Manually creating eligibility records by benefit plan

  1. Select Benefits > Maintenance > By Benefit Plans.
  2. On the Eligible tab, click Create.
  3. Specify this information:
    Plan
    This field is pre-selected.
    Employment ID
    Select the resource.
    Coverage Class
    Select whether the resource is an employee or retiree.
    Manual Eligibility
    Select this check box if the eligibility group on the benefit plan should be bypassed, the eligibility date will be one that is not calculated, or if you do not want this employee’s eligibility to be evaluated when the Employee Enrollment Updates process is run.
    Eligibility Date
    Select Calculate to use the system-calculated date. If you select Specify Date, specify a date in the date field that becomes available.
    Enroll In Benefit
    Select this check box to enroll the employee at the same time. When this is selected, enrollment fields become available.
  4. If the Enroll in Benefit check box is selected, the specify this information:
    Start Date
    Select Use Eligibility Date when the enrollment begins on the same date as the eligibility. If you select Specify Date, specify a date in the date field that becomes available.
    Smoker
    Select whether the individual or spouse/domestic partner is a smoker. This field is available when the plan Coverage Type is Coverage Options or Coverage Amounts.
    Number of Hours
    Specify the number of hours that are bought and sold for the vacation plan. This field is only available for vacation plans.
    Manual Eligibility
    Select this check box if the eligibility group on the benefit plan should be bypassed or if you do not want this enrollment to be evaluated when the Employee Enrollment Updates process is run.
    Email Template
    Select an email template to send an email when this enrollment is created.
  5. In the Coverage section, the fields that are available depend on the Coverage Type defined on the benefit plan:
    Coverage Option
    For plans defined with a Coverage Type of Coverage Option, select the option for this enrollment.
    Coverage Amount
    For plans defined with a Coverage Type of Coverage Amounts, specify the coverage amount.
    Eligibility
    The default Eligibility option from the spouse or domestic partner of the employee for plans that include eligibility surveys is selected. The benefit manager can override and change the value of Eligibility. Here the survey is not required. Changing the eligibility impacts the contributions if changing to or from Eligible With Surcharge.
    Salary
    For plans defined with a Coverage Type of Coverage Amounts, specify the salary.
    Salary Multiple
    For plans defined with a Coverage Type of Coverage Amounts, specify the multiple of salary.
  6. In the Employee Contribution section, these fields are available depending on coverage type defined on the benefit plan:
    Tax Type
    If the contribution can have pre-tax and after tax contributions, select Pre Tax or After tax.
    Percent Or Amount
    For plans defined with a Coverage Type of No Coverage, specify whether the contribution is a percent or an amount.
    Pre Tax
    For plans defined with a Coverage Type of No Coverage and that are not vacation type plans, specify the annual pre tax employee contribution amount/percent.
    After Tax
    For plans defined with a Coverage Type of No Coverage and that not vacation type plans, specify the annual after tax employee contribution amount/percent.
  7. In the HIPAA 834 section, which is only available if the Benefit Plan has HIPAA 834 selected as an export file, specify this information:
    Create Transactions
    Select this check box to enable the transaction for HIPAA 834 for this enrollment.
    Benefit Reason
    This field is required if Create Transactions is selected. This is the reason that is passed in the file.
    Member ID Type
    Specify the member ID that is passed in the file.
  8. Click OK.