Introduction
In Empeon Workforce, Users are able to register the details of the various health, dental and visions plans that are offered to employees. By registering the details of the plans at the company level, Users can facilitate the enrollment of these benefits for their employees. Registering health plans is particularly helpful when there are ACA Rules set up within Empeon Workforce, because it allows Users to quickly identify and offer coverage to employees identified as full-time.
Setting Up A Benefit Plan
To register a Health, Dental and/or Vision plan that is offered by the organization, or view the benefit plans that have already been set up, navigate to the Benefits section within the Company tab, and select the Benefits Administration Card.
Next, switch to the Plans section to view and manage existing benefit plans or add a new one by clicking the blue "+ New Benefit Plan" button.
Plan Type
When registering a Benefit Plan in Empeon Workforce, there are three types of core plans that can be set up: Health, Dental, and Vision. Each plan offered by the organization requires a separate setup.
Empeon does not currently support voluntary benefit enrollments in the Benefits module. Voluntary plan deductions can be added in payroll strictly as a deduction.
General Info
While the steps for configuring these plans are generally the same across all three types, there are a few additional fields that are specific to Health plans.
The first section when setting up a Benefit Plan is the General Information section, which includes establishing the carrier, plan name, and registering the Group Number. For each benefit type, the following fields are required:
- Carrier - Use the dropdown to select the carrier of the plan. If the carrier is not listed, select the option for "Other".
- Enter the Plan Name - This is the internal name for the plan. It is recommended to include the year in the Plan Name to easily identify the current version each time it is renewed.
- Display Name for Employees - This is the name that will be visible to employees when they are offered to enroll in the plan. It can be the same as the Plan Name or something more specific. The Display Name is used exclusively with Empeon's digital Open Enrollment process.
- Plan Year Begin Date/Plan Year End Date - Enter the available coverage start date and end date for this plan.
- Plan Code - This is a unique code that references the plan within Empeon Workforce, mainly when importing enrollments or running reports. It is NOT recommended to include the year within the Plan Code as this code remains the same even if the plan is renewed.
For Health Plans only, it will ask to indicate whether the plan is self-insured or not, and whether it meets Minimum Essential Coverage (MEC) and Minimum Value (MV) for ACA reporting purposes. All plan types will have a field for both the Policy Number and the Subgroup Number, if applicable. This information is recommended but not required and can be found on plan documents provided by the insurance company.
Once all fields have been completed, click "Next" to proceed to the Summary of Benefits section.
Summary of Benefits
Within the Summary of Benefits section, plan details such as copays, deductibles, and plan information documents can be entered. Entering information into these fields can be helpful, but it is not mandatory. This information is ONLY visible to employees during Open Enrollment to help them understand their plan options.
Please note that relevant plan documents can be uploaded in this section to be stored on file and made available to employees during Open Enrollment. In order to do this however, the document must be uploaded to the Document Library first. This is a feature only available for those subscribed to Empeon's HR Premium package.
Since this section is only relevant to Open Enrollment, it can be skipped if there is no intention to initiate an Open Enrollment session through Empeon. Once all fields have been attended to according to preference, click "Next" to move onto the Coverage & Premiums section.
Coverage & Premiums
In this section, details about the coverage level and associated premiums can be entered, defining who can enroll in the plan and what the monthly premium will cost.
The first step on this screen is to establish the levels of coverage for Employee only, Employee and Spouse, Employee and Children, and Employee and Family. For each level of coverage, enter the Monthly Premium, which represents the total cost of the benefit plan that must be paid each month to maintain the coverage. This cost is typically shared between the employer and employee. The employee contribution amounts will be entered in the next section. In cases where domestic partnerships are applicable for enrollment, there is a toggle to enable this option.
For Health Plans only, there is an additional section to establish the Maximum Age for Dependents to enroll in the plan. Under the ACA guidelines, dependents can generally remain on their parent's health insurance plan until they reach the age of 26. Once a dependent turns 26, they typically lose coverage under their parent's plan and must seek their own coverage. Considering this to be the case, the maximum age for a dependent to be able to enroll in this coverage should be set to 25. It is a common mistake to have 26 entered here.
The last setting within this section will be to establish when the last day of coverage should be if the employee were to be terminated. After all relevant fields have been completed, click "Next" to move onto the Eligibility & Contributions section.
Eligibility & Contributions
The Eligibility & Contributions section is where rules can be set up to determine which employees are eligible for the benefit. This section is also where the employee portion of the monthly premium is established.
Within this section, Rules help to differentiate groups of employees who are eligible for the benefit and determine their associated monthly contributions. In some cases, multiple Rules may need to be established to account for varying eligibility criteria and contribution amounts among different employee groups. This section will automatically default to Rule 1, which can be renamed appropriately, because minimally there needs to be at least one rule to encompass all eligible employees. Should multiple Rules need to be set up to accommodate a separate group of employees, there is the "+ New Rule" button that will add a new rule for separate eligibility settings.
Additional Rules that have been added can be easily deleted, if necessary, using the three-dot menu. When multiple Rules are established, it is recommended to rename the Rule Name to clearly reflect the group of employees the eligibility rules apply to. For each Rule that is established, the first setting that must be configured is: Which Employees are Eligible under this Rule?
For Health Plans only, there is a toggle for Only employees calculated as ACA Full-Time are eligible for this rule. When enabled, the system will use the measurement period defined in the company's ACA Rules to determine which employees are eligible to enroll in this plan. It is recommended to toggle this on if there are ACA Rules established.
For all plan types, this section includes filters for Employment Type and Benefit Class to narrow down the employees eligible for enrollment. Applying more filters will result in a more specific group of eligible employees. To ensure the filters work optimally, this information must be kept up to date on Employee Profiles.
Tying this section back to Rules, when multiple Rules are established, this section for each Rule helps differentiate which employees are assigned to Rule 1 versus those assigned to Rule 2, and so on. Here is a simple example of Rule 1 established for Management employees and Rule 2 established for Non-Management employees.
The next setting on this screen to consider is: When are New Hires Eligible to Enroll?
This establishes the eligibility for newly hired employees and when they will be able to enroll. This may also differ depending on the Rules that are set up. For example, Rule 1 for Management employees may be able to enroll Immediately Upon Hire whereas Rule 2 for Non-Management Employees must wait until the first of the month after 30 days from their hire date.
The last configuration within this section will be: What Will the Employees be Contributing Each Month?
This section will establish the employee portion of the Monthly Premium. When there are multiple Rules established, this section helps to differentiate the employee contributions for each Rule.
There is also the ability to structure employee contributions to be based on length of service (in months). By toggling LOS Based Contributions on, the system will allow for their to be "Tiers" established to associate the the employee's monthly contribution to be based on how long they have been with the company. Typically, when contributions are structured by length of service, the monthly contribution amount decreases the longer the employee is with the company.
Associated with this feature is a setting for Calculate LOS Midplan which ensures that employees move to the next tier as soon as they qualify, rather than waiting until January 1st of the following year.
After all relevant fields have been completed, click "Next" to move onto the Deductions section.
Deductions
The final step in configuring a benefit plan is to establish the payroll deduction associated with the plan. Here there is the option to link the benefit plan to a deduction so that any time an employee is enrolled in the plan, the deduction for it is automatically set up for them within their Employee Profile.
This step can be skipped over however, if there is the preference to manually add the deduction to the Employee's Profile after they have elected coverage. To skip over this section, and manually add the deduction to the Employee Profile after enrollment, simply toggle off Should contributions be deducted and tracked in payroll? Keep this toggled on however to link the deductions to the benefit so that they can automatically be set up and tracked in payroll upon enrollment.
- Deduction Taxability - Should this deduction be structured as a pre-tax or post-tax deduction? This section defaults to Section 125, Pre-tax which is what is used in most cases, however this section can adjusted if necessary.
- Deduction Code - Assign the Deduction Code that will be used for this benefit plan. Only one generic Deduction Code is necessary; there is no need to create multiple codes to distinguish between specific plans.
- Contribution Schedule - This will determine how the employee's monthly contribution will be paid. The most common option here is Per Payroll Annual Calc because it calculates the annual contribution and divides it by the number of pay periods in the year, ensuring a consistent fixed amount is deducted each pay period. There are other options available here such as:
- Per Payroll Monthly Calc Block Extra- This will calculate the total monthly contribution, divide it by the number of pay periods in the month, to get the amount that should be deducted each pay period within the month.
- Monthly First Payroll - This will deduct the total monthly contribution on the first payroll of the month.
- Monthly Last Payroll- This will deduct the total monthly contribution on the last payroll of the month.
- Employer Contribution Memo Code - Since the benefit plan's monthly premium is split between the employee and the employer, a memo code is assigned here to indicate the employer's portion of the premium.
Click "Save" to finalize the configuration of the benefit plan. For each additional benefit plan the company offers, these steps will need to be repeated. Once the benefit plan is set up, enrollments can be entered manually on the Employee Profile, imported using the Benefit Enrollments Power Import, or offered through an Open Enrollment Session.
For more information on how benefit plans can be offered, refer to Empeon's article: Benefits Administration: Enrollments.