!!!DEFINE PLAN/COVERAGE DEFINITIONS Plans and Coverages are created in the Define Plan/Coverage Definitions (IBPN) screen. \\ \\ Maintain Plan/Coverage Definitions Usages data is stored on the [P2K_BE_PLAN_DEFINITIONS]. \\ ;[Plan|PLAN_CODE]:Plan is a user-defined code uniquely identifying the plan to the organization. Plan_Code is a mandatory 16-character alphanumeric field you must manually enter. ;[Description|DESCRIPTION]:This field provides a user-defined description of the benefit plan. Description is an optional 50-character alphanumeric field you may manually enter. \\ ---- !!Plan Details tab ;[Entity|ENTITY_CODE]:The Entity field identifies the organization to which this plan is restricted. This field may be left blank if there is no restriction. Entity from [P2K_CM_ENTITIES] is an optional 16-character alphanumeric field you may manually enter or use the LOV (F9). ;[Plan Type|PLAN_TYPE_CODE]:This field indicates the plan type that categorizes this plan. Plan_Type_Code is a mandatory 16-character alphanumeric field you must either manually enter or use the LOV (F9). ;[Policy #|POLICY_NUMBER]:This field supplies the insurance policy number assigned by the insurance carrier. Policy_Number is an optional 30-character alphanumeric field you may manually enter. ;[Calc #|CALCULATION_SEQUENCE]:This field determines the order in which the plan will be processed by the benefit calculation. Calculation_Sequence is an optional 5-digit numeric field that will default from the Plan Type ([IBPT]) form but may be overridden by you. ;[Established|ESTABLISHED_DATE]:This is the date the plan was first established at the organization. Established_Date is an optional date field you may manually enter. ;[Plan End Date|END_DATE]:This is the date after which dependent coverage or beneficiary. End_Date is a mandatory date field you must manually enter. ;[Web Document|WEB_DOCUMENT]:This field is contains the file related to the benefit plan ;[Last Remittance|LAST_REMIT_DATE]:This field holds the date this plan was last remitted to the insurance carrier (or reconciled for internal plans). Each time the remittance process is run, this date is updated by the system to reflect the latest date processed. When a user runs remittances for a specific time period, the system checks that there are no missing remittance periods since the last run. ;:%%warning It is recommended that this field be initialized to the end of the remittance period prior to the commencement of parallel testing for testing purposes, and to the remittance period prior to the live date for production purposes.%% ;:Last_Remit_Date is an optional date field will be updated by the system, however you may alter this field. ;[Remittance Report|REMIT_REPORT_CODE]:Remittance Report is a user-defined code uniquely identifying the report within the organization. Remit_Report_Code is a 16-character alphanumeric optional field you may manually enter or use the LOV(F9). ;[Plan Remit Seq #|PLAN_REMIT_SEQUENCE]:Remittance Sequence determines the order in which each plan will be printed when more than one benefit plan is printed on the same remittance report. Plan_Remit_Sequence is a 5 digit numeric optional field you may manually enter. ;[Participation|PARTICIPATION_RULE]:This field indicates whether participation in a benefit plan or coverage is mandatory or optional. The participation rule on the plan definition is used as a default entry to the benefit schedule. Only the participation rule from the benefit schedule is enforced. Participation_Rule is an optional fixed lexicon ([X_PARTICIPATION_RULE]) that you may use to look up the value. ;[Calendar|CALENDAR_CODE]:This field provides the user-defined calendar code, which uniquely identifies the calendar by which the plan must be remitted. Calendar_Code is a 16-character alphanumeric mandatory field you must manually enter or use the LOV(F9). ;[Not Scheduled|NOT_SCHEDULED]:If the ‘Not Scheduled’ toggle is ON, then this plan may be added to the Benefit Election form ([IBEL]) without being placed on the Benefit Schedule ([IBSC]). If the toggle is OFF, the plan must be on the schedule to allow employee to elect it. Not_Scheduled is an optional toggle field. ;[Remit As Of Day|REMIT_ASOF_DAY]:This field specifies the day of the remittance period on which remittances are assessed. Remit_Asof_Day is a 5-digit numeric optional field defaulting from the remittance report or you may manually override. ;[Remit Date Rule|REMIT_DATE_RULE]:This field indicates the date at which remittances must be assessed. Remit_Date_Rule is an optional fixed lexicon ([X_REMIT_DATE_RULE]) that you may use to look up the value. ;[Print Zero Rule|PRINT_ZERO_RULE]:This field controls whether employees with zero premium amounts (for any reason) who are enrolled in the benefit plan should get printed on the remittance report. Print_Zero_Rule is an optional fixed lexicon ([X_PRINT_ZERO_RULE]) that you may use to look up the value. ;[Access_Code|PLAN_ACCESS_CODE]:Plan Access is a security feature providing the ability to control access to different types of benefits information. ;:%%information This feature is not currently available. Planned for a future release. ;:Plan_Access_Code is an optional fixed lexicon ([X_SECURITY_ACCESS]) that you may use to look up the value. ;[Approval Required|APPROVAL_REQUIRED]:If the ‘Approval Required’ toggle is ON, employer authorization is required before an employee can enroll in the specified plan. If the toggle is OFF authorization is not required. ;:Approvals are set up through the IDAR form. Approval_Required is an optional toggle field. ;[Track Decline|TRACK_DECLINE]:If the ‘Track Decline’ toggle is ON, a form is created in the enrollment file when an employee declines coverage under a plan. If the toggle is OFF declined benefits are not tracked. Track_Decline is an optional toggle field. ;[Remit by State|REMIT_BY_STATE]:If the ‘Remit by State’ toggle is ON, the state or province of the employee’s residence separates remittance history records. If the toggle is OFF there is no separation by state or province. Remit_By_State is an optional toggle field. ;[Remit by Unit or Group|REMIT_BY_UNIT_OR_GROUP]:If the ‘Remit by Unit or Group’ toggle is ON, remittance history records will be separated by group or unit, based on the employee’s [Prime Assignment Information (IEAS)|IEAS] form. If the toggle is OFF there is no separation by unit and group. Remit_By_Unit_Or_Group is an optional toggle field. ;[Print All Waivers|PRINT_ALL_WAIVERS]:If the ‘Print All Waivers’ toggle is ON, employees receiving a benefit waiver that reduces their premium to zero will still appear on the remittance report. If the toggle is OFF employees on a waiver with a zero premium will not get printed. Print_All_Waivers is an optional toggle field. ---- !!Coverages Tab ;[Coverage|COVERAGE_CODE]:Coverage is a user-defined code uniquely identifying the coverage to the organization. Coverage_Code is a mandatory 16-character alphanumeric field you must manually enter. ;[Seq #|COVERAGE_REMIT_SEQUENCE]:Remit Sequence determines the order in which all the Coverages will be printed when more than one benefit coverage is printed on the same remittance report. Coverage_Remit_Sequence is an optional 5-digit numeric field that will default from the plan or you may manually enter. ;[Policy #|POLICY_NUMBER]:Insurance Policy Number for the coverage. Policy_Number is an optional 30-character alphanumeric field that will default from the plan or you may manually enter. ;[Contact|CONTACT_ROLE]:Contact Role identifies the contact eligible under this coverage. Contact_Role is an optional 16-character alphanumeric field you may manually enter. ;[Recipient Type|RECIPIENT_TYPE]:This field determines the recipient eligible in the Benefit Plan. e.g Children, Spouse/Others, Not Applicable, Beneficiary. Recipient_Type is a fixed lexicon ([X_PLAN_RECIPIENT_TYPE]) ;[Display Sequence|DISPLAY_SEQUENCE]: This field determines the sequence in of candidates in the Benefit Plan. ;[Waiting Period|WAITING_PERIOD]: ;[Minimum hrs/wk|MINIMUM_HOURS_PER_WEEK]: ;[Max # Recipients|NUMBER_RECIPIENTS]: ;[Max Child Age|MAXIMUM_CHILD_AGE]: ;[Max Student Age|MAXIMUM_STUDENT_AGE]: ;[Evidence Required|EVIDENCE_REQUIRED]: ;[Estimated Costs|ESTIMATED_COSTS]: ;[Pre Tax|PRE_TAX]: ;[Exclude From OE|EXCLUDE_FROM_OPEN_ENROLLMENT]: \\ ---- !!Coverages Tab - Details ;[Description|DESCRIPTION]:This field holds a user-provided description of the coverage. Description is an optional 50-character alphanumeric field you may manually enter. ;[Remit Basis|REMIT_BASIS]:Remit Basis is the unit of measure in which remittances are stored and sent. Remit_Basis is a mandatory fixed lexicon ([X_RATE_BASIS]) that you may use to look up the value. ;[Rate Basis|RATE_BASIS]:Rate Basis indicates the unit of measure that coverage rates are stored in for coverage components, plan rates or enrollment tables. All rates entered on the Rates tab must be of the 'Rate Basis' indicated here. Rate_Basis is a mandatory fixed lexicon ([X_RATE_BASIS]) that you may use to look up the value. ;[Frequency|FREQUENCY_CODE]:Frequency defines the condition under which the benefit is processed. The processing frequencies may be set by month, pay period, type of pay and number of times within a pay period. Frequency_Code is a mandatory 16-character alphanumeric field you must either manually enter or use the LOV (F9). ---- !!Coverages Tab - Components Coverage Components identify which benefit components are applicable to a particular benefit coverage. They specify the information on the rules, usercalcs, [elements|PAY ELEMENTS], field values, factors and constants associated with a coverage. ;:%%information If there is a component that must be manually entered at the time the employee elects the coverage then the component should have a BC Action of ‘Store on Enroll’ or ‘Store on Line & Enroll’ and have the ‘Allow Value Override’ toggle ON. This ensures that the component will be provided for input in the Process Benefit Elections ([IBEL]) form. All other components may have the ‘Allow Value Override’ OFF, but still have a BC action of ‘Store on Enroll’ or ‘Store on Line & Enroll’.\\ \\A [pay component|PAY COMPONENTS] may be indicated in the <PC Code> field if the result is required for Payroll processing or reporting. The BC action must be ‘Store on BE Line’ or ‘Store on Line & Enroll’.\\ \\ If any of the ‘Convert to Pay Period Amount’ components are to be used ensure that the ‘Week per Year’ and ‘Months per Year’ fields are completed on the Group ([IDGR]) form in order for the benefit calculation to process the conversion appropriately.%% ;[Seq #|COMPONENT_SEQUENCE]:Sequence specifies the order in which the Benefits or Payroll Calculation Program will calculate the benefits components. ;:For example, in order to calculate the employee deduction to be collected in a pay, it may be necessary to know the premium amount. In order to know the premium, it is necessary to know the coverage amount. Therefore, the sequence of which of these items (Benefits Components) should be found, derived or calculated first is essential for proper benefit enrollment maintenance. ;:%%information It is recommended the sequence numbers not be changed without the supervision of a consultant.%% ;:Component_Sequence is a 5-character numeric mandatory field that is provided. ;[BC|BC_CODE]:BC Code is used to define the benefits component. All BC codes begin with the letter “B” followed by a 4-digit number. ;:%%information Definitions of each of the benefits components may be found in the [Benefit Components|BENEFIT COMPONENTS#Benefit Component Codes] section.%% ;:BC_Code is a provided mandatory 16-character alphanumeric field you may manually enter or use the LOV (F9). ;[BC Code|DESCRIPTION]:The component description is a brief explanation of the benefits component code highlighted. Description defaults in from the benefit code. ;[Rule|BC_RULE_CODE]:This field is used to describe the possible options available for each benefits component. The rules shown are applicable to the highlighted benefits component in the BC Code field of the form. BC_Rule_Code from the [P2K_BE_BC_RULES] table is a mandatory 2-character numeric field either provided, manually enter or selected with the LOV (F9). ;[Rule Description|DESCRIPTION]:The rule description is a brief explanation of the benefits component rule highlighted. The description defaults in from the rule code chosen. ;[BC Action|BC_ACTION]:This is the action will be performed by this benefits component. ;:%%information You may move a component action forward from ‘Calculate’ to ‘Log to BE line’ or ‘Store on Enroll’ but may not move backwards.%% ;:BC_Action is a mandatory fixed lexicon ([X_BC_ACTION]) you may use to look up the value. ;[PC Code|PC_CODE]:Users may select a [pay component|PAY COMPONENTS] where the result of the component may be stored. In this manner, amounts calculated for benefit lines or enrollments may be recorded in Payroll, available for the Pay Register, employees’ pay stub and/or financial ledgers (as required). PC_Code is a 4-digit numeric optional field you may manually enter or use the LOV (F9). ;[Element|ELEMENT_CODE]:Users may enter an element to calculate the benefits component. The rules for the benefits component must include a “Use an Element” rule for this field to be used. Element_Code is a 16-character alphanumeric optional field you may manually enter or use the LOV (F9). ;[PC Abbrev.|PC_ABBREVIATION]:Abbreviation is a description of the [pay component|PAY COMPONENTS] chosen. PC_Abbreviation is a 30-character alphanumeric field defaulting from the [pay component|PAY COMPONENTS]. ;[User Calc|USER_CALC_CODE]:You may specify a usercalc to calculate the benefits component amount, date, etc. This field is appropriate for those benefits components for which the Rule 00 – “Use UserCalc” is defined. UserCalcs may also be used to verify or change the component amount calculated. User_Calc_Code is a 16-character alphanumeric optional field you may manually enter or use the LOV (F9). ;[Allow Value Override|ALLOW_VALUE_OVERRIDE]:If the ‘Allow Value Override’ toggle is ON, the system allows you to see value on [IBEL], and update it (must also have ‘enter on enrollment’ ON, and ‘enter on enrollment’). Allows users to override value on [IBEN]. If the toggle is OFF, a value may not be overridden. Both original values and overridden values are stored. The program will use the original or the override based on this toggle. Allow_Value_Override is an optional toggle; the value of which is provided for each benefits component. ;[Enter Enrollment|ENTER_ENROLLMENT]:If the ‘Enter Enrollment’ toggle is ON, the coverage component value may be overridden on the employee's enrollment form. This allows the user to enter the value when enrolling. Both 'Allow Value Override' and 'Enter Enrollment' must be on, and BC action including ‘Store on Enroll’, in order to see on [IBEL]. If the toggle is OFF, the component may not be overridden. Enter_Enrollment is an optional toggle; the value of which is provided for each benefits component. ;[Enter Benefit Lines|ENTER_BENEFIT_LINES]:If the ‘Enter Benefit Lines’ toggle is ON, a benefit line may override the coverage component value. ;:This field allows users to enter values on the [IBBL] to update this component. ;:If users ever have to edit the values updated on the [IBBL] (which updates remittance), they will have to enter a benefit line ([IBBL]) line. This will happen if a pay reversal is run (does not update benefit line automatically) or if an adjustment is made to a PC after benefits are calculated in [UPCALC] due to an overpayment/underpayment from a past period. Editing a PC does not update the line. ;:Should be ON for any component that updates remittance (Elig $, Covg, Prem, ER, EE), since users may have to add a benefit line to update. ;:If the toggle is OFF, the component may not be overridden. Enter_Benefit_Lines is an optional toggle; the value of which is provided for each benefits component. ;[Enter Remit History|ENTER_REMIT_HISTORY]:If the ‘Enter Remit History’ toggle is ON, the coverage component value may be overridden on the remit history form. ;:This field allows users to enter adjusting values (lines, similar to [IBBL] lines) to remittance history form ([IBRH]). ;:Edits on [IBRH] might be necessary to fix historical values, however these amounts should be updated by the B1400’s series of components, whose purpose is to make adjustments to previous remittance period. ;:If the toggle is OFF, the component may not be overridden. ;:Enter_Remit_History is an optional toggle; the value of which is provided for each benefits component. ;[Update Remit History|UPDATE_REMIT_HISTORY]:If the ‘Update Remit History’ toggle is ON, the coverage component value will be picked up during the Update Remittance History process. If the toggle is OFF, the component will not be entered into remittance history. Update_Remit_History is an optional toggle; the value of which is provided for each benefits component. \\ ---- !!Coverages Tab - Rates Coverage Rates specify the set of rates applied to a specific step within the coverage detail. %%information If using BC550, the rate steps must be 1, 2, 3, etc. not 01, 02, AA, BB etc. The Benefit Calculation routine expects all rates to be for the rate basis indicated on the Coverage tab.%% ;[Step|COVERAGE_STEP_CODE]:Coverage Step is a user-defined code uniquely identifying a set of rates for a coverage. Codes may be numeric (e.g. 01, 02, 03...) or alphanumeric (e.g. A, B, C, FS, MN, A1, A2...). ;:%%information If you are using component BC500, the rate steps must be 1, 2, 3,4, not 01, 02, AA, BB etc.%% ;:Coverage_Step_Code is a mandatory 16-character alphanumeric field you must manually enter. ;[Description|DESCRIPTION]:This field describes the rate step. Description is an optional 50-character alphanumeric field you may manually enter. ;[Up to Limit|UP_TO_LIMIT]:Up to Limit (up to but not including) specifies the upper limit to which the step applies when the rates vary based on age, salary or other range criteria. Used for component B0500, Rule 05, 06, 08 and 09. Up_To_Limit is an optional 18-digit numeric field you may manually enter. ;[Next Step|NEXT_STEP_CODE]:Next Step code indicates the next set of rates that will apply when rates are stepped based on a date. Next_Step_Code is a mandatory 16-character alphanumeric field you must manually enter. ;[Flex Amount|FLEX_AMOUNT]:This field provides the amount of the flex fund credit being contributed by the organization; used for component B0810, Rule 07. Flex_Amount is an optional 18-digit numeric field you may manually enter. ;[Premium 1 Rate|PREMIUM1_RATE]:This is the regular premium rate used in normal premium calculations; used for component B0600, Rule 02. Premium1_Rate is an optional 18-digit numeric field you may manually enter. ;[Premium 2 Rate|PREMIUM2_RATE]:Additional premium rate used when a second premium rate must be applied after a coverage limit is reached (e.g. $0.50 per $1,000 on 1st $50,000 coverage, $1.00 per $1,000 for any coverage in excess of $50,000). Used for component B0610, Rule 02. Premium2_Rate is an optional 18-digit numeric field you may manually enter. ;[ER Contribution Rate|ER_CONTRIBUTION_RATE]:This is the rate used in the employer's contribution calculation; used for component B0800, Rule 02. ER_Contribution_Rate is an optional 18-digit numeric field you may manually enter. ;[EE Deduction Rate|EE_DEDUCTION_RATE]:This field provides the rate used in the employee's deduction calculation; used for component B1000, Rule 02. EE_Deduction_Rate is an optional 18-digit numeric field you may manually enter. ;[Taxable Benefit Rate|TAXBEN_RATE]:This is the rate used in the taxable benefit calculation; used for component B1200, Rule 02. Taxben_Rate is an optional 18-digit numeric field you may manually enter. ;[User 1 Rate|USER1_RATE]:This field provides the first user-defined rate. User1_Rate is an optional 18-digit numeric field you may manually enter. ;[User 2 Rate|USER2_RATE]:This is the second user-defined rate. User2_Rate is an optional 18-digit numeric field you may manually enter. ;[User 3 Rate|USER3_RATE]:This is the third user-defined rate. User3_Rate is an optional 18-digit numeric field you may manually enter. ---- !!Coverages Tab - Waivers Waiver and Reduction Rules govern the way an employee will be processed when they are either in a special employment status that causes premiums to be waived, or when they reach an age limit that triggers a reduction in benefit coverage. ;[Employment Status|STATUS_CODE]:The employment status of an employee may be pending approval, active, on a leave of some type, or terminated. Status_Code is a mandatory 16-character alphanumeric field you must manually enter or use the LOV (F9). ;[Up to Limit|UP_TO_LIMIT]:This field indicates the highest age for which this reduction rule applies, if applicable. Up_To_Limit is a mandatory 18-digit numeric field you must manually enter. ;[Waiver Method|WAIVER_METHOD]:This field indicates who pays the premium amount when an employee is on a benefit waiver. Waiver_Method is an optional fixed lexicon ([X_WAIVER_METHOD]) that you may use to look up the value. ;[Coverage Reduction %|COVG_REDUCTION_PERCENT]:This field indicates by how much the coverage/benefit amount is reduced. Covg_Reduction_Percent is an optional 5-digit numeric field you may manually enter. ;[Premium Reduction %|PREM_REDUCTION_PERCENT]:This field indicates by how much the premium is reduced. Prem_Reduction_Percent is an optional 5-digit numeric field you may manually enter. ;[EE Reduction %|EE_REDUCTION_PERCENT]:This field indicates by how much the employee deduction is reduced. EE_Reduction_Percent is an optional 5-digit numeric field you may manually enter. ;[ER Reduction %|ER_REDUCTION_PERCENT]:This field indicates by how much the employer contribution is reduced. ER_Reduction_Percent is an optional 5-digit numeric field you may manually enter.