You define eligibility requirements as part of your plan design to determine eligibility for compensation and benefits.
You group eligibility criteria into participant eligibility profiles for primary participants and dependent coverage eligibility profiles for dependents. Eligibility profiles are re-usable. After you create an eligibility profile, you can link it to a compensation object (such as a program, plan, or option), a collective agreement, a grade ladder, or a work schedule to restrict eligibility for these.
Eligibility is determined according to the order of the compensation object hierarchy:
Program
Plan Type in Program
Plan in Program
Plan
Option in Plan
If a participant is eligible for a program, then the system checks for plan type in program eligibility, and so on down the hierarchy. This allows you to link different eligibility profiles to different benefits that you offer within a program.
Eligible participants are created when you run the Participation batch process (if you are an Advanced Benefits customer) or when you process a participant's election using an enrollment form (if you use Standard Benefits).
The standard criteria that you can include in an eligibility profile are grouped into five factors:
Personal Factors
Employment Factors
Derived Factors
Related Coverages
Other Factors
Each factor contains a variety of criteria from which you select one or more criteria values.
For example, let's say you administer a benefit plan with the eligibility requirement that all participants must work in California, Washington, or Indiana. You could define an eligibility profile using the Employment Factor criteria of Work Location. The values for the Work Location criteria would be California, Washington, and Indiana. (You need to define these work locations using the Locations form). A participant must meet one of the criteria values.
Apart from the above standard criteria that Oracle HRMS delivers, you can create your own criteria that meet the particular needs of your organization. For example, if your organization employs deep sea divers and varies benefits to the divers based on how deep they dive, you can create your own depth of diving criteria that you can use in your eligibility profiles.
See: User-defined Eligibility Criteria
See: Defining an Eligibility Profile
You define dependent coverage eligibility profiles to restrict the criteria that a dependent must meet in order to be covered by a benefit. Dependent coverage profiles are often used to exclude certain dependents from receiving coverage under a plan. For example, you can define a plan that excludes coverage for dependents age 21 and over.
Dependent eligibility factors include the dependent's:
Relationship (to the primary participant)
Age
Status (disabled, marital, military, student)
Postal zip
Other
After you define a dependent coverage eligibility profile, you associate it with one or more programs, plans, or options to limit the dependents covered by that benefit.
When you select more than one value for an eligibility criterion, at least one of the values must be present in the participant's record for the participant to be eligible for the benefit. In our example above, the participant must have a Work Location of either California, Washington, or Indiana.
However, when you use multiple criteria in an eligibility profile (for example, a Work Location and an Organization), the participant must meet at least one criteria value for each criterion.
Note: If you use a FastFormula eligibility rule as part of your eligibility profile, the participant must meet the criteria of the rule and one value from any other criteria that you include in the eligibility profile. If you use more than one FastFormula rule, by default the participant must meet the criteria of all the rules. If you change the user profile option BEN:Eligible Profile Rule from AND to OR, the participant need only meet the criteria of one rule.
For situations where eligibility does not guarantee access to a personnel action or a compensation object (for example, due to limited vacancies or restricted budget), you can rank an employee's eligibility relative to the eligibility of other employees.
During implementation, you can define a score and weight for each criteria in a participant eligibility profile. The application totals the score for all criteria that the person satisfies and assigns the person a rank relative to the total evaluated population.
You enter a score as a flat value for an eligibility criteria. If a person satisfies the eligibility criteria, the application records the score for the person.
A weight is a value that the application multiplies with a criteria value to compute a total. You can only use weights with criteria that contain numeric values.
Scores and weights are independent of one another. You can specify a score for a criteria, a weight, or both a score and a weight.
Currently, this feature is only available for Grade/Step Progression.
Because eligibility profiles are re-usable, you define them separately from any object. You link a profile to a compensation object, collective agreement, grade ladder, or a work schedule that you have created, to restrict eligibility for these.
When you link the eligibility profile to the object, you specify if the profile is required. The participant must satisfy all profiles marked as Required and at least one profile that is not marked Required.
As part of your plan design, you can specify the minimum and maximum length of time that a participant is either required or allowed to remain enrolled in a compensation object.
Define a minimum enrollment period for those compensation objects that require a participant to remain enrolled for a specified period.
For example, you could define a required enrollment period of two years for a dental plan.
Define a maximum enrollment period for those compensation objects that place a time limit on length of coverage. Maximum enrollment periods are often used in the US for managing COBRA participation.
If you are an Advanced Benefits customer, the system automatically detects when a participant has reached a maximum enrollment period that you have defined. Standard customers are notified that a participant has reached a maximum enrollment period when an enrollment form is opened and that person's record is queried.
When eligibility for a plan varies for a group of persons, you can define a benefits group to explicitly group those persons together. Defining a benefits group is useful for grouping grandfathered participants, or administering highly complex participation eligibility involving a small number of people.
You use the Benefits Groups window to define a Benefits Group and you enter a person into a group using the Person form.
Attention: You may assign a person to only one benefits group.
You can define a range of postal zip codes that can be used to determine eligibility and activity rates for a benefit. Postal code ranges can be combined into service areas that you can also use as eligibility criteria.
Service areas are a useful means of defining eligibility for a particular geographical region when Work Location is not adequate.