Understanding Enrollment with Eligibility

When you need to change an employee's enrollment information for plans that have eligibility requirements, use the Enrollment with Eligibility program (P08334) to make the change.

When the organization discontinues a plan or an employee wants to stop participating in a plan, you must end the employee's enrollment in the plan. During an open enrollment period, you might need to end an employee's enrollment in one plan and then enroll the employee in another plan.

You also must end enrollment when you terminate an employee. When you end enrollment for a terminated employee, the system does not re-enroll the employee in required plans.

For plans that require an amount or rate, you occasionally might need to change that amount or rate. For example, an employee might want to change the percentage of salary to contribute to a retirement plan.

When you discover that an employee is enrolled in an incorrect plan or plan option, you must correct the mistaken enrollment. If you have not yet processed payroll for the employee, the system deletes the mistaken enrollment record. If you have already processed payroll for the employee, the system creates an audit record of the mistaken enrollment.

For a plan that has continuing eligibility requirements, you can verify an employee's eligibility in the plan. When an employee fails the continuing eligibility test, the system automatically ends the employee's enrollment in the plan and assigns the employee an ineligible status.

For ACA Eligibility plan, you can verify an employee's eligibility in the plan. The system uses the Effective Date from the enrollment process to find the ACA Eligibility Status record in the ACA Employee Eligibility table (F081161). It selects the record with eligibility date nearest to, but less than or equal to the effective date that you specify in the Enrollment with Eligibility program. In case of more than one such records, the system uses the record with the latest parameter control number to determine the benefit eligibility status for the employee.

Events in an employee's life might require that the employee change enrollment in one or more plans. Marriage or the birth of a child are examples of life events. You can set the processing options for the Enrollment with Eligibility program to enable these changes.