Establishing Basic Parameters

The plan description in Spanish.

The cost basis associated with premiums and contribution amounts for the benefit plan.

Refer to this field when changing premium rates or assigning employee overrides.

Companies may offer their employees a set amount of life insurance coverage and the option to buy more at the employee's expense. The manual premium calculation enables you to manually enter the employee's individual premium and contribution on the employee enrollment record. Manual premiums can also apply to some medical plans that do not have set premiums.

Whether the employee can waive the benefit during an enrollment. (PrismHR Benefits Enrollment only.) This option must be used with other settings in the system. See for more information.

One of the following options:

Whether the benefit can be elected for flexible spending plans.

Whether the benefit plan can be elected for COBRA coverage.

Specify a ruling state or U.S. territory for state continuation of coverage or mini-COBRA offerings within the Benefit Plan. This field is for informational purposes only in PrismHR. PrismHR Marketplace partners use this data via PrismHR’s API for state continuation or mini-COBRA offerings through their services.

Note: If you set a state in the State Continuation field, we recommend also checking the COBRA Electable checkbox located directly above the State Continuation field. This ensures coordination with federal continuation, where applicable.

Set this flag if the service provider is responsible for updating carrier eligibility information such as enrollments, terms, coverage modifications, or other changes which may affect carrier eligibility. Once you flag the plans, you can use this information to create a report in Report Center showing a list of plans where the Carrier Eligibility Management checkbox is set.

Whether the benefit plan has a high deductible that may entitle the employee to participate in a health savings account (HSA).

Whether the benefit plan is employee-only. When this option is selected, the employee contribution must be defined as a percentage of the employee's earnings when the employee contribution rules are set up in the Benefit Rules form.

This option must be enabled in System Parameters with the custom feature code SHOWSINGLEGROSSWAGE.

Select this checkbox to set the Percent of Gross Wages as the employee contribution towards a medical plan (employee premium only). Clicking this checkbox will display the multivalued grid where you can enter an Effective Date along with a Percent of Gross Wages which will be used as a default setting.

Note: To select the Allow Gross Wage % Contribution Method checkbox please ensure that the following checkboxes have been unchecked:

Additionally, you can select this checkbox only if the Cost Basis field is set to either Monthly, Quarterly, or Yearly. If it is set to Weekly, then a message stating This feature is not compatible with a Cost Basis of Weekly is displayed.

Whether the Group Benefit Plan is of the PEO’s Master Benefit Plans.

Whether the benefit plan is client-sponsored.

Whether premium rates are maintained separately for each rate group.

The Deduction and Bill Code is displayed in a tabular format that represents the billing or deduction this benefit plan uses.

This table has the following rows:

The table has the following columns for each of the Deduction or Bill Codes:

Please note the following validations with regard to the display of different deduction and bill codes:

Note: If you do not enter or select a Benefit Plan ID, then clicking any of the deduction or bill codes hyperlink in the table will display an error message stating, Benefit Plan ID is mandatory.

An associated domestic partner plan (if any) to link to this plan. The system reports the domestic partner as a dependent. If your organization uses Benefits Enrollment, the domestic partner plan require that you set up a dependency.

Select the offer type that classifies the benefit plan according to offer type and assures that the plan displays in the correct form in enrollment workflows. (PrismHR Benefits Enrollment only.) The Offer Type field will only show the list of compatible options based on the selection made for the Insurance Class field on this form.

When you select Offer Type other than Voluntary, then the Insurance Class field will automatically be assigned to corresponding insurance class without any manual intervention.

Note:  The Offer Type field becomes a required field from the Q1 2025 quarterly release. So from now on, you will get a warning message when you enter a plan with a blank offer type in any of the following forms:

Use the Offer Types Import Template on the Data Import Tool to update the Offer Types field for existing Benefit Plan IDs on the Group Benefit Plans form. If you try to modify any other field using this process, you will receive an error.

There are seven insurance classes that can be assigned to a Group Benefit Plan. The corresponding Offer Types are as follows:

Insurance Class: Medical

Insurance Class: Dental

Insurance Class: Vision

Insurance Class: Life Insurance

Insurance Class: Short-Term Disability

Insurance Class: Long-Term Disability

Insurance Class: Other

Insurance Class: Bond

Note:

When no Insurance Class is available, the Offer Type dropdown lists --Select One-- as the only option.

For an existing Offer Type in PrismHR which is not compatible with the Insurance Class selected, PrismHR will now display the words (Not Valid) next to the Offer Type name. If you try to save a Group Benefit Plan record which has a non-compatible Offer Type, the following message displays:

Offer Type “XXXX” is not compatible with the current Insurance Class.

Select a compatible Offer Type from the dropdown or set this field to the default value of “--Select--”. Once you select a compatible Offer Type, the invalid Offer Type is removed from the dropdown list.

Whether to include the group benefit plan in the EDI file feed.

Note: The system only uses this field for reporting/tracking purposes.

Informs the clients whether the plans are client-paid while setting up benefit rules.

When you select this checkbox, the system checks for any clients to which the plan is currently assigned to and displays a warning message stating, Important Notice: You currently have <number of clients> active Clients associated with this plan. We strongly advise reviewing the Benefit Contribution Rules to ensure your plan aligns with the selected requirements. Would you like to go to Clients Assigned To to see the list of associated Clients?.

Note: When you select this checkbox, then on the Benefit Rules form, if the following validations are not met:

then, while saving the benefit rules, a warning message stating, This plan configuration prevents employee contributions, please review the Contribution Rules and verify the plan meets this requirement. is displayed.

Similarly, on the Benefit Rules Import form, the above mentioned validation is reviewed. If you select the Do Not Allow EE Contribution checkbox, then the system checks the import file data to ensure a valid setup is entered and a warning message stating The plan configuration for <Plan ID> prevents employee contributions, please review the Contribution Rules and verify the plan meets this requirement. is displayed.