Creating enrollment rules

Enrollment rules control how an enrollment event works for a benefit group. The enrollment rule defines how the enrollment event is displayed to the employee, the content of the automated emails that are generated, and the benefit plans that are available. A resource can only see benefits for which they are eligible.

Part of defining an enrollment event is defining the benefit enrollment rules. After defining an open enrollment, a life event, or a COBRA event, use this procedure to define the enrollment rules.

Use the Copy action to avoid re-keying rules with similar attributes.

See Copying an enrollment rule.

  1. Select Benefits > Enrollment Events > Set Up > Enrollment Events, and open an event.
  2. On the Enrollment Rules tab, click Create.
  3. On the Details tab, specify this information:
    Benefit Group

    Select a benefit group for the event. Groups should be mutually exclusive.

    Cost Display

    Select the cost basis in which the contributions will be displayed.

    Show Additional URL Links From Organization

    Select to show the links that are defined on the Benefits Organization. These are displayed when the individual is on Enrollment or for a benefit manager from Enrollment Information.

    Allow Smoker Update

    Select to enable employees to change their smoker status during enrollment. In order for the enrollee to use the change of smoker status for both themselves and for their spouse or domestic partner, it must be available for each Enrollment Rule within each Enrollment Event that you allow the Smoker Status change.

    Allow Change Contribution Taxation
    Select to enable resources to choose between pre tax and after tax contribution elections for the benefits that can be changed. This creates a Change Taxation Election section on the Enrollment Information tab of the employee's enrollment event.
    Benefit Reason

    Select a benefit reason code for HIPAA 834 transactions. This is required if any associated plans create HIPAA 834 transactions.

    Create ACA Offers
    Select to create an employee enrollment that includes ACA Offer records for the health benefits.
    Disable Worksheets
    Select to prevent worksheets from generating for employee and COBRA participant enrollments created based on the enrollment rule.
    Preselect Benefits
    Select to have the individual’s current benefits selected when the enrollment is created. When this is selected, these options are displayed:
    • Preselect Date Option: Specify the date used to determine existing benefits:
      • Current: Benefits that are in effect on the date of the creation.
      • Enrollment Date: Benefits that are in effect on the enrollment date.
      • As Of Date: When selected, a new field to specify a different date on which the benefits must be in effect is shown.

      • Number of Days Past: Uses the specified number of days in the past.

      • Termination Date: Benefits that are in effect as of the employee termination date.
      • Retirement Date: Benefits that are in effect as of the employee retirement date.
      • Other Date: Benefits that are in effect as of the specific Other Date on the employee profile.
    • Preselect Worksheet: Select if the worksheet that is created for the individual should show the existing benefits with a check mark (selected).
    As Of

    This field is available only when Preselect Date Option is As Of Date. This is the date that is used to determine which of an individual’s benefits to preselect.

    Enable Reset

    Select to enable the user to reset all of their elections in the enrollment event to the preselected benefits.

    Passive Enrollment

    Select Do No Stop Existing Benefits does not change the employee's current benefit enrollment when the enrollment is finalized and the employee did not submit enrollment. Use Select Enroll with Preselected Benefits only if Preselect Benefits is selected. When the enrollment is finalized and the employee did not submit their enrollment, existing enrollments for plans included in the enrollment event stop. New enrollments for the employee that are for the same plans that were preselected are created.

    Finalize Immediately

    When this check box is selected, the request is immediately finalized when the employee takes the Submit action if there are no errors. When this is not selected, the individual can continue making changes as long as they are in the enrollment period.

    Survey
    If an eligibility survey is needed for spouses or domestic partners, select where in the enrollment process the survey is presented to the individual survey:
    • Show In Enrollment Information: Select to display the survey on the employee's Enrollment tab. When the survey is displayed, completion of the survey is required in order for the individual submit the enrollment form.
    • Show In Benefit Plan Enrollment: Select to display the survey when the individual elects coverage that includes the spouse/domestic partner (as defined by the survey) in a plan that enables the survey. When the survey is displayed, only those that elect the impacted coverage are required to complete it.
    Flex Plan

    Select a full flex plan if this rule is for a Full Flex Plan. This will automatically create flex credit records for eligible employees.

    Calculate Flex Credits

    Select whether to Calculate Flex Credits if the employee already has flex credits. If the employee does not have flex credits, they are created.

  4. The COBRA Participant Automation section is displayed only for life events and when the organization enables COBRA processing. Specify information in only one of these fields:
    Occurrence Type

    Select life event occurrence type.

    Enrollment Event

    Select COBRA enrollment event.

  5. On the Email Automation tab, configure the email templates and email attachments for the listed enrollment statuses.

    The worksheet and confirmation files can also be attached to send with the email notification, if the corresponding check boxes are selected.

  6. On the Enrollment Display tab, specify the below information. You will only be able to add document logos and videos if the Responsive version of enrollment is enabled. See Creating organization rules. Document logos must be added by the Administrator in Administrator > Set Up > Document Logos.
    Instructions

    Open this section and select whether instructions are shown to the employee. If so, specify the header, sub header, and instructions. You can also specify the instruction text that is displayed to the employee, select a document logo, specify a video, and how that video is displayed. The video link displayed here navigates the employee outside of their enrollment event.

    Video
    Open this section and select Display to display an embedded video to the employee. Specify a header and, optionally, a sub header for the video. In the Video field, you can specify a URL for the video.
    Note: The Responsive version of enrollment must be enabled to use the video functionality. See Creating organization rules.
    Current Benefits

    Open this section and select whether current benefits are shown to the employee. If so, specify the header and sub header.

    Dependents and Beneficiaries

    Open this section and select whether dependents and beneficiaries are shown to the employee. Depending on the value that you select in the Display Option list, dependents and beneficiaries can be combined on a single tab or displayed on separate tabs. You can also select to show only dependents or only beneficiaries.

    Then specify the header and sub header, and select the actions that are available for dependents: Add, Update, Remove. Beneficiaries can always be added.

    Enrollment

    This section is always displayed. Specify the header and sub header. The header is always required, so a default header of Enrollment is created. A document logo can be specified if using the Responsive version of enrollment.

    In the Worksheet Message field, you can specify text that will be displayed above the worksheet that is created for the enrollment event. You can also use the No Plan Message field to specify text to be displayed if a resource is not eligible to enroll in benefits. The default text is "You are not eligible to enroll in any benefits."

    Electronic Signature

    This section is shown when the Submit action is taken. The header is required. The default header is "Click OK to confirm you are submitting your benefits" and the default setting for the Electronic Signature Type is None. If this is changed, then text must be specified in the Text field, such as Terms and Conditions.

    Review and Submit

    This section is always displayed. The default header is displayed as Review and Submit. It can be changed and a document logo can be chosen. Open the record to take these actions:

    • Change the header

    • Add a sub header

    • Select whether flex credits and any cash for unspent credits are displayed

    • Select whether the cost summary is displayed and identify whether it includes employee and employer costs

    Select the Submitted Time field to show the date and time that the enrollment was last submitted on the Review and Submit tab. You can also specify messages that will show to employees regarding their submission status in these fields:
    • Not Submitted And No Errors - Text shown to employees just above the Submit button when the Submit action can be taken.
    • Not Submitted With Errors - Text shown to employees when they cannot submit their enrollment due to existing errors.
    • Submitted - Text shown to employees when their enrollment has been submitted and no further changes have been made.
    • Submitted And Pending Change - Text shown to employees when their enrollment was submitted and then further changes were made.
    Note: These fields are only available with the Responsive version of enrollment: Submitted Time, Not Submitted and No Errors, Not Submitted with Errors, Submitted, and Submitted and Pending Change.
    Summary

    Open this section to specify summary text that is displayed to the employee after benefits are finalized. You can also select document logo that will be displayed.

  7. On the Benefits tab, you can select the enrollment groups that the enrollees will see. Use the Display Sequence - New column to change the order in they are presented to the enrollee.
    Documentation
    Select whether the Documentation section is displayed to employees. You can also select a document logo that is displayed in this section.
  8. Click Save.