Defining Event Rules

Event Classification

Select an event classification.

You can have more than one event classification for an event rule to cover all expected contingencies and usages.

Use History

Reviews the eligibility history of the participant's benefit plan option and the eligibility of the participant's current benefit plan option to determine whether the employee can change an election. If the lists of eligible options are the same, the participant is not allowed to make plan option changes. This setting is used to filter out events that do not result in an opportunity for an employee to change elections.

If, after processing, the participant is eligible for new options, Benefits Administration prepares the event for further processing and enables new enrollment elections. If the participant has lost eligibility for one or more current elections, he or she can make a new election.

Pre-enter

Select to populate the Benefits Administration data entry pages with the participant's current elections for the plan type associated with the event rule. Doing so enables you to view current elections during data entry and change them as necessary.

Current elections include the option code of the enrolled benefit plan and the coverage code, as well as dependent, beneficiary, and 401(k) investment elections. The system only pre-enters current elections if the participant's current option is in the participant's current eligible list of options.

Ignore Plan

Select to make changes to plan information without restrictions as to how often or when the changes are made. When this option is selected, the plan types linked to this event rules ID and event classification combination are unaffected by Benefits Administration processing. You can use this option to arrange for specific plan types to have automatic event processing only for major event classifications such as hires, terminations, and open enrollment, while leaving them unaffected by lesser event classifications.

When you select Ignore Plan, the system selects and locks Ignore Dep/Ben Edits and Ignore Investment Edits. The system also sets Select Allowed to None, and all participate and waive level values to 99.

Ignore Plan does not interfere with eligibility rule processing. It does not enable employees to stay in or enroll in plans for which they are no longer eligible.

If participant plan eligibility does not change, the system gives employees their current coverage. But if participant plan eligibility does change—that is, if employees lose eligibility for their current plan—you need to set a default method of Assign Cur Covg Else Option, Assign Cur Covg Else Low Opt, or Assign Cur Covg Else None.

With Ignore Plan selected, the system ignores:

• Change level maximums and proof required for changing levels.

• Plan-specific edits (life insurance settings, individual FSA (Flex Spending Account) maximums, vacation limits, and so on).

• Edits on dependent or beneficiary information.

• Edits on investment elections.

The system continues to:

• Flag errors generated due to invalid setup, such as missing table entries or pay calendars.

• Require that the option code entered through data entry be a valid selection from the eligible plans on the program.

• Consider the coverage amount for all life and AD/D plans when evaluating coverage group maximums.

• Include the annual pledge on all FSA plans when evaluating total FSA maximums.

Select Ignore Plan when your automatic benefits processing responsibility has to share (or completely abdicate) responsibility for the processing of certain plan types with an outside or manual process. Don't use it only to suppress the entry of elections. A Select Allowed value of None, an appropriate default method setting, and the Use History rule are generally sufficient to control employee involvement in benefit elections.

Elect Required (election required)

Select to note the absence of elections for this plan type as an error in the Benefits Administration Messages table.

Ignore Overage Dependent

Select to control when and how dependents are actually dropped from coverage. You can create a midyear event that allows overage dependents to remain covered until the open enrollment event, when they are dropped from the coverage.

Retain Covered Dependent

Select to enable employers to move employees from one plan to another, while maintaining the current coverage code and dependent elections (default plan). In case of no matching coverage, the system assigns the default coverage and the existing dependent is not retained.

If the employee has lost eligibility for a current election and the default election is supplied, the system determines the plan for the default option and attempts to move that employee into an option with the default plan and the employee's current coverage code.

Ignore Dep/Ben Edits (ignore dependent or beneficiary edits)

Select to skip all checks for the presence of dependents or beneficiaries and bypass all edits on dependents or beneficiaries already present or entered with elections.

Provide FlexCR Upon Default (provide flex credit upon default)

Select if you want participants that appear by default in a plan type to continue to receive credits that are tied to the default plan type.

When this check box is deselected for plan types 1x through 3x (plan types 1x through 2x for federal users), participants who accept election defaults do not receive any credits (general plan type credits or option-based credits) for those plan types.

For employees who elect to have excess credits applied to an FSA plan type and who are not enrolled in an FSA plan type, and for whom the Default Method field is set to Default Option for Excess Credit, the system creates an enrollment for the employee with a contribution amount equal to the excess credits.

Ignore Investment Edits

Select to skip all checks for the presence of investments on savings plans and bypass all edits on investment elections already present or entered with elections.

Default Method

Indicates what happens when an employee does not select an election for a particular plan type. Values are:

• Assign Cur Covrg Else Option (assign current coverage else option): Select to assign and continue the participant's current coverage.

  If participants do not have current coverage, or have lost eligibility to current coverage, they are assigned to the default for the specific plan type, as defined in the Benefit/Deduction Program table. The participant must be eligible for the current election for it to be used as the default.

• Assign Cur Covrg Else None (assign current coverage else none): If the employee loses eligibility for the current plan, another plan is not set up to replace the old one.

• Assign Cur Covrg Else Low Opt (assign current coverage else low option): Select to assign and continue the participant's current coverage.

  If the participant has no current coverage, or if the participant has lost eligibility to current coverage, the system assigns the lowest-level option available, as defined in the Benefit/Deduction Program table. This option is not recommended for Savings, FSA, and Vacation Buy/Sell plan types.

• Default to Lowest Elig Option (default to lowest eligible option): Select to assign the lowest-level option for which the employee is eligible.

  This option is not recommended for Savings, FSA, and Vacation Buy/Sell plan types.

• Default to Option and Coverage: Select to assign the option marked for default on the Benefit Program Definition page.

  The participant must be eligible for the option for it to be used as the default. This option is not recommended for Savings, FSA, and Vacation Buy/Sell plan types.

• Default Option for Exc Credit: (default option for excess credit) Applicable only to FSA plan types.

  If the employee has indicated that excess credits should be directed to an FSA enrollment, this rule assigns the option marked for default on the Benefit Program Definition page and sets the annual pledge to the amount of the excess credits. The participant must be eligible for the option for it to be used as the default, and excess credits must exist.

  Note: During enrollment, the system does not create a zero-monetary annual pledge enrollment when excess credits do not exist, and any current FSA enrollment is terminated if not reelected by the employee.

• Terminate Coverage: Inserts a termination entry for the plan type covered by this event rule.

  This option is commonly used for FSA and Vacation Buy/Sell plan types, because employees are usually required to reenroll in them each year or lose coverage.

Allowable FSA Pledge Changes (allowable flexible spending account pledge changes)

Select either Increase or decrease to indicate whether employees can increase or decrease their FSA pledges based upon the event classification that is being processed. For example, if the event classification is Birth, employees can increase, but not decrease their FSA pledge. This field applies only to 6x plan types and should be set to N/A for all other plan types.

Collect Dep/Ben (collect dependent or beneficiary coverage)

Select this check box when you want the system to collect information pertaining to dependents and benefits and display that information on the eBenefit Summary and eBenefit Detail Information pages.

For 1x Health plans on the enrollment form, the system collects elections at the plan level. The system then derives the coverage code based on the dependents covered. When this check box is deselected, the system collects elections at the coverage code level for 1x plans on the enrollment form.

This works in conjunction with the Ignore Dep/Ben Edits check box on the Event Rules page.

Allow Dep/Ben Additions (allow dependent or beneficiary additions)

Select to indicate that an employee can add new dependents through the eBenefits enrollment process.

Enable Dep Proof

Select to validate only qualified dependents while running the Benefits Admin process. If the dependent is not qualified, then the Ben Admin process will create an error.

Collect Fund Allocations

When this check box is selected, the system collects the information pertaining to savings plans and displays that information on the eBenefit savings pages.

Certificate ID

Select from available certificates that will appear during self-service enrollment for this event class

Select Allowed

Provides a means for you to indicate which plan or plans an employee can select from among all eligible types of plans. Values are:

• All Plans: Select to enable employees to select from any option within the list of eligible options for the event.

• Current Plan: Select to indicate that employees can make changes only to the current plan.

• Current Plan + Waive: Select to enable employees to change only coverage levels (eligible options), including electing Waive, within their currently enrolled benefit plan. However, if the employee's current election is a waive of the plan type, she can elect any eligible option within any benefit plan.

  For example, an employee has single coverage and gets married and the new spouse has health coverage through her employer. They decide that covering both individuals under the spouse's benefit plan is a better choice. In this case, the employee is allowed to waive his current coverage because the spouse is adding the employee to the spouse's coverage.

  Suppose that the employee in the example is married, and at the last open enrollment she waived health coverage because she was covered under the spouse's plan. Now suppose that the spouse terminates employment, thereby losing eligibility for the plan that covered both the spouse and the employee. In this situation (which is also considered an FSC event by most customers), the employee is allowed to enroll in any eligible option in the plan type.

• None: Select to disallow employees from making any changes to their elected option (unless eligibility for their current option or plan has been lost, in which case the system automatically overrides this setting and allows All Plans.)

Coverage Code Control

Select to enable employees to change only coverage levels (eligible options) within their currently enrolled benefit plan (applies only to the 1x series of plans). Coverage code control rules specify the criteria you use to select a valid coverage code for presentation to the employee for election. The rule specifies one set of criteria that is used when current coverage is in effect, and another set of criteria to be used when no current coverage is in effect.

If an employee loses eligibility for his current benefit plan, the system automatically overrides this setting and allows all options.

When you select the Coverage Code Control check box, the Coverage Code Control group box appears, where you can define coverage types and indicators.

Covered Person Type

Select a person category that determines how the person is to be processed by the system. In using covered person types, each relationship type that is eligible to enroll in benefits must be mapped to a covered person type. A given relationship code can map to zero or one covered person type code, while a particular covered person type code can map to one or more relationship codes.

You specify the rate separately for each type of person. You can use the same rate table ID for both employees who have adult children and those who do not. The system accumulates the rates for each dependent who is enrolled on the employee’s health election. If an employee has an adult child, the system adds the rate to the deduction. If an employee only has children who are not adult children, it will accumulate only at the regular child rate.

The following values are defined in the Dependent Relationship table. This table makes consistency across all types of covered persons possible, while allowing for new types of covered persons to be added in the future. The table is used as a child table of the Coverage Codes table.

• Child

• Adult Child

• Dom Partner (domestic partner)

• Employee

• NQ Dependent (nonqualified dependent)

• Oth Q Dependent (other qualified dependent)

• Spouse

Same, More, and Less

The Same, More, and Less check boxes apply if the employee is already enrolled in a plan.

Select Same to keep the same number of covered persons in the plan. You can enroll more, less, or the same number of a particular covered person type. An example of using the Same, More, and Less check boxes to define covered person type might be in the case of a divorce event class. In a divorce, you might have more, the same, or fewer children enrolled depending on the situation. So you would select all three check boxes for the Child person type option.

Continuing with the divorce event class example, you would add a row, select the Spouse person type in the Covered Person Type field, and select the Less check box because the spouse will no longer be covered. Finally, you would select the Employee person type and select the Same check box. The coverage code control rule allows for all variations of a particular event class, so you could allow more and less in the same event classification. In addition the same, more, or less applies if the employee is already enrolled in a plan. The Coverage indicator on the right applies if the employee is newly enrolled in the plan.

Select Same to keep the same number of covered persons in the plan.

Select More to allow more covered persons to be added to the plan.

Select Less to allow fewer covered persons to be enrolled in the plan.

If No Current Coverage

Indicate the status of the covered person type enrollment if the employee is enrolling in the plan for the first time.

• Allowed: Select to indicate that enrollment for the covered person type is allowed.

• Not Allowed: Select to indicate that enrollment for the covered person type is not allowed.

• Required: Select to indicate that enrollment for the covered person type is required.

Max Number of Change Levels (maximum number of change levels)

Indicates how many levels a participant can change or jump.

Levels of Change w/o Proof (levels of change without proof)

Indicates how many levels a participant can change without proof of good health or insurability.

Proof Required at Plan Level

Indicates the initial level at which proof of good health or insurability is required.

Amt. Proof Required (amount at which proof is required)

Enter the amount of coverage above which proof of good health or insurability is required.

Max Number of Change Levels (maximum number of change levels)

Indicates how many levels a participant can change.

Proof Required at Plan Level

Indicates the initial level at which proof of good health or insurability is required.

Amt. Proof Required (amount at which proof is required)

Enter the amount of coverage above which proof of good health or insurability is required.

Waiting Period...

To calculate the date that coverage begins when a waiting period exists, the system:

1. Begins with the event date.

2. Adds the number of months.

3. Adds the number of days.

4. Applies the Coverage Begins rule to the resulting date.

Use Exist?

Select to enable the system to search for any waiting periods on prior events. If this option is selected, and a waiting period is found, the system honors the prior event's waiting period if the prior event's coverage begins date is later than the coverage begins date normally associated with the current event.

For example, new hires have a three-month period before their benefits become effective. Under this rule, an employee hired on November 1 has a health benefit election with a coverage begin date and deduction begin date of February 1.

Now, suppose that you've scheduled an open enrollment for January 1. During that time, the employee was processed for an open enrollment event. If the event rules for the open enrollment specify that the coverage begin date equals the event date, January 1, the employee would have a health benefit election posted with a coverage and deduction begin date that is earlier than the health benefit coverage and deduction begin date that the employee originally received when hired.

Selecting Use Exist? for the OE event rule would prevent this from happening because the system would preserve the waiting period from the employee's previous HIR event.

Days and Months

Enter the number of days and months for the system to use as a waiting period to begin coverage.

Grace Period Days and Grace Period Months

To establish a grace period before coverage is terminated, enter the appropriate number of days or months that the system uses to calculate the resulting end date in a manner similar to Waiting Period.