Manually Enrolling an Employee in a Benefit Plan

The Benefit Plan in which to enroll the employee. The selection determines what other panels display.

Note: If the employee is currently enrolled in a medical plan, the system displays an alert.

If carrier websites were set up in System > Change > Payees, available carrier website links display once you select a Benefit plan. Clicking a link launches the associated URL in a separate browser tab.

Note: Depending on your configuration, when 1Password is used to store site credentials, clicking a link may also simultaneously log you in to the site.

The benefit plan enrollment Status.

Note: The Terminated - COBRA data field displays when the employee moves from a COBRA status to a Terminated status, indicating that the termination status is a termination from COBRA.

If the employee is currently enrolled in a medical plan, and you change the Status to Active, the system displays an alert that prompts you to confirm whether the new plan should replace the old plan by clicking Yes or No.

Whether the employee elected this benefit as part of a section 125 plan.

Link that displays for selected employees who are designated company officers. Selecting the Officer Details link opens a read-only dialog where information about the employee displays, including their assigned business entity type and whether they are an S-Corp Principal, business owner, family member, or company officer.

Note the following:

Read-only field that indicates the deduction codes used in the employee's benefits enrollment. (The system references these deduction codes from the Group Benefit Plans form for the selected plan.)

Note: Enabling the Section 125 field displays the corresponding deduction code.

If required for the benefit plan, the date when coverage starts.

If the coverage status is Terminated, the date when the benefits coverage ends.

If required for the benefit plan, the date when the regular payroll deductions begin for this benefit plan, which is the first day of the month following the coverage start date, or following the date of entry. For example, if the enrollment record is entered on January 15 with a coverage start date of February 15, the regular deduction schedule begins on February 1.

You must select the Suppress Automatic Benefit Adjustment parameter in the System Parameters form for this to be an active field. Otherwise, the Deduction Starts field is read-only and populates with the date specified in the benefit plan.

See Setting Up Deduction Start Dates for more information on how deduction start dates are set in PrismHR, and how to adjust them if needed.

If the coverage Status is Terminated, enter the date when payroll deductions stop for this benefit plan.

The number the insurance carrier uses to identify this employee . If the field is left blank, the system assumes the Social Security number is used.

If the benefit was waived, the reason it was waived.

If applicable, the plan number that associates codes that you need to report to some insurance carriers.

Whether this employee's enrollment was reported to the insurance carrier.

Indicates whether or not a plan is an HDHP plan.

Note:  Please note the following validations:

The ID of the primary care physician the employee sees to report a visit to insurance carrier.

Note: This ID needs to adhere to the PCP Validation Format under the Web Enrollment Parameters section on the Group Benefit Plans form if any.

Check this box if the employee is a current patient of the doctor noted above.

If required, enter the Alt. Calc Network ID to use to calculate premiums.

The PPO Dental Plan No for dental coverage.

The date on which the selected plan becomes effective. This date must match the Coverage Starts date.

You can change the Existing Effective Date as follows:

The Employee Premium, Dependents Premium, Employee Contribution, and Employee Contribution amounts display. If the benefit plan is a medical, dental, or vision plan with premium rate factors, Premium Rate Factors display.

Note:  A tooltip displays next to Employee Contribution or Employer Contribution (as applicable based on the value shown in the Contribution rule amounts made by Company or Employee field of Benefit Rule setup) when a Max Contribution has been applied.

Employee Premium and Dependents Premium amounts are defined in Setting Health Plan Premium Rates. Employee Contributions are defined in Setting Up Employee Enrollment Conditions.

Read-only field that displays the related Bill Code for the selected Benefit Plan for users to easily and accurately view what impact the pay period premium will have on invoice billing.

Read-only field that displays the related Deduction Rebate Bill Code for the selected Benefit Plan for users to easily and accurately view what impact the pay period premium will have on invoice billing.

Takes the Bill Code and Deduction Rebate Bill Code values into account and accurately assess and calculates the Net Inv Effect. It is a read-only field.

For enrollment in a medical benefit plan set up to use wellness banded rates, information for the Qualifies for Wellness? option on the Employee Details form Personal tab displays.

The amount of Coverage for STD, LTD or Life insurance plans. There is a Coverage field in the Employee, Spouse and Dependents sections.

Initial election amount used as the basis for calculating Coverage prior to applying the Percent of Full Coverage defined within the Age Reduction Schedule. This is a system-calculated field that only displays for Life plans with an associated Age Reduction Schedule.

A system-calculated field used in coverage and premium calculations.

Each dependent's ID. The Last Name, First Name, and Birth Date populate from the dependent's record.

The Network ID.

Whether the dependent's coverage was reported to the insurance carrier.

The ID of the primary care physician the covered dependent needs to visit to report a visit to insurance carrier.

Note: This ID needs to adhere to the PCP Validation Format under the Web Enrollment Parameters section on the Group Benefit Plans form if any.

Whether the covered dependent is a current patient of the primary care physician noted above. Select:

The date when the benefits become effective.

The date when the benefits coverage ends.