Creating benefit plan coverage
Coverage can vary by benefit group and
coverage class. You can define the dependent rules, default coverage rules from the coverage
options table on.the Main tab of the plan. You can
also activate or inactivate coverage options. Fields may vary depending on the coverage type
and coverage class selected for the benefit plan.
- Select Benefits > Plans > Benefit Plans.
- Open the Benefit Plan.
- On the Coverage tab, click Create.
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Specify this information:
- Coverage Class
- Select a coverage class for the enrollee. You must create separate records for Employee, Retiree and COBRA Participant.
- Benefit Group
- Select the benefit group.
- Coverage Date
- Specify the date coverage begins.
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On the Details tab, specify
this information:
- Covered
- Select who is covered on this benefit plan.
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In the Dependent Criteria section, specify this information:
- Dependent Age
- If dependents are covered by the plan, specify the maximum age for a Dependent or Non Tax Qualified Dependent.
- Student Age
- Specify the maximum age for a student who is a Dependent or Non Tax Qualified Dependent.
- Part Time Students
- Select this check box if part time students are considered a student for benefit purposes.
- Termination Option
- Select the stop date to use when dependents are no longer eligible for coverage due to age.
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In the Calculation section, specify this information:
- Calculation Type
- Select a Calculation Type: Flat Amount, Multiple of
Salary, Percent of Salary, Supplemental, Fixed Multiple of Salary. Note: Depending on the calculation type selected, additional fields may be needed.
- Currency
- Select the currency used for the calculation.
- Flat Amount 1
- This field is available when the Calculation Type is Flat Amount. If the plan covers both spouses/domestic partners and dependents/non tax qualified dependents, specify the spouse/domestic partner amount.
- Flat Amount 2
- This field is available when the Calculation Type is Flat Amount. If the plan covers both spouses/domestic partners and dependents/non tax qualified dependents, specify the dependents/non tax qualified dependents amount.
- Salary Multiple
- If coverage is a multiple of an employee's salary, specify the multiple in which coverage can be purchased. For example, if you specify 0.5, coverage can be purchased in multiples of .5. Valid coverage multiples are 0.5, 1.0, 1.5, etc.
- Salary Percent
- If coverage is a percent of an employee's salary, specify the percent.
- Increments
- Specify the increments for coverage. For example, life insurance can be purchased in multiples of 10,000.
- Default Coverage Option
- If the coverage type is coverage options and the plan is identified as a default plan, select the coverage option that is the default level.
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On the Limit Of Another
Plan tab, specify the coverage limits when benefit plan coverage type is
coverage amount. This is applied when a benefit plan’s coverage is limited by coverage in
another plan. Amounts that are over the approved amount on the limiting plan times the
percent require EOI. There are not EOI rules set up on the coverage rules for this. These
can be approved only after the coverage on the limiting plan is approved.
- Amount Limits
- Specify the minimum and maximum amount limits.
- Multiple of Salary Limits
- Specify the minimum and maximum multiples for salary limits.
- Limit of Another Benefit
- Specify percent and benefit plan.
- Coverage Reduction Rules
- Coverage reduction rules reduce the employee's coverage based on age. The calculation used is defined in a coverage reduction rates table.
- Default Rules
- If the plan is defined as a default plan, specify the coverage with which the employee's benefit will be created.
Note: Spouse supplemental plan limits coverage to 50% of employee life plan. The employee life plan requires EOI for late entrants after 30 days. As a late entrant an employee enrolls to employee life for 300,000. Their enrollment to spouse life will require EOI with the reason of Limit Of Another Plan because the full 300,000 on the employee life required EOI and their spouse life coverage is based upon the employee life coverage. - On the Salary tab, available when Coverage Type is Coverage Amounts, specify how the employee salary is calculated.
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On the Evidence of
Insurability Rules tab, specify this information:
New Plan Entrant:
- EOI Days
- Specify the number of days after enrollment that a newly eligible employee can make an election without being subject to providing Evidence of Insurability. When the employee makes an election after this time period expires beyond eligibility, start date for example, they must provide EOI.
- From Date
- The date used to compare with the eligibility date to determine if this is a late entrant.
- Late Entry Always
- Always make enrollments pending EOI with reason Late Entry, regardless of EOI days.
- Salary Changes
- This determines if a salary increase may update an employee’s coverage.
This rule is applied when the enrollment’s EOI status is approved, the reason is
Late Entrant, and where salary increases may change the coverage. Note that this
only applies to salary increases. For salary decreases, the approved amount is not
changed. When the EOI status is pending, salary changes are allowed.
- Allow Change: Salary changes will be processed to update the employee’s benefit. All EOI rules will apply after the change.
- Change Not Allowed: Salary changes will not update coverage
- Message
- Specify the message that is shown on an enrollment event when employee enrolls and an EOI for Late Entrant is determined.
- Email Template
- Select the email template to send correspondence to the applicant when the EOI Days have passed. This is used on enrollments that having pending EOI with Reason Late Entrant and either of the actions of Send EOI Email or Create Notifications For Evidence Of Insurability are taken.
- Email Attachment
- Attach a document to include in the email sent to newly eligible employees who are late in entering the plan.
Note: The total amount goes into EOI when these these actions occur:- The date specified in From Date is after the eligibility date + number of days specified in EOI Days, or
- The Late Entry Always is selected, or
- The immediately preceding enrollment to same plan is pending EOI for with reason of late entrant.
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In the Guaranteed Issue Limit section, specify this information:
- Salary Multiple
- Specify the largest salary multiple amount of coverage an eligible person can elect without having to submit to Evidence of Insurability. The limit amount is calculated by using the value in this field multiplied by the employee's salary.
- Amount
- Specify the largest amount of coverage an eligible person can elect without having to submit to Evidence of Insurability. If you specify both Salary Multiple and Amount, the smaller amount is used to determine the coverage limit.
- Always Enforce Issue Limit
- All enrollments where the coverage exceeds the issue limit amount and have not been approved require EOI with reason of Issue Limit. EOI is required for coverage over the amount determined by the lower of salary multiple or amount, or their currently approved amount of coverage, whichever is greater.
- For example, the amount for Guarantee Issue Limit is 10,000. The employee enrolled for 200,000. EOI was required for 190,000. The EOI was approved. The next year the employee enrolls for 250,000. This is over 10,000, so it will be evaluated for EOI under the Guarantee Issue Limit rule. The employee already has 200,000 in coverage. Therefore, 50,000 will require EOI.
- Salary Changes
- This determines if a salary increase may update an employee’s coverage.
This rule is applied when the enrollment’s EOI status is approved, the enrollment
required EOI for Issue Limit, and where salary increases may change the coverage.
Note that this only applies to salary increases. For salary decreases the approved
amount is not changed. When the EOI status is pending, salary changes are allowed.
- Allow Change: Salary changes will be processed to update the employee’s benefit. All EOI rules will apply after the change.
- Change Not Allowed: Salary changes will not update coverage
- Message
- Specify an Issue Limit Message that is shown on the employee enrollment if they elect an amount that exceeds the guaranteed issue amount.
- Email Template
- Select the email template to use to send correspondence to the enrollee when the guaranteed issue limit is exceeded.
- Email Attachment
- Attach a document to include in the email that sent to those exceeding the guaranteed issue limit.
Note: Any amount over the specified amounts goes into EOI. This is only evaluated if Late Entrant is not determined for an employee’s enrollment. The lowest guarantee issue limit is the lower of the amount determined based upon the salary multiple or the amount. EOI is required for coverage over the lowest guarantee issue limit or amount already approved, whichever is greater. -
In the Coverage Increase Limit section, specify this information:
- Salary Multiples
- Specify the largest salary multiple amount of coverage an eligible person can elect without having to submit to Evidence of Insurability. The limit amount is calculated by using the value in this field multiplied by the employee's salary.
- Amount
- Specify the largest amount of coverage an eligible person can elect without having to submit to Evidence of Insurability. If you specify both Salary Multiple and Amount, the smaller amount is used to determine the coverage limit.
- Any Increase
- EOI is required for any increase in coverage.
- Salary Changes
- This determines if a salary increase may update an employee’s coverage.
This rule is applied when the enrollment’s EOI status is approved, the enrollment
required EOI for Increase Limit, and where salary increases may change the coverage.
Note that this only applies to salary increases. For salary decreases the approved
amount is not changed. When the EOI status is pending, salary changes are allowed.
- Allow Change: Salary changes will be processed to update the employee’s benefit. All EOI rules will apply after the change.
- Change Not Allowed: Salary changes will not update coverage
- Message
- Specify an Increase Limit Message that is shown on the employee enrollment if they elect an amount that exceeds the guaranteed issue limit.
- Email Template
- Select the email template to use to send correspondence to the enrollee when the guaranteed issue limit is exceeded.
- Email Attachment
- Attach a document include in the email that sent to those exceeding the guaranteed issue limit.
Note: Any increase in coverage over the specified amounts goes into EOI. This is only evaluated if EOI is not determined from either Late Entrant or Issue Limit. The increase limit is the lower of the amount determined based upon the salary multiple or the amount. EOI is required for coverage over the lowest increase limit or amount already approved, whichever is greater. -
Click Save.
To view pending or all records for Evidence of Insurability in the Employee Benefits menu, see Evidence of insurability records.