Coverage Detail Subtask

Use the Coverage Detail subtask to enter additional information about this benefit plan.

Because this subtask is primarily a continuation of the Manage Benefit Plans screen, you must enter coverage detail information before you can establish benefit packages or benefit package defaults. Entering information on this screen is part of the first step in setting up any new benefit package.

Calculation Rules

Use this group box to define how an employee's age is calculated when the Premium Rates by Age and Coverage Amounts by Age tables (set up in the Premium and Coverage Tables menu) are used during the Compute Payroll process.

Field	Description
Age Calculation Method	Use this drop-down list to define which date should be used to determine an employee's age. Options are: Start of Year: Select this option to use the employee's age at the beginning of the calendar year when computing payroll. This is the system default. End of Year: Select this option to use the employee's age at the end of the year when computing payroll. Start of Pay Period: Select this option to use the employee's age at the beginning of the pay period when computing payroll. The pay period date is determined on the Manage Pay Periods screen. End of Pay Period: Select this option to use the employee's age at the end of the pay period when computing payroll. The pay period end date is determined on the Manage Pay Periods screen. Policy Date: Select this option to use employee's age at the provider's policy start date when computing payroll. The provider's policy start date is determined on the Manage Benefit Providers screen. System Date: Select this option to use employee's age as of the system (current) date when computing payroll. Coverage Start Date: Select this option to use the employee's age at the coverage start date when computing payroll. Hire Date: Select this option to use the employee's age at his or her hiring date year when computing payroll.
Rounding Criteria	Use this drop-down list to control how coverage amounts are rounded. 1: Select this option to round coverage amounts up to the next whole dollar. This is the system default. 10: Select this option to round coverage amounts up to the next $10. 100: Select this option to round coverage amounts up to the next $100. 500: Select this option to round coverage amounts up to the next $500. 1,000: Select this option to round coverage amounts up to the next $1,000. 10,000: Select this option to round coverage amounts up to the next $10,000.
Salary Calculation Method	Use this drop-down list to control how an employee's salary is calculated when the Coverage Amounts by Salary table or the Premium Amounts by Salary table are used during the Compute Payroll process. End of Prior Year: Select this option if you want the rate calculated on the employee's salary at the end of the prior year. The system determines the prior year by subtracting one year from the pay period end date in the Manage Pay Periods screen. This is the system default. Start of Pay Period: Select this option to use the employee's salary at the beginning of the pay period. The start date of the pay period is determined on the Manage Pay Periods screen. End of Pay Period: Select this option to use the employee's salary at the end of the pay period. The end date of the pay period is determined on the Manage Pay Periods screen. System Date: Select this option to use the employee's salary as of the system (current) date.
Coverage Type	Use this drop-down list to define the benefit plan type. This designation is for information only. Point of Service: Select this option if the employee can choose from a network of doctors and hospitals. HMO: Select this option if the employee is required to choose a primary care physician and facility. Indemnity Plan: Select this option if this benefit plan partially reimburses employees for their medical expenses. Other: Select this option if none of the above are applicable (as for a Life Insurance benefit plan). This is the system default.

Age Based On

This group box displays only if you are using Employee Self Service 3.0.

Field	Description
Employee	Select this option to base the age calculation on the employee's age.
Spouse	Select this option to base the age calculation on the age of the spouse.

Copayments/Deductibles

Use this table to enter any copayments, deductibles, or out-of-pocket amounts that are required for this benefit plan. These fields are for information only, and this table is optional.

Field	Description
Type	Enter up to 15 alphanumeric characters to uniquely identify the type of copayment or deductible. For example, you might specify a copayment for an expense that is In the Network or one that is Out of Network.
Office Visit Copay	Enter the copay amount this benefit plan requires for an office visit.
Specialist Visit Copay	Enter the copay amount this benefit plan requires for a specialist visit.
Preventive Care Copay	Enter the copay amount this benefit plan requires for a preventive care visit.
Brand Prescriptions	Enter the copay amount this benefit plan requires for a brand prescription.
Generic Prescriptions	Enter the copay amount this benefit plan requires for a generic prescription.
Individual Deductible	Enter the annual deductible amount this benefit plan requires for an individual. You can enter an amount as large as $9,999,999,999.00.
Family Deductible	Enter the annual deductible amount this benefit plan requires for a family.
Employee Pmnt After Deductible	Enter for the percentage (not to exceed 100.00%) the employee must pay for medical expenses incurred after the annual deductible has been met.
Indiv Max Out of Pocket	Enter the maximum annual amount this benefit plan requires an individual to pay "out-of-pocket."
Family Max Out of Pocket	Enter the maximum annual amount this benefit plan requires a family to pay "out-of-pocket."
Comments	Enter any additional comments about this benefit plan.