Client Benefit Plans Export Merge

Use the Client Benefit Plans Export merge to export Active Offered Benefit Plans (OBPs) to PrismHR via their built-in import functionality. Plan setup details, rate group tiers, are included in the export.

IMPORTANT: The Client Benefits Plan Export merge will no longer receive updates after ClientSpace Release 166. To ensure access to future enhancements and ongoing support, we recommend using the Benefits Plan Export API which will continue to be the supported solution for exporting benefits plan data. See Exporting Benefit Plans to PrismHR.

Configuration

Default configuration on the Merge Admin Detail configuration form is located in System Admin > Outputs > Merges in the Client Benefit Plans record:

Client Benefit Plans Merge Admin Detail Record

Running the Merge

To run the merge:

  1. Open the Benefits Batch where you want to run the merge.

    1. From the modules bar, click Workspaces.
      The Workspace Search dashboard opens.
    2. Select the desired workspace and click (Open).
      The Workspace page opens.

    3. Move down the page to the administrative tiles where you see the dataform categories.

    4. Enter "Benefits Batch" in the search for dataform field and then click the Benefits Batch tile.

      The Benefits Batch dashboad/search window displays.

    5. Locate the batch and click (Open) next to it.

  2. In the Action Center, under Reports, click the Export Client Benefit Plans link.

  3. Retrieve the merge document from your Windows Downloads folder.

  4. Open the file and then click the Create Export File button to run the macro.

    Note: 

    • This gets the file in the correct format for importing into the PrismHR application.

    • If you need assistance importing the data into PrismHR, please refer to the "Importing Company Benefits" topic in the PrismHR application Help.

    • The Premium and Contribution fields are rounded to 4-digit decimal precision.

How the Client Benefit Plans Export Sets the Rate Group

For health plans that use risk tiers, set the Default Rate Group for an Offered Benefit Plan from the parent Benefit Plan. Otherwise set the Default Rate Group on the Benefits Batch associated with the OBPs. For more information on setting default rate groups, seeSetting Default Rate Groups.

 

Then, when you use the Client Benefit Plans Export, the Default Rate Group is referenced to set the Rate Group column correctly in the merge for all of the associated Offered Benefit Plans in a batch:

  • If the Rate Source on the parent Benefit Plan is defined as "Manual", then set the Rate Group field for the associated OBPs in the merge to the value in the Title field of the Rate Group Detail record.

  • If the Rate Source on the parent Benefit Plan is defined as "Percentage", then set the Rate Group field for the associated OBPs in the merge to the Default Rate Group value from the parent Benefit Plan (not the Default Rate Group from the Benefits Batch.)

  • If no Default Rate Group is defined on the parent Benefit Plan, set the Rate Group field for the associated OBPs in the merge using the Default Rate Group defined on the Benefits Batch, if a value is present.

  • If no Default Rate Group is defined on either the parent Benefit Plan or the Benefits Batch, set the Rate Group on for the associated OBPs in the merge to STANDARD.

How the Client Benefit Plans Export Handles Replaced Plans

When a Benefit Plan is renewed and the carrier for the current year plan is remaining the same as the prior year plan, the Action column in the Client Benefit Plans Export merge file is set to "CHANGE" and the Start Date field is left blank so that it remains unchanged in PrismHR.

When the new plan is being replaced with a different plan in the renewal year, the merge file shows two Action line items instead of one (as it does for a CHANGE Action). The two Action line items are added to reflect addition of the new plan and the termination of the old plan. The following logic is used to determine this: 

  • If the Carrier Plan Code from the Current Year Plan does not match the Renewed plan, insert an "ADD" Action line item in the Client Benefit Plans Export merge file for the Current Year Plan.

  • If the Carrier Plan Code from the Current Year Plan does not match the Renewed plan, insert a "TERM" Action line item in the Client Benefit Plans Export merge file for the Prior Year Plan.

Note: If you need more information on using this import in the PrismHR application, please contact PrismHR Support.

How the Client Benefit Plans Export Handles Terminated Plans

Although the Client Benefit Plans Export includes a "TERM" line indicating an exported plan, because of the way that the Prism import process works, the Benefit Batch Stop Date is also used as follows to ensure terminated plans are properly set.

  • When multiple Benefit Groups are Active:

    • If at least one benefit group has the offered benefit plan marked as Active, include only the active rows from Column E.

    • Also, populate Column G [Stop.Date] with the current BenefitsBatch.ExpirationDate.

    • We are not sending Terminated statuses anymore but when these are terminated, we use the Prior Batch expiration date if available, else the current batch expiration date as [Stop.Date].

Exported Risk Factor Details

ClientSpace exports Risk Factor values based on the data available on the Benefit Batch, associated OBPs, and associated Rate Group records. The logic defined below helps prevent duplicate plan rows during import, preserves historical Risk Factor data, and ensures exported values align with Prism's rate group and risk factor processing rules.

Risk Factor Values (PremRiskFactor 1-6)

ClientSpace evaluates available Risk Factor values in the following order and populates the corresponding PremRiskFactor columns (PremRiskFactor1 through PremRiskFactor6):

  1. PremRiskFactor1 = Benefits Batch OBP Risk Factor

  2. PremRiskFactor2 = Source OBP Risk Factor (i.e., the Risk Factor associated with the "Renewed From" OBP)

  3. PremRiskFactor 3 - 6 = Additional source OBP Risk Factors in sequential order, if present.

Each Risk Factor is exported directly into its corresponding PremRiskFactor column.

Note: ClientSpace does not create additional rows for multiple Risk Factors associated with the same plan.

For each populated Risk Factor:

  • Corresponding Risk Factor Date columns use the Benefits Batch Effective Date.

  • PremRiskFactor 1-6 contain the Risk Factor values identified through the hierarchy described above.

  • If a PremRiskFactor value is blank, its corresponding Risk Factor Date field is also left blank.

Rate Group Values

ClientSpace populates the Rate Group columns using the following logic:

  • If an OBP Rate Group is specified, that value is used.

  • If no OBP Rate Group is specified, the Benefits Batch Default Rate Group is used.

  • If neither value is populated, the system defaults the Rate Group to "GLOBAL", which is Prism's standard default rate group.

  • If the OBP Rate Group is set to Manual, the Premium Risk Factor is exported as 1.0000.

  • Otherwise, the value from the Rate Group Percentage is used.

  • If the OBP Rate Group is blank and the Benefits Batch Default Rate Group is used, the Premium Risk Factor field is left blank to preserve existing Risk Factor history during import

Risk Factor Date Value Edge Case Logic

ClientSpace uses the following logic for Risk Factor Date columns when there are missing Risk Factor or Rate Group field values:

  • If both the OBP Rate Group and Benefits Batch Default Rate Group are blank, the Premium Risk Factor field and related Risk Factor Date fields are left blank.

  • If a PremRiskFactor 1-6 field is blank, its corresponding Risk Factor Date field is also blank.

Exported Auto Enrollment Settings

There is an Auto Enroll field in the Setup Details fieldset of the Offered Benefit Plan record. If you set this field to Yes, the offered plan is set up for automatic enrollment upon import into PrismHR. This selection is saved in column BE (BEN.AUTO.ENROLL.DECISION) of the Client Benefit Plans export.

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