Maintaining medical benefit plans and profiles is very important in order to have 1094's and 1095's populate accurately for ACA purposes. Any time an employee is hired, terminated, or changes their benefit plan, adjustments need to be made.
Medical deductions should no longer be added/edited. Medical plans are directly linked with medical deductions. When a medical plan is added to an employee, a deduction will automatically be added based on the employee’s coverage level. After adding a plan, always check an employee's deduction to ensure it is calculating as expected.
If for any reason an adjustment needs to be made to the deduction amount, please contact your CSR. These changes should no longer be done at the payroll level since changes will affect ACA.
Adding a Benefit Profile:
When an employee is hired and will be eligible for benefits after the waiting period, assign a "Non-Benefits Eligible" Benefit Profile during the hiring process. After the waiting period is completed you will update the employee’s Benefit Profile with an effective date they become eligible.
After the employee has completed the waiting period, on the MAIN tab of the employee profile, go to the Profiles section and select the link Manage Profiles. Under the Benefit section select , this will add an additional Benefit Profile to display the employee’s history.
Click the lookup icon to select the appropriate Benefit Profile and then add the date the employee will be eligible to receive benefits. (example: An employee is hired 1/5/2021 and is eligible to receive benefits the first of the following month after 60 days, they are then eligible on 4/1/2021). Then click ‘Save’ to update your settings.
The employee should list two profiles, one "Non-Eligible" profile with an Effective Date 12/31/1900 (beginning of time) and another profile stating their “eligible” profile with an Effective Date they are eligible.
Creating Account Contacts
Account contacts will be used when an employee selects a Benefit Plan that has dependents/beneficiaries. To add an Account Contact, go to the MAIN tab, then click the "Jump To" link on the left for the Account Contacts section. Click in the in the top right of the widget to add a contact.
A sub-window will appear to enter the contact information:
#1: Contact Type: If this is a dependent or spouse ensure you check “Dependent”
#2: First Name and Last Name: **Required**
#3: Relationship: If the option you need is not in the drop-down, you can type directly into this field. **Required**
#4: Social Security: **Required**
#5: Birthday: **Required**
#6: Full Time Student: **Required**
Click at the bottom of the sub-window to complete adding the dependent/contact.
Adding Benefit Plans:
Upon eligibility, you must add to the system whether an employee chose to enroll or waive coverage. In the employee's information screen, under either the HR tab (if applicable) or the Payroll tab, select the "Jump To" link on the left for Benefit Plans.
Within the Benefit Plans widget select link on the right. This will pull up all your available benefit plans.
In the sub-window, enter the Effective From date for the benefit plan that reflects the date the employee became eligible for benefits. Then select the lookup list icon to choose a benefit plan from your list. You can utilize the Search option in the top right to search for a plan by name (i.e. “Kaiser"), then select the radio dial next to the Coverage Name and Benefit Plan Name you want to enroll or waive. Once a selection is made, click in the sub-window
This will pull up a new window. The Benefit Plan Effective From dates are the dates of the benefit plan year - those cannot be adjusted. You must add the Deduction Effective date and Coverage Effective dates. The Coverage Effective From date should be the same date the employee is eligible for coverage. The Deduction #1 Effective From date should be the effective date of the deduction (generally both list the same date).
Select in the top right corner.
If you choose a Benefit Plan that has dependent(s) you will either ADD CHILD and/or ADD SPOUSE in the Dependents/Beneficiaries section. Select to choose an existing dependent or to add a new dependent
Then select the Effective From date to add this dependent. The Effective To date should remain as 12/31/999, unless the child(ren) are beyond 26 years of age.
Then select to save the benefit plan assignment
Court-Mandated Benefit Coverage:
If an employee has a court order to provide coverage for a specific dependent, you can add this court order by going to Team>Court Mandated Benefit Coverage. Click on the top right and select the employee. You can then enter the order details:
• Effective Dates: These are the From/To dates of the court order.
• Dependent: Select the dependent under the court order. Only one at a time can be selected since the Effective To date
can vary among dependents. So if there are multiple dependents, multiple entries will need to be created.
• Benefit Plan Types: Select one or more benefit plans for which the employee is required to provide coverage.
• Comments: Enter any supporting information here.
If the employee has a Court Mandated Benefit Coverage active for a specific plan type, you will only be able to add a coverage level for that plan that includes the dependent they must have covered. For example, if they have court mandated Medical coverage for a child, they must be enrolled in EE+Child(ren) or EE + Family, or you will get the error message below.
Once the correct coverage level is elected, the dependent will automatically be added to the plan.
If the court order expires during the Coverage Effective Dates, the dependent from the court order is NOT automatically removed from the coverage. The dependent's coverage can be updated or removed manually from the employee's plan.
If an employee already has a current benefit plan active and a new court order is added, a warning message will display: Court Orders will be enforced when new plans are added to the employee. Please review employee's current benefit selections to ensure dependent is added to any applicable plans.
If an employee chooses to add, cancel or change coverage during the year, this must be updated in the benefit plans section of the system.
Example: An employee is currently enrolled in the employee only plan and has a life change event. The employee now enrolls in the employee + family plan effective 7/1/2021.
First, you must end-date their current plan. Do this by selecting the Actions ellipses button to the right of the plan, then select ‘View/Edit’.
You will then need to end-date their Deduction Effect To date and Coverage Effective To date to be the day before their new coverage begins (i.e. 6/30/2021, since the EE+Family will begin 7/1/2021)
Select in the top right corner.
Select in the Benefit Plans widget to add a new plan and select their new plan/waiver.
In the sub-window, enter the Effective From date for the new benefit plan that reflects the date of enrollment (i.e. 7/1/2021 is when EE+Family coverage will begin). Then select the lookup list icon to choose a benefit plan from your list. You can utilize the Search option in the top right to search for a plan by name (i.e. “Dental”), then select the radio dial next to the Coverage Name and Benefit Plan Name you want to enroll or waive. Once a selection is made, click in the sub window
You can then see plans by selecting the view for "All" to see enrolled plans or select the button to see waived plan enrollment.
Terminating an Employee:
When an employee is terminated, you must end-date their benefit plans to be the last day of coverage of the month they were terminated. This is done from the employee's profile under the 'Benefit Plan' widget, while active the employee will list an 'Effective To' date as the end of time (12/31/9999) this will need to be updated, without HRIS this date cannot be automatically applied.
- Example 1: If a benefit plan year is from 12/1/2019-11/30/2020 and an employee is terminated 1/12/2020 the benefit plan must be end-dated 1/31/2020
- Example 2: If a benefit plan year is 12/15/2019-12/14/2020 and an employee is terminated 1/12/2020, coverage must be end-dated 1/15/2020.