Creating enrollment group rules

After you have created a benefit plan and an enrollment group, you can create enrollment group rules. Benefit plans are associated with enrollment events using enrollment groups. Enrollment group rules apply only to the enrollment group and not to the overall benefit plan. This enables an enrollment group to be used again with the associated rules or for a new one to be created, as well as separate rules for different groups for an enrollment event.

  1. Select Benefits > Plans > Benefit Plans.
  2. Open a benefit plan and select Enrollment Groups > Create.
  3. Specify this information:
    Enrollment Group
    Select the enrollment group for which you want to create enrollment rules.
    Preselect Disabled
    Select this check box to allow the preselect functionality to be turned off for this benefit plan.
    Ask Smoker Question
    Select whether to use the same rule as the benefit plan or for the smoker question to be disabled.
    Passive Enrollment
    Select whether to use the same rule for passive enrollment as the benefit plan, to enable, or to disable this functionality.
  4. In the Enrollment Changes Allowed section, specify this information:
    Increase
    If the plan's Coverage Type is Coverage Options or Coverage Amount, selecting this check box will increase the coverage amount. If the plan's Coverage Type is No, selecting this check box will increase the contribution amount. You can specify the maximum increase amount in the Amount field.
    Decrease
    If the plan's Coverage Type is Coverage Options or Coverage Amount, selecting this check box will decrease the coverage amount. If the plan's Coverage Type is No, selecting this check box will decrease the contribution amount. You can specify the lowest decrease amount in the Amount field.
    Add Benefit Plan
    Select to enable an individual to elect this benefit plan, even if they are not enrolled as of the event date. If this option is not selected, individuals cannot elect the plan unless they are enrolled as of the event date.
    Remove Benefit Plan
    Select to enable an individual to choose not to elect this benefit plan, even if they are currently enrolled. If this option is not selected, individuals must elect this benefit plan if they are currently enrolled.
    Remove Benefit Plan Required
    Select if the resource must unenroll in the benefit. For example, if a divorce life event occurs and the resource is enrolled in Spouse Life Insurance, the event will prevent the resource from continuing this election, even if they are currently enrolled in it.
    Dependent Enrollment
    This setting can only be changed if the plan setting for Dependent is Prompt For Enrollment or Automatic Enrollment. If dependents are restricted from enrolling in a plan, this rule does not enable them to enroll. Select one of these options:
    • Use Plan Rule: Use the plan's rule for dependents, either Prompt For Enrollment or Automatic Enrollment.
    • Prompt For Enrollment: A resource must select the dependents to be enrolled.
    • Automatic Enrollment: All qualified dependents are enrolled upon the election of the benefit.
    Eligibility Survey
    The use of the eligibility survey for a benefit plan can be disabled for an enrollment group. In that case, when the enrollment group is used in the enrollment, the survey is not displayed. By default, the use of the survey rule, as defined by the benefit plan, is enabled. The survey cannot be enabled for a plan that does not have a survey. This can only be turned off in enrollment when the plan enables it.
    Coverage Add Allowed
    Select the dependent relationships that can be newly enrolled.
    Coverage Remove Required
    Select the dependent relationships that must be removed from enrollment.