PPS Requirements Health Care Reimbursement Account...

PPS Requirements

Health Care Reimbursement Account

Service Request 80238

Final 9/17/02

Revised 10/21/02

Alice PlebuchHuman Resources & Benefits

Paul Wehan/Kathy KellerInformation Resources & Communications

Table of Contents

1.0 BACKGROUND......................................................................................................................................................... 1

2.0 HEALTH CARE REIMBURSEMENT ACCOUNT PLAN RULES..................................................................... 1

3.0 PPS MODIFICATIONS............................................................................................................................................. 2

3.1 OVERVIEW OF PPS MODIFICATIONS ......................................................................................................................... 23.2 NEW GROSS-TO-NET NUMBER .................................................................................................................................. 33.3 NEW DATA ELEMENTS .............................................................................................................................................. 33.4 ON-LINE SCREENS ..................................................................................................................................................... 4

3.4.1 ERET screen ..................................................................................................................................................... 43.4.2 Web EDB Inquiry Benefits page ....................................................................................................................... 43.4.3 Other screens.................................................................................................................................................... 43.4.4 On-line help ...................................................................................................................................................... 4

3.5 EDB EXPLICIT MAINTENANCE.................................................................................................................................. 63.5.1 Implied Maintenance (Derivations).................................................................................................................. 63.5.2 Edits.................................................................................................................................................................. 7

3.6 EDB PERIODIC MAINTENANCE – DAILY TRANSACTIONS FROM IVR/WEB ............................................................... 83.7 EDB PERIODIC MAINTENANCE – MONTHLY ............................................................................................................. 93.8 EDB PERIODIC MAINTENANCE – CALENDAR YEAR END.......................................................................................... 93.9 POST AUTHORIZATION NOTIFICATION (PAN) ........................................................................................................... 9

3.9.1 Trigger PAN Event ........................................................................................................................................... 93.9.2 CICS PAN......................................................................................................................................................... 93.9.3 Web PAN........................................................................................................................................................... 9

3.10 EMPLOYEE DOCUMENTS (IDOC) ........................................................................................................................ 103.11 COMPUTE ............................................................................................................................................................ 103.12 INTERFACE FILES FOR UCOP .............................................................................................................................. 10

3.12.1 WEB/IVR Nightly file...................................................................................................................................... 103.12.2 CPS/BCS Monthly file..................................................................................................................................... 113.12.3 UCRS Monthly file.......................................................................................................................................... 11

3.13 FORMS................................................................................................................................................................. 113.14 VENDOR FILE FOR SHPS..................................................................................................................................... 11

4.0 ATTACHMENTS..................................................................................................................................................... 13

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Page 1

10/21/02 Revised to reflect the following additions and modifications to the original requirements:

• Modify the derivations and edits related to HCRA processing.• Add additional data to the ERET screen.• Revise the process for creating the vendor file; instead of creating it centrally at UCOP from

PAR data sent here, campuses will create a file that will be sent here and consolidated. Aseparate service request will provide the details.

1.0 Background

Flexible Spending Accounts (FSA) were established in 1986 under Section 125 of Internal Revenue Code.Accounts can be established up to $5,000 to pay for IRS recognized expenses. The two most commonplans utilized by organizations are DepCare, which covers expenses associated with caring fordependents while employees are at work (childcare, aging parents, disabled spouse) and MedicalSpending Account which covers expenses associated with health care (medicines, glasses, co-paymentsand orthodontia).

In 1988 the University initiated an in-house MedPlus plan. Low participation (2,032 members) led to thetermination of MedPlus. At the time, benefits were less costly, so the plan was not regarded as a greatmoney saver. With the recent escalation of health co-payments and premiums, interest was renewed inFlexible Spending Accounts. The Health Care Reimbursement Account (HCRA) will cover the growingcosts not covered by health plans.

The implementation of HIPAA and the emphasis on personal and confidential information, made theUniversity recognize that it did not want to administer flexible spending accounts. It was determined thatHIPAA requirements could best be met by outsourcing all Flexible Spending Accounts. A task force wasformed to review FSA options. The task force solicited, reviewed and scored bids by seven vendors. Itwas eventually recommended that SHPS of Louisville, KY be selected as the vendor to administer bothDepCare and the new Health Care Reimbursement Account. Associate Vice-Chancellor Judy Boyetteendorsed the recommendation and authorized the University to enter into an agreement with SHPS

The outsourced Flexible Spending Accounts will be implemented on January 1, 2003.

2.0 Health Care Reimbursement Account Plan Rules

Under the Health Care Reimbursement Account (HCRA) rules, the employee enters into an irrevocablesalary reduction agreement for a plan year (January 1 – December 31). The agreement is for an annualamount. As of the start date of the agreement, a participant is eligible to make claims up to the fullamount of the agreement. Any unused funds revert to the plan, not to the employee.

Employees must have an assigned Benefits Eligibility Level Indicator (BELI) of 1, 2, 3 or 4 to be initiallyeligible for HCRA. An employee does not automatically lose eligibility when moving to BELI 5. Thechange to BELI 5 is a qualifying event that allows the employee to withdraw from the plan if so desired.

All HCRA agreements will be effective on the first of a month. Newly eligible employees may enroll duringa Period of Initial Eligibility that corresponds to the 31-day period for other benefit plans. The plan will beeffective on the first of the month following enrollment SO LONG AS PAYROLL DEADLINES are met.Electronic enrollments will enforce a cutoff date and time of 3 PM on the 20th of the month for enrollmentthe first of the next month. The electronic enrollment application will calculate the number of monthsremaining in the plan year and pass both the annual amount and the monthly amount of the agreement tothe Payroll System.

Enrollments not meeting the deadline, will be effective the first of the month following the next month. Forexample, an on-line enrollment done on 3/20/03 at 9:00 A.M. will have an effective date of 3/31/03, so thatdeductions will be taken out of pay with a 4/01/03 or later pay date; an on-line enrollment done on 3/20/03


at 4:00 P.M. will have an effective date of 4/30/03, so that deductions will be taken out of pay with a5/01/03 or later pay date. When enrolling on paper, the department should set the effective date for thenext last day of the month that will meet local payroll deadlines.

The minimum annual contribution is $180. The maximum annual contribution is $5,000. Thesemaximums and minimums apply regardless of what month the employee enrolls. As a point ofclarification, this translates into a minimum $15 per month reduction for an employee having a twelvemonth agreement, whereas an employee who enrolls as of July 1 will have minimum reduction of $30 permonth.

The plan is designed so that employees on a leave without pay are terminated from the plan. Theemployee may choose to continue enrollment through COBRA during the leave, but that election is madedirectly with SHPS. A new period of initial eligibility (PIE) is established when the employee returns fromleave. Re-enrollment must be completed “on paper”.

Special rules surround leaves covered by FMLA (Family Medical Leave Act). An employee on a FMLAleave without pay chooses between:

1. Prorated Level

If the employee chooses the prorated level option, upon return, payments are resumed at the sameamount. The monthly contributions will not change, but the annual amount will be adjusteddownward. This is a manual process

2. Pre-existing Level

If the employee chooses the pre-existing level option, upon return, the pay period contributionamount will be increased to match the annual amount. This is a manual process.

3. Termination of Agreement

The employee can choose to terminate the agreement. No claims can be submitted for expensesincurred after the termination date.

3.0 PPS Modifications

To implement the Health Care Reimbursement Account Plan at UC, several modifications are required inthe Payroll/Personnel System (PPS).

3.1 Overview of PPS Modifications

1. A new GTN number will be established to take the deduction for the employee’s Health CareReimbursement Account (HCRA) agreement.

2. A Nnew EDB data elements will be established to carry the HCRA annual amount and thetermination date of the HCRA agreement.

3. CICS and web on-line screens will be modified to allow entry and display of the HCRA dataelements. On-line help should be developed for the new data elements.

4. EDB Explicit Maintenance will be modified to allow the update of the HCRA data, and to perform therequired edits on that data.


5. The EDB Daily Maintenance process that accepts transactions from the Web/IVR applications willbe modified to accept transactions to update the HCRA data elements.

6. The EDB Monthly Maintenance process will be modified to clear out the HCRA deduction whenthere is a HCRA termination date.

7. EDB Calendar Year End Maintenance will be modified to initialize HCRA data elements.

8. The CICS and web PAN formats will be modified to display the HCRA data.

9. The IDOC will be modified to display the HCRA data.

10. The Compute process must be modified to identify employees who are on leave without pay andhave insufficient earnings to take the HCRA deduction. A HCRA Termination date should beestablished.

11. Interface files will be modified to include the HCRA data on the Web/IVR interface file, the CPS/BCSinterface file, and the UCRS interface file.

12. Forms may need to be developed to capture HCRA information for input to PPS. UCOP Benefitswill coordinate forms development.

An interface file must be provided to SHPS containing all employees with HCRA agreements and theHCRA deduction amounts for each pay period. This file will be created at UCOP using data from theWeb/IVR database and the campus PAR files that are made available for UCOP processing. Separaterequirements will be prepared for this process.

Modifications will also be required for the IVR/WEB benefit enrollment process and for the retirementsystem. Separate requirements will be prepared for these processes.

3.2 New Gross-to-Net Number

A new Gross-to-Net number, 338, has been assigned for the Health Care Reimbursement Accountdeduction. This GTN should be set up as a pre-tax reduction. An effective date should be required. Partialdeductions should not be allowed, and the deduction should not be allowed to suspend if there areinsufficient funds to take the complete deduction. A declining balance will be established to limit the totalamount that is taken in the plan year. A year-to-date balance should be maintained for the GTN. TheGTN should be set up to display on the IRTR EDB Inquiry screen.

3.3 New Data Elements

The monthly HCRA deduction amount will be stored as the G-balance of the new HCRA GTN number(6338G), the year-to-date deduction amount will be stored as the Y-balance of the new HCRA GTNnumber (6338Y), and the HCRA effective date will be stored as the GTN effective date of the new HCRAGTN number (7338E). It is suggested that the HCRA Annual Amount could be stored as the ‘U’ balance(6338U). The HCRA Annual Amount is needed to pass to SHPS so that claims can be paid based on thetotal amount of the agreement, not on what has been paid into the plan so far. A declining balance(6338D) will also be established which will initially be equal to the annual amount, and will bedecremented as deductions are taken.

Additionally, a new EDB data elements must be established to store the HCRA annual amount and theHCRA termination date.

HCRA Annual Amount – The HCRA Annual Amount is needed to pass to SHPS so that claims can bepaid based on the total amount of the agreement, not on what has been paid into the plan so far.


HCRA Termination Date – The HCRA Termination Date will record the end date of the agreement. It isthe last day for which claims can be made against the Health Care Reimbursement Account. Thetermination date will normally be initial values. When the agreement is terminated prior to the end of thecalendar year, the termination date is recorded.

Refer to Attachment A for a drafts of the Data Dictionary pages.

3.4 On-line Screens

3.4.1 ERET screen

The HCRA Annual Amount, HCRA Monthly Amount, HCRA Effective Date and HCRA Termination Dateshould be added to the ERET screen on a new line inserted below the line that contains the field labels“DCP Plan Code”, “DepCare Amount” and “Effective Date”. The field labels should read, “HCRAAnnual:”, “Monthly:”, “Eff Date:” and “Term Date:”. Corresponding space should be provided to the rightof each field label for displaying the value of each data element. To make space for this new line, anexisting line that displays deductions should be removed resulting in the display of eight lines fordeductions instead of nine. The HCRA Annual amount should be entered and displayed as a five digitwhole number, even though it will be stored as a U-balance.

Additionally, the HCRA Declining Balance and Year-to-date amounts should be added to this screen as‘display only’ fields. To make room for these fields, the 403(b) MAC and change date should be movedto the right.

All four data element should be available for update on this screen.

Refer to Attachment B for a mockup of the CICS on-line screen changes.

3.4.2 Web EDB Inquiry Benefits page

The HCRA Annual Amount, HCRA Monthly Amount, HCRA Effective Date and HCRA Termination Date,should be added to the Benefits Enrollment Information page of Web EDB Inquiry just below the linedisplaying DepCare Amount and Effective Date. The label, “Health Care Reimbursement Account”should be added, and immediately below that, the field labels “Annual Amount:”, “Monthly Amount:”,“Effective Date:” and “Termination Date:”. Corresponding space should be provided to the right of eachfield label for displaying the value of each data element. The HCRA Annual Amount should bedisplayed as a five digit whole number, even though it is stored as a U-balance.

Refer to Attachment C for a mockup of the EDB Web Inquiry screen changes.

3.4.3 Other screens

The IRTR screen should display the HCRA monthly deduction amount (G-balance) and year-to-dateamount (Y-balance) in a manner similar to the display of the DepCare GTN. No changes are required tothe screen format.

3.4.4 On-line help

On-line field-level help for the displayed data elements, “ HCRA Annual Amount”, “HCRA MonthlyAmount”, “HCRA Effective Date” and “HCRA Termination Date”, “HCRA Declining Balance” and ‘HCRAYear-to-date Amount” should be made available.

The field-level help for the Annual Amount and Termination Date should use the Data Dictionary as thebasis for field-level help. Field-level help for the annual amount, monthly amount, declining balance,


year-to-date amount, and effective date should be developed similar to the field-level help for theDepCare fields. Wording for that help is shown below:

EDB6338U GTN HCRA Annual Amount Description: The annual amount electedby the employee to be deducted in a planyear for the Health Care ReimbursementAccount salary reduction plan.

EDB6338G GTN HCRA Deduction Amount Description: The deduction associated with theemployee's voluntary participation in theUniversity's Health Care Reimbursement Account(HCRA) program.

Format: nnnnnnn.nnCode Translation: N/A

EDB67338YE GTN HCRA Eff Date Description: The effective date for the deductionassociated with the employee's voluntaryparticipation in the University's Health CareReimbursement Account (HCRA) program.

Format: nnnnnnn.nnCode Translation: N/A

EDB6338D GTN HCRA Decl Bal

Description: The declining balance for the deductionassociated with the employee’s voluntary participation inthe University’s Health Care Reimbursement Account(HCRA) program.

EDB6338Y GTN HCRA YTD

Description: The declining balance for the deductionassociated with the employee’s voluntary participation inthe University’s Health Care Reimbursement Account(HCRA) program.

No changes are required to screen-level help.


3.5 EDB Explicit Maintenance

3.5.1 Implied Maintenance (Derivations)

1. The HCRA Effective Date must be derived when the HCRA enrollment is first established.

The derivation of the HCRA Effective Date (7338E) should be triggered by an update to theHCRA Annual Amount (6338U). When the prior value of the Annual Amount is zero, and thenew amount is greater than zero, the HCRA Effective Date should be set as follows:

• if the actual current date is equal or prior to the 20th of the month, and the month is Januarythrough November, the HCRA Effective Date should be set equal to the 1st day of the nextmonth; if the month is December, the HCRA Effective Date should be set equal toDecember 31

• if the actual current date is later than the 20th of the month, the HCRA Effective Dateshould be set equal to the 1st day of the month following the next month.

Examples: If the HCRA Annual Amount is changed from zero to $4000 on 3/20, the HCRAEffective Date should be set to 4/1. If the change is done on March 21, the HCRA EffectiveDate should be set to 5/1. If the change is done on December 19, the HCRA Effective Dateshould be set equal to 12/31.

Note that if the Annual Amount is changed and the prior value is NOT zero, the HCRA EffectiveDate should NOT be derived. Users may change the date if necessary.

2. The HCRA Declining Balance must be derived when the HCRA Annual Amount is set.

The derivation of the HCRA Declining Balance (6338D) should be triggered by an update to theHCRA Annual Amount (6338U). When the HCRA Annual Amount is changed, the HCRADeclining Balance should be set equal to the HCRA Annual Amount minus the HCRA Year-to-Date (6338Y) amount.

For example, if the employee signs up for a $2400 HCRA Annual amount, and contributes $200for three months, the year-to-date amount will be $600. If the Annual amount is changed to$1800, the declining balance should be set to $1200 (1800 – 600). The g-balance will bemanually adjusted as required.

3. Separation from the University for any reason, including retirement, terminates the HCRAAgreement. The system must establish a HCRA Termination Date (new data element) whenthe employee separates. This derivation should be triggered whenever there is a change to theSeparation Date (EDB 0140) and the employee is currently enrolled in HCRA (HCRA AnnualAmount is greater than zero). The HCRA Termination Date should be set as follows: equal tothe Separation Date. No message is required.

The HCRA Termination Date should be set equal to the last day of the month following themonth of the Separation Date, except in the following cases:

• there is an existing HCRA Termination Date that is prior to that date; in that case theexisting date should be retained

• the end date would be in a calendar year later than the year of the HCRA agreement; inthat case, the HCRA Termination Date should be set equal to the last day of the calendaryear (i.e. 12/31).

Examples:1) On May 15, 2003, the employee’s separation date is set to 05/31/03. The HCRA

Termination Date should be set to 6/30/03.


2) On May 15, 2003, the employee’s separation date is set to 05/31/03. There is anexisting HCRA Termination date of 05/31/03. The HCRA Termination Date should notbe changed.

3) On December 15, 2003, the employee’s separation date is set to 12/10/03. The HCRATermination Date should be set to 12/31/03.

On January 5, 2004, the employee’s separation date is set to 12/27/03. The HCRATermination Date should be set to 01/31/04 (since the HCRA Effective Date in thiscase would be 12/31/03).

3.5.2 Edits

1. An edit must be established to check that the employee is eligible for benefits at the time the HCRAagreement is initially established. The edit should be triggered by a change to the HCRA deductionamount (6338G).

If the HCRA deduction amount is greater than zero, and the previous value of the HCRA deductionamount is zero, and the BELI is not 1, 2, 3, or 4, the enrollment should be blocked. An errormessage with the text ‘BELI Ineligible For HCRA Enrollment’ should be issued in both the USER08and the USER12 processes. The message should have a severity level of ‘Employee Reject’ inboth batch and on-line.

2. Edits must be established to check that the HCRA annual amount is within the minimum andmaximum allowed. by federal regulations. It is suggested that the minimum and maximum amountbe stored as parameters as they may change in a new plan year. These edits should be triggeredby a change to the HCRA Annual Amount (new data element 6338U).

If the HCRA Annual Amount is less than 180, the update should be blocked. An error message withthe text ‘HCRA Annual Amount May Not Be Less Than $180’ should be issued in both the USER08and the USER12 processes. The message should have a severity level of ‘Employee Reject’ inboth batch and on-line.

If the HCRA Annual Amount is greater than 5000, the update should be blocked. An error messagewith the text ‘HCRA Annual Amount May Not Exceed $5000’ should be issued in both the USER08and the USER12 processes. The message should have a severity level of ‘Employee Reject’ inboth batch and on-line.

3. An edit must be established to ensure that the HCRA Annual Amount is not less than any existingHCRA Year-to-date Amount. This edit should be triggered by a change to the HCRA AnnualAmount.

If the HCRA Annual Amount (6338U) is less than the HCRA Year-to-date amount (6338Y), theupdate should be blocked. Note that this includes the case where the Annual Amount is set to zero.An error message with the text ‘HCRA Annual Amount may not be less than year-to-date amount’should be issued in both the USER08 and the USER12 processes. The message should have aseverity level of ‘Employee Reject’ in both batch and on-line.

4. An edit must be established to ensure that the HCRA Annual Amount is not zero when there is anexisting HCRA deduction amount. This edit should be triggered by a change to the HCRA AnnualAmount or HCRA deduction amount.

If the HCRA Annual Amount (6338U) is zero, and the HCRA Deduction Amount (6338G) is not zero,the update should be blocked. An error message with the text ‘HCRA Annual Amount is requiredwith HCRA deduction’ should be issued in both the USER08 and USER12 processes. Themessage should have a severity level of ‘Employee Reject’ in both batch and on-line.

5. An edit must be established to ensure that the total of the HCRA Declining Balance and the HCRAYear-to-Date amount do not exceed the HCRA Annual Amount. The update should be triggered bya change to the HCRA Annual Amount or the HCRA Declining Balance.


If the HCRA Declining Balance (6338D) plus the HCRA Year-to-date Amount (6338Y) are greaterthan the HCRA Annual Amount (6338U), the update should be blocked. An error message with theText ‘HCRA Annual Amt must be greater than Declining Bal + YTD’ should be issued in both theUSER08 and USER12 processes. The message should have a severity level of ‘Employee Reject’in both batch and on-line.

6. An edit must be established to ensure that the HCRA Termination Date is not prior to the HCRAEffective Date. This message should be triggered by a change to the HCRA Termination Date orthe HCRA Effective Date.

If the HCRA Termination Date (new data element) is prior to the HCRA Effective Date (7338E), theupdate should be blocked. An error message with the text ‘HCRA Termination Date must be laterthan begin date’ should be issued in both the USER08 and the USER12 processes. The messageshould have a severity level of ‘Employee Reject’ in both batch and on-line.

3.An edit must be established to check that the HCRA Effective Date is the last day of the month. The editshould be triggered by a change to the HCRA Effective Date.

If the HCRA Effective Date is other than the last day of a month, the update should be blocked. Anerror message with the text ‘HCRA Eff Date Must Be the Last Day Of A Month’ should be issued inboth the USER08 and the USER12 process. The message should have a severity level of‘Employee Reject’ in both batch and on-line.

4.An edit must be established to prevent setting the HCRA Termination Date to a date that is later than theSeparation Date. The edit should be triggered by a change to the HCRA Termination Date.

If the HCRA Termination Date is later than the Separation Date (EDB 0140), the update should beblocked. An error message with the text ‘HCRA Termination may not be later than Separation’should be issued in both the USER08 and the USER12 processes. The message should have aseverity level of ‘Employee Reject in both batch and on-line.

3.6 EDB Periodic Maintenance – Daily Transactions from IVR/Web

EDB Daily Maintenance processes transactions from the Web/IVR applications and performs limited editson the transaction data. The following additional transactions must be accepted by the process:

• X1 transaction for the 6338Unew data element, the HCRA Annual Amount• X1 transaction for 6338G and 7338E for HCRA Monthly deduction amount and effective date

Edits are needed as follows:

1. The existing edit associated with message 13-055 EMPLOYEE ID NOT ON EDB, ALL WEBAND IVR ACTIVITY REJECTED, should reject the HCRA data transactions as well. Thetransaction format should be displayed on the error report along with any other rejectedtransactions for the employee.

2. An edit should be provided to reject the HCRA transactions if the employee’s Assigned BELI(EDB 0360) does not indicate eligibility for HCRA participation. If the Assigned BELI is not ‘1’,‘2’, ‘3’, or ‘4’, the transactions for the HCRA Annual Amount, deduction amount, and effectivedate should be blocked. A message with the text ‘HCRA Enrollment Blocked Due To BELIIneligibility’ and a severity level of Transaction Reject should be issued. The transaction datashould be written to the benefits error report.

3. An edit should be provided to reject the HCRA transactions if the employee is already enrolledin HCRA. If the current value of the HCRA Annual Amount (new data element) is not initial


values, the X1 transactions for the HCRA Annual Amount, deduction amount, and effective dateshould be blocked. A message with the text ‘HCRA Enrollment Blocked – Already Enrolled’ anda severity level of Transaction Reject should be issued. The transaction data should be writtento the benefits error report.

If the HCRA Enrollment transactions pass the edits, the HCRA Declining Balance (EDB 6338D) should beset equal to the HCRA Annual Amount (EDB 6338U).

3.7 EDB Periodic Maintenance – Monthly

1. The EDB monthly maintenance process must be modified to initialize the HCRA data elements whenthe HCRA Termination Date has been achieved. If the HCRA Termination Date is prior to the monthbeing started by EDB Monthly Maintenance, The HCRA Annual Amount (new data element), HCRATermination Date (new data element) HCRA deduction amount (EDB 6338G), and the HRCAEffective Date (EDB 7338E) should be set to initial values.

2. The EDB monthly maintenance process must be modified to establish a HCRA Termination Datewhen it establishes a Separation Date due to I-4 separation. The HCRA Termination Date should beset equal to the last day of the month of the Separation Date.

3.8 EDB Periodic Maintenance – Calendar Year End

HCRA Agreements expire at the end of the plan year (December 31) and must be renewed through apositive enrollment. At year’s end, the current year’s agreements must be removed prior to the recordingof the upcoming year’s agreements.

Set the HCRA EffectiveBegin Date (EDB 7338E), HCRA Annual Amount (EDB 6338U), HCRA MonthlyAmount (EDB 6338G), HCRA Declining Balance (EDB 6338D) and HCRA Termination Date to initialvalues.

3.9 Post Authorization Notification (PAN)

3.9.1 Trigger PAN Event

A change to the HCRA Annual Amount, Deduction Amount, Effective Date or Termination Date shouldtrigger the Benefits (BENE) PAN event.

3.9.2 CICS PAN

The new data elements, “HCRA Annual Amount” and “HCRA Monthly Amount” should be added to theBenefits section of the CICS PAN page just below the line displaying the field label, “Dependent CareDeduction:”. The field labels should appear to the right of the label, “Health Care ReimbursementAccount” and should read, “Annual Amt:” and “Monthly Amt:”. Corresponding space should be providedto the right of each field label for displaying the contents of each field.

Refer to Attachment D for a mockup of the CICS PAN changes.

3.9.3 Web PAN


The new data elements, “HCRA Annual Amount”, “HCRA Monthly Amount”, “HCRA Effective Date” and“HCRA Termination Date” should be added to the Benefits section of the Web PAN page just below theline displaying the field label, “Dependent Care Deduction”. The field labels should appear to the right ofthe label, “Health Care Reimbursement Account” and should read, “Annual Amt:”, “Monthly Amt:”, “EffDate” and “Term Date:”. Corresponding space should be provided to the right of each field label fordisplaying the contents of each field.

Refer to Attachment E for a mockup of the Web PAN changes.

3.10 Employee Documents (IDOC)

Insert the label, “Health Care Reimbursement Account” and the following wording just below the label,“You have signed up for a $_____ annual amount” and “Your monthly pre-tax contribution is: $_____” asthe last item in the section marked, “Additionally, you have enrolled in the following:” of the Health andWelfare Benefit Enrollment Information section of the IDOC.

Refer to Attachment F for a mockup showing the IDOC changes.

3.11 Compute

The Compute must be modified to recognize an employee who is on leave without pay (other than aFMLA leave) and has insufficient earnings to take the HCRA deduction. In this case, instead ofsuspending the deduction, the employee’s HCRA agreement must be terminated, and any temporarysuspense that is created should be cleared out.

For employees who meet all the following criteria:

• The employee has a HCRA deduction (EDB 6338G not = zero)• The Employment Status (EDB 0144) is “N” (Leave Without Pay)• The Leave of Absence Type Code (EDB 0139) is not “15” (FMLA)• There are insufficient funds for the deduction

the HCRA Termination Date should be set equal to the last day of the month of the compute’s Pay PeriodEnd Date. later of the PAR Pay Period Begin Date or the employee’s Leave of Absence Begin Date (EDB0137). For example, if the Pay Period End Date is 11/2/03, the HCRA Termination Date should be set to11/30/03; if the Pay Period End Date is 10/31/03, the HCRA Termination Date should be set to 10/31/03.

3.12 Interface Files for UCOP

3.12.1 WEB/IVR Nightly file

The Web/IVR history file and interface file must be modified to include HCRA data. The G-balance, Y-balance, and effective date should be included on the deduction record in group 9. The annual amountand termination date should be added to the employee record. It is suggested that filler space be used.Filler space is being made available by removal of the UC Contribution and Employee Cost fields forMedical, Dental, Vision, and Legal. The removal of those fields is being done in response to changes tothe benefits premium calculation specified in Service Requests 80134 and 80191.


Refer to Attachment G for the proposed changes to the Web/IVR file employee and deduction recordlayouts.

3.12.2 CPS/BCS Monthly file

The Corporate Personnel System (CPS) will need HCRA data for discrimination testing reports and foropen enrollment related reports. The Benefits Counseling System (BCS) may need HCRA data forvarious screens and reports. The exact needs have not yet been finalized, so these requirementspropose the following changes to the CPS/BCS files. An amendment will be provided if changes arerequired after the requirements have been made final.

1. A one character field indicating participation in the HCRA plan will be added to the CPSEmployee record (similar to what is currently done to indicate DepCare enrollment). If there is anon-zero value in the G-balance of the HCRA GTN (EDB 6338G), a ‘Y’ (yes) should be writtento the indicator, otherwise an ‘N’ (no) should be written to the indicator.

2. A field for the year-to-date HCRA deduction amount will be added to the CPS Employee record.The amount in the Y-balance of the HCRA GTN (EDB 6338Y) should be passed in the year-to-date HCRA deduction field.

3. A field for the HCRA Annual Amount will be added to the CPS Employee record. If the value iszero, the field should be left blank.

4. A field for the HCRA Termination Date will be added to the CPS Employee record. The dateshould be written to the file in the format YYMMDD.

Currently all PAR deductions with a GTN Group type of ‘R’ (retirement) or ‘M’ (miscellaneous) areincluded on the BCS deduction file. Assuming that the HCRA GTN will be set up as a miscellaneousdeduction (as DepCare is), no programming changes will be required to include the monthly HCRAdeduction amount on the file.

Refer to Attachment H for the proposed CPS/BCS file record layout changes.

3.12.3 UCRS Monthly file

A new UCRS plan code, 51, is being established for the HCRA deductions. The deductions associatedwith PPS GTN 338 should be included on the UCRS file contribution record, associated with Plan 51.

Note that PPI740 maintains a list of GTN numbers for voluntary plans. The list includes the DepCareGTN number. This list is used as one of the ways of determining if an employee should be included onthe UCRS file. The HCRA GTN number, 338, should be added to this list.

No record layout changes are required to the UCRS interface files.

Attachment I shows the layout of the UCRS Transaction file Contribution segment and lists the UCRSPlan codes and associated GTN numbers.

3.13 Forms

UCOP Benefits will coordinate any required changes to benefits forms.

3.14 Vendor File for SHPS

The vendor selected as the third party administrator, SHPS, requires that a flat, 800 character enrollmentfile be submitted following each pay cycle. The file is produced as a complete replacement. If a payment


is made, the file contains the employee contribution. If the employee does not have a contribution in thatpay cycle, the contribution amount is zero.

It is expected that a consolidated file will be created at UCOP using a combination of data from theWeb/IVR data sent daily be each campus and the PAR (Payroll Audit Record) files sent after each paycycle by each campus.Campuses will be asked to send to UCOP a file with the required data twice a month, and the files will beconsolidated here for transmission to SHPS. Separate requirements, including the required file layout, willbe prepared specifying the creation of that file.

Note that the three national laboratories will send their own interface files to SHPS and will not beincluded in the consolidated file prepared at UCOP. The laboratories do not run the base PPS andtherefore are not providing PAR data to UCOP.


4.0 Attachments

Attachment A EDB Data Dictionary PagesAttachment B CICS On-line ScreensAttachment C Web EDB Inquiry ScreenAttachment D CICS Post Authorization Notification (PAN)Attachment E Web Post Authorization Notification (PAN)Attachment F Employee Documents (IDOC)Attachment G IVR/Web Interface FileAttachment H CPS/BCS Interface FileAttachment I UCRS Interface File-Contribution Segment

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment A - Page 1

System Number: EDBxxxx

User Access Name:

Programming Name:

Revision Date:

Comments:

Source(s): Use(s):Location(s):

Name: HEALTH CARE REIMBURSEMENT ACCOUNT ANNUAL AMOUNT

Type: NUMERIC

Length: 5

Format: nnnnn

General Description:

The annual amount elected by the employee to be deducted during a plan year for theHealth Care Reimbursement Account salary reduction, expressed in whole dollars.

Code Interpretation:

N/A

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment A - Page 2

System Number: EDBxxxx

User Access Name:

Programming Name:

Revision Date:

Comments:

Source(s):Use(s):Location(s):

Name: HEALTH CARE REIMBURSEMENT ACCOUNT TERMINATION DATE

Type: NUMERIC

Length: 6

Format:

MM/DD/YY - Inquiry Only; MMDDYY - Entry/Update

General Description:

The date on which the Health Care Reimbursement Account agreement ends for theemployee. Claims may not be made for expenses incurred after this date.

Code Interpretation:

N/A

Health Care Reimbursement Account Final 09/17/02 Revised 10/87/02 Attachment B - Page 1

PPERET0-E1219 EDB Entry/Update 08/20/02 9:17:00 07/03/02 13:30:23 Retirement Information Userid: PAYPCW ID: 000050020 Name: PRESENT, MARCUS SSN: 555-55-5020 Pri Pay: MO

Retirement System Code: U FICA Eligibility Code: E Ret FICA Derive: Covered Comp Limit Cd : G DCP Plan Code : S DepCare Amount: Effective Date:1HCRA Annual: _5000 Monthly: ____425.00 Eff Date: 010103 Term Date: 063003 HCRA Decl/YTD: __________/__________ 403b Lmt: _________ MAC Change: 010104 Voluntary Contribution Deduction Num Description Amount/Percent Decl Balance Eff Date 030 UCRS-BOND 110.00 0101932____________________________________________________________________________

Next Func: ID: Name: SSN:

===> F: 1-Help 3-PrevMenu 4-Print 5-Update F: 9-Jump 12-Exit

1 Insert the field labels and space for entering and displaying the contents for “HCRA Annual:”,“Monthly:”, “Eff Date:” and “Term Date:” Add field labels for displaying the HCRA declining balance andyear to date amounts. Move the 403b Limit and MAC Change date to the right.

2 Remove one line for displaying data to provide space for the new field labels and field content.

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment C - Page 1

Web EDB Inquiry Mockup

Benefits Enrollment Information

Assigned BELI: 1 - Full Benefits Derived BELI: 1 - Full Benefits

Benefit Plan CoverageLevel

CoverageEff Date

CoverageEnd Date

EmployeeCost

UCContribution

Medical FP - PacifiCare U - One Party 01/01/90 0.00 183.46 Dental D3 - PMI U - One Party 01/01/90 0.00 15.70 Vision VI - Vision Services U - One Party 01/01/90 0.00 12.11 Legal J1 - Signature Legal U - One Party 01/01/90 6.70 0.00 3Contribution Base-Current Year: ___ Contribution Base-Next Year: ___Are there future enrollments? No Insurance Reduction Code (TIP): Y - EnrolledCurrently Enrolled Family MembersThere are no enrolled family members for this employee.

Insurance Type CoverageSalary Base/

Coverage Amt.Effective

DateEmployee

Cost

Short Term Disability A - Covered 0.00 Supplemental Disability 007 - 7 day waiting period 4,117 01/01/90 56.40 Basic Life Enrolled 50,000 01/01/90 0.00 Supplemental Life 1 - 1 X Annual 50,000 01/01/90 4.95

Dependent Life Insurance B - Spouse/Domestic Partner &child(ren) 01/01/90 2.61

AD&D Insurance M - Modified Family Plan 85,000 01/01/90 0.00 DepCare Amount: Not Enrolled Effective Date:4Health Care Reimbursement Account

Annual Amount: _5000 Monthly Amount: ____400.00 Effective Date: 01/01/03 Termination Date: 06/30/03

3 The field labels, “Contribution Base-Current Year” and “Contribution Base-Next Year” and space fordisplaying the 3 character contents for Contribution Base-Current Year and Contribution Base-Next Yearwere added in service request 80191.

4 Add the section label, “Health Care Reimbursement Account” and field labels, “Annual Amount:”,“Monthly Amount:”, “Eff Date:” and “Term Date:” and space for displaying the contents.

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment D - Page 1

CICS Post Authorization Notification (PAN) Mockup

----------------------------- Benefits Information ---------------------------- Medical: PacifiCare Eff Dt: 01/01/90 End Dt: Cov: One Party

Dental: PMI Eff Dt: 01/01/90 End Dt: Cov: One Party

Vision: Vision Services Eff Dt: 01/01/90 End Dt: Cov: One Party

Legal: Signature Legal Eff Dt: 01/01/90 End Dt: Cov: One Party

Contribution Base: ___5

Medical Plan Opt Out: Dental Plan Opt Out: Vision Plan Opt Out:

Supplemental Life: 1 X Annual Salary Base: 50 Cov. Eff Date:01/01/90

*Dependent Life: Spouse/Domestic Partner & child(ren) Cov. Eff Date:01/01/90 <none> <none>*Supplemental Disability: 007 Days Salary Base: 4117 Cov. Eff Date:01/01/90 <none> <none> AD&D Plan: Modified Family Plan Principal Sum: 085 Cov. Eff Date:01/01/90

*TIP Code: Y

Dependent Care Deduction: 500.00

6Health Care Reimbursement Account–Annual Amt: _5000 Monthly Amt: ____400.00

5 The field label “Contribution Base” and space for displaying the 3 character Medical Contribution Base– Current Year was added in service request 80191.

6 Insert the label, “Health Care Reimbursement Account” and field labels and space for displaying thecontents for “Annual Amount:” and “Monthly Amount:”.

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment E - Page 1

Web Post Authorization Notification (PAN) mockup

BenefitsMedical PacifiCare

EffDt

01/01/90

EndDt

Cov

OneParty

Dental PMI EffDt

01/01/90

EndDt

Cov

OneParty

Vision Vision Services EffDt

01/01/90

EndDt

Cov

OneParty

Legal SignatureLegal

EffDt

01/01/90

EndDt

Cov

OneParty

Contribution Base 0307

Medical Opt Out Dental Opt Out Vision Opt Out Supplemental Life 1 X Annual Salary Base 50 Cov. Eff Date 01/01/90Dependent Life Spouse/Domestic Partner & child(ren)<<none>> Cov. Eff Date 01/01/90<<none>>Supplemental Disability 7 Day Waiting Period<<none>> Salary Base 4117 Cov. Eff Date 01/01/90<<none>>AD&D Plan Modified Family Plan Principal Sum 085 Cov. Eff Date 01/01/90TIP Code Y<<none>>Executive Life Change Code Change Eff Date Dependent Care Deduction Health Care Reimbursement Account Annual Amt: _____ Monthly Amt: __________ Eff Date: ________ Term Date:8________

7 The field label, “Contribution Base” and space for displaying the 3 character Medical Contribution Base– Current Year was added in service request 80191.

8 Add the section label, “Health Care Reimbursement Account” and field labels, “Annual Amt:”, “MonthlyAmt:”, “Eff Date:” and “Term Date:” and space for displaying the contents.

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment F - Page 1

-------------------------------------------------------------------------------HEALTH AND WELFARE BENEFIT ENROLLMENT INFORMATION-------------------------------------------------------------------------------You are enrolled in the following health and welfare plans:* Core Medical Single Party Coverage Coverage Effective date: 04/01/97 Your monthly cost for this coverage is: $ 0.00

Your contribution base is: 0309

* Delta Dental Single Party Coverage Coverage Effective date: 04/01/97 Your monthly cost for this coverage is: $ 0.00* Vision Services Plan Two-Party Coverage Coverage Effective date: 04/01/97 Your monthly cost for this coverage is: $ 0.00* Signature LegalCareThe following family members are enrolled:Name Relationship Enrolled/Effective Date/EndDateNo. Birthdate Sex Social Sec.No. Medical Dental VisionLegal-------------------------------------------------------------------------------MICHAEL B DOGSLED Legal Ward No No YesYes01 10/01/89 Male 987-73-8762 04/01/9704/01/97

(It is your responsibility to ensure that all family members meet UCeligibility requirements. Contact your campus Benefit Representative formore information.)Additionally, you are enrolled in the following:* Short Term Disability Insurance* Basic Life Insurance in the amount of $ 50,000.00* Dependent Care Assistance Program Your monthly pre-tax contribution is: $ 400.0010* Health Care Reimbursement Account

You have signed up for a $xxxxx annual amount Your monthly pre-tax contribution is: $xxx,xxx.xx

You are participating in the Tax Savings on Insurance Premium (TIP)Plan. Any premiums you pay as an employee for health will be on apre-tax basis.

9 The phrase “Your contribution base is:” followed by space for displaying the Medical Contribution Base– Current Year was added in service request 80191.

10 Add the label, “Health Care Reimbursement Account” and the following wording, “You have signed upfor a $______ annual amount and “Your monthly pre-tax contribution is: $______.

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment G - Page 1

File Layout for Web/IVR Extract FileEmployee Record

Data Element Name Position Length/Format

EDB# Comments

Add/Change/Delete 01 01 n/a

IVR Employee RecordUpdate Date

02 10mm/dd/yyyy

n/a Update Date is set to the currentdate when PPS program PPIIVRdetects that a change has beenmade to any field in the IVRemployee record.

Location Code 12 02 n/a A unique code assigned to eachcampus, lab, Hastings, andASUCLA.

Employee SSN 14 09 0111

Employee ID Number 23 09 EDB record key

Employee Name 32 26 0105

Date of Birth 58 10mm/dd/yyyy

0107

Sex 68 01 0108

Hire Date 69 10mm/dd/yyyy

0113

Home Department Code 79 06 0114Leave Begin Date 85 10

mm/dd/yyyy0137

Leave Return Date 95 10mm/dd/yyyy

0138

Leave Type Code 105 02 0139Separation Date 107 10

mm/dd/yyyy0140

Employment Status Code 117 01 0144

Primary Title Code 118 04 0460Personnel Program Codefor Primary Title

122 01 n/a The Personnel Program Code forthe Primary Title Code is looked upon the PPS TCT (Title Code Table).

FICA Eligibility Code 123 01 0120

Prior Year FWT Gross 124 109(07).99

0481

Address-Line 1 134 30 0204Address-Line 2 164 30 0205Address-City 194 30 0206Address-State 224 02 0207Address-Zip 226 05 0208Retirement System Code 231 01 0122




EDB# Comments

UC Paid Disability Code 232 01 0123DCP Plan Code 233 01 0129Age on Jan 1 234 02 0254403(b) Change Date 236 10 0279TIP Code (InsuranceReduction Code)

246 01 0299

Supplemental DisabilityWaiting Period

247 03 0231

Supplemental DisabilitySalary Base

250 089(05).99

0232

Supplemental DisabilityCov Eff Date

258 10mm/dd/yyyy

0233

Supplemental Disability -employee cost

268 069(03).99

n/a The employee premium forEmployee Paid Disability is lookedup on the PPS Benefits RatesTable.

Dental Plan Code 274 02 0272Dental Plan CoverageCode

276 03 0273

Dental Plan PCED 279 10mm/dd/yyyy

0274

Dental - UC contribution 289 089(05).99

n/a The UC-paid portion of the dentalpremium is calculated using datafrom the Benefits Rates Table.

Dental - employee cost 297 089(05).99

n/a The employee-paid portion of thedental premium is calculated usingdata from the Benefits Rates Table.

HCRA Annual Amount 289 5 newHCRA Termination Date 294 10

mm/dd/yyyynew

Filler 304 1 Filler recovered from dentalcontribution and cost, less spaceused for HCRA

Suppl Life Ins Salary Base 305 06 0275Suppl Life Ins Plan Code 311 01 0276Suppl Life Ins CED 312 10 0277Suppl Life Ins Amount 322 07 n/a The amount of Life Insurance is

calculated, or looked up on theBenefits Rates Table.

Suppl Life Ins Premium 329 089(05).99

n/a The life insurance premium islooked up on the Benefits RatesTable.

Dep Life Ins Plan Code 337 01 0278Dep Life CED 338 10

mm/dd/yyyy0188

Dep Life Premium 348 089(05).99

n/a The dependent life insurancepremium is looked up on theBenefits Rates Table.

Accidental Death andDismemberment Principal

356 06 0280




EDB# Comments

SumAccidental Death andDismemberment CoverageCode

362 01 0281

Accidental Death andDismemberment CED

363 10mm/dd/yyyy

0282

Accidental Death andDismemberment Premium

373 089(05).99

n/a The AD&D premium is looked up onthe Benefits Rates Table.

Medical Plan Code 381 02 0292Medical Plan CoverageCode

383 03 0293

Medical Plan PCED 386 10mm/dd/yyyy

0294

Medical - UC contribution 396 089(05).99

n/a The UC-paid portion of the medicalpremium is calculated using datafrom the Benefits Rates Table.

Medical - Employee cost 404 089(05).99

n/a The employee-paid portion of themedical premium is calculated usingdata from the Benefits Rates Table.

Filler 396 16 Filler recovered from medicalcontribution and cost

Basic Life Insurance 412 06 0330Basic Life Insurance CED 418 10

mm/dd/yyyy0451

Vision Plan Code 428 02 0347Vision Plan CoverageCode

430 03 0348

Vision CED 433 10mm/dd/yyyy

0349

Vision - UC contribution 443 089(05).99

n/a The UC-paid portion of the visionpremium is calculated using datafrom the Benefits Rates Table.

Vision - employee cost 451 089(05).99

n/a The employee-paid portion of thevision premium is calculated usingdata from the Benefits Rates Table.

Filler 443 16 Filler recovered from visioncontribution and cost

Legal Plan Code 459 02 0353Legal Plan Coverage Code 461 03 0354Legal Plan PCED 464 10

mm/dd/yyyy0355

Legal - UC contribution 474 089(05).99

n/a The UC-paid portion of the legalpremium is calculated using datafrom the Benefits Rates Table.

Legal - Employee cost 482 089(05).99

n/a The employee-paid portion of thelegal premium is calculated usingdata from the Benefits Rates Table.

Filler 474 16 Filler recovered from legalcontribution and cost

Executive Life Indicator 490 01 0356




EDB# Comments

Executive Life Sal Base 491 06 0357Executive Life CED 497 10

mm/dd/yyyy0452

Medical Opt Out Code 507 01 0377Dental Opt Out Code 508 01 0378Vision Opt Out Code 509 01 0379Deduction Pay ScheduleCode

510 02 0152

BELI Code-Assigned 512 01 0360BELI Code-Derived 513 01 0375BELI Effective Date 514 10

mm/dd/yyyy0341

US Savings Bond 1Denomination Code

524 04 1103


528 04 1203


532 04 1303


536 04 1404

403(b) Maximum AnnualContribution (MAC)

540 09-9(05).99

6008U

Medical Plan ECED 549 10mm/dd/yyyy

0454

Dental Plan ECED 559 10mm/dd/yyyy

0455

Vision Plan ECED 569 10mm/dd/yyyy

0456

Legal Plan ECED 579 10mm/dd/yyyy

0457

Employee Unit Code 589 02 0255Employee Relations Code 591 01 0160Employee RepresentationCode

592 01 0295

Employee SpecialHandling Code

593 01 0256

Employee Distribution UnitCode

594 01 0257

PIN AuthorizationSignature Date

595 10mm/dd/yyyy

0750

Period of Initial EligibilityEnd Date

605 10mm/dd/yyyy

0751

Direct Deposit Indicator 615 01 .Separation Reason Code 616 02 0141Federal Tax Marital StatusCode

618 01 0127

Federal Tax WithholdingAllowances

619 03 0128

State Tax Marital Status 622 01 0130




EDB# Comments

CodeState Tax Personal TaxWithholding Allowances

623 03 0131

State Tax ItemizedDeductions WithholdingAllowances

626 03 0132

Surepay Bank AccountNumber

629 17 225

Surepay Checking/Savings 646 1 226Bank Name 647 35Bank Transit RoutingNumber

682 9

Anticipated RetirementDate

691 10mm/dd/yyyy

0765

Foreign Address Code 701 1 0291Address PermanentForeign Province

702 15 1120

Address PermanentForeign Country Code

717 2 1118

Address PermanentForeign Postal Code

719 10 1119

Employee HomeTelephone

729 10 0210

Spouse Name 739 25 0312Employee OrganizationHome Address DisclosureCode

764 1 0247

Employee OrganizationHome Phone DisclosureCode

765 1 0248

Home Address ReleaseCode

766 1 0244

Home Phone ReleaseCode

767 1 0245

Spouse Name ReleaseCode

768 1 0246

Employee Name Suffix 769 4 0106Employee First Name 773 30 0250Employee Middle Name 803 30 0251Employee Last Name 833 30 0252Net ID 863 10 0249Citizenship Status Code 873 1 0109Visa Type Code 874 2 0110Federal Tax-MaximumWithholding Allowances

876 3 0320

State Tax-MaximumWithholding Allowances

879 3 0321

State Declaration ofDomestic Partnership

882 1 0288

Medical Contribution Base 883 3 Added in SR 80191




EDB# Comments

– Current YearMedical Contribution Base – Next year

886 3 Added in SR 80191

Filler 889 4 Value is spacesEmployment StatusChange Date

893 10mm/dd/yyyy

0766 This field must always be the lastfield on the employee record


File Layout for Web/IVR Extract FileDeduction Record


EDB# Comments

Add/Change/Delete 01 01 n/a

IVR Deduction RecordUpdate Date

02 10mm/dd/yyyy

n/a Update Date is set to the current datewhen PPS program PPIIVR detectsthat a change has been made to anyfield in the IVR deduction record.

Location Code (key) 12 02 n/a A unique code assigned to eachcampus, lab, Hastings, and ASUCLA.

Employee SSN (key) 14 09 0111

GTN Group Code 23 01 Code assigned by the IVR extractprogram (see attached)

GTN Number 24 03 GTN Number or the literal ‘AVH, ‘LVH’or ‘GRS’

GTN G-balance 27 109(07).99

6nnnG Deduction amount

GTN D-balance 37 109(07).99

6nnnD Declining balance amount

GTN Y-balance 47 109(07).99

6nnnY Year-to-date balance deductionamount

GTN Effective Date 57 10mm/dd/yyyy

7nnnE GTN effective date

Data Elements and Groups for Web/IVR File

Deduction Record

Data Element Name and Number GroupCode

Sick Leave Hours in the ‘G’ balance field Literal“LVH”EDB5186

0

YTD Total Gross in the ‘G’ balance fieldYTD FWT Gross in the ‘D’ balance fieldPrior YTD Total Gross in the ‘Y’ balance field

Literal’GRS’EDB5501EDB5502EDB0767

0

Average Hours Per Week in the ‘G’ balance field Literal‘AVH’EDB5132

0

Tax Deferred SavingsEffective Date

6001G7001E

1



Deduction Record


YTD 6001YTax Deferred BondEffective DateYTD

6002G7002E6002Y

1

Tax Deferred EquityEffective DateYTD

6003G7003E6003Y

1

Tax Deferred ICCEffective DateYTD

6292G7292E6292Y

1

Tax Deferred Money MarketEffective DateYTD

6293G7293E6293Y

1

Tax Deferred CalvertEffective DateYTD

6294G7294E6294Y

1

Tax Deferred Multi AssetEffective DateYTD

6228G7228E6228Y

1

Tax Deferred FidelityEffective DateYTD

6246G7246E6246Y

1

Tax Deferred Savings % Effective DateYTD

6232G7232E6232Y

2

Tax Deferred Bond %Effective DateYTD

6233G7233E6233Y

2

Tax Deferred Equity %Effective DateYTD

6234G7234E6234Y

2

Tax Deferred ICC %Effective DateYTD

6235G7235E6235Y

2

Tax Deferred Multi Asset %Effective DateYTD

6229G7229E6229Y

2

Tax Deferred Money Market %Effective DateYTD

6236G7236E6236Y

2

Tax Deferred Fidelity %Effective DateYTD

6247G7247E6247Y

2

Tax Deferred Calvert %Effective DateYTD

6237G7237E6237Y

2

DCP Casual Savings YTD 6036Y 3



Deduction Record


DCP Casual Equity YTD 6037Y 3

DCP Casual Bond YTD 6038Y 3

DCP Casual ICC YTD 6039Y 3

DCP Casual Money Market YTD 6155Y 3

DCP Casual Multi Asset YTD 6156Y 3

DCP Casual Fidelity YTD 6278Y 3

DCP Career Savings YTD 6211Y 3

DCP Career Equity YTD 6212Y 3

DCP Career Bond YTD 6213Y 3

DCP Career ICC YTD 6214Y 3

DCP Career Money Market YTD 6215Y 3

DCP Career Multi Asset YTD 6216Y 3

DCP Career Fidelity YTD 6217Y 3

SSDCP Fidelity–employer contribution YTD 6380Y 3

SSDCP Savings–employer contribution YTD 6381Y 3

SSDCP Equity-employer contribution YTD 6382Y 3

SSDCP Bond-employer contribution YTD 6383Y 3

SSDCP Insurance Company Contract-employercontribution YTD

6384Y 3

SSDCP Money Market-employer contribution YTD 6385Y 3

SSDCP Multi Asset-employer contribution YTD 6386Y 3

SSDCP Fidelity YTD 6387Y 3

SSDCP Savings YTD 6388Y 3

SSDCP Equity YTD 6389Y 3

SSDCP Bond YTD 6390Y 3

SSDCP Insurance Company Contract YTD 6391Y 3

SSDCP Money Market YTD 6392Y 3

SSDCP Multi Asset YTD 6393Y 3

Fidelity - NTDEffective DateYTD

6279G7279E6279Y

4

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment G - Page10


Deduction Record


Insurance Company Contract - NTDEffective DateYTD

6202G7202E6202Y

4

UCRS Savings - NTDEffective DateYTD

6023G7023E6023Y

4

Money Market - NTDEffective DateYTD

6203G7203E6203Y

4

Multi Asset - NTDEffective DateYTD

6252G7252E6252Y

4

UCRS Equity - NTDEffective DateYTD

6031G7031E6031Y

4

UCRS Bond - NTDEffective DateYTD

6030G7030E6030Y

4

IDS IRAEffective DateYTD

6239G7239E6239Y

5

American CenturyEffective DateYTD

6284G7284E6284Y

5

Loan - Short Term Amt BalanceYTD

6243G6243D6243Y

6

Loan - Long Term Amt BalanceYTD

6253G6253D6253Y

6

UCRS RetroUCRS Retro-balance

6006G6006D

7

UCRS BuybackUCRS Buyback-BalanceTD Buyback#1TD Buytback1-BalanceTD Buyback#2TD Buytback2-BalanceTD Buyback#3TD Buytback3-BalanceTD Buyback#4TD Buytback4-BalanceTD Buyback#5TD Buytback5-BalanceNTD Buyback#1NTD Buytback1-BalanceNTD Buyback#2NTD Buytback2-Balance

6029G6029D6351G6351D6352G6352D6353G6353D6354G6354D6355G6355D6361G6361D6362G6362D

7

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment G - Page11


Deduction Record


NTD Buyback#3NTD Buytback3-BalanceNTD Buyback#4NTD Buytback4-BalanceNTD Buyback#5NTD Buytback5-Balance

6363G6363D6364G6364D6365G6365D

PERS BuybackPERS Buyback Balance

6034G6034D

7

PERS Additional 6033G 7

PERS Survivor 6026G 7

403(b) total YTD403(b) MAC (6008U) - put in extract in 'D' field

6008Y6008D

9

DepCareDepCare Effective DateDepCare YTD

6225G7225E6225Y

9

Health Care Reimbursement Account (HCRA)HCRA Effective DateHCRA YTD

6338G7338E6338Y

9

Additional Federal Tax Withholding 6010G6010Y

9

Additional CA State Tax Withholding 6011G6011Y

9

Additional Federal Tax Withholding forNonresident Aliens

6301G6301Y

9

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment H - Page 1

CPS/BCS Record Layout (PPP711)

Positions Field Description Comments

1 – 2 Location

3 – 11 Employee Identification Number

12 – 46 Employee Name EDB0105

47 – 76 Address Permanent Line One EDB0204

77 – 106 Address Permanent Line Two EDB0205

107 – 127 Address Permanent City EDB0206

128 – 129 Address Permanent State EDB0207

130 – 134 Address Permanent ZIP EDB0208

135 – 137 Number of Registered UC Student Units EDB0237

138 – 139 Filler

140 Home Address Disclosure Indicator EDB0211

141 – 149 Social Security Number EDB0111

150 Sex Code EDB0108

151 – 156 Date of Birth EDB0107 (YYMMDD)

157 Citizenship Status Code EDB0109

158 – 159 Ethnic Origin Code EDB0112

160 Retirement System Code EDB0122

161 FICA Eligibility Code EDB0120

162 Unemployment Insurance Coverage Code EDB0121

163 UC Student Status Code EDB0119

164 – 172 Previous ID Number

173 – 175 Prior Service Credit Months EDB0146

176 – 177 Filler

178 – 193 Organization Code

194 Position Type Code

195 Confidential Information Code

196 – 201 Most Recent Hire Date EDB0113 (YYMMDD)

202 – 205 Next Salary Review EDB0136 (YYMM)

206 Next Salary Review Type EDB0135




207 Employment Status Code EDB0144

208 – 209 Visa Type Code EDB0110

210 – 213 Merit Percent EDB0153

214 – 219 Separation Date EDB0140 (YYMMDD)

220 – 221 Separation Reason Code EDB0141

222 – 227 Leave of Absence Begin Date EDB0137 (YYMMDD)

228 – 233 Leave of Absence Return Date EDB0138 (YYMMDD)

234 – 235 Leave of Absence Type Code EDB0139

236 DCP Plan Code EDB0129

237 – 240 Sick Leave Used Zero Filled

241 – 245 Sick Leave Hours Balance (Current) EDB5186

246 Retirement/FICA Derivation Indicator EDB0238

247 – 249 Vacation Used Zero Filled

250 – 252 Vacation Leave Hours Balance (Current) EDB5185

253 – 256 Vacation Lost Zero Filled

257 – 259 Compensation Time Used Zero Filled

260 – 263 Compensatory Time Hours Balance (Current) EDB5110

264 – 268 Overtime Paid Zero Filled

269 – 273 Overtime Worked Zero Filled

274 – 279 Overtime Hours Worked YTD EDB5103

280 Month Pay Indicator-January EDB0171

281 Month Pay Indicator-February EDB0172

282 Month Pay Indicator-March EDB0173

283 Month Pay Indicator-April EDB0174

284 Month Pay Indicator-May EDB0175

285 Month Pay Indicator-June EDB0176

286 Month Pay Indicator-July EDB0177

287 Month Pay Indicator-August EDB0178

288 Month Pay Indicator-September EDB0179

289 Monthly Pay Indicator-October EDB0180




290 Monthly Pay Indicator-November EDB0181

291 Monthly Pay Indicator-December EDB0182

292 – 297 Accidental Death and Dismemberment CoverageEffective Date

EDB0282 (YYMMDD)

298 Accidental Death and Dismemberment CoverageCode

EDB0281

299 – 301 Accidental Death and Dismemberment PrincipalSum

EDB0280

302 – 307 Dental Plan Coverage Effective Date EDB0274 (YYMMDD)

308 – 309 Filler

310 – 315 Suppl Life Insurance Coverage Effective Date EDB0277 (YYMMDD)

316 Suppl Life Insurance Plan Code EDB0276

317 – 319 Suppl Life Insurance Salary Base EDB0275

320 Dependent Life Insurance Plan Code EDB0278

321 – 326 Medical Plan Coverage Effective Date EDB0294 (YYMMDD)

327 – 328 Medical Plan Code EDB0292

329 Filler

330 – 332 Medical Plan Coverage Code EDB0293

333 – 338 Basic Life Insurance Effective Date EDB0451 (YYMMDD)

339 – 343 Filler

344 – 345 Primary BELI Status Qualification Code EDB0240

346 – 351 Primary BELI Status Qualification Effective Date EDB0241 (YYMMDD)

352 – 353 Secondary BELI Status Qualification Code EDB0242

354 – 359 Secondary BELI Status Qualification Effective Date EDB0243 (YYMMDD)

360 Short Term Disability Insurance Code EDB0123

361 – 363 Medical Contribution Base – Current year Added in SR 80191

364 – 366 Medical Contribution Base – Next Year Added in SR 80191

367 – 368 Filler

369 War/Campaign/Expedition Veteran Status Code EDB0345

370 Vietnam Era Veteran Status Code EDB0350

371 Veteran Disability Status Code EDB0351




372 Handicapped Status Code EDB0352

373 Insurance Reduction Code EDB0299

374 – 375 Employee Unit Code EDB0255

376 Employee Special Handling Code EDB0256

377 Employee Distribution Unit Code EDB0257

378 Employee Representation Code EDB0295

379 – 384 Executive Life Insurance Effective Date EDB0452 (YYMMDD)

385 – 390 Original Hire Date EDB 0704 (YYMMDD)

391 Depcare Participation

392 – 399 Filler

400 FCP Select Flag

401 – 402 Dental Plan Code EDB0272

403 – 405 Dental Coverage Code EDB0273

406 Federal Tax Marital Status Code EDB0127

407 State Tax Marital Status Code EDB0130

408 Filler

409 – 414 Vision Plan Coverage Effective Date EDB0349 (YYMMDD)

415 – 416 Vision Plan Code EDB0347

417 – 419 Vision Plan Coverage Code EDB0348

420 – 423 Filler

424 – 426 Life Insurance-UC Paid EDB0330

427 UCRS Short Loan

428 UCRS Long Loan

429 – 430 Legal Plan Code EDB0353

431 – 433 Legal Plan Coverage Code EDB0354

434 – 439 Legal Plan Coverage Effective Date EDB0355 (YYMMDD)

440 – 442 Federal Tax Withholding Allowances EDB0128

443 – 445 State Tax Personal Withholding Allowances EDB0131

446 – 448 State Tax Itemized Deduction WithholdingAllowances

EDB0132




449 Executive Life Insurance Indicator EDB0356

450 – 452 Executive Life Insurance Salary Base EDB0357

453 Benefits Eligibility Level Indicator Assigned EDB0360

454 Benefits Eligibility Level Indicator Derived EDB0375

455 – 458 Benefits Eligibility Level indicator Conflict Date EDB0376 (YYMM)

459 Medical Insurance Opt Out Code EDB0377

460 Dental Insurance Opt Out Code EDB0378

461 Vision insurance Opt Out Code EDB0379

462 – 465 Average Hours Worked Per Week EDB5132

466 – 471 Dependent Life Coverage Effective Date EDB0188 (YYMMDD)

472 – 480 Total Gross YTD EDB5501

481 – 489 Federal Withholding Tax Gross YTD EDB5502

490 – 498 YTD Depcare Deduction EDB6225Y

499 – 507 Hours Toward Career Status Eligibility – Total EDB0426

508 – 516 Hours Toward Benefits Eligibility – Total EDB5142

517 – 522 Last Day On Pay Status EDB0189

523 – 531 SPP-Total Interest-Sr Mgt EDB0409

532 – 540 SPP-Total Contribution-Interest Posted- Sr Mgt EDB0402

541 – 546 SPP-Changed Date- Sr Mgt EDB0411 (YYMMDD)

547 – 555 SPP-X Month Contribution-No Interest- Sr Mgt

Where X = 1st, 2nd, 3rd, 4th, 5th, 6th

EDB0403 – EDB0408 (1st – 6th

Month)

556 – 564 SPP Current Month Contribution

565 – 573 SPP-Total Interest-HS EDB0439

574 – 582 SPP-Total Contribution-Interest Posted-HS EDB0432

583 – 588 SPP-Changed Date-HS EDB0441 (YYMMDD)

589 – 597 SPP-X Month Contribution-No Interest-HS

Where X = 1st, 2nd, 3rd, 4th, 5th, 6th

EDB0433 – EDB0438 (1st – 6th

Month)

598 - 606 HSPP Current Month Contribution

607 Supplemental Disability Insurance Plan Code

608 – 610 Supplemental Disability Waiting Period EDB0231




611 – 615 Supplemental Disability Salary Base EDB0232

616 – 621 Supplemental Disability Coverage Effective Date EDB0233 (YYMMDD)

622 – 625 Primary Title Code EDB0460

626 – 637 Filler

638 – 643 Short Term Disability Coverage Effective Date EDB0453 (YYMMDD)

644 – 652 Federal Withholding Tax Gross - FYTD EDB5545

653 – 658 Home Department Code EDB0114

0659 – 688 Home Department Name EDB0114(From the Home DepartmentTable)

689 – 690 Country of Residency Code EDB0143

691 – 720 Country of Residency EDB0143(From the Foreign CountryTable)

721 – 721 Health Care Reimbursement Account Indicator ‘Y’ if EDB 6338G is zero,otherwise blank

722 – 726 HCRA Annual Amount New data element

727 – 732 HCRA Termination Date New data element

733 - 741 HCRA Year-To-Date Deductions EDB 6338Y

9(07)V99

742 – 760 Filler

721 – 760 Filler

Health Care Reimbursement Account Final 09/17/02 Revised 10/21/02 Attachment I - Page 1

UCRS Transaction File Layout

Contribution Segment

(the contribution segment occurs zero to 200 times)

RelativePosition

FieldLength

Field Description Comments

1 1 Segment Type Code “C” for Contribution

2 – 3 2 Plan Code See Plan Code/GTN list below

4 – 10 7 Contribution Amount S9(5)V99 Format

11 – 14 4 Contribution Tax Year CCYY Format

15 – 23 9 Year-to-Date Contribution S9(7)V99 Format

24 – 26 3 Buyback #/GTN number if plan 19 or 20

Or

Leave blank

029, 351, 352, 353, 354, 355,361, 362, 363, 364, 365

27 – 40 14 Filler Spaces

UCRS PLAN CODES AND PPS GTNsUCRS Plan Code GTN Number GTN Description

028 UCRS-Basic029 UCRS Buyback032 UCRS Under 30361 Non-Tax Deferred Buyback1362 Non-Tax Deferred Buyback2363 Non-Tax Deferred Buyback3364 Non-Tax Deferred Buyback4365 Non-Tax Deferred Buyback5

03

006 (subtracted) UCRS-Retroactive04 023 UCRS Savings

005 UCRS Basic-R006 UCRS Retroactive351 Tax Deferred Buyback#1352 Tax Deferred Buyback#2

353 Tax Deferred Buyback#3354 Tax Deferred Buyback#4

05

355 Tax Deferred Buyback#5001 403(b) Savings10232 403(b) Savings-percent

12 031 UCRS-Equity003 403(b) Equity14234 403(b) Equity-percent

15 030 UCRS-Bond002 403(b) Bond16233 403(b) Bond-percent

19 (memo plan) 361 Tax Deferred Buyback#1


UCRS PLAN CODES AND PPS GTNsUCRS Plan Code GTN Number GTN Description

362 Tax Deferred Buyback#2363 Tax Deferred Buyback#3364 Tax Deferred Buyback#4365 Tax Deferred Buyback#5361 Tax Deferred Buyback#1362 Tax Deferred Buyback#2363 Tax Deferred Buyback#3364 Tax Deferred Buyback#4

20 (memo plan)

365 Tax Deferred Buyback#531 202 Insurance Company Contract-Non-Tax Deferred

292 403(b) Insurance Company Contract33235 403(b) Insurance Company Contract-percent

34 203 Money Market-Non-Tax Deferred293 403(b) Money Market36236 403(b) Money Market-percent294 403(b) Calvert39237 403(b) Calvert-percent

40 243 UCRS-Short Term Loan41 253 UCRS-Long Term Loan

246 403(b) Fidelity42247 403(b) Fidelity Percent

43 279 Fidelity-Non-Tax Deferred44 217, 380, 387 DCP Fidelity45 278 DCP Casual Fidelity46 (memo plan) 387 SSDCP Fidelity47 (memo plan) 380 SSDCP Fidelity-employer contribution50 225 Dep Care51 338 Health Care Reimbursement Account52 (memo plan) 388 SSDCP Savings53 252 Multi-Asset-Non-Tax Deferred

228 403(b) Multi-Asset54229 403(b) Multi-Asset-percent

55 (memo plan) 389 SSDCP Equity56 (memo plan) 390 SSDCP Bond57 (memo plan) 391 SSDCP Insurance Company Contract58 (memo plan) 392 SSDCP Money Market59 (memo plan) 393 SSDCP Multi Asset61 (memo plan) 381 SSDCP Savings-employer contribution62 (memo plan) 382 SSDCP Equity-employer contribution63 (memo plan) 383 SSDCP Bond-employer contribution64 (memo plan) 384 SSDCP Insurance Company Contract-employer

contribution65 (memo plan) 385 SSDCP Money Market-employer contribution66 (memo plan) 386 SSDCP Multi Asset-employer contribution71 211, 381, 388 DCP Savings72 212, 382, 389 DCP Equity73 213, 383, 390 DCP Bond74 214, 384, 391 DCP Insurance Company Contract75 215, 385, 392 DCP Money Market76 216, 386, 393 DCP Multi-Asset81 036 DCP Casual Savings


UCRS PLAN CODES AND PPS GTNsUCRS Plan Code GTN Number GTN Description82 037 DCP Casual Equity83 038 DCP Casual Bond84 039 DCP Casual Insurance Company Contract85 155 DCP Casual Money Market86 156 DCP Casual Multi-Asset

PPS Requirements Health Care Reimbursement Account...

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