Difference between revisions of "BenSelect:Admin:Plan:Enrollment Rules"

Revision as of 21:02, 8 June 2023

The Enrollment Rules tab helps you define specific rules for each rate group and benefit plan. Therefore, Enrollment Rules need to be set for each Rate Group on each benefit plan.

Effective Dates

Enroll Through 

The last day that this plan will be offered. Should be set to some day way in the future which would indicate the last day that anyone could possibly enroll. It is not necessary to put the end of the current plan year, because this will cause this value to have to be re-set in each future copy of the case. Default on a new plan is 5 years from the end of open enrollment.

Effective Date 

The first available date to be assigned by the system at enrollment. This date will not be forced as the effective date, but is the earliest effective date the system will assign after following other enrollment rules, including waiting periods. The "to" date is the date the plan will term. Generally, it is recommended to leave this field blank. If a "to" date is given, all employees enrolled in this plan will have a pre-termination date populated of this date. Sometimes this is desirable for a non-evergreen FSA-type plan, but generally not in other cases.

Waiting Period 

The period of time, calculated from Eligibility Date that employees must wait before coverage becomes effective. Can be set by days, months, or years

Status Change: Credit for time worked 

Checking this box makes Waiting Period and Grace Period calculate off Hire Date rather than Eligibility Date. This is helpful for cases that base Waiting Period and Grace Period off original hire date, rather than first time the employee is in an eligible job class.

Cut-off Day 

The Cut-off day is used to calculate the effective date in the step after the waiting period and before the “first of month” rule.

Enrollments with first possible effective dates (prior to “First of Month” rule being applied) that are on or before the cut-off day (day of the month) will be effective the first day of the following month.

For example, a “15” in this field and a 30-day waiting period for an employee with an Eligibility or Hire Date of 3/5 would calculate a first possible effective date of 4/4 (3/5 + 30 days), then look at the cut-off date, and apply the normal calculation (first of the month) and set the effective date to 5/1.

Enrollments with first possible effective dates (prior to "First of Month" rule being applied) that are after the cut-off day (xx day of the month) will be effective the first day of the second month following.

For example, a “15” in this field and a 30-day waiting period for an employee with an Eligibility or Hire Date of 3/30 would calculate a first possible effective date of 4/29 (3/30 + 30 days), then apply the cut-off date of 15 to that (since 29 is after 15) and move the effective date out to 6/1 rather than 5/1 as it would be without the cut-off date.

Effective 1st day of month on or after waiting period 

Causes effective date to be on the first day of the month after waiting period is met. Example: a 30 day waiting period and 1st day of month set will cause an employee with an eligibility date of 1/15/2012 and enrolled on 1/18/2012 to have an effective date of coverage of 3/1/2012 (eligibility date + 30 days, then 1st of month after)

Effective Immediately after waiting period 

Causes effective date to be the actual day that waiting period ends. Example: a 30 day waiting period and Effective immediately causes an employee with an eligibility date of 1/15/2012 who is enrolled on 1/18/2012 to have an effective date of 2/14/2012 (eligibility date + waiting period)

Force Plan Effective Date during Open Enrollment 

Allows you to set the Effective Date set above to always be the plan effective date. This setting will set a new effective date even if the benefit is set to carry forward.

Extend Coverage through the End of the Month when it terminates 

Terminates coverage at end of month after termination of coverage even if coverage began immediately after waiting period. Note - "Effective Immediately" rules on Life Events overrules this checkbox. In general - the way an employee enters a plan is the way the plan will terminate. So if "1st of month after waiting period" is checked, typically coverage will extend to the end of the month, and if "Effective immediately" is checked, typically coverage will terminate immediately. This setting allows that to be overridden.

Allow retroactive effective date during Grace Period 

This allows employees to have a retroactive grace period, back to first available effective date, as long as employee enrolls during their grace period.

Enrollment Period

Special Enrollment Start and End 

These settings allow for a group to have a plan that enrolls on a separate schedule than all other plans. For example, a group that typically enrolls in the summer time may need a special enrollment in December for calendar-based plans, such as FSAs or HSAs. Enter the start and end date of the Open Enrollment Period for the plan here if different than the Open Enrollment period for all other plans.

Grace Period 

The number of days after the Eligibility Date in which an employee is allowed to enroll. After the grace period has expired, an employee can only enroll during an open enrollment period or as part of a life event.

Grace Period Start 

Number of days after hire date/eligibility date restricting employees from entering the enrollment system.

When a number larger than 0 is entered for Grace Period Start, employees are not allowed into the system to enroll until that number of days after their hire date/eligibility date. Then, the time frame set in Grace Period is the "window of opportunity" that they have to enroll. For example, if Grace Period Start is 60 days, and Grace Period is 30 days, an employee hired on 2/1 could not enter the system to enroll until 4/2, and then would have until 5/2 to complete their enrollment.

Extend grace period to end of month 

Allows grace period window to extend through end of month in which it would end based on Grace Period setting.

Dependent Eligibility

Age Limits table 

Employee and dependent ages are computed as of the proposed effective date of the coverage. The Full-time Student age limit applies only to dependents with the Student flag set to True. The Disabled age limit applies only to dependents with the Disabled flag set to True.

Age calculation mode 

Determines age at Effective Date based on this factor. Can be Last Birthday (most typical), End of this year, End of last year, Beginning of this year, Application Date, or Plan Anniversary Date.

Examples:

1. Last Birthday - The age will be calculated by when the plan becomes effective.

• If OE was from 1/1-2/1 with an effective date of 3/1, then the age would calculate as the Employee's current age (or last birthday)as of 3/1.
• If the EE is 35 with a birthday on 1/15 (turning 36) and takes an application of 01/02 (before his Birthday), his age as of the 'LastBirthday' definition would be 36. This is because as of 3/1 the EE is 36 years old. If another employee is hired later on after OE, his Age will be calculated based upon his effective date.
• If the EE is hired on 5/1 and enrolls on 5/15, but the policy is not effective until 7/1, his age will be calculated as of 7/1.

Note: When using the 'Last Birthday' Calculation mode, the system will always output the EE's age on when the plan becomes effective for the EE, regardless of the day that the application was taken. Similar to Plan Anniversary Calculation mode, except for the fact that the effective date may change for each employee instead of having a fixed effective date such as the Plan Anniversary.

1. End of this Year
   1. This is where the age is calculated at the "End of the Current Year" (12/31/20)
2. End of Last Year
   1. This is where the age is calculated as of the "End of Last Year" (12/31/19)
3. Beginning of this Year
   1. This is where the age is calculated at the "Start of This Year" (01/01/20)
4. Application Date
   1. This will be the age of the Employee at the time he enrolls in the policy (it will have nothing to do with the effective date or the deduction date).
5. Plan Anniversary Date
   1. This calculation mode uses the Plan Year Begins Date on the Case Info screen as the date to use for the age calculation.
   2. Enrolls during 1st quarter 2020 open enrollment with a Plan Year Begins Date of 4/1/2020.
      1. During their initial enrollment it will be their age as of 4/1/2020.
      2. Next year it will be their age as of 4/1/2021. The year after that, it will be 4/1/2022, etc.

Note: Plan Anniversary Date calculations will not work correctly if the case does not have current or multiple plan years.

Domestic Partners

Same sex domestic partner as spouse, if over __ years of age 

Select if allowing domestic partner of the same sex, and then set a minimum age for eligibility

Opposite sex domestic partner as spouse, if over __ years of age 

Select if allowing domestic partner of the opposite sex, and then set a minimum age for eligibility

Domestic Partner PostTax Only 

Select if deductions for domestic partner coverage are taken after tax instead of pre-tax (when pre-tax is enabled for employee)

Same Sex Spouse 

Select to allow enrollment of spouses of the same sex as the enrollee

Adult Benefit Recipient as Spouse 

Select to allow enrollment of an Adult Benefit Recipient as a spouse

Deductions

Deduction Frequency 

Select how frequently a deduction for this rate group will be taken. Default Deduction means it will use whatever is set in the employee's pay group. Anything else will over-ride for this plan/rate group only. Cannot be more deductions than there are pay periods.

Pre-tax 

Check here to set pre-tax deductions for this plan and rate group

Allow Change 

Check here if employee can choose whether deductions are pre- or post-tax.

Deduction Before 

In some cases, the payer may require that premiums be deducted for a period of time before coverage can become effective. Set this value to the number of days before the initial effective date that premiums must initially be collected. For most products, this value is set to zero.

Beneficiaries

Primary 

Option on whether to collect a Primary Beneficiary for current plan/rate group. Can be NotShown, Required, Optional, RequiredIfNew (only required if employee didn't have election previously), or ReadOnly (will display any beneficiaries in the system already but will not allow edits).

Contingent 

Option on whether to collect a Contingent Beneficiary for current plan/rate group. Can be NotShown, Required, Optional, RequiredIfNew (only required if employee didn't have election previously), or ReadOnly (will display any beneficiaries in the system already but will not allow edits).

Beneficiary Name 

How to display name - as two fields, first and last, or as one full name field.

Beneficiary Age/DOB 

Allow entry of Age or Date of Birth.

Age/DOB options 

NotShown, Required, Optional, or ReadOnly.

Relationship 

NotShown, Required, Optional, or ReadOnly.

SSN 

NotShown, Required, Optional, or ReadOnly.

Address 

NotShown, Required, Optional, or ReadOnly.

Tax ID 

NotShown, Required, Optional, or ReadOnly.

Country of Citizenship 

NotShown, Required, Optional, or ReadOnly.

Phone 

NotShown, Required, Optional, or ReadOnly.

Generic Beneficiaries allowed 

Show the generic beneficiaries on all employees as a selectable option or not.

Rates and Forms

Rates & Forms 

The default rates and forms selection is by Session Location. This selection can also be set by Group Domicile Address or by Employee Home Address. This information comes from the carrier.

Round Mode 

How to round benefit amounts on plans with benefit amounts. (See below for more information on each option.)

Benefit amount round factor 

Rounding factor to be used when rounding benefit amount.

Premium Round Mode 

Select the method for rounding Premiums.(See below for more information on each option.)

Apply FTE Rate 

If selected, the employer/employee contributions for this rate group are applied based on an employee’s rate status (taken from a percentage provided by the census). If this option is not selected, then the contributions are applied as given.

Allow self service w/o agent signature 

This box ignores any product-based requirements for agent questions or forms and over-rides the need for an agent signature on products that normally require it.

Disable signature types 

This box allows you to select which signature types will be ignored for this case only on the product associated with the benefit plan. For example, if a form set up on the product allows for Digitized (Topaz) and Voiceprint signatures, bur you want to only accept Digitized (Topaz) for this case, then you would select the Disable signature types: Voiceprint for this plan on the case.

Allow 1 step signature

Selecting this option allows for one signature (such as PIN) to be used for the form attached to the benefit plan and the confirmation form.

How Rounding Works in BenSelect

The options for Round Mode and Premium Round Mode are the same. Additionally, there is an option to set the Benefit Amount Round Factor to the place to round to (ie. ones, tens, tenths, etc.). The rounding options are described below.

• NoRound – this is the default value and won’t enforce any rounding on any values
• Round Down – this will round the value down to the nearest factor you provide as a Benefit amount round factor. So, if you have a factor of 1 and use round down, a value of $15.37 becomes $15.00.
• Round – this is the same as Financial round and is covered there.
• Round Up - this will round the value up to the nearest factor you provide as a Benefit amount round factor. So, if you have a factor of 1 and use round up, a value of $15.37 becomes $16.00.
• Math – this is mathematical rounding. It uses the same logic rounding in Excel uses or the same rounding rules you learned in school. 5 or greater rounds up and less than 5 rounds down. So, if you have a factor of 1 and use math, a value of $15.37 becomes $15.00. If you had a value of $15.51 it would become $16.00.
• Financial – Financial rounding (banker’s rounding) is an algorithm for rounding quantities to integers, in which numbers are equidistant form the two nearest integers are rounded to the nearest even integer. This means it could round up or down to get to the nearest even integer. For example, 0.5 rounds down to 0; 1.5 rounds up to 2. Other decimal fractions round as expected (ie. 0.4 to 0, 0.6 to 1, 1.4 to 1, 1.6 to 2, etc.). Only x.5 numbers get the "special" treatment.

Benefit amount round factor scripting is also an option. If the needed value is not available in the drop-down list of choices, OnLoad script can be added to set the factor. For example:

//OnLoad Event.Config.RoundFactor = 75;

This example would set the rounding to round to the nearest 75. So a value of 120 would round down to 75 or round up to 150. A value of 3,212 would round down to 3150 and up to 3225.

Enrollment

New Coverage

This section sets how the system operates for employees who did not have this coverage prior to enrollment.

Open for Enrollment 

Plan is listed without any prior selection for eligible employees in enrollment system

Auto-enroll 

Plan is listed as being elected for eligible employees without employee or enroller being required to make the election (typically used for fully employer-paid plans, such as a Group Life)

Cannot Waive 

Plan is not listed as elected already in enrollment system, but cannot be waived for eligible employees. In this situation, the enroller or employee is required to step through the enrollment for the plan

Waive 

Plan is listed as being waived for eligible employees without employee or enroller being required to waive.

Existing Coverage

This section sets how the system operates for employees who had this coverage prior to enrollment.

Open for Enrollment (default) 

Plan is listed without any prior selection for eligible employees in enrollment system

Recalculate 

Applies this year's rates and rules to last year's election and marks as pre-elected, but with this year's rates (including based on age bands)

Carry Forward 

Keeps last year's coverage exactly the same for this year and marks as pre-elected. Not recommended if plan needs to use new rates, look at age band, or take into account any new information on the employee or the plan. Often used on legacy or dummy coverage.

Cancel only 

Can only cancel the benefit plan, which is not offered for the current plan year.

Waive 

Plan is listed as being waived for eligible employees without employee or enroller being required to waive. May be used if a plan is not being offered anymore as this will create a term date on last year's coverage.

Case wrap-up

This section sets how the system will operate for employees who do not complete the enrollment process during Case Wrap-up. Case wrap-up is discussed in general on the Enrollment Status page.

Pending Applications 

Determines what to do with applications where an election was made (or a waiver) yet an Enrollment Confirmation was not signed. Accept makes these applications into coverage, while Discard disregards the application and treats the employee like no election was made.

Default Action 

Determines what to do with employees who had prior coverage in the current plan. Enroll will enroll the employee in the same product, tier, and/or benefit amount they previously had, while Waive will terminate prior coverage as of the end of the last plan year.

Default Action (no prior coverage) 

Determines what to do with employees who did not have prior coverage in the current plan. Enroll will put all employees who did not complete an Enrollment Confirmation into a default level of the plan, while Waive will waive the coverage for all employees who did not complete an Enrollment Confirmation.

Confirm waive?

The options here let you set how confirm waiving coverage works, as well as other general enrollment rules for the selected plan.

Do not confirm waive 

Select this option if you do not want a confirmation of waive question to be asked of the applicant.

Confirm waive 

Select this option if you want a confirmation of waive question to be asked of the applicant.

Confirm waive if not late entrant 

This option provides a message to applicants who are being offered a plan for the first time, and which in later offerings may be subject to underwriting. It’s an attention getter for the applicant – a way to let them know that they may not want to waive the plan on offer.

Show on Enrollment Site 

Generally want this selected. Deselect if the product is only offered for employees who are already enrolled in the product. For example, a life insurance plan that was offered the previous year is discontinued, but payroll deductions can still be taken for it. With this option not selected, employees who did not previously have the coverage do not see it on the site.

Disable Quick Enroll 

If Quick Enroll is set for this case on Case Info, selecting this box over-rides that and does not allow the current plan/rate group to be enrolled via Quick Enroll.

Open Year Round 

Select to allow employees to enroll for this product at any time with no qualifying event.

Prerequisites

The options here require this information to be given before employees can enroll. This overrides anything on the Personal Info tab under Case Info. For example, a group may not wish to require a SSN for Insureds unless the employee elects medical coverage. In that case, the Prerequisite for Insured SSN should be set on the Medical Plan, but not set to be required on the Personal Info page.

Sample settings for New, Existing, and Case wrap-up

Typical setup for Medical, Dental, Vision, or other N-Tier plans

The setup example below reflects a typical setup for a medical or other multi-tier plan.

With these settings, both new and existing coverage are Open for Enrollment (no election made when user enters system), and at case wrap-up, the system will discard applications that were started but not signed, enroll employees in last year's coverages, and waive coverage for those not enrolled last year.

Typical setup for Employer Paid plans

The setup example below reflects a typical setup for entirely employer-paid plans that every employee gets, such as a Group Life.

With these settings, the coverage is given to every employee and is marked as "pre-selected" when employees enter the enrollment site.

Typical setup for Legacy Voluntary plans

Oftentimes a group will continue to carry forward plans that they have not offered to employees in a long time. Perhaps all the information the group still has on the plan is what the employee's deduction is. These plans are not eligible to be added, changed, or deleted through the enrollment site. The settings below are appropriate for this situation.

This will cause coverage to be automatically waived for anyone who did not have it previously and carried forward (without an attempt at recalculation) for those who had it.