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The Eligibility tab determines who is eligible for the plan and when. More than one Eligibility can be set up per plan to simplify the set up process and limit the number of plans needed. Example: Both Corporate and Retail employees are eligible for a PPO plan but Corporate employees' contributions are slightly different than Retail employees. One plan can be built with two eligibilities.
The "General" Eligibility will automatically be included when a plan is added. Actions > Add Eligibility adds an additional eligibility option to the plan. Eligibility options would be used when the same plan may be offered to different groups of employees, but the waiting period, rates, contributions or policy/subgroup numbers differ for each group of employees. The advantage for setting up multiple eligibilities within the same plan is to allow for easy plan management and maintenance.
In order to enter eligibility rules, enter the details and then click Add Eligibility. Name the new Eligibility option and choose an existing Eligibility option to copy any eligibility rules already entered. The default existing option is General. The General Eligibility can be renamed after creating the new Eligibility. Select any combination of Locations, Divisions Departments, or Job Classes for each eligibility. The system will display the appropriate waiting periods, rates, and contributions to employees assigned to these specified company groups.
A Policy Number and Subgroup Number entered here is added to carrier forms. Different Policy Numbers and Subgroup Numbers can be assigned per Eligibility in cases where the same plan uses different numbers for different groups of employees for billing purposes.
The Waiting Period Amount and Type can be entered for each plan. The default option is first of the month following date of hire. For example, if there are a certain number of days that employees must wait after their date of hire, enter the number the Waiting Period Amount and choose Days in Waiting Period Type.
Tax Determination options are Pre-Tax and Post-Tax. If the employee contribution for domestic partners should be Post-Tax, select that in the Domestic Partner Tax Determination field.
Entry Date is used to determine when after the waiting period the plan becomes effective. For example, if the plan is effective the first of the month following 60 days, select First of the Month in Advanced Settings along with 60 and Days in Details > Waiting Period Amount and Type.
Termination Date is used to determine when benefits will end after a termination.
Age Determination allows the system to calculate rates based on the carriers' rules. More information can be found here.
Require Enrollment For is used when an employee does not have the option of waiving a plan like a company-paid benefit. This can be set to None, Employee Only, or Employee & Dependents.
Remaining pay periods can be applied to a plan year per plan type by checking the Use Remaining Deduction Periods? option. The system looks at the Pay Schedules listed in Company > General > Pay Schedules to calculate premiums deductions. This is typically used for plans that request an annual election during enrollment like FSA plans. The annual amount will then be divided by any remaining pay periods.
Provider Network is used to communicate the name of the provider network for a specific plan.
Choose which Locations, Divisions, Departments, and Job Classes are eligible for the plan. If all employees within an organization type (Location, Division, Department and Job Class) are eligible for the plan, the best practice is to leave the field blank. If nothing is selected in each option, all employees will be eligible. For example, if there are two Locations, San Diego and San Francisco, and both Locations are eligible for the plan, leave the Locations field blank so all employees will be eligible for the plan.
If enrollment in a plan is contingent on being enrolled, not enrolled or bundled with another plan, these options can be selected for the Contingency Type and Contingency Plans. Please note the following rules on Contingency Types:
- Enrolled - the employee must be enrolled in the contingency plan in order to have access to the benefit
- Enrolled Bundled - the employee must be enrolled in the contingency plan and will be enrolled at the same tier. For example, if enrolled Employee-Spouse for Medical and it is bundled with dental, the spouse will be enrolled in dental as well.
- Enrolled Bundled (COBRA) - the employee must be enrolled in the contingency plan and will be enrolled at the same tier for both Active and COBRA enrollments.
- Not Enrolled - the employee must not be enrolled in the contingency plan in order to have access to the benefit. For example, an employee must not be enrolled in an HSA in order to enroll in an Health FSA.
The Ineligible Employees option will only be used if an employee is not eligible for the particular plan, when they would otherwise be eligible based on their Scheduled Hours, Locations, Divisions, etc. This option will rarely to be used.
If Min or Max Scheduled Hours Per Week are entered, the plan will only be offered to employees who have appropriate Scheduled Hours entered in their profile.
Be sure to select all Eligible Dependents.
Minimum or maximum ages can be entered under Age Eligibility for employees, spouses/domestic partners, and children. Employees and dependents will be eligible for coverage in EaseCentral through the age listed here. Example, if a child is eligible to be enrolled until age 26, age 25 should be entered in this field. Common examples of when age rules by plan may be used are a 401(k) plan having a minimum age requirement of 18 or a life plan allowing spouses to be covered until age 70. Ages with zero (0) are ignored.
Enrollment Instructions can be added for a plan or a specific plan Eligibility. The instructions display in the Plan Information section during enrollment.