Default Eligibility Rules
Plan configuration just got simpler with the ability to setup company level Default Eligibility Rules. The Default Eligibility Rules tool is designed so that most users will only need to configure eligibility rules once, then pull them into each plan with the click of a button. Talk with your HR about syncing their new hire, demographic change, and rehire eligibility rules today to help you increase plan build efficiency and reduce your implementation timeline.
Default Rule Setup
From the Benefits tab > Settings > select Default Eligibility Rules.
Select Add to add a new default eligibility rule for the company. Default eligibility rules support all standard rules currently available from the plan level:
New Hire Rules
- Coverage Waiting Period
- Coverage Begins/Entry Date (After Waiting Period)
- Termination Date
- *Employee Change Frequency (*applies to Dependent Care/Transit/Parking Plans only)
Demographic Change Rules
- Demographic – Coverage Waiting Period Based on
- Demographic – Coverage Begins/Entry Date (After Waiting Period)
Name the rule, then select a Benefit Category. If all plans have the same eligibility rule, only 1 eligibility rule will need to be configured. To build a rule for all plans, select "All". This will be your company's standard rule.
In some cases, certain Benefits may have slight variances from the standard company rule. For example, all of the company Medical plans may have a termination rule = End of the month, while Group Life and Disability terminates on the termination date. Similarly, the Demographic Change rule may apply to some Benefits, but not others. Multiple rules can be built to accommodate exceptions to the standard rule for all benefits.
To add a Benefit specific rule, select Add from the Default Eligibility Rules page, name this rule, then select the applicable Benefit Category. Employee Navigator has built in logic that will recognize the plan you are configuring, check for a default Benefit eligibility rule first, and if one does not exist, then the standard rule you've built for All benefits will apply.
A standard or Benefit specific rule can be edited any time or deleted by selecting the trashcan icon on the rule list page. Editing or deleting a rule will never directly impact a plan that has been configured using your default. We will never push a default rule to the plan, default rules will always need to be pulled into a plan from the plan > Eligibility Rules setup.
Adding a new plan
The option to "Use Default Eligibility Rules" will be immediately available on all modals used to add a new plan. This includes building a custom plan from scratch, copying from the Marketplace, the current company, a different company, or the company library. This option is defaulted to = Yes but can be deselected or overwritten from the plan's Eligibility Rules page. If a default rule does not exist, no rules will be applied to the plan.
From the plan > Eligibility & Enrollment > Eligibility Rules > edit > there is a button available to "Use Default Eligibility Rules". Selecting this button will pull in the applicable eligibility rule you've built. If rules already exist on the plan, the button will override the existing rules (Note: this includes blank fields!)