Troubleshooting Employee Enrollment/Eligibility Issues
- Admin users can test employee enrollment from the employee's point of view by going into the employee record and clicking the Employee Home Page link (bottom right under Reviews section)
- Admin users can view an employee's eligibility information such as eligible plans, eligibility dates and which enrollment window certain plans fall under by going to the employee's Benefits Summary tab > Benefits Eligibility
- Admin users can also troubleshoot eligibility issues from the employee's Benefits Eligibility tab by clicking the magic wand icon next to the corresponding plan. This tool reflects the plan value, employee value and status. Pay close attention items that reflect a status for problem or needs deeper look
Employee's Start button is missing and/or homepage indicates that employee's New Hire or Open Enrollment window is closed.
Applies to both NH & OE:
- Employee is missing required HRIS or Benefit fields (incomplete profile status) that must be completed before the enrollment window is activated. To review, go to the employee's Employee Management tab > Status section. For a deeper look into the missing fields, clicking the employee's Profile tab.
- Required HRIS fields are driven by fields marked as HR Required listed under the company Settings tab > HRIS Field Tracking. When a fields is marked for HR Required, HR users must complete those fields before an employee can enroll. To correct, either HR must complete the missing fields, or the fields must be unchecked for HR Required.
- Required Benefit fields are driven by rules setup at the plan level, such as eligibility based on employee department. To correct, these fields must be completed.
Applies to NH only:
- The employee's eligibility date falls before or after the number of days indicated for the company's enrollment window settings. To check, compare the employee's eligibility date (employee's Benefits tab > Benefits Eligibility) against the settings under the company Benefits tab > Enrollment Window. For example, if the enrollment window is only set to open 30 days before the effective date and an employee is not eligible for another 60 days. To correct, adjust the enrollment window settings or the employee will need to wait until the window should open.
- The employee is eligible for future effective plans and there is no active OE, or OE was closed out early (e.g. employee is eligible for plans with a 3/1/17 start date and the current date is 2/15/17). The Current system logic requires an active OE in order for employees to enroll in future plans (for both new hire and open enrollment). To correct, create an OE (if applicable) or the employee will need to wait until the plan start date = the current date.
Applies to OE only:
- The enrollment window may be closed for employees. To check, go to the Open Enrollment setup > List tab and confirm the dates listed for Enrollment Starts and Enrollment End.
Issue: Plan(s) are missing from an employee's enrollment window.
Applies to both NH & OE:
- The employee isn't in eligible. Compare plan Eligibility Rules against employee's demographics.
- The plan does not have costs listed for the employee.
- Rates are banded and the plan does not have a rate for the employee's age, or rates are gender/tobacco banded and employee is missing gender/tobacco status.
- Contributions are based on certain conditions, such as employee Department, and there is no contribution schedule for the employee's assigned Department.
- Contributions are based on Dynamic Classes and the employee does not fall under any of the corresponding dynamic class conditions.
Applies to NH only:
- The waiting period rules under the plan's Eligibility Rules tab were inadvertently set to Months or Quarters instead of Days.
- The current plan ends prior to the employee's eligible start date and no new plan has been configured (e.g. employee is eligible for the plan on 1/1/17 and the plan ends 12/31/16). To correct, renew/add a new plan for the upcoming year. Note! If the plan has a future start date, the company must have an active OE season configured
- Based on the plan's Eligibility Rules and the employee's effective date, the NH window has closed for the plan. Compare the employee's Hired Eligibility Date (employee's Benefits Summary tab > Benefit Eligibility) against the settings configured under the company Benefits tab > Enrollment Window.
- The plan is configured to disable new hire enrollment on the plan's Eligibility Options tab > Disable New Hire / Newly Eligible Enrollment.
- The plan is configured to enforce variable hour eligibility and the employee's ACA classification is Variable Hour or Ineligible. To check, go the company ACA tab > Assign ACA Plans and confirm if Enforce variable hour eligibility is checked.
Issue: Employee completed enrollment but was able to decline a required, employer paid plan.
Sounds like the plan wasn't always set to require enrollment. If the plan is configured correctly now, go back into the employee's enrollment window (or Modify link if enrollment window is closed) and enroll employee in the plan.
Issue: Employee isn't enrolled in an HSA/HRA even though they enrolled in the corresponding medical plan.
The HSA/HRA plan is not configured to require enrollment. Confirm that Allowed to decline and not checked under the plan's Enrollment Options tab.
Issue: Employee's cafeteria page in the enrollment flow reflects the incorrect number of pays remaining.
- The employee's payroll calendar is not setup correctly.
- The employee is not assigned to the correct payroll group, or the employee's assigned payroll group was overridden. Check by going to the employee's Profile tab > Compensation > Override pay frequency field.
- The company's payroll calendar was changed after the employee enrolled. Changes made to payroll will not apply to existing enrollments. To correct, decline the benefit and then re-elect to apply the calendar changes. Confirm your payroll groups/calendars are setup correctly.
Issue: Employee's Enrollment Summary indicates that the Universal step isn't complete, but the employee saved the enrollment.
The plan is configured as a communication only plan, but it is also configured to require employees to enter benefit amounts and/or costs. To correct, review the plan settings under the plan's Rates tab. If employees are required to enter benefit amounts/costs, it cannot be configured as a communication only plan. If it is a communication only plan, unset the fields requiring employees to enter benefit amounts/costs.
Issue: An employee was able to enroll an overage dependent in coverage.
The dependent is listed as disabled. Since disabled dependents are eligible to remain on coverage beyond the dependent age limits, Employee Navigator excludes disabled dependents from the plan's overage rules. To check, go to the dependent's record and confirm if Yes is checked next to the Disabled field.