Open Enrollment FAQs

Always list a contact who has the power to make OE decisions for your company. If you require a Paycor contact, please use [email protected]. Your assigned EDI Consultant will review and provide a timely response. If you have a new benefit contact at your company, please add them by submitting the Paycor Authorized 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.

E-mail all structures to: [email protected]

If your OE file requires a structure update, Paycor needs to receive the update at least 30 days before the renewal date. Structure updates that does not require testing can take up to 1-2 weeks to complete once we receive the account structure document. If the structure update requires testing, the update can take 3-4 weeks to complete. Paycor will provide the initial test file within 3-5 business days once we have received the account structure to make the changes.

COBRA Files: If you have an existing COBRA file feed in production and plan changes are made during OE, such as, removing a plan, adding a plan or a change to the plan name. Please consult with your COBRA vendor to prepare an updated structure to provide to Paycor to avoid issues with your COBRA files.

Paycor must receive the structure updates at least 30 days before the renewal date to initiate the testing process with the carrier. Once the structure is received, Paycor will provide an initial test file to the carrier within 3-5 business days. Testing can take between 3 – 4 weeks to complete and could exceed this timeframe depending on the carrier requirements. OE files cannot be sent until Paycor receives approval from the carrier.

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.

Termination and cancellation dates are critical markers. A termination date is recorded when an employee or their dependent opts out of coverage due to significant life events, which could include obtaining alternative insurance or employment changes. This date is typically communicated in weekly data files to the insurance carrier and not on the OE file. Conversely, a cancellation date is noted when an employee’s coverage is retracted, often due to employment termination before the activation of benefits. This date, along with other cancellation scenarios such as administrative errors or immediate benefit withdrawal requests, is also relayed to the carrier on weekly data files, marking the start and end date of the intended coverage period with the new plan year start date. Cancellations are recorded on the first weekly data file and ongoing files for the new plan year.

Yes, term by omission logic is used on all open enrollment files. Term by omission logic is referred to as an implicit termination on the EDI file. Since the OE files only include active benefits, it implies that any employee or covered dependent that is missing from the file is terminating coverage by omission from the file. Most carriers can accept this and will apply end-of-the-month term logic to terminate coverage in their system. Clients should confirm with their carriers if they can apply this logic to their benefits.

Most carriers can apply term by omission logic. If your carrier cannot term by omission they may provide a processing/discrepancy report which will outline the processing changes made on your OE file. This report will highlight employees and covered dependents who are active in the carrier’s system but missing from the OE file. The client is responsible for reviewing this report thoroughly and must provide the explicit coverage termination date to the carrier for manual updating in their system. This will help prevent incorrect enrollments and invoice over payments.

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.

If an employee opts out of coverage for the upcoming year, their termination date (12/31) will not be included in the weekly file; instead, it must be communicated manually to the carrier to prevent billing errors. However, if the coverage termination is due to a qualifying event and the coverage termination date is prior to the end of month, it will automatically be included in the weekly file. This distinction ensures accurate record-keeping and helps avoid issues with enrollment across different plan years.

Yes, new hires are passed on the OE file, with a coverage start date equal to the new plan year.

The timing of new hire enrollment reporting during the OE period determines when the enrollment is sent on the EDI file. If the new hire enrolls in coverage for the current plan year through a New Hire Event, before the last scheduled current year weekly file is sent the original coverage effective date will pass on the weekly file. However, if an employee enrolls in coverage for the new plan year during Open Enrollment their enrollment will pass on the OE file with a minimum effective date equal to the new plan year or later.

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.

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)

If the new hire enrolls during the black out period, the coverage will need to be manually added in the carrier’s online portal to ensure the correct coverage start date is applied to avoid access to care issues and denial of claims.

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

You will receive an email if you are listed as a file confirmation recipient. Contact your Paycor Consultant to add new recipients.

Paycor will send your existing OE file to the carrier on the original requested date outlined in the OE EDI Expectations email so the carrier can begin processing membership and generate hard copy ID cards (if provided). If the enrollment is extended within 2 weeks of the renewal date, the enrollments will pass on the first weekly file of the new plan year. The client should set expectations with employees that hard copy versions of the ID cards may be delayed. However, the electronic version of the ID cards can be accessed via the carrier’s membership portal if care is needed.

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 a case via Paycor Support Center, following the instructions below.

• Visit the client support portal. support.paycor.com
• Navigate to the ‘Submit a Case’ section.
• Fill in the required details and attach this email for reference, if necessary.

This process will ensure your inquiries are tracked and visible, allowing us to address them promptly.

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.

EDI will provide each client with an OE timeline with key dates to outline the file schedules for the current and new plan year data transfer. The timeline provides clear visibility to the customer, which can also be shared with brokers, and carrier partners to mitigate confusion of the file schedule and black out period. The timeline provides detailed descriptions of each milestone and explains the responsibility for each stakeholder during the blackout period.

This enhancement automates the scheduling of your OE file, eliminating the need for manual scheduling. It ensures that all files are automatically scheduled, so they are sent on time according to the insurance carrier’s requirements to initiate the generation of ID cards and allow sufficient mail time for employees to receive them before the renewal month. The files will be transmitted to carriers two to three weeks before the renewal date.

We understand the importance of having real-time benefit deduction data available within Paycor. All clients must review their benefit deduction settings and codes before their annual enrollment window opens.

Outlined below are a few critical steps that our mutual clients need to complete to ensure accuracy of their deductions.

• Adding a new benefit plan that requires a new deduction code? New deduction codes are required to be added within Paycor.
• Review deduction within Benefits Advisor by running the Benefit Administration report and confirm all deduction codes match what is listed in Paycor.
• Confirm your Open Enrollment benefit deduction settings are set correctly within Paycor.
• Proactively review scheduled deductions to ensure accuracy prior to processing payroll for the new year.

If any deduction codes need to be updated within Benefits Advisor (newly added or changes), please have them contact their OE consultant for help.

Confirming benefit deduction settings within Paycor:

• People >> People Settings >> Benefit Deduction Settings >> Click Open Enrollment Tab
• Select rule for each date type >> Input benefit effective >> Test
• This will allow you to confirm the pay period dates and check date are correct >> Save

 Proactively review OE deductions:

• Login to Paycor >> Search “Benefits Advisor” in the search navigation field >> Select “Benefits Advisor”
• Select “Reports” >> Report Center >> Select “Benefit Administration” report
  • Current Deduction Codes: To review current deduction codes, simply select “Run”

Future Deduction Codes: To review future deduction codes, change the report effective date to fixed date and input the renewal effective date and select “Run”