Enrollment/Coverage Rules Tab
Use the Enrollment/Coverage Rules tab to define additional rules for this benefit plan.
Enrollment Rules
Use this group box to define the open enrollment period and which events allow for different times of enrollment. This group box is for information only.
| Field | Description |
|---|---|
| Any Time |
Select this checkbox if there is no time restriction on enrollment for this benefit plan. If you select this checkbox, the remaining checkboxes and fields in this group box are disabled. |
| On Hire |
Select this checkbox if an employee should be enrolled in this plan upon being hired. Your entry in the Grace Period Days field defines the grace period for enrolling after the hire date. |
| On Qualifying Life Event |
Select this checkbox if the enrollment can be changed because of a qualifying life event. |
| Open Enrollment Period |
Select this checkbox to if you want to define a period during which employees may enroll for this benefit. If you selected this checkbox, both the Open Enroll Date and Grace Period Days fields are active and required. Note: You must select either the
Any Time checkbox or one of the
On Hire,
On Qualifying Life Event, and/or
Open Enrollment Period checkboxes.
|
| Open Enroll Date |
Enter the date, in MM/DD format, on which open enrollment in this benefit plan begins. This field is required only if you selected the Open Enrollment Period checkbox. |
| Grace Period Days |
If you selected the Open Enrollment Period checkbox, you must enter the number of days an employee has beyond the open enrollment date to enroll in this benefit plan. If you selected the On Hire checkbox, you must enter the number of days an employee has to enroll. |
Coverage Rules
| Field | Description |
|---|---|
| Core Benefit |
Select this checkbox if this benefit is automatically granted to an employee, unless specifically waived. |
| Eligible for COBRA |
Select this checkbox to indicate that this benefit needs to be offered as a part of COBRA continuation. This is for information only. |
| Dependents Eligible |
Select this checkbox if dependents can be covered under this plan. If you do not select this checkbox, you cannot assign employee dependents to this benefit plan. |
| Dependent Spouse or Child |
Select this checkbox if only the spouse or child of the employee are the only dependents eligible for this plan. This will be used when assigning dependents to plans. |
| Beneficiaries Required |
Select this checkbox if you selected Beneficiaries Required on the Manage System Benefit Types for this system benefit type and you require beneficiaries to be assigned to the plan. This checkbox is for information only. |
| Disability Exclusion |
Select this checkbox if disabled persons are excluded from this benefit plan. This checkbox is for information only. |
| Require HR Approval in ESS |
Select this checkbox if the plan requires approval before it is effective. |
| Require PCP Name and Number |
Note: This checkbox displays only if you are using Employee Self Service 3.0.
If you select this checkbox, employees will be required to specify the Primary Care Physician (PCP) name and number when the benefit plan is elected in Employee Self Service or when the benefit plan is assigned to the employee in Costpoint. |
| Evidence of Insurability Required |
Select this checkbox if Evidence of Insurability is needed for the benefit plan. If you select this checkbox, use the EOI Rules tab to specify the following:
If you select this checkbox for a benefit plan, you will not be able to assign the plan to an employee in the Manage Employee Benefit Elections table. Instead, you will have to enter a record into the Manage Employee Evidence of Insurability (EOI) screen which determines if the employee’s calculated coverage amount requires evidence of insurability (EOI) and, if so, you will be able to approve or deny the coverage amount. Note: If this checkbox is selected but the coverage option is
NO CVG (no coverage), it should be assigned to the employee on the Manage Employee Benefit Elections screen.
NO CVG coverage option cannot be assigned in Manage Employee Evidence of Insurability (EOI) screen.
In cases of denial or pending coverage, the Substitution Rules you specify on the EOI Rules tab of the Manage Benefit Plans screen will be used to determine the coverage amount, if any, for which the employee is eligible. This checkbox is only available if the System Benefit Type is one of the following:
|