Health Plan Processing

When processing health plans, the system is designed to process:

  1. An eligibility check.

  2. Medical deductions.

  3. Dental deductions.

Eligibility Check

To perform the eligibility check, the system:

  1. Processes BEN FM BASIC ELIG.

    BEN FM BASIC ELIG looks at the Primary Job and Include Deductions check boxes. If the check boxes are not selected, then zero is assigned to the formula BEN FM BASIC ELIG and to the variable BEN VR BASIC ELIG.

  2. If BEN FM BASIC ELIG equals one, the system processes the section HEALTH INIT.

    HEALTH INIT calls the array BEN AR HLTH PLANS. BEN AR HLTH PLANS uses the formula BEN FM HLTH PLANS to retrieve the employee's health benefit enrollment information for plan types 10 and 11 from the Health Benefit Election page in PeopleSoft HR.

Medical Deductions

To calculate medical deductions, the system:

  1. Performs another eligibility check using the formula BEN FM MED ELIG.

    If retroactive adjustments exist, and if the employee's plan type 10 election coverage is not blank, then one is assigned to the formula BEN FM MED ELIG.

    If the value of BEN VR BASIC ELIG equals zero, then zero is assigned to the formula BEN FM MED ELIG.

    If the employee's plan type 10 election coverage equals blank, T, or W, then zero is assigned to the formula BEN FM MED ELIG.

    If the Primary Job check box for this employee is selected, then one is assigned to the formula BEN FM MED ELIG.

  2. If BEN FM MED ELIG equals one, the system processes the section MEDICAL DED. MEDICAL DED uses:

    1. The formula BEN FM PLN TYP 10 to set plan type 10-specific search criteria.

    2. The array BEN AR BEN PRG DEF to retrieve benefit option and cost information from the Benefit Program page in PeopleSoft HR.

    3. The arrays BEN AR RATE TBL and BEN AR RATE DAT2 to retrieve benefit rate data from the BN_RATE_TBL and BN_RATE_DATA tables respectively.

    4. The array BEN AR CALC RULE to retrieve the calculation rules from the Calculation Rules page in PeopleSoft HR.

    5. The deduction MEDICAL EE to calculate the employee's portion of the deduction. MEDICAL EE uses the formula BEN FM MED EE COST.

    6. The deduction MEDICAL ER to calculate the employer's portion of the deduction. MEDICAL ER uses the formula BEN FM MED ER COST.

Dental Deductions

To calculate dental deductions, the system:

  1. Performs another eligibility check using the formula BEN FM DEN ELIG.

    If retroactive adjustments exist, and if the employee's plan type 11 election coverage is not blank, then one is assigned to the formula BEN FM DEN ELIG.

    If the value of BEN VR BASIC ELIG equals zero, then zero is assigned to the formula BEN FM DEN ELIG.

    If the employee's plan type 11 election coverage equals blank, T, or W, then zero is assigned to the formula BEN FM DEN ELIG.

    If the Primary Job field for this employee is selected, then one is assigned to the formula BEN FM DEN ELIG.

  2. If BEN FM DEN ELIG equals one, the system processes the section DENTAL DED. DENTAL DED uses:

    1. The formula BEN FM PLN TYP 11 to set plan type 11-specific search criteria.

    2. The array BEN AR BEN PRG DEF to retrieve benefit option and cost information from the Benefit Program page in PeopleSoft HR.

    3. The arrays BEN AR RATE TBL and BEN AR RATE DAT2 to retrieve benefit rate data from the BN_RATE_TBL and BN_RATE_DATA tables respectively.

    4. The array BEN AR CALC RULE to retrieve the calculation rules from the Calculation Rules page in PeopleSoft HR.

    5. The deduction DENTAL EE to calculate the employee's portion of the deduction. DENTAL EE uses the formula BEN FM DED EE COST.

    6. The deduction DENTAL ER to calculate the employer's portion of the deduction. DENTAL ER uses the formula BEN FM DEN ER COST.