Design Benefits Connectors
Overview
This chapter introduces the functional side of Workday Benefits, providing context to Cloud Connect for Benefits (CCB) integration systems.
Objectives
By the end of this chapter, you will be able to:
- Communicate effectively using benefits terminology.
- View benefits reports to aid in CCB configuration.
- Identify the employees to include in the output file.
- Interpret the information in an 834 file.
Cloud Connect For Benefits
Workday Benefits end-to-end connector integrations are part of Cloud Connect for Benefits (CCB). There are hundreds of benefits connectors specific to certain endpoints, often benefits providers. Benefits integrations transport necessary data to providers so they can perform tasks. Tasks may include:
- Providing ID cards
- Billing customers
- Maintaining coverage information for doctors and hospitals
- Processing claims
Important
: Customers must purchase a separate license to access the CCB catalog.Note
: Most CCB templates are U.S.-centric. Since the United States does not have universal healthcare, Workday customers use numerous different providers.Advantages
Since employers frequently change benefit providers, building custom integrations is inefficient. End-to-end connectors are simpler and quicker to build.
Additionally, many Workday customers use the same providers, so creating and maintaining end-to-end connector templates is a better use of resources than building custom integrations for each customer.
History
You may encounter several historical terms in reference to CCBs, including Workday Carrier Exchange (WCE) and Workday Benefits Network (WBN). WBN templates are also called version one, which references an outdated format for benefits end-to-end connectors. CCB templates are also known as version two.
Important
: Never use version one templates. Only use version two templates to ensure Workday supports your integrations and they have the latest functionality.Benefit Products
Workday CCB templates support many different benefit products. The categories include:
- Health Care (Medical, Dental, and Vision)
- COBRA
- Commuter Benefits
- Life Insurance
- Disability
- Retirement Savings
- Spending Accounts
- Health Savings Accounts
- Other (Legal, Behavioral Health, ESPP, and more)
Templates function differently based on what type of benefit coverage they support.
Workday Benefits
To configure and troubleshoot CCBs, familiarize yourself with Workday Benefits terminology.
Term | Definition |
|---|---|
Coverage | An employee's benefits enrollment details, including the level of benefits and their expiration. |
Benefit Plan | A set of coverage rules for one specific benefit, like health care. |
Eligibility | A set of rules that determine what benefit plans an employee can enroll for and when. |
Life Event | An occurrence in an employee's life that impacts their benefits plans. |
Open Enrollment | An annual process where employees select benefits for the upcoming year, which often occurs in the fall. Outside of life events, open enrollment is the only time when employees can change, add, or discontinue benefits plans. |
Provider | A company that administers a benefit for other companies, like Aetna. |
Flexible Spending Account (FSA) | An account that employees can make pretax contributions to, either for health care or dependent care, that they can later use for health care costs throughout the year. |
Health Savings Account (HSA) | A tax-advantaged account that employees on a high-deductible health plan (HDHP) can contribute to and use for health care costs. Unlike FSAs, HSAs accumulate from year to year. |
Life Insurance | A benefit that pays a predetermined amount to a named recipient upon the holder's death. Life insurance can be available to employees and dependents and can be employer-required or optional. |
Critical Illness | A benefit where insurers pay a lump-sum cash payment if the policyholder is diagnosed with one of the predetermined critical illnesses on the policy. |
Short-term Disability (STD) | A benefit that pays a predetermined percentage of an employee's salary for the first 30 days of a disability. STD is only available to the employee (not dependents) and can be employer-required or optional. |
Long-term Disability (LTD) | A benefit that pays a predetermined percentage of an employee's salary for any disability that lasts more than 30 days. LTD can be available to employees and dependents and can be employer-required or optional. |
Accidental Death and Dismemberment (ADD) | A benefit that pays a predetermined amount to the employee or a named recipient if they die accidentally or suffer certain irreversible injuries from an accident. ADD can be available to employees and dependents and can be employer-required or optional. |
Prescriptions | A benefit that enables employees to receive lower prices for prescription drugs. |
Retirement Savings | A benefit that enables employees to make contributions to a retirement savings account such as a 401k or IRA. |
Employee Stock Purchase Program (ESPP) | A benefit that enables employees to purchase company stock, often at a discount. |
Legal Plan | A benefit that provides legal advice and consultation to employees in various legal situations. Legal plans can be available to employees and dependents. |
Transit/Commuter | A benefit that enables employees to make pretax contributions for public transportation costs. |
Consolidated Omnibus Budget Reconciliation Act (COBRA) | An act passed by the U.S. Congress that gives workers and dependents who lose their health benefits the right to continue benefits provided by their group health plan for a limited period of time. COBRA coverage is limited to certain circumstances, such as job loss. |
Enrollment Events
In Workday, changes to benefit plans are called enrollment events.
Example
: If an employee adopts a child, then includes them as a dependent on a health care plan in Workday, that is an enrollment event.Enrollment events have enrollment event rules that define:
- Coverage start and end dates
- Waiting periods
- Coverage increase limits
- Evidence of Insurability requirements
- Other coverage rules and conditions
Modifying enrollment events and enrollment event rules impacts CCB integrations. Often, a change to an event or rule will determine whether an integration includes a worker.
Benefits Reports
To locate or verify worker benefits data, you can use several common Workday reports from a worker's profile:
- View Benefits Eligibility: Shows a worker's eligibility for benefits plans.
- View Current Benefit Elections: Shows the benefit plans a worker currently enrolls in.
- View Benefit Election History: Shows the benefit plans a worker previously enrolled in.
- View Benefit Coverage History: Shows coverage start and end date for a worker's current and past benefit elections.
834 Files
Many health care plans and providers exchange information in the ANSI 834 EDI Enrollment Implementation Format, also known as an 834 file. The file format is a standard established by the U.S. Congress as part of the Health Insurance Portability and Accountability Act (HIPAA) for transporting medical, dental, and vision health care data.
Because most U.S. providers use this file format, Workday developed an ANSI ASC X12N 834 integration template that complies with the 834 file format standard. You will use the ANSI ASC X12N 834 template for many CCB integrations.
834 File Structure
834 files consist of two main components: segments and loops.
Segments
A segment is a line of elements that represents one or more pieces of related data, such as a single benefit plan. The following is an example of a segment.
Example Segment
: NM1*IL*1*McNeil*Logan~
Segments consist of multiple smaller components. Review the table below to learn more about each component of a segment.
Component | Definition | Example |
|---|---|---|
Segment | A line of elements, representing one or more pieces of related data, like a single benefit plan. | NM1*IL*1*McNeil*Logan~ |
Segment Identifier | The first element in a segment, which tells you what the segment is. | NM1 |
Data Element Delimiter | The symbol that separates elements, generally an asterisk. | * |
Element | A portion of a segment that represents a specific piece of data, like the status of a single benefit plan. Count elements from left to right, starting with 01 for the first element after the segment identifier. | 01 - IL 02 - 1 03 - McNeil 04 - Logan |
Segment Terminator | The last symbol in a segment, generally a tilde. | ~ |
834 files also contain special segments called header segments and trailer segments to denote the beginning and end of the file. The header segment appears once at the beginning of the file, and the trailer segment appears once at the end of the file. These segments are not specific to a policyholder or a dependent.
Loops
Each 834 file contains multiple segments, which are organized into loops. Loops are groups of segments that contain similar data, like benefit plan information.
Note
: Loop information is not physically denoted in the 834 file, but Workday and benefits providers use loops to identify segments with similar data. By referencing the relevant companion guide, you can determine which segments correspond to a specific loop.Example
: Loop 2100A contains multiple segments including NM1, PER, N3, N4, and DMG.Companion Guides
Though providers use the same 834 file format, they may use different values to represent information. Providers create companion guides that detail different values and their meaning to ensure you can correctly associate Workday values with the endpoint's values using integration attributes, maps, and field overrides.
Note
: Companion guides do not explicitly detail integration attributes, maps, and field overrides. You will need to use your best judgment and testing to make these connections.