Ways to Enforce Benefits Restrictions

Setup of benefits certification coverage restrictions at the plan level varies depending on whether the restriction type is Benefit amount or Plan or option sequence.

You can set up restrictions for the entire plan or for specific life events for the plan. You can't set up restrictions based on coverage calculation amounts if you set the Restriction Type to Plan or option sequence. Configure restrictions in the Plan Configuration work area using the Manage Benefit Plan Details task.

Benefit Amount

Use the Benefit Amount Restrictions section of the Plan Certifications page, Benefits Certifications tab, General Configuration subtab, for both first-time enrollments and changes in enrollments.

For first-time enrollments, you can specify the Minimum, Maximum, and Maximum with Certification coverage amounts.
For enrollment changes, you can also specify Maximum Increase and Maximum Increase with Certification amounts.

Elections submitted outside of these specifications trigger enrollment suspension and application of interim coverage, if configured on the Plan Enrollment page.

You can impose benefits certification restrictions in plans that have coverage with either of the following calculation methods:

Flat range
Flat amount

To see this method, you must first select the Participants enter value at enrollment check box.

Typical scenarios don't call for simultaneously setting all benefits amount restriction fields.

Plan or Option Sequence

The Plan or Option Sequence Restrictions section targets both first-time enrollments and changes in enrollments. Elections submitted outside of the following specifications trigger enrollment suspension and application of interim coverage, if configured on the Plan Enrollment page.

For first-time enrollments, you can specify Minimum Sequence Number, Maximum Sequence Number, and Maximum Sequence Number with Certification.
For enrollment changes, you can also specify Maximum Sequence Number Increase and Maximum Sequence Number Increase with Certification.

Plan configurations that include all of the following aspects can impose option restrictions:

Options
Coverages that use the Multiple of compensation calculation method

Selecting Plan or option sequence as the restriction type enables the Restrictions on Changes field. When configured, the selected restriction on changes rule limits the choices that workers see during enrollment. For example, No restrictions allows workers to see all available options. Increase only allows workers to see just those options that are greater than the current election.

Enrollment processing determines whether an option represents an increase or decrease with respect to the currently elected option based on the option sequence numbers. You set the sequence numbers in the Options section table of the Plan Basic Details page. Typical scenarios don't call for simultaneously setting all option restriction fields.