CLER for Carriers

501

Payroll/Personnel Office Did Not Process 2809 Or 2810

Use this code when the 2809, 2810, or Employee Express transaction was not received or not processed by the payroll office. Once the payroll/personnel office has processed the change, it needs to be transmitted to the carrier.

502

Payroll/Personnel Office Did Not Process 2809 Or 2810 Correctly

Use this code when the 2809, 2810, or Employee Express transaction was created but was either entered into the system incorrectly or was not properly processed by the payroll/personnel office. Once the payroll/personnel office has processed the change, it needs to be transmitted to the carrier.

520

Carrier Did Not Process 2809 Or 2810

Use this code when the 2809, 2810, or Employee Express transaction was either not received or not processed by the carrier. The payroll/personnel office should then use CLER Federal Employees Health Benefits, Centralized Enrollment Clearinghouse System to create a 2809 or 2810 transaction that will be sent to the carrier. The 2809 or 2810 may be faxed or mailed to the carrier in lieu of using CLER Federal Employees Health Benefits, Centralized Enrollment Clearinghouse System. The 2809 or 2810 that is provided to the carrier is a reissue of the initial form.

521

Carrier Did Not Process 2809 Or 2810 Correctly

Use this code when the 2809, 2810, or Employee Express transaction was not received or processed correctly by the carrier. The payroll/personnel office should then use CLER Federal Employees Health Benefits, Centralized Enrollment Clearinghouse System to create a 2809 or 2810 transaction that will be sent to the carrier. The 2809 or 2810 may be faxed or mailed to the carrier in lieu of using CLER Federal Employees Health Benefits, Centralized Enrollment Clearinghouse System. The 2809 or 2810 that is provided to the carrier is a reissue of the initial form.

522

Carrier Enrolled Person Without Payroll/Personnel Office Authorization

The enrollee sent his/her information directly to the carrier (bypassing the personnel office). The carrier should never enroll an individual unless it receives the information from an authorized source, i.e., the payroll/personnel office or Employee Express. In the unlikely event this does happen, the payroll office should work with the personnel office, enrollee, and carrier to get proper enrollment paperwork that it can use to update the payroll office system.

523

Carrier Changed Plan - Enrollee Out Of Service Area

The enrollee requested a plan that is not allowed for the area in which he/she lives and the carrier automatically switched the enrollee to the correct plan. This should never happen as the carrier should never make enrollment changes unless it receives the information from an authorized source, i.e., the payroll/personnel office or Employee Express. In the unlikely event it does happen, the payroll office should work with the personnel office, enrollee, and carrier to get proper enrollment paperwork that it can use to update the payroll office system.

524

Carrier Changed Option Without Payroll/Personnel Office Authorization

The enrollee sent his/her information directly to the carrier (bypassing the personnel office) or the carrier automatically changed the option when the enrollee got married or when the last dependent turned 22 years of age. The carrier should never make enrollment changes unless it receives the information from an authorized source, i.e., the payroll/personnel office or Employee Express. In the unlikely event it does happen, the payroll office should work with the personnel office, enrollee, and carrier to get the proper enrollment paperwork that they can use to update the payroll office system.

525

Carrier Rejected SF 2809 - Enrollee Out Of Service Area

The enrollee requested a plan that is not allowed for the area in which he/she lives so the carrier rejected the enrollment or enrollment change. The payroll office should work with the personnel office and enrollee to get the proper paperwork so that it can update its system and send the enrollment or enrollment change to the carrier.

526

Carrier Terminated Coverage Due To Death Of Enrollee

This should never happen as the carrier should never make enrollment changes unless it receives the information from an authorized source, i.e., the payroll/personnel office or Employee Express. In the unlikely event it does happen, the payroll office should work with the personnel office, enrollee, and carrier to get proper enrollment paperwork that they can use to update the payroll office system.

540

Enrollee In Unpaid Status - No Deductions For Pay Period

Some payroll offices only send in records for those enrollees for whom premiums were paid (either by deductions from enrollee pay or by contribution from the enrollees Agency). If an enrollee did not pay that pay period but was truly enrolled, then use this code to indicate why the discrepancy occurred. For this situation, no change would be required to either the payroll office’s records or the carrier’s records.

541

Enrollee Separation Not Submitted Timely

Use this code if the enrollee’s separation paperwork is not received promptly by the payroll office and is therefore still reported by the payroll/personnel office (and possibly the carrier) as being enrolled.

542

Enrollee Reported Under Two Payroll Offices - Transfer During Pay Period

Use this code if two different payroll offices or Agencies report an enrollee because that enrollee was transferring-in during the reconciliation pay period. For this situation, no corrective action is required as both payroll offices and Agencies properly reported this enrollee to CLER Federal Employees Health Benefits, Centralized Enrollment Clearinghouse System.

550

Transfer In Not Processed Timely By Gaining Payroll Office

Use this code when the gaining payroll office has not processed the transfer in for the enrollee’s prior payroll office. Contact the other payroll office so that it can obtain the proper paperwork and update its records.

551

Transfer In Not Processed Timely By OWCP

Use this code if the carrier reports an enrollee as belonging to your payroll office even though that enrollee should be handled by the Office of Workers Compensation Program (OWCP).

552

Transfer In Not Processed Timely By Gaining Payroll Office

Use this code if the carrier reports a retiree as still belonging to the enrollee’s prior payroll office. A transfer in to correct both records needs to be processed.

560

Retiree Transfer In Not Processed Timely

This code should be used when the discrepancy is due solely to the difference in extraction date between the payroll office and carriers (refer to the Payroll Office Enrollment File Layout Specifications for more details). For example, the carriers extract their data on the first of the month and a payroll office that pays biweekly might extract data on the fifth. Between the first and fifth of the month, some enrollees may have dropped or changed coverage while others may have enrolled for the first time.

570

Pseudo SSN Social Security number Used

Enrollees are not required to provide their SSN Social Security number to the carrier so some enrollees provide a fake or pseudo SSN Social Security number. This can result in a discrepancy unless the payroll office system also sends the pseudo SSN Social Security number to CLER Federal Employees Health Benefits, Centralized Enrollment Clearinghouse System so that records can be properly matched. Use this code whenever the discrepancy is due to a pseudo SSN Social Security number.

580

Other - See Comments

Use this code when no other code is suitable. Comments must be supplied to explain the reconciliation reason.

590

OPM USE ONLY - Multiple Accounts with Shared CSA/CSF number

Civil Service Retirement Claim (CSA/CSF) number shared by more than one annuitant/survivor.

591

OPM USE ONLY - Enrollee Dropped Due to Death/Suspend Status - PO to investigate

Enrollment is dropped due to death or because the case is in suspend status - Payroll office will investigate these and notify carrier of the termination effective date.