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This guide also applies to on-premise implementations

Table of Contents

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1 Manage Benefit Plans, Programs, and Events

This chapter contains the following:

Define Benefits: Overview

Manage Benefit Eligibility

Manage Benefit Life Events

Manage Benefit Programs and Plans

Manage Benefit Rates and Coverage

Manage Enrollment Display

Define Benefits Configuration Copy

Define Extracts

Define Benefits: Overview

Defining benefits involves three categories of setup tasks.

  • Set up benefits objects. Organize the objects into hierarchies to help efficiently configure and maintain benefits packages. While defining benefits objects, you can also make configurations to automate administration of corporate policies regarding eligibility, enrollment, rates, and coverages.

  • Set up benefits peripheral components. You typically use or reuse these components while defining different benefits objects.

  • Set up general components, such as third-party administrators, benefits carriers, regulatory bodies, and reporting groups.

Benefits Object Hierarchies

Fusion Benefits configuration flexibly supports a wide variety of implementation strategies. While making trade-off decisions, such as processing time versus ongoing maintenance effort, you consider whether to control characteristics such as participant eligibility at a general level, at a detailed level, or at a combination of general and detailed levels.

Later documentation details the benefits object hierarchy, setup override rules, and configuration examples. At this point of this overview topic, the important points are:

  • A benefits object hierarchy organizes a benefits program, plan types, plans in program or plans not in program, and options from top to bottom, general to detailed.

  • Depending on the outcomes of strategic implementation trade-off decisions, you have the flexibility to configure most aspects of a benefits package at more than one level in the hierarchy.

  • Population of all four levels of a benefits object hierarchy is not required.

The following diagram shows the four levels of benefits object hierarchy: benefits program, plan types in program or not in program, plans in program or plans not in program, and options from top to bottom, general to detailed.

Benefits object hierarchies

Object Creation Sequence

The sequence for creating benefits hierarchy objects differs from the resulting hierarchical order. You can create new objects as needed at any time. However, because some benefits hierarchy objects are referenced during the definition of other benefits hierarchy objects, it is more efficient to create these objects in the order shown in the figure. Benefits object hierarchy architecture is further described in the related topic: Benefits Hierarchy Objects: How They Work Together.

This figure illustrates the most efficient sequence for creating benefits hierarchy objects: plan types, options (if used), plans, then programs.

Sequence for creating benefits hierarchy objects

  1. Begin by creating one or more plan types. Plan types organize plans into groups that provide similar categories of benefits, such as health, savings, education, and so on. At the plan type level of the hierarchy, you can efficiently administer corporate benefits policies that apply across all plans within that benefit category or type.

  2. When creating an option, you can optionally associate one or more existing plan types. This restricts the availability of the option to plans that belong to the named plan types.

  3. When using the plan configuration process to define benefit plan details, you must associate one existing plan type, and can optionally tie existing options to the plan.

  4. When using the program configuration process to define program details, you can associate existing plan types and existing plans with the program.

Benefits Component Creation Sequence

The following figure illustrates some of the dependencies among setup data components, showing several types of setup components organized around the periphery of the main benefits objects. Some types of components are delivered and some types are not.

Benefits setup components

Here is additional information about some of the setup components in the figure.

  • A lengthy list of derived factors is delivered.

    Various combinations of derived factors can be used to define different eligibility profiles.

  • Some temporal and scheduled life events are delivered.

    On the Create Life Events page, you can extend the list of available life events by creating as many of your own unique life events as you need. You can set up life events so that they will be triggered by certain temporal derived factors, such as age or length of service. Life events are reusable, and can be used to control enrollment at the program, plan, and option levels.

  • The enrollment certification types and determination rules are delivered.

    You cannot extend the available list of certification types or determinations rules, but you can rename the existing lookup values that appear in those fields. You can select different combinations of types and rules, and then set up the association with plans on the plan configuration process certification page.

  • A set of action items is delivered.

    You cannot extend the list of available action items, but you can rename them on the Manage Action Items page. You can associate action items with designation requirements at the plan type level or at the plan level, but not at both levels within the same object hierarchy.

  • No eligibility profiles are delivered.

    You can create as many eligibility profiles as you need. Eligibility profiles are reusable. You can associate eligibility profiles at the following levels: option in plan, plan, plan in program, plan type in program, and program. Eligibility profiles are also used in definitions for variable rate and variable coverage profiles. An eligibility profile must be specified when you create variable rate or variable coverage profiles.

  • A set of option types is delivered for selection when you define your plan type objects.

    Option types control internal processing. For example, plan types in the Health coverage category are processed differently than plan types for Savings . The delivered list of option types is not extensible.

  • Rates and coverages setup follows plan and option setup because rates and coverages are specific to named plans and options.

    Rates and coverages can be associated at many levels in your configuration, such as plan, option in plan, and option in plan in program.

  • Variable rate and coverage profiles can be associated with rates and coverages, respectively, so that the calculated results vary with factors that change over time, such as age group or work location.

  • If you define coverage across plan types, that setup occurs after setting up the affected programs.

    You must select one existing program and one or more existing plan types during setup of coverage across plan types.

Note

You will not always perform setup for all of the components shown in the figure.

Manage Benefit Eligibility

Eligibility Components: How They Work Together

You add eligibility criteria to an eligibility profile, and then associate the profile with an object that restricts eligibility.

The following figure shows the relationships between eligibility components.

Eligibility profile components and associated objects

Eligibility Criteria

You can add different types of eligibility criteria to an eligibility profile. For many common criteria, such as gender or employment status, you can select from a list of predefined criteria values. However, you must create user-defined criteria and derived factors before you can add them to an eligibility profile.

Eligibility Profile

When you add an eligibility criterion to a profile, you define how to use it to determine eligibility. For example, when you add gender as a criterion, you must specify a gender value (male or female) and whether to include or exclude persons who match that value.

Associating the Profile with Objects

You can associate an eligibility profile with different kinds of objects:

  • Associate an eligibility profile with a variable rate or variable coverage profile to establish the criteria required to qualify for that rate or coverage.

  • Associate an eligibility profile with a checklist task to control whether that task appears in an allocated checklist.

  • Associate an eligibility profile with a total compensation statement to apply additional eligibility criteria after statement generation population parameters.

  • Associate one or more eligibility profiles with a benefits or compensation object to establish the eligibility criteria for specific plans and options.

Derived Factors: Explained

Derived factors define how to calculate certain eligibility criteria that change over time, such as a person's age or length of service. You add derived factors to eligibility profiles and then associate the profiles with objects that restrict eligibility.

Derived Factor Types

You can create six different types of derived factors: age, compensation, length of service, hours worked, full-time equivalent, and a combination of age and length of service.

Determination Rules and Other Settings

For each factor that you create, you specify one or more rules about how eligibility is determined. For example, the determination rule for an age derived factor specifies the day on which to evaluate the person's calculated age for eligibility. If the determination rule is set to the first of the year, then the person's age as of the first of the year is used to determine eligibility.

For the full-time equivalent factor, you specify the minimum and maximum full-time equivalent percentage and whether to use the primary assignment or the sum of all assignments when evaluating eligibility. For example, if the percentage range is 90 to 100 percent for the sum of all assignments, then a person who works 50 percent full-time on two different assignments is considered eligible.

Other settings define the unit of measure for time or monetary amounts, rounding rules, and minimums and maximums.

Derived Factors: Examples

The following scenarios illustrate how to define different types of derived factors:

Age

Benefits administrators frequently use age factors to determine dependent eligibility. You can also use age as a factor when determining life insurance rates. Age factors typically define a range of ages, referred to as age bands, and rules for evaluating the person's age. The following table illustrates a set of age bands that could be used to determine eligibility for life insurance rates that vary based on age.


Derived Factor Name

Greater Than or Equal To Age Value

Less Than Age Value

Age Under 25

1

25

Age 25 to 34

25

35

Age 35 to 44

35

45

Age 45 to 54

45

55

Age 55 to 64

55

65

Age 64 or Older

65

75

The determination rule and other settings for each age band are the same:


Field

Value

Determination Rule

First of calendar year

Age to Use

Person's

Units

Year

Rounding

None

Length of Service

A derived factor for length of service defines a range of values and rules for calculating an employee's length of service. The following table illustrates a set of length-of-service bands that could be used to determine eligibility for compensation objects such as bonuses or severance pay.


Derived Factor Name

Greater Than or Equal To Length of Service Value

Less Than Length of Service Value

Service Less Than 1

0

1

Service 1 to 4

1

5

Service 5 to 9

5

10

Service 10 to 14

10

15

Service 15 to 19

15

20

Service 20 to 24

20

25

Service 25 to 29

25

30

Service 30 Plus

30

999

The determination rule and other settings for each length-of-service band are the same:


Field

Value

Period Start Date Rule

Date of hire (This sets the beginning of the period being measured.)

Determination Rule

End of year (This sets the end of the period being measured.)

Age to Use

Person's

Units

Year

Rounding

None

Compensation

A derived factor for compensation defines a range of values and rules for calculating an employee's compensation amount. The following table illustrates a set of compensation bands that could be used to determine eligibility for compensation objects such as bonuses or stock options.


Derived Factor Name

Greater Than or Equal To Compensation Value

Less Than Compensation Value

Less than 20000

0

20,000

Salary 20 to 34000

20,000

35,000

Salary 35 to 49000

35,000

50,000

Salary 50 to 75000

50,000

75,000

Salary 75 to 99000

75,000

100,000

Salary 100 to 200000

100,000

200,000

Salary 200000 Plus

200,000

999,999,999

The determination rule and other settings for each compensation band are the same:


Field

Value

Determination Rule

First of year

Unit of Measure

US Dollar

Source

Stated compensation

Rounding

Rounds to nearest hundred

Age to Use: Points to Consider

The Age to Use value that you select is an important aspect of an age derived factor. This value determines whose birth date is used to calculate the derived age.

Selecting Person's Age to Use

In most cases, you use the Person's value in the Age to Use field to define an age derived factor for either a participant or dependent eligibility profile. In this case, each person's birth date is used to calculate the age criterion by which eligibility is evaluated for that person.

Example

For example, if you select Person's as the Age to Use value, and associate the age derived factor with a dependent eligibility profile, each dependent's eligibility is evaluated based on the age calculated from his or her own birth date.

Selecting Other Age to Use Values

You might select another predefined value in the Age to Use field if you intend to evaluate participant or dependent eligibility or rates based on someone else's age, such as a spouse, child, or other dependent.

Note

If you choose Inherited Age, the evaluation is based on the date of birth as defined in the person extra information flexfield.

Example

If you select Person's oldest child as the Age to Use value, and associate this derived factor with a dependent eligibility profile, eligibility for all dependents is evaluated based on the age of the participant's oldest child. Consequently, when the oldest child reaches the maximum age of eligibility, for instance, all dependents become ineligible.

User-Defined Criteria: Explained

You can define your own eligibility criteria that meet any special requirements of your organization. Associate your criteria with eligibility profiles for benefits, compensation, performance management, and so on. For example, your organization wants to use work-at-home assignment as the eligibility criteria for a monthly telecommunications allowance. While the table and column already exist, the data is not available from existing eligibility criteria tabs when creating the eligibility profile. You must first define the work-at-home criteria so that you can then use it with an eligibility profile.

The data for the eligibility criterion must be stored in a table that is accessible to the application.

  • If the data is stored in either the Person Attributes or Assignments table, you can:

    1. Select the table and column from a list.

    2. Select the lookup type to use to validate input values, including custom lookup types that you created for either table.

      For details, see the Setting Up Lookup-Based User-Defined Criteria: Worked Example topic.

    3. Optionally, specify a range of valid values, if the field stores a numeric value or a date.

    To select the correct values for the column and lookup fields, you must understand the basic structure of the Person Attributes and Assignment tables, which store the eligibility criteria data.

  • If the data is stored in a table other than the Person Attributes or Assignment tables, you must:

    1. Create a formula to retrieve the data from the table.

    2. Set the formula type to User-Defined Criteria.

You can define one or two sets of criteria in the User-Defined Criteria dialog box. The participant must meet the criteria defined in either set to be considered eligible or ineligible.

After you create your user-defined criteria, you can add it to an eligibility profile. Use it to make participants ineligible by selecting the Exclude check box when adding the user-defined criteria to an eligibility profile.

User-Defined Criteria: Examples

The following scenarios illustrate how you can create different types of user-defined criteria for use in eligibility profiles associated with benefits and compensation objects. In each example, you must:

  1. Create the user-defined criteria using the Manage User-Defined Criteria task in the Plan Configuration work area.

  2. Add the user-defined criteria to an eligibility profile using the Manage Eligibility Profile task.

  3. Set the criteria values to use in the eligibility profile.

  4. Associate the eligibility profile with the relevant benefits or compensation object.

Base Eligibility on a Custom Attribute

Your commercial diving company wants to offer different benefit rates to employees who dive to depths greater than 330 feet. In the Setup and Maintenance work area, you set up the lookup type, value set, and global segment of the Person Attributes descriptive flexfield table to store the data for each employee. For details, see the Setting Up Lookup-Based User-Defined Criteria: Worked Example topic.

  1. On either the create or edit page for user-defined criteria, set the following values.


    Field

    Value

    Table

    Person Attributes

    Column

    BEN_DIVE_DEPTH

    Lookup

    BEN_DIVE_DEPTH

    Enable range validation one

    Selected

  2. On either the create or edit page for the eligibility profile, add the user-defined criteria to an eligibility profile.

  3. On the Other tab, User-Defined Criteria subtab, set the following values.

    You might have to refresh the Meaning list before you see the choice that you want. To do so, click another subtab, such as Formula, and then click the User-Defined Criteria tab again.


    Field

    Value

    Set 1 Meaning

    329

    Set 1 To Meaning

    9999

    Exclude

    Clear

  4. Associate the eligibility profile with a benefit variable rate profile.

Base Eligibility on a Formula

Your company wants to offer a spot incentive bonus to hourly employees who worked 100 percent of their scheduled shift hours in a three month period. In the Setup and Maintenance work area, you used the Manage Fast Formula task to create the formula that calculates Scheduled Hours minus Worked Hours for each week in the previous three months. If the result of successive calculations is less than or equal to zero, then the formula returns a result of Yes.

  1. On the create or edit page for user-defined criteria, enter the following values.


    Field

    Value

    Access One Formula

    Worked_Sched_Hours_Percent

    Enable range validation one

    Clear

  2. On either the create or edit page for the eligibility profile, add the user-defined criteria to an eligibility profile.

  3. On the Other tab, User-Defined Criteria subtab, set the following values.

    You might have to refresh the Meaning list before you see the choice that you want. To do so, click another subtab, such as Formula, and then click the User-Defined Criteria tab again.


    Field

    Value

    Set 1 Meaning

    Yes

    Exclude

    Clear

  4. Associate the eligibility profile with the bonus compensation object.

Note

For very complex scenarios, your organization or implementation team can write a custom program to evaluate eligibility, and then create a formula that calls the custom program.

Use Eligibility to Exclude

Your organization wants to exclude workers with a work-at-home assignment from a transportation allowance.

  1. On the create or edit page for user-defined criteria, set the following values.


    Field

    Value

    Table

    Assignment

    Column

    Work_at_home

    Lookup

    YES_NO

    Enable range validation one

    Clear

  2. On either the create or edit page for the eligibility profile, add the user-defined criteria to an eligibility profile.

  3. On the Other tab, User-Defined Criteria subtab, set the following values.

    You might have to refresh the Meaning list before you see the choice that you want. To do so, click another subtab, such as Formula, and then click the User-Defined Criteria tab again.


    Field

    Value

    Set 1 Meaning

    Yes

    Exclude

    Selected

  4. Associate the eligibility profile with the transportation allowance compensation object.

Setting Up Lookup-Based User-Defined Criteria: Worked Example

This example demonstrates how you create user-defined criteria based on custom lookups and associate the user-defined criteria with benefits eligibility profiles.

A commercial diving company wants to offer different benefits rates to divers who dive deeper than 330 feet.


Decision to Consider

In This Example

Is a new lookup required?

Yes

What is the new lookup type and associated lookup codes?

Create the lookup type is BEN_DIVE_DEPTH with two lookup codes, SHALLOW and DEEP.

Do you want users to make a single selection from a choice list?

Yes

Create the value set BEN_DIVE_DEPTH for the new lookup type.

Should the data be stored in the Person Attributes or Assignments table?

Persons Attributes

To extend the Person Attributes table, associate the BEN_DIVE_DEPTH value set with a new global segment, Dive Depth, on the Persons Attributes descriptive flexfield.

Does the user-defined criteria identify eligibility or ineligibility?

Eligibility (Do not select Exclude)

Summary of Tasks

To create lookup-based user-defined criteria for benefits eligibility profiles, you first perform these tasks in the Setup and Maintenance work area.

  1. Create the benefit lookup.

  2. Create the benefit value set.

  3. Create the additional global segment on the descriptive flexfield.

  4. Deploy the modified descriptive flexfield.

Next, you perform these tasks in the Plan Configuration work area.

  1. Create the lookup-based user-defined criteria.

  2. Create the eligibility profile and associate the new user-defined criteria.

Create Benefit Lookup

While there is a Manage Benefit Lookups task, which you can use to edit existing benefits lookups, you must use this common lookup task to create benefits lookups.

  1. In the Setup and Maintenance work area, search for the Manage Common Lookups task.
  2. Click the Go to Task button for Manage Common Lookups to open the Manage Common Lookups page.
  3. In the Search Results section, create the lookup type, as shown in this table.

    Start the Lookup Type value with BEN_ for easy searching. This also ensures that they are available in the Manage Benefit Lookups task.

    Field

    Value

    Lookup Type

    BEN_DIVE_DEPTH

    Meaning

    Dive Depth

    Description

    Identifies whether the diver dives deeper than 330 feet

    Module

    Eligibility Profiles


  4. Click Save.

    You must create the lookup type before you can add lookup codes.

  5. In the Lookup Codes section, add and enable the lookup codes that you want to use for the lookup, as shown in this table.

    Field

    Values for Code 1

    Values for Code 2

    Lookup Code

    SHALLOW

    DEEP

    Display Sequence

    1

    2

    Enabled

    Select

    Select

    Start Date

    1/1/2000

    1/1/2000

    Meaning

    Shallow

    Deep

    Description

    Dives 330 feet or less

    Dives deeper than 330 feet


  6. Click Save and Close to return to the Overview page.

Create Benefit Value Set

  1. In the Setup and Maintenance work area, search for the Manage Value Sets task.
  2. Click the Go to Task button for Manage Value sets to open the Manage Value Sets page.
  3. On the Search Results toolbar, click the Create button to open the Create Value Set page.
  4. Complete the initial fields, as shown in this table.

    Field

    Value

    Value Set Code

    BEN_DIVE_DEPTH

    Module

    Eligibility Profiles

    Validation Type

    Table

    Value Data Type

    Character


  5. Complete the Definition fields, which appear after you select the validation type, as shown in this table.

    Field

    Value

    FROM Clause

    HCM_LOOKUPS

    Value Column Name

    MEANING

    ID Column Name

    LOOKUP_CODE

    WHERE Clause

    LOOKUP_TYPE='BEN_DIVE_DEPTH'


  6. Click Save and Close to return to the Manage Value Sets page.
  7. Click Done to return to the Overview page.

Create Global Segment

  1. In the Setup and Maintenance work area, search for the Manage Descriptive Flexfields task.
  2. Click the Go to Task button for Manage Descriptive Flexfields to open the Manage Descriptive Flexfields page.
  3. In the Name field of the Search section, enter Person to find the Persons Attributes descriptive flexfield.

    To extend the Assignments table, you would search for and edit the Assignment Attributes descriptive flexfield.

  4. In the Search Results section, select the Person Attributes row.
  5. On the Search Results toolbar, click the Edit button to open the Edit Descriptive Flexfield page..
  6. On the Global Segments toolbar, click the Create button to open the Create Segment page.
  7. Complete the general fields, as shown in this table.

    Field

    Value

    Name

    Dive Depth

    Code

    BEN_DIVE_DEPTH


  8. Complete the Column Assignment fields, as shown in this table.

    Field

    Value

    Data Type

    Character

    Table Column

    The next available attribute, such as ATTRIBUTE1


  9. In the Value Set field of the Validation section, select BEN_DIVE_DEPTH.
  10. In the Display Type field of the Display Properties section, select Drop-down List.
  11. Click Save and Close to return to the Edit Descriptive Flexfield page.
  12. Click Save and Close to return to the Manage Descriptive Flexfields page.

Deploy Modified Descriptive Flexfield

You deploy the edited descriptive flexfield to expose the field in the application and make it available for use when creating user-defined criteria.

  1. On the Search Results toolbar, click Deploy Flexfield.
  2. Click Done to return to the Overview page.

Create Lookup-Based User-Defined Criteria

  1. Open the Benefits Plan Configuration work area.
  2. Click Manage User-Defined Criteria in the Tasks pane to open the Manage User-Defined Criteria page.
  3. On the Search Results toolbar, click Create to open the Create User-Defined Criteria dialog box.
  4. Complete the User-Defined Criteria fields, as shown in this table.

    Field

    Value

    Name

    Ben Dive Depth

    Short Code

    BEN_DIVE_DEPTH


  5. Complete the Set 1 fields, as shown in this table.

    Field

    Value

    Table

    Person Attributes

    Column

    Attribute that you selected for your global segment, for example ATTRIBUTE1

    Lookup

    BEN_DIVE_DEPTH


  6. Click Save and Close to return to the Manage User-Defined Criteria page.

Create Eligibility Profile and Associate User-Defined Criteria

  1. Click Manage Eligibility Profiles in the Tasks pane to open the Manage Eligibility Profiles page.
  2. On the Search Results toolbar, click Create Participant Profile.

    These steps also apply to creating dependent profiles.

  3. In the Name field of the Eligibility Profile Definition section, enter Ben Dive Depth.
  4. Add your user-defined criteria in the Eligibility Criteria section of the User-Defined Criteria tab, as shown in this table.

    Field

    Value

    Sequence

    1

    User-Defined Criteria

    Ben Dive Depth

    Exclude

    Clear

    Set 1 Meaning

    Deep


    Be sure that you select the value in the Set 1 Meaning field. You might have to refresh the list before you see the choice that you want. To do so, click another tab, such as Formula, and then click the User-Defined Criteria tab again.

  5. Click Save and Close to return to the Manage Eligibility Profiles page.

Range of Scheduled Hours: Example

This example illustrates how to define eligibility criteria based on the number of hours an employee is scheduled to work within a specified period of time.

Weekly and Monthly Ranges

You want to limit eligibility for a benefits offering to employees who were scheduled to work between 30 and 40 hours each week or between 130-160 each month as of the end of the previous quarter. To do this, add two different ranges on the Range of Scheduled Hours tab, which is under the Employment tab on the Create or Edit Eligibility Profile page.

Set the values for the first range as shown in this table:


Field

Value

Sequence

1

Minimum Hours

30

Maximum Hours

40

Scheduled Enrollment Periods

Weekly

Determination Rule

End of previous quarter

Set the values for the second range as shown in this table:


Field

Value

Sequence

2

Minimum Hours

130

Maximum Hours

160

Scheduled Enrollment Periods

Monthly

Determination Rule

End of previous quarter

Eligibility Profiles: Explained

An eligibility profile defines criteria used to determine whether a person qualifies for a benefits offering, variable rate profile, variable coverage profile, compensation object, checklist task, or other object for which eligibility must be established.

The following are key aspects of working with eligibility profiles:

  • Planning and prerequisites

  • Specifying the profile type, usage, and assignment usage

  • Defining eligibility criteria

  • Excluding from eligibility

  • Assigning sequence numbers

  • Adding multiple criteria

  • Viewing the criteria hierarchy

Planning and Prerequisites

Before you create an eligibility profile, consider the following:

  • If an eligibility profile uses derived factors, user-defined formulas, or user-defined criteria to establish eligibility, you must create these items before you create the eligibility profile.

  • If you are defining eligibility criteria for a checklist task, variable rate profile, or variable coverage profile, you must include all criteria in a single eligibility profile, because these objects can be associated with only one eligibility profile. You can, however, associate multiple eligibility profiles with benefits offerings , compensation objects and the Performance Management object.

  • Eligibility profiles are reusable, so use names that identify the criteria being defined rather than the object with which the profile is associated. For example, use "Age-20-25+NonSmoker" rather than "Supplemental Life-Min Rate."

Specifying Profile Types, Usage, and Assignment Usage

When you create an eligibility profile, you specify whether the profile applies to participants or dependents.

  • Use participant profiles to define criteria for a person who has a work relationship with the legal employer as an employee, contingent worker, or nonworker.

  • Use dependent profiles for participants' spouses, family members, or other individuals who qualify as dependents. Dependent profiles can be associated with only benefit plans and plan types.

An eligibility profile's usage determines the type of objects with which the profile can be associated. For example, set the profile usage to:

  • Benefits to make the profile available to associate with benefits objects, such as programs, plans, plan types, options, variable rate profiles, and variable coverage profiles

  • Compensation to make the profile available to associate with individual and workforce compensation plans as well as total compensation statements

  • Global to make the profile available to multiple business processes

  • Goals to make the profile available to associate with goals when creating a goal plan or mass assigning goals, or to associate with goal plans

For Performance Management, you can select any usage.

When you create an eligibility profile, you specify which assignment to use with it. For profiles where usage is Compensation or Performance, select Specific Assignment. For Performance Management eligibility profiles, you must select the Participant type and Specific Assignment as the assignment to use.

Defining Eligibility Criteria

Criteria defined in an eligibility profile are divided into categories:

  • Personal: Includes gender, person type, postal code ranges, and other person-specific criteria

  • Employment: Includes assignment status, hourly or salaried, job, grade, and other employment-specific criteria

  • Derived factors: Includes age, compensation, length of service, hours worked, full-time equivalent, and a combination of age and length of service

  • Other: Includes miscellaneous and user-defined criteria

  • Related coverage: Includes criteria based on whether a person is covered by, eligible for, or enrolled in other benefits offerings.

Some criteria, such as gender, provide a fixed set of choices. The choices for other criteria, such as person type, are based on values defined in tables. You can define multiple criteria for a given criteria type.

Excluding from Eligibility

For each eligibility criterion that you add to a profile, you can indicate whether persons who meet the criterion are considered eligible or are excluded from eligibility. For example, an age factor can include persons between 20 and 25 years old or exclude persons over 65. If you exclude certain age bands, then all age bands not explicitly excluded are automatically included. Similarly, if you include certain age bands, then all age bands not explicitly included are automatically excluded.

Assigning Sequence Numbers

You must assign a sequence number to each criterion. The sequence determines the order in which the criterion is evaluated relative to other criteria of the same type.

Adding Multiple Criteria

If you define multiple values for the same criteria type, such as two postal code ranges, a person needs to satisfy at least one of the criteria to be considered eligible. For example, a person who resides in either postal range is eligible.

If you include multiple criteria of different types, such as gender and age, a person must meet at least one criterion defined for each criteria type.

Viewing the Criteria Hierarchy

Select the View Hierarchy tab to see a list of all criteria that you have saved for this profile. The list is arranged by criteria type.

Combining Eligibility Criteria or Creating Separate Profiles: Points to Consider

You can define multiple criteria in an eligibility profile or create separate profiles for individual criterion. To determine the best approach, consider the following:

  • Does the object you are defining eligibility for support multiple eligibility profiles?

  • What is the best approach in terms of efficiency and performance?

Support for Multiple Eligibility Profiles

If you are defining eligibility criteria for a checklist task, variable rate profile, or variable coverage profile, you must include all criteria in a single eligibility profile, because these objects can be associated with only one eligibility profile. You can, however, associate multiple eligibility profiles with benefits offerings , compensation objects and the Performance Management object.

Efficiency and Performance

For optimum performance and efficiency, you should usually attach profiles at the highest possible level in the benefits object hierarchy and avoid duplicating criteria at lower levels. Plan types in program, plans in program, plans, and options in plans inherit the eligibility criteria associated with the program. For example, to be eligible for a benefits plan type, a person must satisfy eligibility profiles defined at the program level and at the plan type in program level.

However, it is sometimes faster to create more than one profile and attach the profiles at various levels in the hierarchy. For example, you might exclude employees from eligibility at the program level who do not have an active assignment. At the level of plan type in program, you might exclude employees who do not have a full-time assignment. Finally, at the plan level, you might exclude employees whose primary address is not within a service area you define.

Note

Eligibility criteria can be used to include or exclude persons from eligibility. Sequencing of criteria is more complicated when you mix included and excluded criteria in the same profile. For ease of implementation, try to keep all excluded criteria in a separate eligibility profile.

Creating a Participant Eligibility Profile: Worked Example

This example demonstrates how to create a participant eligibility profile used to determine eligibility for variable life insurance rates. The profile includes two eligibility criteria: age and tobacco. Once the eligibility profile is complete, you can associate it with a variable rate profile.

The following table summarizes key decisions for this scenario.


Decisions to Consider

In this Example

What is the profile type?

Participant

What type of object is associated with this profile?

Variable rate for benefits offering

What types of eligibility criteria are defined in this profile?

Age derived factor (must have been previously defined)

Uses Tobacco criteria

What are the criteria values?

Age: Under 30

Tobacco Use: None

Should persons meeting these criteria be included or excluded from eligibility?

Included

The following figure shows the tasks to complete in this example:

Tasks involved in creating a participant eligibility profile in this example.

Note

In this example, you create one eligibility profile that defines the requirements for a single variable rate. Typically, you create a set of eligibility profiles, one for each variable rate. When you have completed all steps described in this example, you can repeat them, varying the age and tobacco use criteria, to create a separate profile for each additional rate.

Prerequisites

  1. Create an age derived factor for ages less than 30.

Creating the Eligibility Profile

  1. In the Plan Configuration work area, click Manage Eligibility Profiles.
  2. Click the Create menu, and then click Create Participant Profile.
  3. In the Eligibility Profile Definition region of the Create Participant Eligibility Profile page, complete the fields as shown in this table. Use the default values except where indicated.

    Field

    Value

    Name

    Age Under 30+Non-Smoking

    Profile Usage

    Benefits

    Description

    Participant, age under 30, non smoker

    Status

    Active

    Assignment to Use

    Any assignment


Adding the Derived Factor for Age

  1. In the Eligibility Criteria region, select the Derived Factors tab.
  2. On the Age tab, click Create.
  3. In the Sequence field, enter 1.
  4. In the Age field, select the derived factor that you previously defined for ages under 30.
  5. Do not select the Exclude check box.

Adding the Criteria for Tobacco Use

  1. Select the Personal tab.
  2. On the Uses Tobacco tab, click Create.
  3. In the Sequence field, enter 1.
  4. In the Tobacco Use field, select None.
  5. Do not select the Exclude check box.
  6. Click Save and Close.

Associating the Eligibility Profile with a Variable Rate Profile

  1. In the Plan Configuration work area, click Manage Benefits Rates.
  2. Select the Variable Rates tab.
  3. Click Create.
  4. In the Eligibility Profile field, select the eligibility profile you just created.
  5. Complete other fields as appropriate for the rate.
  6. Click Save and Close.

    Note

    You can reuse this eligibility profile by associating it with other objects that restrict eligibility, including benefits offerings, compensation plans, and checklist tasks.

Eligibility Profiles: Examples

The following examples illustrate scenarios where eligibility profiles are needed and briefly describe the setup required for each scenario.

401(k) Eligibility

A 401(k) savings plan is restricted to full-time employees under 65 years of age. To restrict eligibility for the plan, you must first create a derived factor for the age band of 65 and older, if one does not already exist. Then create an eligibility profile. Set the Profile Usage to Benefits and the Profile Type to Participant. Add the following criteria:


Criteria Type

Name

Values

Employment

Assignment Category

Full-Time

Derived Factor

Age

Select the age derived factor you created previously, and then select the Exclude check box.

Associate the eligibility profile with the 401(k) plan.

Bonus Eligibility

A bonus is offered to all employees who received the highest possible performance rating in all rating categories. To restrict eligibility for the bonus, create an eligibility profile. Set the participant type to Participant, profile usage to Compensation or Global, and use in assignment to Specific Assignment. Add the following criteria for each rating category:


Criteria Type

Name

Values

Employment

Performance Rating

Select the performance template and rating name, and then select the highest rating value.

Associate the eligibility profile with the bonus compensation object.

Checklist Task Eligibility

A new hire checklist contains tasks that do not apply to employees who work in India. To restrict eligibility for the tasks, create a participant eligibility profile. Set the Profile Usage to Checklist and the Profile Type to Participant. Add the following criteria:


Criteria Type

Name

Values

Employment

Work Location

Select India as the work location, and then select the Exclude check box.

Associate the eligibility profile with each checklist task that does not apply to workers in India.

Grandfathered Benefits Eligibility: Explained

Grandfathered eligibility enables participants who have been enrolled in a benefit to retain eligibility to elect that benefit when they would otherwise not be eligible to elect it.

Setting up grandfathered eligibility involves creating a benefits group and an eligibility profile based on the benefits group. You associate the eligibility profile with the benefits offering, and associate the benefits group with the individuals who qualify to be grandfathered into the offering.

This figure shows creating a benefits group, using it in an eligibility profile, and associating the profile to a benefits offering and the group to its members.

Configuring grandfathered benefits eligibility

These are the basic steps:

  1. Create a benefits group named descriptively, such as Grandfathered Eligibility. Select Navigator - Plan Configuration. Then click Manage Benefit Groups in the task pane.

  2. Select the Manage Eligibility Profiles task and create an eligibility profile using these criteria:


    Criteria Type

    Criteria Name

    Value

    Other

    Benefit Groups

    Select the grandfathered benefits group that you created.

  3. On the eligibility step of the plan configuration process, select the grandfathered eligibility profile for the benefits offering and make it required.

  4. Assign the benefits group to workers who qualify for the benefit.

    Either assign to individuals using the Manage Person Habits and Benefit Groups task in the Benefits Service Center, or assign to many workers in a batch load.

Managing Postal Code Ranges and Service Areas in the Integrated Workbook: Explained

You can define postal code ranges and services areas to use as eligibility criteria using the integrated Microsoft Excel workbooks. You group postal codes into ranges, and in turn group ranges into service areas. Service areas define geographical regions as eligibility criteria when work location is not adequate. You can create multiple postal code ranges and service areas in a single integrated workbook. Then, upload them into the application database. Repeat these steps as many times as required to accommodate revisions.

The basic process for managing postal code ranges and services areas using the workbook is:

  1. Generate the workbook.

  2. Edit postal code ranges and service areas in their respective worksheets.

  3. Upload edits.

  4. Resolve errors.

Generating the Workbook

On the Plan Configuration work area:

  1. In the Tasks pane, under Manage Eligibility, click Manage Benefit Service Areas.

  2. In the Search Results section of either the Postal Code Ranges or Service Areas tab, click Prepare in Workbook.

Editing Postal Code Ranges and Service Areas in the Workbook

You add new postal code ranges in the Load Postal Code Ranges worksheet. The columns in the Postal Code Ranges section of the worksheet are the same as the Create Postal Code Ranges dialog box fields.

You add new service areas and edit existing ones in the Load Service Areas worksheet. The columns in the Service Areas section of the worksheet are the same as the Create Service Area dialog box fields. For each service area that you add, enter the postal code ranges that comprise the service area. You can enter multiple postal code ranges for a single service area. Do so by naming the service area in the first column of the Postal Code Ranges section of the worksheet for each postal code row.

Restriction

The postal code ranges must already be in the application database before you can enter them in the worksheet rows. Upload any new postal code ranges first, before you upload your service area edits.

The workbook uses the Changed cell in both worksheets to automatically identify the rows that you edit.

Uploading Edits

After you complete your edits, click Upload. Only those rows marked as changed are uploaded into the application tables.

The Worksheet Status field is updated only if the server or database becomes inaccessible during upload.

Restriction

You cannot edit postal code ranges in the worksheet if they uploaded successfully. To edit the postal code ranges after upload, you must search for the range on the Postal Code Ranges tab of the Manage Postal Code Ranges and Service Areas page. Then, you select the range and click Edit.

Resolving Errors

The application automatically updates the Status value in each row of the workbook. If there are errors that require review, the upload rolls back the change in the application and sets the row status in the workbook to Upload Failed. It then continues to the next row in the workbook. You double-click Update Failed in the Status cell to view the error. Fix any data issues in the workbook and upload the new changes.

When you upload the service area worksheet with postal code ranges that were not successfully uploaded, the data in the Service Area section might upload successfully. However, any rows in the Postal Code Ranges section of the worksheet with values not yet uploaded, have an error status indicating invalid postal code range.

FAQs for Manage Benefit Eligibility

What happens if I include multiple criteria in an eligibility profile?

If you define multiple values for the same criteria type, such as two postal code ranges, a person needs to satisfy at least one of the criteria to be considered eligible. For example, a person who resides in either postal range is eligible. If you include multiple criteria of different types, such as gender and age, a person must meet at least one criterion defined for each criteria type.

What happens if I do not select the Required option when I add an eligibility profile to an object?

If you add only one eligibility profile to an object, then the criteria in that profile must be satisfied, even if the Required option is not selected. If you add multiple eligibility profiles, the following rules apply:

  • If all profiles are optional, then at least one of the profiles must be satisfied.

  • If all profiles are required, then all of the profiles must be satisfied.

  • If some but not all profiles are required, then all required profiles must be satisfied and at least one optional profile must also be satisfied.

Manage Benefit Life Events

Life Events: Explained

A life event is a change to a person or a person's employment that affects benefits participation. Examples of life events are changes in worker assignment, anniversary of employment, and marriage. Life events affect benefits processing for a worker.

Aspects of life events that are related to benefits processing are:

  • Type

  • Status

Type

The four types of life events are explicit, temporal, scheduled, and unrestricted. You configure explicit life events during implementation. They can include either personal or work-related changes, such as an address change or assignment transfer. Temporal life events occur with the passage of time, such as the sixth month of employment, and are predefined. For temporal events, you use derived factors associated with plan design eligibility factors. Scheduled life events are assigned. Open enrollment periods are an example of a scheduled life event. Unrestricted life events are for benefit enrollments that are not time-dependent, such as savings plan enrollments. Participants can make enrollment changes at any time.

Status

Two life event statuses are important for benefits processing, potential and active. Potential life events are detected life events, but they do not generate enrollment actions. Potential life events are processed by the participation evaluation process. If potential life events meet plan design requirements, they become active life events, which can generate enrollment opportunities.

In addition to life events statuses that affect benefits processing, you can update individual life event statuses for a worker. Life events statuses that you can set include closed, backed out, and voided. Closing a life event prevents further enrollment processing of the life event. Backing out a life event rescinds any updates to worker records that are generated by the participation evaluation process. You can back out only life events in the started status or processed status. Voiding a life event rescinds any updates and prevents further processing.

Explicit Life Events: Explained

You configure explicit life events during implementation. They can include either personal or work-related changes, such as an address change or assignment transfer. Define an explicit life event by specifying its processing characteristics and the database changes that generate it. Use criteria similar to those that define eligibility profiles and variable rate profiles.

Aspects of explicit life events include:

  • Type

  • Definition

  • Detection

Type

The two types of explicit life events are person change and related person change. A person change is a change in HR data that you define to indicate that a person has experienced a life event. A related person change is a change in HR data that you define to indicate that a person has experienced a related-person life event.

Definition

To define changes to a person's record that generate a life event, you specify database table and column values that, when changed, are detected and processed as a life event. For example, you might define that a life event occurs when the database value of a person's marital status changes from single to married. An example of a related-person life event is when a participant's child, who is older than 26, becomes disabled. The participant's record can be updated to reflect this and the child can be designated as a dependent.

Note

If you do not find criteria among choices in selection lists of table and column objects, you can use a formula to generate a life event.

Associate the person change that you define with a life event. You can link multiple person changes to a single life event and you can link a single person change to more than one life event.

Detection

Specify the new value for this combination of database table and column that, when detected, indicates that a life event has occurred. A person change can be defined to be detected based on:

  • A new value

  • A change from a specific old value to a specific new value

  • Any change to a value

  • A change from any value to no value

  • A change from no value to any value

You can use a formula to define more complex conditions for detecting a life event.

If you define a life event based on changes to more than one table, the life event is detected when a data change in one of the tables meets the person change criteria. For life events that entail multiple changes to the same table, the person must satisfy all person change criteria associated with the table for the life event to be detected.

Scheduled Life Events: Explained

A scheduled life event is an assigned life event, such as an open enrollment period.

Types of scheduled life events are:

  • Administrative

  • Open enrollment

Administrative

Assign administrative life events to a person or group when the terms and conditions of a benefit plan change significantly and participants must be allowed to re-evaluate their elections. This type of life event is also used during implementation to upload data initially. Examples of administrative life events include renegotiation of contract rates or addition of a new benefit.

Open Enrollment

The open enrollment life event determines eligibility for an open enrollment period. Open enrollment periods typically recur on a scheduled basis, such as an annual health and welfare benefits enrollment or a quarterly savings plan enrollment.

Unrestricted Life Events: Explained

Use unrestricted life events for benefit enrollments that are not time-dependent, such as savings plan enrollments. Participants can make enrollment changes at any time.

The two types of unrestricted life event are:

  • Unrestricted

    Unrestricted life events have a one day enrollment period and remain in the started status until the next unrestricted life event is started.

  • Unrestricted Open

    You can configure the enrollment period for unrestricted open life events.

Aspects of Unrestricted Life Events

These aspects are common to both unrestricted and unrestricted open life events:

A new unrestricted life event is started every time an attempt is made to alter the benefits enrollment. Any previous unrestricted life event is closed at that time. Consequently, from the worker's or benefits professional's perspective, unrestricted life events have no enrollment period limitation.

Unrestricted life events in started status are closed when evaluation processing occurs.

Processing an unrestricted life event with an effective date that is prior to existing unrestricted events will result in the later events being backed out, but does not affect any other types of life events.

Temporal Life Events: Explained

All temporal life events are predefined. Temporal life events occur with the passage of time, such as the sixth month of employment.

Aspects of temporal life events include:

  • Types

  • Detection rules

  • Implementation

Types

The predefined temporal life events use derived factors and include:

  • Derived age

  • Derived combination of age and length of service

  • Derived compensation

  • Derived hours worked in period

  • Derived length of service

  • Derived total percentage of full time

When you run the participation evaluation process in scheduled, life event, or temporal mode, a life event is created when the minimum or maximum boundary is crossed as specified in the definition of the applicable derived factor.

Detection Rules

When you create or edit a life event, select from among these options for the temporal detection rule:

  • Do not detect past or future temporal events

    This option prevents the detection of past temporal events while the application processes this life event.

  • Do not detect past temporal events

    The second option prevents temporal event detection while the application processes the specified life event. Use this rule with open and administrative events, or explicit events, when you do not want to detect temporal events.

  • Never detect this temporal life event

    This option prevents the automatic detection of a specific temporal event. Set this rule for any seeded temporal event, for example, age change or length of service change, that you do not want to detect, such as during mid-year changes.

Implementation

Use predefined temporal life events that are calculated from derived factors in plan and program design configuration, in conjunction with eligibility profiles or variable rate profiles attached to eligibility profiles.

Manage Benefit Programs and Plans

Benefits Hierarchy Objects: How They Work Together

Use one or more benefit object hierarchies to organize and maintain your benefits offerings. Administrative policies and procedures, such as eligibility requirements, life event definitions, costs, and coverage limits that are set at a higher level cascade to objects at lower levels, unless overridden by more specific rules defined at a lower point in the hierarchy.

This figure shows a benefits object hierarchy for a health insurance benefits offering that is populated at all four available levels: program, plan type, plan, and option.

Example benefits object hierarchy for health insurance offerings

Note

The icons shown in the figure also appear next to benefits objects in various places throughout the application. The icons serve to quickly identify the benefits object function: program, plan type, plan, or option

Within the health insurance program are two plan types: medical and dental. Two medical plans are within the medical plan type, and two dental plans are within the dental plan type.

At the fourth level are options to enroll the employee plus family, employee plus spouse, or employee only. Once defined, options can be reused. For example, the option to enroll the employee plus spouse is available to both the health maintenance organization and the preferred provider organization medical plans, but is not available to either dental plan. The employee option is associated with all plans in this hierarchy.

Note

It is not necessary to populate all four levels of the benefits object hierarchy.

  • When plans do not offer options, the options level of the hierarchy is not populated.

  • When a benefits offering such a savings plan is not organized under a program, and is subsequently identified as a plan not in program, the program level is not populated. The plan type becomes the top level, followed by the plan not in program at the next lower level. Options, if any, would populate the lowest level of the hierarchy.

    The following figure shows a hierarchy where the program level is not populated.

    Hierarchy of benefits not organized under a program

The plan type contains a plan not in program. The dashed lines indicate that if the plan not in program does not offer options, then the option in plan level is not populated. In that case, the hierarchy would have only two levels: plan type and plan not in program.

Program

Each program represents a package of related benefits and appears at the top level of its own hierarchy. Plan types, plans, and options appear at subordinate levels of the hierarchy. For example, a health insurance program spans medical, dental, and vision categories of expense coverage. All plans in a program inherit the program's currency definition.

Plan Type

A plan type is a category of plans, such as medical or dental insurance. Use plan types to efficiently define, maintain, and apply one set of administrative rules for all benefit plans of the same type.

Plan

A plan is a specific offering within the plan type. A health maintenance organization and a preferred provider organization are examples of specific medical insurance plans.

Option

An option is an electable choice within a plan, such as coverage for an employee, employee plus spouse, or the employee's immediate family. Options are reusable. Once defined, you can associate an option with one or more plans and plan types. When you associate an option with a plan type, you make that option available for selection in all plans of that plan type.

Benefits Prerequisite Setup Components: How They Work with Other Benefits Objects

You typically set up several components for later use while implementing and maintaining program and plan configurations.

The components specify rules that validate values or determine benefits eligibility. You can set up new, or edit existing components at any time. Because some components are used while defining other components, set up the components in the following sequence when possible.

  • Action items

  • Derived factors

  • Eligibility profiles

  • Life events

  • Variable rate profiles and variable coverage profiles

  • Variable rates and coverages

  • Standard rates and coverages

Enrollment and Beneficiary Action Items

You can define enrollment and beneficiary designation requirement action items which, if not provided, cause either enrollment in the benefit offering to be suspended or beneficiary enrollment to be suspended. You can define different certification requirements for different action items.

Derived Factors

Derived factors typically change with time, such as age, length of service, and compensation. You can use any of the available derived factors as decision criteria in a participant eligibility profile. You can use the Age derived factor in a dependent coverage eligibility profile.

Eligibility Profiles

After you define participant eligibility profiles and dependent coverage eligibility profiles, you can attach them to the appropriate level of the benefits object hierarchy to administer policies regarding who can participate in the benefits objects. You can attach multiple profiles to one object. Each profile can contain required criteria and optional criteria. For example, a profile could specify that eligible employees must work full time, and either have been employed for at least two years, or be assigned to a manager grade. You also associate eligibility profiles to a variable rate profiles and variable coverage profiles.

Life Events

You can administer benefits policies based on life events that occur to participants, such as the birth of a dependent or a work location change. You can set up certification requirements, designation requirements, and adjust rates and coverages based on predefined life events or events that you define. You can set up life events based on derived factors, such as age, length of service, and compensation.

Life events are defined separately from any benefits object or rate so that a single life event can have multiple uses.

  • Enrollment requirements - You can link qualifying life event definitions to the enrollment requirements for a benefits object. Subsequent occurrence of the life event causes participation evaluation processing to consider the person's eligibility for that object.

  • Enrollment coverage - You can vary the amount of coverage available for a plan based on a life event. You define the standard coverage amount for the plan or option in plan and the coverage level available for those participants who experience the life event. You can also limit a currently enrolled participant's ability to change coverage levels.

Variable Rate Profiles and Variable Coverage Profiles

Depending on your business requirements, you can associate one or more variable rate profiles and variable coverage profiles with rates and coverages, respectively.

The variable rate profile definition offers several delivered calculation methods. Also, the selected variable rate profile calculation can be defined to either replace or add to the standard rate calculation. Each eligibility profile can have one or more associated derived factor criteria, such as Age, Length of Service, and Compensation.

For example, you want the calculated rate for a participant's life insurance to vary depending on the participant's age. Participants in the 31 to 40 age group pay $3, those aged 41 to 50 pay $4, and those 51 to 60 pay $5. Configure three variable rate profiles, each with an eligibility profile matching the appropriate Age temporal attribute.

Note

Eligibility Profile is a required field when defining variable rate and coverage profile details.

Standard and Variable Rates

You attach standard rates to a benefits object to specify monetary contributions and distributions to be made by the employee and employer. A variety of standard rate calculation methods are predefined, or you can define your own formulas for this purpose. When a participant enrolls in a plan, participation evaluation processing enters the calculated result on a payroll element for the employee. Informational rates typically used for additional reporting do not use payroll elements.

Standard and Variable Coverages

Standard and variable coverages work similarly to standard and variable rates. Several calculation methods are predefined. You can create and attach variable coverage profiles to coverages using a method that is similar to the way that you create and attach variable rate profiles to rates. Also, variable coverage profile definitions require that you specify an eligibility profile, to which you can optionally attach one or more derived factors. Therefore, variable coverage calculated results can vary depending on the calculation method, associated eligibility profile, and temporal events.

Configuring Eligibility Criteria at General Vs. Detailed Hierarchy Levels: Example

Setup effort and operating performance vary depending on where eligibility criteria are defined within the benefits object hierarchy. Generally, you should associate criteria at the highest level that provides the needed degree of control. If a plan or option has specific requirements that are not common to the levels above it, then it is appropriate to associate criteria at that lower level.

Within the program configuration eligibility page, eligibility requirements can be defined at three levels: program, plan type in program, and plan in program. Within the plan configuration eligibility page, eligibility requirements can be defined at two additional levels: plan and option in plan.

When more than one set of eligibility requirements apply to a given circumstance, the eligibility criteria are cumulative. In other words, criteria set at a detailed level are in addition to, and do not override, criteria set at a general level.

The following figure shows the eligibility determination hierarchy with components organized from top to bottom, general to detailed.

Eligibility determination hierarchy

Wellness Program Eligibility Example

This example of wellness program eligibility illustrates an efficient approach to specifying eligibility requirements when criteria change at different levels of the hierarchy.

A legal employer is setting up a benefits offering. Eligibility for the program and its plans and options vary, depending on employment status, location, and gender criteria. The wellness program is for current and retired employees only. The program contains two plan types: medical and recreational. Within the medical plan type are two plans: the health maintenance organization plan and the preferred provider organization plan. Within the recreational plan type are two plans. The headquarters plan provides access to an on campus recreation facility for current and retired employees who work or live near headquarters. The field plan is for retired employees and current employees located at remote locations. Field options in plan consist of several national fitness franchises. The Esses franchise restricts membership to the female gender.

The following figure shows the wellness program eligibility determination hierarchy, with eligibility requirements set at the wellness program, field plan in program, and Esses franchise option in plan levels.

Eligibility determination hierarchy in the wellness program example

Eligibility Profile Setup

Eligibility Profile Setup

The intended program eligibility configuration requires three eligibility profiles set at three different levels of the hierarchy.

  • An employment status eligibility profile at the wellness program.

  • A location eligibility profile at the field plan in program. This is the highest level in the hierarchy at which this filter can be applied without inadvertently screening (for example, medical plan participants by location).

  • A gender eligibility profile at the Esses option in plan. Again, this filter is positioned at the highest level in the hierarchy that affords control of membership gender for only the Esses franchise.

Analysis

The eligibility determination hierarchy works like a set of increasingly finer sieves, with the program level serving as the coarse sieve.

  1. Because program-level eligibility criteria are evaluated first, the employment status criteria associated at the wellness program level includes only current and retired employees, which causes all persons who are not current or retired employees to be ineligible for further consideration for any objects at lower levels of the hierarchy.

  2. Next, the location eligibility profile on the field plan excludes current employees who live near headquarters from joining off-campus facilities.

  3. Finally, the gender eligibility profile associated with the Esses field plan option includes female membership only.

Eligibility criteria set at lower levels in the hierarchy are in addition to and do not override higher-level criteria. For example, the gender eligibility profile set up at the Esses plan option level includes females, but those females must also satisfy the employment status and location criteria set up at higher levels.

This strategy reduces processing time because the eligible population for consideration diminishes as the eligibility evaluation proceeds down the hierarchy. Although it is possible to attach an eligibility profile to each plan or option individually, that approach is much less efficient both in terms of setup and performance.

Eligibility Determination

Eligibility Determination

John is a retired employee who still lives near headquarters. As a retired employee, John meets the high-level criteria and therefore has access to the on-campus recreation facility plan. Because John is not a current employee working at headquarters, he is not excluded by the field-plan-level criteria for joining a national fitness franchise. Finally, the Esses plan option is not available to John, due to the plan-option-level gender criterion.

Overriding Benefit Plan Standard Eligibility Configuration: Points to Consider

You can override standard enrollment display using a family member rule and standard eligibility processing using eligibility verification. For example, if a participant has no spouse or dependents, show the Employee option and hide the Employee Plus Spouse or Employee Plus Family options.

You use the Manage Benefit Plan Details task in the Plan Configuration work area. On either the create or edit page for plan eligibility:

  1. In the Plan and Option Eligibility section, select the plan or option.

  2. In the Further Details section, click the Configuration tab.

Family Member Rule

Select whether or not to check for designation requirements, or use a formula.

  • The checking rule causes the application to determine whether the worker has any contacts with a relationship type that matches the designation requirements. If the application does not find any matches, it does not display that plan or option.

  • Use a formula if your business requirements are not addressed by designation requirements configuration. Before you can select a formula, you must create it."

Eligibility Verification

Specify whether participant eligibility is based on dependent eligibility and designation requirements associated with the plan or option.

  • Blank: Participant is eligible if he or she meets the eligibility requirements of the participant eligibility profile criteria. Eligibility is not based on dependent eligibility or designation requirements.

  • Dependent only: Participant is eligible only if the participant's dependents meet both the eligibility and designation requirements. Participant eligibility profiles are not evaluated.

  • Participant and dependent: Participant is eligible only if he or she, and his or her dependents, meet both the eligibility and designation requirements associated with the plan.

Configuring Enrollment Criteria at General Vs. Detailed Hierarchy Levels: Example

Setup effort and operating performance vary depending on where enrollment criteria are defined in the hierarchy. Generally, you should associate criteria at the highest level that provides the needed degree of control. If a plan or option has specific requirements that are not common to the levels above it, then it is appropriate to associate criteria at that lower level.

The following figure shows the enrollment determination hierarchy organized from top to bottom, left to right, general to detailed.

Enrollment determination hierarchy

Enrollment requirements defined at a lower level in the hierarchy override those definitions cascading from above.

At the left, the hierarchy shows the three enrollment configuration levels that are available on the program configuration enrollment page. The three enrollment requirement levels available during program configuration (organized from general to detailed) are program, plan type in program, and plan in program. Below the program enrollment configurations are the two enrollment configuration levels that are available on the plan configuration Enrollment page: plan and option in plan. Option in plan enrollment requirements set up on the plan configuration enrollment page override any definitions that have been set up at a higher level, such as the plan in program level of the program configuration enrollment page.

From the life event tabs that appear on the program configuration enrollment page and the plan configuration enrollment page, you can set up enrollment requirements associated with one or more life events at any of the available hierarchy levels.

Shown at the right side of this figure is a hierarchy of five enrollment configurations that are available from the Life Event tabs on the program and plan enrollment pages. Again arranged from general to detailed, these life event enrollment configurations are life event in program, life event in plan type in program, life event in plan in program, life event in plan, and life event in option in plan. Because life events are more specific, the life event configurations override their corresponding parallel configurations appearing immediately to their left in this figure.

For example, enrollment requirements at the life event in option in plan override those set up above, such as for the life event in plan. The life event in option in plan setup also overrides setup at the left for the option in plan.

Wellness Program Enrollment

This wellness program enrollment example illustrates an efficient approach for specifying enrollment requirements when criteria change at different levels of the hierarchy.

A legal employer is setting up an open enrollment period for the wellness program to recur every November. The wellness program contains two plan types: recreational and medical. The medical plan type includes a health maintenance organization (HMO) plan in program and a preferred provider organization (PPO) plan in program. Within the medical plans are options for covering the employee, employee plus spouse, and employee plus family.

Enrollment Requirement Setup

Enrollment Requirement Setup

This program enrollment configuration requires two enrollment period requirements set at different levels of the hierarchy.

  • An open enrollment period at the program level

  • An additional enrollment period at the life event in plan level

Analysis

First, we set up the open enrollment period at the wellness program level, because during that period, enrollment is available for all objects within the wellness program. Enrollment requirements set at a general level of the hierarchy cascade to lower levels, unless you specifically override them at a lower point in the hierarchy. To provide additional enrollment opportunities when a life event istriggered by adding a child to the participant's family, we attach an overriding enrollment requirement at the level of the medical plan.

Enrollment criteria set at lower levels in the hierarchy override higher-level criteria. For example, the program level enrollment period does not allow enrollment at any time other than November. However, life event set up at the plan level overrides the program level criteria. This set up creates an overriding enrollment opportunity whenever a child joins a participant's family.

This strategy reduces maintenance and processing time because the program level criteria controls enrollment for all persons, with one exception for a specific life event.

Enrollment Determination

Enrollment Determination

Jane adopts a child into her family during June. As a current employee, Jane participates in the wellness program, medical plan type, PPO medical plan, employee plus spouse option. Although the open enrollment period for the wellness program occurs only in November, Jane does not need to wait for the open enrollment period. The life event in plan override provides an immediate enrollment opportunity to change the enrollment option to employee plus family. However, Jane must wait for the open enrollment period to change enrollment in any object within the recreational plan type.

Plan Creation Methods: Points to Consider

Create benefits plans by using one of these methods, which are available on the Manage Plans page:

  • Complete the Quick Create Plan page.

  • Prepare and upload an integrated Microsoft Excel workbook.

  • Complete the plan configuration process.

  • Complete the Create Plan page accessed from the Quick Create Program page.

After creating a plan not in program, you can validate the completeness of the plan and options configuration.

Quick Create Plan

The Quick Create Plan page is useful when you want to quickly set up the essential framework of a benefit plan configuration. You can also create many standard rates to associate with the plan or option. This method enables you to create one plan type and multiple options in one place. Otherwise, you have to use first the Manage Plan Types task and then the Manage Benefit Options task.

You can immediately associate an existing, or newly created, plan type and options with the benefit plan.

You can quickly configure essential characteristics for a plan in program or not in program. When you set Usage as Not in program, an additional section appears. Use this section to specify currency, defined rate frequency, and communicated rate frequency, all of which are otherwise inherited from the overarching program configuration.

When you use the Quick Create Plan page, several plan characteristics are automatically set to commonly used values. If you must edit those default settings,, you can use the plan configuration process to retrieve the plan in program or plan not in program. Then, you can edit or add details at any time.

You cannot use the Quick Create Plan method to edit any existing object.

Integrated Microsoft Excel Workbook

The integrated workbook method is useful when you want to set up one or more benefit plans quickly. Enter basic plan details using the workbook. Save the file locally to share the plan designs with others. Then, upload the finalized plans to the application database. Use the Plan Configuration work area pages to edit and add configuration details.

You cannot edit an existing benefit plan using this method.

Plan Configuration Process

The plan configuration process provides you with the complete set of benefit plan characteristics, and therefore the greatest flexibility for setting up and maintaining plans.

This method is the only one that enables you to edit an existing plan, regardless of the method used to create the plan.

If you are midway through the plan configuration process and discover that you have not completed the setup for an object that you require for your plan configuration, you must:

  1. Leave this process.

  2. Go to the relevant task for setting up the missing object.

  3. Complete that auxiliary setup.

  4. Return to this process and complete the plan configuration.

Create Plan Page Accessed from the Quick Create Program Page

Another method to create a plan in program is available while you are using the Quick Create Program page to set up the essential framework of a program configuration. Click Create Plan to open the Create Plan Basic Details dialog box. Use this dialog box to specify the essential characteristics of a plan in program without having to go to the Manage Benefit Plan Details task.

The Create Plan Basic Details page enables you to associate the new plan with an existing plan type and multiple existing options. When you return to the Quick Create Program page, you can immediately associate the newly created plan with the program.

Validation of Plans Not in Program

The validation process identifies errors early in the setup process and enables the implementor to quickly resolve any issues that may occur. Plans in program are validated as part of the program validation.

In the Programs and Plans page, Plans tab, Search Results section, select a plan not in program and click Validate. On the Plan Hierarchy page, select an option and click Validate.

You can hover over those fields with icons to view a description of the status.

Quick Create Plan: Explained

Quick create plan functionality defines essential configuration for benefits plans.

Consider the following aspects of quick create plan functionality while deciding whether this method is appropriate for configuring a particular benefits plan:

  • Capabilities

  • Automatic settings

  • Editing saved plans

Quick Create Plan Capabilities

The ability to very quickly set up a large quantity of items produces a significant time savings. For example, you can quickly create numerous standard rates, and then update them with further details later.

You can use quick create plan functionality to:

  • Set up temporary plans for.

    • Testing and proof of concepts.

    • Confirming understanding of plan configuration requirements.

    • Supporting agile development techniques.

    • Pre-sales customer demonstrations.

  • Set up essential plan configuration, and then use the edit plan configuration functionality to add new or edit existing configuration at a later time.

  • Create and attach objects without exiting to other tasks.

    • Create a plan type and attach the plan to the plan type without exiting to the Manage Plan Types task.

    • Create options and attach them to the plan without exiting to the Manage Plan Options task.

    • Create an option in plan level employee and employer standard rate without exiting to the Manage Benefit Rates task.

    • Create an option in plan level coverage flat amount without exiting to the Manage Benefit Plan Coverage task.

Automatic Settings

When you use quick create plan functionality, the following field values are automatically set.

  • The plan status is set to Pending.

  • The statuses of any associated plan options are set to Active.

  • The types for any associated rates are set to standard rates.

  • The types for any associated coverages are set to standard coverages.

  • Program year periods are automatically selected for the range of two years before and one year after the current year. All plan year periods are of type calendar year.

  • For any associated eligibility profile, the Required criteria match check box is not selected.

  • The enrollment rule is set to Current - can keep or choose; new - can choose.

  • The plan function is set to Regular.

  • If the plan usage is set to In program, then Enable unrestricted enrollment is disabled.

  • If the plan usage is set to Not in program, Enable unrestricted enrollment is enabled. You can either select or not select that field.

  • If you enable unrestricted enrollment, then

    • Rate Start Date and Coverage Start Date are set to Event.

    • Previous Rate Start Date and Previous Coverage Start Date are set to One day before event.

    • Enrollment life event is set to Unrestricted.

    • Enrollment Period Start Date and Enrollment Period End Date are set to As of Event Date.

    • Close Enrollment Period Date is set to When elections are made.

No automatic settings are made for:

  • Dependent or beneficiary designation

  • Primary care physician designation

Note

You can later use Manage Benefit Plan Details configuration process to retrieve existing plan configurations and then edit any of the automatic settings. You can also add definitions that were not specified during the quick create process.

Editing Plan Configuration

You cannot use quick create plan functionality to edit any field of any saved plan. After you use quick create plan functionality to save a plan definition, you use manage benefit plan details functionality to retrieve the existing plan configuration. At that time, you can edit existing previously unspecified settings.

After retrieving a quick create plan, you can:

  • Change plan status.

  • Add predefined options. You can also change option status.

  • Add plan year periods for fiscal years.

  • Add or remove standard rates, and add imputed rates, and variable rates. You can select from several available predefined rate calculation methods or define your own rate calculation formulas.

  • Add or remove standard coverages, and add variable coverages. You can select from several available predefined coverage calculation methods or define your own coverage calculation formulas.

  • Add or remove eligibility profiles. You can also select the Required criteria match check box for any associated eligibility profile.

  • Configure requirements for:

    • Scheduled and life event enrollment

    • Dependent and beneficiary designation

    • Primary care physician designation

Program and Plan Validation Statuses: Explained

Validation results provide statuses for a range of setup objects, such as year periods, life events, action items, and rates, in the program or plan not in program hierarchy.

Examples of issues discovered during validation include:

  • Programs or plans with no associated plan years

  • Programs with no included plans

  • Incomplete configuration where required values are missing

Validation results appear in a tabular display, with the following indicators for each setup object and each level in the specified hierarchy path.


Description of the Cell Contents

Status

Green with check mark

Required setup exists.

Green with red x

Required setup does not exist.

White with green check mark

Optional setup exists.

White with question mark

Optional setup does not exist. No error, informational.

Plain green

Optional level not configured. Setup is required if the level is added.

Plain white

Optional level not configured. Setup would be optional if the level is added.

Gray

Setup is not applicable.

Waive Plans and Waive Options: Explained

Waive plans and waive options enable participants to decline enrollment opportunities for which they are otherwise eligible.

Consider the following aspects

  • Benefits of including waive plans and options in plan configurations

  • Creating and using waive plans

  • Creating and using waive options

Benefits of Waive Plans and Options

By deploying waive plans and waive options, you can use predefined reports to show enrollment results for those employees who have chosen to waive plans and options. Such reports are useful when considering whether to redesign your benefits offerings. Correlation of demographic data with waive enrollments helps discern benefits pricing issues and coverage issues with respect to the nature of benefits that are currently offered.

You typically define a waive plan or option when you want the waive plan or option to appear to the participant as an electable choice amongst other plans or options. Clear choices avoid misunderstandings. For example, the business requirement may be to automatically enroll employees into a basic medical insurance plan by default, unless the employee explicitly opts out of all medical insurance plans. When employees manually elect a waive plan that is clearly presented amongst other medical plans, their intentions to opt out are clear. If medical coverage issues later occur, it is clear that the employees explicitly chose to not be enrolled in either the default plan or any other medical plan offering, and that their choice was not made in the absence of knowledge of available alternatives.

Creating and Using Waive Plans

You can create a waive plan to enable eligible persons to decline participation at the plan type level. To designate a plan as a waive plan, set the plan function field to Waive in the plan configuration basic details section.

After you create the waive plan, use the plans and plan types section of the program configuration basic details page to select and add the waive plan to the table of plans associated with the plan type in that program. When an eligible person elects the waive plan, that person declines enrollment in all plans within that plan type.

Creating and Using Waive Options

Similarly, you can attach a waive option in addition to the regular options in a plan to enable eligible persons to decline participation at the plan level.

After you create the waive option, use the options section of the plan configuration basic details page to select and add the waive option to the table of options associated with the plan. When an eligible person elects the waive option, that person declines enrollment in all options within that plan.

If a plan type contains only one existing plan, consider attaching a waive option to the existing plan instead of adding a waive plan to the plan type.

Note

Do not attach a waive plan or waive option to plan configurations that require eligible persons to elect at least one regular option from a group of options or at least one regular plan from a group of plans.

Defined Rate Frequency and Communicated Rate Frequency Values: How They Work Together

The defined rate frequency and communicated rate frequency values establish the time basis for rate amounts that are either used internally or displayed to participants.

  • The defined rate frequency determines the time basis of rates used in calculations or stored for other internal use.

  • The communicated rate frequency determines the time basis of rates that appear to participants.

Defined rate frequency, communicated rate frequency, and program default currency are program-level attributes. An exception occurs in plan configuration, where setting the plan usage field to Not in program causes the defined rate frequency, communicated rate frequency, and plan default currency fields to appear. In that special case, these attributes are required to be specified as part of the plan-not-in-program configuration. After the defined rate frequency, communicated rate frequency, and currency are appropriately defined for benefits programs or plans not in program, you can use the Create Rates page to define named rates for specific objects within those hierarchies.

Defined Rate Frequency

The time basis of costs defined in the Additional Information section of the Create Rates page is always determined by the relevant defined rate frequency.

For example, a health and welfare program includes the dental plan type. The dental plan type includes the dental preferred provider organization (PPO) plan and the dental health maintenance organization (HMO) plan. The dental PPO plan includes options for covering the employee, employee plus spouse, and so on. The default program currency for the health and welfare program, to which the dental plan type and dental PPO plan are associated, is set to US Dollars. The defined rate frequency of the health and welfare program is Monthly. On the calculation tab of the Create Standard Rates page for the dental PPO plan, employee plus spouse option, the calculation method is set to Flat amount, and that flat amount value is set to 32.50.

The rate inherits the currency defined for the programs or plans not in program to which the benefits object is associated. In this example, the currency for the health and welfare program is US Dollars. Therefore the defined rate is the flat amount: 32.50 US Dollars monthly. That defined rate is stored for use in subsequent calculations.

Communicated Rate Frequency

The communicated rate frequency determines the time basis of costs that appears to participants. The rate communicated to participants differs from the defined rate if the communicated rate frequency is different from the defined rate frequency. For example, the defined rate frequency is monthly, with 12 monthly periods in a year, while the communicated rate has the frequency of the participant's payroll period, such as 26 biweekly periods in a year.

To convert from the defined rate to the communicated rate, the annual cost is first calculated. The annual cost for employee plus spouse participation in the dental insurance plan is:

(32.50 US Dollars per month) * (12 months per year) = 390 US Dollars per year

To continue the example, dental insurance costs are deducted from participants' biweekly paychecks. The communicated rate frequency is set to Per pay period. There are 26 payroll periods in the plan year period.

The communicated rate is the annual cost divided by the number of periods in a year at the communicated rate frequency:

(390 US Dollars per year) / (26 payroll periods per year) = 15.00 US Dollars per payroll period.

Benefits Rate Frequencies: How They Affect Rates

Specify the rate communicated to participants during enrollment by configuring frequency settings in basic details of the program or plan not in program. Use settings on the standard rate to configure the payroll deduction amount. Your configuration determines whether the communicated amount in the self-service enrollment pages and Enrollment work area is the same as the payroll amount.

Program or Plan Frequency Settings That Affect Rates

Select a value for each of the following frequencies when you configure the basic details for a program or plan not in program in the Plan Configuration work area.

  • Defined Rate Frequency: Frequency specified for the activity rate calculation. Possible selections are Annually, Biweekly, Monthly, Hourly, Quarterly, Semiannually, Semimonthly, or Weekly.

  • Communicated Rate Frequency: Used to calculate the rate displayed on the self-service enrollment pages and in enrollment results in the Enrollment work area. Possible selections are Estimated per pay period, Per month, Per pay period, Per pay period with element frequency rules, or Per year.

    The following table defines the pay period values.


    Frequency Value

    Description

    Per pay period

    Uses the number of pay end dates derived from the payroll definition. For example, a weekly payroll might result in 53 end dates in the calendar year.

    Estimated per pay period

    Uses the standard number of periods corresponding to the period type value selected in the payroll definition, regardless of the number of pay end dates in the calendar year. For example, communicated rate calculations use the fixed number of 52 weekly periods, even for years with the nonstandard 53 weekly periods.

    Per pay period with element frequency rules

    Uses the frequency rules of the payroll element associated with the standard rate to determine the number of deductions in the calendar year. For example, one of your benefit deductions occurs only on the first biweekly payroll in each month.

    If you use this communicated rate frequency, select Per-pay-period amount as the value passed to payroll.

    Restriction

    If you select one of the per pay period choices, you must define a corresponding payroll and assign the payroll to the relevant participants. Use the tasks in the Define Elements, Balances and Formulas task list in the Setup and Maintenance work area.

Standard Rate Frequency Settings That Affect Rates

Select a value for each of the following optional attributes when you configure rate details and payroll information for the standard rate in the Plan Configuration work area.

  • Element Input Value: Used to transfer the benefit rate to payroll through the element entry. Before you can select an element input value, you must first select a payroll element for the standard rate.

  • Value Passed to Payroll: Amount that the application passes to the element entry. Possible selections are Annual amount, Communicated amount, Defined amount, Estimated per-pay-period amount, or Per-pay-period amount. Leave this field blank if you do not use element entries.

    Tip

    If you want the communicated amount to be the same as the payroll deduction, be sure to coordinate the settings for the communicated rate frequency and the value passed to payroll.

  • Rate Periodization Formula: You can customize the annual, defined, and communicated rate calculations for any activity rate. To do so:

    1. Create a fast formula using the Rate Periodization formula type.

    2. Select the formula on the Processing Information tab of the standard rate.

How Communicated Rate is Calculated

The following table identifies the possible communicated rate values, the calculation used to determine the amount, an example amount, and the example calculation. The examples are based on a family medical plan and use the following values:

  • Standard rate: 4,000 USD

  • Defined rate frequency: Quarterly

  • Payroll period type: Biweekly

  • Element frequency rules for this deduction: First pay period in the month only


Communicated Rate Frequency

Calculation Used to Derive Communicated Amount

Example Communicated Amount (USD)

Example Calculation Expression

Per year

Standard rate x Number of times defined rate frequency occurs in 1 year

16,000

4,000 x 4

Per month

Annual amount / Number of times communicated rate frequency occurs in 1 year

1,333.3333

16,000 / 12

Per pay period

Annual amount / Actual number of pay periods in 1 year based on payroll frequency

Actual number example: Depending on the year, 52 or 53 for weekly and 26 or 27 for biweekly

One of these two amounts, depending on the year:

  • 615.3846

  • 592.5926

  • Annual amount / 26 pay periods

  • Annual amount / 27 pay periods

Estimated per-pay-period

Annual amount / Standard number of pay periods in 1 year based on payroll frequency

Standard number examples: 52 for weekly, 26 for biweekly, and 24 for semimonthly

615.3846

16,000 / 26

Per-pay-period with element frequency rules

Annual amount / Number of times deduction is taken in 1 year

1,333.3333

16,000 / 12

How Value Passed to Payroll is Calculated

The following table identifies the possible values to pass to payroll, the calculation used to determine the amount, an example amount, and the example calculation. The examples are based on a family medical plan and use the following values:

  • Standard rate: 4,000 USD

  • Defined rate frequency: Quarterly

  • Communicated rate frequency: Per month

  • Payroll: period:

    • Period type: Biweekly

    • Alternative for illustration purposes: Element frequency rule of first pay period in a month.

    • Reminder: Different years have a different number of biweekly payrolls.


Value Passed to Payroll

Calculation Used to Derive Amount

Example Value Passed to Payroll Amount (USD)

Example Calculation Expression

Left blank

None

Not applicable

Not applicable

Defined amount

Standard rate at the specified defined rate frequency

4,000 (per quarter)

None

Annual amount

Standard rate x Number of times defined rate frequency occurs in 1 year

16,000

4,000 x 4

Communicated amount

Annual amount / Number of times communicated rate frequency occurs in 1 year

1,333.3333

16,000 / 12

Estimated per-pay-period amount

Annual amount / Standard number of pay periods in 1 year based on payroll frequency

Standard number examples: 52 for weekly, 26 for biweekly, and 24 for semimonthly

615.3846

16,000 / 26

Per-pay-period amount

Annual amount / Actual number of pay periods in 1 year based on payroll frequency

Actual number example: Depending on the year, 52 or 53 for weekly and 26 or 27 for biweekly

If using element frequency rules: Annual amount / Number of times deduction is taken in 1 year

One of these two amounts, depending on the year:

  • 615.3846

  • 592.5926

If element has frequency rule of first pay period per month:

  • 1,333.3333

  • 1,600 / 26 pay periods

  • 1.600 / 27 pay periods

  • 16,000 / 12

Note

The communicated rate frequency is not coordinated with the value passed to payroll in the preceding examples, which focus on how each amount is calculated.

Dependent Designation Level: Points to Consider

You can define dependent designation requirements either at the plan type in program level or the plan level of the benefits object hierarchy. On the program configuration Basic Details page for a given program, you must select one of these dependent designation levels:

  • Null

  • Plan type in program

  • Plan

Null

When the dependent designation level is null or blank, the Designation Requirements page of the program configuration is disabled. Designation requirements cannot be specified because the dependent designation level is not configured for the program.

Plan Type in Program

When the dependent designation level is set to Plan type in program, the plan types currently attached to this program appear as rows in the table located in the header section of the program configuration Designation Requirements page. To define designation requirements for a particular plan type in this program, highlight the plan type name in the table, and then configure the designation requirements in the tabbed region of the page.

Plan

When the dependent designation level is set to Plan, the Designation Requirements page of the program configuration is disabled. You can configure designation requirements at the plan level on the Designation Requirements page of the plan configuration.

Configuring Allowable Dependent or Beneficiary Designees: Points to Consider

You can configure the details of who can be designated as a dependent or beneficiary at the level of the option in plan, or the plan level if the plan does not have options.

To open the Configuring Allowable Dependent or Beneficiary Designees dialog box, click Create on one of the following pages in the Plan Configuration work area.

  • Manage Benefit Options task: On either the create or edit page, Allowable Dependent or Beneficiary Designees section.

  • Manage Benefit Plan Details task: On either the create or edit page for plan eligibility, Allowable Dependent or Beneficiary Designees tab.

Group Relationships

Select the group relationship for which you are defining designation requirements. For example, select Family when you plan to add child, parent, nephew, and domestic partner relationship types.

Designation Types

You can select a designation type of Dependent or Beneficiary. By default, the following relationship types are considered to be personal relationships that you can designate as dependents.

  • Adopted child

  • Step child

  • Child

  • Domestic partner

  • Foster child

  • Domestic partner child

  • Spouse

Minimums and Maximums

Enter the minimum and maximum number of designees that can be covered under this option or plan. If the plan allows no designees, you enter 0 in the Minimum and Maximum fields.

Cover All Eligible

Set Cover All Eligible to Yes if there are no minimum or maximum numbers of designees for this plan and you want to provide coverage to all designees who meet the eligibility profile criteria.

Important

If you enter a value in one or both of the minimum or maximum fields, then Cover all eligible is ignored, even if set to Yes.

Relationship Type

Add at least one relationship type that corresponds to the group relationship that you selected. For example, if you selected the group relationship Child, then you would add at least one of the following relationship types:

  • Adopted child

  • Step child

  • Child

  • Domestic partner child

  • Foster child

You would not add a relationship type of Nephew or Niece.

Enrollment Rules: How They Are Calculated

Enrollment rules limit enrollment options based on whether the participant is currently enrolled in the benefits object.

Settings That Affect Enrollment Rules

Enrollment rules are affected by two settings: the person's enrollment status and the selected enrollment option.

Enrollment statuses:

  • Current: Participants who are enrolled in the benefits object at the present time

  • New: Persons who are not currently enrolled

Note

Neither of these two enrollment statuses means that continued participation or new enrollment is necessarily granted for the next coverage period. Enrollment for the next period is determined by enrollment options.

Enrollment options:

  • Can choose: Allowed to make new elections.

  • Can keep: Allowed to keep their current elections.

  • Can keep or choose: Allowed to either keep their current elections or make new elections.

  • Keep or choose, starts new: Allowed to keep current elections or make new elections. The coverage ends at the configured end date for the processed life event and restarts the next day. However, the participant must explicitly reelect coverage amounts, even though the coverage amount may stay the same.

  • Choose only: Must make an explicit election to stay enrolled.

  • Keep only: Must keep current elections.

  • Lose only: Must disenroll from current elections.

  • Assign automatically: Enrolled automatically and cannot disenroll.

  • Nothing: Cannot make elections for this benefits object.

  • Formula: Use a formula that you have previously defined to determine electability based on enrollment status. The formula must be of the type Enrollment Opportunity.

How Enrollment Rules Are Interpreted

Each choice in the enrollment rules field represents a combination of options.

For example:

  • Current - keep only; new - nothing means that currently enrolled participants must retain their current set of elections to stay enrolled. Persons who are not currently enrolled are not allowed to make elections for this benefits object.

  • Current - nothing; new - assign automatically means that currently enrolled participants cannot make elections for this benefits object, while persons who are not currently enrolled are automatically enrolled and cannot disenroll.

Default Enrollment Rules: How They Are Calculated

Default enrollment rules limit enrollment options based on whether the participant is currently enrolled in the benefits object.

Settings That Affect Default Enrollment Rules

Default enrollment rules are affected by two settings: the person's enrollment status and the selected enrollment option or plan.

Default enrollment statuses:

  • Current: Participants who are presently enrolled in the benefits object

  • New: Persons who are not currently enrolled

Note

Neither of these two enrollment statuses means that continued participation or new enrollment is necessarily granted by default for the next coverage period. Default enrollment for the next period is determined by default enrollment options.

Default enrollment options:

  • Defaults: Enroll in the default enrollment for the benefit object.

  • Same enrollment and rates: Do not change enrollment or rate.

  • Same enrollment but default rates: Do not change enrollment but assign the default rate.

  • Nothing: Do not enroll the person in the benefit object.

  • Formula: Use a formula that you have previously defined for this default treatment. The formula must be of the type Default Enrollment.

How Default Enrollment Rules Are Interpreted

A default enrollment rule pairs each of the two enrollment statuses with a feasible enrollment option. For example, New - nothing; current - default means that if a person is not yet enrolled in a given benefit, then do not make a default enrollment for that person in that benefit. If a person is already enrolled in a benefit, then automatically enroll that person in the designated default enrollment for that benefit.

Cross-Plan Enrollment Validation: Examples

This topic illustrates examples of setting up enrollment validation across plans when enrollment in one plan affects enrollability in other plans or depends upon enrollment in other plans.

Enrollment in One Plan Requires Enrollment in Another Plan

Scenario: The employer requires enrollment in both a high-deductible health plan (HDHP) and a health savings account plan (HSA).

Setup: You can use one of the following methods to enforce enrollment in both plans:

  • If the entire worker population must enroll in HSA with HDHP, you can enforce enrollment by:

    • Setting up both plans for default enrollment upon new hire

    • Or configure the automatic enrollment method on both plans

    In either method, set up each plan type with a minimum plan enrollment of 1.

  • Create an eligibility profile tied to one of the plans, such as the HDHP using the Other criteria type and the Participation in Another Plan criteria. Select the other plan, such as the HSA plan, as the criteria value. Do not select Exclude. This method uses the participation in one plan as an eligibility criteria for the other plan during validation.

  • Create an eligibility profile tied to one of the plans, such as the HDHP, using the Related Coverage criteria type and the Covered in Another Plan criteria. Select the other plan, such as the HSA plan, as the criteria value. Do not select Exclude.

  • Create a post election coverage calculation formula that enforces coverage in both plans. Select the plan in the plan hierarchy on the enrollment step of the plan configuration process, and then select the post election formula in the Further Details section of the General tab.

Note

There might be cases where you want to control enrollments by selecting the post election formula at the plan type or the option level of the program or plan hierarchy.

Enrollment in One Plan Excludes Enrollment in Another Plan

Scenario: The employer excludes enrollment in a flexible spending account plan (FSA) if electing the health savings account plan (HSA).

Setup: Create an eligibility profile tied to the HSA plan using the Other criteria type and the Participation in Another Plan criteria. Select the FSA plan as the criteria value and select Exclude. Assign this eligibility profile to the HSA plan.

Enrollment in One Plan is Contingent on Enrollment in Another Plan

Scenario: The employer does not permit enrollment in spouse and child supplemental life insurance unless the employee is enrolled in the employee supplemental life insurance.

Setup: You can use one of the following methods to enforce this requirement:

  • Create a participant eligibility profile tied to the spouse and dependent plans, using the Related Coverage criteria type and the Covered in Another Plan criteria. Select the employee supplemental life plan as the criteria value. Do not select Exclude.

  • Create a post election coverage calculation formula that enforces coverage in the employee plan. Select the spouse and dependent plans in the plan hierarchy on the enrollment step of the plan configuration process, and then select the post election formula in the Further Details section of the General tab.

Unsuspend Coverage and Rate Rules: Points to Consider

Unsuspend rules define the coverage and rate start dates to use when a suspended enrollment becomes unsuspended. You can set up one unsuspend rule for a coverage and a different unsuspend rule for the corresponding rate.

When a required action item is completed, the relevant elections are unsuspended if there are no other incomplete required action items. If a required action item is not completed, and the action is due before the close of enrollment, then the Close Enrollment process provides an audit log listing of the action items that failed. Similarly, if the Close Enrollment Action Items process runs with force close, an audit log again lists the action items that failed. In either case, the suspension and any interim rate and coverage will carry forward. Subsequent participation evaluation processing for this participant will generate an error.

Note

  • The unsuspend rule controls the start date of the enrollment if the unsuspend date is equal to or later than the original start date.

  • If you do not select an unsuspend rule, the start date is the date on which the enrollment is unsuspended.

  • If you assign interim coverage while an enrollment is suspended, the interim enrollment is ended one day before the coverage start date of the unsuspended enrollment.

Commonly Used Unsuspend Rules

The sets of predefined rules are identical for the Unsuspend Enrollment Rule and the Unsuspend Rate Rule:

  • As of completed date - Sets the enrollment coverage or rate start date equal to the effective date on which the enrollment is unsuspended.

  • Recalculate with completed date and enrollment start - If the computed start date is earlier than the effective date of the unsuspension, recomputes the start date using the unsuspended date as the life event date or notification date, depending on your life event definition. The rate start and end dates are recalculated based on the coverage start date of the unsuspended enrollment.

  • Use existing enrollment start date - Uses the original coverage or rate start date, even if this date is before the suspension end date.

Other Predefined Unsuspend Rules

The following are examples of some commonly used unsuspend rules.

  • First of month after completed

    • The start date is the first day of the next month that follows the date that required action items are completed.

    • For example, action complete: March 10th. Start date: April 1st.

    • Similar rules are predefined for start dates to occur on the first day of the next year, half year, quarter, and semi-month.

  • First of month on or after completed

    • This rule is much the same as the previous rule, with the exception that if the action is completed on the first day of the period, then the start date occurs on the same day.

    • For example, action complete: July 1st. Start date: July 1st.

    • Action complete: July 2nd. Start date: August 1st.

    • Similar rules are predefined for start dates to occur on the first day of the year, half year, quarter, and semi-month

  • First of pay period after completed

    • The start date is the first day of the next payroll period to occur after action items are completed.

  • First of last pay period plan year after completed

    • The start date is the first day of the last complete payroll period in the plan year.

    • For example, a calendar year period with biweekly pay periods beginning on December 6th and December 20th. Action complete: November 10th. Start date: December 6th, which is the first day of the last complete pay period for the plan year. The payroll period starting on December 20th is considered to be the first pay period of the next plan year.

  • First of last month plan year after completed

    • Assuming a calendar plan year, the start date would typically be December 1st of the plan year in which the required action items are completed.

  • Formula

    • A formula that you define can be used to derive an unsuspend start date when the predefined rules do not fit your needs.

Start Date and Previous End Date Rule Compatibility: Explained

Pairing incompatible start and end date rules during plan configuration can cause processing errors due to overlapping dates.

To reduce such errors and assist with plan configuration, consult the following general guidelines for start date rule compatibility with end date rules:

  • General guidelines and definitions

  • Rates, coverages, and dependent coverages

  • Enrollment periods

General Guidelines and Definitions

For rates, coverages, and dependent coverages, the previous rate or coverage period should end the day before a new rate or coverage begins. Enrollment periods are different in that you create a window of time during which a person has enrollment opportunities. Thus, the enrollment period must end at a time after the enrollment period begins.

Start dates are always computed based on the occurred on date of the life event being processed, unless the rule specifies otherwise. For example, Later of event or notified computes the start date based on the life event occurred on date or the life event notification date, depending on which date occurs later.

Most end date rules, with the exception of rules beginning with 1 prior, are also based on the event being processed. 1 prior means the end date should be one day before the start date of a new rate or coverage. If rates or coverages are completely ending, and will not be superseded by other rates or coverages, the part of the rule that follows 1 prior applies. For example, a health insurance participant voluntarily terminates employment. Although no new coverage period will follow, the 1 prior, or month end rule causes health insurance coverage to remain in effect until the end of that month.

You can define formulas to derive any end date when predefined end date rules do not fit your needs. However, the end date returned by your formula must not cause overlapping dates.

Note

Pairings of start and end date rules are recommendations only, and are not enforced by the application.

Rates and Coverages

All rates and coverages start date rules, with the exception of Elections, can be paired with any previous end date rule that begins with 1 prior. The 1 prior rules can only be used when the start date is computed during the Evaluate Life Event Participation process.

In keeping with the guideline that previous rate and coverages periods should end one day before new rates or coverages begin, pairs of start and end dates that achieve that date relationship are generally compatible. For example:


Rate Start Date Rule

Compatible Previous Rate Period End Date Rule

Event

One day before event date

As of event

One day before event

First of month

End of month

First of next month

End of month

First of month after later event or notified

End of month using later of event or notified

First of month on or after event

End of month using later of event or notified

First of month after enrollment start

End of month after enrollment end

First of quarter

End of quarter

Note

A commonly used rule is 1 prior, or month end. If no new rate or coverage will start, coverage is often extended to the end of the month, and the rate ends with the pay period following the event.

Enrollment Period

All enrollment period start date rules can be paired with any of the three end date rules listed below:

  • Forty-five days after enrollment period start

  • Sixty days after enrollment period start

  • Ninety days after enrollment period start

The following start date rules must be paired with an end date rule that ends with after enrollment period start or a formula.

  • First of next half year

  • First of next pay period

  • First of next semimonthly period

  • First of next year

The following start date rules are compatible with end rules that specify a number of days after the later of the event date or the notification date:

  • As of event date

  • First of next half year after later event or notified

  • First of next month after later event or notified

  • First of next pay period after later event or notified

  • First of next year after later event or notified

  • First of semi-month after later event or notified

  • Later event or notified

  • Later of sixty days before later event or notified

  • Later of thirty days before event or notified

Certifications and Other Action Items: Explained

Action items are steps that must be taken or documents that must be provided to complete enrollment in a benefits offering.

The following are key aspects of certifications and action items:

  • Certification and action item types

  • Required and suspended enrollment options

Action Item and Certification Types

Action items include designation of dependents, beneficiaries, and primary care providers, as well as furnishing of dependent social security numbers, beneficiary addresses, or other items of information. Certification documents, such as birth certificates, marriage certificates, proof of good health, evidence of insurability, and proof of student status, are also action items. You can define certification requirements for any of the following situations:

  • General enrollment in a benefits offering

  • Enrollment following a specific life event

  • Restrictions based on coverage or benefits selected

  • Coverage or benefits restrictions for specific life events

  • Designation of dependents

  • Designation of beneficiaries

Configuring Required Action Items and Certifications

You define action items on the Edit Plan Certifications and Edit Plan Designation Requirements pages in the Plan Configuration work area.

A certification requirement action item may include one or more individual certifications, such as proof of good health or evidence of insurability, that must be provided to fulfill the requirement. When you add a certification, you can select the Required option and then set the Determination Rule, which controls when the certification is required. For example, a certification might be required only when a participant is enrolling for the first time or it may be required for every life event. If you select multiple certifications, then a participant must provide all required certifications and at least one optional certification to fulfill the requirement. For example, you might require that a participant provide either a Marriage Certificate or a Domestic Partner Affidavit when designating a spouse dependent. In this case, you would select the Required option for the certification requirement action item, but not for each of the individual certifications.

Selecting the Required option for other action items, such as designation of a beneficiary, dependent, or primary care physician, does not affect processing, but can be useful for tracking an action item in internal reports.

Configuring Suspended Enrollment

If you select the Suspend Enrollment option for an action item, then a suspension reminder appears to the participant or benefits administrator during enrollment. Enrollment in the benefits offering is suspended until the action item is completed. Interim coverage, if any, is applied, and no further life event processing can take place for the person while enrollment is suspended. If the action item is not completed by its due date, the action item appears on the close action item audit log, the close enrollment audit log, and the participation evaluation error report until the requirement is met.

You cannot select the Suspend Enrollment option for an individual certification; you configure suspension for a certification requirement action item, which may include multiple individual certifications. If you configure suspended enrollment for a certification requirement with multiple certifications, then all required certifications and at least one optional certification must be provided to avoid suspension of enrollment.

For example, if you create a certification requirement with two required and five optional certifications, then the two required certifications and at least one of the optional ones must be satisfied for the certification requirement to be complete. If you configure this certification requirement for suspended enrollment, and only one of the required certifications is provided, then the action item is incomplete and results in suspended enrollment.

Note

You define interim coverage on the Edit Plan Enrollment page in the Plan Configuration work area.

Dependent and Beneficiary Designation Requirements: Examples

The following examples illustrate how to associate designation requirements with benefits offerings.

Dependent Designation Requirements

Scenario: Enrollment in an Employee+1 medical plan option requires designation of a dependent and certification of good health for the designated dependent.

Setup: On the Edit Plan Designation Requirements page in the Plan Configuration work area, create an action item that requires designation of a dependent. In the Dependent Action Items section on the Dependents tab, select the Required and Suspend Enrollment options for the action item, and set a due date. Next, add a certification requirement. Select the Required and Suspend Enrollment options for the certification requirement. Finally, add certifications for a marriage certificate, domestic partner affidavit, birth certificate, and adoption certificate. Do not select the Required option for the individual certifications, so that furnishing any one of the documents satisfies the requirement. On the Edit Plan Enrollment page, define interim coverage for this plan to be the Employee Only option.

Result: When a participant enrolls in the Employee+1 option, they have an opportunity to designate a dependent. They receive a reminder about the pending certificate. Enrollment in the Employee+1 plan is suspended, and Employee Only coverage is in effect until one of the certification documents is provided.

Note

You can also define dependent designation action items and certifications for a particular life event.

Beneficiary Designation Requirements

You can define two kinds of action items for the designation of beneficiaries: action items that cause enrollment of the entire benefit offering to be suspended if not completed, and action items that cause enrollment of only the beneficiary to be suspended. This example illustrates how to set up both types.

Scenario: Enrollment in a life insurance plan requires designation of a beneficiary. It also requires that the beneficiary's address is provided. Enrollment in the plan is suspended if no beneficiary is designated, but enrollment for the designated beneficiary alone is suspended if no address is provided.

Setup: On the Edit Plan Designation Requirements page in the Plan Configuration work area, create an action item for designation of a beneficiary. In the Action Items for Suspending Plan Enrollment section on the Beneficiaries tab, select the Required and Suspend Enrollment options for the action item, and set a due date. Then, in the Action Items for Suspending Beneficiary Enrollment region, add another action item for the beneficiary's address. Select the Required and Suspend Enrollment options, and set a due date.

Result: When a participant enrolls in the plan, they designate a beneficiary, but do not furnish an address. They receive a reminder about the pending action item. Enrollment in the plan is completed for the participant, but enrollment for the beneficiary is suspended until an address is provided.

Enrollment and Benefits Certifications: Examples

The following examples illustrate how to associate enrollment and benefits-based certification requirements with benefit offerings.

General Enrollment Certification Requirement

Scenario: Enrollment in a life insurance plan requires a proof of good health or evidence of insurability certification to be obtained from the employee's physician and supplied to the benefits department.

Setup: On the Edit Plan Certifications page in the Plan Configuration work area, create a general enrollment certification requirement. Select the Required and Suspend Enrollment options, and set a due date for the certification. Define interim coverage for the plan, if not already defined, on the Edit Plan Enrollments page.

Result: When a person attempts to enroll in the plan, they receive a reminder about the pending certification. Interim coverage goes into effect immediately and remains in effect until the certification is provided.

Life Event Enrollment Certification Requirement

Scenario: Enrollment in a life insurance plan requires proof of good health or evidence of insurability certification for a new employee, but not for existing employees who are updating benefits during open enrollment.

Setup: On the Edit Plan Certifications page in the Plan Configuration work area, create an enrollment certification requirement for the New Hire life event. Select the Required and Suspend Enrollment options, and set a due date for the certification. Do not define interim coverage.

Result: When a new hire attempts to enroll in the plan, they receive a reminder about the pending certification. Enrollment in the plan is suspended and no coverage is available until the certification is provided.

Benefits Certification Requirement

Scenario: Enrollment in a life insurance plan exceeding $100,000 coverage requires proof of good health or evidence of insurability certification, but enrollment in plans with coverage below that amount does not.

Setup: On the Edit Plan Certifications page in Plan Configuration work area, create a benefits certification requirement. Select the Required and Suspend Enrollment options, and set a due date for the certification. On the Edit Plan Enrollment page, define interim coverage to be a plan with coverage equal to $100,000.

Result: When a participant attempts to enroll in a plan with coverage exceeding $100,000, they receive a reminder about the pending certification. Enrollment in the plan is suspended and interim coverage in the $100,000 plan is in effect until the certification is provided.

Note

You can also define benefits certification requirements for a particular life event. For example, you might require certification for the Gain Dependent life event if coverage exceeds $100,000.

Action Items: How They Are Processed

The configuration of action items determines what happens during enrollment processing. For example, failure to provide required action items can result in suspended enrollment or simply cause delinquent items to appear in benefits administration reports.

Settings That Affect Action Item Processing

The following action item settings affect processing:


Setting

Description

Suspend Enrollment

When enabled, notifies participant of pending action item during enrollment and causes suspension of enrollment until the item is completed.

Determination Rule

Determines when the item is required, such as always or only for initial enrollment.

Due Date

Determines when the item begins appearing on audit and error reports generated by enrollment processing.

Interim coverage setup also affects enrollment processing, as described in the next section. Interim coverage is defined for a plan or option on the Edit Plan Enrollment page in the Plan Configuration work area.

How Action Items Are Processed

If enrollment is suspended due to incomplete action items, then interim coverage, if configured, applies and no further life event processing takes place until the action items are completed.

Note

Incomplete or past-due action items for one benefits relationship do not stop processing of events for another benefits relationship for the same person.

Reporting of pending action items and certificates occurs as part of enrollment processing. Benefits administrators can use these reports to follow up as needed.


Process

Reporting

Close enrollment action items

Any past-due required action items appear in the audit log, as well as any incomplete action items that are configured to suspend enrollment.

Close enrollment

Any past-due required action items appear in the audit log, as well as any incomplete action items that are configured to suspend enrollment.

Participation evaluation

Any incomplete action items that are configured to suspend enrollment for a person appear in the error report.

The following scenarios illustrate how subsequent life events are processed for a participant with an open action item.

Suspension Results in No Further Life Event Processing

Scenario: Life Event A is processed on 1/15/2010. An outstanding action item exists with a due date of 1/30/2010, and it is configured for suspension. Enrollment is suspended, and interim coverage exists. On 1/28/2010, the benefits administrator attempts to process Life Event B, which has an occurred date of 1/20/2010.

Result: Life Event B cannot be processed until the suspension is resolved for Life Event A. The action item associated with Life Event A appears on the audit report after action item processing, and the participant's name appears on the error report after participation evaluation processing. Contact the participant and attempt to resolve the action item. Once the action item is complete, enrollment for Life Event A is completed and Life Event B can be processed.

Suspension of Beneficiary Designee Only

Scenario: Life Event A is processed on 1/15/2010. An outstanding action item for beneficiary designation exists, and suspended enrollment is configured for the beneficiary designee only, not for the benefits offering itself.

Result: Enrollment is suspended only for the beneficiary, not for the entire offering. Future life events can be processed for the participant.

Suspension with No Interim Coverage

Scenario: Life Event A is processed on 1/15/2010. An outstanding action item exists with a due date of 1/30/2010, and it is configured for suspension. Enrollment is suspended, but no interim coverage exists. On 1/28/2010, the Benefits Administrator attempts to process Life Event B.

Result: Life Event B cannot be processed because the participant is not currently enrolled.

Subsequent Life Event Processing Causes Previous Life Event to be Backed Out

Scenario: Life Event A is processed on 1/15/2010. An outstanding action item exists with a due date of 1/30/2010, and it is configured for suspension. Enrollment is suspended, and interim coverage exists. On 1/25/2010, Life Event B is processed with an occurred date of 1/1/2010.

Result: Life Event A is backed out, along with any pending action items. Life Event B is processed (unless the Timeliness setup for the Life Event prevents life events from being backed out in this situation).

Plan or Option Sequence Restrictions: Points to Consider

Setup for benefits certification coverage restrictions at the plan level varies depending on whether the Restriction Type is set to Benefit restriction applies or Option restriction applies. You can set up restrictions for the entire plan or for specific life events for the plan. You cannot set up restrictions based upon coverage calculation amounts, if the Restriction Type is set to Option restriction applies.

Benefit Restriction Applies

The Benefit Amount Restrictions section of the certifications page, benefits certifications tab, general configuration sub tab, targets both first time enrollments and changes in enrollments. For first time enrollments, you can specify the Minimum, Maximum, and Maximum with Certification coverage amounts. For enrollment changes, you can also specify Maximum Increase and Maximum Increase with Certification amounts.

Elections submitted outside of these specifications trigger enrollment suspension. If interim rules are defined on the plan configuration enrollment page, then the interim coverage is applied during suspension.

You can impose benefits certification restrictions in plans that have coverages that use either the Flat range calculation method or the Flat amount calculation method with the Participants enter value at enrollment check box selected.

Typical scenarios do not call for simultaneously setting all benefits amount restriction fields.

Option Restriction Applies

The Plan or Option Sequence Restrictions section also targets both first time enrollments and changes in enrollments. Here, you can specify the Minimum Sequence Number, Maximum Sequence Number, and Maximum Sequence Number with Certification. For enrollment changes, you can also specify Maximum Sequence Number Increase and Maximum Sequence Number Increase with Certification.

Elections submitted outside of these specifications trigger enrollment suspension. If interim rules are defined on the plan configuration enrollment page, then the interim coverage is applied during suspension.

Plan configurations that include options and are associated with coverages that use the Multiple of compensation calculation method can impose option restrictions. When option restrictions apply, the Restrictions on Changes field is enabled. When configured, choices seen during enrollment are limited by the rule selected there. For example, No restrictions allows all available options to be seen, while Increase only allows just those options that are greater than the current election to be seen.

The application determines whether an option represents an increase or decrease with respect to the currently elected option based on the sequence numbers assigned to the options as they appear in the table of the Options section of the plan configuration basic details page.

Typical scenarios do not call for simultaneously setting all option restriction fields.

Plan or Option Sequence Restrictions: Examples

Some benefits provide options for different levels of coverage, such as life insurance coverage that is offered in multiples of a participant's annual salary. You can define sequence restrictions to limit the number of levels of increase from one enrollment period to the next or due to occurrence of a life event. You can also set the minimum and maximum sequence levels that can be selected with and without certification.

You define sequence number restrictions on the Benefit Certifications General Configuration tab in the Certification Details region of the Create or Edit Plan Certifications page.

Sequence Number Increase Restriction

A life insurance plan has options for $10k, $20k, $30k, $40k, and $50k, associated respectively with sequence numbers 1 through 5. A participant with existing coverage of $10k can only jump one level up to $20k without certification and two levels, to $30k, with certification of good health or evidence of insurability.

To set up this scenario, first select Option restriction applies for the Restriction Type, and then set the sequence restriction values in the Plan or Option Sequence Restriction region as follows:


Field

Value

Maximum Sequence Number Increase

1

Maximum Sequence Number Increase with Certification

2

Maximum Sequence Number Restriction

A supplemental life insurance plan has four coverage options with sequence numbers 1 through 4. You want to restrict the highest level of coverage (sequence number 4) to only those participants who provide certification.

To set up this scenario, first select Option restriction applies for the Restriction Type, and then set the sequence restriction values in the Plan or Option Sequence Restriction region as follows:


Field

Value

Maximum Sequence Number

3

Maximum Sequence Number with Certification

4

Plans in Program Vs. Not in Program: Critical Choices

When you define a benefits plan, it is not necessary that the plan be placed in a program. However, there are advantages to associating a plan with a program.

Plans in Program

In general, associate a plan with a program when:

  • Participants typically enroll in the plan at the same time that they enroll in other plans in the program.

  • Participation eligibility requirements defined for the program also apply to the plan.

Plans Not in Program

Plans not in a program enable participants to enroll and disenroll multiple times throughout the year. For example, a retirement savings plan not in program that allows unlimited, unrestricted enrollment changes.

In general, do not associate a plan with a program when:

  • Participants typically enroll in the plan at a different time than other plans in the program.

  • Participation eligibility requirements defined for the program differ substantially from those defined for the plan.

  • Benefits that the plan provides differ substantially from the benefits provided by other plans in the program.

Program Creation Methods: Points to Consider

Create benefits programs by using one of these methods, which are available on the Manage Programs page:

  • Complete the Quick Create Program page.

  • Prepare and upload the integrated Microsoft Excel workbook.

  • Complete the program configuration guided process.

After creating a program, you can validate the completeness of the configuration.

Quick Create Program

The Quick Create Program page is useful when you want to quickly set up the essential framework of a benefit program configuration. This method enables you to create plans in program and life events to associate with those plans in one place. Otherwise, you have to use first the Manage Plans task and then the Manage Life Event task.

You can immediately associate existing and newly created plans and life events with the benefit program.

When you use Quick Create Program page, several program characteristics are automatically set to commonly used values. If you must edit those default settings, you can use the program configuration process to retrieve the programs, plans in program, and life events created using the Quick Create Program page. Then, you can edit or add details at any time.

You cannot use the Quick Create Program method to edit any existing program.

Integrated Microsoft Excel Workbook

The integrated workbook method is useful when you want to set up one or more benefit programs quickly. Enter basic program details using the workbook. Save the file locally to share the program designs with others. Then, upload the finalized programs into the application database. Use the Plan Configuration work area pages to edit and add program configuration details.

You cannot edit an existing benefit program using this method.

Program Configuration Guided Process

The program configuration process offers the complete set of program characteristics, and therefore the greatest flexibility for setting up and maintaining benefits programs.

This method is the only one that enables you to edit an existing program, regardless of the method used to create the program.

If you are midway through the program configuration process and discover that you have not completed the setup for an object that you require for your program configuration, you must:

  1. Leave this process.

  2. Go to the relevant task for setting up the missing object.

  3. Complete that auxiliary setup.

  4. Return to this process and complete the program configuration.

Program Configuration Validation

The validation process identifies errors early in the setup process and enables the implementor to quickly resolve issues that may occur. On the Programs and Plans page, Program tab, Search Results section, select the program to validate and click Validate. On the Program Hierarchy page, select a plan and option and click Validate. The application generates the program Validation Results page, which displays the output of the validation process.

You can hover over those fields with icons to view a description of the status.

Creating Life Events for Quick Create Program : Explained

Attach enrollment life events to a program to trigger program enrollment opportunities when those life events occur.

Use the create life events feature to make new enrollment life events available for attachment to the quick create program.

You can:

  • Select one or more predefined life event configurations.

  • Create one user-defined life event at a time.

Creating User-Defined Life Events

In the user-defined life event section, enter the new life event name and select its type. You must either associate user-defined events to already existing person changes, or create new person changes and then link the new person changes to the life event using the edit life event page.

Selecting Available Life Event Configurations

Each check box in the available life event configurations section represents a commonly used life event configuration. Each predefined life event configuration contains the triggering mechanism setup and ties to the appropriate tables and columns as required to automatically generate that life event when corresponding personal data changes. You can optionally select one or more of these life events to make them available for attachment to a program. Selected life events appear in the enrollment life event available list with the name displayed on the check box label. Life events that are disabled have already been activated in this implementation. A uniqueness check prevents creation of life events that rely on an already existing set of table and column designations for triggering an event. Each set of life event triggers must be unique across the same implementation.

FAQs for Manage Benefit Programs and Plans

Can I configure designation requirements for benefit plans with no options?

Yes, in the Plan Configuration work area when you create a plan or edit an existing one.

  1. Select the plan in the Plan and Option Eligibility section of either the create or edit page for plan eligibility.

  2. Configure which dependent or beneficiary designees are allowed to enroll in that plan, in the Further Details section.

  3. Configure action items for the associated certification on the Designation Requirements page.

How can I view current program configuration?

You can view the current benefits object hierarchy and a summary of configuration settings for any created program. Highlight the row for the retrieved program, and then scroll to the right side of the table. Click the icon in the Hierarchy column or the Summary column to view the corresponding page.

How can I upload multiple program or plan designs at one time?

Go to the Plan Configuration work area, Overview page, Programs and Plans tab. To generate the integrated Microsoft Excel workbook, in the Search Results section of either the Programs or Plans tab, click Prepare in Workbook. Enter basic program or plan details using the integrated workbook. Save the file locally to share the program or plan designs with others. Then, upload the finalized programs or plans to the application database.

The default characteristics of the plans or programs that you upload from the workbook are the same as those created using the Quick Create methods for either plans or programs.

How can I validate a program or plan configuration?

You can generate a validation report to diagnose common mistakes during plan and program setup or verify integrity after setup completion and before manual testing.

Select the Manage Benefit Programs or Manage Benefit Plans task in the Setup and Maintenance work area or the Plan Configuration work area. Click the Validate button in either the programs or plans search results, in the row for the program or plan not in program that you want to validate. The Validate button is not present for plans that are in program.

  • On the Program Hierarchy page: Select a plan and option, and click Validate.

  • On the Plan Hierarchy page: Select an option and click Validate.

    If there is no option associated with the plan not in program, the choice list will be empty.

The generated Validation Results page displays the output of the validation process.

What's an unrestricted enrollment?

With the exception of a scheduled unrestricted open life events, which do have a specified enrollment window, unrestricted enrollment updates can be submitted throughout the year. They do not require a prerequisite occurrence of a formal personal or work-related life event.

A savings plan is an example of a benefit for which you typically enable the unrestricted enrollment type.

You cannot enable unrestricted enrollment and use life event processing in the same plan.

How can I restrict benefits enrollment opportunities based on provider location?

Use the Manage Eligibility Profiles task to create an eligibility profile that uses the Work Location criteria in the Employment criteria type.

If the work location definition does not correspond to the provider location, use the Manage Benefit Service Area task to define the provider's service area by listing the relevant postal codes. Then use that service area to define an eligibility profile that uses the Service Area criteria in the Personal criteria type.

Assign the eligibility profile to the benefits offering that you want to restrict. Only offerings for which the participant is eligible appear to the worker as enrollment opportunities during enrollment.

Can I change the name of an action item?

Yes, you can edit the meaning of the existing certifications lookup codes in the Enrollment Action Items lookup type, which includes Beneficiary designation, Dependent coverage, Proof of event, and Proof of good health. This change only modifies the display text of the certification. For example, you might want to rename Proof of good health to Evidence of insurability. Use the Define Lookups pages, which you can access by starting in the Setup and Maintenance work area and searching for lookup tasks.

What happens if I select a 1 prior rule for previous rate or coverage end?

Previous rate and coverage end rules that begin with the phrase 1 prior terminate the rate or coverage period one day before the subsequent period starts.

For example, if the previous coverage end is 1 prior or quarter end, and coverage start is First of next month, then the previous coverage ends on the last day of the current month.

If no coverage start is specified, or no next rate or coverage starts, then the second part of the rule goes into effect. In this example, the previous coverage would terminate at the end of the quarter. For example, if a job termination life event is triggered, and no rate start or coverage start is associated with processing the job termination life event, the existing rate or coverage stops at the end of the quarter.

What happens if I track ineligible persons?

Participation processing identifies persons who are found ineligible for participation.

Tracking ineligible persons causes person eligibility records to appear in the Benefits Service Center Eligibility Override page. If you use eligibility override functionality to make a person eligible, a corresponding electable record appears in the Benefits Service Center, Benefits Status Summary section, Electable tab.

Tracking ineligible persons can impact performance. Run a trial in a test instance for ineligible participants to monitor and benchmark run times based on participant population size, your plan configuration, and hardware capacity. An advantage of tracking ineligible persons is that a benefits administrator can make an ineligible person eligible with out the need for reprocessing.

Note

You must track ineligible persons if you determine benefits eligibility based on length of service temporal factors.

What happens if I enable participation eligibility override?

Benefits managers are allowed to override eligibility requirements for plan participation under special circumstances. For example, enable participation eligibility override to allow negotiated benefits packages for new hires.

Note

  • All plans and options in this program inherit this setting unless you specify differently at the plan or option in plan levels.

  • Enabling participation eligibility override can impact performance. Run a trial in a test instance with participation eligibility override enabled to monitor and benchmark run times based on participant population size, your plan configuration, and hardware capacity.

How can I diagnose any issues with delivered data needed for benefits plan configuration?

To verify existing predefined data and formula compilation, you can run the Benefits Setup Diagnostic Test if you have access to the Diagnostic Dashboard. Select Run Diagnostic Tests from the Setting and Actions menu in the global area.

How can I diagnose any issues with a benefit program setup?

After setting up a benefits program, you can run the Program Information Diagnostic Test if you have access to the Diagnostic Dashboard. Select Run Diagnostic Tests from the Setting and Actions menu in the global area. You can also validate the program setup using the Validate button on the Manage Programs page.

How can I use social networking with a benefits plan?

If the benefit plan's configuration page has a Social link, you can invite others to collaborate about the benefit plan design while you create or edit it. You can create one or more conversations tied to the benefit plan and invite others to join in. The conversations remain with the plan as a historical record.

  • Click Social on the benefit plan's configuration pages to collaborate. Click the Share button, or click Join if collaboration has already been initiated.

  • Click the plan name to access its wall, where you can start conversations and add members.

  • After collaboration is initiated for a plan, anyone at your company can be invited to participate in a conversation about it.

  • On the wall of the benefit plan, everyone invited can view basic attributes of the plan and post documents and comments that all members can see. Only those who can edit benefit plans can share a plan, initiate a conversation, and invite members.

  • Use the presence indicators to identify who is available to answer your questions.

Manage Benefit Rates and Coverage

Rates and Coverages

Rates and Coverages: Overview

Rates determine costs for purchasing benefit coverage, such as life or health insurance. Coverages define monetary amounts available to enrolled participants in the event of a claim, such as for medical expenses.

Rates usually determine an amount of monetary contributions paid by the employee, the employer, or a combination of both. Rates can also determine amounts distributed from the employer to the employee, such as for tuition reimbursement.

A variety of calculation methods for standard rates are delivered with the application. When a rate varies based on criteria, you can associate variable rate profiles to further adjust or replace the standard rate when those criteria apply. For example, you can adjust a rate based on combinations of location, length of service, and participant's age.

When you create a variable rate profile, you select one calculation method and attach one eligibility profile that defines criteria to qualify for an adjusted rate. You can associate multiple variable rate profiles to a given standard rate, and control the sequence in which multiple adjustments are applied.

Coverages define the level of benefits that a participant receives according to a benefits contract. A variety of calculation methods for standard coverages are also delivered with the application. As with variable rate profiles, you can associate variable coverage profiles to adjust coverage according to applicable criteria. You can also apply limits and rounding rules to the initial calculation to derive the final coverage.

Standard Rates, Variable Rate Profiles, and Variable Formulas: Points to Consider

You can create benefit rates in several different ways, depending on the type of rate and the complexity of the calculation. You must decide whether to use:

  • Standard rate

  • Variable rate profiles

  • Variable formula

Standard Rate

If a rate does not vary based on any factors, define the rate on the standard rate page. For example, if a dental plan rate is a flat amount of 8.00 per month regardless of age or other factors, a standard rate is appropriate.

Variable Rate Profiles

If a rate varies based on a factor, such as age, smoking status, or compensation amount, create a variable rate profile for each rate amount. For example, if a life insurance plan costs more for a smoker than a nonsmoker, you would create two variable rate profiles, one for smokers and another for non smokers. Each variable rate profile would be associated with an eligibility profile for the appropriate smoking status. The rate for a smoker might be 10.00, while the rate for a nonsmoker might be 5.00.

Note

You can only attach one eligibility profile to a variable rate profile.

If a rate varies based on multiple factors, such as age and smoking status, use the same logic to a create variable rate profiles and associated eligibility profiles for each set of factors affecting the rate, as shown here.

  • Age is less than 25 and person is nonsmoker

  • Age is less than 25 and person is smoker

  • Age is 26 to 40 and person is nonsmoker

  • Age is 26 to 40 and person is smoker

  • and so on

Create the variable profiles first and then add them to the standard rate.

Generally, you define variable rate profiles so that persons who meet certain criteria are eligible to receive the variable rate. However, you can also define a variable rate profile so that persons who meet the criteria are excluded from receiving the variable rate. In such cases, the standard rate for the benefit applies to these persons.

A variable rate profile can define an amount that is added to, multiplied by, subtracted from, or used instead of the standard rate for participants who meet the eligibility criteria. A variable profile's treatment rule (add to standard rate, multiply by standard rate, subtract from standard rate, or replace) defines how the rate defined in the profile is applied to the standard rate.

Variable Formula

If a variable rate is based on a complex calculation, you can define one or more fast formulas to compute the rate and then associate the formulas with the standard rate.

Example: A company provides a payroll service to hundreds of companies and allows its customers the ability to set up their own individual contribution schedules. Companies assign their employees to tiers that determine contribution amounts, as shown in this table.


Company A

Company B

Tier 1 - Employee contribution amount: 100.00

Tier 2 - Employee contribution amount: 150.00

Tier 3 - Employee contribution amount: 200.00

Tier 1 - Employee contribution amount: 50.00

Tier 2 - Employee contribution amount: 75.00

Tier 3 - Employee contribution amount: 100.00

Note

You can associate variable rate profiles or a variable formula to a standard rate; you cannot associate both.

Rates: How They Are Calculated

Rates define contribution and distribution amounts for specific benefits offerings. Rates are calculated by applying a calculation method to values you define or ones that are entered by the participant during enrollment. You can also define limiters and rounding rules to apply to the initial calculation to derive the final rate.

Settings That Affect Rate Calculations

The following calculation methods are available for computing rates:


Calculation Method

Description

Flat amount

Flat amount is predefined or entered during enrollment.

Multiple of compensation

Calculates rate as multiple of participant's compensation amount

Multiple of coverage

Calculates rate as multiple of total coverage amount

Multiple of parent rate

For child rates only, calculates rate as multiple of the parent (primary activity) rate

Multiple of parent rate and coverage

For child rates only, calculates rate as multiple of both parent rate and coverage amount

Multiple of coverage and compensation

Calculates rate as multiple of both coverage and compensation

No standard value used

Uses rate defined in variable rate profiles

Set annual rate equal to coverage

Uses total coverage as the annual rate amount

Post enrollment calculation formula

Calculates rate based on election information entered during enrollment using a formula you define

Calculate for enrollment formula

Calculates rate on enrollment using a formula you define

The calculation method you select works in conjunction with other settings to compute the final rate.

  • For calculations using multiples, you can specify the operation, such as simple multiplication, percentage, or per hundred.

  • For calculations based on compensation, you can specify the compensation factor that defines the basis for the compensation calculation, such as weekly stated salary or stated annual salary.

  • You can specify rounding and limiters for calculated results.

  • If you enable participant input, you can set valid ranges, default values, and increment values, as applicable. The default values are used if you recalculate rates and no user input is available.

  • For a participant whose enrollment coverage date falls within the month, you can define settings for a prorated rate.

If the rate varies based on one or more factors, such as age, you can create variable rate profiles and add them to the standard rate. When you create a variable rate profile, you select one of the calculation methods and attach an eligibility profile that defines the criteria a participant must satisfy to qualify for the rate. You also select a treatment rule for the profile, which determines whether the variable rate is added to, multiplied by, subtracted from, or replaces the standard rate. You can associate multiple variable rate profiles with a single standard rate.

How Rates Are Calculated

The calculation method and other settings defined for a rate determine when and how the rate is calculated. For example, the rate may be calculated prior to enrollment, upon enrollment, or after enrollment has been completed.

Example: Multiple of Compensation

Inputs to Calculation

Calculated Rate

Calculation Details

Compensation Amount: 25,000 (value derived by applying a Compensation Factor of Stated Annual Salary)

Multiplier: 1

Operator: Per ten thousand

2.5

(1/10,000) x 25,000

Example: Multiple of Coverage

Inputs to Calculation

Calculated Rate

Calculation Details

Coverage Amount: 200,000

Multiplier: 1

Operator: Per ten thousand

20

(1/10,000) x 200,000

Example: Multiple of Compensation and Coverage

Inputs to Calculation

Calculated Rate

Calculation Details

Multiplier: 0.0001

Multiple of Compensation Operator: Multiply by

Compensation Amount: 25,000 (value derived by applying a Compensation Factor of Stated Annual Salary)

Multiple of Coverage Operator: Per ten thousand

Coverage Amount: 100,000

25

((.0001 x 25,000) / 10,000) x 100,000

Example: Multiple of Parent Rate

Inputs to Calculation

Calculated Rate

Calculation Details

Multiplier: 2

Parent Rate Operator: Multiply by

Parent Rate: 2.5 (value derived from selected Parent Rate Name)

5

2 x 2.5

Example: Multiple of Parent Rate and Coverage

Inputs to Calculation

Calculated Rate

Calculation Details

Multiplier: 1

Coverage Operator: Per ten thousand

Coverage Amount: 200,000

Parent Rate Operator: Multiply by

Parent Rate: 2.5 (value derived from selected Parent Rate Name)

50

((1 x 2.5) / 10,000) * 200,000

Benefit Standard Rate Creation Methods: Points to Consider

You can create and edit benefits standard rates using one of these methods:

  • Create rates for plans or options during program and plan quick create.

  • Create rates using the Manage Benefit Rates task in the Plan Configuration work area.

  • Create and edit rates in the integrated Microsoft Excel workbooks.

You can also copy rates to additional legal employers.

Creating Rates with Quick Create Program and Plan

You can create rates that use the flat amount calculation method for plans with or without options by entering employer and participant costs using Quick Create Program or Quick Create Plan. Click Quick Create Program or Quick Create Plan in the programs or plans Search Results section.

When you save the program or plan, the application:

  • Creates the rates based on the cost values that you entered

    Restriction

    With the quick create methods, the application automatically creates the rate name when it creates the rate. You cannot name the rates using your own naming conventions.

  • Sets the rates usage to Standard and calculation method to Flat Amount for each cost

You can edit these new rates after searching for them on the Manage Benefit Rates page, Standard Rates tab.

Creating Rates with the Manage Benefit Rates Task

You can create standard rates based on flat amounts or other calculation methods, such as multiple of coverage or multiple of compensation, as well as calculate for enrollment formula. Use the Manage Benefit Rates task to create the standard rate and specify the calculation method, payroll and processing information, extra inputs, partial month determination, and annual rates.

Creating or Editing Rates in the Integrated Workbooks

You can create rates that use the flat amount calculation method when you create plans with or without options using the integrated plans workbook. To generate the workbook, click Prepare in Workbook on the plans Search Results section. Then enter plan and option details, including employer and participant costs. Upload processing is the same as when you save the quick create plan.

While you cannot create standard rates in the edit rates workbook, you can use it to edit many existing rates at once, for example, to reflect annual changes in contribution. To generate the workbook, click Edit Rates in Workbook on the Standard Rates tab. You can download and edit standard rates for only one calculation method at a time. This integrated workbook is for editing standard rates only. You cannot use it to associate variable rate profiles with standard rates.

Duplicating Rates for Additional Legal Employers

Rather than creating the same rates for multiple legal employers, you can create them once and then duplicate them for use by one or more additional legal employers. Use the Manage Benefit Rates task to search for the standard rate that you want to use for additional legal employers.

  1. Click the Duplicate button for the rate to open the Duplicate dialog box.

  2. Select and add the legal employers to which you want to copy the standard rate.

Benefits Variable Rate Creation Methods: Points to Consider

You can create and edit variable rates using one of these methods:

  • Create variable rate profiles and attach them to a standard rate.

  • Create variable formulas and attach them to a standard rate.

  • Use an integrated workbook to create and attach variable rate profiles.

When you duplicate standard rates to additional legal employers, you can also elect to copy the associated variable rates.

Creating and Attaching Variable Rate Profiles

To create variable rates, you first create variable rate profiles and then associate them with standard rates using the Manage Benefit Rates task. You can create variable rate profiles based on flat amounts or calculation methods, such as multiple of coverage or compensation and coverage, as well as calculate for enrollment formula. You must also, specify:

  • A treatment rule to add to, multiple by, replace, or subtract from the standard rate with which the profile is associated

  • An eligibility profile that identifies who is or is not eligible for the variable rate based on one or more factors, such as age, smoking status, or compensation amount

Creating and Attaching Variable Formulas

If a variable rate is based on a complex calculation, you can define one or more fast formulas to compute the rate. Then, associate the formulas with the standard rate in the Variable Rates section, Variable Formulas tab.

Creating Variable Rates in the Integrated Workbook

You can use the integrated workbook to create and upload multiple variable rate profiles at one time. Then associate them with existing standard rates and upload the changes. To generate the workbook, click Prepare in Workbook on the Variable Rate Profiles tab. You must upload new variable rate profiles to the application database before you can associate them with standard rates in the workbook.

Creating a Variable Rate: Worked Example

This example demonstrates how to create a benefit rate for an employee payroll contribution to a life insurance plan. The rate varies depending on the participant's age, so it is associated with multiple variable rate profiles.

The following table summarizes key decisions for this scenario.


Decision to Consider

In this example

Is this a standard or imputed rate?

Standard

What is the activity type for this rate?

Employee payroll contribution

Does this rate vary based on one or more factors?

Yes

What calculation method should be used for the standard rate?

No standard values used. The calculation method for each rate is defined exclusively in the variable rate profile.

What calculation method should be used for the variable rate profiles?

Flat rate

The following diagram shows the task to complete in this example:

Prerequisites and tasks for creating a variable rate profile

Note

The process of creating variable coverages follows the same flow and involves similar tasks, including creating variable coverage profiles, creating a base coverage, and associating variable coverage profiles with the base coverage.

Prerequisites

  1. Create the life insurance plan to which the rate applies.
  2. Define a payroll element and input value to associate with the rate.
  3. Create derived factors for the age bands associated with each variable rate, such as:
    • Age_20-29

    • Age_30-39

    • Age_40-49

    • Age_50-59

    • Age_60-69

    • Age_70-greater

  4. Create eligibility profiles for each age band, and associate with the appropriate derived factor. For example:
    • Life_Age_20-29

    • Life_Age_30-39

    • Life_Age_40-49

    • Life_Age_50-59

    • Life_Age_60-69

    • Life_Age_70-greater

Creating Variable Rate Profiles

  1. In the Plan Configuration work area, select the Manage Benefit Rates task.
  2. Click the Variable Rate Profiles tab.
  3. Click Create.
  4. On the Create Variable Rate Profile page, complete the fields, as shown in this table. Use the default values except where indicated.

    Field

    Value

    Profile Name

    Life_Age_20-29

    Tax Type Rule

    After Tax

    Activity Type

    Employee Payroll Contribution

    Treatment Rule

    Replace

    Defined Rate Frequency

    Biweekly

    Eligibility Profile

    Select the eligibility profile for this age band.

    Status

    Active

    Calculation Method

    Flat Amount

    Value

    4.00


  5. Click Save and Close.
  6. Repeat steps 3-5 to create five additional variable rate profiles, one for each age band. Use the values in the previous table for all fields except the ones below.

    Field

    Value

    Profile Name

    Life_Age_30-39

    Value

    6.00


    Field

    Value

    Profile Name

    Life_Age_40-49

    Value

    8.00


    Field

    Value

    Profile Name

    Life_Age_50-59

    Value

    10.00


    Field

    Value

    Profile Name

    Life_Age_60-69

    Value

    15.00


    Field

    Value

    Profile Name

    Life_Age_70-greater

    Value

    22.00


Creating a Standard Rate

  1. Click the Rates and Coverages tab.
  2. On the Standard Rates tab, click Create - Create Standard Rate.
  3. On the Create Standard Rates page, complete the fields, as shown in this table. Use the default values except where indicated.

    Field

    Value

    Rate Name

    Life Rate

    Legal Employer

    Select your legal employer.

    Plan

    Select the life insurance plan you created for this rate

    Activity Type

    Employee payroll contribution

    Tax Type Code

    After Tax

    Payroll Element

    Select the payroll element associated with this rate

    Element Input Value

    Select the input value for this rate

    Calculation Method

    No standard values used


Associating the Variable Rate Profiles to the Standard Rate

  1. On the Variable Rate Profile Name tab, click Select and Add.
  2. On the Select and Add window, enter a sequence number and select the first of the six variable profiles you created earlier. Click OK.
  3. Repeat steps 1 and 2 to add the other five variable profiles to this rate.
  4. Click Save and Close.

Managing Variable Benefit Rates in the Integrated Workbook: Explained

You can create variable rates by defining variable rate profiles and associating them with standard rates using the integrated Microsoft Excel workbook. Using this integrated workbook, you can create and upload multiple variable rate profiles, associate uploaded and existing profiles with existing standard rates, and upload the standard rate changes into the application database. Repeat these steps as many times as required.

Before you upload new or edited variable rate profiles, confirm that any associated benefit eligibility profiles, plans, and options already exist in the application database. The application database must also contain any referenced:

  • Compensation user-defined factors where Calculation Method is set to Multiple of Compensation

  • Fast formulas associated with variable rate profiles where Calculation Method is set to Calculate for enrollment formula

The basic process for managing variable rates using the workbook is:

  1. Generate the workbook.

  2. Create and edit variable rate profiles.

  3. Upload edits.

  4. Add variable rate profiles to standard rates.

  5. Upload edits.

  6. Resolve errors.

Generating the Workbook

You use the Manage Benefit Rates task in the Plan Configuration work area. Click Prepare in Workbook in the Variable Rate Profiles tab search results.

Creating and Editing Variable Rate Profiles

You can create and edit your variable rate profiles in the Manage Variable Rate Profiles worksheet.

  1. Select a calculation method.

    The calculation method for all rows must match the calculation method for the workbook, which you selected in the Search section. Mismatches result in errors when you upload your data.

  2. Optionally, you can enter an effective as-of date.

    The effective as-of date value is used as a constraint when downloading variable rate profiles. The upload process also uses it to set the effective date for the new and edited profiles. If you leave this field blank, the upload process sets the current date, also known as the system date, as the effective date.

  3. Search for the variable rate profiles that match your criteria.

  4. Create and edit the profiles, as required.

  5. Upload your edits to the application database.

Adding Variable Rate Profiles to Standard Rates

You can associate existing and newly uploaded variable rate profiles with standard rates in the Standard Rate Variable Rate Pro worksheet.

  1. Select a calculation method.

    The calculation method for all rows must match the calculation method for the workbook, which you selected in the Search section. Mismatches result in errors when you upload your data.

  2. Optionally, you can enter an effective as-of date.

    The effective as-of date value is used as a constraint when downloading standard rates. The upload process also uses it to set the effective date for the edited standard rates. If you leave this field blank, the upload process sets the current date, also known as the system date, as the effective date.

  3. Search for the standard rates that match your criteria.

  4. Associate variable rate profiles with the relevant standard rates.

  5. Upload your edits to the application database.

Restriction

  • The variable rate profiles must already exist in the application database before you can associate them with standard rates in the workbook. Upload any new or edited variable rate profiles first, then you can associate them with standard rates.

  • You must associate future-dated profiles with standard rates in the application; you cannot do it in the workbook.

The workbook uses the Changed cell in both worksheets to automatically identify the rows that you edit.

Uploading Edits

After you complete your edits for one of the worksheets, click Upload. Only those rows marked as changed are uploaded into the application tables. You can randomly test that the upload did work as you expected by searching for one or more of the following:

  • New or edited variable rate profiles in the application

  • Standard rates with which you associated a variable rate profile

The worksheet Status field is updated only if the server or database becomes inaccessible during upload.

Resolving Errors

The application automatically updates the Status value in each row of the workbook. If there are errors that require review, the upload rolls back the change in the application and sets the row status in the workbook to Upload Failed. It then continues to the next row in the workbook. You double-click Update Failed in the Status cell to view the error. Fix any data issues in the workbook and upload the changes.

Imputed Rates: Explained

Imputed income refers to certain forms of indirect compensation that US Internal Revenue Service Section 79 defines as fringe benefits and taxes the recipient accordingly. Examples include employer payment of group term life insurance premiums over a certain monetary amount, personal use of a company car, and other non-cash awards.

If a plan is subject to imputed income, you must create an imputed rate, in addition to the standard rates for the plan. You must also create a shell plan to record the imputed income calculation. You typically associate variable rate profiles with the imputed rate, because imputed income taxes vary based on a person's age.

The following figure illustrates the general steps involved in creating imputed rates:

Process of creating imputed rates

Prerequisites

Perform the following tasks before you create an imputed rate.

  • Define the payroll element for the rate.

  • Define derived factors for each age band (or any other factors) for which the rate varies, such as ages 20-25, 26-30, and so on.

  • Define an eligibility profile for each age band and attach the appropriate derived factors.

  • Define any other objects required by the specific rate, such as formulas.

Creating the Imputed Income Plan

Create the plan that is subject to imputed income. Set the Subject To Imputed Income field to the appropriate person type for this rate, such as participant, spouse, or dependent.

Creating the Shell Plan

Create another plan to hold the results of the imputed income calculation, using the following settings:

  • Set the plan type to Imputed Shell.

  • Set the plan function to Imputed Shell.

  • Set the imputed income calculation to the person type (participant, spouse, or dependent) that is subject to imputed income.

Note

The imputed income calculation assumes that the employer pays 100% of the benefit, and does not subtract employee contributions from the calculation.

Creating the Variable Rate Profiles

Create variable rate profiles for each variable rate, using the following settings:

  • Set the activity type to Imputed Benefit.

  • Select the appropriate eligibility profile for the age band.

  • Set the calculation method to Flat Amount.

  • Enter the rate amount.

  • Provide additional information as applicable for the rate.

Creating the Imputed Rate

From the Standard Rates tab, click the Create menu and then click Create Imputed Rate. In the Imputed Shell Plan field, select the shell plan you created earlier. Provide additional rate information as applicable.

Associating the Variable Rate Profiles with the Imputed Rate

Select and add the variable rate profiles to the imputed rate.

Partial Month Determination Rule: Critical Choices

The partial month determination rule calculates the contribution or distribution amount when a participant's enrollment coverage date falls within a month. You can choose from the following options:

  • All

  • None

  • Prorate value

  • Formula

  • Wash formula

All

The amount is calculated as if the participant was enrolled for the entire month.

None

The amount is calculated as if the participant was not enrolled at all for the entire month.

Prorate Value

The standard contribution/distribution is prorated based on the percentage of the month the participant was enrolled. If you choose this option, click Add in the Proration Details region to define proration details, including:

  • Percentage

  • Rounding rule or formula for rounding the calculated prorate value

  • Prorate period

  • Which months the proration details apply to (months with 28 days, 29 days, and so on)

  • Proration formula, if applicable

  • Start and stop coverage rule, if applicable

You can define more than one set of proration details if, for example, the details differ depending on the number of days in a month.

Formula

A formula is used to calculate the rate. If you choose this option, select the formula to use. You must have already defined the formula before you can select it here.

Wash Formula

A wash formula is applied to the rate to determine whether or not participants receive a contribution or distribution. If you choose this option, enter the day of the month (1-31) to be used as the wash rule day. Participants do not receive a contribution or distribution if their start date occurs after the wash rule day or their end date occurs before the wash rule day.

Benefits Rate Frequencies: How They Affect Rates

Specify the rate communicated to participants during enrollment by configuring frequency settings in basic details of the program or plan not in program. Use settings on the standard rate to configure the payroll deduction amount. Your configuration determines whether the communicated amount in the self-service enrollment pages and Enrollment work area is the same as the payroll amount.

Program or Plan Frequency Settings That Affect Rates

Select a value for each of the following frequencies when you configure the basic details for a program or plan not in program in the Plan Configuration work area.

  • Defined Rate Frequency: Frequency specified for the activity rate calculation. Possible selections are Annually, Biweekly, Monthly, Hourly, Quarterly, Semiannually, Semimonthly, or Weekly.

  • Communicated Rate Frequency: Used to calculate the rate displayed on the self-service enrollment pages and in enrollment results in the Enrollment work area. Possible selections are Estimated per pay period, Per month, Per pay period, Per pay period with element frequency rules, or Per year.

    The following table defines the pay period values.


    Frequency Value

    Description

    Per pay period

    Uses the number of pay end dates derived from the payroll definition. For example, a weekly payroll might result in 53 end dates in the calendar year.

    Estimated per pay period

    Uses the standard number of periods corresponding to the period type value selected in the payroll definition, regardless of the number of pay end dates in the calendar year. For example, communicated rate calculations use the fixed number of 52 weekly periods, even for years with the nonstandard 53 weekly periods.

    Per pay period with element frequency rules

    Uses the frequency rules of the payroll element associated with the standard rate to determine the number of deductions in the calendar year. For example, one of your benefit deductions occurs only on the first biweekly payroll in each month.

    If you use this communicated rate frequency, select Per-pay-period amount as the value passed to payroll.

    Restriction

    If you select one of the per pay period choices, you must define a corresponding payroll and assign the payroll to the relevant participants. Use the tasks in the Define Elements, Balances and Formulas task list in the Setup and Maintenance work area.

Standard Rate Frequency Settings That Affect Rates

Select a value for each of the following optional attributes when you configure rate details and payroll information for the standard rate in the Plan Configuration work area.

  • Element Input Value: Used to transfer the benefit rate to payroll through the element entry. Before you can select an element input value, you must first select a payroll element for the standard rate.

  • Value Passed to Payroll: Amount that the application passes to the element entry. Possible selections are Annual amount, Communicated amount, Defined amount, Estimated per-pay-period amount, or Per-pay-period amount. Leave this field blank if you do not use element entries.

    Tip

    If you want the communicated amount to be the same as the payroll deduction, be sure to coordinate the settings for the communicated rate frequency and the value passed to payroll.

  • Rate Periodization Formula: You can customize the annual, defined, and communicated rate calculations for any activity rate. To do so:

    1. Create a fast formula using the Rate Periodization formula type.

    2. Select the formula on the Processing Information tab of the standard rate.

How Communicated Rate is Calculated

The following table identifies the possible communicated rate values, the calculation used to determine the amount, an example amount, and the example calculation. The examples are based on a family medical plan and use the following values:

  • Standard rate: 4,000 USD

  • Defined rate frequency: Quarterly

  • Payroll period type: Biweekly

  • Element frequency rules for this deduction: First pay period in the month only


Communicated Rate Frequency

Calculation Used to Derive Communicated Amount

Example Communicated Amount (USD)

Example Calculation Expression

Per year

Standard rate x Number of times defined rate frequency occurs in 1 year

16,000

4,000 x 4

Per month

Annual amount / Number of times communicated rate frequency occurs in 1 year

1,333.3333

16,000 / 12

Per pay period

Annual amount / Actual number of pay periods in 1 year based on payroll frequency

Actual number example: Depending on the year, 52 or 53 for weekly and 26 or 27 for biweekly

One of these two amounts, depending on the year:

  • 615.3846

  • 592.5926

  • Annual amount / 26 pay periods

  • Annual amount / 27 pay periods

Estimated per-pay-period

Annual amount / Standard number of pay periods in 1 year based on payroll frequency

Standard number examples: 52 for weekly, 26 for biweekly, and 24 for semimonthly

615.3846

16,000 / 26

Per-pay-period with element frequency rules

Annual amount / Number of times deduction is taken in 1 year

1,333.3333

16,000 / 12

How Value Passed to Payroll is Calculated

The following table identifies the possible values to pass to payroll, the calculation used to determine the amount, an example amount, and the example calculation. The examples are based on a family medical plan and use the following values:

  • Standard rate: 4,000 USD

  • Defined rate frequency: Quarterly

  • Communicated rate frequency: Per month

  • Payroll: period:

    • Period type: Biweekly

    • Alternative for illustration purposes: Element frequency rule of first pay period in a month.

    • Reminder: Different years have a different number of biweekly payrolls.


Value Passed to Payroll

Calculation Used to Derive Amount

Example Value Passed to Payroll Amount (USD)

Example Calculation Expression

Left blank

None

Not applicable

Not applicable

Defined amount

Standard rate at the specified defined rate frequency

4,000 (per quarter)

None

Annual amount

Standard rate x Number of times defined rate frequency occurs in 1 year

16,000

4,000 x 4

Communicated amount

Annual amount / Number of times communicated rate frequency occurs in 1 year

1,333.3333

16,000 / 12

Estimated per-pay-period amount

Annual amount / Standard number of pay periods in 1 year based on payroll frequency

Standard number examples: 52 for weekly, 26 for biweekly, and 24 for semimonthly

615.3846

16,000 / 26

Per-pay-period amount

Annual amount / Actual number of pay periods in 1 year based on payroll frequency

Actual number example: Depending on the year, 52 or 53 for weekly and 26 or 27 for biweekly

If using element frequency rules: Annual amount / Number of times deduction is taken in 1 year

One of these two amounts, depending on the year:

  • 615.3846

  • 592.5926

If element has frequency rule of first pay period per month:

  • 1,333.3333

  • 1,600 / 26 pay periods

  • 1.600 / 27 pay periods

  • 16,000 / 12

Note

The communicated rate frequency is not coordinated with the value passed to payroll in the preceding examples, which focus on how each amount is calculated.

Value Passed to Payroll: Points to Consider

In the Value Passed to Payroll field on the Create or Edit Rates page, select the amount that you want to pass to a participant's payroll element entry on enrollment. Your choices are:

Communicated amount

The amount that the participant is told to expect for their contribution or distribution.

Defined amount

The amount that is defined for the rate, which may be different than the amount communicated to the participant.

Estimated per-pay-period amount

An estimate based on a fixed number of pay periods. For example, a biweekly payroll might occasionally have 25 or 27 pay periods in a calendar year, depending on the setup. Likewise, a weekly payroll might have 51 or 53 periods. When you select this option, the calculation uses the usual number of pay periods, which would be 26 for biweekly or 52 for weekly.

Per-pay-period-amount

The actual per-pay-period amount based on defined calculations. If you do not select a value, the calculation uses the per-pay-period amount. You can prorate only per-pay-period amounts.

Annual amount

The defined amount annualized.

Note

When using a formula to define rate periods, select Annual amount, Defined amount, or Communicated amount.

Editing Standard Benefit Rates in the Integrated Workbook: Explained

You can generate the integrated Microsoft Excel workbook in which you download standard benefit rates that match your search criteria. Use the integrated workbook to edit those rates, for example, to reflect annual changes in contribution. Then, upload your changes into the application database. Repeat these steps as many times as required to accommodate revisions.

The workbook enables you to edit existing rates, not add new ones.

The basic process for editing benefit rates using the workbook is:

  1. Generate and populate the workbook.

  2. Edit the standard rates.

  3. Upload edits.

  4. Resolve errors.

Generating and Populating the Workbook

On the Manage Benefit Rates page Standard Rates tab, click Edit Rates in Workbook to generate the workbook. In the search section at the top of the workbook, you must select a calculation formula. This acts as a filter for the records that the application adds as rows in the Search Results section after you click Search. You can also use the Rate Display Type, Effective As-of Date, and Status Rule fields to further filter your search result records.

Currently, the application is limited to a maximum of 500 rows when it generates the workbook, to manage application performance.

Editing Standard Rates

After the download is complete, edit data only in the search results cells with a white background. Edits in search results cells with a nonwhite background are not uploaded or could cause upload errors. The workbook uses the Changed cell to automatically identify the rows that you edit.

Edit the following objects in the Plan Configuration work area, rather than in the workbook: variable rate profiles, variable formulas, extra inputs, partial month determination, and annual rates.

Uploading Edits

After you complete your edits, click Upload. Only those rows marked as changed are uploaded into the application database. During the upload, for records marked as changed:

For records marked as changed, the workbook upload:

  1. End dates the original benefit rate record by setting the effective end date to the day before the effective as-of date that you used as part of your download filter.

  2. Adds a new benefit rate record with your edits. The effective start date is the same as your effective as-of date and the effective end date is the original effective end date.

Changed rows are moved to the bottom of the workbook.

Resolving Errors

The application automatically updates the Status cell in each row of the workbook. If there are errors that require review, the upload rolls back the change in the application database and sets the row status in the workbook to Upload Failed. Then, it continues to the next row in the workbook. Double-click Update Failed in the Status cell to view the error. Fix any data issues in the workbook and upload the new changes.

To validate the changes, return to the Manage Benefit Rates page, Standard Rates tab and search for the changed rate.

Coverages: How They Are Calculated

Coverages define the level of benefits coverage a participant receives under plans such as life insurance. Coverages are calculated by applying a calculation method, also called a determination rule, to values you define or ones that are entered by the participant during enrollment. You can also define limiters and rounding rules to apply to the initial calculation to derive the final coverage.

Settings That Affect Coverage Calculations

The following determination rules are available for computing coverages:


Calculation Method

Description

Flat amount

Flat amount is predefined or entered during enrollment.

Flat range

Flat amount must be within a predefined range.

Flat amount plus multiple of compensation

Calculates coverage as flat amount plus multiple of compensation

Flat amount plus multiple of compensation range

Calculates coverage as flat amount plus multiple of compensation within a predefined range

Multiple of compensation

Calculates coverage as multiple of compensation

Multiple of compensation plus flat range

Calculates coverage as multiple of compensation plus flat amount that is within a predefined range

Multiple of compensation range

Multiple of compensation must be within a predefined range.

No standard value used

Uses coverage defined in variable coverage profiles

Same as annualized elected activity rate

Uses annualized elected activity rate for coverage amount

Post enrollment calculation formula

Calculates coverage based on election information entered during enrollment using a formula you define

The calculation method you select works in conjunction with other settings to compute the final coverage.

  • For calculation methods using multiples, you can specify the operation, such as simple multiplication, percentage, per hundred, and per thousand.

  • For calculations based on compensation, you can specify the compensation derived factor that defines the basis for the compensation calculation.

  • You can specify rounding and limiters for calculated results.

  • If you enable participant input, you can set valid ranges and default values. The default values are used if you recalculate coverages and no user input is available.

If coverage varies based on one or more factors, such as age, you can create variable coverage profiles and add them to the base coverage. When you create a variable coverage profile, you select one of the calculation methods and attach an eligibility profile that defines the criteria a participant must satisfy in order to qualify for the coverage. You also select a treatment rule that determines whether the variable coverage amount is added to, multiplied by, subtracted from, or replaces the base coverage. You can associate multiple variable coverage profiles with a base coverage.

How Coverages Are Calculated

The calculation method and other settings defined for a coverage determine when and how it is calculated. For example, the coverage may be calculated prior to enrollment, upon enrollment, or after enrollment has been completed.

Example: Multiple of Compensation

Inputs to Calculation

Calculated Rate

Calculation Details

Multiplier: 2

Operator: Multiply by

Compensation Amount: 25,000 (value derived by applying a Compensation Factor of Annual Salary)

50,000

2 x 25,000

Example: Multiple of Compensation Range

Inputs to Calculation

Calculated Coverage

Calculation Details

Minimum: 2

Maximum: 6

Increment Amount: 2

Default Value: 4

Operator: Multiply by

Compensation Amount: 25,000 (value derived by applying a Compensation Factor of Annual Salary)

100,000 (using default)

4 x 25,000

Example: Flat Amount Plus Multiple of Compensation

Inputs to Calculation

Calculated Coverage

Calculation Details

Flat Amount: 50,000

Multiplier: 2

Operator: Multiply by

Compensation Amount: 25,000 (value derived by applying a Compensation Factor of Annual Salary)

100,000

50,000 + (2 x 25,000)

Example: Flat Amount Plus Multiple of Compensation Range

Inputs to Calculation

Calculated Coverage

Calculation Details

Flat Amount: 50,000

Minimum: 2

Maximum: 6

Increment Amount: 2

Default Value: 4

Operator: Multiply by

Compensation Amount: 25,000 (value derived by applying a Compensation Factor of Annual Salary)

150,000 (using default)

50,000 + (4 x 25,000)

Example: Multiple of Compensation Plus Flat Range

Inputs to Calculation

Calculated Coverage

Calculation Details

Minimum: 30,000

Maximum: 50,000

Default Value: 40,000

Increment Amount: 10,000

Multiplier: 2

Operator: Multiply by

Compensation Amount: 50,000 (value derived by applying a Compensation Factor of Annual Salary)

140,000 (using default)

40,000 + (2 x 50,000)

Managing Coverage Across Plan Types: Example

Some benefit programs restrict the amount of coverage that a participant can elect across plan types. The following scenario illustrates how to define the maximum coverage amount across two life insurance plan types.

Managing Coverage Across Two Life Insurances Plan Types

Suppose your organization has a program with two plan types: group term life insurance and non-group term life insurance. Within the group plan type, you offer an employee group term life insurance plan, which provides coverage equal to two times earnings up to a maximum of $200,000. Within the non-group plan type, you offer a plan that has a maximum coverage level of $120,000. You want to set a maximum coverage of $300,000 across the two plans.

To accomplish this, create a coverage across plan type record for the program and set the maximum amount to $300,000. Optionally, you can set a minimum coverage amount.

Note

The across plan type maximum coverage cannot be less than the lowest maximum coverage of any plan in the plan type. Thus, the across plan type maximum in this example cannot be less than $120,000.

Flex Credits Configuration

Flex Credit Offerings: Overview

Flex credits are monetary units that workers can use to offset costs of specific plan enrollments. This overview illustrates when to create flex credit offerings, the sequence of setting up a flex credit offering, and how these offerings are made available to participants during enrollment.

Implementers can consider creating flex credit offerings if they want to implement any of the following styles of benefit offerings in an enterprise:

  • Cafeteria plans offered in the US to comply with Section 125 of the Internal Revenue Code

  • Benefit plans offered in the US to comply with the Employee Retirement Income Security Act (ERISA)

  • Benefit plans offered in other countries that enable workers to buy benefits from an allowance that the employer might offer

  • Benefit offerings that provide flex credits, but are not necessarily recognized by or pursuant to a government agency

The following figure illustrates the sequence of creating a flex credit offering.

Figure that illustrates flex credit offering creation sequence

As a benefit administrator, you use the Manage Benefit Program Details task in the Plan Configuration work area to create a program of type Flex credits or Flex credits plus core. Then, create the rest of the benefit objects, such as plan type, plans-in-program, options-in-plan-in-program, rollover rates, and elements in the Plan Configuration work area. Finally, use the Manage Flex Credits Configuration task to create a flex credit shell plan and associate with it the flex program. You create a flex credit shell plan to define your flex credit policy:

  • Create credit pools at specific levels in your benefit hierarchy to calculate and maintain credits.

  • Define which benefit offerings participants can purchase using flex credits.

  • Decide whether participants can spend beyond their flex credit budget.

  • Decide the order in which you want to deal with excess credits that might remain after enrollment. Pay out a percentage or transfer a percentage to other offerings in compliance with corresponding contribution limits, or forfeit the credits.

The flex credit shell plan does not appear during enrollment and participants cannot enroll in a flex shell plan directly. When participants enroll in a program that is associated with a flex shell plan, the rules defined in that plan enable participants to use flex credits to enroll in specific offerings.

Flex Credit Shell Plan Components: How They Work Together

Use a flex credit shell plan to configure benefit offerings with the flex credits policy of your enterprise. Set up flex shell plans for your enterprise using these components: programs, rates, and credit pools. You create flex shell plans on the Manage Flex Credits Configuration page.

This figure illustrates how the flex credit shell plan components fit together.

Figure that illustrates flex credit setup components

Programs that you associate with a flex credit shell plan can contain multiple credit pools to maintain credits that participants can use at specific levels in the hierarchy. For each credit pool:

  • Configure the method to calculate the credit value.

  • Add rates of spending options that must deduct from the credit pool on enrollment.

  • Define rules to handle treatment of excess credits after enrollment.

Flex standard rates that you associate with the flex shell plan store the total flex credit value offered to the participant and the excess credit amount after enrollment.

Flex Credit Shell Plan

Each enterprise can have a maximum of two shell plans: one for unrestricted enrollment and one for life event enrollment. You can associate multiple programs with the same flex shell plan within the enterprise, but associate only one flex shell plan with each program.

Programs

When you create a flex shell plan, you must associate at least one program with it. Programs that you associate with the flex shell plan must belong to the Flex credits program type or the Flex credits plus core program type. When participants enroll in a flex program, they are automatically enrolled in the corresponding flex credit shell plan.

Credit Pools

A credit pool maintains flex credit values that participants can use at specific levels in the benefits hierarchy. You define credit pools in the Credit Pools tab when you create a flex shell plan. Maintain credit pools at the program level, plan-in-program level, and the option-in-plan-in-program level. Use a calculation method to determine the flex credit pool value.

For each credit pool, you configure the following components:

  • Spending Options: Define which benefit offerings participants can spend their credits on. In the Spending Options tab, you add the rates of benefit offerings that must deduct from the credit pool when participants enroll in those offerings. For example, if you want a medical plan to deduct from the credit pool on enrollment, then you add the standard rates for that plan's options.

  • Excess Credits Treatment: Define rules that determine how you want to deal with credits that might remain unused after enrollment. For example, you can select a rule that performs the following functions in a particular order:

    1. Disburse a percentage of unused credits as cash.

    2. Transfer to other offerings a percentage of the credits that remain after disbursement. You must include the rates of these offerings in the Rollover Rates tab when you create a credit pool.

    3. Forfeit the remaining credits.

    If you want to include rules that do not already exist on the Manage Flex Credit Configuration pages, you can create a formula that belongs to the Excess Credits Treatment formula type and select that as the excess treatment rule in the Excess Credits tab.

Flex Standard Rates

For a combination of program and legal entity, you must create the following rates within the flex shell plan:

  • Rate for Flex Credits Provided as Pool: This rate stores in a payroll element, the total amount of flex credits that are available to the participant. The stored amount is an aggregated flex credit value from all of the credit pools that were defined at appropriate levels in the benefits hierarchy.

  • Rate for Unused Credits Disbursed as Cash: One of the functions in the excess credit treatment rules disburses a percentage of unused credits to the participant in cash. This rate stores in a payroll element, the total amount of unused credits that you want to disburse as cash.

You create the flex standard rates for the flex shell plan in the Rates step of the Create Flex Credit Configuration page.

Flex Credit Shell Plan Configurations: Examples

The examples in this topic show different flex credit shell plan configurations and flex credits calculations as a result of those configurations. All values in these examples are in USD.

Plan-in-Program-Level Pool

You configured your flex credit shell plan as illustrated in the following figure.

Figure that illustrates a flex credit configuration using a plan-in-program level pool

The credit pool at the plan level offers 40 credits. The spending options and excess credit rules are defined at this level.

When participants enroll in the Employee Only option of the Be Well plan, they are provided 40 credits from the plan-level pool. The Employee Only option costs 20 USD, which is deducted from the total credits provided. This results in a credit balance of 20.

Excess credit rules transfer 10 credits from the credit balance to a savings plan resulting in a balance of 10. From this balance, 5 credits are disbursed as cash. The remaining balance, 5 credits, is forfeited.

Program-Level Pool and Plan-In-Program-Level Pool Configured to Allow Overspending

You have configured your flex shell plan as illustrated in the following figure.

Figure that illustrates program-level pool and plan-in-program-level pool configured to allow overspending.

The credit pool at the program level offers 60 credits. The Commuter plan is defined as a spending option at this level. The credit pool defined for the Be Well Medical Plan offers 10 credits and has the Employee-Only option defined as a spending option. Note that the Be Well Medical plan is not defined as a spending option. The credit pool at this level allows overspending up to 50 percent beyond the available credits.

Participants enroll in the following offerings:

  • Employee Only option of the Be Well Medical plan

  • Commuter plan

The cost of the Employee Only option is 15 USD. Although the plan-level pool offers only 10 credits, the participant can enroll in the option. This is because the credit pool at this level allows overspending up to 50 percent beyond the provided credits, which equals 15 credits.

The cost of the Commuter plan is 10 USD, which is deducted from the credits provided by the program-level pool, resulting in 50 excess credits. The excess treatment rule disburses 10 credits as cash. From the remaining balance of 40 credits, the rule transfers 10 credits to the savings plan. The rest, 30 credits, is forfeited.

Plan-In-Program-Level Pool and Option-In-Plan-In-Program-Level Pool Configured to Add to Program-Level Pool

You have configured your flex shell plan as illustrated in the following figure.

Figure illustrating plan-in-program-level pool and option-in-plan-in-program-level pool configured to add to program-level pool

The credit pool defined at the program level offers 5 credits and has spending options and excess credit rules defined. Credits pools for the Commuter plan and the Employee Plus Spouse option add to the program-level pool and use its spending options and excess treatment rules.

Participants enroll in the following offerings:

  • Commuter plan

  • Employee-plus-spouse option of the Be Well Medical plan

The credit pool at the Commuter plan level provides 20 credits. The credit pool defined at the Employee Plus Spouse option level provides 30 credits. These credits are configured to add to the program level pool, resulting in 55 credits, which also includes the credits provided by the program pool. The total cost of the Commuter plan enrollment and the Employee Plus Spouse option enrollment is 30 USD, which is deducted from the provided credits resulting in 25 excess credits.

The excess treatment rule transfers 10 credits to the savings plan resulting in a balance of 15 credits. From this balance, 5 credits are disbursed as cash. The rest of the balance, 10 credits, is forfeited.

Enrollment Modes for Flex Credit Shell Plans: Explained

When you create a flex credit shell plan, you must select an enrollment mode for the shell plan. The enrollment mode determines the type of programs that you can associate with the flex shell plan.

Associate Programs According to Enrollment Mode

You configure the flex credit shell plan for either unrestricted enrollment mode or life event enrollment mode.

  • If the shell plan is configured for unrestricted enrollment mode, you can associate with it only those programs that are enabled for unrestricted enrollment.

  • If the shell plan is configured for life event enrollment mode, you can associate with it only those programs that are not enabled for unrestricted enrollment.

After you have associated a program with a flex shell plan, you cannot change the configuration of the Enable unrestricted enrollment check box on the Edit Program page. For example, you cannot deselect the Enable unrestricted enrollment check box for an unrestricted program that you have associated with a flex shell plan.

Number of Flex Credit Shell Plans

An enterprise can have only one flex shell plan for each enrollment mode. In other words, an enterprise can have only one flex shell plan for unrestricted mode, and one flex shell plan for life event mode. You can associate multiple programs with the same flex shell plan within the enterprise, as shown in this figure.

Figure that illustrates enrollment modes

Cash Disbursals and Rollovers of Excess Flex Credits: Explained

The disburse-maximum and the rollover-maximum components that this topic explains are a part of the following excess credit treatment rules that you configure in the Excess Credits tab when you create a flex credit shell plan:

  • Disburse maximum, rollover maximum, then forfeit

  • Rollover maximum, disburse maximum, then forfeit

Disburse Maximum

Excess flex credits are disbursed as cash based on the minimum and maximum limits that you set.

  • Minimum limit scenario: The minimum cash disbursement limit is 50 USD. If the excess credits are 40 USD during enrollment, then no cash is disbursed and the next component in the rule starts to process.

  • Maximum limit scenario: The maximum cash disbursement limit is 80 USD. If the excess credits are 100 USD, then only 80 USD is disbursed before the next component in the rule starts to process.

Rollover Maximum

Flex credits are transferred to other offerings based on the minimum and maximum limits that you set for each rollover rate associated with a flex shell plan. A rollover rate is a rate that you configure for a benefit offering to enable rollover of flex credits into that offering. You create a rollover rate using the Manage Benefit Rates task in the Plan Configuration work area. Then, you add the rollover rate to the flex shell plan on the Excess Credits tab of the Create or Edit Flex Credit Configuration page, Credit Pools step.

If multiple rollover rates exist for a flex shell plan, the excess flex credits transfer to each rollover rate in sequence depending on the sequence numbers that you associated with each rate. The flex credits continue to transfer as long as the excess credits that remain after each transfer are within the maximum and minimum limits set for each rollover rate.

You can restrict rollover of excess credits according to the minimum and maximum contribution limits that you defined for a particular rate. For example, your HCRA plan has a maximum annual contribution limit of 5000 USD and you want to use that limit to restrict rollovers into the plan. When you create a rollover rate for the HCRA plan, you select from the Rate for Limits Enforcement list the standard rate of the HCRA plan for which you defined the contribution limits.

Benefit Program Types: Critical Choices

The program type determines whether you want the program and its offerings to work with a flex credit shell plan. You select the program type when you create a program.

Core

Select this program type if you want to create a program that is independent of a flex credit shell plan.

Flex-Credits Program Type

Select this program type if you want to associate a flex credit shell plan with the program. You can associate with this program only those plans and options that involve flex credits.

Flex-Credits-Plus-Core Program Type

Select this program type if you want to associate a flex credit shell plan with the program. However, you can also associate with this program plans and options that do not involve flex credits.

Creating a Flex Credit Shell Plan: Worked Example

This example demonstrates how to create a flex credit shell plan to conform to the flex credits policy of an enterprise. This example is specific to flex shell plan configurations in the US. All values are in USD.

This table summarizes key decisions for this scenario.


Decisions to Consider

In This Example

Which program must participants enroll in to receive flex credits?

InFusion Wellness program

Does the program enable unrestricted enrollment?

No

Which spending options can participants purchase using the flex credits provided?

Participants can spend their flex credits on the following spending options:

  • InFusion Vision, which costs 200 per year

  • InFusion Dental, which costs 100 per year

  • InFusion Medical, which costs 5000 per year

Include the spending options in the credit pool at which level in the offering hierarchy?

Program level.

What is the amount of flex credits do you want the InFusion Wellness program to provide?

Flat amount of 150.

Do you want to allow participants to overspend?

No

How do you want to deal with excess flex credits?

Excess credits must be dealt with in this order:

  • Rollover 50 percent of the excess credits to the Infusion Savings Account plan.

  • Disburse 40 percent of the remainder after the rollover as cash.

  • Forfeit the remainder after the cash disbursal.

What rollover rates must be created?

Create a rollover rate for the InFusion Savings Account plan.

Are there any limits to the amount of contributions that can be rolled over to a rate in a calendar year?

Yes, the main contribution rate of the plan that the excess flex excess must transfer to must be configured to accept up to an amount of 300 in a calendar year.

Task Summary

Before you start, complete these steps:

  1. Create a program, plans, and standard rates for the plans.

  2. Create a plan type for the flex credit shell plan.

Then, create a rollover rate for the Infusion Savings Account plan that excess credits must transfer to. Finally, create a flex credit shell plan.

The following figure shows the tasks to complete in this example.

Figure that illustrates prerequisite steps for this worked example

Prerequisites

  1. In the Plan Configuration work area, use the Manage Program Details task to create a program called InFusion Wellness. On the Create Program Basic Details page, ensure that you select Flex Credits as the program type.
  2. In the Plan Configuration work area, use the Manage Plan Types task to create a plan type called InFusion Wellness Flex Plans for the flex credit shell plan that you will create in a later step. On the Create Plan Type page, ensure that you select Flex Credits from the Option Type list.
  3. In the Plan Configuration work area, use the Manage Benefit Plan Details task to create these plans:
    • InFusion Vision

    • InFusion Dental

    • InFusion Medical

    • InFusion Savings Account

    On the Create Plan Basic Details page for the Vision and Dental plans, ensure that you select In Program from the Usage list.

  4. In the Plan Configuration work area, use the Manage Benefit Rates task to create rates:
    • Create a standard rate for the InFusion Vision plan. Set the calculation method for the rate as a flat amount of 200.

    • Create a standard rate for the InFusion Dental plan. Set the calculation method for the rate as a flat amount of 100.

    • Create a standard rate for the InFusion Medical plan. Set the calculation method for the rate as a flat amount of 5000.

    • Create a standard rate for the InFusion Savings Account plan:

      • Select Flat amount as the calculation method.

      • Select the Participants enter value during enrollment check box.

      • In the Ranges section, enter 0 in the Minimum Election Value field, and 300, in the Maximum Election Value field.

      • Select 0 as the default value. Select 1 as the increment.

Creating a Rollover Rate

  1. In the Plan Configuration work area, click Manage Benefit Rates.
  2. In the Standard Rates tab, select Create - Rollover Rate.
  3. On the Create Rollover Rate page, complete the fields as shown in this table. Use the default values except where indicated.

    Field

    Value

    Rate Name

    InFusion Savings Account Rollovers (Employee Contribution)

    Plan Name

    InFusion Savings Account

    Legal Employer

    Select your legal employer.

    Status

    Active

    Activity Type

    Employer Contribution

    Tax Type Code

    Pretax

    Rate for Limits Enforcement

    Select the rate that you created for the Savings Account plan.


  4. Click Save and Close.

Creating a Flex Credit Shell Plan

  1. In the Plan Configuration work area, click Manage Flex Credits Configuration to open the Manage Flex Credits Configuration page.
  2. Click Create.
  3. On the Create Flex Credits Configuration: Basic Details page, complete the fields as shown in this table.

    Field

    Value

    Plan Name

    InFusion Wellness Flex Shell Plan - Life Event

    Mode

    Life event

    Plan Type

    InFusion Wellness Flex Plans


  4. In the Year Periods section, select and add year periods from January 1, 2010 to December 31, 2016.
  5. In the Programs section, select and add the InFusion Wellness program.
  6. Click Save.
  7. Click the Rates step.
  8. In the Rate for Flex Credits Provided as Pool section of the Create Flex Credits Configuration: Rates page, complete the fields as shown in this table.

    Field

    Value

    Rate name

    Flex Credits


  9. In the Rate for Unused Credits Disbursed as Cash section, complete the fields as shown in this table.

    Field

    Value

    Rate name

    Cash Disbursement


  10. Click Save.
  11. Click the Credit Pools step.
  12. Select the InFusion Wellness program on the Create Flex Credits Configuration: Credit Pools page.
  13. In the Credit Pool section, click Add Credit Pool, and complete the fields as shown in this table.

    Field

    Value

    Credit Pool Name

    InFusion Program Pool

    Note

    Leave the Credit Provider Plan field and the Credit Provider Option field empty because you are creating a program-level pool.

    Status

    Active


  14. In the Calculation Method tab, complete the fields as shown in this table.

    Field

    Value

    Calculation Method

    Flat amount

    Value

    200


  15. Click the Spending Options tab, and complete the fields as shown in this table.

    Field

    Value

    Spending Options

    Select and add the rates of the following plans that you created in an earlier step:

    • InFusion Vision

    • InFusion Dental


  16. Click the Excess Credits tab, and complete the fields as shown in this table.

    Field

    Value

    Excess Treatment Rule

    Rollover maximum, disburse maximum, then forfeit

    Cash Disbursement Limit

    Percentage of excess credits

    Minimum

    0

    Maximum

    40


  17. In the Rollover Rates section, click Select and Add.
  18. In the Select and Add dialog box, complete the fields as shown in this table.

    Field

    Value

    Rate

    InFusion Savings Account Rollovers (Employee Contribution)

    Sequence

    1

    Rollover Limit Rule

    Percentage of excess credits

    Minimum

    0

    Maximum

    50


  19. Click OK.
  20. Review the information that you entered for the flex shell plan, and click Save and Close.

FAQs for Define Benefit Rates and Coverage

How can I calculate benefit rates per paycheck instead of per pay period?

Scenario: Your payroll processes either weekly or biweekly, so some years you have 52 or 26 payroll runs and others you have 53 or 27. Regardless of the number of payroll runs, you always issue 52 or 26 paychecks per year and you want to calculate the rate communicated to participants per those 52 or 26 paychecks.

  • In the Communicated Rate Frequency field, select Estimated per pay period on the program basic details page.

  • In the Value Passed to Payroll field, select Estimated per-pay-period amount on the standard rates page.

How can I avoid rounding discrepancies for communicated rates?

Scenario: After a rate change, the first element entry might be different from the remaining element entries, for rounding purposes. For example, the rate is 1,333.33333 or 592.592592 and you want the first rate to take the offset so that the subsequent rates round evenly. To avoid rounding the first element entry, and therefore the communicated rate, you can use either of the following two methods:

  • Use a rate periodization formula, which is a fast formula with a type of rate periodization.

    1. Create a fast formula of the Rate Periodization type using the Manage Fast Formulas task in the Setup and Maintenance work area.

    2. Select the formula on the Processing Information tab of the standard rate in the Plan Configuration work area.

  • Set Value Passed to Payroll on the standard rate to either Annual amount, Communicated amount, or Defined amount in the Plan Configuration work area.

    Warning

    If you select Estimated per-pay-period amount or Per-pay-period amount, the first element entry is rounded.

What's the difference between Limiters and Ultimate Limiters?

Limiters establish the minimum and maximum variable rate or coverage amount before it is added to, subtracted from, or multiplied by the standard rate or coverage. Ultimate limiters establish the minimum and maximum variable rate or coverage amount after it added to, subtracted from, or multiplied by the standard rate amount. For example, the ultimate high limit value sets the absolute maximum rate amount when the Add to treatment rule is selected, whereby the variable rate calculated result is added to the standard rate calculation.

Can I edit multiple standard benefit rates at one time?

Yes. You can generate the integrated Microsoft Excel workbook in which you download standard benefit rates that match your search criteria. Use the integrated workbook to edit those rates, for example, to reflect annual changes in contribution. Then, upload your changes back into the application database. To generate the workbook, on the Manage Benefit Rates page Standard Rates tab, click Edit Rates in Workbook.

The workbook enables you to edit existing rates, not add new ones.

How can I use existing rates for additional legal employers?

Click Manage Standard Rates in the Tasks pane of the Plan Configuration work area.

  1. On the Standard Rates tab, search for the rate that you want to use for additional legal employers.

  2. On the Search Results toolbar, click the Duplicate button for the rate to open the Duplicate dialog box.

  3. Select and add the legal employers to which you want to copy the standard rate.

You can also elect to copy the variable rates associated with the standard rate, as well as their child objects, such as variable rate profiles and formulas.

How can I limit spouse and dependent insurance coverage to a percentage of participant's coverage?

Follow these two steps:

  1. On the enrollment step in the program configuration process, select the program level row of the hierarchy. On the General tab, enter a percentage in the Spouse Insurance Coverage Maximum field and the Dependents Insurance Coverage Maximum field.

  2. Select the appropriate insurance plan type row in the program hierarchy on the enrollment step, and scroll to the plan type further details below. In the enrollment section of the General tab, select the Subject to dependent's insurance coverage maximum percentage option and the Subject to spouse's insurance coverage maximum percentage option.

FAQs for Flex Credits Configuration

What's the difference between a flex credit shell plan and benefit plan?

The flex credit shell plan does not appear during enrolment. Participants enroll in a benefit plan, but not in a flex shell plan.

Participants are enrolled automatically in a flex shell plan when they enroll in a program that is associated with that shell plan.

Can I delete a flex credit shell plan?

Yes, but before you delete the flex shell plan, you must delete the plan's child records, such as credit pools and flex rates. Even if a single person was processed for the flex shell plan as part of a flex program that resulted in electable choice records, you cannot delete the plan.

Can I edit a flex credit shell plan?

Yes, but you cannot edit the flex shell plan's plan type, status, associated programs, rate activity type, and tax type code.

Can I delete a standard rate associated with a flex shell plan?

No, but if you want to stop using the current rate and use another one instead, enter an end date, or set the status of the rate to Inactive or Closed.

What happens if I add credits to the program-level credit pool?

If you configured the flex credits to calculate at lower levels in the benefits hierarchy, such as the plan-in-program level, those credits add to the program-level's credit pool. The spending options and excess credit treatment rules defined for the program's credit pool apply.

What happens if I don't specify spending options to deduct from a flex credit pool?

The flex credits calculated for that credit pool will be treated as excess and the excess treatment rule that you defined in the Excess Credits tab applies. If you have not defined excess credit treatment rules, then the entire credit balance is forfeited.

What happens if I don't select an excess credit treatment rule for a flex credit shell plan?

The credit pool's excess flex credit amount is forfeited. Forfeiture is the default excess credit treatment rule.

How can I add a flex credit shell plan to the program?

You use the Manage Flex Credit Configuration pages in the Plan Configuration work area to add the program to the flex shell plan.

Why can't I see all rates while defining limits enforcement?

Rates must use the Flat Amount calculation method and enable participants to enter rate values during enrollment to appear in the Rate for Limits Enforcement list.

Manage Enrollment Display

Configuring Enrollment Display: Points to Consider

You can configure how plans are grouped and displayed on each step in the self-service guided enrollment process and on each administrator enrollment tab

This topic discusses the following decision points:

  • Grouping plans for enrollment

  • Configuring enrollment display

  • Configuring rate display

Grouping Plans for Enrollment

Group plan types into display categories in the Manage Plan Types task. For each plan type:

  • Specify a category for displaying plans in self-service enrollment steps.

  • Specify a category for displaying plans in administrative enrollment tabs.

You can group plan types together for display by assigning the same display category to multiple plan types. For example, you could group several different life insurance plan types together into a single Life Insurance display category. For a single plan type, you can choose a different category for self-service display compared to the administrative display.

When you create new plans, you assign each to a plan type. Each plan inherits the enrollment display category of its assigned plan type.

Configuring Enrollment Display

Use the Manage Plan Grouping page to configure the visibility and display names of plan type enrollment categories for:

  • Steps in the self-service enrollment guided process

    You can change the names of the plan type category groupings, which correspond to self-service enrollment step names, and you can control whether each step is visible. You can also enter a description of the plan grouping to associate with the selected enrollment display name. Participants see this description during self-service enrollment.

  • Tabs for administrator usage

    You can change the names of the plan type groupings, which correspond to tabs in the Benefits Service Center enrollment tasks. You can also specify whether to display each tab.

You can modify only the name and visibility of plan groupings, but you cannot create new groupings on this page. If you decide not to display a plan grouping for self-service enrollment, the benefits administrator can still enroll a participant in that plan grouping if it is displayed for administrator usage.

Configuring Rate Display

Click the button for the plan in the Rate Column Display column to configure the name and visibility of rate columns on each step in the self-service enrollment guided process.

  • You can specify which columns to display on each plan grouping step in the enrollment process. However, the Primary Rate column cannot be hidden.

    For example, you can display rate column 2 on the medical step, but not on the dental step.

  • You can name the displayed rate columns differently on different enrollment steps.

    For example, you can name the first two rate columns Employee Cost and Employer Cost on the medical enrollment step, and name them Pretax and After-Tax on the insurance enrollment step.

It is important to understand that the taxation is not affected by the column name that you enter.

Defining Notes: Points to Consider

A note is a record attached to a business object that is used to capture nonstandard information received while conducting business. When setting up notes for your application, you should consider the following points:

  • Note Types

  • Note Type Mappings

Note Types

Note types are assigned to notes at creation to categorize them for future reference. During setup you can add new note types, and you can restrict them by business object type through the process of note type mapping.

Note Type Mappings

After note types are added, you must map them to the business objects applicable to your product area. Select a business object other than Default Note Types. You will see the note types only applicable to that object. If the list is empty, note type mapping doesn't exist for that object, and default note types will be used. Select Default Note Types to view the default note types in the system. Modifying default note types will affect all business objects without a note type mapping. For example, you have decided to add a new note type of Analysis for your product area of Sales-Opportunity Management. Use the note type mapping functionality to map Analysis to the Opportunity business object. This will result in the Analysis note type being an available option when you are creating or editing a note for an opportunity. When deciding which note types to map to the business objects in your area, consider the same issues you considered when deciding to add new note types. Decide how you would like users to be able to search for, filter, and report on those notes.

Note

Extensibility features are available on the Note object. For more information refer to the article Extending Oracle Sales Cloud Applications: how it works.

FAQs for Manage Enrollment Display

What's a benefit space?

A benefits space is a forum in which participants can share their benefits-related questions, concerns, and experiences. It can be helpful to participants as they select benefits offerings and providers. If you enable benefits spaces, a link appears on the benefits overview page. Before enabling this feature, carefully consider the terms and agreement for participation in the space and any issues of liability on the part of your organization.

Define Benefits Configuration Copy

Export Plan Configuration for Benefits: Explained

You can export a program, plan not in program, or eligibility profile from one environment for import into other environments and to the same or different enterprises in the same environment. You open the Export Plan Configuration task in either the Setup and Maintenance or Plan Configuration work area.

Tip

Before exporting your plan configuration, validate the program or plan not in program that you want to export in the relevant programs or plans Search Results section. Also, on the Processes tab in the Evaluation and Reporting work area, run the Evaluate Life Event Participation process for a sample participant in the program or plan that you intend to export. You can compare the results of this validation and evaluation with the results for the same validation and evaluation in the destination environment, for the imported program or plan configuration.

The following are key aspects of exporting plan configurations:

  • Items included in the export

  • Items excluded from the export

  • Accessing the export and log files

Items Included in the Export

The export process includes the child objects associated with the top-level object that you select.

  • Program configuration exports include the associated plan types, plans, options, year periods, legal entities, reporting groups, organizations, eligibility profiles, life events, action items, formulas, rate, coverage, coverage across plan type, enrollment authorization, and dependent and beneficiary designation.

  • Plan not in program configuration exports include the associated plan types, options, year periods, legal entities, reporting groups, regulations, organizations, eligibility profiles, life events, action items, formulas, rate, coverage, enrollment authorization, and dependent and beneficiary designation.

  • Eligibility profile exports include derived factors, service areas, and formulas

Items Excluded from the Export

Standard rates: The element input and extra input are excluded from exports.

Eligibility criteria: The following eligibility criteria are excluded from all participant eligibility profile exports.

  • Personal criteria: Leave of absence, qualification, and competency

  • Employment criteria: Performance rating

  • Other criteria: Health coverage selected and participation in another plan

    For all dependent eligibility profile exports, the Other - Covered in Another Plan eligibility criteria is excluded.

  • Related Coverage criteria: All criteria

These eligibility criteria export exclusions apply to all exports, regardless of whether you are exporting a program, plan not in program, or eligibility profile.

Accessing Export and Log Files

You monitor the status of the Export Plan Configuration process on the Export Plan Configuration page. When the process finishes, click the corresponding Download icon to open the File Downloaded dialog box. In the dialog box, you can open or save the zip file that contains the exported plan configuration.

Warning

Do not edit the export file after you save it locally. The Import Plan Configuration process detects edits to an exported file and immediately ends, without importing the plan configuration in the edited file.

In the File Downloaded dialog box, you can also open the log file. The log contains details about what plan configuration data was exported by which parent or child process, including the number of business object records. The log also contains details to help you resolve any errors encountered during the export.

Import Benefits Plan Configuration: Explained

You can import a program, plan not in program, or eligibility profile exported from one environment into other environments and to different enterprises in the same environment. During the import, you can create objects or reuse objects that exist in both the source and destination environments. You can also map third-party objects, such as HR and payroll objects, between environments. Open the Import Plan Configuration task in either the Setup and Maintenance or Plan Configuration work area.

Warning

Importing plans from a source environment with a newer application version than that of the destination environment is not supported.

The following are key aspects of importing plan configurations:

  • Set up the destination environment.

  • Import by creating all destination named objects.

  • Import reusing existing destination named objects.

  • Map source and destination HR, payroll, and compensation objects.

  • Review imported plan configuration.

  • Finalize imported plan configuration.

  • Validate imported plan configuration.

Set up the Destination Environment

Before you import a plan configuration, you must set up all of the relevant HR, payroll, and compensation structures and objects:

  • HR objects include legal employer, locations, jobs, and organizations

  • Payroll objects include payroll definition and payroll elements

  • Compensation objects include salary basis

You must also set up any criteria that you used in the eligibility profiles associated with the import object. You can still import any associated eligibility profiles without criteria set up. But if the underlying criteria for an eligibility profile are not present in the environment, the eligibility profile does not work.

Import by Creating All Named Destination Objects

You can create, rather than reuse, all named objects when importing a plan configuration. To do this, enter a prefix, suffix, or both that the import process adds to the start or end of all source named objects during the import. Also, ensure that the Reuse existing named objects checkbox is not selected.

Import Reusing Existing Destination Objects

You can reuse destination named objects that match the source objects that you are importing, as long as the existing destination objects are available as of the import date. Existing named destination objects that match the source objects are not reused if they are available as of a future date. The import process prompts you to enter a prefix or suffix if it finds future-dated destination objects.

  • When you select Reuse existing named objects, the following are always reused: Plan, plan type, options, reporting groups, regulations, eligibility profiles, and user-defined life events.

  • The following are always reused, regardless of whether you select Reuse existing named objects: Year periods, predefined life events, action items, and formulas.

Map HR, Payroll, and Compensation Objects

As part of the import process, you must map any source workforce structure (HR), payroll, and compensation setup objects that you are importing to corresponding destination objects. Source objects that you must map include legal employer, organization, location, department, person type, job, assignment status, grade, position, performance rating, qualification, competency, formulas, payroll definition, and salary basis.

Restriction

To perform mapping during the import process, you must have data access privileges for the destination objects.

Review Imported Objects

On the Review Imported Plan Configuration page, you use the graph to visually identify any discrepancies between the number of source and destination objects. If there is any discrepancy, click the relevant bar to view details about the source and destination objects and identify which source objects were imported.

Source and destination objects that are covered in this review are age and service factor, age factor, benefit balances, benefit groups, compensation factor, coverage across plan types, coverages, eligibility profiles, full-time equivalent factor, hours worked factor, length of service factor, life events, options, plan types, plans, regulations, reporting groups, service areas, standard rates, user-defined criteria, and variable rate profiles.

Finalize Imported Objects

You change the status for the imported program or plan not in program from Pending to Active in preparation for validating it.

Fast Formulas are always reused if they exist in the destination environment. Fast formulas that do not already exist are created at the global level, even though the source formula is defined at LDG level. The import process creates formulas using the same names as the source formulas, ignoring any entered prefix or suffix. You must validate the logic for the imported and created formulas, then compile them individually or in bulk. You compile formulas by running the Compile Formula process on the Submit a Process or Report page.

Validate Imported Objects

You can compare the results of the following destination validation and evaluation with the results for those of the source environment.

  • On the Import Benefits Plan Configuration page, search for your import request and click the name in the Search Results section. Open the Validate Imported Plan Configuration page to validate the imported program or plan not in program.

  • On the Evaluation and Reporting work area, Processes tab, run the Evaluate Life Event Participation process for a sample person.

Define Extracts

Benefits Extracts: Explained

You can extract benefits enrollment information into an XML file and transmit it to a benefits carrier. You generate one extract file for each carrier. If a carrier provides more than one plan, the single extract contains information related to all plans provided by that carrier. For example, if ten plans are provided by four different carriers, you run four separate extracts, one for each carrier.

This topic discusses:

  • Extract setup steps

  • Extract formats

  • Generating and Viewing Extracts

Extract Setup Steps

Set up carrier data and configure extract options that apply whenever the extract is run for that carrier.

  1. Configure the plan carrier details and extract options using the Manage Plan Carriers task in the Plan Configuration work area.

    On the Mapping tab, you can view the mapping of lookup codes to the lookup value that is transmitted to carriers. Edits to mapping values affect all plan carriers that use the lookup.

  2. Configure the carrier names for plan types, plans, and options, using the Manage Plan Types, Manage Benefit Plan Details, and Manage Benefit Options tasks, respectively.

Extract Format

By default, all extracts have the same format, regardless of which carrier receives the extract. You can contract with Oracle's partner, BenefitsXML, to have a carrier's extract data transformed and delivered to the carrier, according to its specifications. For more information on BenefitsXML, see http://www.benefitsxml.com.

If you elect not to use this partner, you can transform and deliver the extract data file directly to each of your plan carriers, according to their specifications. Use the Upload Custom Layout button to specify the layout for the individual carrier as well as select additional file output formats, such as CSV, XML, or fixed length. You must ensure that fields identified in the custom layout map to columns in the application database tables.

Generating and Viewing Extracts

To run and monitor extracts, use the Manage Extracts task in the Evaluation and Reporting work area. For a particular carrier, you can select whether to run a full extract or extract only the changes since you ran the previous extract. Generally, you run a full extract after an enrollment period is closed and enrollments are completed. You run subsequent extracts on a periodic or scheduled basis, in either full or changes only mode. Common practice is to schedule your extracts to run after your regular payroll runs.

You can view, query, and download extracted records for a specific extract run after it completes.

Benefits Extract: Custom Layout

An implementor or developer can create a custom layout to transform the format of extracted benefits enrollment data to match the specifications of a particular carrier. This topic provides descriptions of the tags that you require to create the custom layout as well as table aliases and a sample custom layout. The custom layout becomes the default layout for the plan carrier after you upload it to the plan carrier's extract options.

This figure illustrates the structure of the XML tags in the custom layout.

XML tag structure for custom layouts

The data source for a field on the custom layout can be a:

  • Column on the benefits extract staging tables

  • Column on one of the other tables listed in the Source tag description

  • Constant into which you enter the exact value

Tip

To identify table column names, you can use the data model query builder in Oracle BI Publisher. Search for the table name and view the columns.

XML Tag Descriptions

This section describes each XML tag and lists its attributes, elements (subtags), and parent tags.

Layout

Description: Root tag.

Attributes: None


Elements (Subtags)

Parent Tag

Table

None

Table

Description: The database table from which the data must be extracted.

Attributes: 1. tableName: Supported values = {BEN_EXTRACT_REQ_DETAILS,BEN_EXTRACT_REQUEST, DUAL,PER_ALL_PEOPLE_F,PER_PERSONS,PER_ALL_ASSIGNMENTS_M,PER_PEOPLE_LEGISLATIVE_F,BEN_PL_F,BEN_PL_TYP_F,BEN_OPT_F,BEN_PGM_F }


Elements (Subtags)

Parent Tag

1. RecordType

2. Field: See Field tag description

Layout

Record Type

Description: Specifies how the data should be delimited or laid out in the extract file.

Attributes: Supported values: {FIXEDWIDTH, CSV}

Note

Anything other than CSV is delimited as FIXEDWIDTH by default.


Elements (Subtags)

Parent Tag

None

Table

Field

Description: Corresponds to one column in the extracted document. The text in this column can be sourced from a database table, an SQL function, or a constant.

Attributes: None


Elements (Subtags)

Parent Tag

  1. Name

  2. Source

  3. Width

  4. Padding

Table

Name

Description: Name of the field

Attributes: None


Elements (Subtags)

Parent Tag

None

Field

Source

Description: Source of data for the current field. If the source is a table, the value passed is the column name. If multiple tables are involved, a fully qualified column name is recommended. The aliases are given in the list of allowed tables.

SQL functions in place of column names: Values in this tag are considered as column names if the type is set to TABLE. The column name is used directly while constructing a query, so an SQL function can be used on a column.

  • Example 1

    <Source type="TABLE">GENDER_FLAG</Source>

  • Example 2

    <Source type="TABLE">DECODE(GENDER_FLAG,'F',1,2)</Source>

Attributes:

  1. type:

    • Supported values = {TABLE, CONSTANT}

      • TABLE specifies that the data comes from a database table.

      • CONSTANT specifies that the data is given in the value column of this tag.

  2. table: Use this tag only if the intended column is not from the table given in the 'tableName' attribute of this Table tag. If this tag is not used, the column is searched for in the table given in 'tableName'.

    • Supported values:

      • {BEN_EXTRACT_REQ_DETAILS

      • PER_ALL_PEOPLE_F

      • PER_PERSONS

      • PER_ALL_ASSIGNMENTS_M

      • PER_PEOPLE_LEGISLATIVE_F

      • BEN_PL_F

      • BEN_PL_TYP_F

      • BEN_OPT_F

      • BEN_PGM_F


Elements (Subtags)

Parent Tag

None

Field

Width

Description: Intended width of this field in the extract file. The number passed is the number of character spaces on the file.

Attributes: Supported values are positive integers.


Elements (Subtags)

Parent Tag

None

Field

Padding

Description: Alignment of data in each column.

Attributes: Supported values: {LEFT, RIGHT}


Elements (Subtags)

Parent Tag

None

Field

Table Aliases

Allowed Table

Alias

BEN_EXTRACT_REQ_DETAILS

REQ

PER_ALL_PEOPLE_F

PEO

PER_PERSONS

PER

PER_ALL_ASSIGNMENTS_M

ASG

PER_PEOPLE_LEGISLATIVE_F

LEG

BEN_PL_F

PLN

BEN_PL_TYP_F

TYP

BEN_OPT_F

OPT

BEN_PGM_F

PGM

Sample XML Layout

<?xml version="1.0" encoding="utf-8"?>
<Layout> 
<Table tableName="DUAL"> 
  <RecordType>FIXEDWIDTH</RecordType> 
  <Field> 
    <Name>"Record Type"</Name> 
    <Source type="CONSTANT">001</Source> 
    <Width>3</Width> 
    <Padding>Left</Padding> 
  </Field> 
</Table> 
<Table tableName="BEN_EXTRACT_REQ_DETAILS"> 
  <RecordType>CSV</RecordType> 
  <Field> 
    <Name>"Last Name"</Name> 
    <Source type="TABLE">LAST_NAME</Source> 
    <Width>25</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"First Name"</Name> 
    <Source type="TABLE">FIRST_NAME</Source> 
    <Width>50</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Filler"</Name> 
    <Source type="CONSTANT">XXXXXXXXXX</Source> 
    <Width>10</Width> 
    <Padding>None</Padding> 
  </Field> 
  <Field> 
    <Name>"Plan Name"</Name> 
    <Source type="TABLE">PLAN</Source> 
    <Width>70</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Coverage Start Date"</Name> 
    <Source type="TABLE">COVERAGE_START_DATE</Source> 
    <Width>15</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"SSN"</Name> 
    <Source type="TABLE">NATIONAL_IDENTIFIER</Source> 
    <Width>12</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Gender"</Name> 
    <Source type="TABLE">DECODE(GENDER_FLAG,'F',1,2)</Source> 
    <Width>1</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Person Number"</Name> 
    <Source type="TABLE" table="PER_ALL_PEOPLE_F">PERSON_NUMBER</Source> 
    <Width>30</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Country of Birth"</Name> 
    <Source type="TABLE" table="PER_PERSONS">COUNTRY_OF_BIRTH</Source> 
    <Width>30</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Assignment type"</Name> 
    <Source type="TABLE" table="per_all_assignments_m">assignment_type</Source> 
    <Width>30</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Legislation code"</Name> 
    <Source type="TABLE" table="per_people_legislative_f">LEG.LEGISLATION_CODE</Source> 
    <Width>30</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Legislation code"</Name> 
    <Source type="TABLE" table="ben_pl_f">PLN.PL_ID</Source> 
    <Width>30</Width> 
    <Padding>Left</Padding> 
  </Field> 
</Table> 
<Table tableName="DUAL"> 
  <RecordType>FIXEDWIDTH</RecordType> 
  <Field> 
    <Name>"Record Type"</Name> 
    <Source type="CONSTANT">999</Source> 
    <Width>3</Width> 
    <Padding>Left</Padding> 
  </Field> 
  <Field> 
    <Name>"Record Type"</Name> 
    <Source type="SYSTEM">RECORDCOUNT</Source> 
    <Width>3</Width> 
    <Padding>Left</Padding> 
  </Field> 
</Table>
</Layout>

Valid Extract Names for Benefits Plan Types and Options: Explained

Oracle partner BenefitsXML provides valid extract names that you can enter for benefits plan types and options. You can extend these lists of values, as required.

Benefit Extract Plan Type Names

Valid benefits extract names for plan types:

  • 24 Care

  • Dental

  • Dental Capitation

  • Exclusive Provider Organization

  • Health

  • Health Maintenance Organization

  • Hearing

  • Long Term Care

  • Long Term Disability

  • Mail Order Drug

  • Major Medical

  • Medicare Risk

  • Mental Health

  • Point of Service

  • Preferred Provider Organization

  • Prescription Drug

  • Preventative Care

  • Short Term Disability

  • Utilization Review

  • Vision

Benefits Extract Option Names

Valid benefits extract names for options

  • Children Only

  • Dependents Only

  • Employee and Children

  • Employee and Five or More Dependents

  • Employee and Four or More Dependents

  • Employee and One Dependent

  • Employee and One or More Dependents

  • Employee and Spouse

  • Employee and Three Dependents

  • Employee and Three or More Dependents

  • Employee and Two Dependents

  • Employee and Two or More Dependents

  • Employee Only

  • Family

  • Individual

  • Not Applicable

  • Spouse and Children

  • Spouse Only

  • Two Party

  • Employee and Domestic Partner

  • Domestic Partner and Children

  • Domestic Partner Only

  • Employee and Spouse or Domestic Partner

  • Child or Children of a Domestic Partner

Extracting Benefits Data for Plan Carriers: Worked Example

This example demonstrates how you create benefits plan carriers and configure their data extract settings, associate the plan types, plans, and options with a benefits extract, and generate the extract.

Your company added Global Health, Inc. (GHI) as a medical plan carrier and you must configure the benefits extract for it, using the information provided by GHI.


Decision to Consider

In This Example

What is the extract type?

Full

What is the output file name?

GHI_Medical

What is the processing frequency?

Monthly

What is the processing type?

HRXML

Transmit extracts to Oracle's cloud?

No. Transmit to the carrier.

What is the transmission type?

SFTP

What is the host?

GHI_FTP

What is the port number?

21

What is the remote folder?

c:/users/medical_benefits_extracts

What is the user name?

Betty.Anderson

What is the password?

W3lc0M3

What is the carrier name for the Medical plan type?

Health

What is the carrier name for the Medical PPO plan?

GHIORCL101

What is the carrier name for the Participant Only option?

Employee Only

What is the extract type for the extract request?

Full

Should the extract request include transmitting the extracted data?

No

Summary of Tasks

To configure the benefits data extract, you complete these tasks in the Plan Configuration work area.

  1. Create the plan carrier.

  2. Add the benefits extract plan type name.

  3. Add the benefits extract plan code.

  4. Add the benefits extract option name.

The valid benefits extract plan type and option names are provided by the Oracle partner BenefitsXML. For a list of valid values for each field, see the Valid Extract Names for Benefits Plan Types and Options: Explained topic.

To generate and view the extract, you complete these tasks in the Evaluation and Reporting work area.

  1. Submit the extract request.

  2. View and transmit the extract details.

Create Plan Carrier

Complete these steps in the Plan Configuration work area.

  1. In the Tasks pane, click Manage Plan Carriers to open the Manage Plan Carriers page.
  2. On the Search Results toolbar, click the Create button to open the Create Plan Carrier page.
  3. Enter the carrier information, as shown in this table.

    Field

    Value

    Name

    Global Health, Inc.

    Active

    Active


  4. Enter the extract options, as shown in this table.

    Field

    Value

    Extract Type

    Full

    Output File Name

    GHI_Medical

    Processing Frequency

    Monthly

    Processing Type

    HRXML


  5. Enter the file transfer details for the carrier, as shown in this table.

    Field

    Value

    Transmission Type

    SFTP

    Host

    GHI_FTP

    Port Number

    21

    Remote Folder

    c:/users/medical_benefits_extracts

    User Name

    Betty.Anderson

    Password

    W3lc0M3


    You can transmit extracts directly to the plan carrier, as shown in this step. Alternatively, you can transmit extracts to Oracle's cloud, using its file transfer details, and have your plan carrier download its extract from there.

  6. Click Save and Close to return to the Manage Plan Carriers page..

Add Benefits Extract Plan Type Name

  1. On the Tasks pane, click Manage Plan Types to open the Manage Plan Types page.
  2. Search for the Medical plan type.
  3. In the Search Results section, click the Medical plan type name to open the Edit Plan Type: Medical page.
  4. Select Update in the Actions menu of the Plan Type Definition section.
  5. In the Benefits Extract Plan Type Name field, enter Health.

    For a list of valid extract names, see the Valid Extract Names for Benefits Plan Types and Options: Explained reference topic.

  6. Click Save and Close to return to the Manage Plan Types page.

Add Benefits Extract Plan Code

  1. Click Manage Benefits Plan Details on the Tasks pane.
  2. Search for the Medical PPO plan on the Plans tab and open the Edit Plan Basic Details page.
  3. Click Next to open the Edit Plan Additional Configuration page.
  4. Select Update in the Actions menu of the Configuration Details section.
  5. In the Benefits Extract Plan Code Name field, enter the name GHIORCL101, which was provided to you by the carrier, for this specific plan.
  6. Click Save and Close to return to the Plans tab.

Add Benefits Extract Option Name

  1. Click Manage Benefit Options. on the Tasks pane to open the Manage Benefit Options page
  2. Search for the participant options.
  3. Click the Participant Only option name in the Search Results section to open the Edit Option Participant Only page.
  4. Select Update in the Actions menu of the Basic Details section.
  5. In the Benefits Extract Option Name field, enter Employee Only.

    For a list of valid extract names, see the Valid Extract Names for Benefits Plan Types and Options: Explained reference topic.

  6. Click Save and Close to return to the Manage Benefit Options page.

Submit Extract Request

Complete these steps in the Evaluation and Reporting work area.

  1. Click Manage Extracts on the Tasks pane to open the Manage Extracts page.
  2. On the Search Results toolbar, click Submit to open the request page.
  3. Enter the extract request options, as shown in this table.

    Field

    Value

    Effective Date

    Today's date

    Carrier Name

    Global Health, Inc.

    Extract Type

    Select Full since this is the first extract for the new plan carrier.

    When you create your extract requests for a plan carrier, you can specify whether to do a full extract, or extract only the changes made since the last extract.

    Transmit

    Select No since this is the first extract. You want to view the extract data first, before transmitting.


  4. Click Submit to submit your process and return to the Manage Extracts page.

View and Transmit Extract Details

You can transmit the extract as part of the extract request, or after the requested extract completes and before or after you view the extract details. Since this is the first extract for a new plan carrier, you extract and view the data before transmitting.

  1. In the Search Results section, click the Details button for the most recent Global Health, Inc. extract request to open the Extract Details page.
  2. Review the extracted data.
  3. Click Done to return to the Manage Extracts page.
  4. In the Search Results section, click the Transmit button for the most recent Global Health, Inc. extract request to transmit the extract.