Family Record Types
There are two different kinds of records that can be received on any of the File Types.
Full Record Type
The File only contains all FNRs from a Group Customer, irrespective of whether or not there are changes in the FNR. In this scenario, it is incumbent on OIPA to inspect every FNR to determine if there are changes. For example, if there are 1000 FNRs on a file, it is possible that there are only changes in 100 of the FNRs, and the other 900 FNRs have no changes that need to be applied.
Changes Only Record Type
In a Changes Only File, OIPA will receive records for only those sponsors / employees / primary participants who have changes that need to be applied to OIPA. OIPA will need to calculate what information has changed in the record. For Changes Only Files, all FNRs that are received should have a changes.
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Note: OIPA does not handle missing FNRs.
File Type Matrix
The following table describes the different file type combinations and the expected responsibilities for OIPA.
- Member Info includes client, address, group customer membership info, dependent client and address info
- Eligibility Classes are entries into Class Membership tables in the system for classes that pertain to Eligibility
- Coverage and Enrollment includes the creation and updating of policies and segments
File Type | Record Type | Processing |
---|---|---|
Participation | Changes Only |
|
Participation | Full |
|
Eligibility | Changes Only |
|
Eligibility | Full |
|
Population | Changes Only |
|
Population | Full |
|