Enrollment requirements determine when an eligible person can enroll in a benefit. You define enrollment requirements for a program, plan type, or plan to determine scheduled enrollment periods and the qualifying life events that enable an enrollment.
Enrollment requirements that you define at the program level cascade to the plan type and plan levels unless you override these requirements for a given plan type or plan. Although there are many program-level enrollment attributes, participants do not technically enroll in a program. Instead, they enroll in the plans associated with that program.
You can also use the enrollment requirements forms to implement other restrictions, as follows.
You can coordinate coverage levels between all plans in a plan type. For example, you can require that a person who elects the "employee only" coverage option in one plan elects this coverage level for all plans in the plan type in which they enroll.
For insurance plans, you can limit the coverage level that can be elected by a spouse or a dependent to a percentage of the coverage elected by the primary participant.
Advanced Benefits customers can require that an action item be completed before an enrollment is valid.
You can also define dependent coverage requirements such as dependent information that is required for an enrollment to be valid (date of birth or social security number) and required certifications.
You define beneficiary designation requirements at the plan level.
You can define general enrollment requirements for a program, such as enrollment coverage start and end dates and activity rate start and end dates. These dates are not particular calendar dates, but dates relative to a scheduled enrollment in the program year.
Advanced Benefits customers can define at the program level whether default or automatic enrollments apply to any plans in this program.
For insurance plans, you can limit the coverage level that can be elected by a spouse or a dependent to a percentage of the coverage elected by the primary participant.
You can define enrollment requirements for the plan types in a program if these requirements differ between plan types. For example, you can define a required period of enrollment for the plans in one plan type.
Other requirements you can set at the plan type level relate to life insurance plans. You can:
Specify if the plans in a plan type limit the amount of coverage a spouse or a dependent of the primary participant can elect as a percentage of the coverage elected by the primary participant
Specify if the system determines imputed income and life insurance maximums for a plan type
You can limit the maximum number of plans in a plan type in which a person can enroll, or require that a participant enroll in a minimum number of plans in a plan type.
Advanced Benefits customers can define if a plan in a program is the default enrollment for a participant who fails to make an election. You can limit the circumstances under which a plan is the default based on whether or not the participant is currently enrolled in the program.
For example, you can define a default plan for newly enrolled participants, and indicate that currently enrolled participants must remain enrolled in their current plan.
For scheduled enrollments, you define the enrollment type for the program, either open, administrative, or unrestricted.
Attention: Open and administrative enrollment types are only available to Advanced Benefits customers. Because unrestricted enrollments are not date dependent, the system does not recognize an enrollment period for unrestricted enrollments. An unrestricted enrollment is considered closed when the enrollment is saved.
You cannot combine unrestricted and life event processing in the same program. If a plan does not require a life event for electability, attach the plan to a separate, unrestricted program or set up a plan not in program.
You associate a program year period with those programs that contain one or more plans with scheduled enrollments. Within the program year, you can specify the enrollment period for plans in the program, the date on which defaults are assigned, the date after which no further processing is allowed, and the enrollment close date.
For programs that allow an override to the enrollment start and end dates or the activity rate start and end dates, you can specify these enrollment and activity rate periods.
You can define the life events that trigger an enrollment opportunity for the plans in a program. You can also specify the date on which defaults are assigned, the date after which a person experiencing the life event is no longer eligible for enrollment, and the life event enrollment close date.
You can define the enrollment coverage start and end dates for a life event. This is not a particular calendar date, but a date relative to the life event.
As with scheduled enrollments, you can define overrides to enrollment start and end dates or activity rate start and end dates for a program that are caused by a life event that you associate with the program.
You can associate with a plan type or a plan in program those life events that trigger an enrollment action. Depending on the life event and the participant's current enrollment status, you can define whether or not the life event enables an enrollment action. You select from enrollment codes that limit the participant's enrollment options based on whether they are currently enrolled in the compensation object that you specify.
For example, you can specify that a participant who experiences a particular life event and is currently enrolled in a plan can keep their current elections but cannot change their elections. But, if the participant is not currently enrolled in the plan, then they can enroll. You would select an enrollment code of Current, Keep Only; New, Can Choose.
You can also define for a plan in program the enrollment method associated with a life event, either automatic or explicit.
The information required to enroll a dependent in a benefit can be different from the information required to enroll a primary participant. For dependents you can define:
Dependent coverage start and end dates
Required information for enrollment, such as social security number/legislative ID and date of birth
Required certifications
Dependent coverage eligibility profiles
Enrollment actions triggered by a life event
Certifications required for enrollment after the occurrence of a specific life event
You specify enrollment requirements at the program level if the requirements apply to all the plans in the program. You use plan level enrollment requirements to override values set at the program level for individual plans. The enrollment requirements that you can specify for scheduled enrollments and life event enrollments are the same at the program and plan level.
In addition, you set enrollments requirements for not in program plans and options in plans by using plan enrollment requirements.
You can define general enrollment requirements for a plan, such as enrollment coverage start and end dates. You can also set limitations to the minimum and maximum number of options in a plan in which a person can be enrolled.
If an action must be complete before an enrollment is valid, you can associate enrollment action types with a plan if you are an Advanced Benefits customer.
You can also define designation requirements that limit the familial relationship types covered by an option.
You define enrollment requirements for plans not in program just as you do for plans in program. However, plans not in program also have additional enrollment requirements that you can set.
For each plan not in program, you can select a default enrollment code that determines how the system processes an enrollment when a participant fails to make an election.
For a plan not in program with a required enrollment period, you need to specify whether the required enrollment period applies to the plan, the options in the plan, or the plan type that contains the plan.
You can also specify the time period in which activity rates for a plan not in program are expressed in the user interface, for example by month or annually.
You can define enrollment requirements that apply to the options in a plan, such as:
The default option for participants who do not make an election (Advanced Benefits)
The options that are required for enrollment in the plan
The enrollment method, either automatic or based explicitly on the participant's election (Advanced Benefits)
You can also set designation requirements for an option. See: Defining Options
The Total Compensation processing model uses the rate start and end date codes on the Plan and Program Enrollment requirements windows to derive when the standard rate begins and ends for an enrollment. These codes also determine when the corresponding element entry begins and ends.
Depending on the code you select, the application determines the rate dates based on the life event occurred on date, enrollment coverage date, or effective date of the election.
An enrollment action is any action that is required of a participant to complete an enrollment or de-enrollment. In addition to the enrollment action types delivered with the product, you can use the Enrollment Action types window to define additional enrollment action types.
You associate an enrollment action with the enrollment requirements for a program or plan.