Common VL / ADD Enrollment Issues
Issue: EE or dependent's VL / ADD benefit amount / increment doesn’t match the plan design setup.
- EE enrolled in benefit prior to correct benefit design being set. To reset, go into ee’s enrollment flow, decline coverage and save. Then re-enroll and save.
- Benefit amount was imported. The import tool overrides plan benefit designs and forces the benefit amounts listed on the spreadsheet.
Issue: No option to select SP / CH VL benefits.
- EE doesn’t have dependent records in the system.
- Dependents aren’t eligible due to plan’s dependent / student age limits.
- Plan setup is missing SP rates for SP age.
- Spouse/child is missing DOB, gender, or tobacco status.
Issue: Employee was able to enroll overage dependent in coverage.
- The dependent's record reflects a disabled status (under the dependent record > Disabled field). Disabled dependents are allowed to remain covered, regardless of the plan age limits. If the dependent is not disabled, uncheck this field.
Issue: EE’s VL / ADD benefit election is pending EOI approval but the benefit amount is less than plan's GI.
- EE enrolled in benefit before the plan’s correct GI amounts were set. Go into ee’s enrollment flow, decline coverage and save. Then re-enroll and save to reset and apply correct GI rules. Note: Still pending? Approve the pending amounts under the company's Home tab > Review Insurability Requests.
- One or more of the plan's GI fields are blank. The system treats blank GI fields as $0, so enter correct GI amounts and save. Follow same steps as above to fix ee's record.
Issue: VL / ADD plan restrictions are configured (must match restricted plan amounts) but ADD benefit amount doesn’t match VL.
- EE enrolled in benefit prior to plan restrictions being set. Go into ee's enrollment flow and resave ADD page to reset.
- You imported benefit amounts that don't match. The import tool overrides plan restrictions and forces the benefit amounts listed on the spreadsheet. Follow same steps as above to fix ee's record.
Issue: EE's VL / ADD effective start date is reflecting enrolled on / signature date (or another date) instead of the ee's correct effective date according to plan design/DOH.
Most VL carriers have a wet signature rule, which is layered into our system for all VL enrollments. This wet signature is used to determine an ee's effective date if the ee enrolls AFTER his eligibility date. Example: EE is eligible for benefits 9/1/18 but enrolls in VL on 9/21. The carrier will then use that 9/21 signature date as the effective date. If the employee has not yet been enrolled, the HR Sign Date can be used to backdate the enrollment.
This is a system default setting that can't be changed or turned off. If an admin user is enrolling for the ee, be aware of the signature date field on-screen (HR signing on behalf of ee) and the date being entered when enrolling. To correct ee enrollments after the fact, you can use the enrollment editor tool.
Issue: VL / ADD rates did not update on policy anniversary
- By default, the system will set the plan end date to 12/31/2050. Policies should only be setup for more than 12 months if it is an Issue Age Policy. If you expect the employees' rates to increase at the policy anniversary, we recommend setting the plan up as a 12 month policy and renew each year.
Common VL / ADD Enrollment Errors
Error: Plan restrictions require the elected amounts to match, however the elected amount was not found in this plan.
What it means:
VL / ADD plan restrictions require benefit amounts to match, but benefit designs in plan setup don't match up - e.g. different benefit increments, age reduction schedules, etc. Ensure plan designs match to fix.
Error: Unable to enroll because salary isn't set.
What it means:
- Plan design is based on salary and ee is missing salary info. Note: Only the Annual Base Earnings field is supported for salary-based benefits. Our system doesn't auto calc annual salary for hourly ees (hours worked * hourly rate), so you'll need to manually calculate an annual salary for hourly ees and enter under Annual Base Earnings.
- EE has two or more salaries listed with the same effective date. Usually, one of those salary amounts = $0. Go to ee's Profile > Compensation and click change salary to view salary history. Delete all but one salary for the most recent effective date to fix.
Error: Plan has tobacco-based rates and employee / spouse tobacco option isn't set.
What it means:
VL rates are based on tobacco status and ee and/or spouse is missing tobacco user status. EE will need to complete these fields under Personal / Dependent Info pages in enrollment flow before enrolling plan. Note: If fields aren't visible to ees, go to the company's Benefits tab > Employee / Dependent Profile Fields and check the boxes under Visible and Editable next to Tobacco User.
Error: Unable to determine employee minimum / maximum benefit.
What it means:
- VL benefits are based on X of salary and ee's Annual Base Earnings field isn't set. Go to ee's Profile tab > Compensation > change salary link to add salary info. Note: Only the Annual Base Earnings field is supported for salary-based benefits. Our system doesn't auto calc annual salary for hourly ees (hours worked * hourly rate), so you'll need to manually calculate an annual salary for hourly ees and enter under Annual Base Earnings.
- VL benefits are based on X of salary and ee has two or more salaries listed with the same effective date. Usually, one of those salary amounts = $0. Go to ee's Profile > Compensation and click change salary to view salary history. Delete all but one salary for the most recent effective date to fix.
Common Causes of Incorrect VL / ADD Costs
- Plan's Basic > Policy Settings aren't setup correctly according to plan design - e.g. Change rates, Age reduction effective, etc.
- ER Contribution Type isn't setup correctly (plan's Enrollment tab > Benefits > Employer Contribution Type).
- Plan's rate Options aren't setup correctly - e.g. Spouse rate based on employee age, child rates based on all children, etc.
- Tip: If child rates are off, check the plan's Options tab for Child rates based on all children. When checked, the rate for CH VL is the same regardless of the number of children enrolled. If unchecked, the rate will be applied to the number of children enrolled.
Note: Change made to VL plan designs (rate options, policy settings, etc.) require a recalc of the Plan Costs via the company's Benefits tab > Rate, Eligibility & Bulk Enrollment Tools.
Plan GI rules were changed after employee's enrolled in the plan and their enrollments aren't reflecting the correct pending/approved amounts based on the new rules. How do I fix their records?
Changes made to Guaranteed Issue amounts/rules only apply to enrollments going forward - these changes won't be applied to existing employee enrollments. This was by design, as some carriers may offer special OE GI rules for companies who are switching from another carrier. We need to allow these changes to happen without impacting those existing enrollments.
See scenarios below for instructions on how to update existing employee enrollments to reflect the new GI rules that were put in place.
- The employee enrollment links for New Hire Enrollment, Newly Eligible Enrollment and Modify Current Enrollments all reference the plan's GI amounts listed for New Hire Enrollments
- The employee enrollment link for Open Enrollment references the plan's GI amounts for Open Enrollment (late entrant) and Open Enrollment (existing enrollment). OE late entrant refers to employees who do not have existing VL coverage and are electing new during OE. OE existing enrollment refers to employees who do have existing coverage and are increasing their benefits during OE.
If the change occurred during OE and the OE is still active/open: Admin can go to the employee's record > Employee Management tab > Open Enrollment link and re-save the Voluntary Life page in the enrollment flow. Re-saving the page will keep the employee's original OE election, but the new GI rules will now be reflected.
If the change occurred during OE and the OE is closed out: If the OE has been closed out, admin will need to update the record through the employee's Modify Current Enrollments link. However, the Modify link references the plan's New Hire Enrollments GI amounts, so before re-saving the employee's election, the NH GI rules under the plan setup will need to be changed temporarily so that the GI amounts match the OE GI amounts. Once adjusted, admin can go into the employee's Modify link and re-save the Voluntary Life page in the enrollment flow. Once employee records have been corrected, the plan's NH GI rules can be updated to reflect the correct rules again.
If the change occurred after newly hired and/or newly eligible employees enrolled and their NH/NE windows are still active/open: Admin can go to the employee's record > Employee Management tab > New Hire Enrollment/Newly Eligible Enrollment link and re-save the Voluntary Life page in the enrollment flow. Re-saving the page will keep the employee's original OE election, but the new GI rules will now be reflected.
If the change occurred after newly hired and/or newly eligible employees enrolled and their NH/NE windows are now closed: Admin can go to the employee's record > Employee Management tab > Modify Current Enrollments link and re-save the Voluntary Life page in the enrollment flow. Re-saving the page will keep the employee's original OE election, but the new GI rules will now be reflected.
Why does the VL page in an ee's enrollment flow display HR Must sign on employee's behalf?
Most VL carriers have a wet signature rule, which is used to track the date an ee applies for coverage. If an ee applies for a VL benefit after his eligible effective start date (according to DOH and plan design), then the carrier will use this wet signature date as the effective date. Example: EE is eligible for benefits 9/1/15 but enrolls in VL on 9/21. The carrier will then use that 9/21 signature date as the effective date.
This wet signature rule is layered into our system for all VL enrollments and can't be changed or removed. When an ee is logged in as himself and enrolling in benefits, the system automatically inputs the enrolled on date as the VL signature date - ees do not see this HR signature field. However, if an admin user is enrolling for an ee, this field will appear and requires the HR to insert a signature date on behalf of the ee.
How does an ee elect coverage for himself but decline for his dependents?
The decline button applies to the entire benefit, so this is only used when an ee wants to decline coverage. if the ee wants to elect ee coverage only, he would elect his benefit amount and leave the dependent benefit sliders at $0. This will reflect ee only coverage.
Why are ees being charged for each child enrolled in the VL plan - the same rate should apply regardless of the number of children enrolled?
The plan design wasn't setup to base child rates on all children (instead of each child). To update this, go to the plan's Enrollment tab> Options and check the box next to Child rates based on all children. Once updated, recalc the plan costs via the company's Benefits tab> Rate, Eligibility & Bulk Enrollment Tools.
An ee/spouse's VL cost changed due to System Updated Plan Rate (Age Band and/or Age Reduction) but rates are set to change at Policy Anniversary - why did this happen?
Our system performs a nightly job that scans the system for employees and dependents with birthdays to determine if an age-band or age reduction change is needed according to the plan's rate/reduction rules and processes when applicable. During this scan, the nightly job also checks to ensure that the correct rate/cost is being applied according to the plan design, and corrects if needed. Since this tool's main job is to adjust rates according to age-band/reduction changes, the change text for the event displays as such.
That said, these rate change events aren't a result of age-band/reduction rules, but rather the system is catching the incorrect costs and rectifying. Usually, incorrect costs are due to plan changes that were processed without a proper plan recalculation, or because bad data was imported into the system. For that reason, it is important to ensure that plans are setup correctly prior to enrollment, and that all imported data is correct before committing.
It is recommended that you run a plan cost recalc for your plan to ensure that the plan has been recalced properly and all ee costs will reflect correctly going forward. The recalc can be done under the company's Benefits tab > Rate, Eligibility & Bulk Enrollment Tools.
- Plan GI rules for VL and VXTD don't apply upon import - import ee's approved benefit amount and then use the ee's Modify Link to increase election to full requested benefit amount. NH GI rules are applied when using the Modify Link, so you'll need to temporarily adjust the GI rules so the system pends the remaining benefit amount correctly.
- Plan age reduction schedules don't apply upon import - import ee's original benefit amount and then use the ee's Modify Link to re-save the election and apply reduction rules correctly.