FAQ for Benefit Management: Configure an Age Banded Medical Benefit with Employee/Spouse Coverage

Age banded medical benefits are becoming more common for healthcare providers to offer clients. Employee cost are determined from their age, spouses age and occasionally dependents age. The following information is provided to better educate administrators on proper configuration within the HRIS system for deductions to populate correctly for employees on benefit statements and within change events.

Benefit Type

Benefit Type should be Medical unless this type already exist in your benefit structure. We do not want to repeat benefit type if at all possible. If the benefit must be a already used type then make sure that one of these two benefits will never be needing to be excluded from a change event that the other was available in. If both benefits will always be in the same change event together or excluded together, then duplication of benefit type within the same package is allowed.

If the medical needs to look at the age of the employee and the age of the spouse, we will be building two benefits. Medical will be the first type and generally other (1) will be your second.

Step 1: Plan Properties

Your plan name should be the same as it was provided on the benefit structure or benefit plan summary. If you are doing age banded rates dependent of employee age and spouses age, you will need to duplicate plan name for the dependent plan on the dependent benefit. The purpose of this is to make the employee feel they are in the same benefit even though they will need to make two elections within the same medical benefit.

Coverage / Rate Template

Must select the following: Age Banded - Premium and credit per age band
This will allow the age bands to be placed in for every coverage option the employee sees.

Age Restrictions for Dependents

This will be the same as the plan summary dictates. Usually the age of 25 or 26 is entered depending when the dependent receives coverage until.

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Step 2: Coverage Levels

Within the plan you will need to build out the coverage levels for the employee to see. This could be Employee Only, Employee + Spouse, Employee + Children and Family Coverage. You may also need to add the number of dependents into the coverage options as seen below. If the cost changes for additional dependents like 2 vs. 3 children, your coverages would be build as seen below.

Coverage level rank and display order need to be noted here. Pay attention to both of these fields.

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Step 3: Premiums

Please place in your premiums and employer contributions next to the appropriate age bands. These will not be any different for coverages that include spouse. If spouse and dependent child or employee and dependent children are coverage options, dependent premiums need to be added to employee premiums. Nothing additional needs to be added for the spouse, only the coverage that include dependents.

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Duplicate Benefits

Duplicate the entire benefit and plan that has been built. After selecting the benefit as seen below, select duplicate selected records.

Edit the copied benefit and plan and place in or write over the desired name. You may need to alter the benefit type as well.

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Step 2: Benefit Properties

After changing the benefit type and benefit name by removing copy, please select to use the souse's age in age band calculations and save.

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Step 3: Benefit Dependencies

Select medical and the dependency sentence below.

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Step 3: Premiums

You must now place the spouses premiums in the system. Any coverage option that a spouse is not included in should be zero for premium and employer contribution. In most structures there will not be an additional employer contribution for the spouses coverage option.

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Benefit Processing

Employees must be processed for both benefits. The Benefits > Benefits screen should show the original benefit and the dependent medical where the spouse premiums and age bands are derived.

The system will alert you if the employee is in the incorrect benefit or plan from the dependency you have created.

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Benefit Structure

Your benefit structure will now have two identical benefits with different names and types. These should have the exact same number of employees processed for them.

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