The Employee Navigator Rules Engine combines data in the employee record with the eligibility rule configured on a plan and then "calculates" whether or not the employee is eligible for the plan. While it's simple in its concept, the calculation is very powerful. Like any mathematical equation, all of the values need to be present in order for it to function properly. When an employee isn't able to enroll in the expected plan, or isn't presented the expected benefit or costs, stepping through all the components on both the plan setup as well as the employee record can be a cumbersome process.
The Plan Eligibility Diagnostic Tool allows the plan details used to determine eligibility and benefits to be surfaced next to the employee's eligibility status and identifies all variables in one easy to find location. This provides users with the necessary information to troubleshoot or confirm an employee's eligibility in a specific plan.
To access this tool:
- Search for an Employee > Benefits Summary > Benefits Eligibility
- Select the "Magic Wand" next to the plan name
- For each item, review and compare the Plan Value with the Employee Value
- Use the status icons to point you in the the right toward any discrepancies which may be affecting availability of the plan for the employee.
- grey 'dash' = info only
- green 'check' = ok
- red 'x' = problem
- brown 'lightning bolt' = needs deeper look
When would I use this tool?
The Plan Eligibility Diagnostic Tool can be used anytime. You may simply want to verify that during your testing that the plan configuration is correct and the expected employee values are being checked by the system. However, the most common use of this tool will be to assist in troubleshooting plan availability.
There are several ways plan rules can affect which plans the employee is presented with during enrollment. The most basic, is whether the employee is eligible for the plan. The first place to start is the eligibility rules set on the plan. If eligibility is configured with a "class" rule, is they employee assigned to one of the included "classes"?
It can also be more involved than that. If the waiting period indicates there is a 60 days from the date of hire, maybe the employee won't be eligible for the plan until after the plan ends. You would need to check when the employee was hired, what are the waiting period rules for this plan, is he assigned to these groupings, the plan dates, and what date he is eligible for the plan. In this simple case, there are at least 6 pages that need to be reviewed to obtain enough details to troubleshoot why he can't see the plan to enroll. Given all the variables, any number of these items may not be correct, but the result is the same. The employee can't enroll. Using the Plan Eligibility Diagnostic Tool will provide visibility into any employee values which are not aligned with the plan configuration so that you are able to resolve the issue.