Life Events: Configuration and Management

OVERVIEW

Employee Navigator provides the tools necessary to manage the life events experienced by employees. Our tools not only allow for reporting of employee and dependent events, but support customization of the events along with controls in order to manage which events can be used within the system.  You will find the Life Events under the tab BENEFITS-->SETTINGS-->LIFE EVENTS.

NOTE:  There is also a setting under the tab Settings-->Employee Experience-->General Settings-->Show Coverage links on Benefits tab by default this link is selected, however if it is deselected the employees will NOT be able to access life events. 

Types of Events

Events have been pre-configured based on the most commonly used events impacting employee and dependent coverage.  These events are utilized primarily to report the addition or loss of coverage for the employee and/or family members.  In the drop down menu under Life Events there are 5 categories of events based on the impact the event has on coverage.   

Dependent Add

The following are the pre-configured events that will allow a dependent to be added to coverage. 

• Marriage
• Newborn Child
• Adopt a Child
• Add Domestic Partner
• Dependent Begins or Returns to College
• Court Ordered Dependent Coverage
• Dependent Loss of Coverage
• Temporary Legal Guardianship Begins

Dependent Drop

The following are the pre-configured events that will allow a dependent to be dropped from coverage. Not all reasons listed will trigger COBRA, we have indicated those that will trigger COBRA with the (COBRA) indicator.  

• Unauthorized Employee Change
• Dependent Drop Divorce or Legal Separation (COBRA)
• Dependent Drop Dissolution of Domestic Partnership
• Dependent Drop Death of a Dependent 
• Dependent Drop Dependent Leaves or Completes College (COBRA)
• Dependent Drop Court Ordered Dependent Coverage 
• Dependent Drop Dependent Eligible for Other Coverage
• Dependent Drop Dependent Eligible for Medicare 
• Dependent Drop Temporary Legal Guardianship Ends  
• Dependent Drop Coverage When Dependent Over Eligible Age  (COBRA)

NOTE: For Domestic Partner Add/Drop QLE to be presented, the company must be setup to allow Domestic Partners and the Domestic Partner coverage tier must be configured in the plan rates

Adjust/End Coverage

The following events are used to report changes in the Cafeteria and HSA/HRA plans.

• Change FSA
• Change Limited Purpose FSA
• Change Parking
• Change Transit
• Change Daycare
• Change HSA
• Change Private Insurance

NOTE: Because Parking and Transit do not require a qualifying life event and often have a different waiting period than core benefits, employees can choose to add/change their enrollment for these benefits when these benefits are not in the window, even when other benefits are in an active enrollment window.

Employee Add

The following events are pre-configured to allow for an employee to be add coverage.

• Employee Loss of Coverage 
• Employee Add Divorce or Legal Separation
• Employee Add Dissolution of Domestic Partnership 
• Employee Add Death of Spouse
• Employee Add Death of Domestic Partner 
• Employee Add Increase in Hours 
• Employee Add Return from Leave of Absence 
• Employee Add Spouse Loses Coverage at Their Employer 
• Employee Add Spouse Open Enrollment 

Employee Drop

The following events are pre-configured to allow for an employee to be dropped from coverage. Not all reasons listed will trigger COBRA, we have indicated those that will trigger COBRA with the (COBRA) indicator.  

• Employee Drop HR Override after open enrollment is closed
• Employee Drop Employee Married and Changes to Spouse's Plan 
• Employee Drop Leave of Absence 
• Employee Drop Military Leave (COBRA) 
• Employee Drop No Longer Eligible for Benefits (COBRA) 
• Employee Drop Reduction in Hours (COBRA) 
• Employee Drop Spouse Gains Coverage at Their Employer 
• Employee Drop Spouse Open Enrollment 

NOTE: To better ensure the company paid benefits do not get removed during a life event, we are now preventing employees from dropping plans set to require enrollment for the following Employee Drop Coverage events:

• Employee Married and Changes to Spouse's Plan
• Spouse Gains Coverage at Their Employer
• Spouse Open Enrollment

Tip! Medicare is not a QLE reason at this time. Enrollments can be ended via the Enrollment Editor using the drop reason "Covered employee's becoming entitled to Medicare". 

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SYSTEM CONFIGURATIONS

All life events are programmed with logic which will ensure timely reporting.  No tool can be used to report an event that occurred more than 30-days prior to the current date.  There are also some events such as Marriage, Birth of Child, Death of a Dependent for example that will not allow a future effective date to be entered.  In those cases, the date of the event must be equal to or no more than 30 days past the current date. 

You will find the Life Events under the tab BENEFITS-->SETTINGS-->LIFE EVENTS

NOTE:  There is also a setting under the tab Settings-->Employee Experience-->General Settings-->Show Coverage links on Benefits tab by default this link is selected, however if it is deselected the employees will NOT be able to access life events. 

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CUSTOMIZING EVENTS

Each event has company controls which will assist a company in controlling if a specific event is visible for employees and if the event requests will be pending for HR approval.  There are also additional customization options within each event that will allow the company to modify the event description as well as include any additional instructions or  share any additional information with the employee.  To access these controls, simply select the event category and then select EDIT next to the event to be customized.  Once in the specific event you will see the following:

• Type: The category of event that this reason has been assigned
• Default Description: The description of the reason as defined by Employee Navigator
• Create a Custom Description: This is where a company can mask the description of the event that will display for the employee.  
  • NOTE:  This option allows the company to modify the naming of an event, but will not allow for any changes to the behavior of the event for purposes of COBRA notification.
  • The Custom Description will only display for the employee. The default description will still appear on reports even when a custom description is added.  
• Employee Visible: Control to indicate if the event is accessible by the employee.  A box selected will allow the employee to access the event.  A box not selected will “hide” the event type from employee view
• Approval Required: Control to indicate if the event will pend for HR/Admin approval if utilized by the employee. A box selected will set the event to pend for approval.  A box not selected will allow the event to process without HR/Admin approval.
  • NOTE: Events set to pend for approval will only pend when the employee is the one initiating the request.  If HR processes on behalf of the employee the approval is automatic.
    • SPECIAL NOTE: The Approval Required feature is only supported for Dependent & Employee Add and Drop events.  While the tool will appear under the Adjust/End Coverage events, it is NOT currently supported and these changes WILL NOT PEND even if the checkbox is selected.   
• Describe Required Documentation: This is a communication section that will allow the company to describe to the employee any additional documentation that may be necessary in order to change coverage due to the specific life event. 
  • Example: Group may require a copy of a marriage certificate.  This section can be used to communicate to the employee that HR will need to review a copy of the marriage certificate if coverage is being added due to marriage.
• Show System Default: Selecting this checkbox will allow administrator to see the standard text that Employee Navigator has defined.
  • Customize this text: Selecting this checkbox will allow the administrator to customize the default text
  • NOTE:  Many groups are using the Employee Tasks as an enhancement to this option.  Please visit this link to learn more about customizing task options. Options can be added to require employees to take additional action such as scanning a copy proof of dependent status.  These options are available based on license level.  

• Free Form Text Box: Allows for the administrator to add additional language that will display on the page when the life event is being processed. This section is often used to share additional information about other services or requirements that may be necessary related to the event. 

It is recommended that each group review each of the events to determine which events should be showing for the employees and which events will need to pend for approval. 

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PROCESSING EVENTS

Events can be processed in the system by either the Employee, HR or Administrator. 

HR/Admin can process events by accessing an employee record and then proceeding to the Update Benefits tab.  Here the user will see the full suite of reasons available to add/drop/change coverage.  Events processed by an admin user (such as broker or HR) will NOT pend for approval.  The system will not apply the pending application as it is understood that the admin has already verified the change is valid. 

Employees access life events through the Benefits link on their home page.  From this section, the employee can select the appropriate link under the Change Coverage section.  Employees can see their pending requests on the enrollment summary, or summary details.  A message also displays on their home page in the “what’s missing” section indicating they have life event changes awaiting HR approval.

All events can be disabled in the event a company wants to prevent employees from requesting changes due to a life event.  The controls to disable all life event reporting is under tab Settings-->Employee Experience-->General Settings-->Options Affecting Employee Display-->Show Coverage Links on Benefit Tab.  This does not remove the Life Events from the employee view, but will disable the ability for the employee to select life events to process.  

SPECIAL NOTE

  The plans that can be added through a Life Event are as follows:

• Medical
• Dental
• Vision
• Supplemental Medical
• Rx
• Tricare
• HSA/HRA
• Pediatric Dental
• Voluntary Life (only for Newborn child and only if employee is actively enrolled)

Other plan types will be phased into the life events such as the Telemedicine with medical component. 

If coverage needs to be added for any other plan type, use the Modify Current Enrollment Link to add coverage.  The Enrollment Editor can be used to override an effective date as needed. 

For Daycare, Transit, Parking or HSA account adjustments you can use the "Adjust" tools found under Update Benefits. 

For Medical FSA and/or Limited Purpose FSA, The option to "Adjust" FSA or "Adjust" LPFSA will be available for the employee to use for 31 days after their Life Event Date. A QLE is required to change contribution to an FSA plan so the timeline to make a change is limited. The effective date of change will default to the employee's QLE date. However, Adjust FSA/LPFSA events will always be surfaced for Admin users. Admin Users will have the option to Adjust FSA/LPFSA on behalf of the employee anytime and will not be bound to the employee's QLE date if the need to make a change on the employee's behalf.

Drop Employee Coverage

When dropping coverage, the first step is to enter the date of the event.  The date entered is used to determine the effective date of the drop of coverage.  The system is designed to use this date in combination with the termination rules for each enrolled plan to properly end benefits.  The date should be equal to the actual date the event occurred or the last day of expected coverage. 

• Example: Coverage being dropped due to eligibility under a new plan. If the new plan starts as of 8/1 then the date of the event would be 7/31 as that is the expected last date of coverage for the member.  In the event of a drop due to a divorce or any other similar event, it would be expected that the date of the event is entered.  A divorce awarded on 8/2 would have an event date of  8/2.  If the rules of the plan indicate coverage was to extend through the “end of month”, the system will automatically adjust to reflect a drop coverage date of 8/31.

Once the date has been entered for the event, the next step will to select the benefits to be dropped as a result of the event.  When an employee is dropped from benefits, any enrolled dependents automatically are dropped from coverage as well. 

Drop Dependent Coverage

In the case of the drop of dependent coverage, the process remains the same in that the first step is to enter the date of the event.  The date expected for entry is the date of the loss of coverage of the date of the actual event just as in the example above. 

The next step will be to select the dependent the event will be applied to, followed by selecting the benefits to be dropped.  If more than one dependent needs to be dropped because of the event, once the first event is recorded there will be an option to “Remove Another” and the steps are repeated to select the dependent and coverage to be dropped. 

Add Employee Coverage

Employee add coverage events are slightly different in that the employee is put back into the enrollment process to complete their requested changes.  The first step is still selecting the event triggering the ability to add coverage, followed by entering the date of the event.  As in the example given previously, event date is going to be the date that is triggering the event.  Generally speaking, this date will equal the first day the employee would be without coverage.  The system is using this date to determine the start date of the newly added plan.  The system will also request information about the date the previous coverage ended.  If there was no previous coverage, the default would be to enter a date one day prior to the requested effective date. 

• Example: Coverage being added due to loss of coverage under another plan would require the user to enter the first day of loss of coverage under the old plan. If the last day the employee was covered was 7/31, then the date entered would be 8/1.   The previous coverage end date would be entered as 7/31.

Once the information about the dates of the event have been recorded, the employee is then placed into the enrollment process where benefits can be elected.  Employees may complete one or more enrollment pages based on eligibility. 

• IMPORTANT: Employees will need to select “Submit Pending Life Event for HR Approval” on the Life Event Summary Page.  Once selected, the HR will get the proper notifications to approve the life event change.  If the employee does NOT complete this last step, the enrollment change request will NOT be submitted for HR approval.

Add Dependent Coverage

When adding dependent coverage, the first step is still selecting the event triggering the ability to add coverage, followed by entering the date of the event.   The next step is to then select the dependent to be added.  This can either be an existing dependent on the employee record or there will be a selection to allow for a new dependent record to be created.  Once the dependent is selected, the next step is to select benefits for the dependent to be enrolled under as a result of the event. 

•  NOTE: Dependents can only be added to existing coverage.  In the event that the life event is triggering the need to add new coverage, this will have to be processed as an EMPLOYEE life event to first add the coverage to the employee record. 

 If more than one dependent needs to be added because of the event, once the first event is recorded there will be an option to “Add Another” and the steps are repeated to select the dependent and coverage to be added. 

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HR Notification

HR is can be notified of event changes by logging into the system, then checking the Pending HR Approval section of the home tab.  Additionally, the HR can use the Wall Feeds to create alerts to help keep them updated when there are requests pending approval. 

In the Wall feed the event “HR Tasks” can be utilized to trigger notification for the HR user when there is an event pending approval.  For additional information about using The Wall, please review the article The Wall - Company Level

REVIEW PENDING LIFE EVENTS

When events are requested by the employee and they are set to Require Approval, the event will remain in a “pending” status until approved by either the HR or Broker.  The employee request will appear under the HOME tab for the group in the section Pending HR Approval.  The admin user will then select the name of the employee which will then allow the user to “review” the request. 

In the review process the admin user will be able to review the changes requested and then will have the following options:

• Cancel This Enrollment Change Request:  This action will cancel the request and no coverage changes will be applied. 
• HR Approve Pending Life Event Enrollments:  This action will approve the requested changes. 
• HR Decline Pending Life Event Enrollments:  This action will deny the request and no coverage change will be applied.  

*Partial events cannot be approved.  In the event that one more changes request are not permitted the entire request must be cancelled or declined and then reprocessed.

*If multiple life events were submitted before action was taken on the initial request, you will only have the option to cancel the enrollments. You will then need to reprocess the life event manually.  

• EXAMPLE: Employee request to drop coverage due to becoming eligible for other coverage.  Employee request to drop ALL benefits including company sponsored plans like Group Life, Short Term Disability and Long Term Disability.  If the employee should NOT be permitted to drop the core plans, the request should be denied or cancelled so that the employee can reprocess and request to only drop the elective plans such as medical, dental and vision.

HR decisions on pending requests cannot be reversed.

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REPORTING

In addition to setting up Wall feeds in order to help manage the life events, there are also several reports found under the tab REPORTS for each company.  Some reports to review are:

• Change History Reports
  • Event Reports
  • Payroll Deduction Changes
  • Enrollment Changes
• Carrier Reports
  • Carrier Updates Detail Report
• Ad Hoc
  • Column-Based
  • Row-Based

For more information on reporting options, visit our Reporting articles. 

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Special Event Notes

Open Enrollment

It is important to carefully monitor any events that occur during an open enrollment.  Using the Life Events will only change the CURRENT coverage and will not apply the changes to any future elected plans that are being included in the open enrollment.  It is important that if the life event change is also to be applied to the future effective coverage that those changes are also recorded through the open enrollment election process. 

• Example: Open Enrollment is currently being conducted for plans expected to begin as of January 1^st.  It is currently December 15^st and an employee has experienced a life event and needs to add a newborn child to coverage as of December 10^th.  When the employee or admin uses the life event to add the child to the coverage, the system is only applying that change to the current plan.  If the child should also be added to the coverage that is to be effective January 1^st, then the employee or admin will need to also access the Open Enrollment for the employee in order to record the change in the future election. 
  • Even if the group is conducting a “passive” enrollment, it is best to manually add the coverage change to the open enrollment.

Life Events During New Hire/Newly Eligible Window

Life events are disabled when the New Hire or Newly Eligible Window is active.  In the event that there is an event that occurs during a period when a new hire or newly eligible window is open it is expected that the coverage would be modified through the enrollment window.

Plan Changes

In the event a life event requires a plan change a two-step process will need to occur.  The first step will be the drop of the plan no longer being continued.  The second step will be to add the new plan.  This process is required since the system will not allow two records to be “current” in the system for the same benefit model. 

• Example: Employee moves out of the coverage area for the HMO plan and needs to change to the PPO plan.  The first event that needs to be recorded is the drop of the HMO plan.  Once the first plan has been dropped, then the second event can be recorded to add the new coverage.