Reasons shaded and denoted with an asterisk (*) can be created by Agency HR.

·        ADDF* - Enroll Family- Enroll family when:

o       Spouse loses eligibility in his/her employer's plan

o       Spouse terminates employment and loses coverage

o       Spouse changes employment status from F/T to P/T

o       Spouse or dependent loses Medicaid/Health Choice eligibility

·        ADMN - Admin. Corrections (Administration Corrections) - Change enrollment when:

o       Corrections are needed

o       Other Adjustment Reasons do not fit reason listed.

·        BENE - Beneficiary Changes - Add or change beneficiaries assigned to life

o       Note: Changes are allowed anytime.

·        CTO - Court Ordered Support - Add dependent to employee's SHP and other health insurance plans per Child Support Garnishment notification order

·        DCAR* - FSA Dep Changes (Dependent Child FSA Changes) - Change FSA deductions when:

o       Child becomes ineligible at age 13

o       Child begins kindergarten or 1st grade

o       Provider changes rates

o       Provider changes coverages

o       Employee changes day care provider

o       Employee terminates day care

·        DRPF* - Drop Family Terminate participation when:

o       Spouse begins employment and gains coverage,

o       Spouse changes employment status from P/T to F/T

o       Employee, spouse, or dependent gains Medicare or Medicaid eligibility

·        DTH* - Death of Dependent - Terminate participation of a deceased dependent

·        DVC* - Divorce - Terminate participation of a spouse due to a legal divorce

·        FLOE - NCFlex Annl Enroll (NCFlex Annual Enrollment) - Open enrollment for NC Flex Plans

o       Note: Open enrollment is usually set for October through the first week of November.

·        FSC - Cancel while on FMLA (FMLA Subscriber Cancel) - Terminate participation when an employee on an FMLA leave elects to cancel coverage.

o       Note: Employee on an FMLA leave will pay premiums for NC Flex plans directly to the plan providers.

·        FSN - FMLA Nonpayment (FMLA Subscriber No Payment) - Terminate participation in SHP when an employee on an FMLA leave fails to pay the premium.

o       Note: Employee on an FMLA will directly pay the vendors of NC Flex plans.

·        HIOE - Hlth Ins Annl Enroll (Health Insurance Annual Enrollment) - Open enrollment for health plans

o       Note: Enrollment is usually set for one month.

·        HIRE - New Hire (also used for reinstated EE) - Manually create adjustment reason to enroll new hires or reinstated employee in benefits plans.

o       Note: SAP will automatically generate this adjustment reason during the Hiring action. Shared Services may manually create the New Hire adjustment reason for an eligible employee.

·        LATE - Late Entry in Health (SHP only) - Enroll or change participation in SHP after 30 days. Employees may enroll up to 60 days but they are subject to preexisting condition from the 31st to 60th day.

o       Note: You will be required to the date of the qualifying event. This date is submitted to SHP.

·        MCP - Medicare is Primary - Terminate participation in SHP when employee or dependent elects Medicare as primary insurer.

o       Note: If employee or dependent elects Medicare as the Primary insurer, he/she must cancel participation in SHP, however for Cancer the employee or dependent may continue or stop his or her participation.

·        MLT - Military Leave Term:

o       Terminate SHP participation for employee or dependent on a Military Leave.

o       Terminate employee's participation in NC Flex plans

o       Enroll employee in NC Flex plans because spouse is on a Military leave.

·        MRG* - Marriage (Employee marries)

o       Terminate participation in plans

o       Enroll self, spouse, and eligible children in plans

·        MRGD* - Dependent marries - Terminate participation for married dependent.

·        NCHD* - Add Foster/Step Child - Enroll a foster or step child to benefit plans. Employee may change dependent coverage.

·        NEWB* - Birth or adoption of a child

o       Enroll a newborn or adopted child in SHP when the coverage is to start on the day the child is born.

o       Enroll employee in health care FSA after a birth or adoption of a child.

o       Note: SHP coverage will begin when the first of the month or the first of the next month.

·        NLS - No Longer a Student - Change dependent coverage when dependent is over 19 years old and is not attending school full-time.

·        NPY - Nonpayment of Health (SHP only) - Used when an employee:

o       Experiences a significant change in premiums or benefits

o       Does not pay premiums

·        NWEL - Newly Eligible - Enroll employee in plans when employee becomes eligible due to a:

o       Change in position.

o       Change in hours.

o       Position transfer from a Non SAP agency to SAP Agency.

·        ODP - Maximum Age Dep. (Dependent) - Terminate participation for a dependent who has reached a plan's maximum age limit for coverage.

·        OLV - LOA w/out leave (and without pay) - For employees on an LOA without leave (and without pay) for an extended period of time or who will miss at least one payroll deduction for premiums

o       Notes: This action will send an electronic notification to vendors of leave.

o       For SHP, this action is used after the FMLA period has elapsed.

·        PTAX - Pretax to Post tax Clear pretax option on health insurance when employee submits written form

·        REC - Hrs<20 Not eligible:

o       Terminate participation in SHP when an employee's work hours is reduced to less than 20 hours.

o       Terminate participation in NC Flex plans when an employee's hours are below 20 hours. The employee is no longer eligible for coverage.

·        RET - Retirement Changes:

o       Enroll employee in retirement plan (missed during PA40 action)

o       Enroll School of Science & Math EPA employees when they choose the ORP plan

o       Stop participation in retirement plan when employee loses eligibility.

·        RFL - Return LOA w/out Leave (Return for LOA without Leave) - Enroll employee returning from an LOA without leave in plans.

o       Notes: If employee is returning from a leave without any compensation within the same calendar year, enroll the employee in the same level of NC Flex plans that were elected prior to leave, except for Life Insurance. Note: Follow the LOA guidelines set by NC Flex

o       If employee's LOA was greater than 30 days and extended into new calendar year, have employee elect level of benefits by following the new hire procedure.

o       If employee's leave occurred during open enrollment, allow employee opportunity to enroll following the guidelines established for that open enrollment event.

·        RHN - Reduced Hrs - No COBRA - Terminate SHP participation when an employee's hours are reduced to be between 20 and 30 hours and the employee chooses not to continue the Health Plan.

·        SAV - Savings Plans - Enroll, change, or stop participation in the 401k, 401kRoth, 457 or 403(b) plans.

o       Note: Used primarily for 403(b) plans.

·        SEP* - Separation - Stop participation for a legally separated spouse.

·        SMC - Subst. Money Change (Substantial Money Change) - Maintain SHP participation when a change in health premiums occurs by plus or minus fifty dollars ($50.00).

·        SRQ* - Subscriber Request - Terminate SHP participation when employees want to cancel coverage for themselves and their dependents.

·        STD - Short-term Disability:

o       Terminate participation in SHP and NC Flex plans for an employee on STD

o       Change premiums to a post-tax basis for an employee on STD that elects to continue participation in NC Flex plans.

·        STU - New Student - Used when a dependent is ineligible due to being over the allowable age, but now is eligible as a new or returning student.