Eligibility Underwriting Questions
Eligibility underwriting questions are presented on the enrollment page before the employee is allowed to make an enrollment selection and provide field underwriting to ensure employee and/or spouse meets minimum necessary requirements to enroll in a plan. Questions are configured at the agency level, and are available for use on medical model plans and voluntary life model plans. Questions are free-form, meaning the user can insert custom question text; however the answers must be either Yes or No.
Once a plan has been configured with an eligibility question, the employee is presented with the question(s) that must be answered prior to making an enrollment selection. There is no option to bypass the question(s) and enroll in the plan. It is important to note that the purpose of these questions is to determine eligibility and not just to collect information.
Questions may be applied to more than one plan, and employee's answer is stored and only presented once. If employee realizes they responded incorrectly, the employee can edit the responses, which may affect an election that has already been made in another plan. Any discrepancies will be identified on the enrollment summary, and prevent an employee from selecting agree & complete. This process is similar to plan restriction enforcement.
Configuring Agency Eligibility Questions
Questions are configured at the agency level, on the Settings tab, In the Libraries section called Questions. Select "Add a new question" to begin.
- Begin by typing in the question exactly as it will appear for the employee.
- Set Eligibility rule
- Check the "ineligible if answer is Yes" box if a “Yes” response will make the employee/spouse ineligible for the plan.
- Leave the "ineligible if answer is Yes" box unchecked if a "No" response will make the employee/spouse ineligible for the plan.
- Finally, use the drop down to determine if the question is applicable for the employee (and all their dependents) or simply the spouse. Don’t forget to activate when you are completed with the configuration.
**It is important to note that either a response of "Yes" or "No" will cause the employee to be ineligible for the plan. Use the eligibility setting outlined above to set which response will result in ineligibility.
Adding a Question to a Plan
Now that your agency questions are built, you can assign the questions to a medical model or voluntary life model plan. In a plan, under the Eligibility & Enrollments tab, you will find a link for Questions. Note, if there are no active agency questions, a message will display indicating there are no available questions. Assuming this is already complete, you can select Add a Question. If more than one are available, select which question is applicable to this plan.
Carrier Value is an optional field that can be used for tracking and reporting. Note – responses to underwriting questions are not displayed for an administrator due to HIPAA. The responses may be reported directly to a carrier if configured in EDI, but there is not a report available to HR or administrator identifying the employees and the responses.
Repeat steps for each plan in which the question applies. This is important because an employee may not complete the enrollments in order, and it is imperative to ensure that employee be prevented from enrolling in any plan in which the eligibility questions must be answered prior to enrolling.
Disclosures are another vehicle of getting required information to an employee regarding enrollment in a plan. Disclosures are slightly different from questions in two ways. First, the employee is not presented with an option to agree/disagree with disclosure language. It is automatically presented on the page after the employee enrolls and employee cannot break the flow without closing out the disclosure. Secondly, the disclosure does not make an employee ineligible for a plan if they do not complete an action. After an employee enrolls in a plan that has an active disclosure, the disclosure language is presented on the page before the next enrollment is presented to the employee.
Configuring a Disclosure
Disclosures are set on the plan level. In a plan, Eligibility & Enrollment, you will find a link for Disclosures. We built three types of disclosure: Certification, Disclosure, and Agreement. At this time, there is no material difference between the three. Next either type or copy the required text into the text box. Typically, this is required text from a carrier with approved legal language. Then save changes.
Now, when an employee enrolls in a plan and selects save for the election, the disclosure language is presented on the page for the employee to review.
Q: How can I pull a report of the answers to the Eligibility Questions?
A: The questions tool was designed to determine eligibility, not to record answers to health questions. The tool was designed only to help groups who needed to prevent an employee from being allowed to enroll in a plan based on their answer and not to simply collect data. Answers to the questions are not stored in our system anywhere for reporting purposes, as for HIPAA purposes we are not permitted to allow a group to report on health history for an employee.