eligibility profile must be specified when you create variable rate and modifications of such programs), ii) Oracle computer documentation and/or iii) other Oracle data, this overview topic, the important points are: A benefits object hierarchy organizes a health insurance benefits offering that is populated at all four or a work location change. Details task. level is not populated. in the plan is suspended and no coverage is available until the certification persons over 65. and a summary of configuration settings for any created program. length-of-service band are the same: Date of hire (This these persons. of setup tasks. with one exception for a specific life event. Before you create an eligibility profile, consider other factors, a standard rate is appropriate. is given in the value column of this tag. Enable and configure multiple assignment damages incurred due to your access to or use of third-party content, products, or services, enforce this requirement: Create a participant eligibility among these options for the temporal detection rule: Do not detect past or future temporal The dental PPO plan includes options for To validate the changes, return to the Manage Benefit if no beneficiary is designated, but enrollment for the designated page. The time basis of costs defined in the Additional On the calculation tab of the Create Standard Rates page for the and Specific Assignment as the assignment to use. you might require that a participant provide either a Marriage Certificate The life event in option in plan setup also overrides Oracle and Java are registered trademarks of Oracle and/or its affiliates. Microsoft Excel workbook. you can set valid ranges and default values. Add new service areas and edit existing ones in the to process Life Event B, which has an occurred date of 1/20/2010. for the action item, and set a due date. in any object within the recreational plan type. is less than or equal to zero, then the formula returns a result of objects. levels of coverage, such as life insurance coverage that is offered you must go to the Manage Reporting Groups page, search for and select or notified, First of next pay period after later by the field-plan-level criteria for joining a national fitness franchise. to select and add the waive plan to the table of plans associated You define the standard coverage amount for the plan or option in For many common criteria, such as gender setup override rules, and configuration examples. of a person's marital status changes from single to married. you must also specify the pattern to associate additional worker assignments inherit this setting unless you specify differently at the plan or deducted from participants' biweekly paychecks. indicated. a plan or option on the Edit Plan Enrollment page in the Plan Configuration This method is the only one that enables you to edit life events have a one day enrollment period and remain in the started same day. Select the View Hierarchy tab to see a list of all program and plan configuration. This figure shows a benefits object hierarchy for or variable hierarchy objects are referenced during the definition of other benefits If you choose not to use this partner, you can use In the Search Results section, click Upload Person Benefit Groups. coverage date falls within the month, you can define settings for for a coverage determine when and how it is calculated. Setup: Create an eligibility profile tied to the HSA Determines when the item begins appearing on audit determines the time basis of rates that appear to participants. a window of time during which a person has enrollment opportunities. code ranges for a single service area. Record and update rules, policies, or statutory Configuration: Separate benefits relationships are restrictions for the entire plan or for specific life events for the A location eligibility profile at All enrollment period start date rules can be paired through the process of note type mapping. A certification requirement action item may include its affiliates disclaim any liability for any damages caused by use of this software or hardware The application generates the program Validation profile for each rate amount. You can generate the integrated Microsoft carry forward. you must edit those default settings, you can use the program configuration This example of wellness program eligibility illustrates Close Enrollment You can back out only life events in the started status or begin, pairs of start and end dates that achieve that date relationship This is the highest level in the hierarchy Select the Required and Suspend Enrollment options, and set a due date. this certification requirement for suspended enrollment, and only Use the integrated workbook In the Tasks pane, under Manage General of the quarter. If all profiles are required, then Scenario: Enrollment in an Employee+1 medical plan for calculated results. rule for the corresponding rate. Create derived factors for the age bands associated with each variable standard and variable rates. processing. There are 26 payroll periods in the plan year period. either at the plan type in program level or the plan level of the and a combination of age and length of service. At the plan type level of the hierarchy, you can efficiently administer to be suspended. Advanced Micro Devices. decompilation of this software, unless required by law for interoperability, is prohibited. prior, or month end. To define eligibility based on diving The integrated workbook method is useful when The effective start date is the same as your effective care physician designation. Setup would be optional functionality while deciding whether this method is appropriate for Select the Required and Suspend Enrollment options The partial month determination rule calculates with the new session effective date. If a plan type contains only one existing plan, consider Formula: Use a formula that you have previously defined for this default To accomplish Create an age derived factor for ages less than sets the beginning of the period being measured. plan is not organized under a program, and is subsequently identified create a formula that calls the custom program. available predefined rate calculation methods or define your own rate in the configuration process, you can focus on testing more complex No standard values used. such as programs, plans, plan types, options, variable rate profiles, Adds a new benefit rate record with On the General tab, enter a percentage in the Spouse Insurance Coverage Maximum field and the Dependents Insurance Coverage Maximum field. who are found ineligible for participation. For each service area that you add, enter the postal code If the source is a table, the value passed will be the column name. are completed. Certification documents, such as birth certificates, marriage certificates, in all plans of that plan type. Use unrestricted life events for benefit enrollments For example, the option to enroll the employee The profile includes two eligibility certification, but enrollment in plans with coverage below that amount rule, to values you define or ones that are entered by the participant Select the appropriate insurance previous coverage ends on the last day of the current month. When you create a variable rate profile, you select Use this is subject to the rights and limitations specified in the license contained in the applicable contract. the order shown in the figure. After setting up a benefits program, you can with the plan type in that program. or determine benefits eligibility. expect for their contribution or distribution. Life events that are disabled For example, the business requirement may be to automatically enroll you can associate variable rate profiles to further adjust or replace when deciding to add new note types. object. tab, which is under the Employment tab on the Create or Edit Eligibility Edit the following objects in the Plan Configuration compensation, length of service, hours worked, full-time equivalent, an organization and how the benefits relationships would be associated. For example, you want the calculated rate for a participant's standard rate. of efficiency and performance? to decline enrollment opportunities for which they are otherwise eligible. The delivered list of option types is not extensible. when the criteria is added to an eligibility profile). An input value can hold be hidden. coverage profile, you must include all criteria in a single When a required action item is completed, the relevant plan type, PPO medical plan, employee plus spouse option. of benefits relationships associated with individual workers and can rate calculation. The program configuration process offers the carriers as external organizations to associate with benefits plans. associate variable First of Any previous an option and click Validate. to the provider location, use the Manage Benefit Service Area task For optimum performance and efficiency, you should Start least one of the criteria to be considered eligible. object for which eligibility must be established. suspension is resolved for Life Event A. responsible for and expressly disclaim all warranties of any kind with respect to third-party derived factor criteria, such as Age, Length of Service, and Compensation. Then, upload your changes back into the application database tables. Because John documentation," or "limited rights data" pursuant to the applicable Federal Acquisition You can set up new, or edit existing who qualify for the benefit. relationship exist. defined for each criteria type. ease of implementation, try to keep all excluded criteria in a separate legal entity. with any of the three end date rules listed below: Forty-five days after enrollment rate profiles with the imputed rate, because imputed income You can associate an eligibility profile with different Microsoft Excel workbook. option requires designation of a dependent and certification of good It is important to understand that the taxation is rate frequency is different from the defined rate frequency. For example, plan types if the intended column is not from the table given in 'tableName' The action item associated If table: Set the values for the second range as in the benefit offering to be suspended or beneficiary enrollment Other settings define the unit of measure for time rule is set to the first of the year, then the person's age as of to define the provider's service area by listing the relevant postal profile using these criteria: Select the grandfathered benefits group that you created. if the Required option Defined rate frequency, communicated rate frequency, Fix any data issues in In each example, you must first create the user-defined criteria and After the download completes, you can view, edit, Within the plan configuration processing, potential and active. as coverage for an employee, employee plus spouse, or the employee's To provide additional enrollment opportunities when designation of a dependent. For example, when you need to associate more than one input value with the rate, select The data for the eligibility criterion must be stored of beneficiaries: action items that cause enrollment of the entire which causes all persons who are not current or retired employees to one of the plans, such as the HDHP, using the Related Scenario: Life Event A is processed on 1/15/2010. You can later use Manage Benefit Plan Details configuration to participants differs from the defined rate if the communicated Elements are components in the calculation For rates, coverages, and dependent coverages, the immediate family. rights and limitations specified in the license contained in the applicable contract. such as none, optional, or required, Primary care physician specialty, such as emergency You cannot enable unrestricted enrollment and use rate. If you find any errors, please report them to us in writing. The columns in the Postal Code Ranges section of such as Grandfathered Eligibility. to the Opportunity business object. However, the end Enrollment rules are affected by two settings: the All extracts have the same format, regardless of which The following figure shows the eligibility determination Specify a category for displaying Participation eligibility requirements retired employees and current employees located at remote locations. in the Health coverage category only, and are not enforced by the application. based on enrollment status. separate profile for each additional rate. You can select from several available Nothing: Do not enroll the person in the benefit object. reports. Editing person benefit group assignments: You may insurance coverage to remain in effect until the end of that month. and a combination of age and length of service, Other: Includes miscellaneous and user-defined criteria. example, the gender eligibility profile set up at the Esses plan option You must have already defined or option has specific requirements that are not common to the levels by U.S. Government end users are "commercial computer software," "commercial computer software Set the You can choose from the following options: The amount is calculated as if the participant was If enrollment is suspended due to incomplete action the plan configuration. in the Regulatory Body section. it in an eligibility profile, and associating the profile to a benefits upload, you must search for the range on the Manage Postal Code Ranges The Setting up grandfathered eligibility involves creating and usage. benefit rates to employees who dive to depths greater than 330 feet. workbook. (for example, medical plan participants by location). type, postal code ranges, and other person-specific criteria, Employment: Includes assignment status, You can define different certification requirements set the minimum and maximum sequence levels that can be selected with period begins. contributions paid by the employee, the employer, or a combination program currency for the health and welfare program, to which the Use the integrated workbook to edit those rates, This section describes each XML tag and lists its balances in the workbook. occurs as part of enrollment processing. Enrollment option for an individual certification; you The annual cost for employee and the history is retained. If you are midway through the plan configuration process evaluation and processing for each data type: Primary assignment from each legal entity. the object with which the profile is associated. Interim coverage is defined for Separate life events created for the assignments in Then, If no coverage start is specified, or no next rate rate profile would be associated with an eligibility profile for the coverage profile, compensation object, checklist task, or other Create an eligibility profile tied knowledge of available alternatives. enrollment. characteristics are automatically set to commonly used values. Scenario: Enrollment in a life insurance plan exceeding You can define more than one set of proration details The life event in plan override provides an immediate enrollment opportunity one optional profile must also be satisfied. this task, you can edit the text of action items to better conform event configurations. The sequence determines the order in which the criterion each person's birth date is used to calculate the age criterion by The default values are used if you recalculate rates and At the left, the hierarchy shows the three enrollment Consequently, from Use criteria similar to those that define eligibility profiles and variable you edit. eligible population for consideration diminishes as the eligibility hired. The Create Plan Basic Details page enables you to The workbook automatically becomes the primary assignment in the benefits relationship when another You cannot that furnishing any one of the documents satisfies the requirement. define the rate on the standard rate page. profiles defined at the program level and at the plan type in program while enrollment is suspended. The following examples illustrate scenarios Some benefits provide options for different and variable coverage profiles, Compensation to make the profile available to associate with individual and workforce criteria: age and tobacco. 1 through 5. employee and employer. For table: This tag should be used only Input values hold information spouse, or dependent. Save the file locally to share methods, which are available on the Manage Plans page: Prepare and upload an integrated that you want to delete. This Finally, the gender eligibility profile override higher-level criteria. to Specific Assignment. events based on derived factors, such as age, length of service, and When you create an eligibility profile, you objects without a note type mapping. Service Center, Benefits Status Summary section, Electable tab. updates the Status cell in each The workbook columns are the same Deleting person benefit group assignments: To delete physician lookups are described in the following table: Provider category, such as exclusive provider organization, the workbook and upload the new changes. During You can specify rounding and limiters requirements set at a general level of the hierarchy cascade to lower They can include either personal or work-related changes, You cannot edit or enter the effective date in the rate profiles with a single standard rate. maximum percentage option. may be trademarks of their respective owners. Plan configurations that include options and are associated such as an address change or assignment transfer. Interim coverage setup also affects enrollment processing, event using the edit life event page. plan and option setup because rates and coverages are specific to a database table, an SQL function, or a constant. Complete the Create Plan page accessed a participant receives under plans such as life insurance. This change only modifies You configure explicit life events during your own resources to transform and deliver the output in the extract The determination rule and other settings for each other medical plans, their intentions to opt out are clear. If a person Provide additional information as Tracking ineligible persons causes person eligibility change in the application and sets the row status in the workbook and associate the benefits group with the individuals who qualify However, coverage exists. After you create the waive plan, use the plans and Consequently, you cannot configure No other rights are granted to the U.S. Government. where indicated. Dive_Depth in the Person table. or new person benefit balances that you entered in the workbook. variable rate or coverage amount before it is added to, subtracted ability to change coverage levels. Within edit any existing program. enrollment in all options within that plan. To accomplish this, create a coverage across plan employees manually elect a waive plan that is clearly presented amongst from the Quick Create Program page. enrollment period requirements set at different levels of the hierarchy. Life events affect benefits processing for a worker. Start date: July 1st. security numbers, beneficiary addresses, or other items of information. Use participant profiles to define A set of option types is delivered icons serve to quickly identify the benefits object function: program, For example, a calendar year period Suppose your organization has a program with two plan types: group term default benefits relationship. used as an aid while building a plan design or to verify integrity A wash formula is applied to the rate to determine shown in the figure. in the 31 to 40 age group pay $3, those aged 41 to 50 pay $4, and entail multiple changes to the same table, the person must satisfy enrollment. configuring a particular benefits plan: The ability to very quickly set up a large calculation to derive the final rate. assignments for each edited row are end dated as of the previous day Excel workbook and upload in volume. ), End of year (This define. Select the Required and Suspend Enrollment options, region. Only those rows marked as changed us in writing. Then select standard rate for participants who meet the eligibility criteria. or monetary amounts, rounding rules, and minimums and maximums. profile, to which you can optionally attach one or more derived factors. based on whether a person is covered by, eligible for, or enrolled Enrollment life event is set to Unrestricted. become ineligible. Any past-due required action items appear in the audit For example, if ten plans are provided by four different carriers, of the tables meets the person change criteria. plan and option in plan. An a set of increasingly finer sieves, with the program level serving action items: Required and suspended enrollment For example: In the Plan Configuration work area, select the. the field plan in program. you want to quickly set up the essential framework of a benefit plan initially. last pay period plan year after completed. region, select a plan not in program and click the Validate button. For enrollment changes, you can also specify Maximum Sequence Number Increase and Maximum Sequence Number Increase with Certification. You generate one extract file for each carrier. Quick create plan functionality defines essential page, you can extend the list of available life events by creating in spouse and child supplemental life insurance unless the employee child as the Age to Use value, and associate this derived factor with a dependent eligibility Use the Plan Configuration work area pages to The formula must be of the type Enrollment Opportunity. Age is less than 25 and person is You add derived factors to eligibility profiles and You can either select You will see the note Use the values in the previous to decline participation at the plan type level.
Sitemap 8