Setting Up Employee Enrollment Conditions

Use the Benefit Rules form to establish the conditions that employees of a client must satisfy to enroll in a benefit plan.

Note: To quickly access the Benefit Rules Import form, select Import Benefit Rules. You can use procedures to create the benefit rules import file and to import benefit rules information into PrismHR from a tab-delimited text file.

You can also access benefit-related features and settings using the Actions menu:

• Audit
• Clone Another Rule: Creates Company Benefit Rules records with any benefits found on the company you select
• Copy Rule to other Benefit Groups: Copies a benefit rule to another benefit group

Creating Benefit Rules

You can define the benefit plan using the Benefit Rules form.

To create the benefit plan rules:

1. On the Work Centers menu, select Benefit Plan Maintenance, then Benefit Rules.
2. In Benefit Rules, specify the following information:
In this field Enter this
Benefit Group

The Benefit Group ID. Select the benefit group to associate with this rule.

Note: Any Benefit Groups that have been terminated (i.e., have a stop date entered in the Stop All Use On field of the Benefit Group record) show "(Terminated as of [Stop All Use On Date])" next to the list item.

If you select a terminated group on the Benefit Rules form, the Benefit Plan and Effective Date selector fields are enabled. (This allows you to select from these fields to retrieve and view any previously saved Benefit Rule settings. However, saving benefit rule edits with a terminated group selected is disallowed as all remaining fields on the form are disabled and "read only".) Additionally, the Clone Another Rule and Copy Rule to Other Benefit Rule Action menu items do not display when a benefit rule has a terminated group.

Benefit Plan

The Benefit Plan ID. The selected benefit plan determines which panels display.

Note:  When you select a Benefit Plan and the Effective Date, the system checks if the Allow Gross Wage % Contribution Method field has been flagged for the selected Benefit Plan on the Group Benefit Plans form and also if the plan has a value in the Max Contribution column, then a warning message stating, Benefit Plan <Benefit Plan ID> had a Max Contribution previously assigned and is now setup to use ‘Allow Gross Wage % Contribution Method’. This record must be saved in order to resolve this conflict. is displayed.
Network ID If required, the Network ID for this plan.
Effective Date

The date when the plan becomes effective.

• You cannot delete the sole Benefit Rule Effective Date for a Benefit Group having a specified Benefit Plan if there associated Employee Benefit Enrollment records for the Benefit Group and that specified Benefit Plan with a status of Active or COBRA. This action will orphan the associated records and can cause payroll errors along with other issues. If you try to delete it, you will receive an error message stating This benefit rule cannot be deleted. There are employees using this benefit rule with active enrollments. Example: Employee Enrollment for Employee ID [XXXXX] and Effective Date [XX/XX/XXXX].
• If it is not the sole Benefit Rule Effective Date for that Benefit Group having that Benefit Plan, OR there are no active enrollments associated with the benefit rule, then you can delete it.

Contribution rule amounts made by Company or Employee

The person who makes the contribution for the benefit defined by this rule, either Employee or Company.

Exempt take on employees from Minimum Days of Service Requirement

If selected, exempts imported employees from the minimum service requirement.
Alternate Contribution Plan

The Alternate Contribution Plan if contributions are based on another plan's billing rates. You can enter the benefit plan ID here or click the Alternate Contribution Plan hyperlink to open the Benefit Plan selector which displays the list of Group Benefit Plans offered by the client. You can use the various filters on the Benefit Plan selector to refine your search for example Plan ID or Name. You also use the following additional filters:

• The default High Deductible Plan (HDHP) filter status is All. You can choose any of the following options:
• All - The list will include both High Deductible Plans and plans that are not High Deductible Plans.
• Yes - The list will include only those benefit plans which are High Deductible Plans. It is indicated with a status Y in the list.
• No - The list will include only those benefit plans which are not High Deductible Plans. It is indicated with a status N in the list.
• The default Status filter status is Active. You can choose any of the following options:
• Active (Default) - The list will display only the active Group Benefit Plans offered by the client.
• Terminated - The list will display only the terminated Group Benefit Plans offered by the client
• Never Implemented - The list will display only the Group Benefit Plans offered by the client but were never implemented.
Alternative Contribution Rate Group

The Alternative Contribution Rate Group if contribution calculations are based on a rate group other than the one defined in the Alternate Contribution Plan.

An Alternate Contribution Plan is required before selecting an Alternative Contribution Rate Group. This information is also provided as a tooltip for this field on the form. If you try to enter a value in the Alternative Contribution Rate Group field when the Alternate Contribution Plan is blank, then you will get an error message stating An Alternate Contribution Plan has not been defined. The Alternative Contribution Rate Group will be cleared out. Click OK to acknowledge the message and you will be returned to the Benefit Rules form with all previously entered data populated except for the value in the Alternative Contribution Rate Group field which is cleared out.

• When selecting the Alternative Contribution Rate Group hyperlink, the selector will only populate Rate Groups based on the Alternate Contribution Plan defined.
• Any existing value in the Alternative Contribution Rate Group field will remain visible regardless of whether an Alternate Contribution Plan had been defined earlier or not. You can delete the existing Alternative Contribution Rate Group value.
• If an Alternate Contribution Plan has been defined but you have not entered any value in the Alternative Contribution Rate Group field, upon Save, a message will display stating An Alternate Contribution Plan has been defined which requires an Alternative Contribution Rate Group to be selected. Click OK to acknowledge the message and you will be returned to the Benefit Rules form to enter a value in the Alternative Contribution Rate Group field.

Show Employees with Overrides

A list of employees who override the client's regular benefit plan eligibility rules.

Group Benefit Auto Enrollment (Client)

A conditional field which is displays only if you have a plan labeled as Auto-Enroll at the global or client level for you to easily enroll eligible employees in the plan.

Note:  While saving the form, if the plan is set to auto-enroll, an additional routine is called to check for employees within the selected client who meet the eligibility requirements of the plan but are not enrolled. A message stating We have identified X eligible employees who are not enrolled in this plan. Would you like to be taken to the Group Benefit Auto Enrollment (Client) form to enroll these employees? is displayed to notify you of the eligible employees.

• Click Yes to save the changes made on the Benefit Rules form and open the Group Benefit Auto Enrollment (Client) form.
• Click No to save the changes made on the Benefit Rules and remain on the same form.
• Click Report to display the list of eligible employees who are not enrolled and review them.
3. In Contribution Rules, specify the following information:
In this field Enter this
Plan Type

The Plan Type ID. For example, EE for Employee, ES for Employee + Spouse, EC for Employee + Child and FAM for Family.
Contribution Method

The calculation method for contribution amounts:

• Percentage - The employee's contribution towards the premium as well as the portion of the premium allocated for dependent coverage is calculated by percentage.
• Fixed - The employee's contribution towards the premium as well as the portion of the premium allocated for dependent coverage is a fixed amount.
• Fixed EE, Percent DEP - The employee's contribution towards the premium is a fixed amount, and the portion of the premium allocated for dependent coverage is calculated by percentage.
• Percent EE, Fixed DEP - The employee's contribution towards the premium is calculated by percentage and the portion of the premium allocated for dependent coverage is a fixed amount.

Note:  When you select any Benefit Plan other than Insurance Class of Medical, Dental, or Vision, then under the Contribution Rules section if you have entered a value in the Contribution amount or the DEP Contribution Amount field, then this field becomes a mandatory field.

If you save the form without fulfilling the above criteria then an error message displays stating Contribution Method is required..
Contribution EE Bill The employee's contribution amount towards the premium. This is either percentage or flat amount, depending on the Contribution Method.
Contribution DEP Bill The employee's contribution amount towards the portion of the premium allocated for dependent coverage. This is either a percentage or a flat amount, depending on the Contribution Method.

Max Contribution ($)

The monthly maximum contribution dollar amount that can be made by the employee or employer (as applicable based on the value shown in the Contribution rule amounts made by Company or Employee field of Benefit Rule setup). A maximum contribution amount can only be defined on age banded, Monthly cost basis plans with an insurance class of Medical.

Note:  The Max Contribution ($) column displays but is disabled with N/A shown in the column when any following conditions are True:

  • The plan is not a Medical Insurance Class plan with Age Banded Medical Rates.

  • The plan has a Cost Basis of Weekly, Quarterly or Yearly on the Group Benefit Plans Premium Rates form.

  • The Contribution Method for the Plan Type in the "Contribution Rules" section of the Benefit Rules form = Fixed.

  • The Cafe Plan Eligible checkboxes in the "Group Benefits Setup" section of the Benefit Plan Setup form (Benefit Plan Maintenance > Group Benefit Plans (Client) > Benefit Plan Setup) is checked.

  • The HI 1.5% Rule Applies column in the "Hawaii 1.5% Rule" section of the Benefit Plan Setup form is set to Yes for the Benefit Group.

  • Any of the following checkboxes are checked in the "Other Processing Parameters" section of the Group Benefit Plans form (Benefit Plan Maintenance > Group Benefit Plans (Global) > Group Benefit Plans):

    • Premium Rates vary by Network

    • Family Rated Premiums

    • Tobacco Banded Rates

    • Gender Banded Rates

    • Spouse Gender Banded Rates

    • Wellness Banded Rates

  • The Billing Rates Vary by Network field in the "Other Processing Parameters" section of the Group Benefit Plans form is set to Yes or Both.

Show Billing Information

Additional information (shown in the Billing Information panel) for benefit plans that calculate an exact premium and billing amount:

• The Total Contribution is the total amount contributed.
• The Contribution is the amount contributed by the employer.
• The Total Billed is the total amount billed to the client for the plan.

Note: When you select the Do Not Allow EE Contribution checkbox on the Group Benefit Plans form, then under the Contribution Rules section, beside the Show Billing Information hyperlink, an informational text stating, This plan is set to not allow employee contributions, please ensure the contribution rules meet this requirement. is displayed to notify you that the plan is set up to disallow employee contribution so that you are aware while adding or updating the contribution rules.

4. In Eligibility Rules, specify the following information:
In this field Enter this
Employment Status Class

Select the employee statuses associated with this benefit rule:

• Active
• On leave
• Terminated
Minimum Age

The minimum age required to be eligible for this benefit.

Maximum Age

This field allows to set the Maximum Age value for eligibility in a given plan.

Minimum Days of Service

The minimum days of service required to be eligible for this benefit.

Eligibility Days From

Whether to count benefit rule eligibility days from the Hire Date or Status Date.

• Hire Date - Eligibility is based on the employee's latest hire date, regardless of the employee type at that time.
• Status Date - Eligibility based on the date reflected in the Status Date field on the Employee Details record.

Eligibility Date Used

The Eligibility Date Used determines how the system calculates the date employees meet eligibility requirements for this plan.

• Calculated Eligibility Date: The first day of calculated eligibility.
• First of Month after Calculated Date: The first of the month after the date of calculated eligibility.
• First of Quarter after Calculated Date: The first day of the next quarter after the date of calculated eligibility.
• If Calculated is 1st of month, use that else next 1st of month: If the calculated date is the first of a month, the system uses that. If it is another day in the month, it uses the first of the following month.

Note:  When you select the Mid-Month Coverage Dates field on the Group Benefit Plans (Global) form, then you can select only the Calculated Eligibility Date option. The other two options will be disabled with a tag, Not Valid next to the option names.

Employment Type

Select the types of employment associated with this benefit rule.

Exempt/Non-Exempt

The employee FLSA status required to be eligible for this benefit, or nothing if employees of all statuses are eligible.

Network Availability Stop Date

An expiration date for the network attached to the benefit.
5. Click Save to save the benefit rule.
6. Click Delete to delete the benefit rule.
• You cannot delete the sole Benefit Rule Effective Date for a Benefit Group having a specified Benefit Plan if there associated Employee Benefit Enrollment records for the Benefit Group and that specified Benefit Plan with a status of Active or COBRA. This action will orphan the associated records and can cause payroll errors along with other issues. If you try to delete it, you will receive an error message stating This benefit rule cannot be deleted. There are employees using this benefit rule with active enrollments. Example: Employee Enrollment for Employee ID [XXXXX] and Effective Date [XX/XX/XXXX].
• If it is not the sole Benefit Rule Effective Date for that Benefit Group having that Benefit Plan, OR there are no active enrollments associated with the benefit rule, then you can delete it.
7. Click Cancel to clear this form at any time. Any unsaved changes will be lost.