Understanding Benefit Category Rules for Self Service
Benefit category rules and specifications need to be set up before the new benefit self-service features are available to employees. To ensure that employees make benefit selections that are consistent with your organizational and provider policies, you use the Categories by Benefit Group program (P08350) to specify a classification for each benefit category and to specify that changes in employee elections must remain within a current group of benefit plans.
For self service, benefit categories must be defined as belonging to one of these classifications:
Health and Welfare
Indemnity
Retirement Savings
Other
For example, medical, dental, and vision categories are in the health and welfare classification. Life insurance and tax-deferred savings categories are in the retirement savings classification. Employees might be allowed to decline inclusion in some categories, but not in others. For example, inclusion in a retirement savings plan might be optional. However, medical coverage might be required unless employees are included in spousal coverage with another employer. You can specify whether the Human Capital Management administrator is notified when employees elect to decline coverage.
Most insurance providers allow employees to change their coverage when they experience a qualifying life event. For example, a married employee who gives birth to, or adopts, a child can usually change their medical insurance from employee plus spouse to employee plus family within 31 days of the birth of the child. The employee cannot ordinarily change from the current provider to an alternate provider until the commencement of an open enrollment period.
The Categories by Benefit Group program is normally used in the initial setup of benefits information. You use this program to link benefit categories to benefit groups when you set up the benefits administration software. The entire task is included as part of employee self-service benefits setup to ensure that the requirements to set up self service are reviewed and completed.
After you set up benefit groups and benefit categories, you can link categories to each benefit group. For example, you can link the benefit categories for medical, dental, and life to the management benefit group. When you link a category to a benefit group, all of the employees in that group are eligible for all of the benefit plans in that category.
When you link categories to groups, you can also include this information:
Whether the benefit group has flex plans
The sequence in which the benefit categories appear on the enrollment form
The election criteria for a benefit category
The benefit category type for special flex plans
The benefit category classification
An employee option to print a form for declining benefit coverage
Whether employees must stay within the current benefit group options or within a current group of benefit plans
If a benefit group has flex plans, you must set up a benefit category for employee flex deductions (category type 2). This benefit category is the mechanism for deducting a negative flex balance from employee pay. If the employer awards members of the benefit group a lump sum of flex credits, you must set up a benefit category for those lump sum credits (category type 1).