This essay discusses implementing dependents and beneficiaries in the US for basic benefits administration. Specifically, it covers the following topics:
Overview
Design
Windows and data entry
Additional notes
Oracle HRMS maintains basic benefit enrollments. A benefit enrollment gives rise to an employee contribution, which is deducted from the employees pre-tax or post-tax pay, and an employer contribution. A benefit enrollment has a coverage type.
A benefit enrollment may have a number of covered dependents. Details of the covered dependents are stored on the database. Covered dependents may be entitled to continued coverage through COBRA upon termination of the employee enrolled.
A benefit enrollment may have designated beneficiaries. Multiple beneficiaries may be designated for a benefit enrollment. Each designated beneficiary must have a proportion of the benefit assigned to them. Beneficiaries may also have a level specified for them. Benefit goes to the highest surviving level only.
Details of beneficiaries are stored on the database. There should, at least, be sufficient information to allow the beneficiary to be contacted in the case of payment. Beneficiaries may be either people or organizations.
Basic benefit plans are defined as element types. The benefit plan has a benefits classification. The benefits classification indicates whether the benefit plan requires or allows beneficiaries or dependents.
An element entry is given to an assignment to enroll in a benefit plan. Enrollments should always be for the primary assignment. Deductions will be made for the benefit plan.
Depending on the dependents allowed flag for the benefit classification, a benefit plan may have various coverage types, such as employee only, employee and spouse, employee and children and employee and family. The coverage type is held on the coverage input value for the benefit enrollment.
If the benefit classification specifies that dependents are not allowed for this benefit plan, the coverage input value is set to Employee Only. The employee and employer contribution input values are copied from the contribution table but can be overwritten for individual employees.
If the benefit plan benefit classification allows dependents or beneficiaries, it is possible to work flow from the Element Entries window to the Covered Dependents window (dep) and the designate beneficiaries window (ben). (It is possible for a benefit plan to allow both dependents and beneficiaries).
Dependents for a benefit plan are stored on the database in the people tables. The user enters dependents using the define contact window. A valid dependent type is any contact type with a row existing in the valid dependent types table. Entries in the valid dependent type table are provided as startup data and specify which contact types are covered by a coverage type.
If the benefit enrollment coverage is other than Employee Only, then the covered dependents table is populated for the benefit enrollment element entry.
The Covered Dependents window allows the user to modify the covered dependents for a benefit enrollment. Allowed dependents are restricted to those who had a dependent flag set when entered, and who are of a valid dependent type for the coverage. Covered dependents are date effective. It is possible to display the date tracked history of dependents covered by a benefit enrollment.
The beneficiaries allowed flag on the benefit classification specifies whether beneficiaries may be designated for a benefit plan.
Beneficiaries can be organizations or people. People may be entered using the define contact screen. The contact should have the beneficiary flag set. The relationship to the plan enrollee is not significant.
Organizations may be entered using the Organization window. The organization is given a classification of benefit beneficiary. The benefit beneficiary organization type is provided with the startup data. Beneficiary organization addresses may be entered using the location screen. The location screen includes a field into which a contact at the organization may be entered.
Beneficiaries are specified using the designate beneficiary window. This window allows the user to enter multiple beneficiaries for a benefit enrollment. For each designated beneficiary a beneficiary type (person/organization) is selected. The beneficiary type restricts the values displayed in the beneficiary list. A beneficiary person is selected from all contacts for the plan enrollee with the beneficiary flag set. A beneficiary organization may be selected from all organizations of type benefit beneficiary.
Each designated beneficiary is given a level (the benefit goes to the highest surviving level) and a proportion (the benefit is divided according to the proportions of surviving beneficiaries at a beneficiary level). There is a text field to allow the enrollee to enter special instructions against the beneficiary. Designated beneficiaries are date effective. It is possible to display the date-tracked history of the beneficiaries of a benefit enrollment.
The user can define benefit plans using the Deduction window for US Payroll or the Element window for Oracle HRMS-only installations.
If the benefit classification indicates that the benefit contributions table is to be used, then the user uses the Benefit Contributions window to enter benefit coverages for a benefit plan and the contributions for them.
See: Configuring Components for Health Care Benefit Plans, Oracle HRMS Compensation and Benefits Management Guide
See: Establishing Health Care Plan Coverage and Default Contributions, Oracle HRMS Compensation and Benefits Management Guide
The user uses the Element Entries window to enroll an assignment in a benefit plan. The user then queries the deduction for the benefits plan and selects the correct coverage type for the coverage input value for the element entry. The employee and employer contributions default from the contribution table, but may be overwritten for the enrollment. The user can workflow from this window to the cover dependents window and the designate beneficiary window (depending on the benefit classification of the benefit plan).
The user enters beneficiaries using the designate beneficiary window. This window allows the user to enter multiple beneficiaries for a benefit enrollment. The user can select a beneficiary person from all contacts for the plan enrollee with the beneficiary flag set. A beneficiary organization may be selected from all organizations of type benefit beneficiary.
Each beneficiary is given a beneficiary type (person/organization), a beneficiary level (benefit goes to the highest surviving level) and a proportion (benefit is divided according to the proportions of surviving beneficiaries at a beneficiary level). The user may also enter a text string for special instructions to be considered with each beneficiary.
The start and end dates for the designated beneficiary are displayed.
The Covered Dependents window is used to enter or modify dependents covered by an benefit enrollment. Dependents may be selected from the contacts specified with the dependent flag set. When the covered dependents are entered they are tested to ensure that the contact type is one of the valid dependent types for the coverage specified for the benefit enrollment. A test is made to ensure that the number of contacts of the type does not exceed the maximum specified for the valid dependent type.
The start and end date for coverage of the dependent is displayed.
The Organization window is used to enter organizations. The organization is given a classification benefit beneficiary.
The Contact window is used to enter people. The window allows entry of the name, address, telephone number and social security number. Flags indicate whether the contact is a dependent of the employee, a beneficiary of the employee, or a series EE bond recipient. If the contact is a dependent of the employee, then the contact type must be a valid dependent type.
The following warnings are displayed:
When the user attempts to leave the window without specifying a social security number.
When the user makes changes to contacts who are assigned as beneficiaries or dependents to benefit enrollments. The warning indicates that coverage should be checked.
When a new contact is entered of a dependent type which would be covered by an existing plan enrollment. The warning suggests that the user check the coverage.
When changes to dependents are made, covered dependents for a benefit are not updated. Each time there is a change to the details of a covered dependent, or a new dependent is entered, the user must ensure that the dependents for a plan remain valid.
A warning message is displayed when dependent/beneficiary details are altered to warn that the person is assigned to benefit plans and coverage details should be checked.
Dependents are validated only against the dependent contact type and the maximum number of the dependent contact type for the coverage. There is no attempt to ensure that the dependent meets more sophisticated criteria (children must be under 18 or in school full time, for example). Changes to dependents eligibility due to age or other time dependent features is not detected.
Changes to the plan enrollment such as coverage result in revalidation of covered dependents. A change to a plan enrollment should be given a reason. There is no attempt to ensure that enrollment changes result from valid life events.
This document does not address COBRA coverage issues and responsibilities.
Date track history is available for covered dependents and designated beneficiaries. However, it should be noted that these are multirow tables and the history relates to the row rather than to the person/organization concerned.