Some plans designs require an employee enroll in another plan before they are eligible to enroll in a specific plan. Use plan restrictions to configure the enrollment rules.
Example 1: Employees may not be eligible to enroll in a supplemental GAP policy unless they have elected the medical coverage.
Example 2: Employees who elect Medical automatically get Dental.
Identifying the Restricted Plan:
Plan restrictions are configured on the restricted plan. Before an employee can elect in the restricted plan, there must be an enrollment in this restricting plan. In our examples, the GAP plan and the Dental plans are the restricted plans, and would have the restrictions setup. Based on the enrollment in the restricting medical plan, the employee is evaluated to determine if he/she is eligible to enroll in the restricted dental plan.
Designate Restricting Plan/Benefit Category:
From the restrictions tab on the restricted plan, select whether enrollment is dependent on the enrollment in a specific plan(s) or in a benefit category. Making a selection on either a) or b) activates plan restrictions.
A) Enrollment in a specific plan: Identify restricting plan(s). Employee must be enrolled in any of the specific plans before they can elect the restricted plans. This may be one or more plans.
- Example: Employee who elects the PPO can elect the dental plan. Enrollment in any of the non-selected plans will make employee ineligible to enroll in the restricted plan.
Tip - If you are selecting all the plans in the benefit category, such as all medical, use option b) to configure based on benefit category.
B) Enrollment in a benefit category: Identify the restricting benefit category. Employee must be enrolled in a specific benefit category before they can elect the restricted plans.
- Example: Employees who elect ANY of the medical plans, regardless of which one, can elect the GAP plan.
To turn off restrictions, change the option back to “select”.
Additional Configuration Options:
Additional configuration options allow more flexibility in defining the plan restrictions. These options are all in section c).
- Enforce restriction at the same coverage level:
When checked, enrollment into the restricted plan must have the same members covered. This configuration would be used in Example 2 (listed above). If everyone enrolled in medical also get dental, you would check “Enforce coverage level” to ensure the same members who have medical also get dental. If the enrolled members don’t need to be same, you would leave this option off.
When this option is activated, the enrollment page will pre-load with the eligible dependents based on the enrollment in the restricted plan. Employees cannot change the covered members, and will receive a message referencing the plan restriction requirements.
If employee changes enrollment in the restricting plan after they elect the restricted plan, a message on the enrollment summary will reflect restrictions are not satisfied and employee will be prevented from selecting "Agree and Complete" until restrictions are satisfied.
Note: This option doesn’t require a member to enroll in the restricted plan. This can be used separately or in conjunction with the require enrollment option.
- Require enrollment in the plan if restriction conditions are satisfied: When checked, employees who enroll in the restricting plan are not given the option to decline the restricted plan.