Client: OPERS
Company template: Discovery Benefits_COBRA_OPERS_Global
Type: Row Wise / csv
Export date: 2/19/18
*Exported file:* 021920181733_15462826732.txt
Plan: UHC Medical Plan
Required plan: Express Scripts Rx

Hello Development Team,

We have been working with Discovery regarding a COBRA file that has been live since 2017 and found out the file has been delivered to them manually with extra QBPLAN segment for the Rx plan. Because the UHC Medical COBRA PPO OPERS plan is passed on QBPLAN segment with bundle name UHC Medical PPO OPERS/Express Scripts Rx, the carrier requires a 2nd QBPLAN segment for the Express Scripts Rx for it to load the record successfully or else it will reject the member. Below is what they expect to see on file whenever someone had UHC Medical coverage and was terminated:

[QBPLAN],UHC Medical COBRA PPO OPERS,03/01/2018,,EE+1,,,,,,,,,,F,UHC Medical PPO OPERS/Express Scripts Rx
[QBPLAN],Express Scripts Rx,03/01/2018,,EE+1,,,,,,,,,,F,UHC Medical PPO OPERS/Express Scripts Rx

What I have done so far was I added a 2nd sub template called QBPLAN Rx for the purpose of Express Scripts Rx and data transform the UHC medical and mapped to this Rx plan. When I exported it, the following resulted:

[QBPLAN],UHC Medical COBRA PPO OPERS,03/01/2018,,EE+1,,,,,,,,,,F,UHC Medical PPO OPERS/Express Scripts Rx
[QBPLAN],Delta Dental OH COBRA PPO OPERS,03/01/2018,,EE+1,,,,,,,,,,F,
[QBPLAN],UHC Vision COBRA OPERS,03/01/2018,,EE+1,,,,,,,,,,F,
[QBPLAN],Express Scripts Rx,03/01/2018,,EE+1,,,,,,,,,,F,UHC Medical PPO OPERS/Express Scripts Rx
[QBPLAN],,03/01/2018,,EE+1,,,,,,,,,,,
[QBPLAN],,03/01/2018,,EE+1,,,,,,,,,,,

I believe the blank row 5 and 6 is coming from the dental and vision. Is there a macro indicator or configuration that can get this subtemplate QBPLAN Rx to only pull medical benefit? If this is possible, it should take care of the issue without getting Client Technology involve with building a separate Rx plan in Workterra. I want to avoid building a separate plan for the Rx for an issue that seems small. I couldn't find file spec version 1.1 for this existing build, but it should be similar to other Discovery COBRA specs. Attached is version 1.0 COBRA File Integration Guide.pdf belonging to another client, SuperHeat.

Let me know if you need additional info.

Thank you,

Alex

CC: Deborah Larue