Building Automated Benefit Programs

This chapter provides an overview of benefits programs and discusses how to:

• Build benefit programs with the Benefit Program table.

• Work with flexible credits.

• Set up cross-plan validation.

Understanding Benefit Programs

Use the Benefit Program table to bring together all of the information that relates to a benefit program and to set up your benefit programs for automatic enrollment processing.

First, build the foundation by setting up base benefit information:

1. Define benefit deductions using the Deduction Table - Setup page.

2. Identify benefit plans using the Benefit Plan Table page.

3. Identify benefit providers using the Provider and Vendor Table - Vendor Information page.

4. Define benefit coverage using the Coverage Codes - Coverage Code Tbl page.

5. Establish rate tables using the Age-Graded Rate Table page, the Salary Rate Table page, the Service Rate Table page, and the Flat Rate Table page.

6. Establish calculation rules using the Calculation Rules Table - Calculation Rules page.

Next, build your Automated Benefits program:

1. Define the benefit program using the Benefit Program Table pages.

2. Link your plan types and options.

3. Attach event and eligibility rules.

4. Define costs and credits.

See Also

Setting Up Deduction Codes

Setting Up Benefit Plans

Setting Up Rates and Premium Limits

Setting Up Calculation Rules

Setting Up Vendors

Building Benefit Programs with the Benefit Program Table

To set up benefit programs for automation, use the Benefit Program Table (BEN_PROG_DEFN) component.

This section provides an overview of building benefit programs and discusses how to:

• Define benefit programs.

• Set up plan types and options.

• Calculate costs and credits.

Understanding Building Benefit Programs with the Benefit Program Table

Building benefit programs through Benefits Administration is the same process as with the base benefit process. When you create a benefit program through Benefits Administration, the program type will be Automated and a number of fields will be available for use that would otherwise (in the case of a Manual benefit program) be closed to the entry of data.

Important! If you're planning to set up an automated benefit program that will be used for automatic benefits eligibility and enrollment processing, you must go to the Installation Table - Products page and select Benefits Administration before creating the program. You can't create an automated benefits program until Benefits Administration is selected.

See Also

Building Base Benefit Programs

Pages Used to Build the Benefit Program Table

Defining Benefit Programs

Access the Benefit Program Table - Benefit Program page.

See Also

Building Base Benefit Programs

Setting Up Plan Types and Options

Access the Benefits Program Table - Plan Type and Option page.

Use the Benefit Program Table - Plan Type and Option page to set up the basic plan types for your benefit program.

Use the Self Service Configuration group box with PeopleSoft eBenefits.

See Setting Up eBenefits.

This table displays the field requirements for the Plan Type level of the Plan Type and Option page for the Benefit Program Row (Plan Type 01) and the Benefit Plan rows (Plan Types 1x-9x):

After you set up a plan type on the Plan Type and Option page, select the plan options that you want to associate with the plan type.

Associating Plan Options with Plan Types

Use the Benefit Program Table - Plan Type and Option page, and the Eligibility tab in the Option group box, to set up the options within a plan type.

When you create a new option row by clicking the Insert Row button, the system automatically assigns the option a unique option ID value. You cannot update this value.

The first value that you enter for a new option row is the option type. Select from one of the following valid values:

Note. The manner in which you fill out the rest of a given option row depends on the plan type the row belongs to and the option type of that row.

Field Requirements for the Option Grid by Plan and Option Type

This table describes field requirements for the Option Grid by Plan and Option type:

Option Type Designations Allowed Per Plan Type

This table describes option type designations allowed per plan type:

Setting Up the Benefit Program Row (Plan Type 01)

Access the Benefit Program Table - Plan Type and Option page: Eligibility tab.

A Benefit Program Row is required for all automated Benefit Programs. The eligibility rules established for plan type 01 govern the entire benefit program.

Calculating Costs and Credits

Access the Benefit Program Table - Cost page.

Cost Type

Each option can have one price element defined, while options and general credits can have multiple credit elements defined. Select from the following values: Price: The system calculates deductions for employees who select this option according to the deduction code that you identify for this benefit option. Credit: The system calculates earnings for employees who select this option according to the earnings code that you identify for this benefit option. The system assigns the frequency of the additional pay based on the deduction code that you identify for this benefit option.

Note. You can also go to the Benefit Program row (plan type 01) and use the Cost page to define general flexible credits for the Benefit Program.

Warning! The Earn Code for each benefit plan type within a benefit program must be unique. Otherwise, flexible credits might not start and end correctly during Benefits Administration processing.

Rate and Calculation Rules Requirements

This table describes rate and calculation rules requirements:

Note. In almost all cases, agencies in the U.S. Federal Government do not use general credits, and do not use the cost type of credit when designing benefit programs.

See Also

Building Base Benefit Programs

Creating Event Rules

Working with Flexible Credits

This section provides an overview of working with flexible credits and discusses how to use flexible credits to achieve your Benefits Administration goals.

Understanding Flexible Credits

You can define three kinds of credits for your employees:

• General credits that apply to all participants in a benefit program.

• General plan-based credits that apply to individual plan types.

• Option-based credits that employees receive because they have chosen a specific benefit plan option.

When you run the Open Enrollment and Event Maintenance processes, the system calculates the value of the credits using the earnings codes that are associated with them. It will sum all the credits by earnings type for each employee, regardless of whether the credits are general credits or option-based credits, and pass the total credits by earnings type to payroll. PeopleSoft Payroll treats these credits as additional earnings for an employee.

Note. Be aware that you must associate the earnings types you set up with the earnings program to which an employee belongs before they can be processed by your payroll system.

See Also

Establishing Earnings Programs

Setting Up FEGLI Codes

Pages Used to Work with Flexible Credits

Using Flexible Credits to Achieve Your Benefits Administration Goals

This section provides examples of how to:

1. Define credit for employees who enroll in a particular plan type.

2. Encourage employees to elect employee-only coverage.

3. Define credits for participants who waive coverage.

4. Define credit amounts based on employee health coverage.

5. Set up life or disability plan-based credits according to level of life coverage.

6. Set up life plan credits based on a flat dollar amount.

Example 1: Defining a Credit for All Employees Who Enroll in the Plan Type

Suppose you want to give all of your employees a general plan-type credit to help offset the cost of coverage, regardless of the benefit plan option within that plan type in which they elect to enroll. Start by adding a new rate schedule to specify the credit amount on the Flat Rate table, and enter a G row for the plan type credit.

1. Access the Flat Rate Table page.

   Add a new rate schedule for the credit amount.

2. Access the Benefit Program Table - Plan Type and Option page.

   Enter a G row for the plan type credit.

3. Access the Benefit Program - Cost page and enter Credit as your cost type and reference the new rate schedule created for plan type general option.

Example 2: Encouraging Employees to Elect Employee-Only Coverage

Suppose that you want to encourage employees to elect employee-only coverage in a medical benefit option. One way to do this is to give your employees an option-based credit equal to the cost of coverage, effectively making the benefit plan employer-paid.

1. Access the Benefit Program Table - Cost page, insert a new row, and enter Credit as the cost type value.

2. You must also enter the same rate type and rate table ID that you used for the Price row. The system calculates the credit using the same rates and calculation rules it used for the Price row; therefore, the amount credited is equal to the amount deducted.

Example 3: Defining Credits for Participants Who Waive Coverage

Suppose that you want to give a credit to your employees who waive coverage in any health benefit plan.

1. Access the Flat Rate table.

   Define the amount of the credit for waived coverage.

2. Access the Benefit Program Table - Cost page.

   Insert a row for the waived coverage credit.

3. Enter Credit as the cost type value on the Benefit Program - Cost page. This is the flexible credit that employees will receive when taking the waive option.

Example 4: Defining Credit Amounts Based on Employee Health Coverage

Suppose that your company offers employee - only medical coverage at a cost of 50 USD per month and family coverage at a cost of 100 USD per month. You want to give all employees, regardless of whether they choose employee only or family coverage, a credit equal to the cost of employee only coverage.

Follow the process outlined in example 2. When you set up the option-level flexible credit for the family coverage, use the rate table designed for the employee-only benefit.

Example 5: Setting Up Life or Disability Plan-Based Credits According to Level of Life Coverage

Suppose you have three Life benefit plans: a basic life plan, a one times salary plan, and a two times salary plan. Define option-based credits that will provide the same credit as the one times salary option regardless of the coverage level the employee chooses.

Use the option type General Credit to set up flexible credits for Life and Disability plan types that provide the same credit no matter which coverage level an employee chooses.

1. Access the Benefit Program Table - Plan Type and Option page.

   Set up an option type row with a General value. Give it the same deduction code as the other life plans.

2. Access the Benefit Program Table - Cost page.

   Enter a Credit cost row for the general credit. Give it the same rate type and rate table ID as the one times salary life plan option.

Example 6: Setting Up Life Plan-Based Credits According to Flat-Dollar Amounts

Suppose that you want to define a plan-based credit equivalent to 50,000 USD of coverage regardless of the life coverage level that the employee selects.

1. Access the Benefit Plan table.

   Define a special 50,000 USD Basic Life Benefit Plan.

2. Access the Life/Accidental page.

   Complete the life plan definition of the 50,000 USD Life Benefit Plan.

3. Access the Benefit Program Table - Plans and Options page.

   Create a General row for the 50,000 USD Life Benefit plan. Give it the same deduction code as the other benefit plan options.

4. Access the Benefit Program Table - Cost page.

   Enter Credit as the cost type for the General credit. The Credit cost row should reference the appropriate rate schedule, earnings code, and set of calculation rules.

Setting Up Cross-Plan Validation

You use the Benefit Program Table to set up cross-plan validation. This section discusses how to:

• Set up cross-plan validation checks for plan types.

• Use the Load Cross Plan Values page.

• Set up and add cross-plan validation for domestic partners.

Note. You cannot enter cross-plan validation rules for the Benefit Program (plan type 01).

Pages Used to Set Up Cross-Plan Validation Checks

Setting Up Cross-Plan Validation Checks for Plan Types

Access the Benefit Program Table - Plan Type and Option page: Cross Plan tab.

Cross Plan Type	Identifies the controlling plan that the employee or dependent must be enrolled in before they are eligible for enrollment in the option being defined. This field is required for all other cross-plan validations.
Cross Benefit Plan	The “controlling” benefit plan that is required for an employee to elect this option. If this field is blank, then any election in a benefit plan within the Cross Plan Type field meets the criteria for cross plan validation.
Coverage Limit Pct (coverage limit percentage)	Used primarily for life plan options to place a limit on the amount of the coverage the enrollee (employee or dependent) can receive. This field becomes available after you attach a cross-plan type to a benefit plan. Note. During Benefits Administration validation processing, the system will check to ensure that the coverage elected or afforded under this benefit plan does not exceed the specified percentage of the coverage elected or afforded under the Cross Benefit Plan.
Check Dependents	When selected, this option informs the system to check that potential dependents (for the specified benefit plan or option) are also enrolled as dependents for the specified Cross Benefit Plan. This only available to 1x plan types and becomes available after you associate a cross-plan type with a benefit plan.

Using the Load Cross Plan Values Page

Access the Load Cross Plan Values page.

This page is a data entry aid to enable you to replicate common cross-plan validation criteria to a large number of options, rather than individually specifying the criteria for each option row.

Note. Use the Load Cross Plan Values page to clear the cross-plan validation values for a plan type. Access the Load Cross Plan Values page, select blank values for the fields that you want to clear from Cross-Plan Dependent Enrollment, and click OK. The system clears the fields that you selected.

Setting Up and Adding Cross-Plan Validation for Domestic Partners

Access the Benefit Program Table - Plan Type and Option page and select the Cross Plan tab in the Option group box.

Setting Up Non-Qualified Dependent Plans

In order to create a benefits system that accommodates and processes benefits for nonqualified dependents, set up separate health plan types and identify them as nonqualified health plans. PeopleSoft delivers the following three sample nonqualified dependent plans:

If you're setting up a life plan for domestic partners and other nonqualified dependents, use a Dependent Life plan type.

Note. Keep in mind that the IRS considers all of the benefits received by nonqualified dependents to be taxable income. This means that the IRS will tax employees for the employer-paid portions of nonqualified health benefits, and it will also tax all of the benefits that nonqualified dependents receive from dependent life plans. In both cases, the system will perform imputed income calculations.

Employees can enroll both qualified and nonqualified beneficiaries into a dependent life plan. However, when nonqualified beneficiaries are mixed with qualified beneficiaries in a dependent life plan, the IRS will tax all of the beneficiaries as if they were nonqualified, which means that they will all lose the "2000 or less" de minimus fringe benefit.

Adding Cross-Plan Validation Rules to Domestic Partner Plans

When you design a benefit program that will enable employees to offer health and life benefits to domestic partners and other nonqualified dependents or beneficiaries, set up rows for nonqualified dependent health plan types—such as NQ Medical and NQ Vision. Your employees must elect both an ordinary health plan type to provide health coverage for themselves and their qualified dependents and a complimentary NQ health plan type to provide health coverage for their nonqualified dependents.

Use the Cross-Plan Validation feature to set up a Cross-Plan Type check on your NQ Medical, NQ Vision, and NQ Dentalplan types that prevents employees from enrolling in an NQ health plan type if they are not enrolled in a regular health plan type.