PeopleSoft Enterprise Benefits Administration 9.1 PeopleBook

Building Automated Benefit Programs

This chapter provides an overview of benefit programs and discusses how to:

Build benefit programs with the Benefit Program table.
Work with flexible credits.
Set up cross-plan validation.

Understanding Benefit Programs

Use the Benefit Program table to bring together all of the information that relates to a benefit program and to set up your benefit programs for automatic enrollment processing.

First, build the foundation by setting up base benefit information:

Define benefit deductions using the Deduction Table - Setup page.
Identify benefit plans using the Benefit Plan Table page.
Identify benefit providers using the Provider and Vendor Table - Vendor Information page.
Define benefit coverage using the Coverage Codes - Health Coverage Codes page.
Establish rate tables using the benefit rates tables.
Establish calculation rules using the Calculation Rules Table - Calculation Rules page.

Next, build your Automated Benefits program:

Define the benefit program using the Benefit Program Table pages.
Link your plan types and options.
Attach event and eligibility rules.
Define costs and credits.

See Also

Setting Up Deduction Codes

Setting Up Benefit Plans

Setting Up Benefit Rates

Setting Up Calculation Rules

Setting Up Benefit Providers

Building Benefit Programs with the Benefit Program Table

To set up benefit programs for automation, use the Benefit Program Table (BEN_PROG_DEFN) component.

This section provides an overview of building benefit programs and discusses how to:

Define benefit programs.
Set up plan types and options.
Calculate costs and credits.

Understanding Building Benefit Programs with the Benefit Program Table

Building benefit programs through PeopleSoft Benefits Administration is the same process as with the base benefit process. When you create a benefit program through Benefits Administration, the program type will be Automated and a number of fields will be available for use that would otherwise (in the case of a Manual benefit program) be closed to the entry of data.

Important! If you're planning to set up an automated benefit program that will be used for automatic benefits eligibility and enrollment processing, you must go to the Installation Table - Products page and select Benefits Administration before creating the program. You can't create an automated benefits program until Benefits Administration is selected.

See Also

Building Base Benefit Programs

Pages Used to Build the Benefit Program Table

Page Name	Definition Name	Navigation	Usage
Benefit Program Table - Benefit Program	BEN_PROG_DEFN1	Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Benefit Program	Define benefit program information.
Benefit Program Table - Plan Type and Option	BEN_PROG_DEFN2	Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Plan Type and Option	Set up plan types and options for the benefit program and add important information about plan types, including event and eligibility rules.
Benefit Program Table - Cost	BEN_PROG_DEFN3	Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Cost	Calculate costs and credits by linking rate and calculation rules to a benefit program and plan type.
Benefit Program/Plan/Options	RUNCTL_BAS_PGM	Set Up HRMS, Product Related, Automated Benefits, Reports, Benefit Program/Plan/Options, Benefit Program/Plan/Options	For a specified benefit program, print program-level information (effective date and status, program type, age criteria, COBRA, FMLA, and FSA parameters, and self-service configuration) along with the plan-level and option-level structure (event rules, eligibility rules, coverage levels, and deduction codes).
Benefit Program Costs	RUNCTL_BAS_PGM	Set Up HRMS, Product Related, Automated Benefits, Reports, Benefit Program Costs, Benefit Program Costs	For a specified benefit program, print the program description along with the cost and credit structure for all of the offered options (deduction and earnings codes, rate information, and calculation rules).

Defining Benefit Programs

Access the Benefit Program Table - Benefit Program page (Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Benefit Program).

See Also

Building Base Benefit Programs

Setting Up Plan Types and Options

Access the Benefit Program Table - Plan Type and Option page (Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Plan Type and Option).

Use this page to set up the basic plan types for your benefit program.

Use the Self-Service Configuration group box with PeopleSoft eBenefits.

This table displays the field requirements for the Plan Type level of the Plan Type and Option page for the Benefit Program row (Plan Type 01) and the Benefit Plan rows (Plan Types 1x-9x):

Field	Values	Values	Values
Plan Type	01	1-5x, 7-9x	6x
Display Sequence	Required; default is Plan Type. Must be unique within the benefit program.	Required; default is Plan Type. Must be unique within the benefit program.	Required; default is Plan Type. Must be unique within the benefit program.
Event Rules ID	Required	Required	Required
Waive Coverage	Not available for selection	Allowed, but default is N (not allowed).	Allowed, but default is N (not allowed).

After you set up a plan type on the Plan Type and Option page, select the plan options that you want to associate with the plan type.

Associating Plan Options with Plan Types

Use the Benefit Program Table - Plan Type and Option page and the Eligibility tab in the Option group box to set up the options within a plan type.

When you create a new option row by clicking the Insert Row button, the system automatically assigns the option a unique option ID value. You cannot update this value.

The first value that you enter for a new option row is the option type. Select from one of the following valid values:

Values	Plan Type
P (program)	Required for automated benefit programs. It is allowed for the Benefit Program row (plan type 01) only, and only one is allowed per benefit program.
G (general credit)	Optional, allowed for most plan types except 4x–9x. Only one is allowed per plan type.
O (option)	At least one is required per plan type except for the Benefit Program row (plan type 01), where it is not allowed.
W (waive)	Only one is allowed per plan type. It follows the waive coverage rule setup at the plan-type level.

Note. The manner in which you complete the rest of a given option row depends on the plan type to which the row belongs and the option type of that row.

Field Requirements for the Option Grid by Plan and Option Type

This table describes field requirements for the Option Grid by Plan and Option type:

Field	Values	Values	Values	Values
Plan Type	01	01−3x	1x−9x	1x−9x
Option Type	P - Program	G - General Credit	W - Waive Controlled by waive coverage.	O - Option
Benefit Plan	Not allowed	Required for plan types 2x−3x.	Required for plan types 2x−3x, when you want a credit for the waive election. Not allowed for other plan types.	Required
Covg Code (coverage code)	Not allowed	Not allowed	Not allowed	Required for plan type 1x. Not allowed for other plan types.
Deductn Code (deduction code)	Not allowed	Required	Required for plan types 1x−3x if you want a credit for the waive election. Not allowed for other plan types.	Required
Option Code	Not allowed	Not allowed	Required	Required
Default Option	Not allowed	Not allowed	Allowed	Allowed for plan types 1x−3x, 5x, 7x, and 8x. For 2x, you cannot define options that require coverage to be specified at the employee level as default options. Only the Waive option is allowed as the default for plan types 4x, 6x, and 9x. Options requiring proof are not allowed as defaults.
Opt Level (option level)	Not allowed	Not allowed	Not allowed	Required
Option Seq (option sequence)	Required	Required	Required	Required
Geog Locn (geographic location)	Allowed	Not allowed	Not allowed	Allowed
Elig ID (eligibility rules ID)	Required	Not allowed	Not allowed	Required

Option Type Designations Allowed Per Plan Type

This table describes option type designations allowed per plan type:

Plan Type	Option Type Allowed
01 (Benefit Program)	G, P
1x–3x	G, W, O
4x–9x	W, O

Setting Up the Benefit Program Row (Plan Type 01)

Access the Benefit Program Table - Plan Type and Option page: Eligibility tab.

A Benefit Program row is required for all automated benefit programs. The eligibility rules established for plan type 01 govern the entire benefit program.

Calculating Costs and Credits

Access the Benefit Program Table - Cost page (Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Cost).

Cost Type

Each option can have one price element defined, while options and general credits can have multiple credit elements defined. Select from the following values:

Price: The system calculates deductions for employees who select this option according to the deduction code that you identify for this benefit option.

Credit: The system calculates earnings for employees who select this option according to the earnings code that you identify for this benefit option. The system assigns the frequency of the additional pay based on the deduction code that you identify for this benefit option.

Note. You can also go to the Benefit Program row (plan type 01) and use the Cost page to define general flexible credits for the Benefit Program.

Benefit Rate Type	Enter which table to use to determine rates for the cost or credit entry.
Rate lID	Indicate the appropriate rate table because multiple tables may exist. In the case of credits, only the Employee Portion is picked up and reflected as the credit amount.
Earnings Code	Tells the system how to calculate the flexible credit earnings for a participant. This option is not applicable for Price rows.
Calc TblID (calculation rules table ID)	Indicates an applicable calculation rule, which references what dates and rules to apply to determine age, service, and compensation amounts for the purpose of rate calculation. Calculation rules are also used to determine what point in time to use to determine the calculation of service for service step calculations.

Warning! The earn code for each benefit plan type within a benefit program must be unique. Otherwise, flexible credits might not start and end correctly during Benefits Administration processing.

Rate and Calculation Rules Requirements

This table describes rate and calculation rules requirements:

Plan Type Series	Rate Table Required?	Calculation Rules Required?	Comments
01	Yes	Yes	Earnings codes are also required for credits.
Ax	Yes	Yes
1x	Yes
2x	Yes	Yes
3x	Yes	Yes
4x	Not Allowed	Yes	The calculation rules support the service step calculation and provide a placeholder for possible future functionality.
5x–9x	Not Allowed	Not Allowed	Not Used

Note. In almost all cases, agencies in the U.S. Federal Government do not use general credits and do not use the cost type of credit when designing benefit programs.

See Also

Building Base Benefit Programs

Creating Event Rules

Working with Flexible Credits

This section provides an overview of flexible credits and discusses how to use flexible credits to achieve your Benefits Administration goals.

Understanding Flexible Credits

You can define three kinds of credits for your employees:

General credits that apply to all participants in a benefit program.
General plan-based credits that apply to individual plan types.
Option-based credits that employees receive because they have chosen a specific benefit plan option.

When you run the Open Enrollment and Event Maintenance processes, the system calculates the value of the credits using the earnings codes that are associated with them. It will sum all the credits by earnings type for each employee, regardless of whether the credits are general credits or option-based credits, and pass the total credits by earnings type to PeopleSoft Payroll. Payroll treats these credits as additional earnings for an employee.

Note. Be aware that you must associate the earnings types that you set up with the earnings program to which an employee belongs before they can be processed by your payroll system.

See Also

Establishing Earnings Programs

Setting Up FEGLI Codes

Pages Used to Work with Flexible Credits

Page Name	Definition Name	Navigation	Usage
Benefit Program Table - Plan Type and Option	BEN_PROG_DEFN2	Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Plan Type and Option	Link plan types to the benefit program and to add important information about plan types.
Benefit Program Table - Cost	BEN_PROG_DEFN3	Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Cost	Link a benefit program and plan type to rate and calculation rules.

Using Flexible Credits to Achieve Your Benefits Administration Goals

This section provides examples of how to:

Define credit for employees who enroll in a particular plan type.
Encourage employees to elect employee-only coverage.
Define credits for participants who waive coverage.
Define credit amounts based on employee health coverage.
Set up life or disability plan-based credits according to level of life coverage.
Set up life plan credits based on a flat-monetary amounts.

Example 1: Defining a Credit for All Employees Who Enroll in the Plan Type

Suppose that you want to give all of your employees a general plan-type credit to help offset the cost of coverage, regardless of the benefit plan option within the plan type in which they elect to enroll. Start by adding a new rate schedule to specify the credit amount on the Benefit Rate Table, and enter a G row for the plan type credit.

Access the Benefit Rate Table page.

Add a new rate schedule for the credit amount.
Access the Benefit Program Table - Plan Type and Option page.

Enter a G row for the plan type credit.
Access the Benefit Program - Cost page and enter Credit as your cost type and reference the new rate schedule created for plan type general option.

Example 2: Encouraging Employees to Elect Employee-Only Coverage

Suppose that you want to encourage employees to elect employee-only coverage in a medical benefit option. One way to do this is to give your employees an option-based credit equal to the cost of coverage, effectively making the benefit plan employer-paid.

Access the Benefit Program Table - Cost page, insert a new row, and enter Credit as the cost type value.
You must also enter the same rate type and rate table ID that you used for the Price row. The system calculates the credit using the same rates and calculation rules it used for the Price row; therefore, the amount credited is equal to the amount deducted.

Example 3: Defining Credits for Participants Who Waive Coverage

Suppose that you want to give a credit to your employees who waive coverage in any health benefit plan.

Access the Benefit Rates table.

Define the amount of the credit for waived coverage.
Access the Benefit Program Table - Cost page.

Insert a row for the waived coverage credit.
Enter Credit as the cost type value on the Benefit Program - Cost page. This is the flexible credit that employees will receive when taking the waive option.

Example 4: Defining Credit Amounts Based on Employee Health Coverage

Suppose that your company offers employee-only medical coverage at a cost of 50 USD per month and family coverage at a cost of 100 USD per month. You want to give all employees, regardless of whether they choose employee-only or family coverage, a credit equal to the cost of employee-only coverage.

Follow the process outlined in example 2. When you set up the option-level flexible credit for the family coverage, use the rate table designed for the employee-only benefit.

Example 5: Setting Up Life or Disability Plan-Based Credits According to Level of Life Coverage

Suppose that you have three life benefit plans: a basic life plan, a one times salary plan, and a two times salary plan. Define option-based credits that will provide the same credit as the one times salary option regardless of the coverage level that the employee chooses.

Use the option type General Credit to set up flexible credits for Life and Disability plan types that provide the same credit no matter which coverage level an employee chooses.

Access the Benefit Program Table - Plan Type and Option page.

Set up an option type row with a General value. Give it the same deduction code as the other life plans.
Access the Benefit Program Table - Cost page.

Enter a Credit cost row for the general credit. Give it the same rate type and rate table ID as the one times salary life plan option.

Example 6: Setting Up Life Plan-Based Credits According to Flat-Monetary Amounts

Suppose that you want to define a plan-based credit equivalent to 50,000 USD of coverage regardless of the life coverage level that the employee selects.

Access the Benefit Plan table.

Define a special 50,000 USD Basic Life Benefit Plan.
Access the Life and AD/D Plan Table page.

Complete the life plan definition of the 50,000 USD Life Benefit Plan.
Access the Benefit Program Table - Plans and Options page.

Create a General row for the 50,000 USD Life Benefit plan. Give it the same deduction code as the other benefit plan options.
Access the Benefit Program Table - Cost page.

Enter Credit as the cost type for the General credit. The Credit cost row should reference the appropriate rate schedule, earnings code, and set of calculation rules.

Setting Up Cross-Plan Validation Checks

You use the Benefit Program Table to set up cross-plan validation. This section discusses how to:

Set up cross-plan validation checks for plan types.
Use the Load Cross Plan Values page.

Note. You cannot enter cross-plan validation rules for the Benefit Program (plan type 01).

Pages Used to Set Up Cross-Plan Validation Checks

Page Name	Definition Name	Navigation	Usage
Benefit Program Table - Plan Type and Option page: Cross Plan tab	BEN_PROG_DEFN2	Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Plan Type and Option Select the Cross Plan tab in the Option group box.	Link plan types to the benefit program and add important information about plan types.
Load Cross Plan Values	BEN_PROG_XLOAD	Click the Load Cross Plan Values link on the Plan Type and Option page.	Create codes that will automatically populate the Cross-Plan Type, Coverage Limit (Pct), and Check Dependents fields on the Benefit Program Table - Plan Type and Option page.

Page Name

Definition Name

Navigation

Usage

Benefit Program Table - Plan Type and Option page: Cross Plan tab

BEN_PROG_DEFN2

Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Plan Type and Option

Select the Cross Plan tab in the Option group box.

Link plan types to the benefit program and add important information about plan types.

Load Cross Plan Values

BEN_PROG_XLOAD

Click the Load Cross Plan Values link on the Plan Type and Option page.

Create codes that will automatically populate the Cross-Plan Type, Coverage Limit (Pct), and Check Dependents fields on the Benefit Program Table - Plan Type and Option page.

Setting Up Cross-Plan Validation Checks for Plan Types

Access the Benefit Program Table - Plan Type and Option page: Cross Plan tab (Set Up HRMS, Product Related, Base Benefits, Program Structure, Benefit Program Table, Plan Type and Option).

Option: Cross Plan Tab

Cross Plan Type	Identifies the controlling plan that employees or dependents must be enrolled in before they are eligible for enrollment in the option being defined. This field is required for all other cross-plan validations.
Cross Benefit Plan	The controlling benefit plan that is required for an employee to elect this option. If this field is blank, then any election in a benefit plan within the Cross Plan Type field meets the criteria for cross-plan validation.
Coverage Limit (Pct) (coverage limit percentage)	Used primarily for life plan options to place a limit on the amount of coverage the enrollee (employee or dependent) can receive. This field becomes available after you attach a cross-plan type to a benefit plan. Note. During Benefits Administration validation processing, the system checks to ensure that the coverage elected or afforded under this benefit plan does not exceed the specified percentage of the coverage elected or afforded under the Cross Benefit plan.
Check Dependents	When selected, this option informs the system to check that potential dependents (for the specified benefit plan or option) are also enrolled as dependents for the specified Cross Benefit plan. This is available only to 1x plan types and becomes available after you associate a cross-plan type with a benefit plan.

Using the Load Cross Plan Values Page

Access the Load Cross Plan Values page (click the Load Cross Plan Values link on the Plan Type and Option page.

This page is a data entry aid to enable you to replicate common cross-plan validation criteria to a large number of options, rather than individually specifying the criteria for each option row.

Cross Plan Type	Identifies the benefit plan that employees or dependents must be enrolled in before they are eligible for enrollment in the specified benefit plan or option. This field is available to all plan types.
Cross Coverage Limit Percent	Places a limit on the amount of the coverage the dependent can receive. This is available only to 2x plan types.
Cross Plan Dependent Check	When selected, this option tells the system to check whether potential dependents for the specified benefit plan or option are also enrolled as dependents for the specified Cross Benefit plan. This is available only to 1x plan types.
OK	Click to save the information and close the page. This option copies the criteria to each underlying option row.
Cancel	Click to close the page and not save any information.

Note. You can also use the Load Cross Plan Values page to clear the cross-plan validation values for a plan type. Access the Load Cross Plan Values page, select the Load check box and deselect the values for the fields that you want to clear from the cross plan type, coverage limit percent, and dependent check fields, and click OK. The system clears the fields that you selected.