It is important to set up proper employee eligibility rules for the plan and in the Eligibility section. The default setting is for all employees to be eligible. However, eligibility can be restricted by Organization Groups such as Departments, Divisions, Employee Job Classes and/or Locations, etc. You may set up eligibility for all employees or with restrictions by certain organizational groups or locations.
It is important to note that all types of employees, such as Full-Time, Part-time, Seasonal, and Contractors are considered to be employees and if employee eligibility is set to all employees, all of these employee classifications are eligible to select the plan during enrollment. If that is not desired, it is recommended to create an Employee Group with job classes (refer how to create groups under company setup) and restrict eligibility based on group classes.
To set up eligibility based on certain employee group, location or organizational structure, first make sure all information is correctly set up under company Locations and Groups. Also, make sure employee records are correctly set up by assigning appropriate work location and company groups. Toggle the All Employees are Eligible button to No to set up eligibility based on these groups or locations. Selected groups or locations in this field will be considered Eligible. Those not selected, will not be eligible to enroll.
Also, Waiting period for the New Hire, Newly Eligible, and Rehire employees can be the same for all employees regardless of their organizational group or location or could be different among such groups.
Note: The system calculates an employee's hire date as day 0. For example, if a plan has a 30 day waiting period, employees will be eligible on day 31.
This rule indicates the coverage waiting period for newly hired employees (similar workflow for Newly Eligible and Rehired employees). Coverage Begins/Entry Date after waiting period can also be set with waiting period.
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Immediately (after waiting period): Coverage begins immediately after waiting period is satisfied.
- Example: Waiting period is 30 days, the employee will be eligible for coverage on day 31.
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1st of month after: Coverage begins the first of the month following the date the employee satisfies the coverage waiting period. If an employee satisfies the waiting period on the 1st of the month, coverage will not begin until the 1st of the following month.
- Example 1: Employee satisfies 30 day waiting period on 3/14/2019, coverage will begin on 4/1/2019
- Example 2: Employee satisfies 30 day waiting period on 3/1/2019, coverage will begin on 4/1/2019
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1st of month coinciding with or after: Coverage begins the first of the month following the date the employee satisfies the coverage waiting period. If an employee satisfies the waiting period on the 1st of the month, coverage will begin on that day.
- Example 1: Employee satisfies 30 day waiting period on 3/21/2019, coverage will begin on 4/1/2019
- Example 2: Employee satisfies 30 day waiting period on 3/1/2019, coverage will begin on 3/1/2019
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15th of month after: Coverage begins on the 15th of the month following the date the employee satisfies the coverage waiting period. If an employee satisfies the waiting period on the 15th of the month, coverage will not begin until the 15th of the following month.
- Example 1: Employee satisfies 30 day waiting period on 3/18/2019, coverage will begin on 4/15/2019.
- Example 2: Employee satisfies 30 day waiting period on 3/15/2019, coverage will begin on 4/15/2019.
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15th of month coinciding with or after: Coverage begins on the 15th of the month following the date the employee satisfies the coverage waiting period. If an employee satisfies the waiting period on the 15th of the month, coverage will begin on that day.
- Example 1: Employee satisfies 30 day waiting period on 3/18/2019, coverage will begin on 4/15/2019
- Example 2: Employee satisfies 30 day waiting period on 3/15/2019, coverage will begin on 3/15/2019
- Plan termination rules can also be part of employees benefits eligibility.When an employee is terminated or changes to a different class and is no longer eligible for the plan, the following options are available for end of coverage:
Termination Date: Coverage will end on the employee's termination date.
- Example: Employee is terminated on 4/16/2019, coverage will end on 4/16/2019
End of Termination Month: Coverage will end on the last day of the month in which the employee was terminated.
- Example: Employee is terminated on 4/9/2019, coverage will end on 4/30/2019
1st of Month After Termination: Coverage will end on the first day of the month following the employee's termination date.
- Example: If an employee is terminated on 4/10/2019, coverage will end on 5/1/2019