Coverage Option Details Subtask

If different benefit plans offer different types of coverage, the Coverage Option Details subtask allows you to specify if the benefit plan/coverage option provides minimum essential coverage and/or minimum value at the date range/benefit plan/coverage option level.

Contents

Field	Description
Start Date	After selecting the button on the toolbar, enter the date, in MM/DD/YYYY format, on which this coverage option begins. This is a required field.
End Date	Enter the date, in MM/DD/YYYY format, on which this coverage option ends. This is a required field.
Coverage Option	Enter, or click to select, the code for this coverage option. This code is validated against the Coverage Options table. If you want to assign a cash out value to a benefit plan, you must enter only one line in this table with a Coverage Option of NO CVG.  The only time the Cash Out Amount column is enabled is when you enter a Coverage Option of NO CVG. This field is required.
Coverage Option Description	This non-editable field displays the name or description of the coverage option you entered. If you entered NO CVG in the Coverage Option field, the description No Coverage displays.
Deduction	Enter, or click to select, the deduction code that applies to this coverage option. This code is validated against the Deductions table in Costpoint Payroll. An employee electing this coverage option will be assigned this deduction code. You cannot use a code more than once in this table and it must be flagged as a deduction in the Deductions table. It cannot be a benefit package, and the deduction type must correspond to the system benefit type: System Benefit Type Deduction Type Health Health Care Benefit Dental Dental Care Benefit Life Life Insurance Benefit Vision Vision Care Benefit Disability Disability Plan Benefit This field is required unless you entered NO CVG in the Coverage Option column.
Deduction Description	This non-editable field displays the description or name of the deduction code you entered.
Provides Minimum Essential Coverage	Select this check box if the Benefit Plan/Coverage Option combination offers minimum essential coverage to the employee and, where applicable, his/her spouse and dependents. This value will be used in the Affordable Care Act reporting of form 1095-c.  Please see U.S. government regulations for a definition of “minimum essential coverage”.
Provides Minimum Value	Select this check box if the Benefit Plan/Coverage Option combination provides the minimum value to the employee and, where applicable, his/her spouse and dependents. This value will be used in the Affordable Care Act reporting of form 1095-C. Please see U.S. government regulations for a definition of “minimum value”.
Dependent(s) Eligible and Required	Select this check box if a dependent or dependents are eligible and required for the Benefit Plan/Coverage Option combination. If you select this check box, the Dependent Type drop-down list will be enabled and set to All. You will have the ability to update the Dependent Type. Use the Dependent Type combo-box to select the type of dependent or dependents that are eligible and required for the coverage. If selected, you will be reminded to assign a dependent to the benefit plan when you link the employee to the Benefit Plan and Coverage Option in Costpoint. ESS users must select the appropriate dependent or dependents when electing the coverage.
Dependents Type	If you entered a Y (Yes) in the Dep Req field, you must select a dependent eligibility code. This field does not display unless you are licensed for ESS 7.15 or greater. Selected dependents must have the same benefit plan as the employee. Valid options are: Any: Select this option for anything else. Costpoint checks to make sure that one or more dependents of any type have been selected. Children: Select this option for any qualified children or step-children. Family: Select this option for a spouse and at least one child or step-child. Group: Select this option for two or more of any type of dependent. One: Select this for one dependent of any type. Spouse: Select this option for a spouse. If you select Any, One, Family, or Spouse in this field, the Spousal Conditional Offer drop-down list will be enabled. Use that drop-down to indicate whether or not the coverage that is offered to spouses is subject to one of more reasonable, objective conditions If you change the eligibility code for an existing record, you may be required to change the dependents for that coverage option in ESS and the Assign Dependents to Benefit Plans screen.
Spousal Conditional Offer	This drop-down list is only available if spousal coverage is offered (Dependent Type is set to Any, One, Family, or Spouse). If the employee’s spouse (if any) is eligible for the coverage, use this drop-down list to indicate whether or not the spousal coverage is subject to one or more reasonable, objective conditions. For example, an offer to cover an employee’s spouse only if the spouse is not eligible for coverage under Medicare or a group health plan sponsored by another employer. Yes: Select this option if spousal coverage is subject to one or more reasonable, objective conditions. For example, an offer to cover an employee’s spouse only if the spouse is not eligible for coverage under Medicare or a group health plan sponsored by another employer. No: Select this option if spousal coverage is not subject to one or more reasonable, objective conditions Not Applicable: The field displays this option by default if coverage cannot be offered to a spouse (Dependent Type is not Any, One, Family, or Spouse). Code 1J will be reported for the appropriate months on the employee’s Affordable Care Act 1095-C if the following conditions are met: The Provides Minimum Essential Coverage and Provides Minimum Value check boxes are selected. The Spousal Conditional Offer drop-down list is set to Yes. The Dependent Type is Spouse or One (coverage includes spouse, but not children). The coverage is offered to the employee. Code 1K will be reported for the appropriate months on the employee’s Affordable Care Act 1095-C if the following conditions are met: The Provides Minimum Essential Coverage and Provides Minimum Value check boxes are selected. The Spousal Conditional Offer drop-down list is set to Yes. The Dependent Type is Any or Family (coverage includes spouse and children). The coverage is offered to an employee.
Coverage Factor/Amount	If you selected the Factor option in the Coverage Calculation Method group box, enter the factor by which an employee's salary must be multiplied for this coverage option. If you selected the Amount option in the Coverage Calculation Method group box, enter the amount of coverage for this option. You can enter an amount as large as $999,999,999,999.00. This is a required field if you selected either the Factor or the Amount option in the Coverage Calculation Method group box.
Coverage Table	Enter, or click to select, the code for the coverage table that applies to this coverage option. This field will be validated against the option you selected in the Coverage Table group box and the Coverage Amounts by Salary table or the Coverage Amounts by Age table, depending on your selection. This field is required only if the Coverage Table option is selected in the Coverage Calculation Method group box.
Rate Table	Enter, or click to select, the code for the rate table that applies to this coverage option. This field will be validated against both the option you selected in the Premium Calculation Method group box and the Premium Amount by Salary table or Premium Amount by Age table, depending on your selection. This field is required unless you selected the None option in the Premium Calculation Method group box.
Employee Amount	If you selected the Amount option in the Premium Calculation Method group box, enter the amount of the monthly premium for which the employee is responsible. This field is required only if you selected the Amount option in the Premium Calculation Method group box.
Company Amount	If you selected the Amount option in the Premium Calculation Method group box, enter the amount of the monthly premium for which the employee is responsible. This field is required only if you selected the Amount option in the Premium Calculation Method group box.
Premium	If rate tables are not being used, enter the monthly premium amount for this coverage option. This field is required if you selected either the Amount or Cost Per $1,000 option in the Premium Calculation Method group box. This amount will be treated as either a straight amount or a cost per $1,000, depending on your selection. You may enter an amount as large as $999,999,999,999.00.
Employee Percent	Enter the percentage, in XXX.XX format, of the premium the employee must pay. If you selected either the Cost Per $1000 or Rate Table option in the Premium Calculation Method group box, this field is required. Otherwise, this field is optional.
Company Percent	Enter the percentage, in XXX.XX format, of the premium the company will pay. If you selected either the Cost Per $1000 or Rate Table option in the Premium Calculation Method group box, this field is required. Otherwise, this field is optional.
Cash Out Amount	If a cash out option is available for this benefit, and you have entered NO CVG in the Coverage Option column, enter the cash amount for which this benefit may be traded.
Apply Override	Select this check box if the Employee Premium Amount specified in the Amounts/Tables group box is not the amount that is ultimately paid by the employee due to an offset done through Payroll. An example of this is the Health and Welfare fringe benefit requirement for the covered Service Contract Act (SCA) employees. If this check box is selected, you must enter the monthly premium amount ultimately paid by the employee in the Override Employee Amount data field.
Override Employee Amount	If the monthly Employee Amount is not the amount that is ultimately paid by the employee due to an offset done through Payroll, then enter the monthly premium amount ultimately paid by the employee. This is the amount that will be used for Affordable Care Act 1095-C reporting. It will only be used for 1095-C reporting and will not be used to deduct the premium from the employee.