Understanding the Evaluation of Event Rules

PeopleSoft Benefits Administration processes all participant events by using the appropriate event rule or event classification rule for each covered plan type. Depending on the results of this evaluation, Benefits Administration either sets the participant event up for further processing or closes the event.

To evaluate events, the system runs through the following sequence for each plan type:

Benefits Administration uses the eligibility rules that you have defined to determine the participant's eligibility as of the effective date of the event.
For example, if a participant has moved from full-time to part-time status, he might be ineligible for current elections and would need to select from part-time plan options.
If the event causes the participant to lose eligibility for current elections, the event is prepared for further processing, regardless of how you defined your event rule.
At a minimum, the system terminates the participant's newly ineligible elections. If the participant selects a new election within the plan type, the prior election is replaced as of the new election coverage and deduction begin dates.
If the event rule has the Use History check box selected, the eligible options as of the event date are compared to the prior eligible options.
If the participant has gained eligibility to new options, Benefits Administration prepares the event for further processing and enables new enrollment elections.

If the event rule does not have the Use History check box selected, the Select Allowed field controls further processing of the event. For example, for a family status change, plan type 10 (Medical), Select Allowed could be set to change the coverage code only. The options prepared by the system are only those within the same benefit plan as the current enrollment.

Loss of eligibility to a current election takes priority over event rule selection for both Use History and Select Allowed. The system's selection for Use History takes priority over Select Allowed.

Recommended Event Rule Definitions for FSC and HIR Events

This table lists the recommended event rule definitions for family status change (FSC) and new hire (HIR) events:

Fields	FSC Event Class (commonly used for plan types 1x–3x, 6x)	HIR Event Class
Pre-enter	Yes.	No.
Use History	No. Typically, the event should be controlled by the Select Allowed setting.	No. If your organization uses multiple-jobs processing, you would typically select the Use History check box for the HIR event, and set the default method to one of the Current/Else settings.
Elect Required	Depends on company policy.	Depends on company policy.
Provide FlexCR Upon Default (provide flex credits upon default)	Depends on company policy.	Depends on company policy.
Default Method	Assign Cur Covrg Else Option (assign current coverage else option) and Assign Cur Covrg Else Low Opt (assign current coverage else low option) are typical selections.	Default to Lowest Elig Option (default to lowest eligible option) and Default to Option and Coverage are typical selections. If your organization processes employees with multiple jobs, use Assign Cur Covrg Else Low Opt or Assign Cur Covrg Else Option.
Select Allowed	Current Plan + Waive is the typical selection for plan type 1x. For plan types 2x and 3x, use All Plans. For plan type 6x, use Current Plan.	All Plans.
If currently Enrolled, or not participating Max Number of Change Levels (maximum number of change levels)	Use the same setting that you use for the Open Enrollment (OE) event class. This maximum number varies by plan type; 99 appears by default.	Not applicable for new hires with no current elections. The value 99 appears by default. You can set levels for hire; the system restricts what employees can choose.
Levels of Change w/o Proof (levels of change without proof)	Use the same setting that you use for the OE event class. This value varies by plan type; 99 appears by default.	Not applicable for new hires with no current elections.
Proof Required at Plan Level	Use the same setting that you use for the OE event class. This value varies by plan type; 99 appears by default. Proof required at plan level is typically used for life and accidental death and dismemberment (AD/D) plans.	Use the same setting that you use for the OE event class.
Amt. Proof Required (amount proof required)	Used for life and AD/D plans. The limit is linked to coverage amounts. The same limit by plan type is used across all event classes.	Use the same setting that you use for the OE event class.
If currently Waived Max Number of Change Levels	Use the same setting that you use for the OE event class.	Not applicable for new hires with no current elections (including waive).
Proof Required at Plan Level	Use the same setting that you use for the OE event class.	Use the same setting that you use for the OE event class.
Amt. Proof Required	Use the same setting that you use for the OE event class.	Use the same setting that you use for the OE event class.
Coverage Begins On the Event Date Month-Begin After Event Dt (month-begin after event date) On Pay Pd Begin after Event Date (on pay period begin after event date)	Depends on company policy. For FSC events, On the Event Date is a common selection.	Depends on company policy.
Waiting Period... Days Waiting Period... Months	On the Event Date is a common selection.	Depends on company policy.
Coverage Ends On the Event Date On Month-End after Event Date (on month end after event date) On Pay Pd Begin after Event Date	Depends on company policy.	Not applicable for new hires. On Event Date appears by default.
Grace Period Days Grace Period Months	Depends on company policy.	Not applicable for new hires. The value 0 (zero) appears by default.
Deduction + Flex Credits Begin 1st Full PayPd After Covg BgDt (first full pay period after coverage begin date) On CovgBegin Date (on coverage begin date) Pay Pd Containing Covg BegDt (pay period containing coverage begin date) Pay Pd Preceding Covg BegDt (pay period preceding coverage begin date)	Depends on company policy.	Do not use Pay Pd Containing Covg BegDt for HIR events. This can result in enrollments for which the benefits coverage begin date precedes the hire date. Use On CovgBegin Date instead.
Deduction + Flex Credits End On Covg End Date 1st Full PayPd after Event Dt Pay Pd Containing Event Date Pay Pd Preceding Covg EndDt	Depends on company policy.	Depends on company policy.

Recommended Event Rule Definitions for MSC, OE, and SNP Events

This table lists the recommended event rule definitions for miscellaneous (MSC), OE, and snapshot (SNP) events:

Fields	MSC Event Class	OE Event Class	SNP Event Class
Pre-enter	Yes. Common for MSC events. Saves data entry effort.	Yes. Common for OE events. Saves data entry effort.	No.
Use History	Yes. Common for MSC events.	No.	No.
Elect Required	Depends on company policy.	Depends on company policy.	No.
Provide FlexCR Upon Default (provide flex credits upon default)	Depends on company policy.	Depends on company policy.	Yes.
Default Method	Assign Cur Covrg Else Option and Assign Cur Covrg Else Low Option are common selections.	Assign Cur Covrg Else Option and Assign Cur Covrg Else Low Option are common selections, except for plan types 6x and 9x, which use Terminate Coverage.	Assign Cur Covrg Else Low Option.
Select Allowed	None. Use History controls whether the enrollment is allowed for an event.	All Plans.	All Plans.
If currently Enrolled, or not participating Max Number of Change Levels	Use the same setting that you use for OE events. This maximum number varies by plan type; 99 appears by default.	This maximum varies by plan type; 99 appears by default.	This maximum number varies by plan type; 99 appears by default.
Levels of Change w/o Proof	Use the same setting that you use for OE events. This value varies by plan type; 99 appears by default.	This value varies by plan type; 99 appears by default.	This value varies by plan type; 99 appears by default.
Proof Required at Plan Level	Use the same setting that you use for OE events. This value varies by plan type; 99 appears by default. Proof required at plan level is commonly used for life and AD/D plans.	This value varies by plan type; 99 appears by default. Proof required at plan level is commonly used for life and AD/D plans.	This value varies by plan type; 99 appears by default.
Amt. Proof Required	Used for life and AD/D plans. Limit is linked to coverage amounts. The same limit by plan type is commonly used across all event classes.	Used for life and AD/D plans. Limit is linked to coverage amounts. The same limit by plan type is commonly used across all event classes.	Used for life and AD/D plans. Limit is linked to coverage amounts. The same limit by plan type is commonly used across all event classes.
If currently Waived Max Number of Change Levels	Use the same setting that you use for OE events.	This maximum varies by plan type; 99 appears by default.	This maximum varies by plan type; 99 appears by default.
Proof Required at Plan Level	Use the same setting that you use for OE events.	This value varies by plan type; 99 appears by default. Proof required at plan level is typically used for life and AD/D plans.	This value varies by plan type; 99 appears by default. Proof required at plan level is typically used for life and AD/D plans.
Amt. Proof Required	Use the same setting that you use for OE events.	Used for life and AD/D plans. Limit is linked to coverage amounts. The same limit by plan type is typically used across all event classes.	Used for life and AD/D plans. Limit is linked to coverage amounts. The same limit by plan type is typically used across all event classes.
Coverage Begins On the Event Date Month-Begin On/Aft Event Dt On Pay Pd Begin after Event Dt	Depends on company policy. For MSC events, On the Event Date is the common selection.	On the Event Date is the common selection for OE events. The event date for OE events is equal to the period begin date for the Open Enrollment definition.	On the Event Date is the common selection for SNP events. The event date for SNP events is equal to the period begin date for the Snapshot definition.
Waiting Period... Days Waiting Period... Months	On the Event Date is a common selection for FSC events.	On the Event Date is a common selection for OE events.	Zero days and months.
Coverage Ends On the Event Date On Month-End after Event Dt On Pay Pd End After Event Dt	Depends on company policy.	Depends on company policy.	Depends on company policy.
Grace Period Days Grace Period Months	On the Event Date is a common selection for FSC events.	On the Event Date is a common selection for OE events.	On the Event Date is a common selection for SNP events.
Deduction + Flex Credits Begin 1st Full PayPd After Covg BgDt On CovgBegin Date Pay Pd Containing Covg BegDt Pay Pd ePreceding Covg BgDt	Depends on company policy.	Depends on company policy.	1st Full Pay Pd After Covg BgDt.
Deduction + Flex Credits End On Covg End Date 1st Full PayPd after Event Dt Pay Pd Containing Event Date Pay Pd Preceding Covg EndDt	Depends on company policy.	Depends on company policy.	1st Full Pay Pd After Covg BgDt.

Recommended Event Rule Definitions for TER Events

The Termination (TER) Event class assumes that the participant is not eligible for any benefit programs and that Consolidated Omnibus Budget Reconciliation Act (COBRA) enrollment is managed outside of Benefits Administration.

This table lists the recommended event rule definitions for TER events:

Fields	TER Event Class
Pre-enter	No.
Use History	No.
Elect Required	No.
Provide FlexCR Upon Default (provide flex credits upon default)	No.
Default Method	Terminate Coverage.
Select Allowed	None.
If currently Enrolled, or not participating Max Number of Change Levels	Not applicable; 99 appears by default.
Levels of Change w/o Proof	Not applicable; 99 appears by default.
Proof Required at Plan Level	Not applicable; 99 appears by default.
Amt. Proof Required	Not applicable; 99,999,999 appears by default.
If currently Waived Max Number of Change Levels	Not applicable; 99 appears by default.
Proof Required at Plan Level	Not applicable; 99 appears by default.
Amt. Proof Required	Not applicable; 99,999,999 appears by default.
Coverage Begins On the Event Date Month-Begin After Event Dt Month-Begin On/Aft Event Dt On Pay Pd Begin after Event Dt	Not applicable; On the Event Date appears by default.
Waiting Period... Days Waiting Period... Months	Not applicable; 0 (zero) appears by default.
Coverage Ends On the Event Date On Month-End After Event Dt On Pay Pd End after Event Dt	Depends on company policy. Selection is typically based on benefit claims processing agreements with carriers and participants.
Grace Period Days Grace Period Months	Depends on company policy.
Deduction + Flex Credits Begin 1st Full PayPd After Covg BgDt On CovgBegin Date Pay Pd Containing Covg BegDt Pay Pd Preceding Covg BegDt	Not applicable; 1st Full Pay Pd After Covg BegDt appears by default.
Deduction + Flex Credits End On Covg End Date 1st Full PayPd after Event Dt Pay Pd Containing Event Date Pay Pd Preceding Covg EndDt	Depends on company policy.