Enrollment Overview

Employee / members of a particular Class will have the opportunity to enroll in benefits offered by the Group Customer. The determination of eligibility for the employee / member is often based on employment status (full-time, part-time, salaried, or hourly) and is particular / specific to a Class based on or created for the purpose of Eligibility.

• Members are those individuals who may be employees and could also be individuals belonging to a group, association, or organization such as an alumni, church, or trade association. The Group Customer divides the population into Classes and an employee can become a Member of a Class.

• Employees are individuals employed by the Group Customer (who may be subject to further qualification such as employment status, as stated above).

• Membership is defined and executed using Rules (Class Rules and Class Rule Variables) within OIPA. Membership Rules are defined by the Group Customer. The rules define the logic and criteria for which an individual becomes a member of a Class.

Note: A Member may belong to a Class outside of the realm for Enrollment. The Class may be specific to billing, reporting, etc... and not specific to Eligibility and/or Enrollment.

Enrollment is the act performed by an eligible member / employee of the Group Customer where benefits are selected and dependents / beneficiaries are designated. The Enrollment Screen allows for the manual entry of enrollments for a Group Customer.

• Logic and rules defined by the Group Customer are enforced during the enrollment process. An enrollment period designates the time frame in which the member has to register for coverage(s).
• A policy certificate will be issued to the participant upon completion of the enrollment and approval of the coverage(s). The participant that has enrolled in a group plan has the right to elect dependents and beneficiaries.
• The policy owner for group insurance is the Group Customer.