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Policy Info
The Policy Info section includes information including the Product/Benefit Type, Provider/Carrier Name, Internal Plan Name, Group#, Effective Start Date and Effective End Date of the plan. For medical, dental, and vision plans, plan type and meta 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 allow all employees to enroll. However, eligibility can be restricted by Organization Groups such as Departments, Divisions, Employee Job Classes and/or Locations, etc.
The waiting period for New Hire, Newly Eligible, and Rehire employees can either be the same for all employees irrespective of their organizational group or location, or could be different among different 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, including Deductible amount, Office Visit amount, Inpatient and Outpatient amounts for medical, dental, and vision plans. For plans such as 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 a 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; 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 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 configured. After specifying which grouping of employees the Contribution Group is based on, select the desired Contribution structure associated with Contribution Types, and 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 the additional settings section.
Resources
The Resource section on a plan record provides an method for setting up any external (carrier) weblinks, Plan level contact information, or Plan documents. All this information will be displayed under plan details during the 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.
Payroll
In the Payroll section, there are two tabs. The first tab, Payroll Deduction Codes, is where you may set up the Deduction codes for the the plan, including both pre-tax and post-tax specifications. You also will need to enter the employer code here. On the second tab, Deduction Frequency Overrides you may provide optional override settings for deductions if the employee's pay and deduction frequencies are different. This can occur, for example, if an employee is paid bi-weekly (resulting in 26 pay periods) and where deductions are designed to be bi-monthly (24 pay periods).