There are multiple ways to generate the Health (Medical) Enrollment form (HBD-12) for an employee in CHRS:

On the On Demand Event Maintenance > CSU On-Demand page or,

On the Health Benefits > CSU Hlth Perm Evt page or,

Via mass print (batch) processing.

The Medical enrollment form has a batch process in CHRS to print multiple enrollments, changes and cancellations for a specified coverage election date range (the date that coverage is finalized-enrolled into CHRS), business unit and Ben Admin Schedule ID.

Note that a permitting event code(s) is required with a Benefit enrollment, change and cancellation transaction in order to generate a Medical enrollment form. Medical enrollment forms are not generated when the employee has not enrolled in a medical plan. Waive rows with permitting event codes 600 and 610 do not generate Medical Enrollment forms.

Medical permitting event codes are entered via nightly process CSU_PERM_INS for eBenefits ESS enrollments. Medical permitting event codes are entered manually via the On Demand Event Maintenance > CSU Perm Event page and the Health Benefits > CSU Hlth Perm Evt page.

A medical enrollment form generates for each permitting event code/change made on an enrollment/dis-enrollment. If a benefits transaction has more than one permitting event code, ‘Form X of X prints at the top of each form (for example, Form 1 of 2, Form 2 of 2). The last form generated lists all enrolled dependents and the subscriber (employee).

Forms print using a permitting event code order: If applicable, the form with permitting event code 101 prints first, then, if applicable, 206, then if applicable 203, then if applicable 201, then if applicable 215, then if applicable 216, then if applicable 320, then if applicable 400 (the form for perm event code 400 is always the last code when there are multiple perm event codes are in the transaction). If the permitting event code is not one of the above listed permitting event codes, the print order starts with the perm event code at the top of the stack.

Below are example scenarios where multiple permitting events can occur that require multiple enrollment forms:

Scenario 1: An employee uses the EGC (Employee Gains Coverage) or the DGC event class (Dependent Gains Coverage) in CHRS Self-service and drops their spouse/DP and child, step child, etc. for Plan Type 11 (Dental) – this should results in two perm event codes for insertion: 23 and 24 – and each perm event code requires a separate dental form.

Scenario 2: OE – For Plan Type 10 (Medical) and Plan Type 11 (Dental), an employee adds dependents, deletes dependents and changes the benefit plan. This should result in three permitting event codes being inserted (206, 320, 400) and three separate forms for Medical and two permitting event codes being inserted and two separate forms for Dental (28, 15). Note: if the employee changes plans and adds a dependent but does not delete a dependent from the plan, permitting event code 28a can only be used for the Dental form.

BAS Events Where Medical and/or Dental Are Configured for Multiple Permitting Events

Note: Change Control 1127 is approved and submitted to modify the CHRS PSR interface to only send one permitting event code per plan type and permitting event code effective date at a time for Medical plans (Plan Type 10). Until this modification is in place there is a PSR Interface workaround for v9.0 and for v9.2. Refer to the PSR Interface 9.0 and 9.2 Business Process for workaround details.

Note: The nightly CHRS CSU_PERM_INS process (part of the GRP 74 solution) inserts all applicable permitting events for a BAS event and plan type if a permitting event code has not been entered for a plan type and employee for submitted BAS events. The nightly CHRS CSU_PERM_INS process will mainly determine and insert permitting event codes for Benefit transactions submitted via eBenefits Employee Self Service. The CHRS CSU_PERM_INS process generates a report listing the permitting event codes inserted by employee and plan type. As part of their daily CSUBAS auditing, campus Benefits Office staff will print out the CSU_PERM_INS process reports and then, via the On Demand Event Maintenance page, if multiple permitting events exists for one plan type and permitting event date, delete the permitting event codes per plan type and permitting event date until one permitting event code exists for the plan type and date, run the daily PSR interface process, then the next business day re-insert the deleted permitting event code and run the daily PSR interface as part of the 9.2 PSR Interface Workaround. Refer to the PSR Interface 9.2 Business Process and Auditing CSUBAS DL Business Process for details.

Note that if the employee waives Medical and was never enrolled in Medical, a Medical Enrollment form does not print.

If changing the Relationship to Employee from a Spouse or Domestic Partner to an ex-spouse or ex-domestic partner, make the change after you have removed the employee from benefit plans, and make the change effective-dated one day after the coverage change effective date so the correct Relationship to Employee value prints on the Medical enrollment form. Note that means that, for the dependent, you won’t have the correct Marital Status Effective Date for the marital status change, but you will have this information on the employee’s Marital Status in the Modify a Person page.

Important: Make sure that you have updated the employee’s Marital Status if applicable before you generate forms, especially if the form contains employee’s Marital Status. Remember that employees are not able to update their Marital Status in Benefits Employee Self Service in CHRS Release 1.

What Not to Do

• Do not skip doing the correct work around process on this document.
• Do not skip enrolling the employee and his/her dependents into Benefits in PeopleSoft and instead call CalPERS with the enrollment information.

1. Go to the On Demand Event Maintenance page (click on the NavBar Icon

, then click on Menu > Benefits > Manage Automated Enrollment > Events > On Demand Event Maintenance).

1. Enter the EMPLID and then click on the Search button.
2. Click on the CSU On Demand Printing tab to generate Medical, Dental, Flex Cash and HCRA/DCRA enrollment forms for the BAS event that you just processed or the last processed BAS event. Make sure to disable your browser pop-up blocker in order to print enrollment forms on demand.

For Medical forms:

• Click the Print button to generate the form in PDF in a new window.
• Print the form from the PDF menu that appears at the bottom of the PDF document.

1. Go to the Health Benefits page (click on the NavBar Icon

, then click on Menu > Benefits > Enroll in Benefits > Health Benefits) and position on the Medical plan.

1. Position on the applicable enrollment row, then click on the CSU Health Perm Evnt tab.
2. The CSU Health Perm Evnt page appears.

1. Click on the Print button.

1. Generate Medical enrollment forms after finalizing employee enrollments into Ben Admin. Click on the NavBar Icon

, then click on Menu > Benefits > Reports > CSU Benefits Forms > CSU Medical Form Batch.

1. Enter an existing Run Control ID and then click on the Search button. If you do not have a Run Control ID, click on Add a New Value and create one, and then and then click on the Search button. A Run Control ID can have up to 30 characters but cannot have any spaces.

1. Enter the Business Unit, Sched ID and the Coverage Election Date Range in the From Date and Thru Date fields. The Coverage Election Date is the date that the enrollment was finalized-enrolled in Ben Admin (the Coverage Election Date is not the coverage begin date). Note that the From Date and Thru Date fields can equal the same date. Also note that there is no limit as to how many times you can reprint a form.
   
   Note that you are unable to generate and print medical enrollment forms in batch for an OE Schedule ID until OE2025 occurs. You can, however, generate and print medical enrollment forms for an OE BAS event for an employee using the On Demand Event Maintenance > CSU On Demand Printing page and the Health Benefits > CSU Hlth Perm Event page.

1. Click on the Run button.
2. Click on the OK button.

1. From the Run Control page, click on the Process Monitor link to view the processing status of your job. Click on the Refresh button periodically to refresh the page. When your job says Success or Error processing is completed.
2. Click on the Process Monitor link to view the processing status of your job. Click on the Refresh button periodically to refresh the page. When your job says Success or Error processing is completed.
   1. If the job says Error, click on the Details link, then View Log/Trace, and then click on the .log link to see the error message. Report the error message to your campus technical resource.
   2. If the job says Success, click on the Go back to CSU Medical Form Batch link.

1. Click on the Report Manager link. FYI, if no batch forms generate, nothing writes to Report Manager.
2. On the List page, click on the CSU_BN_HBD12… link.

1. The Report page appears. Click on the CSU_BN_HBD12.log to see/print/save a list of employees with generated medical forms. Click on the Health Benefits Plan Enrollment (HBD12).pdf link to see/print/save the generated forms.

• Note that one form generates listing all changes for Medical. A change control request is submitted to modify the process to generate one form for each change/permitting event code.
• Review the CSU_BN_HBD12.log to see the employee IDs that generated forms. This log lists forms that populate with ‘eSignature’ and the eSignature date noting benefit enrollments that occurred in the CHRS eBenefits ESS. ‘Signature On File’ indicates that the enrollment/enrollment changes were processed via the On Demand Event Maintenance page and not via CHRS eBenefits ESS.

There are multiple ways to generate the Dental Enrollment form for an employee in CHRS:

On the On Demand Event Maintenance > CSU On-Demand page or,

On the Health Benefits > CSU Hlth Perm Evt page or,

Via mass print (batch) processing.

The Dental enrollment form has a batch process in CHRS to print multiple enrollments, changes and cancellations for a specified coverage election date range (the date that coverage is finalized-enrolled into CHRS), business unit and Ben Admin Schedule ID.

Dental permitting event codes are entered via nightly process CSU_PERM_INS for eBenefits ESS enrollments. Dental permitting event codes are entered manually via the On Demand Event Maintenance > CSU Perm Event page and the Health Benefits > CSU Hlth Perm Evt page.

Note that a permitting event code(s) is required with a Benefit enrollment, change and cancellation transaction in order to generate a Dental enrollment form. Dental enrollment forms are not generated when the employee has not enrolled in a dental plan. Waive rows with permitting event codes 60 and 61 do not generate Dental Enrollment forms.

A dental enrollment form generates for each permitting event code/change made on an enrollment/dis-enrollment. If a benefits transaction has more than one permitting event code, ‘Form X of X prints at the top of each form (for example, Form 1 of 2, Form 2 of 2). The last form generated lists all enrolled dependents and the subscriber (employee).

1. Forms print using a permitting event code order: If applicable, the form with permitting event code 24 prints first, then if applicable 15, then if applicable 28 (perm event code 28 is always the last code when multiple perm event codes are in the transaction). If the permitting event code is 17 or a 18 and a 16 is also used, the 17 or 18 prints first. If the permitting event code is not one of the above listed permitting event codes, the print order starts with the perm event code at the top of the stack.

Below are example scenarios where multiple permitting events can occur that require multiple enrollment forms:

Scenario 1: An employee uses the EGC (Employee Gains Coverage) or the DGC event class (Dependent Gains Coverage) in CHRS Self-service and drops their spouse/DP and child, step child, etc. for Plan Type 11 (Dental) – this should results in two perm event codes for insertion: 23 and 24 – and each perm event code requires a separate dental form.

Scenario 2: OE – For Plan Type 10 (Medical) and Plan Type 11 (Dental), an employee adds dependents, deletes dependents and changes the benefit plan. This should result in three permitting event codes being inserted (206, 320, 400) and three separate forms for Medical and two permitting event codes being inserted and two separate forms for Dental (28, 15). Note: if the employee changes plans and adds a dependent but does not delete a dependent from the plan, permitting event code 28a only can be used for the Dental form.

BAS Events Where Medical and/or Dental Are Configured for Multiple Permitting Events

Note that if the employee waives Dental and was never enrolled in Dental, a Dental Enrollment form does not print.

If changing the Relationship to Employee from a Spouse or Domestic Partner to an ex-spouse or ex-domestic partner, make the change after you have removed the employee from benefit plans, and make the change effective-dated one day after the coverage change effective date so the correct Relationship to Employee value prints on the Dental enrollment form.

Important: Make sure that you have updated the employee’s Marital Status if applicable before you generate forms, especially if the form contains employee’s Marital Status. Remember that employees are not able to update their Marital Status in Benefits Employee Self Service in CHRS Release 1.

What Not to Do

• Do not skip doing the correct work around process on this document.
• Do not skip enrolling the employee and his/her dependents into Benefits in PeopleSoft and instead call CalPERS with the enrollment information.

1. Go to the On Demand Event Maintenance page (click on the NavBar Icon

, then click on Menu > Benefits > Manage Automated Enrollment > Events > On Demand Event Maintenance).

1. Enter the EMPLID and then click on the Search button.
2. Click on the CSU On Demand Printing tab to generate Medical, Dental, Flex Cash and HCRA/DCRA enrollment forms for the BAS event that you just processed or the last processed BAS event. Make sure to disable your browser pop-up blocker in order to print enrollment forms on demand.

For Dental forms:

• Click the Print button to generate the form in PDF in a new window.
• Print the form from the PDF menu that appears at the bottom of the PDF document.

1. Go to the Health Benefits page (click on the NavBar Icon

, then click on Menu > Benefits > Enroll in Benefits > Health Benefits) and position on the Dental plan.

1. Position on the applicable enrollment row, then click on the CSU Health Perm Evnt tab.
2. The CSU Health Perm Evnt page appears.

1. Click on the Print button.

1. Generate Dental enrollment forms after finalizing employee enrollments into Ben Admin. Click on the NavBar Icon

, then click on Menu > Benefits > Reports > CSU Benefits Forms > CSU Dental Form.

1. Enter an existing Run Control ID and then click on the Search button. If you do not have a Run Control ID, click on Add a New Value and create one, and then and then click on the Search button. A Run Control ID can have up to 30 characters but cannot have any spaces.

1. Enter the Business Unit, Sched ID and the Coverage Election Date Range in the From Date and Thru Date fields. The Coverage Election Date is the date that the enrollment was finalized-enrolled in Ben Admin (the Coverage Election Date is not the coverage begin date). Note that the From Date and Thru Date fields can equal the same date. Also note that there is no limit as to how many times you can reprint a form.
   
   Note that you are unable to generate and print dental enrollment forms in batch for an OE Schedule ID until OE2025 occurs. You can, however, generate and print dental enrollment forms for an OE BAS event for an employee using the On Demand Event Maintenance > CSU On Demand Printing page and the Health Benefits > CSU Hlth Perm Event page.

1. Click on the Run button.
2. Click on the OK button.

1. From the Run Control page, click on the Process Monitor link to view the processing status of your job. Click on the Refresh button periodically to refresh the page. When your job says Success or Error processing is completed.
2. Click on the Process Monitor link to view the processing status of your job. Click on the Refresh button periodically to refresh the page. When your job says Success or Error processing is completed.
   1. If the job says Error, click on the Details link, then View Log/Trace, and then click on the .log link to see the error message. Report the error message to your campus technical resource.
   2. If the job says Success, click on the Go back to CSU Dental Form Batch link.

1. Click on the Report Manager link. FYI, if no batch forms generate, nothing writes to Report Manager.
2. On the List page, click on the CSU_BN_DENTL – CSU Dental Form.pdf link.

1. The Report page appears. Click on CSU_BN_DENTAL.log to see/print/save a list of employees with generated dental forms. Click on the CSU Dental Form.pdf link to see/print/save the generated forms.

• Note that one form generates listing all changes for Dental. A change control request is submitted to modify the process to generate one form for each change/permitting event code.
• Review the CSU_BN_DENTAL.log to see the employee IDs that generated forms. This log lists forms that populate with ‘eSignature’ and the eSignature date noting benefit enrollments that occurred in the CHRS eBenefits ESS. ‘Signature On File’ indicates that the enrollment/enrollment changes were processed via the On Demand Event Maintenance page and not via CHRS eBenefits ESS.

There are multiple ways to generate the Flex Cash Enrollment form for an employee in CHRS:

On the On Demand Event Maintenance > CSU On-Demand page or,

On the Health Benefits > CSU Hlth Perm Evt page or,

Via mass print (batch) processing.

The Flex Cash enrollment form has a batch process in CHRS to print multiple enrollments, changes and cancellations for a specified coverage election date range (the date that coverage is finalized-enrolled into CHRS), business unit and Ben Admin Schedule ID.

Note that a permitting event code(s) is required with a Benefit enrollment, change and cancellation transaction in order to generate a Flex Cash enrollment form. Flex Cash enrollment forms are not generated when the employee has not enrolled in a Flex Cash plan.

Flex Cash permitting event codes are entered via nightly process CSU_PERM_INS for eBenefits ESS enrollments. Flex Cash permitting event codes are entered manually via the On Demand Event Maintenance > CSU Perm Event page and the Health Benefits > CSU Hlth Perm Evt page.

Alternative Coverage information is entered via eBenefits by employees for eBenefits ESS enrollments, and manually via the Enter Non-CSU Insurance Information link in the On Demand Event Maintenance page. The most recent Alternative Coverage information entered in CHRS is stored in CHRS. Historic Alternative Coverage information is not stored in CHRS.

Important: Employees who are enrolled in Flex Cash plans at the time of conversion to CHRS may not have permitting event codes entered/stored in Health Benefits. You may need to manually add Flex Cash permitting event codes to current and historic rows in order to generate the form correctly, if needed. This is a cutover issue from 9.0 to 9.2 that will lessen with time.

Also, alternative coverage information is not stored in 9.0 for the employee, so the Alternative Coverage section on the Flex Cash Enrollment form is blank if you print historic forms for converted employees who are enrolled in Flex Cash medical/dental plans. This is a cutover issue from 9.0 to 9.2 that will lessen with time. If desired, you can reprocess the applicable BAS event back to a Re-entered status via the On Demand Event Maintenance page and enter the alternative coverage information in the Enter Non-CSU Insurance Information link, then finalize the BAS event.

Note that there is two Subscriber SSN fields on the Flex Cash Form, one for Medical and one for Dental in case the subscriber’s SSN differs.

Note that manual remarks entered into the Remarks field in the Non-CSU Insurance Information link via the On Demand Event Maintenance page are applicable to both plan types 1Y and 1Z. Each plan type does not have its own Remarks section. Manual remarks entered into the Remarks field in the Non-CSU Insurance Information link print before the permitting event code description in the Remarks field on the Flex Cash Enrollment form.

One Flex Cash form prints for all Flex Cash enrollment changes on a BAS event. If each enrollment change results in separate permitting event codes, the permitting event code of 44 prints on the form, regardless of the permitting event codes inserted manually via the On Demand Event Maintenance page or by the new CSU_PERM_INS (automated permitting code insert) process.

Alternative Coverage history rows are not stored in CHRS. Alternative Coverage data is cleared when the employee waives Med Flex Cash and/or Den Flex Cash. If the employee re-enrolls into Med Flex Cash and/or Den Flex Cash, new Alternative Coverage data must be entered.

1. Go to the On Demand Event Maintenance page (click on the NavBar Icon

, then click on Menu > Benefits > Manage Automated Enrollment > Events > On Demand Event Maintenance).

1. Enter the EMPLID and then click on the Search button.
2. Click on the CSU On Demand Printing tab to generate Medical, Dental, Flex Cash and HCRA/DCRA enrollment forms for the BAS event that you just processed or the last processed BAS event. Make sure to disable your browser pop-up blocker in order to print enrollment forms on demand.

For Flex Cash (DenFlex/MedFlex)forms:

• Click the Print button to generate the form in PDF in a new window. You only have to print one Flex Cash form as all changes to Medical Flex Cash and Dental Flex Cash if applicable are included on one form.
• Print the form from the PDF menu that appears at the bottom of the PDF document.

1. Go to the Health Benefits page (click on the NavBar Icon

, then click on Menu > Benefits > Enroll in Benefits > Health Benefits) and position on the applicable Flex Cash plan.

1. Position on the applicable enrollment row, then click on the CSU Health Perm Evnt tab.
2. The CSU Health Perm Evnt page appears.

1. Click on the Print button. One form prints for both Flex Cash plans.

1. Generate Flex Cash enrollment forms after finalizing employee enrollments into Ben Admin. Go to Benefits > Reports > CSU Benefits Forms > CSU Flex Cash Batch.
2. Enter an existing Run Control ID and then click on the Search button. If you do not have a Run Control ID, click on Add a New Value and create one, and then and then click on the Search button. A Run Control ID can have up to 30 characters but cannot have any spaces.

1. Enter the Business Unit, Sched ID and the Coverage Election Date Range in the From Date and Thru Date fields. The Coverage Election Date is the date that the enrollment was finalized-enrolled in Ben Admin (the Coverage Election Date is not the coverage begin date). Note that the From Date and Thru Date fields can equal the same date. Also note that there is no limit as to how many times you can reprint a form.

1. Click on the Run button.
2. Click on the OK button.

1. From the Run Control page, click on the Process Monitor link to view the processing status of your job. Click on the Refresh button periodically to refresh the page. When your job says Success or Error processing is completed.
   1. If the job says Error, click on the Details link, then View Log/Trace, and then click on the .log link to see the error message. Report the error message to your campus technical resource.
   2. If the job says Success, click on the Go back to CSU Flex Cash Batch link.

1. Click on the Report Manager link. FYI, if no batch forms generate, nothing writes to Report Manager.
2. On the List page, click on the CSU_BN_FLEXC – FlexCash Program Enrollment Authorization.pdf link.

1. The Report page appears. Click on CSU_BN_FLEXCASH.log to see/print/save a list of employees with generated dental forms. Click on the FlexCash Program Enrollment Authorization.pdf link to see/print/save the generated forms.

• Note that one form generates listing all changes for Flex Cash.
• Review the CSU_BN_FLEXCASH.log to see the employee IDs that generated forms. This log lists forms that populate with ‘eSignature’ and the eSignature date noting benefit enrollments that occurred in the CHRS eBenefits ESS. A warning also prints on the log if more than one permitting event code exists for a coverage begin date for the plan type. The following example screen shot shows ‘eSignatures.’ ‘Signature On File’ indicates that the enrollment/enrollment changes were processed via the On Demand Event Maintenance page and not via CHRS eBenefits ESS.

Example Batch Log Showing eSignature and Signature on File

There are multiple ways to generate the HCRA/DCRA Enrollment form for an employee in CHRS:

On the On Demand Event Maintenance > CSU On-Demand page or,

On the Health Benefits > CSU Hlth Perm Evt page or,

Via mass print (batch) processing.

The HCRA/DCRA enrollment form has a batch process in CHRS to print multiple enrollments, changes and cancellations for a specified coverage election date range (the date that coverage is finalized-enrolled into CHRS), business unit and Ben Admin Schedule ID.

Note that a permitting event code(s) is required with a Benefit enrollment, change and cancellation transaction in order to generate a HCRA/DCRA enrollment form. HCRA/DCRA enrollment forms are not generated when the employee has not enrolled in a HCRA/DCRA plan.

HCRA/DCRA permitting event codes are entered via nightly process CSU_PERM_INS for eBenefits ESS enrollments. HCRA/DCRA permitting event codes are entered manually via the On Demand Event Maintenance > CSU Perm Event page and the Spending Accounts > CSU FSA Perm Evt page.

One HCRA/DCRA form prints for all HCRA/DCRA enrollment changes on a BAS event. If each enrollment change results in separate permitting event codes, the permitting event code of 44 prints on the form, regardless of the permitting event codes inserted manually via the On Demand Event Maintenance page or by the new CSU_PERM_INS (automated permitting code insert) process.

You can enter the monthly contribution amount for the employee on the Spending Accounts page or via the On Demand Event Maintenance page before generating the form. Navigation is Benefits > Enroll in Benefits > Spending Accounts. If a monthly contribution amount is not entered, the estimated monthly contribution amount is printed on the HCRA/DCRA form based on the remaining pay periods in the calendar year for pay check issue dates that have not passed as of the coverage begin date. This occurs as the Employee Contribution Amount field in Spending Accounts is not generally populated for employees who enroll via eBenefits ESS (note that the Employee Contribution Amount field in the Spending Accounts page is automatically populated by the system if the employee uses the FSA Worksheet to calculate their monthly contribution deduction in eBenefits. However, this calculated amount will generally be incorrect as the calculation amount is not based on the date that the employee submits their enrollments). Check the FSA Form process log to see the HCRA/DCRA forms that have an estimated monthly contribution amount populated on the form. These are the employees that you can manually enter the monthly contribution amount on the Spending Accounts page. Note that a monthly estimate amount is calculated every time a form is generated for the employee until the monthly contribution amount field in Spending Accounts for the plan type is populated, so be sure to populate this field as soon as possible. This form may require change when road mapped item GRP 50 is developed.

1. Go to the On Demand Event Maintenance page (click on the NavBar Icon

, then click on Menu > Benefits > Manage Automated Enrollment > Events > On Demand Event Maintenance).

1. Enter the EMPLID and then click on the Search button.
2. Click on the CSU On Demand Printing tab to generate Medical, Dental, Flex Cash and HCRA/DCRA enrollment forms for the BAS event that you just processed or the last processed BAS event. Make sure to disable your browser pop-up blocker in order to print enrollment forms on demand.

For FSA Health/FSA Depnd (HCRA/DCRA) forms:

• Click the Print button to generate the form in PDF in a new window. You only have to print one FSA form as all changes to HCRA and DCRA if applicable are included on one form
• Print the form from the PDF menu that appears at the bottom of the PDF document.

1. Go to the Spending Accounts page (click on the NavBar Icon

, then click on Menu > Benefits > Enroll in Benefits > Spending Accounts).

1. Position on the applicable enrollment row, then click on the CSU FSA Perm Evnts tab.
2. The CSU FSA Perm Evnts page appears.

1. Click on the Print button. One form prints for both FSA plans.

1. Generate HCRA/DCRA enrollment forms after finalizing employee enrollments into Ben Admin. Go to Benefits > Reports > CSU Benefits Forms > CSU FSA Form Batch.
2. Enter an existing Run Control ID and then click on the Search button. If you do not have a Run Control ID, click on Add a New Value and create one, and then and then click on the Search button. A Run Control ID can have up to 30 characters but cannot have any spaces.

1. Enter the Business Unit, Sched ID and the Coverage Election Date Range in the From Date and Thru Date fields. The Coverage Election Date is the date that the enrollment was finalized-enrolled in Ben Admin (the Coverage Election Date is not the coverage begin date). Note that the From Date and Thru Date fields can equal the same date. Also note that there is no limit as to how many times you can reprint a form.

1. Click on the Run button.
2. Click on the OK button.

1. From the Run Control page, click on the Process Monitor link to view the processing status of your job. Click on the Refresh button periodically to refresh the page. When your job says Success or Error processing is completed.
   1. If the job says Error, click on the Details link, then View Log/Trace, and then click on the .log link to see the error message. Report the error message to your campus technical resource.
   2. If the job says Success, click on the Go back to CSU FSA Form Batch link.

1. Click on the Report Manager link. FYI, if no batch forms generate, nothing writes to Report Manager.
2. On the List page, click on the CSU_BN_FSA – Flexible Spending Account Enrollment form.pdf link.

1. The Report page appears. Click on CSU_BN_FSA.log to see/print/save a list of employees with generated dental forms. Click on the Flexible Spending Account Enrollment form.pdf link to see/print/save the generated forms.

• Note that one form generates listing all changes for Flex Cash.
• Review the CSU_BN_FSA.log to see the employee IDs that generated forms. This log lists forms that populate with ‘eSignature’ and the eSignature date noting benefit enrollments that occurred in the CHRS eBenefits ESS. ‘Signature On File’ indicates that the enrollment/enrollment changes were processed via the On Demand Event Maintenance page and not via CHRS eBenefits ESS.A warning also prints on the log if more than one permitting event code exists for a coverage begin date for the plan type.
• The warning message “*****Plan Type 60 and 61 Estimated contribution amount” prints on the log for employees where the process determined an estimated monthly contribution amount for the applicable plan type generated on the form but do not have a monthly contribution amount entered in the Spending Accounts component. This message alerts Benefits Office staff that an estimated monthly contribution amount was printed on the form, and that the Employee Monthly Contribution amount must be entered via Base Benefits or via the On Demand Event Maintenance page if the event class is reprocessed back to Re-enter via ODEM.
• The warning message “Review/enter a revised Employee Contribution Amount for increase/decrease changes” prints on the log when the perm event codes 16 and 23 are used and this is updating an existing enrollment (i.e., this is not a new mid-year enrollment and COVERAGE_ELECT is currently E and with the contribution change will remain as E) and a new employee monthly contribution amount is not entered via the On Demand Event Maintenance page (i.e., the change occurs via ESS and the prior monthly contribution amount is copied from the prior row and carried forward into the new row)). This message alerts Benefits Office staff that the old Employee Monthly Contribution amount printed on the form and to revise the old amount to reflect the new contribution amount via Base Benefits or via the On Demand Event Maintenance page if the event class is reprocessed back to Re-enter via ODEM.
• If employee use the FSA Worksheet in eBenefits Self Service while doing their HCRA/DCRA enrollment, the FSA worksheet calculates the monthly contribution amount based on the original event date. It does not calculate the monthly contribution amount based on the coverage effective date based on the submission date. This calculated monthly contribution amount is then automatically updated into the Employee Monthly Contribution field the Spending Accounts base benefit table when the BAS event is finalized unless you overwrite the amount in the On Demand Event Maintenance page. Also, the applicable “*****Plan Type 60 and 61 Estimated contribution amount” doesn’t print on the FSA Enrollment form process log. Be sure to correct this amount in the On Demand Event Maintenance page or via correction mode on the Spending Accounts page before printing out your HCRA/DCRA Enrollment form.

Example Batch Log Showing eSignature and Signature on File

Benefit-eligible employees can populate (fill out) the CHRS Affidavit of Parent Child Relationship form when they use CHRS eBenefits Employee Self Service (ESS) to submit Life Events, the New Hire/Newly Eligible enrollment transaction and the annual Open Enrollment event. Benefit-eligible employees can use CHRS eBenefits Employee Self Service Life Events, the New Hire/Newly Eligible enrollment transaction and the annual Open Enrollment event only if their benefits primary campus uses full eBenefits ESS.

Benefit-eligible employees with campuses using full eBenefits ESS can also print the populated (filled out) CHRS Affidavit of Parent Child Relationship form by clicking on the NavBar Icon

, then clicking on Menu > Self Service > Benefits > Dependents > Dependent Coverage, and then clicking on the Affidavit of Parent Child Relationship (PCR Affidavit) link. Note that employees cannot print/download a blank Affidavit of Parent Child Relationship form. Employees can only print a completed Affidavit of Parent Child Relationship form.

If the employee has multiple dependents who are recognized children with multiple Affidavit of Parent Child Relationship forms filled out and submitted in eBenefits, all forms generate, but only one employee signature page and one privacy notice page generates for use with all forms. Users receive a message when they click on the applicable print links on the Dependent and Beneficiary Coverage Summary page if the form is not populated to print out. Forms must be filled out and submitted in order for employees to print them in eBenefits ESS.

Important: The annual Affidavit of Parent-Child Relationship form process is not in CHRS. The annual Affidavit of Parent-Child Relationship form process remains manual until change control 1037 is completed.

Campus Benefits Office staff can generate the populated Affidavit of Parent Child Relationship form from the Benefits > Update Dependent/Beneficiary > CSU Dependent page.

1. For campus Benefits Office to print the Affidavit of Parent Child Relationship form, click on the NavBar Icon

, then click on Menu > Benefits > Update Dependent/Beneficiary > CSU Dependent.

1. Enter the Empl ID, select Include History, and then click on the Search button.

1. Click on the CSU Dependent tab, and then position on the dependent that is a Recognized Child.

1. Select Print Affidavit of PCR Form in the Action Taken field.
2. Click on the Go button.
3. The current Affidavit of PCR Form PDF generates, if populated. Note that CHRS does not currently store historic Affidavit of PCR forms. The annual APCR re-certification process remains manual until change control request 1037 is completed.

1. For campus Benefits Office to print the Domestic Partner Dependent Certification form, click on the NavBar Icon

, then click on Menu > Benefits > Update Dependent/Beneficiary > CSU Dependent.

1. Enter the Empl ID, select Include History, and then click on the Search button.

1. Click on the CSU Dependent tab, and then position on the dependent that is a Domestic Partner Adult.

1. Select Print Domestic Partner Cert in the Action Taken field.
2. Click on the Go button.
3. The current Domestic Partner Dependent Certification PDF generates, if populated. Note that CHRS does not currently store historic Domestic Partner Dependent Certification forms.

1. Enter the Empl ID, select Include History, and then click on the Search button.

1. Click on the CSU Dependent tab, and then position on the dependent that is a Domestic Partner Adult.
2. Insert a new effective-dated row in the CSU Dependent Forms section and then change the dependent’s tax status by selecting/deselecting the Tax Dependent checkbox, enter the Tax Year, select the Certificate on File checkbox and type your name into the Certified By free-form field and then click on the Save button. The dependent tax status entered on the CSU Dependent page is what populates the applicable fields on the Dental enrollment form from this point forward if it is within the effective date range. Note that updating the tax status for the dependent overwrites the previously-entered data on the form as CHRS currently does not store historic DPDC forms.

Benefit-eligible employees can populate and generate the CHRS Dependent Re-verification Affidavit form when they use CHRS eBenefits Employee Self Service (ESS) to submit Life Events, the New Hire/Newly Eligible enrollment transaction and the annual Open Enrollment event. Employees can use CHRS eBenefits Employee Self Service Life Events, the New Hire/Newly Eligible enrollment transaction and the annual Open Enrollment event only if their benefits primary campus uses full eBenefits ESS.

Benefit-eligible employees with campuses using full eBenefits ESS and view only eBenefits ESS can generate the CHRS Dependent Re-verification Affidavit form by clicking on the NavBar Icon

, then clicking on Menu > Self Service > Benefits > Dependents > Dependent Coverage, and then clicking on the Dependent Re-verification Affidavit link.

The Dependent Re-verification Affidavit electronic form allows for a maximum of 12 dependents to be verified per form. The employee needs to complete a paper form if there are more than 12 dependents to verify at one time.

Dependents can be deleted from the form. Once a dependent is deleted from the form for the verification period, the dependent is not added back to the form.

Campus Benefits Office staff can generate the populated Dependent Re-verification Affidavit form from clicking on the NavBar Icon

, then clicking on Menu > Benefits > Employee/Dependent Information > CSU Dependent Verification page or, once dependent verification is marked received and verified on the CSU Dependent Verification page, campus Benefits Office staff can generate the populated Dependent Re-verification Affidavit form from the CSU Dependent Ver History page.

1. Click on the NavBar Icon

, then click on Menu > Benefits > Employee/Dependent Information > CSU Dependent Verification.

1. Verify the Business Unit, then select Medical for the Plan Type, then enter the Emplid or select the Employee Birth Month, and then click on the Search button.

Example entering Employee Birth Month

1. If applicable, enter the date that you received the Dependent Re-verification Affidavit form in the Received Date field.
2. Click on the Print PDF button to generate the Dependent Re-verification Affidavit.
3. A new window appears and displays the draft Dependent Re-verification Affidavit form. If needed, update the Effective Date and delete dependents. Click on the Save button if you made updates. Click on the Print .PDF button to generate the final PDF.

1. The Dependent Re-verification Affidavit form generates, if populated with dependents.
2. Click on the Save button on the CSU Dependent Verification page. The employee and dependent(s) are no longer accessible on the CSU Dependent Verification page but are accessible on the CSU Dependent Ver History page.