Benefit Administration Business Processes

This section discusses:

  • Open Enrollment and Event Maintenance preparation.

  • Flexible Spending Account (FSA) Administration.

  • (CAN) Canadian Flexible Credit allocations.

PeopleSoft Benefits Administration automates open enrollment and event maintenance processing. Benefits Administration for U.S. Federal Government automates open season and employee benefit changes with the Open Enrollment and Event Maintenance processes.

Eligibility Rules to Determine Benefit Program and Option Eligibility

To prepare for open enrollment and event maintenance, first define the eligibility rules that drive benefit determination. These eligibility rules can be based on job information (such as pay group or department) and geographic location (such as home or work address).

Because you define PeopleSoft table information using an effective date, you can easily define different eligibility rules for each plan year. Associate an effective date with each set of rules and the system will apply the correct rules according to the effective date.

Event Rules Setup to Determine What an Employee Can Choose

While eligibility rules determine what programs and plan options employees are eligible for, you also need event rules and coverage codes to determine what your employees can choose, based on the type of event that has triggered the change in eligibility. For example, when an employee divorces, that act does not enable the employee to change all of his or her benefits elections. That's an opportunity most employees should receive only during open enrollment or for federal users, open season. Instead, you will probably want to design the system to enable them to change only their health and life plan enrollments and update their dependent and beneficiary information.

Automated Benefits Program Design

PeopleSoft Benefits Administration enables you to create benefit programs using the benefit plans and plan type options that you set up with the Manage Base Benefits business process. After the benefit program framework is defined, you can create eligibility rules, event rules, rates, calculation rules, and flexible credits. Benefits Administration also enables you to set up automated cross-plan validation checking, which you can use to set up prerequisites for plan enrollment.

System Preparation for PeopleSoft Benefits Administration

PeopleSoft Benefits Administration provides a variety of tools to help you prepare your system for automated benefit processing, from audits to pages that enable you to set up specialized schedules of employees for processing.

Flexible Spending Account Administration is designed for companies located in the United States and Canada. Use FSA Administration to administer health care and dependent care FSA claims and to:

  • Track pledges, process claims, disburse money, print checks, and account for funds according to the amounts employees pledge and the rules for health care and dependent care disbursements.

  • Schedule claims processing based on your operational needs, and view the year-to-date status of employee FSAs.

  • Use a minimum check option. Selecting this option automatically puts claims below the minimum into a pending file. When the total of pending claims reaches the minimum, the system processes a check for the employee.

  • Process pending claims. For example, if an employee submits a claim for more than the amount in his or her FSA, you can pay the claim and hold the excess in a pending account.

Under Canadian rules, some common benefit plans have a premium cost tax status under which all employer-paid portions are nontaxable and all employee-paid portions are taxable. With PeopleSoft Benefits Administration, you can set up benefit plans that automatically provide the best tax advantage to employees by allocating flexible credits to those benefits that would be taxable unless paid for by credits.