Benefit Rule Management

 

 

Clicking on the Benefit Rule Management icon displays the Benefit Rule Management page.  

For an authorized user, this function provides for the creation of a Benefit Rule and its assignment to a specific Benefit Group and Plan. The association between Rule, Group and Plan ensures that employees are only offered plans that they are eligible for.

 

After Division Selection, the system displays a list of current rules for reference purposes.  You may view, edit or delete a rule, and create new rules.  

 

Add New Rule

Click to display the Plan Group Selection page.

 

First, select the Plan to associate with the Rule.

Note

You can associate a rule with only one plan, and associate a plan with only one rule.  Therefore, the system displays only plans without a rule assigned.

 

Enter a Rule Name for the new rule.

 

Select the group(s) to associate with the new rule and click to move your selection(s) to the right side of the page.

Click to further refine the rule you created.

 

Time Period

Indicate whether or not there is a waiting period.

 

If Yes, specify how long.

 

Select from the drop-down "when" the employee is eligible for the plan.

 

Click to further refine the rule you created.

 

 

Age

Indicate whether or not:

  • Age affects the premium.

  • An Age Reduction Schedule is applicable

 

(An Age Reduction Schedule reduces premiums as an employee's age changes.)

 

If Age does affect the premium, specify:

• On whose age the premium is based.

 

 

• How changes in age affect rates.

 

 

If an Age Reduction Schedule (future release– not yet implemented) is applicable, specify:

• The age at which it begins.

• The reduced premium as a percentage of the original cost.

After entering the data, click .  In the example,  the premium is 95% of the original upon reaching the age of 80.

Click to further refine the rule you created.

Note

You have an opportunity to further refine age criteria, such as different rates for different age ranges, using the Generate Rate Scenarios function in Benefit Billing Rates.

 

Good Health

Indicate whether or not:

  • The plan offers preferred rates to employees without pre-existing medical conditions, such as obesity and high blood pressure.

 

  • The plan charges higher rates for terminated employees eligible for COBRA (future release– not yet implemented).

  • The plan charges different rates for employees that smoke.

Click to further refine the rule you created.

 

Dependents

Indicate whether or not dependents are eligible for the plan.

(future release– not yet implemented)

 

If Yes, select the Dependent Type(s) to associate with the new rule and click to move your selection(s) to the right side of the page.

 

Also indicate if overage children are covered by the plan and the maximum ages.

 

Click to further refine the rule you created.

 

Other

Indicate whether or not EE and ER contributions vary based on other factors.

 

 

 

Note

If there is a Plan Basis, it can be salary or volume, but not both.

 

Volume Based

If the Plan Basis is Volume Based and the Volume Basis Benefit is Flat:

 

    • Enter the dollar amount.

    • Select the frequency

    • Enter the maximum dollar amount (if any).

 

 

If the Plan Basis is Volume Based and the Volume Basis Benefit is Percentage:

    • Enter the percentage.

    • Select the frequency

    • Enter the maximum dollar amount (if any).

If the Plan Basis is Volume Based and the Volume Basis Benefit is  Rate Per Coverage Amount:

    • Enter the dollar amount for Maximum Coverage.

    • Enter the employee's (EE) default dollar contribution per amount of coverage.

    • Enter the employer's (ER) default dollar contribution per amount of coverage.

 

Salary Multiple

If the Plan Basis is Salary Multiple:

    • Enter the percentage of the employee's Salary

 

    • Select the frequency

    • Enter the maximum dollar amount (if any).

    • Select your dollar rounding options.

 

 

Click to further refine the rule you created.

 

 

 

Note

You have an opportunity to further refine salary criteria, such as different rates for different salary ranges, using the Generate Rate Scenarios function in Benefit Billing Rates.

 

Open Enrollment

Open Enrollment is generally considered the period when employees can make/change benefit choices for the coming benefit year.

 

Employees enrolled in a Plan that supports Open Enrollment can make changes if the Rule is set to  .

 

When they can make those changes is determined by the administrator’s selection in the drop-down.

Click to review your selections for the Rule.

Click to store your new Rule.

 

 

Edit Rule

To edit an existing Rule, click in the rule row to cycle through the criteria described above and make your changes. Click to undo any changes.

 

Delete Rule

To delete a Rule, click in the rule row. The system will request confirmation.