Defining Plan Level Setup

In the Define Plan Level Setup panel, you can use the following tabs to set up benefit plan details for specific benefit plans offered during enrollments.

Use this tab	To do this
Plan Details	Enter plan specific information to go with the options set up in Comparison Fields for the benefit plans you offer to employees during enrollments.
Documents	Attach a Summary of Benefits Document and additional Supporting Documents to the benefit plan record.
Plan Dependency	Set up dependencies at the plan level.
Terms & Conditions	Enter content for terms and conditions that the user must acknowledge. This content displays for all confirmation forms

To set up plan details:

1.

Click Back Office.

2.

From System|Change, select Benefits Enrollment Plan Details.

3.

In What would you like to do today? select Define Plan Level Setup > Plan Details.

4.

Select the Offer Type, Plan Description, and Effective Date for the benefit plan to configure. You can enter multiple effective dates as needed for the benefit plan selected in the Plan Description list. Each effective date creates a new record, allowing you to enter contribution information on the same benefit plan for different enrollment periods. You also have the following options:

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To enter a new effective date for the plan, click New Date.

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To copy all settings to a new effective date and create a duplicate record, click Copy Date.

Defining Plan Details

To enter plan specific information for the benefit plans offered to employees during enrollments, use the Details tab.

To enter specific information about a benefit plan:

1.

Select the Details tab.

For this option	Define this information
Field	The benefit plan information options for the offer type set up in the Comparison Fields tab in the Define Offer Type Level Setup panel.
Value	Corresponding information about the options.

Additional Plan Details displays the following options:

Option	Description
PCP Lists	If benefit plans require primary care physician (PCP) information, the URL where employees can look up their PCP. Typically, these are health maintenance organization (HMO) medical plans, but some dental or voluntary benefit plans might also require this information. This list is shown only for benefit plans that have the Collect PCP Information option enabled in the Web Enrollments Parameters panel on the Group Benefit Plans form.
Participation Requirement	How to track carrier plan participation requirements at the system level to ensure client and employee enrollments abide by carrier guidelines. Percentages must be from 1 to 100%.
Plan Application	At the system level, you can enable employees to complete a carrier plan application through Benefits Enrollment, enter a website URL to a carrier application. When defined, the Plan Application link displays in the Required forms section of the benefit plan tile. When an employee clicks the link, the application opens in a new browser window. Note: This feature is only for the Medical (MED), Dental (DEN), and Vision (VIS) offer types.
Description Text	Enter a description for the plan application link.
Use aggregate spouse maximum	Whether the maximum coverage for the employee's spouse should not exceed the aggregate coverage amount of an employee’s basic and additional life insurance plan selections. You must select Require Basic Life Enrollment if you select Use Aggregate Spouse Maximum.

Attaching Documents

To attach a Summary of Benefits document and additional supporting documents to the benefit plan record, use the Documents tab.

Life insurance and disability plans display an additional option to attach an Evidence of Insurability (EOI) form. If you attach an EOI form, you must also enter an Evidence of Insurability Message to display during enrollments.

Before you begin:

•

Upload files you plan to attach to the benefit plan to the Document Repository.

To attach documents to a benefit plan:

1.

Select the Documents tab.

2.

In Summary of Benefits Document, click Add and select a document from the search list that opens.

3.

In Supporting Documents, click Add and select a document to attach from the search list that opens. You can repeat this step to include additional supporting documents.

The names of the selected documents display in Summary of Benefits Document and Supporting Documents.

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To update an attached file, click (Edit), make changes if necessary, and then click Upload New Version.

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To remove an attached file, click (Delete).

Setting Up Plan Dependencies

To set up dependencies at the plan level, use the Plan Dependency tab. For example, a domestic partner medical plan that you select might require the employee to enroll in a specific medical benefit plan as well.

If this dependency is set up at the plan level, you can specify which benefit plans are required. The employee can select only those benefit plans.

To set up plan dependencies:

1.

Select the Plan Dependency tab.

2.

In Offer Type, select the offer type.

3.

In Plan Description, select the benefit plan to use as a dependency.

4.

Click Add. The specified plan displays as a dependency in the table.

•

You can add as many dependencies as needed. The benefit plan being viewed in the form requires enrollments in one of the specified dependencies.

•

To remove a dependency, click (Delete).

5.

You can specify an additional tier-based dependency as needed. Tier-based dependencies further limit which benefit plans are available to employees during enrollments:

The option to set up additional dependencies is available only in offer types that use tiers. It is not available in life insurance or disability benefit plans, which use coverage levels rather than tiers.

Tier	Description
Exact Tier	Dependency plans must have a tier level that is an exact match for the tier or coverage level selected in the plan that requires the dependency.
Limited Tier	Dependency plans can have a tier level that includes the tier or coverage level selected in the plan that requires the dependency.

Defining Terms and Conditions

In Benefits Enrollment, employees cannot submit their enrollment without affirming the terms and conditions. If they decline, a warning message displays indicating what they must do to proceed. After submitting their enrollment, the affirmation displays on the Benefit Confirmation Statement.

To enter content asking employees to affirm or decline the terms and conditions provided, use the Terms & Conditions tab. This content displays for all confirmation forms, based on the plan offerings.

1.

Click the Terms & Conditions tab. Complete the following:

Use this option	To define this
Display Terms and Conditions	The Terms and Conditions as defined by the carrier for the plan.
Acknowledgment Question	The employee and proxy question to show with the acknowledgment check box. • Example employee question: Have you read and understand the Terms and Conditions? • Example proxy message: Have you reviewed the Terms and Conditions with the employee? You can edit the default text in the text boxes.
Acknowledgment Response	The employee and proxy affirmation and declination messages. • Example employee affirmation: I have read and understand the terms and conditions. • Example proxy affirmation: I have reviewed the terms and conditions with the employee. • Example employee declination: I either do not understand or am unable to review the terms and conditions at this time. • Example proxy declination: The employee either did not understand the terms and conditions or I was not able to review the content with the employee at this time.

2.

Select one of the following options:

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To save settings, click Save.

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To save settings and close the tab, click Save and Close.

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To close the tab without saving settings, click Cancel.

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To delete the record, click Delete.

If you switch to another tab, the system prompts you to save any unsaved settings.

Managing Underwriting Questions

In some cases, insurance companies require employees to complete underwriting questions to enroll in benefit plans. Underwriting questions determine whether an employee can enroll in a benefit plan based on the response. For example, when enrolling in a benefit plan, the system could ask an employee, "Does this coverage replace or change any existing insurance?" Based on the response, the system could deny employee enrollment. To configure required questions for enrollment, use the Underwriting Questions option when defining plan level setup.

To add underwriting questions:

1.

On the Underwriting Questions tab, click Add. The Add/Edit Underwriting Questions dialog box displays.

2.

Complete the following:

Use this option	To define this
Question	The underwriting question. The character limit is 500 characters.
Response Type	The type of response: • Yes/No: The employee selects Yes or No. • Multiple Choice: The employee selects a multiple choice option. To add multiple choice options, click . To delete multiple choice options, click .
Disclaimer	A disclaimer statement. The character limit is 500 characters.

3.

Click Save.

After adding underwriting questions, you can:

•

Click to move the question in the order of the list.

•

Click to delete the question.

•

Click to edit the question.

After adding underwriting questions to a benefit plan in PrismHR, they display in a BE workflow when electing plan coverage. The BE benefit plan tiles now have an Underwriting tab where employees can answer any necessary questions. If a benefit plan requires employees to answer underwriting questions, they cannot elect coverage until they answer.

After an employee answers underwriting questions for an elected benefit plan and submits their enrollment, the questions and responses display on the Benefit Confirmation Statement. The questions and responses also display on the employee benefits enrollment record in PrismHR. You can view this information on the Employee Benefits Enrollment form.