Examples of Validating Enrollment Across Plans

This topic provides examples for setting up enrollment validation across plans when enrollment in one plan depends upon enrollment in one or more other plans.

Enrollment in One Plan Requires Enrollment in Another Plan

Scenario: You require enrollment in both a high-deductible health plan (HDHP) and a health savings account plan (HSA).

Setup: Use one of the following methods to enforce enrollment in both plans.

• If the entire worker population must enroll in HSA with HDHP, you can enforce enrollment using one of these methods:

  • Set up both plans for default enrollment upon new hire.

  • Configure the automatic enrollment method on both plans.

  For either method, you must set up each plan type with a minimum plan enrollment of 1.

• Create an eligibility profile tied to one of the plans, such as the HDHP, using either method 1 or 2 values. Don't select Exclude.

  Field	Method 1 Value	Method 2 Value
  Criteria Type	Other	Related Coverage
  Criteria	Participation in Another Plan Method 1 uses participation in one plan as eligibility criteria for the other plan during validation.	Covered in Another Plan
  Criteria Value	Other plan, such as HSA	Other plan, such as HSA

• Create a post election coverage calculation formula that enforces coverage in both plans. On the Plan Enrollment page of the plan configuration process:

  1. Select the plan in the plan hierarchy.

  2. Select the post election formula in the Further Details section of the General tab.

  Tip: You can also control enrollments by selecting the post election formula at the plan type or the option level of the program or plan hierarchy.

Enrollment in One Plan Excludes Enrollment in Another Plan

Scenario: You exclude enrollment in a flexible spending account plan (FSA) for participants electing the health savings account plan (HSA).

Setup:

1. Create an eligibility profile using these values:

   Field	Value
   Criteria Type	Other
   Criteria	Participation in Another Plan
   Criteria Value	FSA plan

2. Select Exclude.

3. Assign this eligibility profile to the HSA plan.

Enrollment in One Plan is Contingent on Enrollment in Another Plan

Scenario: You don't permit enrollment in spouse and child supplemental life insurance unless the worker is enrolled in the employee supplemental life insurance.

Setup: Use one of the following methods to enforce this requirement.

• Create a participant eligibility profile tied to the spouse and dependent plans, using the following values. Don't select Exclude.

  Field	Value
  Criteria Type	Related Coverage
  Criteria	Covered in Another Plan
  Criteria Value	Employee supplemental life plan

• Create a post election coverage calculation formula that enforces coverage in the employee plan.

  On the Plan Enrollment page of the plan configuration process:

  1. Select the spouse and dependent plans in the plan hierarchy.

  2. Select the post election formula in the Further Details section of the General tab.