Enrollment management is the process of registering your employees and other eligible participants in benefit plans and options. It includes recording contribution rates and coverage amounts and entering the dependents and beneficiaries of the primary participant into the system.
Enrollments commonly occur when a benefits specialist enters a participant's elections into the HR system. However, for Advanced Benefits users, enrollments can also include default enrollments for persons who do not specify elections during an enrollment period and automatic enrollments which are typically used to enter newly hired employees into interim coverage until they can make their own elections.
Because enrolling employees in benefits programs can be a labor intensive process for an organization with many employees, the product enables self-service enrollments using web enrollment forms and interactive voice response technology (IVR).
Enrollment eligibility and electable benefit choices are based on the eligibility profiles and enrollment requirements that you associate with a benefit.
You can override eligibility results if you are an Advanced Benefits customer. You can grant an exception so that an ineligible person can enroll in a plan or option for which they are otherwise ineligible. Conversely, you can waive a person's participation in a plan for which they have met the eligibility criteria.
The system is delivered with four enrollment forms:
Flex Enrollment (Advanced Benefits)
Non-Flex Enrollment
Savings Plan Enrollment
Miscellaneous Plan Enrollment
You use the Flex enrollment form to enroll participants in flexible benefits programs and vacation buy/sell programs.
You use the Non-Flex enrollment form if you are implementing a benefits program that does not use flex credits.
You use the Savings Plan form to enroll a participant in an investment plan.
You use the Miscellaneous Plan form to enroll participants in plans that are not part of a program.
You manage open enrollment and life event enrollment for a flex program or a flex plus core program using the Flex Enrollment form.
You use the form to enter an eligible person's elections, contribution rates, and coverage levels. As elections are entered, the system calculates the eligible person's spent and unspent flex credits.
From the Flex Enrollment window you can taskflow to windows that enable you to:
View the flex credits an eligible person can spend
Distribute excess flex credits, as allowed by your flex program definition
Record receipt of certifications required for enrollment in the program
Record completed enrollment action items
Enter plan dependents and beneficiaries
Record a participant's primary care provider
You use the Non-Flex Enrollment form to enroll participants in plans and options that are not funded by flex credits. This is the enrollment form you use if you have not purchased the Advanced Benefits product license, or if you are an Advanced Benefits customer who maintains benefit programs that are not funded by flex credits.
You use the form to enter an eligible person's elections, contribution rates, and coverage levels. From the Non-Flex Enrollment window you can taskflow to windows that enable you to:
Record completed enrollment action items (Advanced Benefits)
Record receipt of certifications required for enrollment in the program (Advanced Benefits)
Enter plan dependents and beneficiaries
Record a participant's primary care provider
You use the Savings Plan Enrollment form to record a person's contribution rate and their investment option elections for a savings plan.
From the Savings Plan Enrollment form you can taskflow to windows that enable you to:
Record completed action items (Advanced Benefits)
Record receipt of certifications required for enrollment in the program (Advanced Benefits)
Enter plan dependents and beneficiaries
Attention: The product does not accommodate 401(k) balance transfers from other benefits systems for employees who are rolling over 401(k) balances from a previous employer.
You use the Miscellaneous Plan Enrollment form to enroll a participant in a plan that is not part of a program and is not a savings plan. Miscellaneous plans do not provide flex credits to participants.
You use the form to enter an eligible person's elections, contribution rates, and coverage levels. From the Miscellaneous Enrollment form you can taskflow to windows that enable you to:
Record completed action items (Advanced Benefits)
Record receipt of certifications required for enrollment in the program (Advanced Benefits)
Enter plan dependents and beneficiaries
Record a participant's primary care provider
Note: The special plan rates feature is reserved for future use.
Special contribution rates are sometimes offered by a benefits carrier for the joint election of two plans. When a participant elects a plan that is defined as part of a special rate pair, they receive a discounted rate on the second plan.
You use the Special Rates form to view any special rates offered for the plans in a Flex program, Non-Flex program, or for a miscellaneous (not in program) plan.
As part of enrolling a participant in a benefit, you can view the action items that must be completed before the enrollment is valid.
From the Person Enrollment Action Items form, you can navigate to the following forms to enter changes to the record of a participant, dependent, or beneficiary in order to complete the action item.
Person Enrollment Certification
Dependent/Beneficiary Designation
People
You define required action items as part of your plan design.
If you process a subsequent life event for a participant with an open action item, how the application processes the suspended election and any interim coverage for the participant depends on a variety of factors. The scenarios below outline how the application processes action items under different conditions.
Scenario 1: If you process a subsequent life event with an occurred on date that is before the action item due date of the original event, the application retains the action item, certification, interim coverage, and suspended enrollment for the original election. If the subsequent life event occurred on date is after the action item due date, you close the action item by running the Close Unresolved Action Item Process. The application assigns the interim election to the employee as the actual election and deletes the suspended election.
Scenario 2: If you process a subsequent life event before the action item due date, the application creates a new action item. Suspended elections and interim coverage carry forward, and you can complete the action item when you receive the required certification. If you want to close the action item prior to processing the subsequent life event, you must back out the life event; however, if the action item completion date is on or after the subsequent life event, you do not need to back out the life event.
Scenario 3: For a subsequent life event, the participant is eligible for a plan but has no electable choices. In this case, the application does not end date the action item from the original life event. Suspended enrollments and interim coverage carry forward to the subsequent event. The application creates a new action item that corresponds to the new enrollment results created for suspended elections and interim coverage.
Scenario 4: If the participant makes an election change based on a subsequent life event, the application retains the action item and suspended election for the original life event. If necessary, the application creates a new action item with a new due date for the new enrollment based on the subsequent life event.
As part of enrollment processing, you record the persons selected by a participant as dependents or beneficiaries of a plan or option. The system displays eligible designees for participants with enrollments in progress.
Because you can limit the relationship type of the dependents who are eligible to receive coverage under a benefit plan, the system displays only those dependents eligible for coverage. For example, if a participant elects employee plus spouse coverage, the system only displays dependents of the spouse relationship type.
You use the Dependent/Beneficiary Designation form to:
Enter and modify dependent or beneficiary designation information
Assign a benefit to a beneficiary as a percentage or an amount
Monitor certification requirements (Advanced Benefits)
Participants can designate dependents at the plan or option level; beneficiaries are designated at the plan level.
You can record in the system the physician or dentist that a participant elects to be their primary care provider. Providers are categorized by their service provider type, such as General Practitioner, Dentist, or Ob/Gyn. The system provides these and other service provider types and your system administrator can extend this list as part of your implementation.
Note: A person can have only one primary care provider of each provider type within the a plan.
After you enroll a participant in a benefit, you can display the enrollment results for that person.
Enrollment information is date effectively displayed so that you can view historical or future-dated information. You can display enrollment results that are created by one of the following means:
An electable choice is saved on an enrollment form
A default or automatic enrollment is processed
The close enrollment process has completed
The ability to override eligibility results is a requirement for enterprises with a high need for flexible benefits administration. Grand-fathered coverage, special employment terms, or required adjustments for highly compensated employees are all typical reasons for overriding eligibility results.
You use the Person Participation Information window to override eligibility results for a person for one or more plans after you run the Participation process to determine eligibility and electable choices. You then enroll the person using the Enrollment Override window.
You also use the Person Participation Information window to record an election for a person who was not processed in the Participation batch process.
You use the Enrollment Override window to enroll a person in a plan or option for which they have been found ineligible. You can also use this window to override rate and coverage amounts for a plan or an option and to override dependent eligibility results.
You can allow an eligible person to waive participation in a plan type or plan in one of two ways. You can enroll the person in a special plan called a waive plan, or, if you are an Advanced Benefits customer, you can use the Waive Participation form to specify which plan types or plans a person is waiving.
You typically define a waive plan when you want the waive plan to appear to the participant as an electable choice.
When you waive a person's participation in a plan type, the person waives the ability to enroll in all plans in that plan type. You cannot override a plan type waiver for any plans in that plan type.
A variety of common business practices dictate that enrollment coverage may start retroactive to the current system date. These examples include:
Enrollments based on retroactive life events, including enrollments that replace existing coverage
Enrollment coverage and activity rates that start based on the life event occurred date as opposed to the life event notification date
Suspended coverage that becomes unsuspended when interim coverage had been assigned
Note: SSHR users: Suspended plan rates are not included in displayed used amounts, and so are not deducted from Flex credits.
Participant election changes within an enrollment period
Participant elections that replace automatically assigned coverage
Administrative changes to current enrollments
You define enrollment coverage start dates and activity rate start dates for a compensation object as part of your plan design. Because coverage can start based on a date prior to an election, there is the potential for activity rates to also start before the election is recorded.
If a payroll run occurs between the activity rate start date and the election date, the activity rate will not be processed in the payroll run. Since the election had not yet occurred, the activity rate did not exist for the payroll run.
In this scenario, and in other cases where activity rates start before an election is recorded in the system, you may need to create payroll adjustments to deduct payments if your organization requires retroactive benefits payments.
For retroactive enrollments that replace a previous enrollment, the system end-dates the previous enrollment based on the coverage and rate end dates defined for the compensation object. You should define your enrollment coverage and rate start and end dates such that overlapping dates do not occur.
You can use the product to record court orders that require a participant to provide coverage for a dependent or that place restrictions on how a benefit payment can be distributed.
In the US, regulations termed Qualified Medical Child Support Orders (QMCSO) require a participant to cover a dependent when the participant is eligible for a plan and a court order has been issued.
A Qualified Domestic Relations Order (QDRO) is a judgement, decree, or order that relates to the provision of child support, alimony payment, or marital property rights to a spouse, child, or other dependent of a participant.
You can use the product to:
Record those persons subject to a Qualified Medical Child Support Order or a Qualified Domestic Relations Order
Specify the benefit plan or plan type that is subject to the provisions of the court order
Enter the names of the claimants eligible to receive benefit coverages based on the court order
For QDROs, enter the benefit amount or benefit percentage due to each applicable claimant or designee
During enrollment, the system issues a warning message indicating that a participant is subject to a court order. This warning does not prevent the election because the participant may have covered the dependent outside of the employer's plan.
You define enrollment requirements and restrictions for QMCSOs and QDROs as part of your plan design.