Best Practices for Setting Up Enrollment Criteria in a Benefits Hierarchy

Setup effort and operating performance vary depending on where you define enrollment requirements within the benefits object hierarchy. This example illustrates best practices.

Use the enrollment step in the Plan Configuration guided process and decide at which levels you want to define the enrollment requirements.

• Three levels when configuring programs: program, plan type in program, and plan in program

• Two levels when configuring plans: plan not in program and option in plan

Use the General, Scheduled, and Life Events tabs to configure enrollment at any of the available program and plan hierarchy levels. You can associate enrollment requirements with one or more explicit life events.

The following figure shows the enrollment determination hierarchies with components organized from top to bottom, general to detail.

When evaluating enrollment configuration, requirements at lower levels in the hierarchy override higher-level requirements. If a plan or option has specific requirements that aren't common to the levels above it, then it's appropriate to configure enrollment at that lower level. Further, life event enrollment configuration overrides corresponding general plan or program enrollment configuration. For example, life event requirements for option in plan override general enrollment requirements for option in plan.

Wellness Program Example Scenario

Your organization is creating a wellness program that's for current and retired employees only.

The program hierarchy includes:

• Two plan types: medical and recreational.

• Two plans within the medical plan type: HMO and PPO

• Three options for both medical plans: Employee Only, Employee Plus Spouse, and Employee Plus Family

You want to set up enrollment to achieve the following results:

• Enable all eligible persons to make benefit elections within this program during a specific annual period.

• Enable participants to review and revise elections when they add a child or spouse to their families.

Enrollment Setup

You create the Wellness benefit offering and attach life events at the highest hierarchy level for open enrollment and explicit life event enrollment.

The following figure shows the resulting enrollment determination hierarchy for your Wellness benefit offering.

The following table identifies the enrollment requirements that you configure at each level in the hierarchy.

Level	Enrollment Requirement
Program	Attach the Scheduled Open event and configure the November enrollment period for the Wellness program
Plan type in program	Attach the Add a Child life event and Marriage life event to the Medical plan type and configure the enrollment period and other settings for each event. This configuration provides medical plan enrollment opportunity at any time during the year for Wellness program participants who add a child or spouse to the family. None for the recreational plan type
Plan in program	None for any of the plans. Enrollment requirements for the Medical plan type cascade down to the plans under that plan type.
Option in plan	None for any of the options. Enrollment requirements for the Medical plan type cascade down to the options in plans under that plan type.

This strategy reduces maintenance and processing time because of the following factors:

• Program level criteria controls enrollment for all persons

• Life event in plan level criteria provides an exception for a specific life event

Resulting Enrollment

Jane is a current worker participating in the Employee Plus Spouse option of the PPO medical plan.

When Jane adopts a child into her family during June:

• She can immediately review her current PPO plan elections and switch to the Employee Plus Family option.

• She can't change her elections within the recreational plan type.