The Benefit Elections Change Report contains the following fields:
- Employee ID
- Employee SSN
- Employee Full Name
- Dependent SSN
- Relationship
- Last Name
- First Name
- Middle Name
- Suffix
- Legal Gender
- Date of Birth
- Marital Status
- Tobacco User
- Full Time Student
- Disabled
- Home Street Address
- Apt/Suite/PO Box
- City
- State
- Zip Code
- County
- Country
- Mailing Address Same As Home Address
- Mailing Street Address
- Apt/Suite/PO Box
- City
- State
- Zip Code
- Country
- Phone
- Office Location
- Eligibility
- Eligibility Code
- Department
- Department Code
- Divisions
- Divisions Code
- Company Structure
- Company Structure Code
- Hire Status
- Hire Status Code
- Quarterly Elgibility
- Quarterly Eligibility Code
- Pay Type
- Pay Rate
- Est. Hours Per Week
- Annual Base Salary
- Annual Benefit Salary
- Prior Year W-2 Earnings
- Employment Start Date
- Employment Termination Date
- Termination Reason
- Employment Status
- Change Type
- Change Reason
- Change From
- Change To
- Change Event Date
- Effective Start Date
- Effective End Date
- Carrier/Provider
- Product Type
- Plan
- Group Number
- Subgroup Number
- Coverage Level
- Requested Benefit Amount
- Approved Benefit Amount
- Pending Benefit Amount
- Riders
- Employee Monthly Cost
- Employee Per Pay Cost
- Employee Annual Contribution
- Company Monthly Cost
- Company Per Pay Cost
- Company Annual Contribution
- Employee Tax Determination
- Method
- Submitted By
- Submitted On
- Changed By
- Changed On
