Policy Info
The Policy Info section includes information such as the Product/Benefit Type, Provider/Carrier Name, Internal Plan Name, Group#, Effective Start Date & Effective End Date of the plan. For medical, dental, and vision plans, plan type and metal level are just a few of the options that can be entered.
Eligibility
Eligibility rules can be managed in the Eligibility section. Generally, for small groups, eligibility is set to all employees. However, eligibility can be restricted by Organization Groups such as Departments, Divisions, Employee Job Classes and/or Locations, etc.
Waiting period for New Hire, Newly Eligible, and Rehire employees can be the same for all employees irrespective of their organizational group or location or could be different among such groups.
Plan termination rules can also be part of employees benefits eligibility. All information mentioned above is housed in this section. Also, in this section, you will find the Eligibility options for Domestic partner and age rules for eligible Dependents.
Coverage
Detailed benefit information can be added in this section, such as Deductible amount, Office Visit amount, Inpatient and Outpatient amounts for medical, dental, and vision plans. For plans like Life, Disability, and AD&D, you can view/configure/manage Flat amount benefits, Incremental benefit coverage or Multiple of Earning types of coverage options. For Life, Disability and AD&D plans, you can configure benefits based on different employee groups or locations. However, reimbursement plans and retirement plans do not have coverage section.
Rates
In the Rates section, you will find the MONTHLY PREMIUM for the plan. You can set up different types of rate structures such as Individual Banded Rates and Composite Rate structure for Medical, Dental, and Vision plans. You can also set either type of rate based on Tobacco – Non-Tobacco, Tobacco Surcharge, or Location based rate structure.
For Life, Disability, and AD&D plans, rates can be configured per benefit coverage, also additional factors such as gender, age, location, tobacco and tobacco surcharge can be set for the calculation.
Contributions
In the Contributions section, you will find the contribution details for the plan. You have the option to enter either the Employer or Employee contribution. Different contribution structures for different groups of employees can also be set up. After specifying which grouping of employees the Contribution Group is based on, select the desired Contribution structure associated Contribution Types, then enter the monthly contribution for all applicable coverage tiers.
Our system supports different contribution strategies such as Flat Contribution amount or percentage, Tier based contribution, Base/ Buy-up Contribution, and product/plan contingency.
Additional Settings
The Plan Additional Settings section provides certain plan level settings. You can set employee’s enrollment to the plan as mandatory. This means that during the employee’s benefits selection process, the employee cannot decline plan benefits. Mandatory enrollment is most common with 100% employer sponsored benefits such as Group Life/AD&D, where employer wants employees to know that benefits are provided and employee cannot decline this benefit. Also, you can set up the employer contribution that displays during employee’s benefit selection or not. For example, certain plan level information collection, such as Primary Care Physician (PCP) information collection for certain health plans that are required to enroll, or Beneficiary’s information that is important in some life, accident, and disability plans, can be required. This information can be collected from employees during their benefits selection process just by setting these fields to Optional, Required, or Not Required under additional setting section.
Resources
The Resource section on a plan record provides an area to set up any external (carrier) weblinks, Plan level contact information, or Plan documents. All this information will be displayed under plan details during employee’s benefits selection process. Also, you can add an Evidence of Insurability Form or an external link to this form under this section, which should be available to the employee and filled out by Insured during enrollment process.