Open Enrollment

Always list a contact who has the power to make OE decisions. If you require a Paycor contact, please use [email protected] If you have a new benefit contact at your company add them with the Paycor Contact Form. 

This document or spreadsheet provided by your carrier details your unique employee classification data requirements (Ex. If you have multiple medical plans across several divisions).

Any change you make to your existing benefit group structure, other than premium rates, requires a structure change (Ex. Adding a new location or benefit class). If you are unsure, reach out to your carrier’s billing contact to confirm.

All OE files will be sent to carriers at least 2-3 weeks prior to your renewal date.

If your OE file requires a structure update, the OE file will be delayed for an additional 3-5 business days from receipt of the structure document to allow time for the EDI time to make the appropriate updates to each carrier file. As soon as you receive the document, please provide this to Paycor immediately to mitigate extensive delays.

If this is required, the OE file will not be sent until Paycor receives approval from the carrier to send a full OE production file.  If no testing is required by the carrier, the OE file will be scheduled to send on the following business day following the completion of the structure changes.

Paycor will attempt to resolve the discrepancies first; however, we may need your guidance. If we do, it’s critical that you immediately review the discrepancies to prevent enrollment processing delays.

No, OE files will not include terminations. Current terminations must be manually updated in the carrier system.

The weekly production file will pause once the full annual OE file has been sent to your carriers. At this time, your current year files will enter a black-out period.

The black-out period is the time between Paycor sending your annual OE file to your carrier(s) and the first “production” file of the new plan year (typically between 2-3 weeks).

Paycor will pause weekly production files for the current plan year to the carrier for the remainder of the plan year once your OE file has been sent.

It is the responsibility of the client to ensure all current plan year new hires, changes, and terminations are manually updated in the carrier system and with Paycor.

You can use the following reports in Benefits Advisor under the Report Center. We recommend running these reports weekly to provide timely updates to your carrier.

1. Change report— This report provides a list of demographic and enrollment changes for employees, spouses, and dependents. Report name in BA: Enrollment Changes ( EE, DEP)
2. Census Report— This report provides a list of all employees, spouse, and dependent benefit elections currently in the system. Report name in BA: Benefit Elections ( EE. Dep. No Codes)

Weekly files resume the first week of the new plan year on the scheduled day that was agreed upon by the carrier.

1. You will receive an email if you are listed as a file confirmation recipient. Contact your Paycor Consultant to add new recipients.
2. Contact your Paycor Consultant to add file confirmation alerts to your Benefits Advisor home page.

Paycor will send your existing OE file to the carrier on the original requested date so that they have most enrollments to begin processing ID cards (if provided) and updating membership and billing information. Enrollments entered after the extended date will pass on the first weekly file of the new plan year once weekly files resume. Set expectations with your employees that ID cards may be delayed. Electronic ID cards can be accessed via the carrier’s membership portal if care is needed before receiving hard ID cards.

Paycor’s best practice is to send all OE files at least 2–3 weeks before the renewal date. We understand that the date the carrier requires doesn’t always align with your OE start and close date. If this happens, Paycor will not provide an off-cycle file to your carrier. OE enrollments will be provided to the carrier on the first weekly file of the new plan year.

Please submit an urgent case to [email protected] with the subject Post OE Structure Update. Attach the structure change document from the carrier as well as carrier contact information (name, email, and phone). Note that this may cause a delay with your new plan year enrollment updates and could also delay access to care for your employees. Manual enrollments in the carrier system and Benefits Advisor may also be required.

No, unless the PCP information was already included in your current weekly production file.

Carriers commonly do not accept new EDI files during the Q4 peak renewal season starting in October. This applies only if your EDI file must go through a new implementation. Depending on when the carrier’s paperwork is finalized, your EDI file may be postponed until Q1 (around February). If this happens, your implementation project manager and the carrier will consult on options to manage enrollment data in Paycor and the carrier’s system.