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State-Active Health Premium Reconciliation

May 31, 2024
Circular Letter: 600-025-24
Topic: Health Benefits

To: All Health Benefits Officers for State Agencies and California State Universities

Purpose

The purpose of this Circular Letter is to inform you of reconciliation tools to assist in resolving discrepancies between employee health enrollment premiums owed and employee health premiums paid through the California State Controller’s Office (SCO) warrant deductions and receivables. These report tools will allow you to:

  • Validate myCalPERS health enrollment data for your employees.
  • Identify discrepancies in enrollment data.
  • Identify discrepancies in health premiums owed vs. paid.

Health Premium Reconciliation

It is critical for health enrollment and health premium payments to be properly maintained by all agencies for their state active subscribers. To help agencies meet these responsibilities, two Cognos reports are available in myCalPERS:

  • State Active Health Enrollment and SCO Health Deduction Discrepancy Report
    The purpose of this report is to display and compare myCalPERS health enrollment data and SCO payroll deduction data for enrolled state active subscribers, and to identify any discrepancies in premium amounts. The report is generated for a selected agency by either choosing warrant issue date range or health coverage period range. The report can be run for the entire agency or for a single subscriber. External users can select their associated agency only.
    • Verify appointment demographics, health effective date, enrollment details, and premium deduction are accurate. Enrollment discrepancies can be addressed through collaboration with California Public Employees’ Retirement System (CalPERS) and premium deduction discrepancies can be addressed with SCO – contact information provided below.
  • Employer Health Event Transaction Report
    The purpose of this report is to show all health enrollment transactions submitted by a given agency; this includes all batch transactions based on a Create Date Range (when the transaction was processed) or for a given Effective Date Range (when the transaction takes effect). The subscriber CalPERS ID can be used to limit the results to a single participant.

To learn how to access and use Cognos reports in myCalPERS, view the myCalPERS Employer Reports (Cognos) (PDF) student guide located on the myCalPERS Student Guides & Resources webpage.

Common Causes of Discrepancies

  • Entering health transactions and appointment changes that affect premiums after payroll cutoff could cause:
    • the effective date of a new enrollment to not align with employee premium deductions.
    • health enrollment changes, rescissions, dependent eligibility verifications, and permanent separations to not update the premiums in a timely manner.
  • Health enrollment changes due to health events, appointment changes, and permanent separations are not entered into myCalPERS in a timely manner.

Actions to Prevent Discrepancies

  • Report health enrollment transactions accurately and timely.
  • Confirm health enrollment changes by reviewing the Employer Health Event Transaction Report.
  • Validate coverage is for eligible members only with the correct health plan and party rate.
  • Ensure the first month’s premium of a new enrollment is captured in a timely warrant deduction transaction or set up the deduction utilizing the Standard Form 674 – Payroll Adjustment Notice – Accounts Receivable (A/R).
  • Submit a Standard Form 674 – Payroll Adjustment Notice - Accounts Receivable (A/R) when health premium deductions have not been processed by the SCO.

Employer Resources

  • State Health Benefits Guide (PDF)
    Find exclusive online information on health benefits officer (HBO) roles and responsibilities, eligibility requirements, permanent intermittent employees, enrollment, health benefits into retirement, survivor benefits, Medicare, COBRA, state health vesting, state dental for retirees, and available resources. The benefits guide is located on the Reference & Health Guides webpage.
  • myCalPERS State-Active Health Premium Reconciliation Student Guide
    Review active employee health premium discrepancies between CalPERS and the State Controller’s Office (SCO). The student guide is located on the myCalPERS Student Guides & Resources webpage.
  • myCalPERS Health: Reconcile State-Active Premiums Online Class
    Learn to run and review the State Active Health Enrollment and SCO Health Deduction Discrepancy Report and understand the next steps once a discrepancy has been identified. This class can be accessed from the Education tab of your myCalPERS account.
  • SCO Payroll Letters
  • SCO Website – Human Resources

Questions

If you have enrollment questions, call the CalPERS Customer Contact Center at 888 CalPERS (or 888-225-7377888-225-7377).

If you have benefit deduction questions, call SCO’s Statewide Customer Contact Center at (916) 372-7200(916) 372-7200.

 

Michele L. Nix, Controller
Financial Reporting and Accounting Services Division