operations, PresidentFrequencyMonthlyMode ofemailDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManual/AutomatedManualInput to reportEffective DateOutput of theGroup Type, Current New Groups, Current NewReportSubscribers, Current New Dependents, CurrentNew Member, Prior Year Current New Groups, PriorYear Current New Subscribers, Prior YearCurrent New Dependents, Prior Year Current NewMembers, This Month New Subscribers % ofTotal, This Month New Groups % of Total,% of Change from Prior Year

Report IDBPI_CAS_REP_SM_005Report NameGroup Enrollment With line of CoveragePurpose ofThis report is used to identify the groups enrolledReportwith each line of coverage based on effective date.Delivery ToBSS Manager, Vice President Operations, PresidentFrequencyMonthlyMode ofemailDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManual/AutomatedManualInput to reportEffective DateOutput of theGroup Type, Year To Date Groups, Year To DateReportSubscribers, Year To Date Dependents, YearTo Date Members, Current New Groups, CurrentNew Subscribers, Current New Dependents,Current New Members, Current Terminated Groups,Current Terminated Subscribers, CurrentTerminated Dependents, Current TerminatedMembers, Net Gain/Loss Groups, Net Gain/LossSubscribers, Net Gain/Loss Dependents,Net Gain/Loss Members

Report IDBPI_CAS_REP_SM_006Report NameLeads by Source for Specified PeriodPurpose ofThis report is used to identify the leads generatedReportbased on the source sub type for the specified period.Delivery ToBSS Manager, Vice President Operations, PresidentFrequencyWeekly, MonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceYesRequired Yes/NoAutomated orManual/AutomatedManualInput to reportDateOutput of theSource Code, Last 12 Months Lead Given, LastReport12 Months Lead Sold, Last 12 Months CloseRatio, Last 90 Days Lead Given, Last 90 days LeadSold, Last 90 Days Close Ratio, This MonthLead Given, This Month Lead Sold,This Month Close Ratio,

Report IDBPI_CAS_REP_SM_008Report NameQuote TrackingPurpose ofThis report is used to track the quotes generatedReportper week to the quotes converted to sales.Delivery ToBSS Manager, Vice President Operations,PresidentFrequencyWeekly, MonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceYesRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theFor Quote Generation and Groups SoldReport(Last 30 days, Last 90 days, Last 120 dayand Last 365 days)

Report IDBPI_CAS_REP_SM_009Report NameQuote With 10 or More employeesPurpose ofThis report is used to track the quotes with 10Reportor more employees for follow up.Delivery ToSales TeamFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theQuote No, Company Name, Agent Name, EEReportCount, Quote Date, Quote Rev, Lead No,Source Sub Type

Report IDBPI_CAS_REP_SM_010Report NameSales with 10 of More employeesPurpose ofThis report is used to track the sales with 10 or moreReportemployees for follow up and customer service.Delivery ToSales team, GMS TeamFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequiredYes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup Number, Company Name, Writing Agent,ReportEmployee Count, Effective Date, Quote Number,Lead Number, Source Sub Type

Report IDBPI_CAS_REP_SM_011Report NameQuote by Sales Rep/Work GroupPurpose ofThis report is used to track the quote generatedReportby sales rep belonging to a specific work group.Delivery ToBSS Manager, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theWork Group Name, Date Quoted, Company Name,ReportAgent ID, Marketing Source, Proposed EffectiveDate, EE count.

Report IDBPI_CAS_REP_SM_018Report NameList of Agent with Agencies along with GroupPurpose ofThis report is used to provide information on aReportagencies and the groups and members attachedto the agent/agenciesDelivery ToAll BPIFrequencyAdhoc/MonthlyMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDate,Agency IdOutput of theGroup ID, Group Name, Address, Suite, City,ReportState, Zip, Phone, Email, Group Effective Date,Group ROE Cycle, EE count, DEP count

Report IDBPI_CAS_REP_SM_022Report NameHot and Cold AgentsPurpose ofTo report on the agent based on the agents businessReportwith PacAdvantageDelivery ToBSS Manager, Vice President Operations, PresidentWeekly to each BSU rep in their work group.FrequencyAdhocMode ofnoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDateOutput of theAgent Id, New Agent, Agent Name, Agent Type,ReportBusiness Generated Leads/Conversion, MemberCount, Workgroup, Period

Report IDBPI_CAS_REP_EN_001Report NameEnrollment By PlanPurpose ofThis report is used to provide information on enrollmentReportby Benefit Level for each line of coverageDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportEffective DateOutput of thePlan Name, Plan Type, Line of Coverage, prior monthReportTotal members, Current month New Subscriber, Currentmonth dependent, current termination, current month netgain and loss, total members active last month + net gainand loss, number of members Currently enrolled, Thismonth new subscription % and % change from previousmonth.

Report IDBPI_CAS_REP_EN_002Report NameEnrollment By CountiesPurpose ofThis report is used to provide information on enrollmentReportby Counties for each line of coverageDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theState, County, Plan Type, Line of Coverage, ActiveReportMember last period, New Subscriber Current Month, NewDependent Current Month, Terminated Current Month,Net gain/Loss, System generated Currently EnrolledCount. Currently Enrolled Active Subscribers and ActiveDependents.

Report IDBPI_CAS_REP_EN_005Report NameMonthly Individual Application received and processesPurpose ofThis report is used to provide information on Applica-Reporttions received and processed on weekly/monthly basis.(This report is based on mail room entry)Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL, HTMLUser InterfaceYesRequired Yes/NoAutomated orAutomated, ManualManualInput to reportApplications received DateOutput of theLine Of Coverage, Small Employer Group - Subscribers,ReportSmall Employer Group - Dependents, COBRA Sub-scribers, COBRA dependents, Association Subscribersand Association dependents.

Report IDBPI_CAS_REP_EN_006Report NameTotal Enrollment By Benefit Level (Carrier Offered)Purpose ofThis report is used to provide information on total enroll-Reportment based on the benefit level offered by carriers.(Small Employer Groups)Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportEffective DateOutput of thePlan Name, Plan Type, Active Last Period, This PeriodReportNew Subscribers, This Period New Dependents, ThisPeriod Terminated, This Period Net Gain Loss, ActiveSubscribers, Active Dependents

Report IDBPI_CAS_REP_EN_008Report NameGroup applications Declined by reasonsPurpose ofThis report is used to provide information on GroupReportApplications declined based on specific reasons.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theReasons for Decline, # of Group Application, # of Asso-Reportciation Application, # of COBRA Application.

Report IDBPI_CAS_REP_EN_009Report NameMember Termination SummaryPurpose ofThis report is used to provide information on MembersReportTermed.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup Type, Subscriber Terminated this Period, DependentReportTerminated this period, Members Terminated this period

Report IDBPI_CAS_REP_EN_010Report NameGroup Termination SummaryPurpose ofThis report is used to provide information on GroupsReportTermed.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup Type, No of Groups terminated this period,ReportSubscriber Terminated this period, Dependent Terminatedthis period, Members Terminated this period.

Report IDBPI_CAS_REP_EN_011Report NameNew Group SummaryPurpose ofThis report is used to provide information on NewReportGroups Enrolled during Current PeriodDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup Type, New Groups, New Subscribers, NewReportDependents, New members

Report IDBPI_CAS_REP_EN_012Report NameNew Employees and Add-On SummaryPurpose ofThis report is used to provide information on NewReportEmployees and Add On'sDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup Type, New Subscribers, New Dependents,New members Report

Report IDBPI_CAS_REP_EN_013Report NameGroup Termination details for a specific group size.Purpose ofThis report is used to provide information on termedReportGroups by Group SizeDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theSmall Employer Group Term reasons, Writing Agent,ReportGroup Size (<=4, 5-9, 10-14, 15-24, 25-29, 30>=) TotalGroups, Total Members, Total Subscriber and TotalDependent.

Report IDBPI_CAS_REP_EN_014Report NameMember Demographics by Age BucketPurpose ofThis report is used to provide information on MemberReportdemographics by age bucketDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theAge and gender, Line of Coverage, Group type, NewReportSubscriber this period, New Dependent This period,New Member this period, Total Subscriber, totaldependent, total member Age of enrolled member(<=29, 30-39, 40-49, 50-59, 60-64, 65>=)

Report IDBPI_CAS_REP_EN_015Report NameMember Demographics for Newly Enrolled membersPurpose ofThis report is used to provide information on newlyReportenrolled member by member demographicsDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theAge and gender, Line of Coverage, Group type, NewReportSubscriber this period, New Dependent This period,New Member this periodAge of Newly enrolled subscriberAge of enrolled member(<=29, 30-39, 40-49, 50-59, 60-64, 65>=)

Report IDBPI_CAS_REP_EN_017Report NameGroup Enrollment by group type with and without agentPurpose ofThis report is used to provide information on enrolledReportGroup with/without agent.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup Type, With agent or without agent, GroupReportCount, Total active subscribers, Total activeDependents, This Period New groups, Thisperiod new Subscribers, This period Add ons, Thisperiod terms, Net gain and loss, No of SEG Groups,No of Cobras, No of Associations.

Report IDBPI_CAS_REP_EN_018Report NameAging Report for Pending statusPurpose ofThis report is used to provide information on performanceReportby duration for Received applications and pending up todate. (i.e. how many applications and whattype are in pend status.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyDailyMode ofEmailDeliveryOutput FormatXL, HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDateOutput of theProcess Type, Reference_ID, Date Started, StartedReportBy, Work group, Days in Pending Status.

Report IDBPI_CAS_REP_EN_021Report NameDefine ContributionPurpose ofThis report is used to provide information on groupReportenrolled by Contribution Type for Small EmployerGroupDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theEmployer Defined Contribution, Product Type,ReportContribution Type, Contribution Amount, GroupsCurrent Month, Groups Calendar Year to Date

Report IDBPI_CAS_REP_EN_023Report NameReport on Other's Remarks form all the screensPurpose ofThis report is used to provide information on NewReportremarks that needs to be added in to the systemDelivery ToIT, VP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofManualDeliveryOutput FormatXL , HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportScreen IDOutput of theModule Name, Element Name, Remarks/OthersReport

Report IDBPI_CAS_REP_EN_026Report NameEmployee and Members by Line of CoveragePurpose ofThis report is used to provide information on employeesReportlives by line of coverage and member per group by lineof coverage.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theLine of Coverage, Employees Count, DependentReportCounts, member CountsNumber of Members Per group/Line of Coverage.

Report IDBPI_CAS_REP_EN_030Report NameUn Insured Groups and employeesPurpose ofThis report is used to provide information on Groups andReportEmployees Enrolling without prior coverage.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDate.Output of theEmployee Count Active up to date without prior Coverage,ReportEmployee Count up to date without prior CoverageCurrent Employee Count without prior coverage, CurrentEmployee Count Termed without prior coverage.

Report IDBPI_CAS_REP_EN_030Report NameUn Insured Groups and employeesPurpose ofThis report is used to provide information on Groups andReportEmployees Enrolling without prior coverage.Delivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXL,User InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDate.Output of theEmployee Count Active up to date without prior Coverage,ReportEmployee Count up to date without prior CoverageCurrent Employee Count without prior coverage, CurrentEmployee Count Termed without prior coverage.

Report IDBPI_CAS_REP_EN_032Report NameROE ReportPurpose ofThis report is used to provide information on Ad On,ReportChange after and before ROEDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportOutput of theGroup Id, ROE Status, ROE Result, Date Received RequalReportInfo, Date Postmark Requal info type, No of Employees,No of COBRA'S.

Report IDBPI_CAS_REP_EN_033Report NameCarrier issues by Carrier and By issuesPurpose ofThis report is used to provide information on CarrierReportIssues by Issues and By CarrierDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theCarrier Name, Carrier Issue Reported, Carrier Issue -ReportActual, Date Received, Date Resolved, Total Days Toprocess

Report IDBPI_CAS_REP_EN_035Report NameCOBRA Enrollment by COBRA TypePurpose ofThis report is used to provide information on COBRAReportEnrollment by COBRA type and by Line of CoverageDelivery ToVP Finance, Vice President Operations, PresidentFrequencyMonthlyMode ofEmailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theCOBRA Type, No of New COBRA's GroupsReportSubscribers & Dependents - for Current andEnrolled Total

Report IDBPI_CAS_REP_EN_037Report NameEmployee Status up to datePurpose ofThis report is used to provide informationReporton Employee Status up to date.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportGroup IDOutput of theGroup Id, Group Name, EmployeeReportSSN, Employee Name,Employee Status Up to date, Effective Date

Report IDBPI_CAS_REP_EN_038Report NameEmployer/Group Status (Including COBRA andSmall Employer and Individual AssociationMember and Association group)Purpose ofThis report is used to provide information onReportGroup Level Status up to date.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportGroup IDOutput of theGroup ID, Group Type, Employee Status Up to date,ReportEffective Date, Employee Count, Member Count.

Report IDBPI_CAS_REP_EN_039Report NameCOBRA/Cal COBRA Status up to datePurpose ofThis report is used to provide information onReportCOBRA/Cal COBRA Status up to date.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportGROUP IDOutput of theParent Group Id, Parent Group Name, AnniversaryReportDate, COBRA Group Id, COBRA GroupName, COBRA type, Status Up to Date, EffectiveDate, Member Count, COBRA Tenure,COBRA End Date

Report IDBPI_CAS_REP_EN_040Report NameAssociation Group and Member CountsPurpose ofThis report is used to provide information onReporta specific association and the Groups andindividual members affiliated with the AssociationDelivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportAssociation IDOutput of theAssociation ID, Association name, AssociationReportType, Association Group Type, GroupID/Member ID, Employee SSN, Employee Name,Status Up to Date, Effective Date of Status,Anniversary Date, Employee Count, Member Count

Report IDBPI_CAS_REP_EN_041Report NameCarrier Issues for a specific Carrier (Member Level)Purpose ofThis report is used to provide information onReportCarrier Issues on a specific carrier.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportCarrier IDOutput of theCarrier ID, Carrier Name, List of Member forReportthe carrier specified with SSN # or ID, Date ofBirth, Effective Date with the carrier, Plan Optedby Member, Transmission status, TransmissionDate.

Report IDBPI_CAS_REP_EN_043Report NameReport on Transaction History forEnrollment (Group Level)Purpose ofThis report is used to provide informationReporton the History of all the transactions and changes(Enrollment) made on the group up to date.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportGroup IDOutput of theGroup Id, Group Name, Group Type, Nature ofReportTransaction, Transaction Description, EffectiveDate, User Id

Report IDBPI_CAS_REP_EN_044Report NameReport on Transaction History forEnrollment (Employee Level)Purpose ofThis report is used to provide information onReportthe History of all the transactions and changes(Enrollment) made on the employee up to date.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportGroup IDOutput of theGroup Id, Group Name, Group Type, Employee ID,ReportEmployee SSN, Nature of Transaction,Transaction Description Effective Date, User Id

Report IDBPI_CAS_REP_EN_045Report NameReport on Transaction History forEnrollment (Dependent Level)Purpose ofThis report is used to provide information on theReportHistory of all the transactions and changes(Enrollment) made on the dependent up to date.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportGroup IDOutput of theGroup ID, Group name, Group Type, Employee ID/ReportSSN, Dependent Id Dependent SSN, Natureof Transaction, Transaction Description,Effective Date, User Id

Report IDBPI_CAS_REP_EN_046Report NameAgent Change record for a specific groupPurpose ofThis report is used to provide information on theReportAgent Change record for a specific groupDelivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDateOutput of theAgent ID, Agent Name, Effective Change DateReport

Report IDBPI_CAS_REP_EN_047Report NameReport on ROE/OE on GroupsPurpose ofThis report is used to provide information on theReportGroups that underwent or is in process for ROE/OE.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDateOutput of theGroup Id, Group Name, Group Type, Effective Date,ReportProcess (ROE or OE), ROE/OE Date.

Report IDBPI_CAS_REP_EN_048Report NameReport on Blended Vs Non Blended GroupPurpose ofThis report is used to provide informationReporton the Blended Vs Non Blended Group.Delivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDateOutput of theGroup Id, Group Name, Group Type, Effective Date,ReportBlended/Non Blended, Blended GroupCount, Non Blended group Count

Report IDBPI_CAS_REP_EN_051Report NameReports on Group schedule to be termed.Purpose ofThis is to report on the Groups whoseReportare scheduled to be termed.Delivery ToVP Operations, GMS ManagerFrequencyMonthlyMode ofemailDeliveryOutput FormatXLUser InterfaceNoRequired Yes/NoAutomated orAutomatedManualInput to reportDateOutput of theGroup ID, Group name, Group Type, Work Group,ReportTerminated Date, Term Process initiationDate, Term Reasons, Days Pending

Report IDBPI_CAS_REP_FI_044Report NameEnrollment Transmission StatusPurpose ofThis report is used to show the status for the transmissionReportfor various external transmissions for a specified durationDelivery ToITFrequencyNon periodicMode ofNoneDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportFrom DateTo DateOutput of theTransmission Time and Date, Process Period, Data FormatReportTransmission Type, File Size, Record Count, Status.

Report IDBPI_CAS_REP_FI_016Report NameGroup and Premium transmitted to the CarrierPurpose ofTo report on the Groups and the premium transmittedReportto the carriers based on the member. (PremiumTransmission based on membersDelivery ToGMS, FinanceFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportStart DateEnd DateOutput of theEmployer Tax ID, Group ID, Employer Tax ID,ReportEmployee ID, Carrier ID, Year ID, Plan Code,Premium Code, Premium Billed Amt (as Sent),Premium Billed Amt (Translated), Premium AppliedDate, Premium Due Date, Geographic Area.

Report IDBPI_CAS_REP_FI_018Report NameFees Applied or Waived on Group LevelPurpose ofTo report on all types of fees applied and or waivedReportfor a specific group during the defined period.Delivery ToGMS, FinanceFrequencyAdhocMode ofnoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportStart DateEnd DateOutput of theGroup ID, Group Name, Fees Type, Fees Amount,ReportInvoice Number, Invoice Date, Reconciliation Status.

Report IDBPI_CAS_REP_FI_029Report NameSummary of unpaid CommissionPurpose ofTo preview all commission to be paid this period.ReportIncludes current period and those payable fromthe prior periods (previously pended). Sum ofCurrent amount will be equal to the cash balancereport for the commissions for the same period.Delivery ToCommission Specialist and CFOFrequencyRun after each Commission RunMode ofEmailDeliveryOutput FormatXLUser InterfacenoRequired Yes/NoAutomated orAutomatedManualInput to reportCommission PeriodOutput of theAgent ID, Commission payee, type, Period End Date,ReportPeriod, Commission fees.

Report IDBPI_CAS_REP_FI_033Report NameListing of an agent's groups and reconciliation historyfor the last 4 months invoices with current commissionpayable.Purpose ofTo report on the group's recent history, agent and totalReportcommission payable by agent and to show whatcommissions are currently payable. (Should be able to sort)Delivery ToCommission specialist, GMS, Finance and CFO and agentFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportDateAgent IDOutput of theAgent Id, Agent Name, Agent License, Group Id, GroupReportName, Enrolled Status, Invoices For 30 Days, Invoices For60 Days, Invoices For 90 Days, Invoices For 120 Days,

Report IDBPI_CAS_REP_FI_044Report NameFinance Transmission StatusPurpose ofThis report is used to show the status for the transmissionReportfor various external transmissions for a specified durationDelivery ToITFrequencyNon periodicMode ofNoneDeliveryOutput FormatXL or HTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportFrom DateTo DateOutput of theTransmission Time and Date, Process Period, Data FormatReportTransmission Type, File Size, Record Count, Status.

4.5. Module Name: Miscellaneous (Security, Work Group, Supply Request and Associates)

Report IDBPI_CAS_REP_ MISC_001Report NameUser Access right report from SecurityPurpose ofThis report is used to provide information on the userReportname, user roles, user groups and access rightsDelivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportUser IDOutput of theUser ID, User name, User roles, User group, Resource,ReportAccess rights.

Report IDBPI_CAS_REP_MISC_002Report NameReport on Work groupPurpose ofThis report is used to provide information on the workReportgroups and the Groups and member counts per workgroupDelivery ToAll BPIFrequencyAdhocMode ofNoneDeliveryOutput FormatHTMLUser InterfaceYesRequired Yes/NoAutomated orManualManualInput to reportWork group IDOutput of theWork Group ID, Work Group Name, Group Count,ReportMember Count

5. Interface Flow

This outlines the menu for the reports. (See FIG. L-3)

6. Data Structures

Not Applicable

Data Element NameData Element Type

6.1. Back End Validations

Not applicable

Field Element NameBack End Validation

Non Functional RequirementDetails

8. Access Control List

Benefit Partners Inc

Process Specification

Campaign

This functional specification document addresses the part of the sales and marketing system that would assign and track the marketing campaigns, which are made by BPI as part of their marketing efforts.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_SM.DOCSales & MarketingBPI_SCOPE_SM_01Create Sales Rep Master

2. Process Identification

2.1. Process Description & Flow

A marketing campaign is an initiative where an identifiable segment of potential employer groups are targeted through the media like the radio, newspaper, mailers etc. Benefit Partners organizes for the marketing campaigns through third parties or by itself periodically.

The details of a campaign initiative are captured in the system through the campaign master.

The campaign master provides information on the campaign, duration and the personnel associated with the campaign. The media through which a campaign is done is captured in the system using the source type and source subtype.

The source type defines the media through which a campaign can be conducted and the source sub type provides the information on the subcategory that may come under the source type.

The source type and source sub type are configurable and must be created in sequence of source type followed by source subtype. For associated source type and source subtype for a campaign, the details get reflected on the campaign master only if it is captured prior to creation the campaign master.

Creation and modification of a campaign master leads to generation of email to the internal and external sales reps.

The source type can be used as an input for marketing methods in the agent profile and as source in the employer group master on enrollment.

The responses received from a marketing campaign are captured in Employer Group Master.

This would typically help in analyzing the responses made to the marketing campaign and also provide necessary tracking information for future market campaign planning and decision-making on the effectiveness of the campaign. This would provide a tracking mechanism that would measure the affect that an ad or ad campaign has on brand and/or company awareness, interest, attitude and enrollment conversions.

The internal sales rep makes a request for the welcome packets through the supply request

The flow diagram describes a typical flow on a campaign. The source type, source subtype and campaign can also be modified, viewed and inactivated.

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface ID: Source Type

3.1.2.3. Front End Validations

3.1.3. User Interface ID: Source Sub Type

3.1.3.3. Front End Validations

3.1.4.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextCampaignMandatory EntryWhen the “Save” HTML Button isNamepressed with an empty entry on theEntrycampaign name, an Error Dialog BoxFieldpops up with the message “Pleaseenter the Campaign Name” with“yes” option.On press of Yes Button, The cursormust be placed on the campaignname entry fieldImportMust be visible only if the source typeButtonselected has input source option asyesSaveOn clicking the save button or pressing theWhen the save HTML Button isenter key field with the cursor positioned onpressed with an empty entry on thethe save button, The data gets inserted to theCampaign, an error dialog box popspermanent repository.up with the message “Please enterValidation checks are done to not allow nullthe campaign name” If campaignvalue on the campaign name.name is not filled up and placementMust not allow duplicate entries for aof cursor in respective field.combination of campaign for a from date andFor duplicate entries, Error dialogto date for a combination of source type andbox - “Duplicate values not allowed.source subtypePlease enter again”Must not allow the length of the field entry toFor Invalid dates (fromgo beyond as per the database design for thedate - beyond - to date) orcolumn(To date - before - from date) - Errordialog box -Must choose the Source Type, Sub Type.“Please check the validity ofFrom date must not be less than the systemfrom and to dates” with Yes optiondate - caution messageFor invalid dates (from date, to dateFrom date must not be beyond the to date orless than the system date) - cautionto date must not be before the from date.message in an error dialog box -To date must not be lesser than system date -“Dates selected is before the systemcaution messagedate - is it valid entry?” with yes andno option. If Yes - acceptable and if -No - not acceptable.If the source type is not selected,then on press of the save buttonleads to error dialog box with errormessage “Choose Source Type”with Yes optionIf the source subtype is not selected,then on press of the save buttonleads to the error dialog box witherror message “choose the sourcesubtype” with Yes optionOn press of Yes on both cases, goesto the screen with the original valuesand enables the user to choose theSource Type or Source Subtype

3.1.5. User Interface ID: Modify Campaign Master

3.1.5.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextModify inMust choose a campaignWhen the modify button is pressedstep 1without choosing the campaign, errorscreendialog “Choose a campaign” with ayes option.CampaignNon Editable Campaign Name fieldNameTextImportMust be enabled only if the campaignButtonmaster create record has an inputsourceModifyOn clicking “Modify” button or pressing theWhen the “Modify” HTML Button isenter key field with the cursor positioned onpressed with an empty entry on thethe “Modify” button, the data gets modified toCampaign, an error dialog box popsthe permanent repository and makes the dataup with the message “Please enterof an input file of the previous entry inactive.the campaign name”Validation checks are done to not allow nullFor duplicate entries, Error dialogvalue on the campaign name.box - “Duplicate values not allowed.Must not allow duplicate entries for aPlease enter again”combination of campaign for a from date andFor Invalid dates (from date -to date for a combination of source type andbeyond - to date) or (To date -source subtypebefore - from date) - Error dialog box -Must not allow the length of the field entry to“Please check the validity of fromgo beyond as per the database design for theand to dates” with Yes optioncolumnFor invalid dates (from date, to dateFrom date must not be less than the systemless than the system date) - cautiondate - caution messagemessage in an error dialog box -From date must not be beyond the to date orDates selected is before the systemto date must not be before the from date.date - is it valid entry?” with yes andTo date must not be lesser than system date -no option. If Yes - acceptable and ifcaution messageNo - not acceptable.If the source type is not selected,then on press of the save buttonleads to error dialog box with errormessage “Choose Source Type”with Yes optionIf the source subtype is not selected,then on press of the save buttonleads to the error dialog box witherror message “choose the sourcesubtype” with Yes optionOn press of Yes on both cases, goesto the screen with the original valuesand enables the user to choose theSource Type or Source Subtype

3.1.6. User Interface ID: View Campaign Master

This screen below captures the information for viewing campaign masterStep—1: Choose the campaign for viewing navigates to the view campaign master screenStep—2: View the campaign master

ElementElementNameTypeLabelPurposeMain HeaderTextMain HeaderTo give the heading for the screen being“View“View CampaignnavigatedCampaignMaster”Master”CampaignTextCampaignText For “Campaign Name”NameNameCampaignTextCampaignNon Editable field for viewing campaignNameNamenameDescriptionTextDescriptionText for “Description”DescriptionTextDescriptionNon Editable field for viewing the descriptionSource TypeTextSource TypeText for “Source Type”Source TypeTextSource TypeNon Editable field for viewing the SourceTypeSource SubTextSource SubText for “Source Sub Type”TypeTypeSource SubTextSource SubNon Editable field for viewing theTypeTypeSource Sub TypeAssociatedTextAssociatedText for “Associated Workgroups”WorkgroupsWorkgroupsAssociatedNon EditableAssociatedContains the Workgroup list active for theWorkgroupsCombo BoxWorkgroupscampaignCombo BoxCombo BoxDurationTextDurationText for “Duration”From DateTextFrom DateText for “From”To DateTextTo DateText for “To”From DateTextFrom DateShows the from date for the campaignTo DateTextTo DateShows the to date for the campaign

3.1.6.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextView inMust choose a campaignWhen the view button is pressedstep 1without choosing the campaign, errorscreendialog “Choose a campaign” with ayes option.

4. Business Rule Mapping

Source Type

ActivityRulesCreate Source TypeShould have unique Id for a source Type - 10digits with an increment of 1, Say 0000000001,0000000002, 0000000003 and so on.

Source Sub Type

ActivityRulesCreate Source Sub TypeShould have unique Id 10 digit for a source subtype with an increment of 1, Say 0000000001,0000000002, 0000000003 and so on.

Campaign

ActivityRulesCreate Campaign MasterShould have unique Id 10 digit for a campaignwith an increment of 1, Say 0000000001,0000000002, 0000000003 and so on.

Benefit Partners Inc

Process Specification

Sales Master

This functional specification document addresses the part of the sales and marketing system that would deal with creation of master records for sales like the Lead master, Agent/Agency master.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_SM_002Agent MasterBPI_SCOPE_SM_003Agency MasterBPI_SCOPE_SM_006Lead Master

2. Process Identification

The user creates the sales masters which shall include lead master, agent master and agency master and has the ability to view, delete and modify apart from create function.

user can navigate to the screens from the content area or from the menus

The users also maintain tracking information of a lead in a lead master.

3. User Interface

3.1. User Interface Screens

<List SID and the Screen Name and Corresponding HTML File for the Screen.>

Corresponding HTML FileScreen ID (SID)Screen NameNamesales.leadmaster.creategeninfoLead Master Page 1 of 2LeadMasterCreate1.jspsales.leadmaster.createotherinfoLead Master Page 2 of 2LeadMasterCreate2.jspsales.leadmaster.searchSearch Lead MasterLeadMasterSearch.jspsales.leadmaster.viewView Lead MasterLeadMasterView.jspsales.agentmaster.creategeninfoAgent Master Page 1 of 2AgentMasterCreate1.jspsales.agentmaster.createotherinfoAgent Master Page 2 of 2AgentMasterCreate2.jspsales.agentmaster.searchSearch Agent MasterAgentMasterSearch.jspsales.agentmaster.viewView Agent MasterAgentMasterView.jspsales.agencymaster.creategeninfoAgency Master Page 1 of 2AgencyMasterCreategeninfo.jspsales.agencymaster.createotherinfoAgency Master Page 2 of 2AgencyMasterCreateotherinfo.jspsales.agencymaster.searchSearch Agency MasterAgencyMasterSearch.jspsales.agencymaster.viewView Agency MasterAgencyMasterView.jspsales.leadmaster.leadtrackLead TrackingLeadTrack.jsp

3.1.2. User Interface ID: Create Lead Master

This screen below captures the information for creating lead master.Step 1: Fill the mandatory information in page1. Click “Next” to navigate to page2.Step 2: Fill the mandatory information in page2 and click “Save” to save the Lead Master data.Step 3: Saving of Lead data takes you to Confirmation page.

3.1.2.3. Front End Validations

3.1.2.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen:

ScenarioDescriptionNextThe User can navigate to the next screen (page2).PreviousThe User can navigate to the previous screen (page1).SaveThe system checks for all the validations for all themandatory information filled up, the system successfullysaves the data.Upon saving the data, shows a Confirmation page to the user.CancelThe User can have the information reset to the original values

3.1.3. User Interface ID: Search Lead Master

3.1.3.1. Screen Name: Search Lead Master (BPI_CAS_SM_SCR—002—004)

This screen below captures the information for searching an existing “Lead”.Step 1: Enter the mandatory lead information and click the search button. This page will display the result of search. User can choose a lead and navigate to either “Modify” screen or “View/Delete” screen. (See FIG. M-14)

3.1.3.3. Front End Validations

ElementAction/ValidationError MessageNameDetailsTextLead IDMandatory. Any one of the fieldsError Dialog Box on Searchin the search screen is mandatory.“Accepts AlphanumericAccepts Alphanumeric values onlyvalues only.”

3.1.3.4. Screen Flow

The following are the scenarios the user may come across when operating on the search screen.

ScenarioDescriptionSearchThe system checks for all the validations for all the mandatoryinformation. Fetches the lead(s) that matches with the searchconditions.CancelClears the search fields

3.1.4. User Interface ID: Modify Lead Master

This screen below captures the information for modifying lead master.Step—1: Using search screen (BPI_CAS_SM_SCR—002—004), search the available Lead(s).Step—2: Select a Lead and click “Modify” to navigate to page1.Step—3: Modify the lead information and click “Next” to navigate you to page2.Step—4: Click the “Save” to save the modified lead information.Step—5: Saving of Lead data takes you to Confirmation page.

3.1.4.3. Front End Validations

3.1.4.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen:

ScenarioDescriptionNextThe User can navigate to the next screen (page2).PreviousThe User can navigate to the previous screen (page1).SaveThe system checks for all the validations for all themandatory information filled up, the system successfullysaves the data.Upon saving the data, shows a Confirmation page to the user.CancelThe User can have the information reset to the original values

3.1.5. User Interface ID: View & Delete Lead Master

This screen below captures the information for view/delete lead master.Step—1: Using search screen (BPI_CAS_SM_SCR—002—004), search the available Lead(s).Step—2: Select a Lead and click “View/Delete” to navigate to view/delete page.Step—3: Click the “Delete” to delete the lead information.Step—4: Deletion of Lead data takes you to Confirmation page.

DB Admin should only do Delete Lead Master. The “inactivation” of a Lead Master should change the status of Lead as “Dead”. The only other case for “Delete” as noted here would be to get rid of erroneous information added to the system; for this we should prompt for specific reasons as to why the Lead is being deleted. Upon deletion, the status of Lead is changed to “2” in DB.

3.1.5.3. Front End Validations

3.1.5.4. Screen Flow

The following are the scenarios the user may come across when operating on the step2 screen.

3.1.6. User Interface ID: Create Agent Master

This screen below captures the information for creating agent master.Step—1: Fill the mandatory information in page1. Click “Next” to navigate to page2.Step—2: Fill the mandatory information in page2 and click “Save” to save the Agent Master data.Step—3: Saving of Agent data takes you to Confirmation page.

3.1.6.3. Front End Validations

Element NameAction/Validation DetailsError Message TextFirst NameMandatory. Accepts all alphanumeric andError Dialog Box on SaveSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”.Last NameMandatory. Accepts all alphanumeric andError Dialog Box on SaveSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”.CompanyMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”ZipMandatory. Accepts exactly 5 numeric digits.Error Dialog Box “Acceptsexactly 5 digits number only”.Contact1 FirstMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”Contact1 LastMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”Contact1 ZipMandatory. Accepts exactly 5 numeric digits.Error Dialog Box “Acceptsexactly 5 digits number only”.InternalMandatory.Error Dialog on Save “IsworkgroupRequired”.

3.1.6.4. Screen Flow

The user enters the information on the agent master

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionSaveSaves the agent data and shows the userconfirmation page.NextNavigates to the page2.PreviousNavigates to the page1.CancelResets the information

3.1.7. User Interface ID: Search Agent Master

3.1.7.1. Screen Name: Search Agent Master (BPI_CAS_SM_SCR—002—013)

This screen below captures the information for searching an existing “Agent”.Step—1: Enter the mandatory agent information and click the search button. This page will display the result of search. User can choose a agent and navigate to either “Modify” screen or “View/Delete” screen. (See FIG. M-23)

3.1.7.3. Front End Validations

3.1.7.4. Screen Flow

The following are the scenarios the user may come across when operating on the search screen.

ScenarioDescriptionSearchThe system checks for all the validations for all themandatory information. Fetches the agent(s) thatmatches with the search conditions.CancelClears the search fields

3.1.8. User Interface ID: Modify Agent Master

This screen below captures the information for modifying agent master.Step—1: Using search screen (BPI_CAS_SM_SCR—002—013), search the available Agent(s).Step—2: Select a Agent and click “Modify” to navigate to page1.Step—3: Modify the Agent information and click “Next” to navigate you to page2.Step—4: Click the “Save” to save the modified agent information.Step—5: Saving of Agent data takes you to Confirmation page.

3.1.8.3. Front End Validations

Element NameAction/Validation DetailsError Message TextFirst NameMandatory. Accepts all alphanumeric andError Dialog Box on SaveSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”.Last NameMandatory. Accepts all alphanumeric andError Dialog Box on SaveSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”.CompanyMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”ZipMandatory. Accepts exactly 5 numeric digits.Error Dialog Box “Acceptsexactly 5 digits number only”.Contact1 FirstMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”Contact1 LastMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”Contact1 ZipMandatory. Accepts exactly 5 numeric digits.Error Dialog Box “Acceptsexactly 5 digits number only”.InternalMandatory.Error Dialog on Save “IsworkgroupRequired”.

3.1.8.4. Screen Flow

The user enters the information on the agent master

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionSaveSaves the agent data and shows the userconfirmation page.NextNavigates to the page2.PreviousNavigates to the page1.CancelResets the information

3.1.9. User Interface ID: View & Delete Agent Master

3.1.9.1. Screen Name: View & Delete Agent Master

This screen below captures the information for view/delete agent master.Step—1: Using search screen (BPI_CAS_SM_SCR—002—013), search the available Agent(s).Step—3: Select a Agent and click “View/Delete” to navigate to view/delete page.Step—3: Click the “Delete” to delete the agent information.Step—4: Deletion of Agent data takes you to Confirmation page.

3.1.9.3. Front End Validations

3.1.9.4. Screen Flow

The following are the scenarios the user may come across when operating on the step 2 screen.

3.1.10. User Interface ID: Create Agency Master

This screen below captures the information for creating agency master.Step—1: Fill the mandatory information in page1. Click “Next” to navigate to page2.Step—2: Fill the mandatory information in page2 and click “Save” to save the Agency Master data.Step—3: Saving of Agency data takes you to Confirmation page.
Page1 (BPI_CAS_SM_SCR—002—019) (See FIG. M-29)
Page2 (BPI_CAS_SM_SCR—002—020) (See FIG. M-30)
Confirmation page (BPI_CAS_SM_SCR—002—021) (See FIG. M-31)

3.1.10.3. Front End Validations

Element NameAction/Validation DetailsError Message TextCompanyMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”ZipMandatory. Accepts exactly 5 numeric digits.Error Dialog Box “Acceptsexactly 5 digits number only”.Contact1 FirstMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”Contact1 LastMandatory. Accepts all alphanumeric andError Dialog Box on SaveNameSpecial characters except double quotes.“Accepts all alphanumeric andSpecial characters exceptdouble quotes”Contact1 ZipMandatory. Accepts exactly 5 numeric digits.Error Dialog Box “Acceptsexactly 5 digits number only”.InternalMandatory.Error Dialog on Save “IsworkgroupRequired”.

3.1.10.4. Screen Flow

The user enters the information on the agent master

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionSaveSaves the agent data and shows the userconfirmation page.NextNavigates to the page2.PreviousNavigates to the page1.CancelResets the information

3.1.11. User Interface ID: Search Agency Master

3.1.11.1. Screen Name: Search Agency Master (BPI_CAS_SM_SCR—002—022)

This screen below captures the information for searching an existing “Agency”.Step—1: Enter the mandatory agent information and click the search button. This page will display the result of search. User can choose a agent and navigate to either “Modify” screen or “View/Delete” screen. (See FIG. M-32)

3.1.11.3. Front End Validations

Element NameAction/Validation DetailsError Message TextAgency IDMandatory. Any one of the fieldsError Dialog Box onin the search screen is mandatory.Search “AcceptsAccepts AlphanumericAlphanumericvalues onlyvalues only.”

3.1.11.4. Screen Flow

The following are the scenarios the user may come across when operating on the search screen.

ScenarioDescriptionSearchThe system checks for all the validations for allthe mandatory information. Fetches the agency(s)that matches with the search conditions.CancelClears the search fields

3.1.12. User Interface ID: Modify Agency Master

3.1.12.1. Screen Name: Modify Agency Master

This screen below captures the information for modifying agency master.Step—1: Using search screen (BPI_CAS_SM_SCR—002—013), search the available Agency(s).Step—2: Select a Agency and click “Modify” to navigate to page1.Step—3: Modify the Agency information and click “Next” to navigate you to page2.Step—4: Click the “Save” to save the modified agency information.Step—5: Saving of Agency data takes you to Confirmation page.

3.1.12.3. Front End Validations

3.1.12.4. Screen Flow

The user enters the information on the agent master

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionSaveSaves the agent data and shows theuser confirmation page.NextNavigates to the page2.PreviousNavigates to the page1.CancelResets the information

3.1.13. User Interface ID: View & Delete Agency Master

3.1.13.1. Screen Name: View & Delete Agency Master

This screen below captures the information for view/delete agency master.Step—1: Using search screen (BPI_CAS_SM_SCR—002—013), search the available Agency(s).Step—2: Select a Agency and click “View/Delete” to navigate to view/delete page.Step—3: Click the “Delete” to delete the agency information.Step—4: Deletion of Agency data takes you to Confirmation page.

3.1.13.3. Front End Validations

3.1.13.4. Screen Flow

The following are the scenarios the user may come across when operating on the step 2 screen.

3.1.14. User Interface Id: Lead Tracking

This screen below captures the lead tracking information of a lead and the lead tracking shall be a tab in lead master screens (See FIG. M-38)

3.1.14.3. Front End Validations

S NoPresent StatusCodePresent Status DescriptionNew1New Lead. The source of the lead could be a dataupload of leadsNew entries on a call from a group If there is a newentry on a call from a group, the status should be“New” with the Source Sub Type determining“Inbound Call.”Dead2The Lead is a dead leadRe Call3When a call is made to the lead and the lead isfound to reachable on a call but the rep is not ableto make contact/wherever a recall has to be madeProspect -No4When a lead is contacted and is found eligible - andQuote/the lead shows interest but doesn't want a quoteMaterialsProspect -5When a lead is contacted and is found eligible - andQuote/Materialsthe lead shows interest and wants a quoteSentPost Quote -6If the present status is not “Dead” then allow changeEnrollingto enrolling status if the lead is in the process ofenrolling (there could be instances where status 3and/or 4 and/or 5 have been skipped all-together)Post Quote -7The lead has enrolled and has been assigned aSoldgroup number

The present status shall be New (1) for a lead where the lead is new to the system and has not been followed up. The data is one that is uploaded into the system. There could be instances where the lead master is created when a lead calls up and this lead's status must be “New”

There shall be 6 sections Call status, Contact Result, Not-Qualified Lead Reasons, Qualified Lead Result, Not Interested Reason, Post Quote Result.

“Call Status” section is enabled when the Status is New (1) or Re-Call (3)

The Call status would have the radio buttons “Disconnected Number”, “Wrong Number”, “Unreachable”, “Made Contact”.

Contact Result

The contact result section shall have the following radio buttons “Qualified Lead” and “Non-Qualified Lead”

Non-Qualified Lead Reasons

The Non Qualified Reasons section shall have the following radio buttons “<2 eligible employees” and “>50 Eligible Employees”

Qualified Lead Result

The “Qualified Lead Result” section shall have the following radio buttons “Produced Quotes”, “No Quote at his Time”, “Not Interested”

Not Interested Reasons

The “Not Interested Reasons” section shall have the following options “Not up for renewal”, “Doesn't Want/Need/Provide Insurance”.

Post Quote

The Post Quote section shall have the following radio buttons

Select Radio ButtonResultEnrollingChange Status - Post Quote Enrolling(6)/LogNot EnrollingChange Status - Dead (2)/Show anentry field for entering the reasons/logSoldChange Status - Sold - Show an entryfield for entering the group number(7)/log

This section will contain the following

Status Log Non Editable Entry field with System Date

Notes Text Area

Add function

Table that would have columns—Log—Log date—Notes—Follow up Date

The Status Log area would automatically have status entries based on whatever choices are made on the screen/maintain log. The Notes Text Area shall contain the space for entering any notes during a call. The next follow up date would be a calendar for choosing the next follow up date.

There could be times when the status has not changed and the log would be empty but notes may be there. In such instances the notes is only added to the table along with follow up date

On adding the information, the information on the Log, Log Date, Notes and Follow up date gets added to the table and the user must save the information to have the data saved in the permanent repository,

When ever the user comes to the lead tracking, the previously made notes/log must be non editable.

The user must add the log entries/Notes or must be displayed with an error dialog “Kindly add the Status Log & Notes”

The user will not be allowed to quit without saving the information

When a user logs in, based on the access control The user is provided with a screen with a button “Things to do today” which shall also be part of the Menu.

The user is provided with the user information to choose from and on selection of the same and confirming the user goes into the “Things to do Today Area”

The user would be provided with a report and with the functionality to print the same.

The report content shall be based on the following based on the follow-up date made by the user in all leads

Details Of lead—Company Name, Contact Name, Phone, Status and “Lead Info” button which on pressing would lead to the opening of the lead master in another window.

A check box to confirm a call has been made

The report would be in scrollable table with check all, clear all feature.

The user must save the information to make the updates in the database

If the user has not completed all calls for the follow up day mentioned, must have the incomplete calls information under pending calls section when the user logs in the next day.

3.1.14.4. Screen Flow

4. Business Rule Mapping

ActivityRulesCreate Lead IDAuto generated ID with values 0000000001to 9999999999Create AgentAuto generated ID with values AG0000001to AG99999999Create AgencyAuto generated ID with values AG00000001to AG99999999

Benefit Partners Inc

Process Specification

Agent Profile

This functional specification document addresses the part of the sales and marketing system that would facilitate the creation of agent profile.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNoneNone

2. Process Identification

2.1. Process Description & Flow

Agent Profile facilitates in creating the profile of agents and ranking them accordingly. The results of this ranking would enable the sales & marketing team to focus on the agents from a better business perspective. The data generated out of an agent profile study leads to identify agent potential and necessary sales strategy.

The prerequisite for creating an agent profile for an agent is that the agent must have an entry in the Agent master.

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface ID: Create Agent Profile

3.1.2.3. Front End Validations

3.1.2.4. Screen Flow

When the user first calls for the step 1 screen, the user is displayed with the choose child work group search feature. The child work group shall contain only those child workgroups, which belong to the category “Agents”. The child workgroups contain a non-editable entry field with search option.

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionOn Entering theThe List of Child work groups be displayed. The child work groups shallscreencontain only those child work groups which are under the category “Agent”After selecting aThe user after selecting the child workgroup, it gets the agents and will bechild work groupdisplayed.After selecting aAgent ID with search feature in the screen snapshot, present rating andagent idaverage group size for Pac advantage is populated with the real time valueson selection of an agent id.All subjective rating will have default values of Unknown.For queries- “Do you currently sell health Insurance?” and “Do you sell PacAdvantage?” - default values is “Yes”Marketing Methods, No 1 Selling Plan and No 2 Selling Plan would defaultwith ‘Choose One ” Option and the values shall be picked up from the productprofile ID from the carrier master.SaveSaves data into the permanent repository on saving the information after thevalidation checks and goes to the confirmation pageCancelResets values to original valuesClose the browserThe browser window cannot be closed/user can't navigate to another pagewithout saving/without saving the data. The user is prompted with the option of either savingNavigating tothe data and closing/leaving the window or not saving the data and closing/leavinganother pagethe window.without savingClose the browser/The browser window can be closed/user can leave once all the data is savedleave the pagein the permanent repository.after saving

3.1.3. User Interface ID: Search Agent Profile

3.1.3.1. Screen Name: Search Agent Profile (BPI_CAS_SM_SCR—003—002)

This screen below captures the information for searching an existing “Agent Profile”.Step—1: Enter the mandatory agent information and click the search button. This page will display the result of search. User can choose a agent and navigate to either “Modify” screen or “View” screen. (See FIG. M-41)

3.1.3.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextAgent IDMandatory. Any one of theError Dialog Box on Searchfields in the search screen“Accepts Alphanumericis mandatory. Acceptsvalues only.”Alphanumeric values only

3.1.3.4. Screen Flow

The following are the scenarios the user may come across when operating on the search screen.

ScenarioDescriptionSearchThe system checks for all the validations for all themandatory information. Fetches the agent(s)that matches with the search conditions.CancelClears the search fields

3.1.4. User Interface ID: Modify Agent Profile

This screen contains the default values—the values created in the database on creation of agent profile

3.1.4.3. Front End Validations

3.1.4.4. Screen Flow

ScenarioDescriptionOn enteringAll values default to the created values. Non-editable textthe screenincludes the agent id and present ratings, which is dynamic.ModifyModifies data in the permanent repository on saving theinformation after the validation checks and goes to theconfirmation page

3.1.5. User Interface ID: View Agent Profile

This screen contains only the values—the values created in the database on creation/modification of agent profile

All the values are NOT EDITABLE

3.1.5.3. Front End Validations

3.1.5.4. Screen Flow

4. Business Rule Mapping

The agent is evaluated with the following ratings. The ratings are established on 2 accounts. One is when the user enters the screen—displays the present rating and another on completion on save operation. The system does an automatic rating of the agent and the same can be viewed by reports and on modify operation. The sales rep on entering the values saves the data and the ratings are picked up based on entries made (ratings described below). The cumulative ratings are stored in the database for reporting purposes.

ActivityRulesCreate Agent profileShould have unique Id 4 digit for a agent profilerecord with an increment of 1, Say 1000, 1001, 1002and so on.

Present Rating for Pac Advantage Business

PacAdvantage BusinessBroker PotentialValueZero sold cases and zero quotes in last 12 monthsInactive1Zero sold cases and 1+ quotes in last 12 monthsQuoter2New agent or old agent with renewed interestProspect3(other than the balance 4)1+ sold cases in last 12 monthsActive41+ sold cases and 1+ quotes in last 12 monthsProducer5(consistently quoting and selling)

Average Group size with in Pac Advantage—Picks up the real time value from the database for the agent.

Profile Information Ratings

Corresponding Rank ValueItemTypeDescription12345Do you currently sell health insurance?Y/NManual EnterNYN/AN/AN/APercentage of time focused on health Insurance%Manual Enter<60%61-70%71-80%81-90%90-100%Average Group Size (outside PacAdvanatge)IntManual Enter>501-56-1011-15>15Average Group Size (within PacAdvanatge)IntSystem Calc>501-56-1011-15>15Date Business Began (years in business)DateManual Enter>15<22-55-1010-15% of Staff concentrating on health?%Manual Enter<60%61-70%71-80%81-90%90-100%

Subjective Ratings

Broker Relationship and Loyalty: Sales Reps opinion of this broker's loyalty to and confidence in PacAdvantage as a program and concept as well as their confidence in PacAdvantage administrative abilities and responsiveness.

Neutral Impression of PacAdvantage. Sells PacAdvantage if there are no other choices available.

Agent has a somewhat favorable but guarded impression of PacAdvantage program and it's responsiveness. Sells PacAdvantage when group has too many Kaiser enrollees, when pricing is favorable, or when program is specifically requested but prefers to sell other health products or competing programs.

The agent has a positive impression of PacAdvantage program. Sees value in choice concept. Confident in the administration of the PacAdvantage program, but often sells competing products.

Agent is fully confident of PacAdvantage administration and concept. Sells us in most situations; may occasionally sell a competing product.

Agent promotes the choice concept. Has total confidence in PacAdvantage product, service and administration. Sells PacAdvantage before all other products and competing programs. Broker Knowledge Of PacAdvantage: Sales Reps opinion of this broker's knowledge of choice. Includes PacAdvantage and other choice based product concepts (i.e. CC, BC). Ranks brokers' confidence in being able to independently sell and promote PacAdvantage and related programs.

1. (Neutral) Agent has little or no knowledge of PacAdvantage or other choice programs and products.

2. (Neutral Plus) Knows a little about PacAdvantage and other choice programs, but focus and preference is for other health products. Requires significant coaching on basics of our product, the choice concept and PacAdvantage administration.

Agent understands basics of choice programs and PA, but may not be familiar with many administrative details of PA, (i.e. enrollment guidelines, participation rules, paperwork requirements, etc.). Does not know all the situations were Pac Advantage or other choice programs can “fit” (answer: just about everywhere). Requires some coaching on the product and concept.

Agent is pretty familiar with PA and its admin rules. Knows most, but not all situations where choice programs work.

They can freely and independently discuss and promote PA or other programs with clients, but may require assistance from time to time.

Agent Broker has very good understanding of choice based programs and concepts and has a solid grasp of most PA administrative details. Familiar with all the situations where PA or other choice based programs “fit”. Can confidently sell Pac Advantage or other choice programs with little or no assistance.

Broker Potential

Sales Reps opinion of this broker's involvement or interest in all OTHER HEALTH INSURANCE programs, besides PacAdvantage, and the reps assessment of this broker's NEW SALES potential for PA.

1 (Neutral) Inactive or broker does very little health insurance. Broker has indicated little or no interest in new group health selling. Does not sell any or very few other group health insurance products.

Broker sells some group health insurance cases upon request, (three or more annually) but it is not the primary focus of business.

Broker has other some health business, (more than 10 cases) and focus is at least 10% on group health. Actively promotes small business health insurance to clients. May primarily work with competing programs but have potential to produce some PacAdvantage Business.

Broker has a significant amount of existing small group business (20 or more groups). Actively interested in selling more group health to all current and prospective clients. Focus is 30% or more on group health.

Broker sells a lot of health insurance and/or has access to a significant amount of small group health insurance business. Focus is at least 50% or more on group health. May have involvement with larger groups, or association business. May be selling some or a significant amount of PacAdvantage, but has potential to produce even more. May be a current top PA producer OR a significant producer for competing plan(s), (i.e., Cal Choice, Blue Cross, Kaiser direct). “Significant” is defined as 10 or more new sales annually.

Cumulative Ratings Stored in Database: Based on the points system @1-5 the cumulative values are stored in the database and is used for reporting purposes.

A Backend subroutine runs at 1200 at night everyday to calculate the Present rating of the agent based on quotes made, cases sold, average group size. This data would be calculated and updated against individual agents and shown in Step 2 screen when accessed.

Benefit Partners Inc

Process Specification

Create Quotes

The purpose of this document is to describe the process of Create Quotes. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPE_SMExternal CommunicationBPI_SCOPEP_SM_005Create Quote MasterBPI_SCOPEP_SM_006Create Lead Master

2. Process Identification

Quotes are provided for potential business entities as well as existing business entities. Quotes can be requested for small Employer Groups or Alternate Groups (Individual Association Member, Association Group, COBRA etc.) as well as for employees of those groups.

2.2. Process Description

The objective of the Create Quotes process is to:1) Provide functionality to create, view and modify quotes

The process should support collecting and storing configurable information for quoting purposes. A quote should be unique for each Group and Lead to allow history of data provided for a quote. The process should also support the versioning of each quote output.

The following are the other requirements that will be supported and constraints on the proposed system:1) The system should allow for updates using current enrollment for existing groups and members2) The system should allow for quoting specific carriers for an employee or for all employees3) The system should allow for excluding certain carriers from a quote4) The system should allow for calculating the rate differential based on the following entry fields: total eligible employees, total waiving, total declining, total COBRAs5) The system should allow for quoting based on blended and non-blended fee structure6) The system should allow for configurable agent fees7) The system should allow the user to choose output types including:(a) Group Rate Summary(b) Group Rate Summary and Worksheet(c) Group Rate Summary, Worksheet and EE Pages(d) Employee Quote(e) COBRA Quote (Cal or Fed)(f) Individual Association Member Quote(g) ROE Quote8) System should allow for configurable effective dates of quotes based on current date and/or enrollment effective date if it is an existing group9) The system should have a functionality to list out all missing information for a quote. It should also have the functionality to print/fax/email this to the agent/prospective group who requested for the quote. At this point in time, the user should be able to save the quote for retrieval at a later point in time.

2.3. Process Flow

Process for Create, View and Modify Quotes1) Enter Tracking Dates2) Choose Lead ID or Group ID; agent information if any gets auto-populated3) Choose all line if coverage to quote; alternately use default coverage4) Define contribution for employee/dependent by line of coverage; alternately use default contribution5) Choose fee type (blended/non-blended). This would default, if Lead, to blended, if Group, to whichever fee structure the group is on)6) Re-configure agent fee, if applicable7) Create employee list; for existing groups this gets auto-populated using current enrollment; for prospective groups this information can be uploaded from a comma-separated (CSV) data file.8) Adjust employee totals as neededi. # waivingii. #decliningiii. #COBRAs9) Quote/exclude specific carriers10) Choose quote typei. Groupii. Employeeiii. Individualiv. COBRA11) Choose output typei. Group Summaryii. Group Summary and Worksheetiii. Group Summary, Worksheet and employee pages12) Specify effective date for quote13) Choose mode of outputi. Viewii. Emailiii. Faxiv. Print for mailing (in the mailroom)14) For print, email, fax options, choose “Send to whose attention” in a pop-up windowi. Agent's attentionii. Group's Attentioniii. Other—For “Other”, enter “attention to”, address and/or email address and/or fax #

3. User Interface

3.1. User Interface Screens

3.1.1. Create Quotes

3.1.1.1. Screen Snapshot

Element NameAction/Validation DetailsMessageLead Group InformationQuoting ForCheck to see that a valid option is“Required information is missing”selected for the fieldLead/Group IdCheck to see that a valid value is“Required information is missing”entered for the fieldGeneral InformationQuote Date“Required information is missing”Mode of RequestCheck to see that a valid option is“Required information is missing”selected for the fieldRequest PostmarkCheck to see that a valid value is“Required information is missing”Dateentered for the fieldRequest ReceiveCheck to see that a valid value is“Required information is missing”Dateentered for the fieldRate TypeCheck to see that a valid option is“Required information is missing”selected for the fieldAgent CommissionCheck to see that a valid value is“Required information is missing”entered for the fieldEffective DateCheck to see that a valid value is“Required information is missing”entered for the field

Element NameAction/Validation DetailsMessageEmployee InformationAge/DOBCheck to see that a valid“Required informationvalue is entered for theis missing”fieldCoverageCheck to see that a valid“Required informationOptionoption is selected for theis missing”fieldNumber ofCheck to see that a valid“Required informationMembersvalue is entered for theis missing”field

Element NameAction/Validation DetailsMessageQuote Generation OptionsGenerateCheck to see that a“Required informationvalid option is selectedis missing”for the fieldQuote ForCheck to see that a“Required informationvalid option is selectedis missing”for the fieldWhen quoting forCheck to see that a“Required informationgroups, includevalid option is selectedis missing”for the fieldMode of outputCheck to see that a“Required informationvalid option is selectedis missing”for the fieldSend to whoseCheck to see that a“Required informationattentionvalid option is selectedis missing”for the field

3.2. Interface Flow

4. Business Rule Mapping

ActivityRulesGenerate1.A lead or a group will be associated with (aQuotemaximum of) one quote number. Changes to thequote will be saved as revisions.2.For an existing group, fee type (blended or non-blended), coverage & contribution information andemployees information gets defaulted from currentenrollment.3.Default coverage and contribution is: Line ofcoverage - Medical; Contribution for employees -50% of lowest cost HMO plan; Contribution fordependents - None4.For each line of coverage, the contribution type fordependents (if any) has to be same as that for theemployee. Only the contribution percentage orvalue can change.5.Quote for an individual association member shouldinclude only one employee.6.If zip code is not provided for an employee, the zipcode of the group is used for rate calculation.7.Number of employees willing to enroll shouldsatisfy the participation rule i.e., number of declinesto (employee count − number of waiving + numberof declines − number of COBRA) should be lessthan 30%.8.Employer's contribution towards employeepremium should be at least 50% of the group'saverage premium for all enrolled employees basedon the lowest cost employee-only plan available.9.Effective date for quote will default to 1stof nextmonth if current date is lesser than or equal to the25thof the month and 1stof the next followingmonth after the 25th.10.Premium rates are calculated based on the logic asdetailed in “Process Specification for Billing -BPI_CAS_FSD_FI_001”.

Benefit Partners Inc

Process Specification

Supply Request

External

This functional specification document addresses the part of the Core Administration System that would facilitate the sending of Supply Requests or any handbooks to employer groups or the members of a group.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNoneNone

2. Process Identification

2.1. Process Description

A Supply Request consists of all handbooks, rate books, forms and application, complementary, super directories that are sent to the employer groups and its members through the mailroom.

3. User Interface

3.1. User Interface Screens

3.1.2.3. Front End Validations

3.1.2.4. Screen Flow

The user enters the information on the workgroup name and description.

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionPre-PopulationThe ID/address fields must be prepopulated withthe address details if the user navigates to the sup-ply request screen from Agent Master, AgencyMaster, Employer Group Master (Sales &Enrollment).SavePressing the save button leads to saving the datain the repository, sending an email to mailroomand confirmation to the user who has checked theconfirmation by email check boxEmail Content - Subject: Supply RequestDear Mail Room Staff,Please forward the following to the addressmention belowItems - QtyCommentsAddressShip ViaThanks< ID of the person who has made the request>Close the browserThe browser window cannot be closed/user can'twithout saving/navigate to another page without saving the data.Navigating toThe user is prompted with the option of either sav-another pageing the data and closing/leaving the window or notwithout savingsaving the data and closing/leaving the window.Close the browser/The browser window can be closed/user can leaveleave the pageonce all the data is saved in the permanent repository.after savingCancelAll the data entered is reset with empty in the dataentry fields as the case may be (Text Field, List etc).

3.1.3. User Interface Id: External Supply Request Mail Room Confirmation

3.1.3.1. Screen Name: Supply Request Mail Room Confirmation

3.1.3.3. Front End Validations

ElementAction/ValidationNameDetailsError Message TextSaveMust choose at leastError Dialog Box - “Pleaseone check BoxCheck at least one row” withyes option

3.1.3.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionOn Entering theProvides a list of all pending requestsscreenCheck AllChecks all the check BoxesClear AllClears all the Check Boxes/Or any checked boxesSaveSaves all the updates made and send email to thepersonnel who made the request where theconfirmation on fulfillment by Email checkBox is checked. The user Email details arepicked up from the security frameworkEmail:Subject: Supply Request Fulfillment”Dear “Name”We have fulfilled your request <Supply Request id>on “date of saving the fulfillment request”ThanksMailroomCancelResets the screen with original values before a save

3.1.4. User Interface Id: Supply Request Confirmation

3.1.4.1. Screen Name: Supply Request Confirmation

3.1.4.3. Front End Validations

3.1.4.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionYesLeads to the Supply Request ScreenNoLeads to the Supply Request Home Page

4. Business Rule Mapping

ActivityRulesCreate Supply Request IDShould have unique Id for a Supply Request - 10digits with an increment of 1, Say EX00000001,EX00000002, EX00000003 and so on.

Benefit Partners

Process Specification

This functional specification document addresses the part of the sales and marketing system that would facilitate the creation of workgroups.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNoneNone

2. Process Identification

2.1. Process Description

Workgroups define the broad categorization of a group of agents, internal working personnel of BPI, external working personnel associated with BPI and Mailing groups.

The process shall include creating1) Categories

Categories define the segment a workgroup can fall under. For eg—Agents, Employees, HR etc.2) Define Parent and assign to a category

A Parent is the highest in the hierarchy of a work group. Typical examples include Agent Work groups, Internal work groups. A parent is assigned to a category3) Define Main Work group and assign to a Parent

A work group defines the various groups that come under a parent—Examples include—Agents by ranking etc. A work group can also be a child workgroup. A workgroup is assigned to a Parent4) Define Child workgroup and assign to a main work group

Child groups is a set of groups under a workgroup and typically examples include—agents in San Diego Area Etc5) Define Mail Members—Create, Modify, View, Delete

Mail Members are the components of a child work group for a category Mail and are assigned to the child workgroups

The work groups are designed in such a way that members can be swapped in full or in partial or duplicated from one work group to another.

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface Id: Category

3.1.2.3. Front End Validations

3.1.2.4. Screen Flow

The user enters the information on the Category name and description.

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionAdd data enteredAdding the data entered (pressing the “Add” Button) leads to adding nameand description to a temporary storage. The data gets loaded into thepermanent repository only after the user saves the information.Modify data enteredWhen a row is selected for an edit operation, the row is highlighted and dataelements populated into respective fields and the add button has a label“modify”. Modifying the data entered (pressing the “Modify” button) leads toadding the non-editable name information and modified “description” to atemporary storage. The data gets loaded into the permanent repository onlyafter the user saves the information.Edit dataEditing the Data (pressing the “Edit” Button).The edit operation may be on any of the two scenarios.1. (Edit for rows from database) When the user comes to theCategory screen and the screen is already loaded with data fromthe permanent repository into a table on the screen.2. (Edit for rows from the temporary storage) When the user has justadded the data into a table on the screen and wants to edit thedata entered before savingThe data in the table on the screen would be shown as green letters for thedata from the database and red letters for the data that is in the temporarystorage (not saved yet).The table shall have alternate rows colored with different light colorsUnder 1, on an edit operation for a row on the table, the row does not getdeleted from the table and the data is transferred to the name (becomes noneditable) and editable description.Under 2, on an edit operation for a row on the table, the row gets deleted fromthe table and the data is transferred to the name and description, which areeditable.When a row is on edit mode, the letters are in dark gray color in the table.Delete CheckedThe data in the table on the screen contains the data, which is from theRowspermanent repository, or the data just added and is in temporary storage.When the rows are “checked” for the rows that contain the data from therepository and a “Delete Checked Rows” is performed, inactivation takesplace on saving the information provided there are no subtypes else providesthe user with the necessary error information in an error page. Message “Thefollowing Category has associated parents” - “parent 1 . . . parent n”When the rows are “checked” for the rows that contain the data from thetemporary storage and a “Delete Checked Rows” is performed, the rows aredeleted from the temporary storage.Check AllEnables checking of all the checkboxes by checking “check All” Check BoxCheck All & DeleteEnables deleting all the rows from the table on the screen enabled by “checkChecked RowsAll”Check Any NumberEnables deleting the rows from the table on the screen that are only checked.& Delete CheckedRowsCheck All & ClearEnables clearing (removing the check) all checked rows done by “Check All”AllCheck Any NumberEnables clearing (removing the check) the rows that are checked.& Clear AllClear All when noThe user can only press the button and nothing happens like checking,rows are checkedremoving a checkSaveAll the data added or modified and added into/deleted from the rows in thetable are saved into the permanent repositoryOnce saving is done, return back to the Category screen with all the freshupdatesCancelAll the data entered is reset with empty/initial values in the data entry fields asthe case may be (Text Field, List etc).If a row (which is retrieved from the database) is already modified and addedto the table on the screen and the “Cancel” button is pressed, the rowremains with the modified values.

3.1.3. User Interface Id: Main Work Group

3.1.3.3. Front End Validations

3.1.3.4. Screen Flow

The user enters the information on the Main work Group name and description and assigns to a parent.

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionAdd data enteredAdding the data entered (pressing the “Add ” Button) leads to adding namedescription, parent and child group option to a temporary storage. The datagets loaded into the permanent repository only after the user saves theinformation.Modify data enteredWhen a row is selected for an edit operation, the row is highlighted and dataelements populated into respective fields and the add button has a label“modify”. Modifying the data entered (pressing the “Modify ” button) leads toadding the non-editable name information, modified “description ”/parent to atemporary storage and child group option. The data gets loaded into thepermanent repository only after the user saves the information. Once themain subgroup has been defined as a child work group, the editable data willbe shown in the child work group screenEdit dataEditing the Data (pressing the “Edit ”Button).The edit operation may be on any of the two scenarios.1. (Edit for rows from database) When the user comes to the Mainworkgroups screen and the screen is already loaded with data fromthe permanent repository into a table on the screen.2. (Edit for rows from the temporary storage) When the user has justadded the data into a table on the screen and wants to edit the dataentered before savingThe data in the table on the screen would be shown as green letters for thedata from the database and red letters for the data that is in the temporarystorage (not saved yet).The table shall have alternate rows colored with different light colorsUnder 1, on an edit operation for a row on the table, the row does not getdeleted from the table and the data is transferred to the name (becomes noneditable) and editable description/ParentUnder 2, on an edit operation for a row on the table, the row gets deleted fromthe table and the data is transferred to the name, description/parent (default),which are editable.When a row is on edit mode, the letters are in dark gray color in the table.SearchThe search window must generate a list of all active Parents. The user will notbe allowed to make entries into the entry field where the search results aregoing to be put in.Delete CheckedThe data in the table on the screen contains the data, which is from theRowspermanent repository, or the data just added and is in temporary storage.When the rows are “checked” for the rows that contain the data from therepository and a “Delete Checked Rows” is performed, inactivation takesplace on saving the information provided there are no subtypes else providesthe user with the necessary error information in an error page. Message “Thefollowing Main workgroup has associated child workgroups” - “childworkgroup1 . . . child workgroup n”When the rows are “checked” for the rows that contain the data from thetemporary storage and a “Delete Checked Rows” is performed, the rows aredeleted from the temporary storage.Check AllEnables checking of all the checkboxes by checking “check All” Check BoxCheck All & DeleteEnables deleting all the rows from the table on the screen enabled by “checkChecked RowsAll”Check Any NumberEnables deleting the rows from the table on the screen that are only checked.& Delete CheckedRowsCheck All & ClearEnables clearing (removing the check) all checked rows done by “Check All”AllCheck Any NumberEnables clearing (removing the check) the rows that are checked.& Clear AllClear All when noThe user can only press the button and nothing happens like checking,rows are checkedremoving a checkWhen “ Is it a childWhen the checking is done and the saving of information takes place theworkgroup” isMain workgroups also becomes a child workgroupcheckedSaveAll the data added or modified and added into/deleted from the rows in thetable are saved into the permanent repository. The main groups gets savedas child workgroup if the check box is selected for “is it a child workgroup?”Once saving is done, return back to the main workgroup screen with all thefresh updatesCancelAll the data entered is reset with empty/initial values in the data entry fields asthe case may be (Text Field, List etc).If a row (which is retrieved from the database) is already modified and addedto the table on the screen and the “Cancel” button is pressed, the rowremains with the modified values.

3.1.4. User Interface Id: Child Work Group

3.1.4.3. Front End Validations

3.1.4.4. Screen Flow

The user enters the information on the Child work Group name and description and assigns to a Main work group.

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionAdd data enteredAdding the data entered (pressing the “Add” Button) leads to adding name,description and Main Workgroup to a temporary storage. The data getsloaded into the permanent repository only after the user saves theinformation.Modify data enteredWhen a row is selected for an edit operation, the row is highlighted and dataelements populated into respective fields and the add button has a label“modify”. Modifying the data entered (pressing the “Modify” button) leads toadding the non-editable name information, modified “description”, mainworkgroup to a temporary storage. The data gets loaded into the permanentrepository only after the user saves the information.Edit dataEditing the Data (pressing the “Edit” Button).The edit operation may be on any of the two scenarios.1. (Edit for rows from database) When the user comes to the Childworkgroups screen and the screen is already loaded with data fromthe permanent repository into a table on the screen.2. (Edit for rows from the temporary storage) When the user has justadded the data into a table on the screen and wants to edit the dataentered before savingThe data in the table on the screen would be shown as green letters for thedata from the database and red letters for the data that is in the temporarystorage (not saved yet).The table shall have alternate rows colored with different light colorsUnder 1, on an edit operation for a row on the table, the row does not getdeleted from the table and the data is transferred to the name (becomes noneditable) and editable description/Main Work groupUnder 2, on an edit operation for a row on the table, the row gets deleted fromthe table and the data is transferred to the name, description/Main workgroup (default), which are editable.When a row is on edit mode, the letters are in dark gray color in the table.SearchThe search window must generate a list of all active Main Work Groups. Theuser will not be allowed to make entries into the entry field where the searchresults are going to be put in.Delete CheckedThe data in the table on the screen contains the data, which is from theRowspermanent repository, or the data just added and is in temporary storage.When the rows are “checked” for the rows that contain the data from therepository and a “Delete Checked Rows” is performed, inactivation takesplace on saving the information provided there are no subtypes else providesthe user with the necessary error information in an error page. Message “Thefollowing Child workgroup has associated members” - “Member1 . . . Membern” members could be employer groups, Agent/Agency, Mail work groups orAssociatesWhen the rows are “checked” for the rows that contain the data from thetemporary storage and a “Delete Checked Rows” is performed, the rows aredeleted from the temporary storage.Check AllEnables checking of all the checkboxes by checking “check All” Check BoxCheck All & DeleteEnables deleting all the rows from the table on the screen enabled by “checkChecked RowsAll”Check Any NumberEnables deleting the rows from the table on the screen that are only checked.& Delete CheckedRowsCheck All & ClearEnables clearing (removing the check) all checked rows done by “Check All”AllCheck Any NumberEnables clearing (removing the check) the rows that are checked.& Clear AllClear All when noThe user can only press the button and nothing happens like checking,rows are checkedremoving a checkSaveAll the data added or modified and added into/deleted from the rows in thetable are saved into the permanent repositoryOnce saving is done, return back to the Child workgroup screen with all thefresh updatesCancelAll the data entered is reset with empty/initial values in the data entry fields asthe case may be (Text Field, List etc).If a row (which is retrieved from the database) is already modified and addedto the table on the screen and the “Cancel” button is pressed, the rowremains with the modified values.

3.1.5. User Interface Id: Mail Members

3.1.5.3. Front End Validations

3.1.5.4. Screen Flow

The user enters the information on the Mail ID and Child Workgroup

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionAdd data enteredAdding the data entered(pressing the “Add” Button)leads to adding mail id and ChildWorkgroup to a temporarystorage. The data gets loadedinto the permanent repositoryonly after the user saves theinformation.Modify data enteredWhen a row is selected for anedit operation, the row ishighlighted and data elementspopulated into respective fieldsand the add button has a label“modify”. Modifying the dataentered (pressing the “Modify”button) leads to adding modifiedinformation to a temporarystorage. The data gets loadedinto the permanent repositoryonly after the user saves theinformation.Edit dataEditing the Data (pressing the“Edit” Button).The edit operation may be onany of the two scenarios.1 (Edit for rows fromdatabase) When theuser comes to the MailMember screen and thescreen is already loadedwith data from thepermanent repositoryinto a table on thescreen.2 (Edit for rows from thetemporary storage)When the user has justadded the data into atable on the screen andwants to edit the dataentered before savingThe data in the table on thescreen would be shown as greenletters for the data from thedatabase and red letters for thedata that is in the temporarystorage (not saved yet).The table shall have alternaterows colored with different lightcolorsUnder 1, on an edit operation fora row on the table, the row doesnot get deleted from the tableand the data is transferred to themail id and Child Workgroup.Under 2, on an edit operation fora row on the table, the row getsdeleted from the table and thedata is transferred to the mail idand child workgroup, which areeditable.When a row is on edit mode, theletters are in dark gray color inthe table.The search window must generate a list of all active Child work groups for category Mail. The user will not be allowed to make entries into the entry field where the search results are going to be put in.Delete Checked RowsThe data in the table on thescreen contains the data, whichis from the permanent repository,or the data just added and is intemporary storage.When the rows are “checked” forthe rows that contain the datafrom the repository and a “DeleteChecked Rows” is performed,inactivation takes place onsaving the informationWhen the rows are “checked” forthe rows that contain the datafrom the temporary storage anda “Delete Checked Rows” isperformed, the rows are deletedfrom the temporary storage.Check AllEnables checking of all thecheckboxes by checking “checkAll” Check BoxCheck All & Delete Checked RowsEnables deleting all the rowsfrom the table on the screenenabled by “check All”Check Any Number & Delete Checked RowsEnables deleting the rows fromthe table on the screen that areonly checked.Check All & Clear AllEnables clearing (removing thecheck) all checked rows done by“Check All”Check Any Number & Clear AllEnables clearing (removing thecheck) the rows that arechecked.Clear All when no rows are checkedThe user can only press thebutton and nothing happens likechecking, removing a checkSaveAll the data added or modifiedand added into/deleted from therows in the table are saved intothe permanent repositoryOnce saving is done, return backto the Mail Member screen withall the fresh updatesCancelAll the data entered is reset withempty/initial values in the dataentry fields as the case may be(Text Field, List etc).If a row (which is retrieved fromthe database) is already modifiedand added to the table on thescreen and the “Cancel” button ispressed, the row remains withthe modified values.

3.1.6. User Interface Id: Swap Members

ElementElement NameTypePurposeMain HeaderTextTo give the heading for the screen“Swap Members”being navigatedChoose SourceTextText For “Choose Source ChildChild Work GroupWorkgroup”Choose SourceSearchSearch window showing a list of allChild Work Groupchild work groupsChooseTextText for “Child Workgroup”DestinationWork GroupChooseListSearch window showing a list of allDestination Childactive child work groupsWork GroupDo you want toTextText for “ Do you want to do a fulldo a full oror partial or duplicate swap?”partial orduplicate swap?Partial/FullRadioDefault - PartialButtonsTableHTMLFor displaying all the information oftablerows retrieved from the permanentrepositorySwapButtonTo swap the rows checked(HTMLButton)Check AllText LinkTo check all the check boxes in the tableClear AllText LinkTo un check all the check boxes checkedin the table/does not function when all thecheckboxes in the table are unchecked

3.1.6.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextSubmitThe source and destinationError Dialog “Source andchild work group must notDestination Child Groupsbe the samecannot be the same” with aThe source and destinationYes Optiongroups must belong to theError Dialog “Source andsame Main WorkgroupDestination Child GroupsThe Child work groups mustmust belong to the samebelong to the same categoryMain Workgroup” withyes optionError Dialog “Childworkgroups must belongto the same category”SwapAs mentioned in scenarioAs mentioned in scenario

3.1.6.4. Screen Flow

The user chooses the source and destination child workgroups and decided whether the swap is for full or partial members of the workgroup.

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionSubmitPress the submit button after choosing the valid values fromthe source and destination child groups and whether theswap is in full or partial.Full swap leads to swapping of all the members of the sourceto the destination.Partial swap leads to the screen showing the list of all mem-bers of the source in alphabetical order and enables the userto check members who are to be swapped to the destinationchild groupDuplicate swap leads to the screen showing the list of allmembers of the source in alphabetical order and enablesthe user to check members who are to be swapped to thedestination child group and would also remain in the sourcechild group (Duplicate)Inserts information of the swap into the database andnavigates to the confirmation screenYes/NoYes leads to the swap members screen and No leads to thework Group Home Page

4. Business Rule Mapping

ActivityRulesCreate CategoryShould have unique Id for a category --10 digits with an increment of 1, SayCT00000001, CT00000002, CT00000003and so on.Create Main WorkgroupShould have unique Id 10 digit for a mainworkgroup with an increment of 1, Say1000, 1001, 1002 and so on.Create Child WorkgroupShould have unique Id 4 digit for achild workgroup with an increment of 1,Say 1000, 1001, 1002 and so on.Create Mail MembersShould have unique Id 4 digit for amail member with an increment of 1,Say 1000, 1001, 1002 and so on.Create swapShould have unique Id 4 digit fora parent with an increment of 1,Say 1000, 1001, 1002 and so on.

Benefit Partners Inc

Process Specification

Supply Request

Internal

This functional specification document addresses the part of the Core Administration System that would facilitate the sending of Supply Requests or any handbooks to employer groups or the members of a group.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNoneNone

2. Process Identification

2.1. Process Description

A Supply Request—Internal contains a list of all stationeries ordered from individual associates for their daily use, which shall be facilitated and fulfilled by a specific department of a person.

3. User Interface

3.1. User Interface Screens

3.1.2.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextSaveShould function with enter key cursorMandatory Entries:positioned on the “Save” button or on6) Choose anyonemouse click.item with QtyOn saving the data the data gets savedError dialog Box -to the permanent repository. And send“Choose Any onean email to the fulfillment staff alongitem with Quantity”with a confirmation page to the userwith Yes optionMandatory Entry1) Choose any one item with QtyCancelAll the data entered is reset with nullNot Applicablevalues in the data entry fields as thecase may be (Text Field, List etc).

3.1.2.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionSavePressing the save button leads to saving the datain the repository, sending an email to fulfillmentSpecialist and confirmation to the user who haschecked the confirmation by email check boxEmail Content - Subject: Internal Supply RequestDear Staff,Please forward the following to the address mention belowItems - QtySpecial InstructionsThanks<ID of the person who has made the request>CancelAll the data entered is reset with empty in the data entryfields as the case may be (Text Field, List etc).

3.1.3. User Interface Id: Internal Supply Request Confirmation

3.1.3.1. Screen Name: Internal Supply Request Confirmation

3.1.3.3. Front End Validations

3.1.3.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionYesLeads to the Supply Request - Internal ScreenNoLeads to the Supply Request - Internal Home Page

3.1.4. User Interface Id: Supply Request Fulfillment Confirmation

3.1.4.1. Screen Name: Supply Request Fulfillment Confirmation

3.1.4.3. Front End Validations

ElementNameAction/Validation DetailsError Message TextSaveMust choose at leastError Dialog Box - “Please Checkone check Boxat least one row” with yes option

3.1.4.4. Screen Flow

The following are the scenarios the user may come across when operating on the screen

ScenarioDescriptionOn EnteringProvides a list of all pending requeststhe screenCheck AllChecks all the check BoxesClear AllClears all the Check Boxes/Or any checked boxesSaveSaves all the updates made and send email to thepersonnel who made the request where the confirma-tion on fulfillment by Email check Box is checked.The user Email details are picked up from the securityframeworkEmail:Subject: Internal Supply Request Fulfillment”Dear “Name”We have fulfilled your request <Supply Request id>on “date of saving the fulfillment request”ThanksInternal SuppliesFulfillment StaffCancelResets the screen with original values before a save

4. Business Rule Mapping

ActivityRulesCreate InternalShould have unique Id for a Supply Request -- 10Supply Request IDdigits with an increment of 1, Say IN00000001,IN00000002, IN00000003 and so on.

Benefit Partners Inc

Process Specification

Associates

This functional specification document addresses the part of the sales and marketing system that would deal with creation of master records for internal and external associates.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNoneNone

2. Process Identification

2.1. Process Description & Flow

The Internal associates are the associates who are employed by BPI and work with BPI. External associates are the associates who are associated with the Business and may not be employed by BPI.

The associates masters are created and assigned to a child work groups

The user has the option to create, modify, delete and view within the same screen.

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface Id: Associates

3.1.2.3. Front End Validations

3.1.2.4. Screen Flow

ScenarioDescriptionClickOn click of Internal/External Association type.Internal/ExternalAvailable Internal/External associated work-workgroup Radiogroup in the system will be listed in the respec-buttontive list box.Add SelectedAssigning the Internal/External workgroup.Internal/ExternalWorkgroupRemove SelectedRemove the assigned Internal/External workgroup.Internal/ExternalWorkgroupAdd data enteredAdding the data entered (pressing the “Add”Button) leads to adding name (first name +Last Name) and child work group to a tempo-rary storage. The data gets loaded into thepermanent repository only after the usersaves the information.Modify data enteredWhen a row is selected for an edit operation,the row is highlighted and data elements pop-ulated into respective fields and the add buttonhas a label “modify”. Modifying the data entered(pressing the “Modify” button) leads to addingthe information to a temporary storage. The datagets loaded into the permanent repository onlyafter the user saves the information.SearchThe search window must generate a list of allactive child groups for Category Internal Asso-ciates. The user will not be allowed to makeentries into the entry field where the searchresults are going to be put in.Edit dataEditing the Data (pressing the “Edit” Button).The edit operation may be on any of the twoscenarios.1. (Edit for rows from database) When the usercomes to the Internal Associates screen and thescreen is already loaded with data from the per-manent repository into a table on the screen.2. (Edit for rows from the temporary storage)When the user has just added the data into atable on the screen and wants to edit the dataentered before savingThe data in the table on the screen would beshown as green letters for the data from thedatabase and red letters for the data that is inthe temporary storage (not saved yet). The tableshall have alternate rows colored with differentlight colorsUnder 1, on an edit operation for a row on thetable, the row does not get deleted from thetable and the data is transferred to the placeholders.Under 2, on an edit operation for a row on thetable, the row gets deleted from the table and thedata is transferred to the placeholders, which areeditable. When a row is on edit mode, the lettersare in dark gray color in the table.Delete CheckedThe data in the table on the screen contains theRowsdata, which is from the permanent repository,or the data just added and is in temporary storage.When the rows are “checked” for the rows thatcontain the data from the repository and a “DeleteChecked Rows” is performed, inactivation takesplace on saving the information When the rowsare “checked” for the rows that contain the datafrom the temporary storage and a “DeleteChecked Rows” is performed, the rows aredeleted from the temporary storage.Check AllEnables checking of all the checkboxes by check-ing “check All” Check BoxCheck All & DeleteEnables deleting all the rows from the table onChecked Rowsthe screen enabled by “check All”Check Any NumberEnables deleting the rows from the table on the& Delete Checkedscreen that are only checked.RowsCheck All & ClearEnables clearing (removing the check) allAllchecked rows done by “Check All”Check Any NumberEnables clearing (removing the check) the rows& Clear Allthat are checked.Clear All when noThe user can only press the button and nothingrows are checkedhappens like checking, removing a checkSaveAll the data added or modified and added into/deleted from the rows in the table are savedinto the permanent repository Once saving isdone, return back to the Internal Associatesscreen with all the fresh updatesCancelAll the data entered is reset with empty/initialvalues in the data entry fields as the case maybe (Text Field, List etc). If a row (which is re-trieved from the database) is already modifiedand added to the table on the screen and the“Cancel” button is pressed, the row remainswith the modified values.

4. Business Rule Mapping

ActivityRulesCreate Associate IDShould have unique Id for an Associates -- 10 digitswith an increment of 1, Say 0000000001,0000000002, 0000000003 and so on.

Benefit Partners Inc

Process Specification

Call Tracking

The purpose of this document is to describe the process of Call Tracking. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNoneNone

2. Process Identification

2.1. Back Ground

Call tracking is used to basically track the calls that are made or received with specific business intentions. The call can be inbound or outbound based on the nature of calls.

2.2. Process Description

The objective of the Call Tracking process is to:1) Provide for a user interface for calls categorized as inbound or outbound.2) The inbound or outbound calls would make up the “To Do List” based on follow up required to be performed by the work group associated with the call in question.

2.3. Process Flow

Process for Call Tracking1) Call would be identified as inbound or outbound.2) The user requests the Call Tracking screen (somehow—either menu or something else) and then the Call Tracking appears as a child window. In this case the user can still view the information brought up for use in the inquiry while completing the Call Log. In this case the user would have to specify the type of referenced entity, either Group or Agent, then enter the ID of the referenced entity, the caller name, the nature of call, any remarks, and finally whether follow-up is required.3) All calls received, having specific inquiries or intentions by the caller, would be documented only at the Group level or Agent level. For instance, if the group calls in reference to a specific employee, then when logging the call, the user will indicate the Group ID, the caller name, the nature of call and indicate in the remarks section of the call log, the specific Employee name/ID.4) All calls made would have the nature of calls that specifies the nature or reasons for the call received or made. If “referenced entity” is “Group” then nature of call list is displayed for “Group”—If referenced entity is “Agent” then nature of call list is displayed for “Agent”.5) Date and time stamp for the calls received or made would be automatically stamped by the system.6) If any call needs follow up it would be flagged for follow up and would be visible in the “To Do List” sorted by Date and Workgroup.7) All completed follow up would have completed status to mark.

3. User Interface

3.1. User Interface Screens

3.1.2. User Interface Id: Call Tracking

3.1.2.3. Front End Validations

ElementNameAction/Validation DetailsMessageCall typeShould list the call types of“Call Type - is required”In bound nad Out bound. Thefirst option should be - ChooseOne -. Subsequent call typesshould listed in alphabeticalorder.Caller nameEntry field for entering the“Caller Name - Is required.”caller name“Caller Name - Acceptsalphabetic characters only”Nature ofNature of call depends on the“Nature of Call - IsCall“referenced entity”. Eachrequired.”“referenced entity” has a dif-ferent list for choosing Natureof Call. Hence the list shouldget populated based on the“referenced entity”. Categoriesfor Nature of Call are includedin the drop down menu list.OtherIf the nature of call is other.“Others - is required.”Entry field to write other.Follow UpCheck box to be un checked byNoneRequireddefault. Checked if required forfollow up.Follow UpTo specify date for follow-up,“Follow-up Date - IsDateshould default to next workingrequired”day following.“Follow-up Date - Acceptsdate from 1900 to 2200 inthe format ofMM/DD/YYYY”CommentsText area to write comments“Comments - Accepts allAlphanumeric and specialCharacters except doublequotes.”SaveOn click should save the data“The Field Name is blank.captured above into thePlease enter a valid value.”repositoryCancelReset to the state as was onNoneloading the page on click.

3.1.2.4. Screen Flow

3.1.3. User Interface Id: Call Tracking To Do List

3.1.3.3. Front End Validations

Element NameAction/Validation DetailsMessageFollow-up DateChoose follow-update radio button.“Follow-up Date - Is required.”And Select the date to show the to do“Follow-up Date - Accepts date from 1900list.to 2200 in the format of MM/DD/YYYY”Called DateChoose Called Date radio button and“Called Date - Is required.”select the date to show the to do list.“Called Date - Accepts date from 1900 to2200 in the format of MM/DD/YYYY”SearchOn Click should show the To DononeList based on the date selectedTableTable to display the data. The tableNoneshould only contain that data orcalled that need to be followed up.(i.e. Check box Checked for theFollow up required in previousscreenBPI_CAS_SCR_UTL_05_001Task CompletedDefault unchecked. If Checked andNonesaved should not allow for Unchecking again.SaveOn click should save the dataNonecaptured above into the repositoryCancelReset to the state as was on loadingNonethe page on click.

3.1.3.4. Screen Flow

4. Business Rule Mapping

Benefit Partners Inc

Process Specification

This purpose of this document is to identify the processes associated with the security mechanism for core administrative system

1.2 Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameNONENONE

1.3 Process Identification

1.3.1 Process Description & Flow

This process describes the security framework requirements. The security framework consists of creating database for security system as well as administrator login into the system. The system also allows the administrator to create users, module, groups, and application, assign user roles and ACL etc. The system also takes care of user login into the core administrative system. The system should generate the ACL for each user when user logs in into the system. The access to any resource in the core administrative system will be decided by this ACL which will be stored in the User Profile object, stored into the session.

The security system for Intranet application built for shall broadly contain following categories.1. Definition of Realms2. Definition of Modules3. Definition of Applications4. Definition of Resources5. Definition of groups (groups can ideally be a department which has a number of users)6. Definition of User7. Definition of User Roles8. Definition ACL/Permissions9. Resources, which can be assigned to the groups.10. User, User Role and Groups mapping11. Overriding the group access rights.

Realms

A realm is a database of users, groups, modules, application resources and access control lists. A user must be defined in a realm in order to access any resources belonging to that realm.

Modules

The modules provide the high level classification for the applications. The module is a group of applications. The following modules have been identified in the initial stage as a part of core administrative system viz. Carrier Maintenance, Enrollment, Sales and Marketing and Finance.

Applications

A module consists of many applications. An application represents the business use case or set of related use cases. A module consists of many applications. For e.g. Carrier Maintenance module consists of following applications viz. Zip Master, Carrier Master, and M Plan etc. Each application can be further classified into the pages.

Resources

An application can be further classified into the Resources. An application can have one or more resources.

Resources are the valuable items accessible from the Web server/Web Application server:

Web Applications: Java Servlet or JSP

The resources can be protected by using a single access control (ACL). The ACL specifies which users or groups are allowed to access or modify the resource.

For each resource to protect, you'll specify:

An access control list (ACL)—a list defining who can use the resource

Groups

A group is a collection of users. A user can belong to multiple groups. The groups can be created based on the department where all the uses are going to perform the similar kind of operation.

Groups are sets of users. Groups provide an efficient way to manage large numbers of users because an administrator can specify permissions for an entire group at one time. The resources pages can be allocated to group instead of assigning to individual user.

The user gets the default access rights as a part of group. The user can override the group access rights.

A person can be defined as both an individual user and as a member of a group. When an individual user also belongs to a group, the individual access permissions override any group access permissions.

For e.g. a set of data entry operators can have be classified into one group. The rights can be assigned to this group as all basically going to do the data entry operation.

USER ROLES

In any system, there are many roles, which a particular entity plays. For e.g. in any industry role played by the manager differs from the subordinate.

The roles need to be classified into the security system. A user can play multiple roles in the system. A manager can play the role as data entry as well as authorizing body.

A data entry operation may not have provision to enter some critical data, which manager does enter if manager is logging into the system as manager role. The managers can login into the system as data entry operator as well.

If manager is logging in as data entry operation he may not have the privileges as he was having in manager role. In such a case he will be treated as data entry operator.

The security system needs to take above situations.

The user roles can beSUPER USERSENIOR MANAGEMENTMANAGERDATA ENTRY PERSONNELPART TIME EMPLOYEE

The user roles need to be configured into the system. The user roles can be added for the future modifications. The CAS (Core Administration System) system need to be pre configured for the basic pre defined roles which will not be editable.

Users

A user is an identity that can be authenticated by the system. A user can represent a person who is working in any of the departments in Benefit Partners Inc.A user can belong to multiple groups.A user can play multiple roles

Permissions represent the privileges required for accessing resources. An administrator protects resources by establishing access control lists to grant permissions to users and groups.

Individual user permissions take precedence over group permissions. Individual user permission overrides the more restrictive group permission. (Even if the group permission is less restrictive than the user permission, the user permission overrides the group permission and vice versa).

List of Programs

1. Security LoginAllows the administrator to login into the security system.

2. Module MasterAllows administrator to do following operationsCreate ModuleModify ModuleDelete Modules

3. Application Master

Allows administrator to do following operationsCreate ApplicationModify ApplicationDelete Application

Allows administrator to do following operationsCreate ResourcesModify ResourcesDelete Resources

5. Group Master

Allows administrator to do following operationsCreate GroupModify GroupDelete Group

6. User Master

Allows administrator to do following operationsCreate UserModify UserDelete User

7. User Role

Allows administrator to do following operationsCreate RoleModify RoleDelete Role

8. User Access Rights

9. User, User Role and Groups Mapping

10. Group Access Rights

Allows administrator to do following operations.

Assign Rights for a User. This program allows the administrator to override the access rights for a user.

11. User Login

When the system user logs in into the core administration system the separate ACL will be generated for each user. The ACL will be stored in the User Profile object, which will be stored in the user session. When user request for a particular page controller will check with the security system whether user is having access to the particular page.

The user password needs to be validated as followsThe password need to be minimum 6 characters long and max 10 charactersThe password needs to be combination of alphabets and special characters and numbers (for e.g. Amit1$3, sriRam9#445 etc).The password is valid for 15 days, which is configurable. The system should prompt user to change the password three days (which is configurable) prior to expiry date of the password.If user changes the password then his password is valid for 15 days (which is configurable) from the date of change.In the same way administrator can configure the minimum limit for password age, which signifies that user cannot change the password for this period from the date of prior change.The minimum limit for the password age, which is configured value, cannot be greater than or equal to configured maximum limit of the password age.First time user must change his password before entering into the system.

ScenarioIf the user password is “123456” the for first time login user goes and change the password to “Mali5%9”. The user is created on date Jan. 4, 2002. User logs in on Jan. 5, 2002 and password expiry date for the user changes to Jan. 19, 2002 (15 calendar days) if the configured time limit is 15 days. The user needs to prompt to change password on Jan. 17, 2002 (3 calendar days prior to the expiry date). If user changes the password within stipulated time then extend the password expiry date. by 15 calendar days. (New Date=Sys Date+15). All changes in the date is effective from 0000 AMThe above validation is not applicable at the time of user creation as administrator can keep the password 123456 for all.The new password in the change password is to be validated for above conditions. The old password need not be validated for above conditions. As user can have 123456 as first time as his password.The old password needs to be maintained in the history. The new password must not be equal to last five passwords. This number of history of passwords (here its 5) should be configurable. (A configurable password history where the administrator can enter value that would represent how many passwords it would remember until the user can use the same password again)The ability to enable or disable Account lockout with a configuration value for the number of user log in attempts at which point a lockout would occur. A way timer for when to reset the count of attempts before lock would be helpful. Also if it possible to make a lockout duration value that would be configurable would also be helpful.User Name cannot be a part of password.

Configurable Items

SrNoItem NameValue1Length Of Password (MinimumInteger (Ranging From 1-n)Value)Need to be set by theadministrator2Length Of Password (MaximumInteger (Ranging From 1-n)Value)Need to be set by theadministratorMaximum need to be greaterthan minimum value3Expiry of the password from theInteger (Number of days)date of validity (Maximum Range)Ranging from 1-nNeed to be set by theadministrator4Expiry of the password from theInteger (Number of days)date of validity (Minimum Range)Ranging from 1-nNeed to be set by theadministrator5Password Repeat allowed valueInteger (Number of days)This indicates that new passwordsRanging from 1-ncan not be same as last n passwordsNeed to be set by theadministrator6Invalid Passwords allowed beforeInteger (Number of days)locking the accountRanging from 1-nIf user enters the password incorrectNeed to be set by thefor n times then his account will beadministratorlocked automatically.7Lock TimeTime for which account to belocked if it is locked becauseof successive invalidpasswords entry.8Password change prompt dateThis value signifies that userneed to be intimated by 3days prior about passwordchange (Value here set as 3)

1.3. Security Framework

1.3.1.1. Script for Setup

Run the basic admin script, which will create the basic administrative user for security login and minimal data into the database.

1.3.1.2. Security Login

Security LoginRefer Process Flow DiagramFIG. 2. The flow of the process is as described below.

System allows user to login into the system. The basic user id and password validation will be done for the administrator for the security system.

On successful login administrator can create modules, groups, applications, user etc.

1.3.1.3. Module Master

Refer Process Flow DiagramFIG. 3. The flow of the process is as described below.

Create Modulesa) On selecting create modules option. The user needs to enter the module name and description.b) The user enters the details and clicks save.c) Upon save the data will be stored in the database.

Delete Modulesa) When user selects the Delete option, the user will be shown all the modules where in user can select one or more access control list and click delete.b) The selected modules will be deleted from the database.

1.3.1.4. Application Master

Refer Process Flow DiagramFIG. 4. The flow of the process is as described below.

Create Applicationa) On selecting create application option. The user needs to enter the application details like application name, module name and description.b) The user enters the data and clicks save.c) Upon save the data will be stored in the database.

Modify Applicationa) When user selects modify applications option. He will be shown all the applications in the selection box. The user selects one application and clicks select.b) The user will be shown the details about the selected application. The user can modify the application details and click save.c) The data will be updated into database.

Delete Applicationa) When user selects the Delete option, the user will be shown all the applications where in user can select one or more applications and click delete.b) The selected applications will be deleted from the database.

1.3.1.5. Resource Master

Refer Process Flow Diagram. The flow of the process is as described below.

Create Resourcea) On selecting create resource option. The user needs to enter the resource details like resource name, application name and description.b) The user enters the data and clicks save.c) Upon save the data will be stored in the database.

Modify Resourcea) When user selects modify resource option. He will be shown all the resources in the selection box. The user selects one resource and clicks select.b) The user will be shown the details about the selected resource. The user can modify the resource details and click save.c) The data will be updated into database.

Delete Resourcea) When user selects the Delete option, the user will be shown all the resource where in user can select one or more resources and click delete.b) The selected resources will be deleted from the database.

1.3.1.6. Group Master

Refer Process Flow DiagramFIG. 6. The flow of the process is as described below.

Create Groupa) On selecting create group option. The user needs to enter the group details like group name and description.b) The user enters the data and clicks save.c) Upon save the data will be stored in the database.

Modify Groupa) When user selects modify group's option. He will be shown all the groups in the selection box. The user selects one group and clicks select.b) The user will be shown the details about the selected group. The user can modify the group details and click savec) The data will be updated into database.

Delete Groupa) When user selects the Delete option, the user will be shown all the groups where in user can select one or more groups and click deleteb) The selected groups will be deleted from the database.

1.3.1.7. User Creation

Refer Process Flow DiagramFIG. 7. The flow of the process is as described below.

Create Usera) On selecting create user option. The user needs to enter the details like user name, description, address details etc.b) The user enters the data and clicks save.c) Upon save the data will be stored in the database.

Modify Usera) When user selects modify user option. He will be shown all the user details in the selection box. The user selects one-user and clicks select.b) The user will be shown the details about the selected user. The user can modify the user details and click savec) The data will be updated into database.

Delete Usera) When user selects the Delete option, the user will be shown all the users where in user can select one or more users and click deleteb) The selected users will be deleted from the database.

1.3.1.8. User Role Creation

Refer Process Flow DiagramFIG. 7a. The flow of the process is as described below.

Create User Rolea) On selecting create user role option. The user needs to enter the details like user role name, descriptionb) The user enters the data and clicks save.c) Upon save the data will be stored in the database.

Modify User Rolea) When user selects modify user role option. He will be shown all the user role details in the selection box. The user selects one-user role and clicks select.b) The user will be shown the details about the selected user role. The user can modify the user details and click savec) The data will be updated into database.

Delete User Rolea) When user selects the Delete option, the user role will be shown all the users roles where in user can select one or more users role and click deleteb) The selected user roles will be deleted from the database.

1.3.1.9. User, User Role and Group Mapping

Refer Process Flow DiagramFIG. 8. The flow of the process is as described below.

Assign Rightsa) On selecting the User, User Role and Group Mapping option. The user will be shown the all the users and user roles in the selection box. The user can select the combination of user and user role.b) On selection user will be shown the all the groups with already assigned groups as checked.c) The user adds or removes the group assignment and clicks save.d) Upon save the data will be stored in the database

1.3.1.10. Group Access Rights

Refer Process Flow Diagram. The flow of the process is as described below.

Assign Rightsa) On selecting the group access rights. The user will be shown the all the groups in the selection box. The user can select any group and click select.b) When user selects the particular group, the user will be shown the all the resources and with the access rights selection box corresponding to each module.c) User can assign one or more resources to the group and click save.d) Upon save the data will be stored in the database.

1.3.1.11. User Access Rights

Refer Process Flow Diagram. The flow of the process is as described below.

As stated earlier, user can override the access specified to the group.

Assign User Rightsa) On selecting the user access rights. The user will be shown the all the users in the selection box. The user can select any one user and click select.b) When user selects the particular user, the user will be shown the all the access rights for his group for corresponding resource.c) The user can add or remove the resources.d) Upon save the data will be stored in the database.

1.3.1.12. Configure Items

Refer Process Flow Diagram. The flow of the process is as described below. This allows administrator to configure various items like password length, expiry etc.

1.4 User Interface

1.4.1.1 User Interface Screen Snap Shot—Screen Name: Security Login

Table for Screen SECURITY_LOGIN_SCREEN—001

Table for Screen SECURITY_LOGIN_SCREEN—002

1.4.1.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.2.1 User Interface Screen Snap Shot—Screen Name: Module Master

Table for Screen SECURITY_SCREEN—003

ElementName ElementType PurposeMain HeadingTextTo give the heading for the screenCreate Modulebeing navigatedSub HeaderTextText for the Module IdModule IdModule IdEntry FieldText for the entry fieldSub HeaderTextText for the Module NameModule NameModule NameEntry FieldText for the entry fieldSub HeaderTextText for the Module NameModuleDescriptionModuleEntry FieldText for the entry fieldDescriptionSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—004

Element NameElement TypePurposeSearchGif FileUsed to search the module

Table for Screen SECURITY_SCREEN—004

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenModify Modulebeing navigatedSub HeaderTextText for the Module IdModule IdModule IdEntry FieldText for the entry fieldSub HeaderTextText for the Module NameModule NameModule NameEntry FieldText for the entry fieldSub HeaderTextText for the Module NameModuleDescriptionModuleEntry FieldText for the entry fieldDescriptionUpdateButton (HTMLTo Save the data this button need toButton)be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—005

ElementElement NameTypePurposeMain HeadingTextTo give the heading for the screen beingDelete ModulesnavigatedSub HeadingTextTo give the sub heading for the screenSelect thebeing navigatedmodulesModule NamesCheck BoxCheck boxes for module names to beSales, financedeleted.Check BoxCheck AllOn clicking the “Check All” link shouldcheck all the check boxes in the HTMLtable.Check BoxClear AllOn clicking the “Clear All” link shoulduncheck all the checked check boxes in theHTML table.DeleteDeleteTo Delete the data this button need to beclicked

1.4.2.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

User Interface Screen Snap Shot—Screen Name: Group Master

Table for Screen SECURITY_SCREEN—006

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenCreate Groupbeing navigatedSub HeaderTextText for the Group IdGroup IdGroup IdEntry FieldText for the entry fieldSub HeaderTextText for the Group NameGroup NameGroup NameEntry FieldText for the entry fieldSub HeaderTextText for the Group NameGroupDescriptionGroupEntry FieldText for the entry fieldDescriptionSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—007

Element NameElement TypePurposeSearchImageTo provide search

Table for Screen SECURITY_SCREEN—007

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenModify Groupbeing navigatedSub HeaderTextText for the Group IdGroup IdGroup IdEntry FieldText for the entry fieldSub HeaderTextText for the Group NameGroup NameGroup NameEntry FieldText for the entry fieldSub HeaderTextText for the Group NameGroupDescriptionGroupEntry FieldText for the entry fieldDescriptionUpdateButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—008

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screen being navigatedDelete GroupSub HeadingTextTo give the sub heading for the screen being navigatedSelect the GroupsGroup NamesCheck BoxCheck boxes for group names to be deleted.Sales, financeCheck BoxCheck AllOn clicking the “Check All” link should check all the checkboxes in the HTML table.Check BoxClear AllOn clicking the “Clear All” link should uncheck all the checkedcheck boxes in the HTML table.DeleteDeleteTo Delete the data this button need to be clicked

1.4.3.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.4.1 User Interface Screen Snap Shot—Screen Name: Application Master

Table for Screen SECURITY_SCREEN—009

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenCreatebeing navigatedApplicationSub HeaderTextText for the Application IdApplication IdApplication IdEntry FieldText for the entry fieldSub HeaderTextText for the Application NameApplication NameApplication NameEntry FieldText for the entry fieldSub HeaderTextText for the Application NameApplicationDescriptionApplicationEntry FieldText for the entry fieldDescriptionSub HeaderTextText for the Module NameModule NameSelection BoxSelection BoxModule NameSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—010

Element NameElement TypePurposeSearchGifTo search the application

Table for Screen SECURITY_SCREEN—010

Table for Screen SECURITY_SCREEN—011

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screen being navigatedDeleteApplicationSub HeadingTextTo give the sub heading for the screen being navigatedSelect theApplicationApplicationCheck BoxCheck boxes for applications names to be deleted.NamesSales, Select boxfor ApplicationCheck BoxCheck AllOn clicking the “Check All” link should check all the checkboxes in the HTML table.Check BoxClear AllOn clicking the “Clear All” link should uncheck all the checkedcheck boxes in the HTML table.DeleteDeleteTo Delete the data this button need to be clicked

1.4.4.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.5.1 User Interface Screen Snap Shot—Screen Name: Resource Master

Table for Screen SECURITY_SCREEN—012

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenCreate Resourcebeing navigatedSub HeaderTextText for Resource IdResource IDResource IDEntry FieldText for the entry fieldSub HeaderTextText for Resource NameResource NameResource NameEntry FieldText for the entry fieldSub HeaderTextText for screen urlScreen URLScreen URLEntry FieldText for the entry fieldResourceTextText for the Resource DescriptionDescriptionResourceEntry FieldText for the entry fieldDescriptionSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—012 & Screen SECURITY_SCREEN—013

Element NameElement TypePurposeSearchGifTo search the resource and application

Table for Screen SECURITY_SCREEN—013

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenCreate Resourcebeing navigatedSub HeaderTextText for Resource IdResource IDResource IDEntry FieldText for the entry fieldSub HeaderTextText for Resource NameResource NameResource NameEntry FieldText for the entry fieldSub HeaderTextText for screen urlScreen URLScreen URLEntry FieldText for the entry fieldResourceTextText for the Resource DescriptionDescriptionResourceEntry FieldText for the entry fieldDescriptionSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—14

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screen beingDelete ResourcesnavigatedSub HeadingTextTo give the sub heading for the screenSelect thebeing navigatedResourcesResourcesCheck BoxCheck boxes for Resources to be deleted.Check BoxCheck AllOn clicking the “Check All” link shouldcheck all the check boxes in the HTMLtable.Check BoxClear AllOn clicking the “Clear All” link shoulduncheck all the checked check boxesin the HTML table.DeleteDeleteTo Delete the data this button need tobe clicked

1.4.5.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.6.1 User Interface Screen Snap Shot—Screen Name: User Master

Table for Screen SECURITY_SCREEN—015

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenCreate Userbeing navigatedSub Header UserTextText for the User IdIdUser IdEntry FieldText for the entry fieldSub HeaderTextText for the Display NameDisplay NameDisplay NameEntry FieldText for the entry fieldSub HeaderTextText for the NameNameSub Header FirstTextText for the First NameNameFirst NameEntry FieldText for the entry fieldSub Header MITextText for Middle InitialMiddle InitialEntry FieldText for the entry fieldSub Header LastTextText for last nameNameLast NameEntry FieldText for the entry fieldSub HeaderTextText for the passwordpasswordPasswordEntry FieldText for the entry fieldSub HeaderTextText for the PhonePhonePhoneEntry FieldText for the entry fieldSub Header FaxTextText for the faxFaxEntry FieldText for the entry fieldSub Header ExtnTextText for the extExtnEntry FieldText for the entry fieldSub Header emailTextText for the emailEmailEntry FieldText for the entry fieldSub Header LockTextText for the lockLockCheck BoxCheck box for lock fieldSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—016

Element NameElement TypePurposeSearchGifTo search the user

Table for Screen SECURITY_SCREEN—016

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenModify Userbeing navigatedSub Header UserTextText for the User NameNameSub Header UserTextText for the User IdIdUser IdEntry FieldText for the entry fieldSub HeaderTextText for the Display NameDisplay NameDisplay NameEntry FieldText for the entry fieldSub HeaderTextText for the NameNameSub Header FirstTextText for the First NameNameFirst NameEntry FieldText for the entry fieldSub Header MITextText for MIMIEntry FieldText for the entry fieldSub Header LastTextText for last nameNameLast NameEntry FieldText for the entry fieldSub HeaderTextText for the passwordpasswordPasswordEntry FieldText for the entry fieldSub HeaderTextText for the PhonePhonePhoneEntry FieldText for the entry fieldSub Header FaxTextText for the faxFaxEntry FieldText for the entry fieldSub Header ExtTextText for the ExtExtEntry FieldText for the entry fieldSub Header emailTextText for the emailEmailEntry FieldText for the entry fieldLockCheck BoxCheck box for the lock fieldUpdateButton (HTMLTo Save the data this buttonButton)need to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—017

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenDelete Userbeing navigatedSub HeadingTextTo give the sub heading for the screenSelect the Userbeing navigatedUser NamesCheck BoxCheck boxes for User names to be deleted.Sales, Select boxfor ApplicationCheck BoxCheck AllOn clicking the “Check All” link shouldcheck all the check boxes in the HTMLtable.Check BoxClear AllOn clicking the “Clear All” link shoulduncheck all the checked check boxesin the HTML table.DeleteDeleteTo Delete the data this button need tobe clicked

1.4.6.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.7.1 User Interface Screen Snap Shot—Screen Name: User Role Master

Table for Screen SECURITY_SCREEN—018

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenCreate User Rolebeing navigatedSub Header UserTextText for the User Role IdRole IdUser Role IdEntry FieldText for the entry fieldSub Header UserTextText for the User Role NameRole NameUser Role NameEntry FieldText for the entry fieldSub Header UserTextText for the User Role NameRole DescriptionUser RoleEntry FieldText for the entry fieldDescriptionSaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—019

Element NameElement TypePurposeSearchGifTo search the user role

Table for Screen SECURITY_SCREEN—019

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenModify User Rolebeing navigatedSub Header UserTextText for the User Role IdRole IdUser Role IdEntry FieldText for the entry fieldSub Header UserTextText for the User Role NameRole NameUser Role NameEntry FieldText for the entry fieldSub Header UserTextText for the User Role NameRole DescriptionUser RoleEntry FieldText for the entry fieldDescriptionUpdateButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—020

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenDelete User Rolebeing navigatedSub HeadingTextTo give the sub heading for the screenSelect the Userbeing navigatedRoleUser Role NamesCheck BoxCheck boxes for User Role namesSales, financeto be deleted.Check BoxCheck AllOn clicking the “Check All” link shouldcheck all the check boxes in theHTML table.Check BoxClear AllOn clicking the “Clear All” link shoulduncheck all the checked check boxesin the HTML table.DeleteDeleteTo Delete the data this button needto be clicked

1.4.7.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.8.1 User Interface Screen Snap Shot—Screen Name: Group Access Rights

Table for Screen SECURITY_SCREEN—021

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenGroup Accessbeing navigatedRightsSub HeaderTextText for the Group NameSelect GroupGroup NameSelection BoxSelection box for the Group NameSub HeaderTextText for the Application NameSelect ApplicationApplication NameSelection BoxSelection box for the Application NameSelectButton (HTMLTo select the current selected GroupButton)to assign rights and modules.CancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—021

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenGroup Accessbeing navigatedRightsSub HeaderTextText for the Resource NameResource NameResource NameCheck BoxesCheck boxesSub HeaderTextText for Access RightsAccess RightsCombo BoxCombo BoxCombo box for selection of access rights.SaveButton (HTMLTo Save the data this button needButton)to be clickedCancelButton (HTMLTo cancel current operation.Button)

1.4.8.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.9.1 User Interface Screen Snap Shot—Screen Name: User, Role and Group Mapping

Table for Screen SECURITY_SCREEN—022

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenUser Searchbeing navigatedSub HeaderTextText for the User IdSelect User IdUser IdText BoxText Field for the User IdSub HeaderTextText for the User NameSelect UserNameUser NameText BoxText Field for the User NameSearchButton (HTMLTo search the current selected User idButton)CancelButton (HTMLTo cancel current operation.Button)

Table Screen SECURITY_SCREEN—022

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenUser Searchbeing navigatedSub HeaderTextText for the User IdSelect User IdUser IdText FieldText Field for the User IdSub HeaderTextText for the User NameSelect UserNameUser NameText FieldText Field for the User NameSearchButton (HTMLTo search the current selected User idButton)CancelButton (HTMLTo cancel current operation.Button)Sub HeadingTextTo give the heading for the searchUser SearchscreenResultsSub Header UserLabelText for the User IdIdSub Header UserLabelText for the User NameNameData Row fromUser IdUser id from database. To be displayeddatabasein tableData Row fromUser NameUser name from database. To bedatabasedisplayed in tableCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—023

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenUser Rolebeing navigatedMappingSub HeaderTextText for the User IdSelect User IdUser IdText LabelText Label for the User IdSub HeaderTextText for the User NameSelect UserNameUser NameText LabelText Label for the User NameSub HeaderTextText for the User RoleSelect User RoleSelection boxSelection BoxSelection Box for User RoleSelectButton (HTMLTo select the current selected User idButton)CancelButton (HTMLTo cancel current operation.Button)

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenUser Rolebeing navigatedMappingSub HeaderTextText for the User IdSelect User IdUser IdText LabelText Label for the User IdSub HeaderTextText for the User NameSelect UserNameUser NameText LabelText Label for the User NameSub Header UserTextText for the User RoleRoleText LabelText LabelSelection Box for User RoleSub HeaderTextText for the GroupsSelect the groupsCheck BoxCheck BoxCheck Box for groups. User can selectone or more groups.SelectButton (HTMLTo select the current selected User idButton)CancelButton (HTMLTo cancel current operation.Button)

1.4.10.1 User Interface Screen Snap Shot—Screen Name: Group Access Rights

Table for Screen SECURITY_SCREEN—024

Element NameElement TypePurposeMain HeadingTextTo give the heading for the screenUser Searchbeing navigatedSub HeaderTextText for the User IdSelect User IdUser IdText BoxText Field for the User IdSub HeaderTextText for the User NameSelect UserNameUser NameText BoxText Field for the User NameSearchButton (HTMLTo search the current selected User idButton)CancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—024

Element NameElement TypePurposeMain HeadingTextTo give the heading for theUser Searchscreen being navigatedSub HeaderTextText for the User IdSelect User IdUser IdText FieldText Field for the User IdSub HeaderTextText for the User NameSelect UserNameUser NameText FieldText Field for the User NameSearchButton (HTMLTo search the currentButton)selected User idCancelButton (HTMLTo cancel current operation.Button)Sub HeadingTextTo give the heading forUser Searchthe search screenResultsSub Header UserLabelText for the User IdIdSub Header UserLabelText for the User NameNameData Row fromUser IdUser id from database.databaseTo be displayed in tableData Row fromUser NameUser name from database.databaseTo be displayed in tableCancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—025

Element NameElement TypePurposeMain HeadingTextTo give the heading for theUser Accessscreen being navigatedRightsSub Header UserTextText for the User NameNameUser NameTextText for the User NameSub Header UserTextText for the User IdIDUser IdTextText for the User IdSub HeaderTextText for the Module NameModule NameSelection BoxSelection BoxSelection Box for Module nameSub Header RoleTextText for the Role NameNameSelection BoxSelection BoxSelection Box for Role nameSelectButton (HTMLTo select the current selectedButton)User assign rights for all the rapplication.CancelButton (HTMLTo cancel current operation.Button)

Table for Screen SECURITY_SCREEN—025

Element NameElement TypePurposeMain HeadingTextTo give the heading forUser Accessthe screen being navigatedRightsSub HeaderTextText for the Resource NameResource NameResource nameTextText for the Resource NameSub HeaderTextText for Access RightsAccess RightsCombo BoxCombo BoxCombo box for selection ofaccess rights.SaveButton (HTMLTo Save the data this buttonButton)need to be clickedCancelButton (HTMLTo cancel current operation.Button)

1.4.10.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.11.1 User Interface Screen Snap Shot—Screen Name: Configurable Items

Table for Screen SECURITY_SCREEN—026

Element NameElement TypePurposeMain HeadingTextTo give the heading for theConfigure Itemsscreen being navigatedSub HeaderTextText for the Password LengthPassword LengthPassword LengthText BoxText Field for the Password LengthSub HeaderTextText for the Password LengthPassword Length(Minimum)(Minimum)Password LengthText BoxText Field for the Password Length(Minimum)(Minimum)Sub HeaderTextText for the Expiry of passwordExpiry ofpassword (Max)Expiry ofText BoxText Field for the Expiry of passwordpasswordSub HeaderTextText for the Expiry of passwordExpiry ofpassword (Min)Expiry ofText BoxText Field for the Prompt Date PeriodpasswordSub HeaderTextText for the Prompt Date PeriodPrompt DatePeriodPrompt DateText BoxText Field for the Expiry of passwordPeriodPrompt Date PeriodSub HeaderTextText for the Password Repeat CountPassword RepeatCountPassword RepeatText BoxText Field for the PasswordCountRepeat CountSub HeaderTextText for the Invalid PasswordsInvalidCountPasswords CountInvalidText BoxText Field for the Invalid PasswordsPasswords CountCountSub Header LockTextText for the Lock TimeTimeLock TimeText BoxText Field for the Lock TimeSearchButton (HTMLTo search the current selected User idButton)CancelButton (HTMLTo cancel current operation.Button)

1.4.11.3 Front End Validation

Validation Details

This section provides the front end screen validations along with the associated message—Success/Error Message text

1.4.12 User Login

When the system user logs in into the core administration system the separate ACL will be generated for each user. The ACL will be stored in the User Profile object, which will be stored in the user session. When user request for a particular page controller will check with the security system whether user is having access to the particular page.

When any user requests a particular page in the core administrative system, the controller will ask the security system about the security rights for the application. If user is having rights he will be allowed to perform the current operation.

For e.g. If user request for create carrier master. The carrier master is registered into the system with system with id as 0001. The controller will check the access rights for the carrier master. If the rights for carrier master is write then user will have access to create carrier master as the user rights are higher than requested one. If user is having access rights as read for carrier master then he would not be able to access because it is having lower rights than requested one.

Password Validation

Password validation to be done as per the requirements specified before. The following items need to be configured as per requirements.

1.5 Business Rules

ActivityRulesDelete RuleFor Deleting referential integrity need to beconsidered.A group can be deleted if no user is referring to thegroupSame applies to other hierarchyModuleApplicationResource

1.6 Help Menu

Help to be provided for all the screens. Help should contain following details.

Basic Functionality Description

Description about the screen fields.

This section describes the likely data structure that would contain the data for/by executing the process

1.8 Back End Validations

This subsection provides the field element name and corresponding back end validation if applicable.

Back end validations are those validations where the validations have got to be necessarily done using the database.

As a general rule backend validations should be done for all the validation checks that are being carrier on the front end.

This subsection corresponds to the requirements that do not relate to the user function. It provides information on the system requirements—Ideally identifies the present problems in the existing system from a non-functional perspective and avoiding the same in the new system

Non FunctionalRequirementDetailsPerformancePerformance criteria should be established basedon the data size and the page size.System ExceptionAll system exceptions should be handled gracefully throwing a error page with relevant exceptioninformation and action to be taken for resolving theexception

1.10 Access Control List

This section describes the classification of users who can access the process under definition

Benefit Partners Inc

Process Specification

Common Functional Features

The purpose of this document is to describe the common functional features available across all the modules. This document is identified as Common Functional Features. This document identifies how the user interacts with the system, the data to be captured, the business logic to be implemented, and the output of the process for the common functional features.

1.2. Business Use Case Specification Reference

Business Use Specification IDBusiness Use Case NameBPI_SCOPEScope DocumentBPI_SCOPE_ADDAddendum to scope

2. Process Identification

Common functional feature is to identify the common functionality across all the modules that have the same usage. This would help in standardization and reuse of the components.

2.2. Process Description

The objective of the Common Functional Features process is to:1) Identify the Common functional features across all the modules:

2.3. Process Flow

Not applicable

3. User Interface

3.1. User Interface Screens

3.1.1. Not Applicable

3.1.2. Not Applicable

Element NameElement TypePurposeFirst nameEntry FieldEnter the First nameLast nameEntry FieldEnter the last nameMiddle name (MI)Entry FieldEnter the middle NameSuffixDrop Down ListList the SuffixSalutationDrop Down ListList the SalutationTitleEntry FieldEnter the Job TitleAddressEntry FieldEnter the first detailabout the addressSuite/Apt. #Entry FieldEnter the suite/ApartmentPO BOX numberCityEntry FieldEnter the name of the cityStateDrop Down ListList all the States in UASZIPEntry FieldEnter the ZIP CodePhone #Enter FieldEnter the Phone numberFax #Entry FieldEnter the FAX numberPhone ExtensionEntry FieldEnter extension numberFAX ExtensionEntry FieldEnter extension numberEmail AddressEntry FieldEnter the email addressCredit Card NumberEnter the CreditEntry Credit Card numberCard NumberCredit Card TypeDrop Down ListList the type of Credit Card(Date) Current DateCalendar/Entry field to type(System Date)Entry Fieldthe date or Calendarto pick the date(Date) Past Date (1900Calendar/Entry field toto system date)Entry Fieldtype the date orCalendar to pick the date(Date) Future DateCalendar/Entry field to type the date or(System date to 100Entry FieldCalendar to pick the dateYr. hence)(Date) Default 1stofCalendar/Entry field toFollowing Month (eg.Entry Fieldtype the date orSystem date is Dec. 2, 2001Calendar to pick the dateshould default toJan. 1, 2002)(Date) Default 1stofCalendar/Entry field tothe current Month (e.g.Entry Fieldtype the date orSystem date is Dec. 2, 2001Calendar to pick the dateshould default toDec. 1, 2001)(Date) Default End ofCalendar/Entry field tocurrent Month (eg.Entry Fieldtype the date orSystem date is Dec. 2, 2001Calendar to pick the dateshould default toDec. 31, 2001)(Date) Credit CardDrop Down ListList all the Months in a yearDate (should onlyaccept future date.)MonthDate) Credit CardDrop Down ListList the year 25 years aheadDate (should onlyaccept future date.)YearSocial SecurityEntry FieldEnter the Social SecurityNumbernumberTAX IdentificationEntry FieldEnter the Tax IdentificationNumberNumberMode ofDrop Down ListList Various modes ofCommunicationcommunicationBrowser Back ButtonButtonValidate the back buttonBrowser ForwardButtonValidate the forward buttonButtonRefresh ButtonButtonValidate Refresh buttonAddress BarsTool BarsHide Address barLink BarTool BarsHide Link barStandard ButtonTool barsHide standard barsWindow CloseBrowser WindowValidate CloseWindow MinimizeBrowser WindowValidate minimize

Note: Validation provided here are the default validations. However if the module functionality has specified different validations for these element described then that would override the default validations provided here.

Element NameAction/Validation DetailsMessageFirst nameEntry Field with 40 Character long.Can accept only Alpha characters.ArnoldLast nameEntry Field with 40 Character longCan accept only Alpha characters.SchwarzeneggerMiddle name (MI)Entry Field with 1 Character longCan accept only Alpha characters.M, A etc.SuffixList should include Jr., Sr., I., II.,III., IV., and V.SalutationList should include Mr., Mrs., Ms.TitleEntry Field with 20 Character longCan accept Alpha and numericcharacter and blank space betweencharacter (Example Administrator 1)AddressEntry Field with 40 Character long3013 Douglas Boulevard,Can accept free form entry with anycharacter.Suite/Apt. #Entry Field with 20 Character longExample 200 or 1 D etc.Can accept free form entry with anycharacter.CityEntry Field with 20 Character longAlpha only and Blank betweenwords allowedRoseville, San Jose, San DiegoStateList all the States in USA inabbreviated form as CA, IL, OH, NYetc.ZIPShould allow maximum andminimum of 5 Numbers only. WholeNumber Field.Phone #Entry Field with 10 Character longShould allow maximum andminimum of 10 Numbers only.Whole Number Field.3 for Area code, 7 for the number.Fax #Entry Field with 10 Character longShould allow maximum andminimum of 10 Numbers only.Whole Number Field.3 for Area code, 7 for the number.Phone ExtensionEntry Field with 5 Character longShould allow maximum of 5 andminimum of 1. Blanks fields areacceptable.Whole Number Field.FAX ExtensionEntry Field with 5 Character longShould allow maximum of 5 andminimum of 1. Blanks fields areacceptable.Whole Number Field.Email AddressEntry Field with 40 Character longAllow entering more than 40character.Validate for a Valid Email Address.Credit CardEntry Field with 20 Character longNumberMinimum and maximum valueshould be 16. Allow only WholeNumber. Numeric FieldFor Amex allow 20 as min and maxvalue.Credit Card TypeList Credit Card type asVisa, Master, Discovery, Amex etc(Date) CurrentEntry Field or Calendar with defaultDate (System Date)system date in the Entry Field andcalendar.(Date) Past DateEntry Field or Calendar with default(1900 to systemsystem date - 1 in the Entry Fielddate)and calendar. Do not allow forCurrent date and future date(Date) Future DateEntry Field or Calendar with default(System date tosystem date in the Entry Field and100 Yr. hence)calendar. Do not allow for past date(Date) Default 1stEntry Field or Calendar with defaultof Followingfirst of the following month date inMonth (eg. Systemthe Entry Field and calendar.date is Dec. 2, 2001should default toJan. 1, 2002)(Date) Default 1stEntry Field or Calendar with defaultof the currentfirst of the current month date in theMonth (e.g. SystemEntry Field and calendar.date is Dec. 2, 2001should default toDec. 1, 2001)(Date) Default EndEntry Field or Calendar with defaultof current Monthend of the current month date in the(eg. System date isEntry Field and calendar.Dec. 2, 2001 shoulddefault toDec. 31, 2001)(Date) Credit CardList to show all the months in a yearDate (should onlyaccept future date.)MonthDate) Credit CardList the years from current year toDate (should only100 years forward hence.accept future date.)Validate The Credit Card month andYearyear together. Should not have pastmonth as credit card entry.Social SecurityEntry Field with 9 Character longNumberShould allow maximum of 9 andminimum of 9.Whole Number Field.TAX IdentificationEntry Field with 9 Character longNumberShould allow maximum of 9 andminimum of 9.Whole Number Field.Mode ofList various modes ofCommunicationCommunication like Fax, Phone,Email, USPSBrowser BackDisable the browser back button andButtonhide the back buttonBrowser ForwardDisable the browser forward buttonButtonand hide the forward buttonRefresh ButtonDisable the browser refresh buttonand hide the refresh buttonAddress BarsDisable the address bar so that usercannot type the URL to navigate tothe respective screenLink BarDisable the link barStandard ButtonDisable the browser standard buttonWindow CloseCatch windows close event withJava script and show the message.Window MinimizeAllow to minimize the window

3.1.5. Interface Flow

3.1.6. Help Menu

Element NamePurposeValid Values

4. Business Rule Mapping

Not Applicable

5. Data Structures

Not Applicable

Data Element NameData Element Type

5.1. Back End Validations

Not Applicable

Field Element NameBack End Validation

Not Applicable

Non Functional RequirementDetails

7. Access Control List

Not Applicable