Configuring and Using Insurance Plans

To create an insurance plan, perform the following steps:

1. Use the Action Search and navigate to the Benefits Admin Overview.

2. Select Benefits Admin Overview from the search result.

3. Select Create New → Insurance Plan.

4. In the Plan ID, enter a unique ID for your insurance plan.

5. In the field Plan Name, specify the name of the plan.

6. In the field Insurance Provider, select the insurance provider or use the + to define details about the provider such as:

   

   • Provider ID

   • Provider Name

   • Contact Person

   • Contact Phone

   • Contact E-mail

   • Useful Links

   • Policy Documents

7. In the field Frequency, specify the premium payment frequency for example, Monthly, Quarterly, Annual, and so on.

   Note

   Based on the employee’s selection, the system reads the rate chart and accordingly displays the employee and employer premium contributions amounts on the screen and the frequency of premium payment.

8. In the field Employer contribution pay component, enter the pay component in which the system stores the employer premium contributions for the corresponding insurance plan.

9. In the field Employee contribution pay component, enter the pay component in which the system stores the employee premium contributions for the corresponding insurance plan.

10. In the field Eligibility Rule for Coverage, select the eligibility rule to define eligibility criteria for the coverage per insurance plan.

11. For the field Premium for, select either Employee and Dependents or Dependents Only.

12. Under the Coverage Options section, specify the coverage and enrollee details. Select Details to enter the information, such as:

    • Enrollment For: Select the relevant enrollee object. Choose the Add button to create a detail object. The Enrollee Option screen appears. Enter the data in the following fields:

      

      • Enrollee Options ID.

      • Enrollee Options Name: Enter the name of the enrollee option.

      • Dependent Option: Select the dependent option for enrolling from the dropdown list. The options include Self, Self + Spouse, and Self + Family.

        Note

        The dropdown values are maintained in the benefitInsuranceDependentOption picklist. The system activates this field only if you have chosen the premium type as Employee and Dependents.

      • Minimum Allowed Dependents: Enter a minimum number of dependents the employee has to enroll.

      • Maximum Allowed Dependents: Enter a maximum number of dependents the employee is allowed to enroll.

      • Dependent Eligibility Rule: Select an eligibility rule for dependents. An employee is shown only the eligible dependents during enrollment. For instance, admin can create rules stating that up to two children below the age of 25 years is eligible for enrollment.

      • In Select Allowed Dependent Type, select the value in Relationship Type, such as Father, Mother, Spouse, and so on.

        Note

        The dropdown values are maintained in the relationShipType picklist.

    • In Coverage Details, select the relevant coverage object in the field Coverage or select Add to create a new object. The Insurance Coverage screen appears.

      • Coverage ID.

      • Coverage Name: Specify the coverage name.

      • Coverage Type: Select the coverage type from the dropdown list. The options include Amount, Percentage, Factor, or Others.

        

        If you choose Amount, enter the coverage amount in the Amount field and also select the relevant Currency.

        

        If you choose Percentage, enter the percentage value in Percentage field and also choose the relevant value in either Pay Component field or Base Pay Component Group field. For example, if you enter 50 in Percentage field and select base salary in Pay component field the system calculates/sets the insurance coverage as 50 percent of the base salary.

        

        If you choose Factor in this field, enter the factor value in the Factor field and also select the relevant value in the Pay Component or Base Pay Component Group fields. For example, if you enter two in Factor field, and select Base Salary in the Pay component field, the system calculates/sets the insurance coverage as two times the base salary.

        

        If you choose Others, values saved in the picklist benefitInsuranceCoverageLevel are displayed in the Coverage Level field.

    Note

    When an employee is enrolling dependents, the following validations must be included:

    • Number of Dependents: While enrolling for Employee + Family options, then it is possible for the administrator to define the maximum number of dependents that are eligible to be enrolled.

    • For some dependents, eligibility criteria apply. For example, children above 26 years are not allowed to be enrolled. The administrator must be able to configure these eligibility rules.

    Note

    While creating this rule, choose the parameters, such as Base Object as the object that is used to define eligible enrollee options and Code as dep_*.

    When an employee enrolls, he is able to enroll his dependents based on the preceding conditions as per the admin configurations for the Insurance plans.

13. After you save your entries, the system generates a unique coverage ID.

14. Enter/choose the relevant coverage value.

To create a rate chart, perform the following steps:

1. Use the Action Search and navigate to the Benefits Admin Overview.

2. Select Create New → Insurance Rate Chart.

3. In the Effective Start Date, specify the date from which a particular rate chart is effective.

4. In the Rate Chart ID field, enter the ID.

5. In the Insurance Plan, specify the plan name.

6. In the Insurance Provider field, specify the provider name.

7. In the Insurance Coverage field, select the relevant coverage object. Choose the Add button to create a detail object.

8. In the Factor field, specify the amount based on which the system calculates the premium for a particular coverage.

   For example, the premium rate could be an amount per EUR 1,000. Let’s assume that the coverage is 2 X Annual salary of the employee. The annual salary of the employee is EUR 10,000. Monthly premium is defined as EUR 0.5 per EUR 1,000 of coverage. In this case, the coverage and premium are calculated as follows:

   • Coverage= 2 X 10,000 (Annual salary) = EUR 20,000

   • Factor= 1000

   • Premium Rate= EUR 0.5

   • Actual Premium= 0.5 X coverage (20,000)/factor (1,000) = EUR 10 per month.

     Note

     If the premium is a flat amount, then the factor is -1.

9. Choose the Currency.

10. In the Age as-of Day field, specify the day on which the employee age is considered for calculating the premium amount.

11. In the Age as-of Month field, specify the month on which the employee age is considered for calculating the premium amount.

12. In the Age as of Year field, select the value based on which the system calculates the employee’s age to determine the premium contributions.

    If you select Enrollment Year, the system calculates an employee’s age on the year in which the employee enrolls for a particular insurance plan.

    If you select Enrollment Effective From, the system calculates the employee’s age based on the year in which the insurance enrollment is effective.

    For example, Carla Grant was born on December 1, 1980. She enrolls for an insurance plan on November 1, 2014. This plan is effective from January 1, 2015. This particular insurance plan runs from January to December every year. Based on the value that you select in the Age on Specific Year field, this is how the system determines her age for premium contributions:

    • If you select Enrollment Year (which is November 1, 2014) in this field, the system computes Carla Grant’s age as 33 years. So, from January 2015 to December 2015, she pays the premiums for a 33-year-old, despite turning 34 years in December 2014.

      From January 1, 2016, she begins paying the premiums applicable for a 34-year-old.

    • If you select Enrollment Effective From (which is January 1, 2015) in this field, the system computes her age as 34 years.

13. In the Gender Relevant field, specify if the gender is relevant for calculation of the premium rate.

14. In Rate Chart for Plans Covering Employee and Dependents section, you can specify the following: In this case, the system calculates the lump sum premium amount irrespective of the number of dependents you enroll.

    • Rate Chart Type: Select the relevant chart type.

    • Gender: Select the gender of the employee.

    • Location.

    • Age From: Specify the minimum age from which the particular premium rate is valid.

    • Age To: Specify the maximum age until which the particular premium rate is valid.

    • Enrollment For: Select the person for whom an employee is seeking the insurance coverage. You have the options such as self, self + spouse, self + family.

    • Smoking: Select the smoking habit of the employee.

    • Employee Contribution.

    • Employer Contribution.

15. In the Rate Chart for Plans Covering Dependents only section, you can specify the following: In this case, the premium amount is calculated separately for each dependent that you enroll.

    • Gender: Select the gender of the dependent.

    • Dependent Type: Select the relevant type, such as, mother, father, spouse, and so on.

    • Age From: Specify the minimum age from which the particular premium rate is valid.

    • Age To: Specify the maximum age until which the particular premium rate is valid.

    • Employee Contribution.

    • Employer Contribution.

    • Rate Applicable For: Select the relevant type, such as, Individual or Group.

      In case you select Group, the system calculates the lump sum premium amount irrespective of the number of dependents you enroll.

      If you select Individual, the premium amount is calculated separately for each dependent that you enroll.

    • Smoking: Select the smoking habit of the dependent.

You can configure the rate chart for plans covering employee and dependents using standard fields, such as legal entity, country/region, job classification, and so on.

1. The Rate Chart Type is defaulted to Regular.

2. In the Rates Based On field, choose Standard Fields.

   Using this option, you can define the rates based on the fields Legal Entity, Country/Region, Job Classification, Employment Type, Employee Class, Contract Type, Regular or Temporary, Pay Grade, Business Unit, Cost Center, Gender, Smoking Habit, Location, and Health Check Status.

   Note

   To display the Health Check field on the enrollment UI, enable the Health Check field on the benefit enrollment configuration UI.

3. In the Age From field, specify the minimum age from which the particular premium rate is valid.

4. In the Age To field, specify the maximum age until which the particular premium rate is valid.

5. In the Enrollment For field, select the people for whom the employee is seeking the insurance coverage. You have the options such as employee, employee + spouse, employee + family, and so on.

6. Enter the employee and employer contribution.

7. Based on the country that you have entered, other details are required. Enter the additional information as necessary.

8. Choose Finished.

To configure an Insurance Plan in your system, perform the following steps:

1. Use the Action Search and navigate to Benefits Admin Overview.

2. Select Create New → Benefit.

3. In the section Step 1: Specify Benefit Type for the Benefit Type field, choose Insurance.

   

4. In the Step 2: General Informationsection, enter the generic data, such as:

   

   • Benefit ID: Specify the benefit name that you want to create.

   • Benefit Name: Specify the benefit name that you want to create.

   • Effective From: Select the date from when the benefit is effective in the organization. Based on this date, all employees for whom the benefit is applicable see it on their Employee Overview page.

   • Benefit Program: Select the relevant benefit program.

   • Status: Select the relevant status for the benefit, either Active or Inactive.

   • Benefit Short Description: Specify the short description for the benefit.

   • Currency.

   • Under the Payroll Integration section, enter the following details:

     • Integration Mode: Select Pay Components if you want the system to replicate the payment information to either compensation portlet or deduction portlet. Based on the benefit type that you select, the system creates payment information entries in one of the portlets.

       Benefit Type	Portlet
       Pension	Deductions Portlet

     • Deduction Start Date: Select the required value from the following options.

       • As of Enrollment Effective Date: Here, the system creates both the enrollment and deduction entries effective from the date the employee enrolls into the benefit.

       • Next Pay Period: Here, the system creates only the enrollment entries effective from the date the employee enrolls into the pension plan. However, the deduction entries are created effective from the start date of the next pay period until the enrollment validity end period, as maintained in the schedule.

         Note

         If you choose the next pay period, ensure that you define the pay calendar.

     • Always Next Pay Period: The system creates the deduction entries effective from the start date of the next pay period. The pay check issue date is not considered.

5. In Step 3: Associate Legal Entities, specify the name of the legal entity/company for which you want this benefit to be active, in the field Legal Entity.

   

6. In Step 4: Specify Enrollment and Claim Dates, specify:

   • Benefit Schedule: Select the schedule. If you want to create a new benefit schedule, select Add. The Benefit Schedules pop-up screen appears. Enter the following data:

     

     • Schedule ID.

     • Schedule Name: Specify the name of the schedule for a particular benefit.

     • Schedule Periods: Select the schedule period or create a new period. To create a new period, select Add. The Benefit Schedule Period screen appears. Enter the following data:

       

       • Period ID.

       • Period Name.

       • Enrollment Opens: Enter the start date for enrolling in a benefit. The employee can enroll for a particular benefit from this date.

       • Enrollment Closes: Enter the end date for enrolling in a benefit. The employee can enroll for a particular benefit until this date.

       • Enrollment Effective From: Enter the date from which the enrollment is valid.

       • Enrollment Valid Until: Enter the date until which the enrollment is valid. After this date, the employee must renew the enrollment to continue being eligible for a benefit.

       • Claim Starts: Enter the Start date for claiming a benefit.

       • Claim Ends: Enter the end date for claiming a benefit. The employee can claim for this benefit until this date.

       • Balance Carry Forward Up to Date: Enter the date up to which an employee can carry forward any unclaimed balances.

   • Frequency: Specify the frequency of occurrence of the benefit.

   • Maximum Claims Per Schedule: Specify the maximum number of claims that you can make in a given schedule.

   • Maximum Claims Per Frequency: Specify the maximum number of claims that you can make in a given frequency that is annual, or monthly, and so on.

   • Days Remaining to Claim Benefit: Specify whether or not to show or hide the number of days remaining to claim for a benefit.

7. In Step 5: Define Enrollment Details specify the following:

   

   • Enrollment Required: Select Yes or No.

     If you select Yes, it means that an employee must enroll to avail of the benefit.

     If you select No, the employee is not required to enroll in a benefit to avail themselves of the benefit. If the employee is eligible, they automatically see the benefit in the Employee Overview page.

   • Days Remaining to Enroll in Benefit: Specify whether or not to show or hide the number of days remaining to enroll in a benefit.

   • In the Enrollment Type and Workflow section, information such as:

     • Enrollment Type: Select either Automatic or Manual. This field displays on the screen only if you select Yes in the Enrollment Required field.

       If you select Manual, the employee must go to the Enrollment Page and enroll for a benefit.

       If you select Automatic in the Enrollment Type field, you must create a job for auto enrollment of benefit.

     • Enrollment Workflow: Associate the workflow that the system must trigger when an employee enrolls for a benefit.

     • E-mail Notification for Enrollment: Select Yes if you want an employee to receive an e-mail notification once an employee enrolls for a benefit and the enrollment is approved.

   • In the Settings for Employee Edit and Opt-out of Enrollments section, enter the following information:

     • Enrollment Edit Allowed: Select either Yes or No.

       • In case you select Yes, the system displays the Allow Edit of Enrollment field. Select one of the following values:

         • Only during Open Enrollment Period

           If you choose Yes, then the employees can edit their enrollment details only when the enrollment window opens.

         • Only while Enrollment is Active

           If you choose Yes, then the employees can edit their enrollment details during benefit validity period and enrollment window opens.

         • Throughout Open and Active Enrollment

           If you choose Yes, then the employees can edit their enrollment details anytime during benefit validity period, enrollment period, and including the gap period between enrollment period and validity period.

           To edit the enrollment details, an edit link appears against each relevant benefit. Employees can use this link to edit the enrollment of the particular benefit in Employee Overview Page.

       • If you select Yes, the system displays the Allow Opt Out of Enrollment and Opt-out Workflow fields.

         • Allow Opt Out of Enrollment

           If you choose Yes, Read-only Effective Date, then the employee can opt out of manually or automatically enrolled benefits during the active enrollment period due to a life event with a benefit exception which allows edit and opt out, and the effective date appears as read-only.

           If you choose Yes, Editable Effective Date, then the employee can opt out of manually or automatically enrolled benefits during the active enrollment period due to a life event with a benefit exception which allows edit and opt out, and the effective date appears editable and can be set in the past, or in the future other than the enrollment date. Even if an employee chooses to opt out they can also re-enroll as per their eligibility and as per the enrollment schedule.

         • Opt-out Workflow

           The admin is able to select an approval workflow for the opt-out event.

       • If you choose No, employees are not allowed to change the enrollment details.

     • Allow Automatic Updates of Enrollment. This field is displayed when the Enrollment Type is set to Automatic.

       If you select Yes in this field, the system allows the job to edit the enrollment details.

       Note

       In the current release, the automatic edit of enrollment is possible only for Pensions.

   • In the Associate Any Additional Enrollment Fields And Config UI Screen Specific to this Benefit (Optional) section, information such as:

     • Enrollment Screen ID.

     • Additional Enrollment Fields: Select the relevant enrollment object.

       You use this field when you want the employee(s) to enter more details while enrolling. For example, for company car benefit enrollment you may want to capture information like route number, home address, emergency contact number and so on. They are not standard fields. You can add these fields to the claim object and then associate them here.

     • Carry Forward Enrollment: Select either Yes or No.

       If you select Yes, you can carry forward the enrollment from the previous periods to the subsequent schedule period.

8. In Step 6: Add Useful Contacts, enter the details of the contact person for the relevant benefit in the Contacts field. You can see this data on the Enrollment and Claim screen.

   

9. In Step 7: Add Policy Documents, Forms, and Links, you can specify the related benefit documents using the following fields.

   

   Under theHyperlinks section, information such as:

   • URL: Enter the target URL.

   • Label: Enter the label for the hyperlink.

   • Policy Documents: Enter the policy description and attach the relevant policy document.

   • Forms: Attach the relevant form which the employee has to fill in.

   • Links: Enter the related web links, if any.

   Note

   To upload, you must save the documents. You can see this data on the Enrollment and Claim screen.

   To upload, you must save the documents. You can see this data on the Enrollment and Claim screen.

10. In Step 8: Specify Insurance Plan Details (if Benefit Type is Insurance), specify the following:

    • Insurance Type: Select the relevant type such as Life, Dental, Medical, and so on.
    • Enrollment Applicable For: Select Employee and Dependents or Dependents Only.
    • Insurance Plans: Select one or more insurance plans.
    • Insurance Plan Standard Fields: Select which standard fields you want to display on the Plan cards.
    • Tobacco and Health Check: Specify if Tobacco and Health Check are applicable for the insurance benefit.
    

In this exercise, you will add a dental insurance plan to your organization's benefit package.

1. Create a new benefit schedule with the following details:

   Field	Value
   Schedule ID	2025DENTAL
   Schedule Name	2025 Dental Plan Schedule
   Schedule Period	Select + and enter the following data: Period ID: 2025DENTAL Period Name: 2025 Dental Plan Schedule Period Enrollment Opens: 01/01/2025 Enrollment Closes: 12/01/2025 Enrollment Effective From: 01/01/2025 Enrollment Effective Until: 12/31/2025

   1. Use the Action Search and navigate to Benefits Admin Overview.

   2. Choose Create New: Benefit Schedules.

   3. Enter the given Schedule ID and Schedule Name.

   4. In the Schedule Period field, choose +.

   5. Enter the details given in the table for the Schedule Period .

   6. Choose Save and close the Benefits Schedule Period screen.

   7. Choose Save.

2. Create a pay component with the following details:

   Field	Value
   Effective as of	01/01/2025
   Pay Component ID	DentalPlan
   Name	Dental Plan
   Status	Active
   Pay Component Type	Amount
   Is Earning	No
   Currency	USD
   Frequency	Monthly
   Recurring	Yes
   Can Override	Yes

   1. Navigate to Employee Files → Manage Organization, Pay, and Job Structures.

   2. Choose Create New: Pay Component.

   3. Enter the data from the table.

3. Create a picklist called Insurance Type and add the entry Dental. Use the following details:

   Picklist Insurance Type

   Field	Value
   code	insuranceType
   Name	Insurance Type
   Status	Active
   Effective Start Date	Jan 1, 2025

   Values for the Picklist Insurance Type

   External code	DENTAL
   label	Dental

   1. Navigate to Picklist Center.

   2. Use the (+) sign to create a new picklist.

   3. Enter the data from the table: Picklist Insurance Type.

   4. Select Save.

   5. Open the new picklist by selecting it in the list.

   6. Select the active version to open the details.

   7. Enter the picklist values as given in the table: Values for the Picklist Insurance Type.

   8. Leave all other values at the default and select Save.

4. Create a picklist called Benefit Insurance Dependent Option and add Employee to the list of options using the data in the following table:

   Picklist - Benefit Insurance Dependent Option

   Field	Value
   code	benefitInsuranceDependentOption
   Name	Benefit Insurance Dependent Option
   Status	Active
   Effective Start Date	Jan 1, 2025

   Values for the Picklist Benefit Insurance Dependent Option

   Field	Value
   External code	EMPLOYEE
   label	Employee

   1. In the Picklist Center, use the (+) sign to create a new picklist.

   2. Enter the data from the table: Picklist - Benefit Insurance Dependent Option.

   3. Select Save.

   4. Open the new picklist by selecting it in the list.

   5. Select the active version to open the details.

   6. Enter the picklist values as given in the table: Values for the Picklist Benefit Insurance Dependent Option.

   7. Leave all other values at the default and select Save.

5. Create an Insurance Plan using the data in the following table:

   Field	Value
   Plan ID	DENTAL
   Effective Start Date	01/01/2025
   Plan Name	Dental Plan
   Insurance Provider	ACE Dental
   Premium Payment Frequency	Monthly
   Employer contribution pay component	Dental Plan
   Employee contribution pay component	Dental Plan
   Premium for	Employee and Dependents
   Enrollment For	Employee
   Coverage	Dental Plan Coverage
   Coverage Type	Other

   1. Use the Action Search and navigate to Benefits Admin Overview.

   2. Select Create New → Insurance Plan.

   3. Populate the fields using the preceding table.

      • To add the insurance provider, select the Add (+) icon next to Insurance Provider.

      • To add the Enrollment For, select the Add (+) icon next to Enrollment For under the Coverage Options in the lower left.

        • Enrollee Options ID: EMPLOYEE

        • Enrollee Options Name: Employee

        • Dependent Option: Employee

      • To add the Coverage and Coverage Type, select Details in the Coverage Options section.

        • Coverage Name: Dental Plan Coverage

        • Coverage Type: Other

        • Coverage ID: DENTAL

   4. ChooseSave.

6. Create an Insurance Rate Chart and add it to your insurance plan.

   Insurance Rate Chart

   Field	Value
   Effective Start Date	01/01/2025
   Rate Chart ID	DentalPlanRateChart
   Insurance Plan	Dental Plan
   Insurance Provider	ACE Dental
   Insurance Coverage	Dental Plan Coverage
   Factor	-1
   Currency	USD

   Plans Covering Employee and Dependents' Details

   Field	Value
   Age From	0
   Age To	80
   Enrollment For	Employee
   Employee Contribution	90

   1. Use the Action Search and navigate to Benefits Admin Overview.

   2. Select Create New → Insurance Rate Chart.

   3. Enter the data from the preceding table. To enter the Employee Contribution, select the Details link next to the Rate Chart and enter the value in the Employee Contribution field.

   4. Select Save.

   5. Add the rate chart to the insurance plan.

      • Use the Action Search and navigate to Benefits Admin Overview.

      • In the Search field, select Insurance Plan.

      • In the field to the right, select Dental Plan.
      • Select Take Action → Make Correction

      • In Step 2: Provide Coverage and Rate Chart Details, select the Details link under Enrollment For.

      • Go to the Rate Chart field and add the rate chart created.

      • Select Done.
      • Select Save.

7. Create a new benefit using the data in the following table:

   Field	Value
   Benefit Type	Insurance
   Benefit ID	DENTAL
   Benefit Name	Dental Plan
   Effective From	01/01/2025
   Status	Active
   Currency	USD
   Benefit Short Description	Dental Plan
   Integration Mode	Benefit Objects
   Legal Entities	Ace USA
   Benefit Schedule	Dental Plan Schedule Period
   Enrollment Required	Yes
   Days Remaining to Enroll	Show
   Enrollment Type	Manual
   Insurance Type	Dental
   Insurance Plan	Dental Plan

   1. Use the Action Search and navigate to Benefits Admin Overview.

   2. Select Create New → Benefit.

   3. Enter the data from the table.

   4. Select Save.

8. Confirm if benefit Dental Plan appears in the People Profile → Benefits tab under the Open Enrollment tab.

   1. From the User menu, select Proxy As.

   2. Enter the user name Carla Grant.

   3. Select View My Profile.

   4. Select the Benefits tab.

   5. Under My Active Enrollments, select Go To Benefits.

   6. Verify the dental plan appears under Open Enrollments.