Overview of Benefits Formulas

Use formulas to configure your plan design to the requirements of your enterprise.

They provide a flexible alternative to delivered business rules for such purposes as:

• Date calculations, such as:

  • Enrollment start and end dates

  • Rate or coverage start and end dates

  • Waiting periods and enrollment periods

  • Action item due dates

• Calculations of rate and coverage amount, minimum and maximum, or upper and lower limits

• Certification requirements

• Partial month and proration calculations

• Eligibility and participation evaluation

For example, you can write a formula to calculate benefits eligibility for those cases where the provided eligibility criteria don't accommodate your particular requirements.

A formula can return more than one value to a calling package. In Benefits, different packages which call the formula expect outputs to be returned differently. Based on the formula type, the number and data types of values to be returned are predefined. Some packages expect the predefined names for output variables; the order of a variable in the return statement does not matter. Some packages expect the return variables to be returned in a certain order; in this case the name of output variable does not matter. If predefined names are expected to be used and the formula does not use the expected names, the process would error out at run time.