Create Benefit Package: Step 2 - Plan Configuration: Step 2.1 - Plan Properties

The Plan Properties allows you to enter the basic information and setup of your plan.

Basic Information

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  • Name - The name of the plan.
  • Policy/Group # - Used for EDI or the electronic data interface module built into the system.
  • Carriers - A carrier should be selected on this step for EDI and reporting purposes. For more information about setting up a carrier, you can refer to the following article.
  • Plan Code - An optional field to store the value/code for the plan that may be used to map the plan to another system. This is most often used to store a Payroll Code that corresponds to this plan for purposes of exporting the Plan Code along with a Deduction Amount to a payroll system.
  • Minimum Premium - An optional field to store a value representing the Annual Minimum Premium that should be charged to an employee. This field is only enabled for Spending Credit Benefit Types. When the Minimum Premium field is used, the value of the Spending Credit will be dynamically adjusted to equal the sum of any spending credit eligible benefits, if the total employee cost of spending credit eligible benefits is less than the Minimum Premium value.

Eligibility Rules

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Select an eligibility rule for your plan.

If eligibility rules are used and your employees pass the eligibility rules at the benefit level, you will need to create another plan with an eligibility rule for employees that do not pass your first eligibility rule.

If employees pass the benefit level eligibility rule but not a plan level rule, their events will error and no coverage options will be visible to the employee. Moving on within the event will not be allowed in this scenario.

For more information about eligibility rules, you can refer to the following article.

Coverage / Rate Template

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The structure of the plan options is determined from your selection here. 

Expand for Available Coverage/Rate Templates
Custom Coverage Levels
Often used for benefits that are completely original in nature and have few coverage options. The system gives you a blank coverage option that can be renamed and configured to your specifications as far as dependent eligibility and coverage codes along with setting this custom option as the default option for the plan.
Composite - EE, EE + Spouse, EE + Child, Family, Waive
Traditional option for Medical, Dental, & Vision benefits with only one plan option for employees where waive is a coverage option within the plan and not its own Waive Plan. Coverages can be edited on step 2 for spelling if needed. If selected employee will have the option of Employee Only, Employee + Spouse, Employee + Children, Employee + Family and Waive within plan.
Composite - EE, EE + 1, Family, Waive
Traditional option for Medical, Dental, & Vision benefits with only one plan option for employees where waive is a coverage option within the plan and not its own Waive Plan. Coverages can be edited on step 2 for spelling if needed. If selected employee will have the option of Employee Only, Employee + 1, Employee + Family and Waive within plan.
Composite - EE, EE + Spouse, EE + Child, Family
Traditional option for Medical, Dental, & Vision benefits with multiple plan options for employees where Waive is its own Plan. Coverages can be edited on step 2 for spelling if needed. If selected employee will have the option of Employee Only, Employee + Spouse, Employee + Children and Employee + Family. A waive plan is then needing to be created under the benefit with that plan having the default option within it.
Composite - EE, EE + 1, Family
Traditional option for Medical, Dental, & Vision benefits with multiple plan options for employees where Waive is its own Plan. Coverages can be edited on step 2 for spelling if needed. If selected employee will have the option of Employee Only, Employee + 1 and Employee + Family. A waive plan is then needing to be created under the benefit with that plan having the default option within it.
Composite - Premium and Credit per X dollars of benefit amount
Common for Basic Life, Basic AD&D, STD and LTD benefits with premiums that are based on benefit divisors like $1000, $100 or $10 dollar amounts. You are able to enter premiums, employer contributions and benefit amount divisors with this option.
Age Banded - Premium and Credit per X dollars of benefit amount
Common for age banded Basic Life, Basic AD&D, STD, LTD and Supplemental Life benefits with premiums that are based on benefit divisors like $1000, $100 or $10 dollar amounts. You are able to enter premiums, employer contributions and benefit amount divisors with this option per age band.
Age Banded - Premium and Credit per age band
Common for age banded Basic Life, Basic AD&D, STD, LTD and Supplemental Life benefits with set coverage amounts not using benefit divisors. You are able to enter premiums and employer contributions per age band .
Age Banded With Dependents - Premium and credit per age band
Should be used only for Medical Age Banded plans. Should not be used for any other type of plan or benefit.
FSA - No Premium or credit
Common for FSA and HSA benefits where employees are able to elect their own contribution. No premiums or employer contributions are used for this option.
FSA - With Premium and or credit
Common for FSA and HSA benefits where employees are able to elect their own contribution. Premiums and employer contributions are used for this option.
Pet Care
Used for pet insurance benefits where the number of pets determine the coverage options that the employee pays for on a per pay basis.
Waive
Commonly used for Waive plans where employees have multiple plans to choose from but need one default waive option to waive all benefit plans instead of waiving each plan separately. Premiums must be entered at zero for this option to be seen by employees and eligibility rules are usually set to all employees eligible if they pass the benefit eligibility rule. When employees get to choose between multiple medical benefits like PPO or HMO then a Waive plan and coverage template are used for employees to default into or choose if they do not want to participate in the benefit.
Spending Credit
Used for spending Credit benefit plans with benefit type being listed as spending credit.
Clear Coverage Premium
Only used when incorrect coverage template was saved and then changed. This will clear out the premiums of the wrongly entered coverage/rate template.

Configure the Tax Rules for this Benefit

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If selected, the benefit plan being created will be deducted on a pre-tax basis or all employees who make election into plan. When left unselected, the plan would be deducted on a post-tax basis. Pre-tax dollar limit can be set and remaining balance would then become a post-tax deduction.

Domestic Partner Portion of Employee Cost Will Be Deducted on a Post-Tax Basis

When selected, the cost for employee + Spouse coverage would be placed into the post tax category if employee was covering a domestic partner. Must also have a relationship created within the HRIS system that is selected as domestic partner.

Relationships

Relationships can be found from the menu under Setup > Setup Properties > Field Value Setup > Relationships. For more information about setting up relationships, you can refer to the following article.

The category must be as shown but the relationship name can be whatever you feel necessary.

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Additional Options

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This Plan Should Be Read Only Regardless of Event Settings

Selected when administrators do not want employees to be able to change or alter elections provided for them. Employee would not be able to make an actual election for plan if this was selected.

Automatically Generate Premium Report/Roster Each Month on the Following Day

Typically selected for all plans but specifically for benefits and plans within them that are self-billed. Administrator is specifying a day in which roster/reposts are run for plan. Also see Reports > Benefit Management > Billing / Reconciliation. For more information about billing/reconciliation report, you can refer to the following article.

If This Plan Requires the Assignment of a Primary Provider Then Configure the Appropriate Requirements Below

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Primary Care Providers (PCP) are often requested from carriers that provide clients with HMO plans for medical, dental and vision coverage.

If a PCP is needed for the employee to select and provide when making elections, an entry requirement is needing to be selected here from the dropdown menu. These can be made optional or required for employees and dependents.

If 'Entry Requirement' has been selected, then a valid entry type may also want to be used to assist employees in selection.

Provider listing can be used to link employees to a document that has been uploaded into the system or to a carrier website to assist in finding PCP ID for In network providers.

Enter any Age Restrictions for Dependents

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Only used for benefit plans that offer dependent coverage where age requirements must be met.

Medical, dental, and vision benefits often have these set to 25 in all three boxes so that dependents that are 26 will fall off coverage and no longer be able to be covered by the employee.

A spouse can be considered overage for plans under spouse supplemental life or other benefits that carriers deem overage for a spouse to be covered. Employees can be considered overage at 80 or any other age the carrier will not offer coverage because the age band is not offered.

Utility: Use the Field Below to Place This Plan Under the Selected Benefit

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This utility used to move plans that were incorrectly built under the wrong benefit. It is preferred that benefit plans are deleted and rebuilt under the correct benefit but this is an option for admins that have incorrectly built plans and then need to move them to an alternate benefit.

The plan is not copied and will not be under both benefits if used. The plan will move to the designated benefit and no longer remain in benefit it originally came from.

The drop-down menu will always default to the first benefit in the benefit structure. This does not mean that plan is currently under that benefit since it will be located under the benefit it has been created within.


Age Banded Medical Plan

To configure an Age Banded Medical Plan, you will need to use the following coverage rate template:

  • Age Banded With Dependents - Premium and credit per age band: Should be used only for Medical Age Banded plans. Should not be used for any other type of plan or benefit.

When using the Coverage Rate Template, the Plan Premium tab will be updated to include three tabs: Employee, Spouse, Non-Spouse Dependent. These are considered the Age Band Type.

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 Next Article

The next article is Step 2.2 - Coverage Levels

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