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      How To -- Configure Benefit Plans

      Purpose Statement

      This document outlines the steps for configuring benefit plans

      Configuring Benefit Plans

      1. From the Admin tab, go to Company Settings>Profiles/Policies>Benefits>Plans
      2. Click on Add New Plan to create a new benefit plan.
      3. A pop-up screen will appear for you to fill in the plan type, number of earning/deduction codes, the coverage type, and the number of coverage levels
      • Plan Type: Select from the plan type list that has already been defined. You can edit the list of plan types by going to Company Settings>Profiles/Policies>Benefits>Type
      • # of Earning/Deduction: You can select up to three earnings/deductions for the benefit plan. If more than one is selected, additional Coverage Type fields will display allowing you to select the coverage type for each deduction/earning
      • Coverage Type #:
        • Age of Dependents: Premium amount is based on the age of the dependent (Child, not Spouse) attached to the plan. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
        • Age of Dependents (ER%): Premium amount is based on the age of the dependent (Child, not Spouse), with the ability to enter the percentage of the premium the employer will contribute. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.

      Note: For coverage types dependent on age of dependent, “Identify Child(ren)” must be checked on the coverage level if more age levels are added in addition to the system default “Initially” level. Incorrect configuration will result in the benefit plan earning/deduction not calculating a value.

        • Age of Employee: Premium amount is based on the age of the employee. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
        • Age of Employee (ER%): Premium amount is based on the age of the employee, with the ability to enter the percentage of the premium the employer will contribute. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
        • Age of Spouse: Premium amount is based on the age of the Spouse attached to the plan. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
        • Age of Spouse (ER%): Premium amount is based on the age of the Spouse attached to the plan, with the ability to enter the percentage of the premium the employer will contribute. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.

      Note: For coverage types dependent on age of Spouse, “Identify Spouse” must be checked on the coverage level if more age levels are added in addition to the system default “Initially” level. Incorrect configuration will result in the benefit plan earning/deduction not calculating a value.

      • Coverage Amount: Allows for coverage amount, premium amount, and employer pay amounts to be entered as dollar amounts or expressions. This coverage type also allows you to enable Use Units functionality. If using employee Salary as part of the coverage amount, premium amount, and/or employer pay amounts, you can tell the system to use salary as of 1/1, 12/31 of last year, 12/31 of current year, Pay Date, Custom Date (this year), Custom Date (Last Year), Custom Date (Next Year), Custom Date (Rolling Year), Employee Benefit Start Date, Company Benefit Plan Start Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date and then adjust this to be used Immediately, the First of the Following Month or the First of the Following Quarter. You may also Freeze Salary As Of Year Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
      • Coverage Amount/Age: Allows for coverage amount, premium amount, and employer pay amounts to be entered as dollar amounts or expressions based on the age of the employee. This coverage type also allows you to enable Use Units functionality. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date. If using employee Salary as part of the coverage amount, premium amount, and/or employer pay amounts, you can tell the system to use salary as of 1/1, 12/31 of last year, 12/31 of current year, Pay Date, Custom Date (this year), Custom Date (Last Year), Custom Date (Next Year), Custom Date (Rolling Year), Employee Benefit Start Date, Company Benefit Plan Start Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date and then adjust this to be used Immediately, the First of the Following Month or the First of the Following Quarter. You may also Freeze Salary As Of Year Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
      • Coverage Amount/Age of Dependents: Allows for coverage amount, premium amount, and employer pay amounts to be entered as dollar amounts or expressions based on the age of the dependent attached to the plan (Child, not Spouse). This coverage type also allows you to enable Use Units functionality. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date. If using employee Salary as part of the coverage amount, premium amount, and/or employer pay amounts, you can tell the system to use salary as of 1/1, 12/31 of last year, 12/31 of current year, Pay Date, Custom Date (this year), Custom Date (Last Year), Custom Date (Next Year), Custom Date (Rolling Year), Employee Benefit Start Date, Company Benefit Plan Start Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date and then adjust this to be used Immediately, the First of the Following Month or the First of the Following Quarter. You may also Freeze Salary As Of Year Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
      • Coverage Amount/Age of Spouse: Allows for coverage amount, premium amount, and employer pay amounts to be entered as dollar amounts or expressions based on the age of the Spouse attached to the plan. This coverage type also allows you to enable Use Units functionality. This option contains the ability to “Freeze Age As Of” a Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date. If using employee Salary as part of the coverage amount, premium amount, and/or employer pay amounts, you can tell the system to use salary as of 1/1, 12/31 of last year, 12/31 of current year, Pay Date, Custom Date (this year), Custom Date (Last Year), Custom Date (Next Year), Custom Date (Rolling Year), Employee Benefit Start Date, Company Benefit Plan Start Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date and then adjust this to be used Immediately, the First of the Following Month or the First of the Following Quarter. You may also Freeze Salary As Of Year Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date.
      • Length of Service: Premium amount is based on the length of service of the employee. Using this coverage type allows you to Use Length of Service between two dates. The first date is either Date Hired or Date Re-Hired and the second date is based on the Use Length of Service At Date selected. The options are 1/1 of the current year, 12/31 of last year, 12/31 of current year, Pay Date, Custom Date (this year), Custom Date (Last Year), Custom Date (Next Year), Custom Date (Rolling Year), Employee Benefit Start Date, Company Benefit Plan Start Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date. You can Freeze Length of Service As of Year Custom Year, Company Benefit Plan Start Date, Employee Benefit Start Date, Pay Date, Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, Frozen Benefit Date. You can tell the system to look at either the Date Hired or Date Re-Hired if the employee is a Re-Hire. Lastly, you can tell the system to use the length of service in Day(s), Week(s), Month(s), or Year(s).
      • Premium: Allows for specific dollar amounts to be entered for Premium and Employer Pays. For Premium you will enter the full monthly premium dollar amount. For Employer Pays $ you will enter the monthly premium dollar amount the employer contributes. The system will automatically calculate the monthly premium dollar amount the employee contributes.
      • Premium (ER%): Allows for specific dollar amounts to be entered for Premium and a percentage the Employer Pays. For Premium you will enter the full monthly premium dollar amount. For Employer Pays % you will enter the % the employer contributes. The system will automatically calculate the monthly premium dollar amount the employee contributes.
      • # Coverage Levels: Allows you to define the number of coverage levels within this benefit plan.
      Once these fields are completed, click OK. You will be taken to the benefit plan set up screen.

       

      Benefit Plan and Dates Widget

      • Benefit Type: A non-editable display of the benefit type that was selected on the create screen
      • Name: Required name for the benefit plan
      • Description: Optional description of the plan being created
      • Active: Check to make this plan active in the system
      • Certificate #: Certificate number associated with this benefit plan
      • Policy #: Policy number associated with this benefit plan
      • Effective From, To: Required date fields for the effective dating of the plan at the company level
      • Eligibility Filter: Filter to include/exclude certain accounts from the plan
      • Cobra Eligible: Check if the plan is COBRA eligible
      • Coverage Provided through End of Term Month: Check if plan coverage is to be provided through the end of the month in which the employee is terminated. The system will use the Termination Date and Benefit Coverage End Date listed in the employee’s account under My Employees.
      • Enroll Only Primary: When checked, this will allow the benefit only to be added to the employee’s primary EIN profile when they have multiple EIN’s
      • Override Benefit Effective Date: When enabled, this option allows for the deduction of the plan premium to occur before the benefit effective from date that is in the future
      • GTLI Earning: This field is only shown if the Benefit Plan Type includes the GTLI Earning. This non-editable field is populated with the Earning Code defined for the GTLI Income in the Benefit Type under Company Settings>Profiles/Policies>Benefits>Types. The amounts are set in the GTLI section of the HR Settings widget under Company Settings>Global Setup>Company Setup, typically under the HR tab
      • Vendor: Allows for the provide/vendor to be listed on the plan. This is required if client will have benefit feeds
      • Custom Form: Allows selection of a custom form, which will be completed by employees and verified or reject by managers during open enrollment.

      Use Units Widget

      1. Benefits can be enabled to use units that represent dollar amounts, allowing users to select a number of units for the benefit plan. Additionally, Evidence of Insurability can be enabled and configured to require users to provide evidence when selecting certain coverage amounts. To use these features, you must configure the benefit plan with a coverage type that includes coverage amount.
      • Unit Minimum, Maximum: Enter the minimum and maximum number of units that can be applied to the benefit plan. Examples might be fore units of life insurance or contribution amounts to FSA or HSA plans.
      • Unit Format: Options include integer or currency. Currency will format the Min and Max to $0.00 format
      • Label: Allows for a title to be applied to the option such as Coverage Amount or Contribution Amount
      • Symbol: Allows for an optional symbol to be applied to the units such as $
      • Evidence of Insurability
        • Require evidence for unit values greater than: Allows for a value to be placed that will require the insured to provide additional information when units requested exceed the number placed here
        • No need to provide if already provided and a coverage amount is not changed: When checked, enrollees are not required to provide evidence of insurability if they have previously done so, and their amount of requested coverage has not been changed.
        • Hide document upload button during open enrollment, new hire enrollment, and in life event: Allows for the ability to hide the Evidence of Insurability Upload function during Open Enrollment, New Hire Enrollment, and Life Events.
        • Allow request over the limit. Defaults to the limit until evidence is uploaded: Will allow employees to request units over the limits and provide the additional evidence of insurability, but sets the value to the default until evidence is provided
        • Enable EOI Tiers: When checked, the edit icon can be clicked and multiple tiers of EOI can be entered
        • Redirect to EOI Provider: You will be able to select this box once the plan has been saved. This can be used for the employee to fill out an EOI on the provider’s website and then download the completed document to then upload it in WFR.
        • Units May Be Overwritten By: When selected, this allows the selected user(s) to increase the amount in the employee benefit plan up to the Unit Maximum, disregarding the guaranteed Units amount and lack of an uploaded EOI.
        • Needs to be Reviewed By: This setting tells the system who needs to review the EOI once it is uploaded by the employee at the time of enrollment.
      • EOI Tiers: Can be defined by completing a table. A set of factors is combined to define each tier
        • Use Date: Years of Enrollment, Years of Service or one of the following: Custom Date (allows users to set any date to calculate the Number of Years used), Hired, Birthday, Started, Re-Hired, Benefits, Review, and Frozen Benefit Date
        • Number of Years: Number of years enrolled in the plan, years of service, or years since the first occurrence of the employee’s birthday, start date, seniority date, re-hire date, benefits date, review date, or frozen benefit date
        • Units Minimum: Minimum number of units that can be selected for the plan
        • Guaranteed Units: If the employee has selected a coverage amount with the specified number of units or less, no EOI is required for the tier. If the Guarantee Units amount is less than the Unit Minimum or more than the Unit Maximum, then the Unit Minimum/Unit Maximum amount is displayed in messages instead of the Guaranteed Units amount. If this value is set, the increase % value cannot be set.
        • Increase %: If an employee is already enrolled in the plan, and they increase the number of units by this percentage, no EOI is required unless the maximum units are exceeded. To define this value, guaranteed units cannot be set. The Increase % option can be set to a value up to 100%
        • Units Maximum: The maximum number of units that can be selected for the plan

      Deduction/Earning # Widget

      • Coverage Type: The non-editable coverage type selected on the set-up screen
      • Description: Optional description of the deduction/earning. The description entered here will show under the description of the benefit plan in employee ESS Benefit Enrollment
      • Earning/Deduction: Allows you to tie the specific deduction or earning code to the benefit plan for reporting purposes.
      • Earning/Deduction Starts On: Allows you to specify if a benefit deduction/earning starts a certain amount of time before or after the benefit’s start date
      • Employee Frequency: Allows you to determine how often the deduction or earning will occur for the employee.
      • Prorate Employee: Available for coverage-based plans only, this option will prorate premium amounts the employee pays based on the remaining months in a calendar year from the deduction effective from date
      • Employer Frequency: Allows you to determine how often the deduction or earning will occur for the employer portion
      • Prorate Employer: Available for coverage-based plans only, this option will prorate premium amounts the employer pays based on the remaining months in a calendar year from the deduction effective from date
      • GTLI Type: If the plan’s coverage type is coverage-based, this field will appear. This selection allows users to define if the Earning/Deduction applies to amounts for the employee, the employee’s children, or the employee’s spouse. When Children or Spouse is selected, the Coverage Level Option for Identify Spouse or Identify Children and Birthday Required are automatically selected because the data is needed for calculation of GTLI.
      • Passive Enrollment Options
        • Plan Requires Re-Election: Check to require that this plan require enrollment each benefit period

      Waiting Period Widget

      1. If there is a defined waiting period the employee must wait before being eligible for the plan, you can use this window to set the waiting period
      2. Standard Waiting Period: Use this option if everyone eligible for the plan has the same waiting period
        • Click on the pencil icon to open the waiting period window
        • Once the window opens, click Add to open the waiting period configuration screen
        • You can choose between X number of Days, Weeks, Months, or Years from Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, or Frozen Benefit Date
        • You can then choose to use Date Hired, Date Started, Birthday, Seniority Date, Date Re-Hired, Review Date, Benefits Date, or Frozen Benefit Date if the first date field is blank
        • Once configured, hit Save
        • You can then choose if you want to adjust that date to Immediately After, First of Following Month, or First of Following Quarter
      3. Advanced Settings: Use this option if there are multiple waiting period scenarios that need to be tied to the benefit plan
        • Click Add Waiting Period Rule to add the first rule to the plan
        • Click the edit Pencil to open the configuration window
          • Rule Name: Each Waiting Period Rule must be given a name
          • Eligibility Filter: Allows you to define what accounts will be affected by this waiting period rule
          • Waiting Period: Define the waiting period for this group of accounts. See Standard Waiting Period steps above.
          • Adjust To: You can then choose if you want to adjust that date to Immediately After, First of Following Month, or First of Following Quarter
          • Hit Save when done
      4. Once done, you can add additional Rules as needed. When this plan is added to the employee record, the system will apply the first rule starting at the top of the list that the employee record fits into, so order that the rules appear is important when building.

        

      ESS Widget

        • Provider Name: The name of the benefit provider, visible to the employee within their self-service session
        • Provider URL: The URL to the benefit provider’s website, visible to the employee within their self-service session
        • Logo: Allows you to attach the logo of the benefit provider, visible to the employee within their self-service session
        • In order to provide additional plan information to employees during the enrollment process, up to 10 documents can be uploaded for the benefit plan. These documents will be available to employees during their self-service session. The documents can also be viewed from the Change Request Detail and Change Request Summary reports

      Supporting Documents Widget

      1. The Supporting Documents widget allows for additional documents to be added to the plan.
      2. To add a document, click the Upload Document button in the top right corner of the screen
      3. A pop-up window will display where a document can be selected
        • Document Type: Allows you to add a document type from a pre-determined list that will allow you to restrict who can view the document
        • Display Name: This will be the name given to the document in WFR
        • Choose File: Allows you to choose the document to attach to the plan
        • Click Upload when done

      Rules Widget

      1. The Rules Widget allows for rules to be added to the plan
      2. To add a rule, click the Add Rules button in the top right corner of the screen
      3. A pop-up window will display where a rule can be built
        • Include: This rule states that benefit plan can only be used if the benefit plan selected within this rule is in use. The include rule can be added multiple times, if multiple plans should be included
        • Exclude: This rule states that the benefit plan cannot be used if the benefit plan selected within this rule is in use. The exclude rule can be added multiple times, if multiple plans should be excluded
        • Coverage Limit: This rule states that coverage amounts cannot go below or exceed limits set in this rule
        • Click Select when done

      Notes Widget

      1. The Notes Widget allows for rules to be added to the plan. Click on New Note in the widget or Add Note in the top right corner
      2. Once the Note has been added, click OK

      Coverage Level Widget

      • Can be Overridden By: Users can utilize this option to specify an Account, Group, or Manager who can override a coverage level for a benefit plan with multiple coverage levels and the Use Units option disabled
      • Coverage Name: Name of the coverage level
      • Brief Explanation: Note field that allows for an explanation of the coverage, which will be visible to the employee
      • Eligibility Filter: Filter to include/exclude certain accounts from the coverage level. This filter also includes Account Extra Fields and HR Custom Fields that checked as enabled
      • Pricing (Premium): Depending on the coverage type selected, you can enter the Age for the premium band, the coverage amount of the plan, the monthly premium for the benefit, and the monthly amount that the employer will pay

      Coverage Level Miscellaneous Settings Widget

      • Show Employer Contribution: Determines if the employer contribution should or should not be visible to the employee enrolled in the coverage level
      • Identify Spouse: Determines if the employee should, or is required, to identify their spouse (with or without their SSN and/or birthday)
      • Identify Children: Determines if the employee should, or is required, to identify the children enrolled in the plan (with or without SSN and/or birthday). You can set the maximum number of children and the minimum number of children to be identified.
        • Child Premium Calculation: Allows users to identify the number of children to be included in the benefit premium calculations. When selected, additional settings will become available to allow users to select the number of children to be included in the premium calculation and to select age preference ranges of Younger to Older or Older to Younger
        • If the Identify Children in enabled, a section for Dependent Eligibility will appear. User can specify the age at which a dependent is no longer eligible to participate in the benefit plan, based on age only, if they are/are not a full-time student, and/or if they are/are not disabled
          • As the full-time student loses the full-time status, the system will automatically move them to the Do not allow participation if dependent is over age __ (age only) criteria. This will ensure an employer’s policy is applied correctly if it allows for an age of 99 years for dependents who are full-time students to allow a full-time student to always be covered.
          • The Do not allow participation if dependent is over age __ and is not disabled criteria can be configured to allow dependent to always be eligible
          • Eligible to enroll up to Dependent’s: Allows you to specify what the last day the dependent can enroll in the benefit plan
          • End date Coverage date at Dependent’s: Allows you to specify when to end date the dependent’s coverage when they are no longer eligible for coverage.
            • Birthday Year Last Day: users can add dependents until the end of the current year in which the dependent reaches the age listed
            • Birthday Month Last Day: users can add dependents under the end of the dependent’s birthday month in which the dependent reaches the age listed
            • Birthday: users can add dependents up to their birthday on which the dependent reaches the age listed
      • Identify Beneficiaries: Determines if the employee should, or is required, to identify their beneficiaries (with or without their SSN and/or birthday). You can set the maximum number of children and the minimum number of children to be identified.
      • Identify Contingent Beneficiaries: Determines if the employee should, or is required, to identify the contingent beneficiaries (with or without SSN and/or birthday). You can set the maximum number of children and the minimum number of children to be identified

      Coverage Level Miscellaneous Settings Widget

      1. Custom fields can be defined for a benefit plan by using the Define Fields link in the Custom Field Settings widget. These fields can then be visible or required for employees when reviewing benefit plans for enrollment
      • Enabled for Employee: Check to make this field available to the employee
      • Required for Employee: Check to make this field required to the employee
      • Enabled for Dependents: Check to make this field available to the employee for their dependent information
      • Required for Dependents: Check to make this field required to the employee for their dependent information
      • Hide from Employee: This field works independently from the other fields and cannot be used in conjunction with other settings. This setting, when checked, will hide the custom field from the employee’s view during open enrollment, new hire enrollment, and life events. This field will be available for a manager or administrator to populate it on behalf of the employee
      • Affects Premium: When the Is List is enabled within the benefit Custom Field, an option for Affects Premium becomes enabled in this widget. When checking this option, premiums for the plan can be specified for a flat dollar amount or a percentage of the premium. When the employee is enrolled in the Benefit Plan and makes a selection from the custom field list, an adjustment to the premium will be made based upon the selection. When the Flat $ Amount is selected, the value is applied to the Monthly Premium, not the per pay period amount.

      Earning Deduction Audit Widget

      1. An audit trail showing changes to the earning/deduction code assigned to the plan will be kept. This will give information any time an earning or deduction code is added or changed in the plan.