Defining Coverage Options

This procedure allows you to define a plan's coverage options. You use two forms: Coverage Options by Plan (BN17.1) and Coverage Option Defaults (BN17.2).

BN17.1 enables you to define all the possible coverage options available for the plan. You also select the number of dependents eligible for coverage under each option.

BN17.2 enables you to define who is eligible for the coverage option and when the options, become active.

To define coverage options

  1. AccessBenefit Plan (BN15.1) .
  2. Select the company, benefit type, and plan you want to define coverage options for.
  3. Select Inquire form function.
  4. Click the Coverage button. The Company, Benefit Type, and Plan are already filled in when Coverage Options (BN17.1) opens.
    Note: You may access Coverage Options (BN17.1) directly, then select the company, benefit type, and plan you want to define coverage options.
    Note: You select whether a dependent is disabled on Dependent (HR13.1).
  5. Define coverage options. Use the following guidelines to enter field values:
    Part-Time Students

    Select whether dependents with a part-time student are eligible for coverage in the plan until they reach the age in the Student Age field. If you select No, dependents with part-time student status are only eligible until they reach the age in the Dependent Age field.

    Opt (Option)

    Type the coverage option number.

    Description

    Type the coverage option description.

    Dep

    Select whether spouse/domestic partner/dependent can enroll when an employee elects this option.

    Note: You need to define records on Dependent (HR13.1) as either a spouse/domestic partner or dependent for benefit enrollment purposes.
    Nbr of Deps

    Type the number of dependents including spouse/domestic partner that can enroll when an employee elects this option.

    If you typed None in the Dep field, do not type any information in this field.

    Stat

    Select the status for this coverage.

    If you select Inactive, you cannot select this coverage option at benefit entry.

  6. Select the Add function. Coverage Option Defaults (BN17.2) opens automatically. You can deactivate an option even if enrollments exist. Existing enrollments are not affected.
  7. Define coverage option defaults. Complete the form using the following guidelines:
    Cover Type

    Select the plan participants for this coverage record.

    If the plan covers employees, COBRA participants, and retirees, you need at least three separate records, for each cover type.

    Start Date

    Type the date this coverage option default record is effective.

    You can vary coverage by start date. This allows you to define unique coverage for different periods. If coverage changes, add a new record for the new coverage.

    Employee Group

    If you define only one coverage option default record for a particular cover type, leave this field blank.

    Note: Employees who do not meet the criteria for the employee group(s) on the other coverage record(s) use this coverage. This is only true if there are group-specific records for this plan, cover type, and date, and if you leave this field blank.

    If you want to define coverage that is unique to a particular group of employees, select the employee group.

    If you are defining coverage for COBRA participants, leave this field blank.

    Note: If you define coverage by employee group, make sure employee groups are defined so that an employee can be a member of only one group at a time. If an employee belongs to more than one group for which coverage options have been defined, benefit entry forms and benefit update reports display an error.
    Default

    Select if you want this option as a default. You can only have one default coverage option per coverage option record.

    If you define a default option, benefit entry forms enroll eligible employees with the default option if no option is selected; if benefit update reports automatically enroll an employee in the plan, the employee is enrolled with the default coverage option.

    If you leave this field blank, No defaults and the benefit update programs list the plan for an eligible employee but not enroll the employee in the plan.

    Status

    Select the status of this coverage option.

    If you select Inactive, you cannot select this coverage option for employees for whom this coverage option will apply.

    Note: This field is where you can deactivate options for COBRA participants and retirees.
  8. Select the Add form function.
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