Setting Up Coverage Codes
To set up the coverage code that defines who can be covered by a benefit, use the Health Coverage Codes (COVERAGE_CODES) component.
This section provides an overview of coverage codes and discusses how to define coverage codes.
|
Page Name |
Definition Name |
Usage |
|---|---|---|
|
COVRG_CD_TBL |
Define coverage codes. |
You define and manage coverage codes for your benefit programs using the Coverage Code table. You will attach these coverage codes to your benefit plan options on the Benefit Program table.
PeopleSoft Manage Base Benefits delivers nine basic coverage codes for which you define a minimum and maximum allowable for each eligible covered person type. These delivered coverage codes are described in this table:
You should create a new Coverage Code or modify your existing Coverage codes as appropriate to include the Covered Person type of Adult Child.
|
Delivered Coverage Code |
Employee Minimum / Maximum |
Spouse Minimum / Maximum |
Domestic Partner Minimum / Maximum |
Other Qualified Dependent or Child Minimum / Maximum |
Other Nonqualified Dependent Minimum / Maximum |
|---|---|---|---|---|---|
|
1 Employee Only |
1 / 1 |
not allowed |
not allowed |
not allowed |
not allowed |
|
2 Employee + Spouse |
1 / 1 |
1 / 1 |
not allowed |
not allowed |
not allowed |
|
3 Employee + Dependents |
1 / 1 |
not allowed |
not allowed |
1 / 99 |
not allowed |
|
4 Family |
1 / 1 |
1 / 1 |
not allowed |
1 / 99 |
not allowed |
|
5 Domestic Partner Adult |
not allowed |
not allowed |
1 / 1 |
not allowed |
not allowed |
|
6 Domestic Partner Child(ren) |
not allowed |
not allowed |
not allowed |
not allowed |
1 / 99 |
|
7 Domestic Partner Adult + Child(ren) |
not allowed |
not allowed |
1 / 1 |
not allowed |
1 / 99 |
|
12 EE + Domestic Partner |
1 / 1 |
not allowed |
1 / 1 |
not allowed |
not allowed |
|
14 EE + Domestic Partner + Child(ren) |
1 / 1 |
not allowed |
1 / 1 |
1 / 99 |
not allowed |
|
22 Employee + Same-Sex Spouse |
1 / 1 |
1 / 1 (US Same-Sex Spouse) |
not allowed |
not allowed |
not allowed |
|
24 Family (with Same-Sex Spouse) |
1 / 1 |
1 / 1 (US Same-Sex Spouse) |
not allowed |
1 / 99 |
not allowed |
|
90 Covered Person |
1/1 |
0/1 |
0/1 |
0/99 |
0/9 |
You can also define coverage codes to validate enrollments against a total number of eligible covered person types, for example, a coverage code that allows enrollment of the employee plus one dependent. The dependent can be either a spouse or a child. The system will sum the allowable covered person types defined for the coverage code rather than look at the minimum and maximum defined for each individual covered person type.
Coverage Code 90 is used to coordinate with the rate structure where you combine a qualified and a non qualified person under one rate, for example, employee and domestic partner. It looks at "who" is covered rather than how many persons are covered.
Use the Health Coverage Codes page (COVRG_CD_TBL) to define coverage codes.
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Image: Health Coverage Codes page
This example illustrates the fields and controls on the Health Coverage Codes page. You can find definitions for the fields and controls later on this page.
|
Field or Control |
Definition |
|---|---|
| COBRA Coverage Set |
A 2-character code that is used to group coverage codes together for COBRA eligibility purposes. When an individual experiences a COBRA event, the system must adjust the range of coverage codes available to each qualified beneficiary. By restricting itself to a specific set of coverage codes, COBRA processing can more accurately determine which benefit options to present to a participant who is eligible for COBRA coverage. If COBRA coverage sets are not established, then COBRA processing may encounter multiple equivalent coverage codes, and eligibility determination may fail. |
| Total Covered Persons |
Select to activate the total covered person types functionality for this coverage code. |
| Total Minimum Covered and Total Maximum Covered |
These fields are visible only when the Total Covered Persons check box is selected. Enter the allowable minimum and maximum covered persons. Include the employee in this count. |
Allowable Covered Person Types
|
Field or Control |
Definition |
|---|---|
| Covered Person Type |
Select from the following values to define the relationship you have to the dependent. Child, Adult Child, Domestic Partner, Employee, ExSpouse, Non-Qualified Dependent, Other Qualified Dependent, Spouse, and US Same-Sex Spouse. Note: The coverage code controls for covered person type are used in PeopleSoft Benefits Administration. |
| Minimum Covered |
Enter the minimum number of covered persons allowed. If you selected the Total Covered Persons check box, this field is not editable. |
| Maximum Covered |
Enter the maximum number of covered persons allowed. If no limit applies to the number for this coverage code, enter 99. If you selected the Total Covered Persons check box, this field is not editable. |