EXHIBIT D 01.11.18 FINAL.DOCX

EXHIBIT D
ROLES AND RESPONSIBILITIES
I. Implementation Service Parameters
A. Implementation Service Timeline Requirements
Responsibilities of Businessolver:
 A project plan for implementation services will be established based on an anticipated Go-Live date for enrollment
and eligibility services.
 This project plan is calculated from the initial planning meeting to the System Go-Live date and will
include key milestones to ensure the implementation is completed timely.
 Additional time may be required if environment specifications and requirements are not fully disclosed
during the creation of the project plan.
 Any changes to the project plan as a result of unanticipated or undisclosed information may result in an
impact on the anticipated Go-Live date, which is July 1, 2018.
Responsibilities of Maricopa County:
 Provide Businessolver with all necessary plan information based on the milestones defined in the Implementation
Project Plan. Delays in receiving this information may result in a delay to Go-Live date.
 Provide Businessolver with the following plan information two (2) weeks prior to the kick-off call:
 Benefit guides / booklets
 Carrier contacts
 New hire kit
 Benefit summaries
 Eligibility guidelines / termination rules
 SPD’s for all benefits
 Copies of current carrier bills
 Rate worksheet
 Logo & pantone colors
 Full data extract from HRIS / payroll system
 Perform the following based on the established milestones in Implementation Project Plan:
 Approve final company structure group worksheet
 Provide Businessolver with source data for System pre-population
B. Data Clean-up; Data Mapping; Data Import
Implementation import involves taking data from identified sources, cleansing it, and preparing it for import into the
Businessolver System. Data shall be provided in a format acceptable to Businessolver. Businessolver will work with
the County to resolve any discrepancies found during the process.
Responsibilities of Businessolver:
 Establish a timeline to import final data files.
 The standard process is five (5) business days before the Go-Live date. The County will provide
Businessolver with all final data that will be used to populate employee records in the System. This may
vary based on the population of employee data and complexity of the System setup.
 Business system analysts will meet with the County’s payroll/HRIS and benefits department representatives to
establish internal procedures for transmitting demographic data between the County and Businessolver.
 Provide final data formatting for System pre-population – match fields (import-system-export).
 Review import data after the data consolidation process.
 Prepare County data for the import process.
 Prepare the import configuration used to import County data into the Businessolver System and develop a data
scorecard to identify discrepancies.
 Test/verify import of data into the System against County-provided data.
 Technical staff will provide data reconciliation services for up to three (3) data sources.
Responsibilities of Maricopa County:
 Complete the implementation data checklist, which sets forth the data required for import.
 Provide import source data to Businessolver in a file format acceptable to Businessolver.
 Provide historical data to the extent it is required for Businessolver to perform a service.
 Correct/update all missing or defaulted data.
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 Review and resolve errors reported by Businessolver in relation to the import file. Error reports will be generated
after each test import is processed and when final data is imported into production.
C. System Set-up
Responsibilities of Businessolver:
 Provide the County with worksheets to identify structure set-up and to finalize the County structure worksheet.
 Set up the first draft of structure information based on what is provided in the benefits information, initial data,
and the carrier account structure information.
 Build plan structures, plan information, plan eligibility rules, and plan pricing tables. The following shall apply to
the aforementioned development:
 Businessolver will support up to one hundred (100) structure groups.
 Businessolver will support bundled plan offerings as necessary.
 Businessolver will support twenty 20 different plan type offerings.
 Configure the Businessolver System to reflect the County’s :
 Eligibility criteria
 Waiting periods
 Credit formulas
 Health and welfare benefit plans
 Employee contributions
 Carrier premiums (when applicable)
Responsibilities of Maricopa County:
 Attend conference calls and other meetings mutually agreed to by Businessolver and the County during the
implementation period.
 Businessolver will work with the County to determine the following benefits information regarding plans:
 Eligibility for specific benefit plans/options
 Waiting period and/or coverage begin/end dates
 Ability to provide enough information on initial and ongoing data to determine structure
 Payroll system breakouts and different company ‘locations’
 Employee cost/premiums
 Coverage tiers
 Billing and/or reporting needs
 Carrier account structure and file needs
 Provide account structure information for each carrier/vendor, along with sample bills, all of which must be
received before any building can occur within the System.
 Provide final approval for System set-up, which includes plan information, company structure, plan eligibility
rules, plan pricing, employee access events, employee access rights, and administrator access.
D. Businessolver Plan Type Support
Responsibilities of Businessolver:
 The Businessolver System will support the following core plan types for the County:
 Medical
 Prescription
 Behavioral Health
 Dental
 Vision
 Basic Life
 Basic AD&D
 Supplemental Life
 Supplemental AD&D
 Short Term Disability
 Health Savings Account
 Flexible Spending Account
 DC Flexible Spending Account
 Employee Assistance Program
 Group Legal
 Wellness
 Health Savings Accounts (transmissions to bank)
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E. Administrator Access
Responsibilities of Businessolver:
 Establish up to ten (10) administrator accounts and five (5) read only administrator accounts for the County.
 Together, Businessolver and the County will create an administrator access spreadsheet, which will detail who has
access to the System and the requested level of access.
 The worksheet will define authorized user access to the following functions:
 Benefits approval
 Billing invoice center
 COBRA admin-read (if applicable)
 COBRA payment admin-read (if applicable)
 Document center-read & read/write
 Add employee
 Employee edit compensation-read & read/write
 Employee edit personal, employment, dependent, elections, and beneficiary information-read &
read/write
 Export log-read
 Generate reports-custom/logs/payroll/standard
 Layout manager
 Member documents-read
 Plan info-read
 Reference center-admin & read
 Transmit file
F. Employee Self-Service Functionality
Responsibilities of Businessolver:
 Set up the employee self-service functionality to support the following types of functions:
 Initial employee enrollment
 Annual/open enrollment
 Life event and employee maintenance changes
 Post-tax life insurance enrollment changes and beneficiary updates
 Dependent verification documentation submission
 Provide first time user functionality that allows employees to establish their own unique sign-on and password.
The County will be able to reset employee passwords whenever necessary.
 As part of the set-up process, the County will be responsible for providing Businessolver with a desired sign-on
disclaimer statement, open enrollment message, initial enrollment message, and life event change messages. If the
language for this set-up is not supplied by the County four (4) weeks prior to the Go-Live date, Businessolver staff
will utilize standard system language.
 Set up the System to allow for beneficiary information collection in the employee self-service module.
Beneficiary functionality will be limited to:
 Standard beneficiary designation
 Edits to ensure that allocations total one-hundred percent (100%)
 Primary and contingent beneficiary assignment
 Beneficiary updates
 Set up the System to inform employees of elections requiring evidence of insurability. The System will instruct
employees to print required forms from the reference center, if applicable. The Businessolver System will provide
evidence of insurability reports as required.
G. Email Notification Functionality
Responsibilities of Businessolver:
 Configure the Businessolver System to provide basic automatic email notification services.
 Configure the Businessolver System to generate a basic non-custom notification to employees for the following
events:
 Open enrollment election approval/disapproval
 Initial enrollment election approval/disapproval
 Life event change approval/disapproval
 Beneficiary updates
 Dependent verification notices
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 The System-generated message will instruct employees to login to the secure message center at Businessolver for
specific/confidential information.
 Email services will only be provided when the County provides email import data for population into
Businessolver.
H. System Training
Responsibilities of Businessolver:
 Provide administrators with access to online help ("Helpsolver") from the Benefitsolver System. County may
print hard copies of help documents from Helpsolver.
 Provide a series of best practice training session and elective training sessions based on services provided to
County.
 All training sessions will take place via web conference call on the Trainingsolver system.
 During implementation, County may select from the following training modules based on the services County
purchased:
 Navigation
 Administration functions
 Tools & resources
 Advanced administration functions
 Reports
 Layout manager
 Exports
 COBRA
 Billing
 Payroll
 Once training begins, one training module will be provided each week and will take approximately one hour to
complete (over approximately ten weeks). Modules may be combined if time constraints arise.
 Ongoing web based training sessions are provided weekly and available to County upon registration.
I. Reference Center / Benefits Library
Responsibilities of Businessolver:
 Set up the reference center functionality for the County and train the County on its use.
 Reference center functionality shall include the ability to upload documents, links, forms, PowerPoint
presentations, etc. for presentation to employees and/or administrators.
J. Data Export – Vendors
Responsibilities of Businessolver:
 Review export requirements for up to twelve (12) carrier/vendor export files associated with the County’s plans.
 If desired or required by the vendors, Businessolver will provide export files in the HIPAA 834 or carrier
proprietary file format for up to twelve (12) carrier/vendor export files. If any carrier requests files be sent in a
proprietary format, this will be discussed and additional fees may apply.
 Review and accommodate carrier file formats, data, and transmission requirements.
 Review test file results with all carriers/vendors and make adjustments as necessary as well as manage the ongoing
error reporting and resolution of errors
 Test data transaction sets with carriers/vendors, which shall include the following:
 New hire test
 Data change test
 Employee termination test
 Annual enrollment test
 Review all data transmissions with the County beginning data exports within the production environment.
 Review all initial error reports from test files and make adjustments as necessary.
 Manage the ongoing error reporting process and resolve errors within Businessolver System and Businessolver’s
control related to the carriers/vendors.
 Review vendor error reports ongoing and resolve errors within Businessolver System and Businessolver’s control.
 Together, Businessolver and the County will begin data export transitions on a mutually agreed upon date.
Responsibilities of Maricopa County:
 Assist as needed in the resolution of data issues reported by carriers.
 Provide Businessolver with carrier account structure, which must be received before Businessolver can begin
building the System or setting up plans.
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K. Payroll Deduction Files
Responsibilities of Businessolver:
 Integrate with the following payroll system:
 Payroll system – ADP
 Provide a custom payroll file, at client-specified pay cycles, based on the payroll import specifications agreed
upon during the payroll module setup and testing process.
Responsibilities of Maricopa County:
 Provide a file specification document.
 Provide information regarding the following:
 Payroll frequency options
 Entering deductions into payroll system (manual/import file)
 Employee payment schedules
 Payroll schedules
 Exclusion of certain employees from sending deduction information across on payroll file
 Benefits that Businessolver should not pass a payroll deduction for
 Any changes to the payroll setup will be performed only at the request of the County.
 Review and approve the payroll system setup to ensure the accuracy of payroll reporting.
 Resolve data discrepancies highlighted in error reports.
 Work closely with Businessolver to assist in the creation of electronic interfaces necessary for appropriate
deductions associated with each employee’s elections.
 Provide an actual payroll deduction file per payroll cycle (responsibility of the payroll vendor and/or the County).
L. Billing & Financial Reporting
Responsibilities of Businessolver:
 Create a premium billing system, which will run twelve (12) times per year, with reports and extracts for complete
calendar months.*
 Create and verify summary and detail reports.
Responsibilities of Maricopa County:
 Provide information regarding the following:
 Current carriers for Self-billing
 Business organization
 COBRA participant reports (if applicable)
 Current billing/payment schedules and rules
 Location payment tracking
*Businessolver has no fiduciary responsibility for payment owed to vendor. The County is responsible for remitting all
vendor/carrier payments.
M. Fulfillment Services
Responsibilities of Businessolver:
 Set up custom document development and fulfillment in the Businessolver System.
 A final list of fulfillment documents will be determined during the implementation process.
N. Dependent Verification Services
Responsibilities of Businessolver:
 Identify the timeline for the audit with County.
 Identify parameters of the audit with County.
 Standard: To include dependents on active medical, dental, or vision coverage.
 Standard: To have members fax, upload to the site, or mail requirements to Businessolver.
 Standard: Required information must be submitted no later than 15 days from the transaction being
processed.
 Review audit guidelines, define process, determine eligibility requirements, and identify parameters of acceptable
evidence of dependent eligibility.
 Develop a letter-based employee communication program tailored to the County’s needs:
 Verification Letter – Lists the dependents being verified.
 Resubmit Letter – Notifies members when inadequate or illegible documentation has been received.
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 Confirmation – Sent when a final action is taken on the dependent, all current benefits and each
dependent’s verified dates are displayed. .
 Appeal Form –Outlines members appeal process, and members can retrieve required appeal form on the
Benefitsolver website
 Establish Service Center processes to support employees and resolve questions throughout the audit process
utilizing inbound and Service Center support and secure web-based solutions.
 Notify County of all undelivered letters.
 Store a copy of each letter in the Benefitsolver System.
Responsibilities of Maricopa County:
 Provide information regarding the following:
 Type of dependent verification service desired
 Previous Full Dependent Audits
 Addition of all new dependents
 Acceptable evidence of dependent eligibility
 Unsigned request forms/ no request form
 Due date for documentation
 Coverage types included
 Standard communication pieces
 Submitting required documentation
 Structure groups incorporated into audit
 Appeal process
 COBRA services for dependents removed during audit
O. Life Event Verification Services
Responsibilities of Businessolver:
 Identify parameters of the audit with Customer. Below are Businessolver’s standard practices. The parties agree
during Implementation to work together to mutually agree to procedures for Maricopa County.
 Standard: To include for Marriage, Divorce, Death, Dependent Gains Other Coverage, Dependent
Loses Other Coverage, and Birth.
 Standard: To have members fax, upload to the site, or mail requirements to Businessolver.
 Standard: Required information must be submitted no later than 15 days from the transaction being
processed.
 Define process, determine proof requirements, and identify parameters of acceptable evidence of proof.
 Develop a letter-based employee communication program tailored to the Customer’s needs and corporate culture:
 Life Event Letter – Lists the acceptable proof.
 Resubmit Letter – Notifies members when inadequate or illegible documentation has been received.
 Confirmation – Sent when a final action is taken on the dependent, all current benefits and each
dependent’s verified dates are displayed. .
 Appeal Form –Outlines members appeal process, and members can retrieve required appeal form on the
Benefitsolver website
 Establish Service Center processes to support employees and resolve questions throughout the audit process
utilizing inbound and Service Center support and secure web-based solutions.
 Notify Customer of all undelivered letters.
 Store a copy of each letter in the Benefitsolver system.
Responsibilities of Maricopa County:
 Provide information regarding the following:
 Acceptable proof for life event verification
 Unsigned request forms/ no request form
 Due date for documentation
 Transaction types included
 Standard communication pieces
P. ACA (Affordable Care Act) Status Tracking Services
Businessolver configures and updates ACA Status Tracking Services at the County’s direction. The County is
responsible for all compliance requirements. Businessolver provides ACA status tracking tools and information which
may be used by the County to assist with reporting and compliance needs. However, Businessolver is not responsible
for ensuring the accuracy, completeness, or final compliance of the County with respect to Employer Shared
Responsibility Final Regulations (79 FR 8543), or other applicable laws and regulations.
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Responsibilities of Businessolver
 Configure the Businessolver System to automatically update the member’s eligibility based on calculated status
Responsibilities of Maricopa County
 Provide all necessary ACA tracking rule defined measurement periods
Q. COBRA Implementation and Set-up
Responsibilities of Businessolver
 Businessolver will establish a process to collect premiums from COBRA participants, deposit those premiums,
and remit the applicable portion of those premiums to the County.
 Businessolver staff will provide the County with takeover documentation. The required documentation will
include plan rates, plan information, current continues, and Pending Qualified Beneficiaries ("PQB’s").
 Businessolver staff will set up the COBRA module on the Businessolver application. Set-up activities will
include:
 Plan Set-up
 Rate Set-up
 Eligibility Group Set-up
 COBRA Rules/Parameters Set-up
 COBRA customer service call center
 Initial and election notices
R. Implementation Milestones
Based upon a Benefitsolver system Go-Live date of July 1, 2018, for Country, the parties agree to the following
milestones related to the Implementation process. The parties further agree a detailed Project Plan, includes the below
set forth milestones will mutually be developed to describe each parties respective deliverables and responsibilities
related to the Implementation, including the configuration of the Benefitsolver system. In the event the Go-Live data is
altered, the parties agree to revise the below milestones in accordance with the adjusted Go-Live date.
 01.31.18 County shall provide to Businessolver all raw materials requested necessary to kick-off the
Implementation project, including carrier/vendor account structure(s)
 02.14.18 The Parties shall complete necessary discovery workshops and Project Plan.
 03.15.18 The Parties shall complete inbound and outbound data file specification for each carrier/vendor.
 04.16.18 Businessolver shall have completed the carrier/vendor test files
 05.01.18 The Parties shall begin validation workshops
 06.01.18 Benefitsolver end to end testing shall begin
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II. Ongoing Services
Businessolver and the County shall continue to maintain service selections by mutual agreement, as recorded below and in the
County Concept of Operations and the Project Plan. A copy of each, with updates, shall be available at all times to the County
upon reasonable request. Any changes shall not modify or have precedence over the terms of the Contract, unless expressly
agreed to, in writing, and signed by both parties.
A. Data Export Services
Responsibilities of Businessolver:
 Provide weekly eligibility file updates from the Businessolver System to the following vendors/providers*:
 Cigna – Medical, Dental
 UHC – Medical
 OptumRx – Prescription
 Delta Dental – Dental
 EyeMed – Vision
 Discovery – FSA
 Securian– Life Insurance
 Hyatt – Group Legal
 Magellan Health Services – Behavioral Health
 Sedgwick – Short-Term Disability
 StayWell – Wellness
 Optum Bank (for health savings accounts)
 Provide an ongoing carrier integration with available web services listed below:
 TBD – Voluntary Life
 Applicable Terms:
 All weekly file transactions are reviewed daily to ensure that the files are successfully transmitted.
 All errors identified during file transmission are updated on the export dashboard daily to reflect resolution
and/or the process for addressing the error.
 All files scheduled to run on any business day are sent before end of business that same day.*
*Businessolver cannot guarantee the quality of file exports when changes or modifications to file formats or
data values occur without prior notification from the carrier and/or client.
B. Ongoing Data Import Services
Responsibilities of Businessolver:
 Load ongoing census files to Businessolver via the online transmit file interface or through FTP.
 Files imported in this manner will result in a processing report for the County’s review, which identifies the
number of additions, changes, deletions and any errors that occurred during the file import process.
 Required fields not provided by the County will be defaulted where feasible.
 Inform the County of import modifications that fall outside of Businessolver standard services. Businessolver will
inform the County of any additional programming costs.
 Establish ongoing imports from the following the County’s system(s):
 County – Ongoing Census
Responsibilities of Maricopa County:
 Provide a weekly or bi-weekly Census file to Businessolver
 Define desired import parameters, import format, and import frequency based on the existing County data.
 Review/update all missing or defaulted data.
 Review and resolve errors reported by Businessolver in relation to the import file. Every time an import is
performed, the Businessolver System will generate an error log and a change log.
C. System Training
Responsibilities of Businessolver:
 Provide one of the following training modules each week via web training sessions:
 Navigation
 Administration functions
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 Tools & resources
 Advanced administration functions
 Reports
 Layout manager
 Exports
 COBRA
 Billing
 Payroll
 Training modules will take approximately one hour per module and will take place via web conference call on the
Trainingsolver system.
D. Payroll File Processing
Responsibilities of Businessolver:
 Review, on a daily basis, all payroll file runs to ensure that the files are successfully processed.
 Update, on a daily basis, all errors identified during file transmission on the payroll dashboard to reflect resolution
and/or the process for addressing the error.
 Send all files scheduled to run on any business day before end of business that same day.*
*Businessolver cannot guarantee the quality of payroll file run times when changes or modifications to file
formats or data values occur without prior notification from the County or payroll provider.
E. Payroll Comparison Services
Payroll Comparison Services are provided to assist the County with identifying potential conflicts between deductions
generated by Businessolver and deductions applied through the County’s payroll system. The County is responsible for
identifying and determining the cause for conflicts and taking appropriate steps to resolve any such conflicts.
Businessolver’s Payroll Comparison Services are not intended to be used as the sole tool for identifying or determining
payroll deduction conflicts and the County recognizes when using these services other payroll errors or conflicts may
still exist that cannot be reasonably identified or determined solely by using Businessolver’s Payroll Comparison
Services.
Payroll Compare:
Responsibilities of Businessolver:
 Create a payroll configuration file to allow for a payroll comparison to be performed
 Provide training to the County on the process for loading the payroll deduction file
 Generate a comparison file through the Businessolver System which lists out discrepancies / mismatches between
deductions sent on Businessolver’s payroll file and deductions taken by the County’s payroll system
 Review the comparison file with the County
Responsibilities of Maricopa County
 Generate a full deduction file from the County’s payroll system
 Load deduction file to the Businessolver payroll comparison module
 Review the comparison file and resolve conflicts that are identified
Closed Loop Payroll:
Responsibilities of Businessolver:
 Establish a process to apply adjustments provided by the County to the following deduction file
 Assist the County with ongoing responsibilities and timeline for loading the deduction file to the Businessolver
System
Responsibilities of Maricopa County
 Review and identify any adjustments that are appropriate
 Provide the adjustments back to Businessolver timely
F. Account Management
Responsibilities of Businessolver:
 Provide service assistance to the County on the following issues, from 7:00am to 6:00 pm MST:
 System training and support services
 System troubleshooting assistance and support
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 Support Administrator set-up and maintenance support
 Assistance with the review of export reports on an ongoing basis
Responsibilities of Maricopa County:
 Appoint a designated support contact person(s) (up to a total of ten persons) for purposes of contacting
Businessolver regarding Maintenance and Support issues, including reporting technical support issues via phone,
email, or through the case manager tool.
G. System Reporting
Responsibilities of Businessolver:
 Set up scheduled reports, or the County may obtain reports as needed, through the Businessolver website.
 Set up the standard reporting module for the County. The standard module includes the following report types:
 Employee Census Benefit Report
 Employee Census Report
 Submitted Changes Report
 Dependent Census Benefit Report
 Employee Directory Report
 EEO-1 Report
 New Hire Report
 Employee Termination Report
 Payroll Deduction Changes Report
 Minimum/Maximum Student Age Report
 Open Enrollment Status Report
 Address Change Report
 Beneficiary Designation Report
 Demographic Change Report
 Payroll Deduction Audit Report
 Evidence of Insurability Report
 Initial Enrollment Status Report
 Employment Change
H. Security, Data encryption, System availability
Responsibilities of Businessolver:
 Businessolver uses a combination of firewalls, data encryption, physical data protection, database activity logging
and application-level security to provide a secure data enrollment.
 Businessolver uses 128-bit secure socket layer (SSL) technology and digital certificates to encrypt and
authenticate transactions.
 Businessolver System availability:
 The Businessolver System will be available no less than 99.5% of the time per month excluding
unavailability due to exclusions to the definition of server downtime (as defined below)
 Server downtime means any interruption of ten (10) minutes or more in the availability of the
Businessolver System; provided, however, that server downtime shall not include time that is
attributable to:
o The County’s breach of its material obligations under the Agreement, which breach causes the
server or site to be unavailable;
o Failure or malfunction of any County- provided equipment or service;
o Other mutually agreed to pre-scheduled System down-time; and
o Scheduled System maintenance down-time.
i. Scheduled System maintenance down-time shall mean any interruption in the availability
of the System due to System maintenance scheduled more than 48 hours prior to the
disruption of service.
ii. Scheduled System maintenance will not exceed 6 hours per month and will occur between
the hours of 12:00 a.m. and 4:00 a.m.
 Businessolver will provide the primary County contact with at least 48 hour notice of scheduled System
downtime.
I. Billing and Financial Reporting
Responsibilities of Businessolver:
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 Develop monthly billing statements for all locations and at least one main consolidated billing statement. The
following types of bills will be generated:
 Location Detail - consists of a structure group or combination of structure groups and shows all
employees and the applicable coverages for all benefits. This is generally used to represent what each
location is responsible for "paying" related to the monthly benefits.
 Location Summary - summarizes the Location Detail and reflects the actual benefits costs/premiums.
 Organization Summary - is a consolidation of each location and reflects the cumulative total benefit
costs/premiums for all locations.
 Vendor Detail - is a "list bill" by vendor for all applicable charges for the billing period.
 Vendor Summary - is a summary by vendor for the specific amount owed to the vendor.
 On a monthly basis, apply debits and credits to bills based upon vendor rules.
 Provide final invoices and any changes or adjustments that are identified will be captured on the next month’s
cycle.
*Businessolver has no fiduciary responsibility for payment owed to vendor. The County is responsible for
remitting all vendor/carrier payments.
J. Fulfillment Services
Responsibilities of Businessolver:
 Provide fulfillment services as outlined during the initial set-up and implementation.
K. Ongoing Dependent Verification Service
Responsibilities of Businessolver:
 Ongoing Dependent Verification Service – Documentation Submission and Verification Process
 Confirmations and Assumptions: Businessolver will identify parameters of acceptable documentation
with the County during Implementation and the parties will work to establish mutually agreed to
procedures for dependent verification for County. Unless otherwise agreed to by the parties during
Implementation, listed below are Businessolver’s standard set of acceptable document verification
standards and processes:
o Any time a new dependent is added to medical, dental, or vision coverage, the entire
transaction will pend, and the initial verification letter will generate. These are mailed to the
member and eligibility documentation requirements are outlined.
o Businessolver will identify parameters of acceptable documentation with the County. Listed
below are Businessolver’s standard set of acceptable document verification standards.
Standard Services
Dependent Group Name Dependent Proof List
Spouse Marriage Certificate
Official Court Documentation
Common Law Spouse Affidavit
and/or Current Tax Return
(with Dependent Listed)
Dependent Child Adoption Certificate
Legal Guardianship Documentation
Birth Certificate
and/or Current Tax Return
(with Dependent Listed)
Step Dependent Child Adoption Certificate
Legal Guardianship Documentation
Birth Certificate
and/or Current Tax Return
(with Dependent Listed)
o Pending the receipt of the required information, no new information will be sent to the carrier
until the pending transaction is approved. For new hire status employees, this means no
information about the member or dependents will be sent to the carrier(s) until all dependent
documentation is received, applied, and the transaction is approved.
o The required documentation for such changes would be sent by the member to Businessolver
either by fax, mail, or utilizing the document upload feature in Businessolver system. Upon
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receipt of documentation, Businessolver staff will load the documents to the member’s System
record.
o Documentation is typically required to be submitted within (15) days of the transaction.
o Once all required documentation is received, Businessolver staff will approve the pending
transaction and enter a verified date on the dependent’s record.
o If documentation is received but does not meet the verification requirements, a resubmit letter
will be provided to the member advising them that additional documentation is required.
o If partial documentation is submitted to Businessolver by a member, Businessolver staff will
approve the transaction on any members and dependents that provided the required
verification documentation.
o If documentation is not provided within the allowed timeframe, Businessolver staff will deny
the transaction unless the member is adding coverage for the first time, for example, new hire.
o Provide services to County employees through the Businessolver Dependent Verification
customer service call center.
L. Life Event Verification Services
 Ongoing Life Event Verification Service - Affidavit Submission and Verification Process
 Confirmations and Assumptions: Businessolver will identify parameters of acceptable documentation
with the County during Implementation and the parties will work to establish mutually agreed to
procedures for life event verification for County. Unless otherwise agreed to by the parties during
Implementation, listed below are Businessolver’s standard set of acceptable document verification
standards.
o Any time a life event transaction is processed (as defined below) the entire transaction will
pend, and the life event letter will generate. These are mailed to the member and acceptable
proof requirements are outlined.
o Businessolver will identify parameters of acceptable documentation with the County. Listed
below are Businessolver’s standard set of acceptable proof.
Standard Services
Life Event Acceptable Proof
Marriage Copy of Marriage certificate
Copy of Divorce Decree or court documentation showing legal
Divorce
separation or annulment; Documentation must include the finalized date.
Death Copy of the death certificate.
Letter from dependent’s employer that indicates the gain of coverage;
Dependent Gains
must include the dependent’s name and date they gained coverage.
Letter from dependent’s employer that indicates the loss of coverage;
Dependent Loses
must include the dependent’s name and date they lost coverage.
Copy of birth certificate, hospital documentation reflecting child’s birth,
Birth
or adoption certificate.
o Pending the receipt of the required information, no new information will be sent to the carrier
until the pending transaction is approved. The required proof for such changes would be sent
by the member to Businessolver either by fax, mail, or utilizing the document upload feature
in Benefitsolver. Upon receipt of documentation, Businessolver staff will load the documents
to the member’s System record.
o Proof is typically required to be submitted within (15) days of the transaction.
o Once all required proof is received, Businessolver staff will approve the pending transaction.
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o If proof is received but does not meet the verification requirements, a resubmit letter will be
provided to the member advising them that additional documentation is required.
o If proof is not provided within the allowed timeframe, Businessolver staff will deny the
transaction.
M. QMCSO Administration
Responsibilities of Businessolver:
 Receive QMCSO Setup requests
 Identify the applicable dependents and update the relationship within the System to reflect the “Court Ordered”
status restricting changes from being made to the member unless processed by an administrator
 Allow members to upload and submit applicable documentation through the case management tool for review by
the County’s administrators
N. Evidence of Insurability Verification Service
Responsibilities of Businessolver:
 Determine a process with the County for ongoing EOI processing and agreed upon coverages.
 Set up review procedures based on the County’s and carrier/vendor requirements.
 Update the System via single sign-on with life insurance vendor, Securian, to reflect the EOI status from the
vendor within the Businessolver System.
 Return members to prior election status if EOI is unapproved.
O. Dependent Max Age Service
Responsibilities of Businessolver
 Remove dependents who have reached maximum age of eligibility from applicable coverage
Offer COBRA coverage to members who no longer have eligibility due to maximum age
Responsibilities of Maricopa County
 Provide Businessolver with all necessary plan rules of maximum age of eligibility for all group plans
P. ACA (Affordable Care Act) Status Tracking Services
Responsibilities of Businessolver
 Collect employee hours weekly from the County
 Calculate eligibility based on ACA full-time employee identification rules as established by the Employer Shared
Responsibility Final Regulations (79 FR 8543), and defined measurement periods elected by the County
 Identify employee ACA status as full time vs. part time based on current definitions outlined by legislation and
guidelines issued by government agencies (e.g. IRS, Dept. of Revenue, Dept. of Health and Human Services) as
well as the County’s defined measurement periods and employee classifications
 Notify the member of new eligibility status through fulfillment as elected and requested by the County. Electronic
or print version available. (Additional postage fees will apply)
Responsibilities of Maricopa County
 Provide Businessolver with ongoing employee hours tracking data*
 Provide Businessolver with eligibility data related to transfers and stability periods
 Provide Businessolver with protected leave and rehire data
 Notify Businessolver of any changes to ACA tracking rule defined measurement periods
 Notify Businessolver of ongoing employee hours tracking data changes
* Monthly charges and fees may apply for all months in the measuring period if service is implemented within a
measuring cycle.
*All data required for provision of any ACA Services shall be provided to Businessolver in Businessolver’s standard
data and file format.
Q. 6055 and 6056 Compliance (Data Storage to meet Form 1095-C Reporting Requirements)
Information necessary for the County to complete IRS Form 1095-C: Employer-Provided Health Insurance Offer and
Coverage. The Reporting Only option is available regardless of whether the County is utilizing any other ACA service
Responsibilities of Businessolver
 Businessolver will provide monthly storage of the data fields identifying offer of health coverage to employees
and enrollment for all covered individuals
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 Businessolver will provide a standard extract file for data management.
Responsibilities of Maricopa County
 Inform Businessolver which IRS form to use for each structure group (or employee population subgroup)
 Provide Businessolver with any undetermined offer and Safe Harbor codes (e.g. information requested on lines 14
and 16 of IRS Form 1095-C)
 Provide Businessolver all necessary SSNs and/or TIN for covered individuals
 Provide Businessolver quarterly confirmation(s) of all information, including offer and Safe Harbor codes (e.g.
information requested on lines 14 and 16 of IRS Form 1095-C)
 Provide Businessolver annual certification(s) of accuracy of all information, including offer and Safe Harbor
codes, no later than October 15 of the reporting year
 Provide Businessolver all required confirmations and certification of data accuracy for 4th quarter changes only by
December 7 of the reporting tax year
* For covered individuals, other than the employees listed in Part I, a Taxpayer Identification Number (TIN) may be
provided instead of an SSN. If Businessolver is not provided the employee’s SSN and/or the SSNs of all covered
individuals by the County, the IRS may not be able to match the Form 1095-C to determine that the employee and the
other covered individuals have complied with the individual shared responsibility provision.
*Charges and fees will apply for all 12 months of a single calendar/reporting year, regardless of actual
implementation date.
*All data required for provision of any ACA Services shall be provided to Businessolver in Businessolver’s standard
data and file format.
Q.1. 1095-C Employer Fulfillment (only available if contracted for Service under 6055/6056 Compliance (Data
Storage to meet Form 1095-C Reporting Requirements))
Responsibilities of Businessolver
 Businessolver will use the data stored and confirmed to generate IRS Form 1095-C
 Final output from Businessolver may be provided either via data file to the County or completed Form
1095-C to employee
 Businessolver will provide Form 1095-C to the address of record of the employee/participant, or via
electronic delivery to employee/participant as elected by employee
Responsibilities of Maricopa County
 Inform Businessolver which IRS form to use for each structure group (or employee population
subgroup)
 Provide Businessolver with any undetermined offer and Safe Harbor codes (e.g. information requested
on lines 14 and 16 of IRS Form 1095-C)
 Provide Businessolver all necessary SSNs and/or TIN for covered individuals
 Provide Businessolver quarterly confirmation(s) of all information, including offer and Safe Harbor
codes (e.g. information requested on lines 14 and 16 of IRS Form 1095-C)
 Provide Businessolver annual certification(s) of accuracy of all information, including offer and Safe
Harbor codes, no later than October 15 of the reporting year
 Provide Businessolver all required confirmations and certification of data accuracy for 4th quarter
changes only by December 7 of the reporting tax year
*Employers are required to furnish Form 1095-C only to the employee. As the recipient of Form 1095-C, the
employee is responsible for providing a copy to any family members covered under a self-insured employer-
sponsored plan listed in Part III of the form if they request it for their records.
* Electronic delivery option is only available for employees who consent to the specific electronic opt-in as
defined by IRS regulations.
*Included in the 1095-C Fulfillment pricing is ongoing storage of an electronic (PDF) file of all produced
1095-C forms, regardless of whether the employee received his/her copy electronically or by mail. The PDF
will be attached to the employee record for ongoing future reference.
Q.2. 1094-C Transmittal (Transmitting/Filing Data with IRS)
1094-C Transmittal includes filing of 1095-C data for all employees and dependents to the IRS via electronic
filing format (pending final guidance issued by the IRS).
Responsibilities of Businessolver
 Businessolver will submit 1094-C and 1095-C data for all employees and dependents via the IRS
prescribed electronic filing format
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*A health coverage provider that is required to file 250 or more Forms 1095-B or 250 or more Forms 1095-
C during the calendar year must file the returns electronically. The 250 return threshold applies separately to
each type of return required to be filed. Only Forms 1095-B or 1095-C are counted in applying the 250
return threshold for section 6055 reporting
Responsibilities of Maricopa County
 Inform Businessolver which IRS form to use for each structure group (or employee population
subgroup)
 Provide Businessolver with any undetermined offer and Safe Harbor codes (e.g. information requested
on lines 14 and 16 of IRS Form 1095-C)
 Provide Businessolver all necessary SSNs and/or TIN for covered individuals
 Provide Businessolver quarterly confirmation(s) of all information, including offer and Safe Harbor
codes (e.g. information requested on lines 14 and 16 of IRS Form 1095-C)
 Provide Businessolver annual certification(s) of accuracy of all information, including offer and Safe
Harbor codes, no later than October 15 of the reporting year
 Provide Businessolver all required confirmations and certification of data accuracy for 4th quarter
changes only by December 7 of the reporting tax year
* For a given Applicable Large Employer (ALE), the IRS may require each FEIN to transmit on a separate
file. (Please see your tax advisor or tax attorney to multiple FEIN determination based on your legal tax
structure).
* Fee charged per successful data transmission. Additional fees may apply in the event a “corrected” file is
required as a result of employer data errors.
* 1094-C Transmittal assumes multiple FEIN’s may be submitted on one transmission. If IRS requirements
vary, additional fees may apply.
R. COBRA Ongoing Administration Services
Responsibilities of Businessolver
 Compliance Services
 Businessolver staff will provide timely updates to COBRA documentation and processes as
legal/legislative updates occur.
 Businessolver staff will notify and/or provide communication to the County as changes to COBRA
documentation and/or processes occur.
 Businessolver staff will provide electronic archival of COBRA election history and payment history.
 COBRA Participant Services
 Businessolver staff will develop and mail (via first class postage) participants’ termination/conversion
notices as required.
 Businessolver staff will mail short payment reminders to participants as necessary.
 Businessolver will provide a toll-free COBRA customer service number. Customer service shall be
provided from 7:00 a.m. to 7:00 p.m. Mountain Standard Time.
 Businessolver staff will monitor and manage the following COBRA timelines that are required by
statute:
o 60 day election window for COBRA Qualified Beneficiaries.
o 45 day payment grace period for initial QB payment.
o 30 day grace period required for monthly payment submission.
o 18, 29, or 36 month COBRA eligibility periods.
o USERRA 24 month Health Benefit Continuation eligibility period.
S. COBRA Accounting and Account Management Services
Responsibilities of Businessolver
 Businessolver staff will manage short payments as directed by the County and NSF payments provided by
COBRA participants.
 Businessolver staff will process COBRA payment receivables and will deposit payments.
 Businessolver will apply subsidies from the retirement system to COBRA premiums
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T. COBRA Web-based Services
Responsibilities of Businessolver
 Businessolver will provide the County with the following web-based access:
 Access to view QB and PQB correspondence/documentation.
 Access to view the status and payment history of QB’s.
 Access to view QB elections and election history.
 Access to COBRA reports.
U. COBRA Initial Rights Services
Responsibilities of Businessolver
 Businessolver staff will provide new plan participants, including new employees, acquisition employees, and new
companies/groups entering the plans, with an initial COBRA rights notice. The notice will be mailed via first class
postage.
 Businessolver staff will provide a separate initial rights notice to dependents if a second address is provided that is
different from the employee’s home address. This notice will be mailed via first class postage.
 Businessolver staff will track any returned and/or undeliverable initial rights notices. Furthermore, Businessolver
will mail an additional initial rights notice if an updated address is provided.
V. COBRA Qualifying Event Services
Responsibilities of Businessolver
 Businessolver staff will assemble and mail (via first class postage), within the time limits required by statute,
Qualifying Event ("QE") paperwork to PQB’s.
 Businessolver staff will mail (via first class postage) separate qualifying event documentation to dependents if a
second address is provided that is different from the employee’s home address.
 Businessolver staff will track any returned or undeliverable QE packages. Furthermore, Businessolver will mail
an additional QE package if an updated address is provided.
 Businessolver staff will process all valid elections received from participants desiring COBRA coverage as well as
the associated payments.
 Businessolver staff will provide annual payment coupon sheets to QB’s who elect COBRA coverage.
 Businessolver will handle first level COBRA appeals, and refer second level COBRA appeals to the County for
decision
W. COBRA Open Enrollment Services
Responsibilities of Businessolver
 Businessolver staff will facilitate the production, assembly, and fulfillment of open enrollment kits for
COBRA participants.
 Businessolver will provide electronic enrollment services for QB’s during the open/annual enrollment
period.
 Businessolver will provide additional open enrollment materials and information to QB’s such as rate
change notices, new payment coupons, and open enrollment alerts/communiqués.
X. COBRA Takeover Services (Included in COBRA fees)
Responsibilities of Businessolver
 Businessolver staff will facilitate the production, assembly, and fulfillment of takeover letters for COBRA
participants.
 Businessolver staff will develop and send a notice of takeover letter to current Qualified Beneficiaries ("QB’s").
 Businessolver will provide additional takeover materials and information to QB’s such as rate change notices, new
payment coupons, and alerts/communiqués.
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