Purpose
Produce a complete, sequenced enrollment submission checklist that prevents rejected applications, missed deadlines, and coverage gaps — tailored to a specific carrier, plan type, and group size so the administrator knows exactly what to collect, verify, submit, and confirm.
When to Use
Invoke this skill when the user asks to:
- Prepare a new group's initial benefits enrollment submission
- Build a checklist for an upcoming open enrollment cycle
- Add a mid-year plan (dental, vision, life, disability) to an existing group
- Onboard new hires or process qualifying life event enrollments in bulk
- Standardize the enrollment process so submissions clear carrier review the first time
- Hand off enrollment work to a new team member with a repeatable process
Inputs Required
Before starting, collect:
- Carrier: The insurance carrier or benefits vendor receiving the submission
- Plan type(s): Medical, dental, vision, life, STD/LTD, FSA/HSA, or combination
- Group size: Number of enrolling employees (drives ACA, ERISA, and participation rules)
- Enrollment type: New group / open enrollment / new hire / qualifying life event / mid-year plan add
- Submission method: Carrier portal, broker platform, EDI feed, or paper/PDF
- Effective date: Requested coverage start date
- Existing coverage status: Replacing prior coverage, first-time coverage, or adding to current plans
If submission method or group size is not provided, default to carrier portal for groups under 50 and EDI/broker platform for 50+, and note the assumption.
Instructions
Step 1: Pre-Submission Data Collection
List every data point required before any form is touched. Organize by category:
- Employer data: Legal entity name, EIN, physical and mailing addresses, SIC/NAICS code, prior carrier name and policy number (if replacing)
- Employee census: Full legal name, DOB, SSN, gender, hire date, employment status (FT/PT), scheduled hours, home ZIP (for rating), salary (required for life/disability calculations)
- Dependent data: Name, DOB, SSN, relationship, and any documentation required (marriage/birth certificates for QLE)
- Plan election data: Plan tier chosen, coverage level (EE / EE+spouse / EE+child / family), waiver reason for declines
- Flag which fields the specific carrier commonly rejects for incompleteness (missing SSN, ZIP not matching rating area, salary blank on life applications)
Step 2: Eligibility Verification
Confirm each enrollee actually qualifies before submitting:
- Waiting period check: Confirm each new hire has satisfied the group's waiting period (default 30/60/90 days from hire) as of the effective date
- Hours threshold: Verify part-time employees meet the group's minimum eligible hours
- Participation minimums: Most carriers require 70–75% participation of eligible employees for group approval — count enrollments vs. waivers and flag if below threshold
- QLE window: For qualifying life events, confirm the election falls within the 30- or 60-day event window and that a dated proof-of-event document exists
Step 3: Required Forms and Documents Checklist
Enumerate every form the submission needs, tailored to plan type and enrollment type:
- Group setup forms (new groups): Master group application, employer agreement, first-month premium check or ACH authorization, wage/tax report or DE-9 to verify eligible headcount
- Enrollment forms: Individual enrollment applications or the census file, signed and dated
- Waiver/decline forms: Required for every eligible employee not enrolling — carriers use these to validate participation
- Plan-specific forms: Evidence of Insurability (EOI) for life/disability above guaranteed issue, HSA banking setup, FSA election forms, beneficiary designations for life
- Supporting documents: Prior carrier bills (for replacement/credit for deductible), dependent verification documents
- For each form, note whether a wet signature, e-signature, or no signature is required by this carrier
Step 4: Carrier-Specific Submission Rules
Apply the submission mechanics for the named carrier and method:
- Portal submissions: Field-level requirements, file format for census upload (typically carrier-specific CSV/Excel template), maximum file size, and known validation errors to pre-check
- EDI feeds: 834 file format, connection setup lead time, and test-file requirement before production
- Paper/PDF: Complete-package requirement — carriers reject partial packets — and correct submission address or secure email
- Underwriting triggers: Note what will kick the submission into medical underwriting or extended review (small groups near participation thresholds, high EOI volume, late enrollees)
Step 5: Deadline Sequencing (Work Backward From Effective Date)
Build a dated backward timeline so nothing lands late:
- Effective date: The target coverage start
- Carrier submission deadline: Typically 15–30 days before effective date — confirm the carrier's cutoff
- Employee election deadline: 5–7 days before submission to allow data cleanup
- Open enrollment window: Communicate 2–3 weeks before elections close
- EOI submission: Submit separately and early — approval can take 2–6 weeks and should not block base coverage
- Present as a countdown table: task, owner, due date, dependency
Step 6: Submission Execution and Post-Submission Confirmation
Define the final actions and the proof that the enrollment is truly complete:
- Submit: Send the complete package via the confirmed method; capture a confirmation number or timestamp
- Confirm receipt: Obtain carrier acknowledgment within 3–5 business days; escalate if silent
- Verify enrollment accuracy: Reconcile the carrier's confirmation roster against the census — check every enrollee, tier, and effective date
- Distribute proof of coverage: ID cards, member portal access, and coverage confirmation to employees
- Reconcile first invoice: Match the first premium bill line-by-line to enrolled members before payment
- Close the loop: File confirmation, note any pending EOI or underwriting decisions, and set follow-up dates
Output Format
- Structure: Six sequenced sections following the enrollment lifecycle, with checkbox-style task lists and one countdown table for deadlines
- Length: 900–1,300 words
- Format: Structured checklist document — scannable checkboxes and a deadline table, not dense prose
- Sections: Pre-Submission Data Collection → Eligibility Verification → Required Forms and Documents → Carrier-Specific Submission Rules → Deadline Sequencing → Submission Execution and Confirmation
- Tone: Operations specialist — precise, compliance-aware, and directive; every item is an action or a verification, not a suggestion
Quality Checklist
Before delivering output, verify:
- [ ] All six lifecycle sections are present and in order
- [ ] The forms checklist is tailored to the specific plan type(s) provided — not a generic list
- [ ] Participation minimum is checked against group size and flagged if at risk
- [ ] Deadline section works backward from the effective date with concrete day counts
- [ ] Every checklist item is a verifiable action (collect, confirm, submit, reconcile) — no vague guidance
- [ ] Post-submission section includes roster reconciliation and first-invoice matching, not just "submit and done"
Notes
- The two most common causes of rejected group submissions are incomplete census data (missing SSN or salary) and failing the participation minimum — front-load both checks.
- EOI and base coverage should always be tracked as separate timelines; blocking on EOI approval delays coverage that could have started on time.
- For open enrollment cycles, save the completed checklist as the group's standing template and update only carrier rules and dates each year.
- When group size is near 50, flag ACA applicable-large-employer implications so the administrator can confirm reporting obligations separately.
How to use this skill
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