Understanding Eligibility Rules

You use eligibility rules to:

  • Determine the benefit program for which each employee is eligible.

  • Determine eligibility for each plan option within a benefit program.

  • Set up the system so that a participant can be eligible for only one benefit program at a time.

  • Define eligibility based on a wide range of personal and job information, as well as geographic location.

After you define the eligibility rule, attach it to your benefit program at the program or plan option level using the Benefit Program table.

Note: For federal users: For Thrift Savings Plans (TSPs), if you want to link an eligibility rule to a TSP option, create a separate eligibility rule to be used exclusively for TSPs.

Never attach the same eligibility rule and geographic eligibility table combination to the program level of more than one benefit program; otherwise, employees will be eligible for more than one benefit program.

For an employee to be deemed eligible for participation in a plan or program covered by an eligibility rule, the employee must meet all of the parameters set for that rule. When defining an eligibility rule, you define the criteria, as well as an indicator that tells the system whether meeting the criteria makes the employee eligible or ineligible.

If you want to define an eligibility rule for a program that is available to employees in the 48 contiguous states but not Hawaii or Alaska, you can select the state criteria to set up the parameter. The system looks at each employee's home address, and makes the employee eligible for the benefit program if he or she lives in one of the 48 contiguous states. A faster way to define this same rule is to say that if the employee lives in Hawaii or Alaska, he or she is ineligible for the benefit program.

The PeopleSoft Benefits Administration software provides 28 different criteria fields (plus two federal-specific fields) that you can use to determine employee benefit eligibility. Nine of these criteria fields can be user-defined to meet the organization's needs. In addition to the Location field, these other criteria fields are available:

  • ACA Eligibility Status

  • Age

  • Benefit Status

  • Eligibility Config 1− 9

  • EmplID Override

  • Employee Class

  • Employee Type

  • FEHB Indicator (federal employee health benefits)

  • FLSA Status (Fair Labor Standards Act)

  • FTE (full-time equivalency)

  • Full/Part Time

  • Medicare

  • Officer Code

  • Pay Group

  • Regular and Temporary

  • Regulatory Region

  • Retirement Plan (Federal)

  • Salary Grade

  • Service Months

  • Standard Hours

  • State

  • Union Code

As you work with PeopleSoft Benefits Administration, times will occur when eligibility rules are improperly configured. You can troubleshoot eligibility problems by using the Benefit Administration Eligibility Debugging tool, which shows you exactly where an individual employee fails and passes program and plan option eligibility checks during the Benefits Administration process.