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.

File Type Record Type Processing
Participation Changes Only
  1. Store Member
  2. Info Store Eligibility Classes
  3. Enroll in Coverage
  4. Update Coverage
Participation Full
  1. Calculate Changes
  2. Store Member Info
  3. Store Eligibility Classes
  4. Enroll in Coverage
  5. Update Coverage
Eligibility Changes Only
  1. Calculate Eligibility
  2. Validate Eligibility Changes
  3. Store Member Info
  4. Store Eligibility Classes
Eligibility Full
  1. Calculate Changes
  2. Calculate Eligibility
  3. Validate Eligibility Changes
  4. Store Member Info
  5. Store Eligibility Classes
Population Changes Only
  1. Calculate Eligibility
  2. IF Eligible:
    • Validate Eligibility Changes
    • Store Member Info
    • Store Eligibility Classes
Population Full
  1. Calculate Changes
  2. Calculate Eligibility
  3. If Eligible:
    • Validate Eligibility Changes
    • Store Member Info
  4. Store Eligibility Classes

 

 

 

 

 

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