EOI Rules Tab

New Employee/New Benefit Plan

The rules in this group box apply to new employees that elect the benefit plan. If the elected coverage amount exceeds the specified threshold amount, EOI will be required for the employee, or spouse for spousal coverage.

An employee is considered "new" if both the following are true:

The start date of the new coverage is before or the same as the employee's new hire period. The new hire period is based on the employee's Current Hire Date from the Manage Employee Information screen and the Number of days that employees are classified as new employees value on the Configure Benefit Settings screen.
The employee does not have a record on the Employee Benefits Elections table where the end date is after or the same as the employee's Current Hire Date on the Manage Employee Information screen; and the coverage option code is not NO CVG.

Field	Description
Over the guarantee issue limit of:	Select this check box to require EOI if a new or rehired employee elects the benefit plan for the first time and the coverage amount is over the guarantee issue limit you specify.
Guarantee Issue Limit Amount	Enter the guarantee issue limit to be used as a threshold for requiring EOI for new employees electing a new benefit plan. If the coverage amount is less than or equal to the guarantee issue limit, the EOI will not be required. If the coverage amount is greater than the guarantee issue limit, EOI will be required.

Existing Employee/New Benefit Plan

The rules in this group box apply to existing employees that elect the benefit plan for the first time or re-elect the benefit plan after a break in coverage. If the elected coverage amount exceeds any of the selected threshold amounts, EOI will be required for the employee (or spouse for spousal coverage).

An employee is considered as "existing" if either of the following are true:

The start date of the new coverage is after the employee's new hire period. The new hire period is based on the employee's Current Hire Date e from the Manage Employee Information screen and the Number of days that employees are classified as new employees value on the Configure Benefit Settings screen.
The employee does have a record in Employee Benefit Elections table where the end date is after or the same as the employee's Current Hire Date on the Manage Employee Information screen; and the coverage option code is not NO CVG.

Field	Description
Any amount	Select this check box to require EOI when: An existing employee elects the benefit plan for the first time. An existing employee elects the or after a break in coverage. EOI will be required regardless of the coverage amount elected. If you select this check box, the other Existing Employee/New Benefit Plan check box options becomes clear and disabled.
Over the guarantee issue limit of:	Select this check box to require EOI when an existing employee elects the benefit plan for the first time or after a break in coverage and the coverage amount is greater than the guarantee issue limit. Note: Even if EOI is not required based on the guarantee issue limit, it may be required based on the other Existing Employee/New Benefit Plan EOI requirement rules.
Guarantee Issue Limit Amount	Enter the guarantee issue limit to be used as a threshold for requiring EOI for existing employees electing this benefit plan for the first time or after a break in coverage. If the coverage amount is less than or equal to the guarantee issue limit, EOI will not be required. If the coverage amount is greater than the guarantee issue limit, EOI will be required.
Greater than the employee's salary multiplied by a factor of:	Select this check box to require EOI when an existing employee elects the benefit plan for the first time or after a break in coverage and the coverage amount is greater than the product of the employee's annual salary multiplied by a factor. Note: Even if EOI is not required based on the Salary multiple, it may be required based on the other Existing Employee/New Benefit Plan EOI requirement rules.
Factor	The factor by which the employee's annual salary is multiplied to determine the amount which will trigger the need for EOI.

Existing Employee/Same Benefit Plan

The rules in this group box apply to existing employees that are currently covered by the benefit plan, but opt to change their coverage amount.

An employee is considered as "existing" if either of the following are true:

The start date of the new coverage is after the employee's new hire period. The new hire period is based on the employee's Current Hire Date from the Manage Employee Information screen and the Number of days that employees are classified as new employees value on the Configure Benefit Settings screen.
The employee does have a record in Employee Benefit Elections table where the end date is after or the same as the employee's Current Hire Date on the Manage Employee Information screen; and the coverage option code is not NO CVG.

Field	Description
Increased by any amount	Select this check box to require EOI for the employee, or spouse for spousal coverage, when an existing employee is already covered by the benefit plan, but increases the coverage amount. EOI will not be required if the employee re-elects the same benefit plan and coverage amount. If this check box is selected, the other options in the Existing Employee/Same Benefit Plan group box becomes cleared and disabled.
Increased by the following amount:	Select this check box to require EOI when an existing employee elects the same benefit plan and the coverage amount increase is greater than the increase limit you specify. For example, you have the following setup: You specify an increase amount threshold of 10,000. The employee currently has Supplemental Life Insurance coverage of $200,000. The employee elects a coverage amount of $215,000 during open enrollment. In this scenario, the EOI would be required because the increase in coverage (15,000) exceeds the 10,000 threshold. Note: Even if EOI is not required based on the coverage increase limit, it may be required based on the other Existing Employee/Same Benefit Plan EOI requirement rules.
Increased by Amount	Enter the coverage amount increment that will require the need for EOI. EOI will be required if an existing employee elects to increase the coverage amount and the increase amount is greater than the amount you specify.
Over the guarantee issue limit of:	Select this check box to require EOI when an existing employee elects the same benefit plan and the coverage amount is greater than the guarantee issue limit. Note: Even if EOI is not required based on the guarantee issue limit, it may be required based on the other Existing Employee/Same Benefit Plan EOI requirement rules. When you select this check box, the employee requires an EOI if the employee currently has this coverage and the coverage amount is over the specified limit.
Guarantee Issue Limit Amount	Enter the guarantee issue limit to be used as a threshold for requiring EOI for existing employees that re-elect this benefit plan and increase the coverage to an amount that is over the guarantee issue limit. If new coverage amount is less than or equal to the guarantee issue limit, EOI will not be required. If the coverage amount is greater than the guarantee issue limit, EOI will be required.
Greater than the employee's salary multiplied by a factor of:	Select this check box to require EOI when an existing employee elects the same Benefit Plan, but increases the coverage to an amount that is greater than the product of the employee's annual salary multiplied by a factor. Note: Even if EOI is not required based on the Salary multiple, it may be required based on the other Existing Employee/Same Benefit Plan EOI requirement rules.
Factor	The factor by which the employee's salary is multiplied to determine the amount which will trigger the need for EOI.

Substitution Rules

Select the substitution rule you would like to apply if the employee elects a new or same benefit plan with a coverage amount requires EOI but the EOI is still pending or was denied. If EOI status is Required, Denied Or Approved, substitute coverage as follows .

Field	Description
New Benefit Plan	Select the substitution rule if you elected a new benefit plan. The options are: Highest coverage amount without requiring EOI: Select this option to assign an employee the highest coverage amount which does not require EOI when you run the Activate Pending Benefit Elections or Process Employee EOI Benefit Elections application. Any existing coverage for that period will be deleted/ended. No coverage: If you select this option and a coverage option of NO CVG exists for the Benefit Plan, the application assigns a NO CVG coverage option to the employee. Otherwise, if NO CVG coverage option does not exist for the benefit plan, the employee will have no election row generated in Manage Employee Benefit Elections for the coverage period. Any existing coverage for that period will be deleted/ended.
Same Benefit Plan	Select the substitution rule for if you elected the same benefit plans. The options are: Highest coverage amount without requiring EOI: Select this option to assign an employee the highest coverage amount which does not require EOI when you run the Activate Pending Benefit Elections or Process Employee EOI Benefit Elections application. Any existing coverage for that period will be deleted/ended. Extend the current coverage option: Select this option to extend the employee's existing coverage option to the end of the coverage period. No coverage: If you select this option and a coverage option of NO CVG exists for the Benefit Plan, the application assigns a NO CVG coverage option to the employee. Otherwise, if NO CVG does not exist for the benefit plan, the employee will have no election row generated in Manage Employee Benefit Elections for the coverage period. Any existing coverage for that period will be deleted/ended.

Field

Description

New Benefit Plan

Select the substitution rule if you elected a new benefit plan. The options are:

Highest coverage amount without requiring EOI: Select this option to assign an employee the highest coverage amount which does not require EOI when you run the Activate Pending Benefit Elections or Process Employee EOI Benefit Elections application. Any existing coverage for that period will be deleted/ended.
No coverage: If you select this option and a coverage option of NO CVG exists for the Benefit Plan, the application assigns a NO CVG coverage option to the employee. Otherwise, if NO CVG coverage option does not exist for the benefit plan, the employee will have no election row generated in Manage Employee Benefit Elections for the coverage period. Any existing coverage for that period will be deleted/ended.

Same Benefit Plan

Select the substitution rule for if you elected the same benefit plans. The options are:

Highest coverage amount without requiring EOI: Select this option to assign an employee the highest coverage amount which does not require EOI when you run the Activate Pending Benefit Elections or Process Employee EOI Benefit Elections application. Any existing coverage for that period will be deleted/ended.
Extend the current coverage option: Select this option to extend the employee's existing coverage option to the end of the coverage period.
No coverage: If you select this option and a coverage option of NO CVG exists for the Benefit Plan, the application assigns a NO CVG coverage option to the employee. Otherwise, if NO CVG does not exist for the benefit plan, the employee will have no election row generated in Manage Employee Benefit Elections for the coverage period. Any existing coverage for that period will be deleted/ended.

EOI Form URL/Location

Enter the URL or network file location for the EOI form that the user must fill out. This field is only available if the Evidence of Insurability Required check box is selected in the Enrollment/Coverage Rules tab of this screen.

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