Benefit Structure

Setting up Plans Years and Program Years

This is the basic and most important set up needed for OAB. Every enterprise runs with a set of dates in hand, that they call it as a year start date and a yearend date. Some stick to the Fiscal years as given by the Tax department / IRS, some define their own set of dates.

For an example, the enterprise may take 1st January to 31st December as a year. Some might look at 1st August to 31st July. Some even prefer the 1st April to 31st March. So here the task is to define the same here. See Figure 6.1 – Program and Plan Years.

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> General Definitions -> Additional Setup -> Program/Plan Years

Steps:

  • In the start date field, key in the start date of the year and in the end date field, enter the end date. like 01-JAN-2011 being the start date and 31-DEC-2011 as the end date
  • It’s advised to create these years for at least 15 years. 5 years backwards and 10 years in front. For an example, if we are implementing the application for the year 2011, we should start from 2006 and create it till 2021.

(Figure 6.1 – Program and Plan Years)

These years will then be used in Benefit structure.

Creating Benefit Structure

A benefit structure is a structure in which the Plan types, plans and options are arranged in a particular fashion based on their availability. Let's first do an exercise by taking an example. We will discuss about the steps later in this section; however now, let’s focus on the designing a Benefit Structure.

Let's say we are implementing the Benefits for a Firm. The Firm has Applicants, Expats, Active employees and Retirees. The Firm also supports COBRA. Now with these in mind, we as designers will divide the group in to Programs.

  1. First thing, Separate COBRA as a different Program
  2. If Retirees get same Benefits as Actives, no need to create a separate Program for them; However if they don't, create a different Program named Retirees.
  3. If Applicants get any benefits and are different than what Actives get, create a separate Program for Applicants
  4. In Active, if there are any other groups, who have different Benefit rules set by HR, divide them in Programs. For an example, if Salaried guys get different benefit sets than the Hourly guys, create two distinct Programs, Salaried and Hourly.
  5. If Expats have different rules than Actives, create one for Expats.

We must make sure; we are not going on making Programs and keeping everything distinct, even if they are not. We should create programs for Groups which are different in many ways with respect to HR rules for Benefits in the Firm.

Now, as the Programs are defined. Create Plan types, Plan and Options. Add the Options to the Plans now. So now we have a structure similar to the image given here.

(Figure 6.2 – Benefit Structure)

If we see Figure 6.2 – Benefit Structure, the Options are not attached uniformly. Plan A and Plan C have similar option structures; however Plan B goes with Option 4 and does not have Option 1 attached. We can do that. As Options are independent, we can just pick the ones that are needed. Now, as the basic structure is defined, we will go up to the Programs.

We will add the appropriate plan types to the Program. Only the ones those are relevant. Like we will not add LTD and STD in Retiree Program, similarly we won’t add the Med, Den and Vis on to the Expats Program. Once the Plan types are added, we will now add the Plans into it. Again the same case here too. We will add only those plans which are relevant. For an Example, We do not offer Plan A to Applicants, so no need to add Plan A to the Applicants Program. Just add the rest two. However in Active all three Plans are available, so add them all. Simple isn't it.

So Options and plans were two different blocks, we combined them as per our requirements. Then we added the Plan Types and then the Plans. So isn't this like the jumble colour cubes that children play with. The Blocks are there, and we just keep on adding them. Every structure is different than the other, although they are made up of the same set blocks. These structures are called Program Structures. These Program structures as a whole are known as the benefit structure of that Firm.

It has Programs, Plan Types and Plans added to them, then each Plan has its own set of Options. If we minutely look at the Levels, we will see five levels there.

  1. Program
  2. Plan Types in Program (PTIP)
  3. Plans in Program (PLIP)
  4. Plans
  5. Options in Plan (OIPL)

Program, PTIP, PLIP makes sense, what is Plan and OIPL doing here? They must be attached to a Program right? NO. As we had discussed earlier, having a program is a good thing, however is not mandatory. So there can be Plans and OIPLs which are not attached to any Program.

How to decide, whether to attach that plan to a Program or not?

Good Question. Plans that are not in any program are usually the ones that are standalone. Usually designers put the Non-Benefit Plans in to that bucket. Pension Plans are the most widely used type of this category, where the pension plans are not attached to any Program, and they are evaluated and elected individually. We will discuss more about these in later sections.

Based on that the fact that, whether a Plan is attached to a Program or not, comp Object levels are also decided. If we consider all possible Comp Object levels, those will be:

As of now, our target was to understand, what Benefit Structure is right? Let's get in to Configuration.

Configuring Benefit Structure

In this portion we will configure the entire benefit structure. We will define plans, Options, Plan types, Programs, and then will link them and create the entire structure. Before getting into that, let's discuss a little about the Effective dates. A lot of tables in Benefits are Date track enabled. That makes us enable to create records as per any day we want. Usually firms prefer to take a date amply in past, so that they can accommodate all the historical data. It is better to use 01-JAN-1951 / 01-JAN-1980. However based on our requirements we can choose a date. Once the date is chosen, remember to date track before creating a record.

Let's start with the Plan types, as that is the most independent Object.

Plan Types

A Plan type is a set of Plans with same Insurance/ coverage type. The Plan type is the one that holds the Plan. In other words, each and every plan must fall under one plan type. Let's define one. See Figure 6.3 – Plan Type.

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> Program and Plans -> Plan Types

Steps: Date track to a suitable effective date, and create a new record with the following details.

(Figure 6.3 – Plan Type)

The Table that stores the Plan type information is BEN_PLN_TYP_F. This is a date tracked table, and stores PLN_TYP_ID as the Primary key. In case we need to store more information in the table, we can use the DFF on the table.

Options

The next task is to create an Option. See Figure 6.4 – Options.

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> Program and Plans -> Options

Steps: Date track to a suitable effective date, and create a new record with the following details.

(Figure 6.4 – Options)

Save the Record. This completes the Basic configuration for Options. Now time for Extra set ups. :)

Let’s click on Designation Requirements (Button)

First of all let's understand, what is a designation requirement? We are creating Options right? And those are tiers. In tiers, we can define who all can be covered. Like, In Employee + Spouse, one can cover his/her spouse, In Employee + Family, one can cover his/her spouse, children etc. So where do we define that.

Where do we say, that one cannot cover a child in Employee + spouse Option. The answer is designation requirements screen. If our firm does not have any restrictions on whom to cover in what option, we do not have to put in a Designation Requirement. Like Employee Only option, will not need a Designation requirement (Still we do that to make sure there are no covered dependents).

NOTE: It is mandatory to have Personal relationship flag (PER_CONTACT_RELATIONSHIPS.PERSONAL_FLAG) checked in Contacts screen in order to make the Contact an eligible dependent.

Now, let's configure. See Figure 6.5 – Option Designations.

(Figure 6.5 – Option Designations)

In an ‘Employee Only’ Option, we can choose the Group as "No Designees" or keep it blank. And put the Min and Max as Zero. This will ensure that, no one can be covered under the Option except the Participant.

So this completes our Option Creation. It’s time to create a Plan.

Plans

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> Program and Plans -> Plans

Steps: Date track to a suitable effective date, and create a new record with the following details. See Figure 6.6 – Plans.

(Figure 6.6 – Plans)

Now, as the Plan's basic set up is done, let's go to the next steps. If we look at the buttons on the Plans screen, there are 5 buttons there:

  • Details: deals with the details of plans like, Plan years, Related Organizations, Reporting Groups etc. See Figure 6.7 – Plan Regulations.
  • Options: To attach options to the plans.
  • Plan Eligibility: To set up eligibility Requirements for the plan.
  • Waiving: To define waiving Logic for the plan. Here we define reasons with which a Participant can opt to waive this plan.
    • Extra Information: This is an EIT. We can use this in a case where we want to store some information related to the plan, other than the ones stored in the attributes.

(Figure 6.7 – Plan Regulations)

We will learn about the Options and Eligibility Tabs in OIPL and Eligibility sections.

This completes our Plan set up. Now, it’s time to create the Programs.

Programs

Responsibility: HRMS Manager

Navigation: Total Compensation -> Program and Plans -> Programs

Steps: Date track to a suitable effective date, and create a new record with the following details. See Figure 6.8 – Programs.

(Figure 6.8 – Programs)

The Plan and Plan Types, Participation Eligibility will be discussed while discussing PTIPs and Eligibility respectively. The Extra Information is an EIT, to store extra information related to the Programs.

This Completes the Program Set up. It’s time to create the links now.

OIPL: Option in Plan

As we already have the Options and the Plans in Place, Let's link the Options to the appropriate Plans.

Note: The Plan type to which the plan belongs to, must be attached to the desired Option. Unless the Plan Type is listed with the Option in the Options screen, it will not let us add the option to any of the Plans in that plan type.

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> Program and Plans -> Plans

Steps: Date track to a suitable effective date, Query the Plan; Click on the Options Button. See Figure 6.9 – OIPL.

(Figure 6.9 – OIPL)

Option Eligibility and Life event Eligibility will be discussed in the Eligibility Section.

PTIP: Plan Type in Program

Let's link the plan types to the Program now.

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> Program and Plans -> Programs

Steps: Date track to a suitable effective date, Query the Programs; click on the Plans and Plan Types Button. Go to Plan Types Tab. See Figure 6.10 – PTIP

(Figure 6.10 – PTIP)

The Participation Eligibility and Life event Eligibility buttons will be discussed in Eligibility sections.

PTIP: Plans in Program

Now its time to link the Plans to the Programs.

  • Responsibility: HRMS Manager
  • Navigation: Total Compensation -> Program and Plans -> Programs

Steps: Date track to a suitable effective date, Query the Programs; click on the Plans and Plan Types Button. Go to Plans Tab. See Figure 6.11 – PLIP

(Figure 6.11 – PLIP)

The Participation Eligibility and Life event Eligibility buttons will be discussed in Eligibility sections.

Now, this completes the entire set up for our Benefit Structure.