Creating enrollment rules

Enrollment rules govern the operation of an enrollment event 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 see only the 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.

See Copying an enrollment rule.

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

    Select a benefit group for the event.

    Cost Display

    Select the cost basis in which the contributions are displayed.

    Benefit Reason

    Select a benefit reason code for HIPAA 834 transactions. This is required if you create any associated plans with 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 this option to use the individual’s benefit as of the Preselect Date Option field to enable the selection of the benefit in the enrollment at the time of creating the event.

    If the plan is defined with Coverage Type of Coverage Option, then the employee's coverage option must match. If the plan is defined with Coverage Type of Coverage Amounts, then the Coverage Amount must match. If the plan is defined with a Coverage Type of No Coverage, then the Contribution must match.

    For example, a plan provides coverage of 70% and the Preselect Date Option is Current. An employee with annual salary of $70,000 is enrolled with a coverage of $49,000. If the employee's salary changes to $75,000, the employee creates a life event, which calculates the coverage at $52,000. This amount does not match the employee's current enrollment, so the amount does not preselect.

    If the Employee Enrollment Updates process is run and processed before the employee creates a life event, then the employee's current enrollment displays coverage at $52,000. When the event is created, the plan does preselect.

    See Employee Enrollment Updates process.
    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's termination date.
      • Retirement Date: Benefits that are in effect as of the employee's retirement date.
      • Other Date: Benefits that are in effect as of the specific Other Date on the employee's profile.
    Preselect Worksheet
    Select if the worksheet that is created for the employee must display the existing benefits with a check mark.
    Submit Immediately
    Select this check box to immediately submit the request.
    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 the option Do No Stop Existing Benefits to retain the employee's current benefit enrollment when the enrollment is finalized and the employee does not submit enrollment.

    Use Select Enroll with Preselected Benefits if Preselect Benefits is selected. When the enrollment is finalized and the employee has not submitted their enrollment, existing enrollments for plans included in the enrollment event stop. New enrollments for the employee that are for the same plans that are preselected are created.

    Finalize Immediately

    When this check box is selected, the request is immediately finalized after submission. When this is not selected, the individual can continue making changes if they are within 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.
  5. On the Email Automation tab, configure the email templates and email attachments for the listed enrollment statuses.

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

  6. Click Save.