Benefits Administration

This file is a combined export of PrismHR help topics in Benefits Administration. Source help system: https://tech-docs.prismhr.com/SP_help/Default.htm Each topic is separated by a heading and includes its original URL.

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Benefit Enrollment Maintenance

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Benefit-Enrollment-Maintenance_Landing.htm Path: BA/Benefit-Enrollment-Maintenance_Landing.htm

Benefit Enrollment Maintenance

The Benefit Enrollment Maintenance landing page organizes forms into the following sections.

• Enrollment Maintenance

• Bulk Change Tools

To open the Benefit Enrollment Maintenance page:

• On the Work Centers panel, click Benefits > Benefit Enrollment Maintenance. The Benefit Enrollment Maintenance page opens. You can also open the page by searching for Benefit Enrollment Maintenance.

To get detailed instructions for using the open form:

• Click [Image: screenshot] (Help) in the header area.

To return to the Benefit Enrollment Maintenance page:

• Click JUMP TO in the header area of the form.

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Benefit Imports & Reporting

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Benefit-Imports-Reporting_Landing.htm Path: BA/Benefit-Imports-Reporting_Landing.htm

Benefit Imports & Reporting

The Benefit Imports & Reporting landing page organizes forms into the following sections.

• Benefit Imports

• Benefit Reporting

Note: Select a link on this page to proceed directly to the form.

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Benefit Plan Maintenance

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Benefit-Plan-Maintenance_Landing.htm Path: BA/Benefit-Plan-Maintenance_Landing.htm

Benefit Plan Maintenance

The Benefit Plan Maintenance landing page organizes forms into the following sections.

The Group Benefit Plans section provides links to the following forms.

• Billing Rate Groups

• Client Benefits Overview

• Default Network By Benefit Plan

• Delete Unused Group Benefit Enrollments

• Tax Rates for Taxable Life Coverage

• Update Client Group Term Life

The Retirement Plans section provides links to the following forms.

• Calculate 401k Eligibility

• Retirement Match Rules

• Retirement Plan Years

• Retirement Plans

• Tax Year Limits Maintenance

The FSA & HSA Plans section provides links to the following forms.

• EFLEX Group ID Maintenance

• HSA PEO Match

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Benefit Rules Import Fields

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Benefit-Rules-Import-Fields.htm Path: BA/Benefit-Rules-Import-Fields.htm

Benefit Rules Import Fields

Disability and life plans are supported with the following field codes:

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Client Benefit Plan Import Fields

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Client-Benefit-Import-Fields.htm Path: BA/Client-Benefit-Import-Fields.htm

Client Benefit Plan Import Fields

Before you can working with client benefit plan import fields, you must first you assign plans to the client. Then you can assign benefit rules to the client. For more information, see the Benefits Administration Guide.

The import process includes the following fields:

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Importing Benefit Enrollments

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Common%20to%20BA_BE/Importing-Benefit-Import-Definition.htm Path: BA/Common to BA_BE/Importing-Benefit-Import-Definition.htm

Importing Benefit Enrollments

Use the Benefit Import process to enroll employees in group benefit plans using the information in an external data file. The process requires you to set up a data file and a benefit import definition. You can set up the data file either before you begin the import or from within the Benefits Import form.

You must set up company benefits and benefit rules before using this process. See “Benefit Groups” and “Benefit Rules” in the Benefits Administration User Guide for more information.

To set up the data file:

1. Create an Excel spreadsheet that includes at least the following columns of information in the same order as in the template. The data file must be either tab-delimited or comma-delimited.

• Action Code

• Company ID

• Employee ID, Employee SSN, or Employee Clock Number

• Benefit Plan ID

• Benefit Plan Type

• Effective Date

2. Save the spreadsheet in either CVS or TXT format.

To set up the import definition:

To import benefit enrollments:

1. Click [Image: screenshot] (Back Office).
2. From Operations|Import Processing, select Benefits Import.
3. In Import Definition Template, select the name of the benefit import template. The system shows the field number and field label that must be included in the data file in the order shown.
4. If the data file was not already set up, create it using the instructions at the beginning of this topic.
5. Click Find File. The Upload a File window opens.
6. In Pick a file to upload, click Choose File, select the data file, and click submit. When you are notified that the file was uploaded, click Close. You return to the Benefits Import page and the name of the selected data file is shown in Filename.
7. Click Import. A progress box displays the status.
8. When the progress box shows that the process is complete, click Close to return to the Benefits Import page or Report to open the Job Control Status Report. See See Viewing the Job Control Status Report

Note: Note: While importing a benefit plan, the Max Days Back Dating value is used to validate a benefit plan that is to be terminated.

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Importing Benefit Rules

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Common%20to%20BA_BE/Importing-Benefit-Rules.htm Path: BA/Common to BA_BE/Importing-Benefit-Rules.htm

Importing Benefit Rules

The Benefit Rules Import form can import benefit rules information into the system. You can also view benefit imports in progress and continue working on an import that was paused.

Note: Note: This form does not use Client Access Group Security.

To import benefit rules and access this form:

1. On the Work Centers panel, under Benefits, click Benefit Imports & Reporting.s

2. Under Benefit Imports, click Benefit Rules Imports. The Benefit Rules Import form opens.

3. Click Upload File and then Choose File to select the data file.

4. You can also click Download Sample Header File hyperlink to download a sample file so that you can view the fields that are required while you upload your own file.

5. Click Submit. A confirmation message displays.

6. Click Close.

Next, validate the import:

1. Click Validate Import File.

2. When the process is complete, click Close.

3. Click Import.

4. When the process is complete, click Close. The data file imported.

5. Click Print Import Report. The Company Benefit Rules Import Report opens.

6. Click the XLS link to download the report.

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Maintaining Enrollment Details

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Common%20to%20BA_BE/Plan_Enrollment_Details.htm Path: BA/Common to BA_BE/Plan_Enrollment_Details.htm

Maintaining Enrollment Details

To perform the following functions, use the Plan Enrollment Details form.

• Define gap coverage amounts in gap (GAP) benefit plans.

• Enable employees to set up beneficiary information in life insurance plans during enrollments.

• Set up dependencies in accidental death and dismemberment (ADD) or group term life (GTL) insurance plans that require employees to enroll in a basic life (LIF) insurance plan.

• Establish settings in long term disability (LTD) or short term disability (STD) benefit plans that determine when an employee is required to submit an Evidence of Insurability (EOI) form.

Accessing Plan Enrollment Details

The offer type for a benefit plan determines the options that are available in the Plan Enrollment Details form.

To access the Plan Enrollment Details form:

1. Click Back Office.

2. From System|Change, select Group Benefit Plans. The Group Benefit Plans form opens.

3. Select a Benefit Plan ID.

4. Click the Actions menu [Image: screenshot] and select Enrollment Details.

The Plan Enrollment Details form opens. You cannot search for this form by normal means.

5. Here, the Benefit Plan ID is auto-populated based on the benefit plan you select on the Group Benefit Plans form. It is a read-only form.

6. Make the required updates on the form and click Save.

Defining Gap Coverage in Gap Plans

The options that are available when you select a gap (GAP) benefit plan enable you to define the gap coverage amount for the plan. You can also restrict employees who are enrolled in health savings account (HSA) benefit plans from also enrolling in gap benefit plans.

Before you begin:

• Set up the gap benefit plan to require a medical dependency at the plan level in the Plan Dependency tab in the Benefits Enrollment Plan Details form.

To define gap coverage in gap benefit plans:

1. Open the Plan Enrollment Details form.

Use this option — To define this

Payment Cycle — The frequency with which the employee’s loan payment is deducted. If the employee does not have a loan, leave the Payment Cycle set to Pay Period.

Effective Date — The effective date for the benefit plan to modify. A benefit plan can have multiple effective dates with different settings that are used for different enrollments. You can click New Effective Date to create a new effective date for the benefit plan.

Gap Coverage Amount — The amount of gap coverage.

HSA Enrollee Not Eligible — Whether to restrict enrollees in HSA plans from also enrolling in the gap benefit plan.

2. Click Save.

Defining Gap Coverage in Medical Plans

When you select a medical (MED) benefit plan, options are available for you to define the gap coverage maximum.

To define gap coverage maximum:

1. Open the Plan Enrollment Details form.

Use this option — To define this

Effective Date — The effective date for the benefit plan to modify. A benefit plan can have multiple effective dates with different settings that are used for different enrollments. You can click New Effective Date to create a new effective date for the benefit plan.

Gap Coverage Maximum — The maximum amount of gap coverage. You cannot set gap coverage maximum amounts on family-rated benefit plans.

2. Click Save.

Enabling Beneficiary Information

When you select a life insurance plan (LIF, GTL, ADD, LIS, LIC, WLI), the Require beneficiaries section option is available. Select this option if employees can enter beneficiaries during enrollments.

Setting Dependencies in ADD and GTL Plans

When you select an additional life insurance plan (GTL or ADD), options are available for you to set up dependencies in life insurance plans that require employees to enroll in a basic life insurance plan (LIF).

You can also use the Plan Enrollment Details form to set the plan to apply an aggregate spouse maximum. This limits the maximum coverage for the employee’s spouse so that it can never exceed the aggregate coverage amount of an employee’s basic and additional life selections.

To set dependencies in ADD and GTL benefit plans:

1. Open the Plan Enrollment Details form.

Use this option — To define this

Effective Date — The effective date for the benefit plan to modify. A benefit plan can have multiple effective dates with different settings that are used for different enrollments. You can click New Effective Date to create a new effective date for the benefit plan.

Require beneficiaries section — Whether to allow employees to enter beneficiaries during enrollments.

Require Basic Life Enrollment — Whether to require enrollment in a basic life insurance plan.

2. Click Save.

Setting Dependencies in Disability Plans

When you select a long term disability (LTD) or short term disability (STD) benefit plan, options are available for you to define settings that determine when an employee is required to submit an EOI form. Set up an LTD or STD benefit plan to require an EOI form at the plan level in the Documents tab on the Benefits Enrollment Plan Details form.

Enrollments that include disability plans that require an EOI are automatically placed in Pending status and trigger an approval process in the Post Benefit Enrollments form.

To set up dependencies in disability benefit plans:

1. Open the Plan Enrollment Details form.

Use this option — To define this

Effective Date — The effective date for the benefit plan to modify. A benefit plan can have multiple effective dates with different settings that are used for different enrollments. You can click New Effective Date to create a new effective date for the benefit plan.

Coverage Minimum — The coverage minimum for the benefit plan.

Coverage Maximum — The coverage maximum for the benefit plan.

Increments — The increments to use for differing coverage levels. For example, if the benefit plan is available in increments of $5,000, enter 5,000.

Guaranteed Issue Amount — The maximum amount that an employee can receive without filing an EOI. The employee is required to submit an EOI to receive further coverage.

Guaranteed Issue Default Percentage — The guaranteed issue default percentage if the benefit plan determines the maximum amount that an employee can receive without filing an EOI. It is based on a percentage of the employee’s salary.

Late Entrant GI Amount — The maximum amount that a late entrant employee can receive without filing an EOI. The employee is required to submit an EOI to receive further coverage.

Late Entrant GI Default Percentage — Whether the benefit plan determines the maximum amount (up to 100%) that a late entrant employee can receive without filing an EOI based on a percentage of the employee’s salary,

2. Click Save.

Required Documentation Rulesets

The Required Documentation Rulesets panel displays for some offer types. You can use this panel to assign one or more required documentation rulesets to a benefit plan. Employees who fit the conditions of the ruleset during enrollments must download and submit an additional form. For more information on Required Documentation Rulesets, see Assigning Documentation Rulesets.

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Setting Up Age Banded Medical, Dental, and Vision Benefit Plans

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Age_MDV_Plans_Intro.htm Path: BA/Topics/Age_MDV_Plans_Intro.htm

Setting Up Age Banded Medical, Dental, and Vision Benefit Plans

This section is a guide to setting up age banded benefit plans for the medical, dental, and vision insurance classes at the system level in PrismHR. It is intended for users who have experience setting up benefit plans in Group Benefit Plans.

Only those settings for age banded benefit plans are covered in this section. Some settings described are used only in Benefits Enrollment, and are labeled accordingly. For more information about using Benefits Enrollment, refer to in-product help or to the Benefits Enrollment User Guide.

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Applying the Billing Wash Rule

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Apply-Billing-Wash-Rule.htm Path: BA/Topics/Apply-Billing-Wash-Rule.htm

Applying the Billing Wash Rule

For group benefit plans in PrismHR, the billing wash rule determines whether the system charges plan premiums and deductions for a month. This is determined based on where the coverage start or end date falls in relation to the wash rule date.

The wash rule applies to new hire and terminated employees. The following examples illustrate how the wash rules can affect the benefit deductions of new hire and terminated employees.

New Hire Employees

Scenario 1: No Wash Rule Applied

On the Benefit Plan Setup form:

• Use Billing Wash Rule? = Enabled

• Wash Rule Date On/Before = 15th Day of the Month

On the Employee Benefits Enrollment form:

• Coverage Starts = 01/08/2021

• Deduction Starts = 02/01/2021

Result: The system performs a benefit adjustment for the full month of January since the employee’s start date (Jan 8) comes before the wash rule date (Jan 15). The system charges the employee their regular scheduled deductions.

Scenario 2: Wash Rule Applied

On the Benefit Plan Setup form:

• Use Billing Wash Rule? = Enabled

• Wash Rule Date On/Before = 15th Day of the Month

On the Employee Benefits Enrollment form:

• Coverage Starts = 01/29/2021

• Deduction Starts = 02/01/2021

The Deduction Starts field shows Wash Rule applied for 202101.

Result: The system does not perform a benefit adjustment for the full month of January since the employee’s start date (Jan 29) comes after the wash rule date (Jan 15). The system does not charge the employee.

Terminated Employees

The following is an example of a scenario where the system does not apply the wash rule to a group benefit plan for a terminated employee.

Note: Note: If the Coverage Ends On field is set to “End of Month Following Termination Date” and the Wash Rule date is set to “End of Month”, the wash rule is not applied. However, any other Coverage Ends On Option will result in a full month’s charge upon termination.

On the Benefit Plan Setup form:

• Use Billing Wash Rule? = Enabled

• Wash Rule Date On/Before = 15th Day of the Month

On the Employee Benefits Enrollment form:

• Coverage Starts = 01/22/2021

• Coverage Ends = 03/05/2021

• Deduction Starts = 02/01/2021

The Deduction Starts field shows Wash Rule applied for 202101.

• Deduction Ends = 03/05/2021

The Deduction Ends field shows Wash Rule applied for 202103.

Result: The system does not perform a benefit adjustment for the full month of January since the employee’s start date (Jan 22) comes after the wash rule date (Jan 15). The system does not charge the employee. Since the employee was terminated on March 5th (before the 15th day of the month), the system also applies the wash rule to the full month of March.

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Benefit Medical Rates Report

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit%20Medical%20Rates%20Report.htm Path: BA/Topics/Benefit Medical Rates Report.htm

Benefit Medical Rates Report

This report displays Premium Rates for all Benefit Plans assigned to the Medical Insurance Class.

Note: Note: Client Access Group security is not enabled on this form.

To access the form, in the Work Centers panel, under Onboarding & Benefits section, click Benefit Imports & Reporting. Under Benefit Reporting click Benefit Medical Rates Report.

To generate the Benefit Medical Rates Report:

1. Complete the following:

• Premium Rates (This is only option available at this time)

2. Click Run to view this report on screen.

3. Click Close to close this form.

This report shows the following columns:

• Plan ID

• Plan Description

• Plan Type

• Effective Date

• From Age

• To Age

• Total Premium

• Employee Premium

• Dependent Premium

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Building the Benefit Rules XML Download

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit%20Rules%20XML%20Download.htm Path: BA/Topics/Benefit Rules XML Download.htm

Building the Benefit Rules XML Download

Use the Benefit Rules XML Download process to create an XML download of the benefit rules for a selected client or for all clients.

Note: Note: This process does not use Client Access Group security.

To access the form, on the Work Centers panel, under Benefits, click Benefit Imports & Reporting. Under Benefit Reporting click Benefit Rules XML Download.

To build the benefit rules XML download:

1. Click Client ID and select the client. Leave the Client ID field blank to build the download for all clients.

2. Click Build. A progress window opens displaying the processing status.

3. Click Close to close the job progress window once the process completes.

4. Click the Download link.

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Benefit Salary Maintenance

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit%20Salary%20Maintenance.htm Path: BA/Topics/Benefit Salary Maintenance.htm

Benefit Salary Maintenance

Use this form to add an effective date to change employee Benefit Salary and track historical Benefit Salary changes. Thus managing changes to Benefits Salary can be done proactively without real-time changes being necessary for Benefit calculation accuracy.

To access this form to add a new benefit salary and update the effective date:

1. Click the HRmenu.

2. From HR|Action, click Benefit Salary Maintenance. The form opens.

3. Fill in the following fields:

4. Click Save to save the new benefit salary for the selected employee. It also updates the current data under the Pay tab on the Employee Details form.

5. Click Cancel to clear this form at any time.

Changing the Current and Future Benefit Salary Dates

The Benefit Salary History section streamlines the process of viewing employee’s benefit salary information. You can track historical Benefit Salary changes that you make for the selected employee. Once you make an update to the benefit salary of the selected employee, the history of the dates from which it was made effective is displayed here.

The following column displays:

• Date Effective - The date from which the updated benefit salary will come into effect.

• Benefit Salary - The updated benefit salary amount.

The past dates in the Date Effective column are a read-only field. However, the current and future dates under this column are hyperlinks which you can click to edit the effective date.

To edit or add a new effective date:

1. Under the Benefit Salary History section, in the Date Effective column, select a current or future date. The future dates will be a hyperlink. A dialog box opens.

2. In the New Effective Date, select an effective date.

3. Click Save to save the selected benefit salary record with the updated effective date.

4. Click Cancel to clear the selected New Effective Date.

5. Click Close to close the modal form and return to the Benefit Salary Maintenance form without making any changes to the selected benefit salary record.

Note: Note: On the Employee Details form, Under the Pay tab, when you delete the current Benefit Salary then the Benefit Salary change is recorded with a null value in the Benefit Salary History section on the Benefit Salary Maintenance form.

To delete a future effective date:

1. Under the Benefit Salary History section, in the Date Effective column, select the checkbox for a future date.

2. Click Delete. A confirmation pop-up message stating, <number of selected record(s)> Benefit Salary change will be deleted. Are you sure? is displayed.

• Click Yes to delete the selected record(s).

• Click No to return to the form.

Note: Note the following validations for the Date Effective column while using Past/Current/Future effective dates for a Benefit Salary History record.

• When you enter Past date as the effective date:

1. — If a Benefit Salary History record currently exists with an Effective Date equal to the past date entered in the Benefit Salary Start Date field, then an alert message stating, A change record with an effective date equal to already exists. If you continue the existing record will be replaced. Do you wish to continue? is displayed.

• Click Yes to save the date selected for the Benefit Salary Start Date field.

• Click No to leave the Benefit Salary Start Date field blank.

2. — If a Benefit Salary History record currently exists with an Effective Date greater than the past date entered in the Benefit Salary Start Date field, then an alert message stating, A future dated change record with an effective date equal to currently exists. Are you sure you want to continue? is displayed.

• Click Yes to save the new history record with the new effective data.

• Click No to leave the Benefit Salary Start Date field blank.

3. — If a Benefit Salary History record currently exists with an Effective Date equal to the past date and a Benefit Salary History record exists with an Effective Date greater than the past date entered in the Benefit Salary Start Date field, then an alert message stating, A change record with an effective date equal to already exists. If you continue the existing record will be replaced. There is also a future dated change record with an effective date equal to . Do you wish to continue? is displayed.

• Click Yes to replace the prior history record with the same effective date with the current data.

• Click No to leave the Benefit Salary Start Date field blank.

• When you enter Current date as the effective date:

1. — If a Benefit Salary History record currently exists with an Effective Date equal to the current date in the Benefit Salary Start Date field, then an alert message stating, A change record with an effective date equal to already exists. If you continue the existing record will be replaced. Do you wish to continue? is displayed.

• Click Yes to save the date selected for the Benefit Salary Start Date field. The newly added Benefit Salary will display immediately in the Benefit Salary field under the Pay tab of the Employee Details form.

• Click No to leave the Benefit Salary Start Date field blank.

2. — If a Benefit Salary History record currently exists with an Effective Date greater than the current date entered in the Benefit Salary Start Date field, then an alert message stating, A future dated change record with an effective date equal to currently exists. Are you sure you want to continue? is displayed.

• Click Yes to create the new history record with the new effective data. The newly added Benefit Salary will display immediately in the Benefit Salary field under the Pay tab of the Employee Details form.

• Click No to leave the Benefit Salary Start Date field blank.

3. — If a Benefit Salary History record currently exists with an Effective Date equal to the current date and a Benefit Salary History record exists with an Effective Date greater than the current date entered in the Benefit Salary Start Date field, then an alert message stating, A change record with an effective date equal to already exists. If you continue the existing record will be replaced. There is also a future dated change record with an effective date equal to . Do you wish to continue? is displayed.

• Click Yes to replace the prior history record with the same effective date with the current data. The newly added Benefit Salary will display immediately in the Benefit Salary field under the Pay tab of the Employee Details form.

• Click No to leave the Benefit Salary Start Date field blank.

• When you enter Future date as the effective date:

1. — If a Benefit Salary History record currently exists with an Effective Date equal to the future date in the Benefit Salary Start Date field, then an alert message stating, A change record with an effective date equal to already exists. If you continue the existing record will be replaced. Do you wish to continue? is displayed.

• Click Yes to replace the prior history record with the current data once you save the form.

• Click No to leave the Benefit Salary Start Date field blank.

2. — If a Benefit Salary History record currently exists with an Effective Date greater than the future date entered in the Benefit Salary Start Date field, then an alert message stating, A future dated change record with an effective date equal to currently exists. Are you sure you want to continue? is displayed.

Note: If there are multiple future dates, the warning message uses the next available pending future date.

• Click Yes to save the effective date and create the new history with the new effective data once you save the form.

• Click No to leave the Benefit Salary Start Date field blank.

3. — If a Benefit Salary History record currently exists with an Effective Date equal to the future date and a Benefit Salary History record exists with an Effective Date greater than the future date entered in the Benefit Salary Start Date field, then an alert message stating, A change record with an effective date equal to already exists. If you continue the existing record will be replaced. There is also a future dated change record with an effective date equal to . Do you wish to continue? is displayed.

• Click Yes to replace the prior history record with the current data once you save the form.

• Click No to leave the Benefit Salary Start Date field blank.

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Benefit Utilities

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit%20Utilities.htm Path: BA/Topics/Benefit Utilities.htm

Benefit Utilities

Use this form to manage Benefit related utilities.

To access this form to add a new benefit salary and update the effective date:

1. Click the Back Officemenu.

2. From Operations|Utility Processing, click Benefit Utilities. The form opens.

3. The form has the following filter:

• Utility- This filter has the following drop-down options:

• Select - This is the default option.

• Manage Orphaned Benefit Records - Select this filter to display the Orphaned Record Type filter, which has the following drop-down options:

• Select - This is the default option.

• Benefit Plan Setup - The orphaned records due to missing Benefit Plan Setup records.

• Group Benefit Plan Types - The orphaned records due to missing Plan Type.

• Plan Types - The orphaned records due to missing Group Benefit Plan Types code.

• Relationships - The orphaned records due to missing relationship code.

• SH2 Auto Enroll - Select this filter to identify the existing employees that are eligible for Safe Harbor 2 Match that do not have an active Retirement Plan Enrollment record.

• Unarchive Enrollments - Select this filter to identify the existing archived employees.

• Auto Escalation - Select this filter to identify enrollments that are not flagged as Auto Escalation?.

4. Click Search to get the results based on your filter selection.

5. Click Cancel to clear this form at any time.

Using the Manage Orphaned Benefit Records Utility

To use and manage orphaned related benefit records utility:

1. From the Utility drop-down, select the Manage Orphaned Benefit Records option. The Orphaned Record Type drop-down displays.

2. Select Benefit Plan Setup, Group Benefit Plan Types, Plan Types, or Relationships from the drop-down list. The Report Filters section displays.

3. In the Report Filters section, fill in the following fields:

For this option — Provide this information

Client ID — This field is optional. Leave this field blank for this report to run for all clients. If you want to restrict this report to run for selected clients, enter their Client IDs here or click the Client ID link and select them from the Select Clients dialog box.

Client Name — This field auto-populates when you select the Client ID.

Benefit Plan ID — This field is optional. Leave this field blank for this report to run for all the benefit plans. If you want to restrict this report to run for selected benefit plans, enter the Benefit Plan IDs here or click the Benefit Plan ID link and select them from the Select Benefit Plan dialog box. > Note: Note: This field does not display for Relationships Orphaned Record Type.

Plan Description — This field auto-populates when you select the Benefit Plan ID.

4. Click Search. A job control runs.

5. The list of orphaned records displays in the Results section.

Note: Note: Based on your selection in the Orphaned Record Type drop-down filter, the results are displayed.

• If you select Benefit Plan Setup, then in the Results section, the list of orphaned records caused due to deleting Benefit Plan Setup records are displayed.

• If you select Group Benefit Plan Types, then in the Results section the list of orphaned records due to missing Plan Type are displayed.

• If you select Plan Types, then in the Results section the list of orphaned records caused by deleting the Group Benefit Plan Type code are displayed.

• If you select Relationships, then in the Results section the list of orphaned records caused by deleting the Relationship Code are displayed.

This Results section displays the following columns:

• File Name

• Employee ID

• Employment Status Class

• Client ID

• Benefit Plan ID

• Billing Rate Group

• Premium Rate Group

• Network ID

• EE Gender

• Effective Date

• Plan Type

• Orphaned Reason

For Relationships, the Results section displays the following columns:

• File Name

• Employee ID

• Employment Status Class

• Client ID

• Dependent ID

• Dependent Name

• Relationship Code

• Orphaned Reason

Export using the Report button

When you select Utility as Manage Orphaned Benefit Records, then for the options under the Orphaned Record Type drop-down, when you click Search to run the report filters, then under the Results section that is displayed, you can export the report of orphaned records for the selected orphaned record types by clicking the Report button.

[Image: screenshot]

Using the SH2 Auto Enroll Utility

To use SH2 Auto Enroll utility:

1. From the Utility drop-down, select SH2 Auto Enroll option. The Report Filters section displays.

2. In the Report Filters section, fill in the following fields:

• All Classes
• Active
• On Leave
• Terminated | Client ID | This field is optional. Leave this field blank for this report to run for all clients. If you want to restrict this report to run for selected clients, enter their Client IDs here or click the Client ID link and select them from the Select Clients dialog box. | | Client Name | This field auto-populates when you select the Client ID. | | Retirement Plan ID | This field is optional. Leave this field blank for this report to run for all the retirement plans. If you want to restrict this report to run for selected retirement plans, enter the Retirement Plan IDs here or click the Retirement Plan ID link and select them from the Select Plan dialog box. | | Retirement Plan Name | This field auto-populates when you select the Retirement Plan ID. |

3. Click Search. A job control runs.

4. In the Results section, the list of eligible employees for Safe Harbor 2 Match that do not have an active Retirement Plan Enrollments records are displayed.

This Results section displays the following columns:

• Client ID

• Employee Name

• Employment Status Class

• Retirement Plan ID

• Status

• Status Date

• Eligible For Match

• Match Starts On

• Loan Payment Cycles

• Retirement Benefit Group

• Catch-Up Starts At Limit

• Effective Date

Note: Note: On the Employee Details form, under the Work tab, if the Retirement Benefit Group field is not assigned for an employee, then the Retirement Benefit Group column in the Results section of Benefit Utilities form is displayed as blank.

Updating Retirement Plan Enrollments

To update retirement plan enrollments for Safe Harbor 2 Match eligible employees:

1. Select the clients from the Results section.

2. Click Update. Based on the number of records you have selected, you will be presented with a confirmation message stating, Retirement Plan Enrollments will be created. Are you sure?.

1. — Click Yes to create an eligible retirement plan enrollment record. Once the retirement plan enrollment record is created, then the payroll process will update these records to Active.

3. Click Cancel to clear this form at any time.

Using the Unarchive Enrollments Utility

The Unarchive Enrollments utility allows you to unarchive employees web enrollment configurations so that you can re-enable an online workflow that had previously been archived.

To use and manage unarchive enrollments utility:

1. From the Utility drop-down, select Unarchive Enrollments option. The Report Filters section displays.

2. In the Report Filters section, fill in the following fields:

For this option — Provide this information

Starting Archive Date — Select the archive start date. This is a mandatory field.

Ending Archive Date — Select the archive end date. This is a mandatory field.

Client ID — This field is optional. Leave this field blank for this report to run for all clients. If you want to restrict this report to run for selected clients, enter their Client IDs here or click the Client ID link and select them from the Select Clients dialog box.

Client Name — This field auto-populates when you select the Client ID.

3. Click Search. A job control runs.

4. In the Results section, the list archived employees are displayed.

This Results section displays the following columns:

• Confirmation #

• Client ID

• Employee Name

• Employment Status Class

• Enrollment Type

• Archive Date

• WEO Status

• Updated

Unarchiving an Archived Employee

To unarchive an employee:

1. Select the clients from the Results section.

2. Click Unarchive. Based on the number of records you have selected, you will be presented with a confirmation message stating, Archived Enrollments will be unarchived. Are you sure?

3. Click Cancel to clear this form at any time.

Using the Auto Escalation Utility

The Auto Escalation utility allows you to identify enrollments that are not flagged as Auto Escalation?.

To use and manage auto escalation utility:

1. From the Utility drop-down, select Auto Escalation option. The Report Filters section displays.

2. In the Report Filters section, fill in the following fields:

For this option — Provide this information

Employment Status Class — Select the employment status criteria.

Enrollment History — Select the type of enrollment history.

Client ID — This field is optional. Leave this field blank for this report to run for all clients. If you want to restrict this report to run for selected clients, enter their Client IDs here or click the Client ID link and select them from the Select Clients dialog box.

Client Name — This field auto-populates when you select the Client ID.

Retirement Plan ID — This field is optional. Leave this field blank for this report to run for all the retirement plans. If you want to restrict this report to run for selected retirement plans, enter the Retirement Plan IDs here or click the Retirement Plan ID link and select them from the Select Plan dialog box.

Retirement Plan Name — This field auto-populates when you select the Retirement Plan ID.

3. Click Search. A job control runs.

4. In the Results section, the list of employees with retirement plan enrollments that are not flagged as Auto Escalation? are displayed.

This Results section displays the following columns:

• Client ID

• Employee Name

• Employment Status Class

• Retirement Plan ID

• Status

• Status Date

• Retirement Benefit Group

• Election Changes Exist

• Last Effective Date

In the results section, you can search for an employee or view the results in according to batches as described below:

• Search Employee Name - This input field allows you to search for a specific employee name. Additionally, when you search for an employee, the results are displayed only within the batch selected.

• Batch No. - It represents the threshold for the returned records. For example, if the threshold is to display 1000 records in one batch and the total results returned are 2500, then it will be divided into 3 batch, where Batch 1 will have 1000 records, Batch 2 will display the next 1000 records, and Batch 3 will display the remaining 500 records. You can select the batch number from the drop-down list.

5. If you want to generate a report of the search results, select the records and click Report.

If the search threshold is reached, the results are then displayed in batches. When there are multiple batches, and you click Report, a pop-up message is displayed stating, Do you wish to generate a report for the current batch or all batches?

6. Click Current Batch to display the report for the current batch.

7. Click All Batches to display the report results for all the batches available in the search results.

Updating the Auto Escalation Enrollments

To update the auto escalation checkbox for the displayed result records:

1. Select the clients from the Results section within a Batch.

2. Click Update. Based on the number of records you have selected, a confirmation message stating, Auto Escalation Enrollments will be updated. Are you sure? is displayed.

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Changing an Employee’s Benefit Billing Record

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Adjustments.htm Path: BA/Topics/Benefit_Adjustments.htm

Changing an Employee’s Benefit Billing Record

To make changes to an employee’s benefit billing record, use the Benefit Adjustments form.

Note: Note: To quickly access the Benefit Adjustments import template in the Data Import Tool, select Import Benefit Adjustments. You can use the Benefit Adjustments import template to import multiple benefit adjustments for multiple employees at once to reduce the amount of manual work required.

To access this form and change an employee’s benefit billing record:

1. Click the HR menu.

2. From HR|Change, click Benefit Adjustments. The form opens.

3. Fill in the following fields:

• All – To list all benefit adjustments for the employee.

• Outstanding – To list all benefit adjustments for the employee where Cycles Billed is less than Cycles.

• Complete – To list all benefit adjustments for the employee where Cycles Billed is equal to Cycles. | Filter By Plan | Use this filter to list all benefit adjustments for the employee by Benefit Plan. Enter or select the Benefit Plan plan from the Select Benefit Plan selector. | A list appears showing the various benefit adjustments for the selected employee as per selections made above.

• An option is available to the left of the header named Benefit Plan. Select this option to select, in bulk, all benefit adjustments for the employee which have zero Cycles Billed. Click Delete to delete all such adjustments in bulk.

• A checkbox is available to the left of each benefit adjustment for the employee which have zero Cycles Billed. Select one or more and click Delete to delete the selected benefit adjustment(s) only.

• The Delete button will by default remain disabled. It will get enabled only if you try to either delete in bulk or delete selected benefit adjustments for the employee which have zero Cycles Billed. Once you click Delete, you will receive a confirmation stating Adjustments will be deleted. Are you sure?

• Click Yes to delete the selected adjustments and return to the Benefit Adjustments form with the updated adjustment list.

• Click No to return to the Benefit Adjustments form without any changes. The selections remain.

New Benefit Adjustment

To enter a new benefit adjustment for a selected employee:

1. Click the New Adjustment hyperlink on the Benefits Adjustments form. The Adjustment Details form displays.

2. Complete these fields as required

3. Click Save to save this new benefit adjustment.

Edit an Existing Benefit Adjustment

To edit an existing benefit adjustment for a selected employee:

1. Click the Benefit Plan hyperlink for the benefit adjustment that you want to edit on the Benefits Adjustments form. The Adjustment Details form opens up.

• When a benefit adjustment is pulled via the payroll process and the Cycles Billed value is updated to the next number in the sequence, the following corresponding information is now listed in the new table on the right of the form:

• Voucher # – You can click this hyperlink to open the Employee Voucher in a modal. You can navigate to the Benefits tab to view the adjustment details.

• Pay Date – The Pay Date of the Employee Voucher.

• Batch # – The Payroll Number of the Employee Voucher.

• Bill Amount - The amount to bill to the client per pay cycle as a result of this adjustment.

• Employee Contribution – The amount to deduct from the employee’s pay check per cycle. This amount is credited to the client to offset the billing amount.

• Net Inv Effect – This will be blank for a new adjustment.

• Total – The total values for the Bill Amount, Employee Contribution, and Net Inv Effect columns of the vouchers.

2. Complete these fields as required:

For this option — Provide this information

Benefit Plan ID — This field is pre-populated with the Benefit Plan ID. You cannot change it

Period (yyymm) — The period for the benefit plan in the format YYYYMM. For example, 201710 for October 2017. If a the pay date for a payroll batch is within this period, the system processes the deduction from the employee’s net earnings, after deducting taxes.

Start Date — The start date of the period when this deduction goes into effect.

Bill Amount — The amount to bill to the client per pay cycle as a result of this adjustment.

Employee Contribution — The amount to deduct from the employee’s pay check per cycle. This amount is credited to the client to offset the billing amount.

Insurance Cost — The premium cost associated with this adjustment.

Net Inv Effect — This field will be auto-populated.

Comment — Descriptive comments about this adjustment, typically something that would help someone understand the benefit adjustment. To view comments previously made in a manually created adjustment, either enter an employee in the Employee field or click the field and select one from the list that displays. The previously entered adjustment displays and also displays a comment if one was previously entered.

Adjust Cycles — Click this hyperlink to change the number of cycles.

Cycles — The number of future payroll cycles to apply this adjustment.

Cycles Billed — This field will be auto-populated with the number of cycles billed. When an adjustment record already has cycles billed, the Cycles Billed field for this adjustment will be read only.

B/R Adjustment — The B/R Adjustment to apply to the benefits reconciliation process of this adjustment.

Retro Enroll — Check this box if the adjustment applies to a retroactive enrollment. Pre-tax contributions cannot fund any part of the premium for retroactive enrollments. Any Employee Contributions for this adjustment will be taken post-tax.

Ref. Number — This field will be auto-populated.

Note: Note: If the Cycles Billed field value is greater than 0 for a selected benefit adjustment record, then the Period (yyyymm), Bill Amount, Employee Contribution, and Insurance Cost fields become read-only. Also, the Adjust Cycles hyperlink is disabled in this scenario.

3. Click Save to save changes to this benefit adjustment.

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Maintaining Benefit Eligibility Groups

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Groups.htm Path: BA/Topics/Benefit_Groups.htm

Maintaining Benefit Eligibility Groups

Use the Benefit Groups form to create benefit groups for each group of employees who have the same benefit eligibility rules for a specified benefit. Each benefit group has the same benefit eligibility requirements and contribution rates. For example, the client may have a “standard” benefit group and an “executive” benefit group.

To create benefit eligibility groups:

1. From the Onboarding & Benefits work center, select Benefit Plan Maintenance|Group Benefit Plans (Client)|Benefit Groups.

2. Complete these fields:

Use this option — To define this

Group — The benefit group ID. If you are creating a new group, use something brief but descriptive, for example, STD. After entering a group, you can view the Employees Assigned To form. See Using the Employees Assigned To form. > Note: Note: The system automatically assigns the Primary Benefit Group as “1,” which cannot be changed. (This Benefit Group Name automatically defaults to “PRIMARY,” which can be changed.) If you try to delete the Primary Benefit Group, an error message displays.

Group Name — A descriptive name for the benefit group, for example, Standard.

Retirement Or Benefit Plans Only — Whether the group applies to Retirement plans only, Benefit plans only, or Both.

Stop New Use On — The date after which this benefit group can no longer be added to new benefit rules or new employees.

Stop All Use On — The date after which this benefit group cannot be used.

3. If a benefit group includes Eligible Benefits for Group Benefit Plans contribution:

Use this option — To define this

Benefit Plan ID — Displays each benefit plan ID for which employees in the benefit group are eligible. Select a plan by clicking Benefit Plan ID.

Plan Description — A description of the Benefit Plan ID.

Import Eligible Benefits — A quick link to import eligible benefit plans. Select this quick link to display the Eligible Benefits import template in the Data Import Tool.

Note: Note the following:

• The Eligible Benefits - Group Benefit Plans panel enables you to select one or more Benefit Plan IDs only if you have selected Benefit Groups Restrict Eligibility option in the Eligible Benefits Determinant field in the Benefits tab on the Client Details form. If you do not select this option, then you will not be able to select any Benefit Plan IDs. A conditional message, “Access to this section requires the Eligible Benefits Determinant to be set to Benefit Groups Restrict Eligibility on the Client Details form.” also displays in the Eligible Benefits - Group Benefit Plans panel.

• If the Eligible Benefits panel is disabled and there is any existing data in this panel, then on saving the form, the system displays a message: “Do you wish to clear the existing Benefit Plan IDs in the Eligible Benefits section? Y/N”.

• Click Yes to clear the existing Benefit Plans data listed in the Eligible Benefits panel and save the rest of the data on the form.

• Click No to save all the data on the form.

4. If a benefit group includes a Cafeteria Plancontribution:

Use this option — To define this

Effective Date — The effective date for the flat company contribution amount.

Contribution Amount — The employer’s flat, monthly contribution amount. The system automatically allocates the employer contributions.

EE First Dollar — If the employee must pay the first dollars, the amount the employee must pay.

EE Premium Only — Whether the cafeteria plan contributes only towards the employee portion of the premium (Yes or No).

5. Click Save to save changes to the record.

Note:

• When using the API or an import, the system writes the benefit group to the employee’s record using the current date. A benefit group history record will be created immediately.

• When using the Bulk Change utility, a benefit group history record will be created immediately.

• All New Hire processes (manual entry, Onboarding, Import, API) will trigger record creation for a benefit group history record, using the Original Hire Date as the Effective Date assigned to the record.

• When using the rehire process, the benefit group will be written to the employee record using the current system date as the Effective Date. If the Benefit Group was not changed when using the rehire process, the system still writes the benefit group to the employee’s record using the current date as the Effective Date.

Using the Actions Menu

You can access other benefit group features using the Actions menu:

• Viewing the Audit Log

• User fields: Enter values for the company in the User-Defined Fields form. Your organization defines these custom fields.

• Employee Assigned To: Select this to view a list of employees at the company assigned to the benefit group.

Using the Employees Assigned To form

After entering a benefit group, you can view the Employees Assigned To form under the Actions menu

[Image: screenshot]

. Use this form to view all employees who are assigned to the selected benefit group for the client.

The form displays two fields:

• Active: The active employee count displays the number of active employees assigned to the selected benefit group regardless of the filter option selected for the Status.

• Status: By default, this lists the total number of active employees assigned to the selected benefit group. You can change this to any one of the options from the drop-down.

The grid includes these columns:

You can sort this grid by any of these three column headers.

Click Report to run the Employees Assigned To report. After running the report, you can download the data as an XLS file.

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Network Zip Codes

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Network_Locations.htm Path: BA/Topics/Benefit_Network_Locations.htm

Network Zip Codes

To enter locations by ZIP code for benefit plans that have a network assigned, use the Network Zip Codes form, accessed by selecting Network ZIP Codes in the Actions menu

[Image: screenshot]

from the Group Benefit Plans form. This form only displays in the Actions menu

[Image: screenshot]

when the Collect Network Information option in the Other Processing Parameters panel is selected.

Users can also import multiple locations using the Network ZIP Code Import form. For more information, see Importing Network ZIP Codes.

To set up locations for a benefit plan with an assigned network:

1. The Benefit Plan ID is prepopulated from the Group Benefit Plans form.

2. Select a Network ID from the drop-down. This is required.

3. In the ZIP Codes column, enter the five-digit ZIP code where this benefit plan is offered. The City & State will display if the ZIP code exists in the system.

You can enter multiple ZIP Codes as needed: click + to add additional rows.

4. Click Save.

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Setting Insurance Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Plan_Billing_Rates.htm Path: BA/Topics/Benefit_Plan_Billing_Rates.htm

Setting Insurance Billing Rates

Insurance billing rates are the amounts billed to the client for each plan type. The plan’s Insurance Class, as well as other settings established in Group Benefit Plans, determine which version of the Billing Rates form displays.

• Setting Health Plan Billing Rates by Rate Group

• Setting Health Plan Billing Rates by Rate Group and Age

• Setting Health Plan Billing Rates by Network

• Setting Health Plan Billing Rates by Network and Age

• Setting Health Plan Billing Rates by Rate Group and Network

• Setting Billing Rates by Rate Group, Network, and Age

• Setting Life Insurance Billing Rates

• Setting Disability Insurance Billing Rates

• Setting Disability Insurance Billing Rates by Salary

• Setting Disability Insurance Extended Precision Billing Rates

• Setting Bond/EPLI Insurance Billing Rates

• Setting Other Type Billing Rates

• Setting Family Rated Plan Billing Rates

• Setting Family Rated Plan Billing Rates by Network

• Setting Family Rated Plan Billing Rates by Rate Group and Network

========================================================================

Setting up Benefit Plan Defaults

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Plan_Defaults.htm Path: BA/Topics/Benefit_Plan_Defaults.htm

Setting up Benefit Plan Defaults

Use this form to set up the benefit plan defaults for the selected plan. On the Client Benefit Plan Defaults form, click the Plan Defaults hyperlink for a Benefit Plan ID to open this form for the selected plan. You will not be able to find this form using normal search means.

To set up benefit plan defaults:

1. Complete the following fields:

• 48
• 52 | Use Billing Wash Rule? | Check this box if you want to use Billing Wash Rule. You cannot enable Billing Wash Rule when Prepay is used. | | Cafe Plan Eligible | Check this box if this benefit plan is eligible for Cafe Plan. | | Coverage Ends On | Specify the date when coverage ends by choosing one of the drop-downs. | | Benefit Billing Frequency | Specify how often benefits are billed from the following options: - Pay Period - Monthly - Monthly, Start Deduction Period 2 - Monthly, Start Deduction Period 3 - Monthly, Start Deduction Period 4 |
• Pay Period
• Monthly
• Monthly, Start Deduction Period 2
• Monthly, Start Deduction Period 3
• Monthly, Start Deduction Period 4 | Pay Deduction Frequency | Specify how often benefits are deducted from payroll from the following options: - Pay Period - Monthly - Monthly, Start Deduction Period 2 - Monthly, Start Deduction Period 3 - Monthly, Start Deduction Period 4 |
• Pay Period
• Monthly
• Monthly, Start Deduction Period 2
• Monthly, Start Deduction Period 3
• Monthly, Start Deduction Period 4

2. Click Save to save the defaults for the selected benefit plan.

3. Click Cancel to clear this form at any time and return to the Client Benefit Plan Defaults form.

Note: Once you make any changes to any plan default, this will be the setting applied to all clients processed during the Client Benefit Plan Defaults update.

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Setting Premium Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Plan_Premium_Rates.htm Path: BA/Topics/Benefit_Plan_Premium_Rates.htm

Setting Premium Rates

The rates you enter in the Premium Rates form, accessed in the Actions menu in Group Benefit Plans, are the actual premium rates charged to your organization by the insurance carrier. The plan’s Insurance Class, as well as other settings established in the Other Processing Parameters panel in Group Benefit Plans, determine which version of the Premium Rates form displays.

• Setting Health Plan Premium Rates

• Setting Premium Rates Based on Network

• Setting Premium Rates Based on Rate Group

• Setting Premium Rates Based on Rate Group and Network

• Setting Other Type Plan Rates

• Setting Life Insurance Premium Rates

• Setting Disability Insurance Premium Rates

• Setting Disability Insurance Rates by Salary

• Setting Disability Insurance Extended Precision Premium Rates

• Setting Billing/Premium Rates for Bond Insurance/EPLI

• Setting Family Rated Plan Premium Rates

• Setting Family Rated Plan Premium Rates by Network

• Setting Family Rated Plan Premium Rates by Rate Group

• Setting Family Rated Plan Premium Rates by Rate Groups and Network

========================================================================

Setting Up a Benefit Plan

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Plan_Setup.htm Path: BA/Topics/Benefit_Plan_Setup.htm

Setting Up a Benefit Plan

To maintain the client’s group benefit, retirement, flexible spending, employer match, and HSA match plans, use the Benefit Plan Setup form.

Note: To quickly access the Client Benefit Plan Import form, select Import Client Benefit Plans. (Set the Plan Class to Group Benefit to view this quick link.) You can use the Client Benefit Plan Import form to import the client benefit plan. After that, you must set up a data file and a benefit import definition.

Benefit plans must first be set up at the system level. When this is done, each plan offered by the client is established in Benefit Plan Setup.

Note: Note: If your organization is using Benefits Enrollment, the forms for flexible spending plans will display in enrollments only if the plans are set up in Benefit Plan Setup and in the Benefits tab in Client Details. see Setting Up Client Benefits for more information.

You can access benefit-related features and settings using the Actions menu:

• Viewing the Audit Log

• Using a Default Benefit Plan Template

• Viewing Employees Assigned to a Benefit Plan

• Maintaining Benefit Eligibility Groups

• Setting Up Employee Enrollment Conditions

• Establishing Eligibility by Benefit Group: Displays only when you select Flexible Spending in the Plan Class drop-down and select the Use Benefit Groups option.

• Clone Benefits: Creates new benefit plans for this client based on the plans for another client.

Establishing Basic Information

Establish the basic information for the plan in the Benefit Plan Setup panel.

Note: Note: Different panels display on this form depending on the selected Plan Class. Refer to the appropriate panel descriptions for the plan you are editing.

To establish basic information about a plan:

1. Open the Basic Plan Setup panel.

2. Set the following parameters.

• You cannot delete a benefit plan using the Benefit Plan Setup form if there are existing benefit rules for that Plan ID for the client as this will orphan the associated benefit rules and can cause payroll errors along with other issues. If you try to delete a benefit plan from the Benefit Plan Setup form and if there are existing benefit rules for that Plan ID for the client, you will receive an error stating There are Benefit Rules assigned to this benefit plan. Please remove all rule references. You can only delete a benefit plan from the Benefit Plan Setup form if there are no existing benefit rules for that Plan ID for the client or after you have removed all the benefit rules for that Plan ID for the client.
• You cannot delete a benefit plan using the Benefit Plan Setup form if there are associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Active, Terminated, or COBRA as this will orphan the associated Employee Benefit Enrollment records and can cause payroll errors along with other issues.
• If you try to delete a benefit plan from the Benefit Plan Setup form and if there are associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Active, Terminated, or COBRA, you will receive an error stating This plan cannot be deleted. There are employees assigned to this benefit plan with enrollment history. Example: Employee Enrollment for Employee ID [XXXXX] and Effective Date [XX/XX/XXXX].
• If you try to delete a benefit plan from the Benefit Plan Setup form and if there are associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Pending, Waived, or Eligible, you will receive a warning stating There are employees assigned to this benefit plan with an enrollment status of pending, waived and/or eligible. Do you wish to continue?
• Click Yes to delete the selected Plan ID.
• Click No to return to the Benefit Plan Setup form with the selected Plan ID and associated data populated.
• You can only delete a benefit plan from the Benefit Plan Setup form if there are no associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Active, Terminated, or COBRA. | Status | The status of the selected plan (required). | | Start Date | The date when the plan becomes active (required). Employees can enroll in the plan only with an effective date on or after this date. | | Stop Date | The date when coverage under this plan ends. This applies only when the plan is no longer offered. Employees cannot enroll in the plan after this date. | | Plan Anniversary Override Month and Day | Displays only if you select Plan Class as Retirement. This field allows users to override Plan Anniversary Month selection made for this field on the Retirement Plans form. > Note: Note: While using Plan Anniversary in the calculation of the Next Auto Escalation Date, the system uses the value defined in the Plan Anniversary Override Month and Day field on the Benefit Plan Setup form. If the plan anniversary override value is not defined, then the system uses the value defined in the Plan Anniversary Month and Day field on the Retirement Plans form. If both the above mentioned fields are left blank, then the system uses the value defined in the Start Date field on the Benefit Plan Setup form as the plan anniversary date. | | Deemed ROTH Override | Allow you to override Deemed ROTH selection made on the Retirement Plans form. Additionally, the selection that you make in the Deemed ROTH field on the Retirement Plans form is displayed as read-only next to the Deemed ROTH Override field. This drop-down field has the following options: - -Select- - This option uses the same logic as the No (Default) option. - No (Default) - Pre-tax Catchup contributions is taken as pre-tax until total pre-tax contributions equals the 402G limit. Once the 402G limit is reached, no further Pre-tax or Pre-tax Catchup will be taken for contributions. - Pre-tax Catchup to ROTH Catchup after 402(g) limit - This option will be available with the January release. Currently, this selection this option uses the logic of No (default) option. - Pre-tax Catchup to ROTH Catchup before 402(g) limit - Pre-tax Catchup contributions will be taken as a ROTH Catchup regardless of whether the total pre-tax contributions equal the 402G limit. - Pre-tax to ROTH and Pre-tax Catchup to ROTH Catchup after 402(g) limit - Pre-tax and Pre-tax Catchup contributions may be taken up to the point when total pre-tax contributions equal the 402G limit. At this point, all pre-tax elections will be taken as ROTH and all Pre-tax Catchup will be taken as ROTH Catchup contributions. |
• -Select- - This option uses the same logic as the No (Default) option.
• No (Default) - Pre-tax Catchup contributions is taken as pre-tax until total pre-tax contributions equals the 402G limit. Once the 402G limit is reached, no further Pre-tax or Pre-tax Catchup will be taken for contributions.
• Pre-tax Catchup to ROTH Catchup after 402(g) limit - This option will be available with the January release. Currently, this selection this option uses the logic of No (default) option.
• Pre-tax Catchup to ROTH Catchup before 402(g) limit - Pre-tax Catchup contributions will be taken as a ROTH Catchup regardless of whether the total pre-tax contributions equal the 402G limit.
• Pre-tax to ROTH and Pre-tax Catchup to ROTH Catchup after 402(g) limit - Pre-tax and Pre-tax Catchup contributions may be taken up to the point when total pre-tax contributions equal the 402G limit. At this point, all pre-tax elections will be taken as ROTH and all Pre-tax Catchup will be taken as ROTH Catchup contributions. | TPA Plan ID Override | If required, the TPA Plan ID Override code to associate with this benefit plan. | | Use Benefit Groups | This field allows you to determine employee eligibility by benefit group. Selecting this checkbox displays the Benefit Groups configured with eligibility for the selected Plan ID. When this checkbox is selected, the existing Eligibility Criteria section is not displayed on the form. Additionally, you can access the Eligibility by Benefit Group modal form by clicking the Eligibility by Benefit Group option under the Actions menu. This modal form displays the same fields that are displayed in the Eligibility Criteria section. This option is available only when Flexible Spending or HSA Contribution is selected in the Plan Class list. | | High Deductible Plan | Indicates whether or not a plan is an HDHP plan. > Note: Note: Please note the following: - This field is displayed only when you select Plan Class as Group Benefit. - The value displayed in this field will be based on the current setup defined on the Group Benefit Plans form. Additionally, please note the following validations: - If on the Group Benefit Plans form, the Insurance Class is Medical and the High Deductible Plan field is: - Checked: then on the Benefit Plan Setup form, the High Deductible Plan field displays Yes. - Unchecked: then on the Benefit Plan Setup form, the High Deductible Plan field displays No. - If on the Group Benefit Plans form, the Insurance Class is set to any option other than Medical, then on the Benefit Plan Setup form, the High Deductible Plan field displays N/A. |
• This field is displayed only when you select Plan Class as Group Benefit.
• The value displayed in this field will be based on the current setup defined on the Group Benefit Plans form.
• If on the Group Benefit Plans form, the Insurance Class is Medical and the High Deductible Plan field is:
• Checked: then on the Benefit Plan Setup form, the High Deductible Plan field displays Yes.
• Unchecked: then on the Benefit Plan Setup form, the High Deductible Plan field displays No.
• If on the Group Benefit Plans form, the Insurance Class is set to any option other than Medical, then on the Benefit Plan Setup form, the High Deductible Plan field displays N/A. | Insurance Class | Indicates the Insurance Class of the Benefit Plan. > Note: Note: Please note the following: - This field is a read-only field and is displayed only when you select Plan Class as Group Benefit. - The value displayed in this field will be based on the current setup defined on the Group Benefit Plans form. |
• This field is a read-only field and is displayed only when you select Plan Class as Group Benefit.
• The value displayed in this field will be based on the current setup defined on the Group Benefit Plans form. | Offer Type | Indicates the Offer Type of the Benefit Plan. > Note: Note: Please note the following: - This field is a read-only field and is displayed only when you select Plan Class as Group Benefit. - The value displayed in this field will be based on the current setup defined on the Group Benefit Plans form. |
• This field is a read-only field and is displayed only when you select Plan Class as Group Benefit.
• The value displayed in this field will be based on the current setup defined on the Group Benefit Plans form. | Exempt take on employees from Minimum Days of Service Requirement | When you select Plan Class as: - Retirement: and you select the Exempt take on employees from Minimum Days of Service Requirement checkbox, then the system waives the waiting period for take-on employees. - Employer Match: and you select the Exempt take on employees from Minimum Days of Service Requirement checkbox, then the system waives the waiting period for 401(k) employer match so that employees can continue receiving contributions without interruption. > Note: Note: Please note the following: - This checkbox is an optional field and the default is set to unchecked. - This option is only functional when the last hire date and the PEO start date are not same. - A read-only field named Global level Setting displays to inform you of the Global level setup. Any Client level settings for the Exempt take on employees from Minimum Days of Service Requirement field will override the Global level setting. - If this field is checked, then on the Calculate 401k Eligibility form, while calculating the 401k eligibility, the logic to override the eligibility rules for take-on employees so that they are eligible for their 401k contributions and/or match as soon as they start with the new company without requiring them to meet the defined waiting period is taken into consideration. - Similarly, on the Benefit Utilities form, while running the SH2 Auto Enroll utility, the same logic as defined above is taken into consideration. |
• Retirement: and you select the Exempt take on employees from Minimum Days of Service Requirement checkbox, then the system waives the waiting period for take-on employees.
• Employer Match: and you select the Exempt take on employees from Minimum Days of Service Requirement checkbox, then the system waives the waiting period for 401(k) employer match so that employees can continue receiving contributions without interruption.
• This checkbox is an optional field and the default is set to unchecked.
• This option is only functional when the last hire date and the PEO start date are not same.
• A read-only field named Global level Setting displays to inform you of the Global level setup. Any Client level settings for the Exempt take on employees from Minimum Days of Service Requirement field will override the Global level setting.
• If this field is checked, then on the Calculate 401k Eligibility form, while calculating the 401k eligibility, the logic to override the eligibility rules for take-on employees so that they are eligible for their 401k contributions and/or match as soon as they start with the new company without requiring them to meet the defined waiting period is taken into consideration.
• Similarly, on the Benefit Utilities form, while running the SH2 Auto Enroll utility, the same logic as defined above is taken into consideration. | View Deduction/Bill Codes | When you select the Group Benefit option in the Plan Class, along with selecting the Plan ID and Status, selecting this link opens the Plan Deduction and Billing Codes form. This read-only form displays the deduction and billing codes used for the selected plan in a grid format. The column headers include Code, Description, Deduction Type, and Rebate Bill Code. In addition, this form displays whether the plan is set up as a Section 125 plan, which assists in determining the deduction code for most enrollees. Note: The Section 125 Eligible field is enabled on the Group Benefit Plans form. | | View Benefit Rules | Click this hyperlink to open the Benefit Rules modal form and view the list of Benefit Rules and their effective dates for the Plan ID indicated on the Benefit Plan Setup form. On the modal form that is displayed: - If a benefit rule does not exist for the on the given Plan ID and Benefit Group combo, then the Effective Date column displays Not Found. - For effective dates greater than the current system date, the Effective Date column displays the future date along with Future written next to the date. - Click the date in the Effective Date column to open the Benefit Rules form to view the rule with the pre-populated data in the fields such as Benefit Group, Benefit Plan, and the Effective Date. - In the Effective Date column, click the Not Found hyperlink to open the Benefit Rules form with the Benefit Group and Benefit Plan values pre-populated so that you can enter a new rule for the given plan or the group and add an effective date. Click the Setup New Rule hyperlink to open the Benefit Rules form and view the preselected Benefit Plan. The View rules that are not found checkbox allows you to filter the benefit group that has the value of Not Found in the Effective Date column. |
• If a benefit rule does not exist for the on the given Plan ID and Benefit Group combo, then the Effective Date column displays Not Found.
• For effective dates greater than the current system date, the Effective Date column displays the future date along with Future written next to the date.
• Click the date in the Effective Date column to open the Benefit Rules form to view the rule with the pre-populated data in the fields such as Benefit Group, Benefit Plan, and the Effective Date.
• In the Effective Date column, click the Not Found hyperlink to open the Benefit Rules form with the Benefit Group and Benefit Plan values pre-populated so that you can enter a new rule for the given plan or the group and add an effective date.

3. Click Save.

Establishing Rate Information

To establish rate information for Group Benefit plans, use the Group Benefits Setup panel.

To establish rate information for group benefit plans:

1. Open the Group Benefits Setup panel.

2. Set the following parameters.

• When the custom feature code named PENDING-BILL-RATE-GLOBAL is NOT assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pending Rate Group field will display as Pending Billing Rate Group. | Pending Rate Group Effective Date | The date when the pending billing rate group becomes effective. - When the custom feature code named PENDING-BILL-RATE-GLOBAL is NOT assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pending Rate Group Effective Date field will now display as Pending Rate Group Effective Date. |
• When the custom feature code named PENDING-BILL-RATE-GLOBAL is NOT assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pending Rate Group Effective Date field will now display as Pending Rate Group Effective Date. | Pend Prem Rate Group | The Pending Premium Rate Group for this plan, if appropriate. When you click the Pend Prem Rate Group hyperlink, the selector will only display those premium rate groups assigned to the Plan on the Benefit Plan Setup form which have an Effective Date tied to the Premium Rate Group. - When the custom feature code named PENDING-BILL-RATE-GLOBAL is assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pend Prem Rate Group field will display as Pending Premium Rate Group. |
• When the custom feature code named PENDING-BILL-RATE-GLOBAL is assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pend Prem Rate Group field will display as Pending Premium Rate Group. | Pend Prem Rate Group Effective Date | The date when the pending premium rate group becomes effective. - When the custom feature code named PENDING-BILL-RATE-GLOBAL is assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pend Prem Rate Group Effective Date field will display as Pending Premium Rate Group Effective Date. |
• When the custom feature code named PENDING-BILL-RATE-GLOBAL is assigned to the System Parameters form for a client, then on the Benefit Plan Setup form, under the Group Benefits Setup section, the Pend Prem Rate Group Effective Date field will display as Pending Premium Rate Group Effective Date. | Rule Template | The Rule Template to use to calculate eligibility, coverage, and employee contributions if there is no client- or plan-specific rule. | | One Month Prepay | Whether to bill the client and deduct the amounts from the employees for the next month in the current month. For example, bill and deduct in July for August. | | Add One Month For Prepay | Whether the system should check for and use any new rates and rules in the upcoming month. For example, during a July payroll, PrismHR would check if there are rules and rates that go into effect in August. - The field One Month Prepay must be flagged in order for you to flag the Add One Month For Prepay field. - If the One Month Prepay field is not flagged and you try to flag the Add One Month For Prepay field, you will receive a warning message stating One Month Prepay must be selected to use this option. - If the fields One Month Prepay and Add One Month For Prepay were initially flagged and the field One Month Prepay is now unflagged, you will receive a warning message stating Removing One Month Prepay will automatically remove Add One Month For Prepay. - Click OK - Add One Month For Prepay field will get unflagged. - Click Cancel - The One Month Prepay and Add One Month For Prepay fields will remain as flagged. |
• The field One Month Prepay must be flagged in order for you to flag the Add One Month For Prepay field.
• If the One Month Prepay field is not flagged and you try to flag the Add One Month For Prepay field, you will receive a warning message stating One Month Prepay must be selected to use this option.
• If the fields One Month Prepay and Add One Month For Prepay were initially flagged and the field One Month Prepay is now unflagged, you will receive a warning message stating Removing One Month Prepay will automatically remove Add One Month For Prepay.
• Click OK - Add One Month For Prepay field will get unflagged.
• Click Cancel - The One Month Prepay and Add One Month For Prepay fields will remain as flagged. | Annual Periods | The Annual Periods to use to calculate the employee deduction amount, either 48 or 52 deduction periods. | | Coverage Ends On | The date coverage ends when an employee is terminated. You can select a specific date (for example, 16th Day of the Month) from the drop-down menu, or the following: - Employee’s Date of Termination: Coverage ends on the date the employee is terminated. - End of Month following Termination: Coverage ends at the end of the month in which the employee is terminated. - Employee’s Term Date if prior to 15th of Month else End of Month: If the employee’s termination is before the 15th of the month, coverage ends on the date the employee was terminated. If the employee’s termination is on or after the 15th of the month, coverage ends at the end of the month in which the employee is terminated. This field becomes a non-mandatory field if the Coverage Ends On field is defined at the global level on the Group Benefit Plans form. However, you can select any options to set the Coverage Ends On and this will act as an override to the global level setting. When you select any Coverage Ends On option on the Group Benefit Plan form, then that option is displayed with a Default tag in parenthesis in the Coverage Ends On field on the Benefit Plan Setup form. This setting provides visibility to help you identify the setting that is being used at the global or the system level. |
• Employee’s Date of Termination: Coverage ends on the date the employee is terminated.
• End of Month following Termination: Coverage ends at the end of the month in which the employee is terminated.
• Employee’s Term Date if prior to 15th of Month else End of Month: If the employee’s termination is before the 15th of the month, coverage ends on the date the employee was terminated. If the employee’s termination is on or after the 15th of the month, coverage ends at the end of the month in which the employee is terminated. | Use Billing Wash Rule? | Whether the system applies the billing wash rule to the group benefit plan for new hires and terminated employees. The Use Billing Wash Rule? is now a drop-down has two options: - Select Yes to enable it, and when enabled, the Wash Rule Date On/Before field displays. You can select for the system to apply the wash rule on or before the 10th Day of the Month through the 20th Day of the Month, or at End of Month. - Select No to not apply the wash rule at the global level. When you select any option in the Use Billing Wash Rule? field on the Group Benefit Plan form, then that option is displayed with a Default tag in parenthesis in the Use Billing Wash Rule? field on the Benefit Plan Setup form. This setting provides visibility to help you identify the setting that is being used at the global or the system level. For examples on applying the billing wash rule, see Applying the Billing Wash Rule. |
• Select Yes to enable it, and when enabled, the Wash Rule Date On/Before field displays. You can select for the system to apply the wash rule on or before the 10th Day of the Month through the 20th Day of the Month, or at End of Month.
• Select No to not apply the wash rule at the global level. | Cafe Plan Eligible | Whether this benefit is eligible for the client’s cafe plan. For example, this option is selected if the client offers $1500 to cover benefit plans and this plan qualifies. | | Benefit Billing Frequency | When plan billing occurs. If you select one of the monthly options, PrismHR bills the client the whole portion at the beginning of the month, and then gives credits for the other pay periods in that month. If you do not make a selection, the system uses the pay period. | | Payroll Deduction Frequency | Whether to override the employee’s normal pay period payroll deduction frequency. The standard is each pay period. | | Payroll Deduction Frequency | If instructed by the PrismHR Customer Support Team, the frequency for calculating premiums. | | Premium Calculation Month/Day | The month and day to use to calculate plan premiums. | | Client Plan Renewal Month/Day | Allow you to provide a plan renewal date for a benefit plan. Select is the default option in both the month and day drop-down lists. A tool-tip is provided with a message stating This field will be used as an override to the date specified on the Group Benefit Plans form. If one exists for the Benefit Plan selected, the Group Benefit Renewal date will be displayed. which explains the functionality of this field. > Note: Note: Please note the following: - This field is used as an override to the date specified on the Group Benefit Plans form (if one exists for the Benefit Plan selected). - On the Group Benefit Plans form, when you assign a value to the Plan Renewal Month field, then that value is displayed as read-only field to the right of the Client Plan Renewal Month/Day field with a label named Group Benefit Renewal on the Benefit Plan Setup form. |
• This field is used as an override to the date specified on the Group Benefit Plans form (if one exists for the Benefit Plan selected).
• On the Group Benefit Plans form, when you assign a value to the Plan Renewal Month field, then that value is displayed as read-only field to the right of the Client Plan Renewal Month/Day field with a label named Group Benefit Renewal on the Benefit Plan Setup form. | Network Selection Rule | Network Selection Rule: For future development. Does not currently impact the functionality of PrismHR. | | Carrier Account | A Carrier Account. It does not need to be one of those entered in Group Benefit Plans, but if it is you must enter the same risk factors in the Risk Factor panel. | | Max Days Back Dating | Client-level limit (in days) for back-dating coverage start/end dates. Note: If the Max Days Back Dating field does not have a value defined on the Benefit Plan Setup form, but has a value defined for this field on the Group Benefit Plans form, then the system uses the value defined on the Group Benefit Plans form as default. | | Auto Enrollment | Whether to enable automatic enrollment and set employee waive options for this benefit plan. This option depends upon other settings in the system; see Setting Up Waive Options for more information. - If selected, the employee auto enrolls in the benefit plan and does not have the option to waive coverage. - If not selected, the employee has the option to waive coverage in the benefit plan. Note: Please note the following: - On the Group Benefit Plans form, if you set Auto Enroll field to No, and then if you select the Auto Enrollment checkbox then a warning pop-up stating Benefit Plan <The selectedPlan ID> is flagged as Auto Enroll ‘No’ on the Group Benefit Plans form. This will override the value assigned on the Benefit Plan Setup form. is displayed. A warning message stating This plan is flagged as Auto Enroll ‘No’ on the Group Benefit Plans form. This will override the value assigned on the Benefit Plan Setup form. is also displayed below the selected Plan ID. - On the Group Benefit Plans form, if you set Auto Enroll field to Yes, and then if you select the Auto Enrollment checkbox then a message stating This plan is setup to auto enroll is displayed. |
• If selected, the employee auto enrolls in the benefit plan and does not have the option to waive coverage.
• If not selected, the employee has the option to waive coverage in the benefit plan.
• On the Group Benefit Plans form, if you set Auto Enroll field to No, and then if you select the Auto Enrollment checkbox then a warning pop-up stating Benefit Plan <The selectedPlan ID> is flagged as Auto Enroll ‘No’ on the Group Benefit Plans form. This will override the value assigned on the Benefit Plan Setup form. is displayed. A warning message stating This plan is flagged as Auto Enroll ‘No’ on the Group Benefit Plans form. This will override the value assigned on the Benefit Plan Setup form. is also displayed below the selected Plan ID.
• On the Group Benefit Plans form, if you set Auto Enroll field to Yes, and then if you select the Auto Enrollment checkbox then a message stating This plan is setup to auto enroll is displayed. | Suppress O/E Auto Term | Whether to prevent the posting procedure from terminating enrollments that are active in that benefit plan. | | Suppress Benefit Adjustment on Employee Termination | Whether the client wants to suppress benefit adjustments that would normally have been created due to payroll timing if an employee is terminated. The Suppress Automatic Benefit Adjustment field in the Benefits tab in the Client Details form overrides this field and must also be selected for this setting to go into effect. | | Default Network ID | The Default Network ID that the system uses as a default for employees who enroll in the plan. | | Rule Date to Use for Take-On | A date that is greater than the PEO start date. This avoids a PEO start date that is less than the benefit rule date (causing employees to not be offered benefits), | | Earliest Premium Rate Date to Use Earliest Billing Rate Date to Use | The available premium and billing rate effective dates set up at the system level for the group benefit plan. If the date you want is not available in the list, set up the effective date and rates at the group benefit plan level. If you have clients with multiple benefit plan billing and premium rates, select these dates to offer those clients interim rates before the next open enrollment date. | ## Setting Up Fringe Benefit Pay Codes

To treat a client-paid portion of this benefit as a fringe benefit, use The Fringe Benefit Pay Codes panel. The system automatically adds the pay code and amount to the Other Earnings section of the calculated regular pay vouchers.

To set up a fringe benefit pay code:

1. Open the Fringe Benefit Pay Codes panel.

2. Set the following parameters.

• If you enable this field, on the Benefit Plan setup only employees who the system designates as an S-Corp Principal employee will have the client-paid portion of the benefit treated as a fringe benefit through the payroll process. (If they are not an S-Corp Principal employee then the employer portion is not treated as a fringe benefit.)
• If you do not enable this field, on the Benefit Plan setup the system performs as usual and treats the client-paid portion of that benefit as a fringe benefit, assigning it to the defined fringe benefit Pay Code through the payroll process.
• The system performs an additional validation during payroll calculation, which checks each employee who is enrolled in the benefit plan to determine if they are an S-Corp Principal. Employees enrolled in the benefit plan who the system designates as an S-Corp Principal must have the client paid portion of that benefit assigned to the defined fringe benefit pay code and listed in Other Payments on their payroll voucher. ## Defining Risk Factors

To enter data about risk factors (if necessary), use the Risk Factor panel. The global settings determine whether the risk factor is standard or extended precision, and whether it applies to premiums, billing, or both.

To set up information about risk factors:

1. Open the Risk Factor panel.

2. Set the following parameters.

Use this option — To define this

Effective Date — The date when the premium risk factor goes into effect.

Premium Risk Factor — The Premium Risk Factor to use as a multiplier when calculating the benefit premiums (both cost and billing) for each unique client/benefit plan combination. The Premium Risk Factor amount is applied to the calculated premium for the benefit. If the system uses standard risk factors, the system limits it to two decimal places. (If you enter more, the system rounds it off to two digits.)

Admin Surcharge — Currently this field is suppressed to only allow a blank value. If a user attempts to enter a value in this field, the system displays the following message: The Admin Surcharge feature is not available in this release. This field will be available in a future release.

Applying the Hawaii 1.5% Rule

Note: Note: The Hawaii 1.5% Rule section will only display on the Benefit Plan Setup form for Plan Class selected as Group Benefit. For all other Plan Class, this section will not display on the Benefit Plan Setup form.

To apply Hawaii’s Prepaid Health Care Act 1.5% health insurance premium rate to selected benefit groups, use the Hawaii 1.5% Rule panel.

See Using the Hawaii 1.5% Rule for detailed information on how the system processes this calculation. This calculation is not available in Benefits Enrollment.

You can select the Exclude Plan When Calculating Medical Premium Limit option in the Special Options panel in Group Benefit Plans to exclude benefit plans from the Hawaii medical contribution calculation at the system-level.

To apply Hawaii’s Prepaid Health Care Act 1.5% rate to selected benefit groups:

1. Open the Hawaii 1.5% Rule panel.

2. Set the following parameters.

Defining Participation Requirements at the Client Level

To establish participation requirements ensuring that client and employee enrollments follow carrier guidelines at the client level, use the Participation Requirements panel.

To establish participation requirements criteria:

1. Select a Participation Requirement Option:

• No

• Yes: Enables the Participation Requirement Start Date and Participation Requirement Percentage fields.

• Use System Default: Uses the values defined at the system level. See Defining Participation Requirements at the System Level.

2. In the Participation Requirement Start Date field, enter the date clients must meet the participation requirement.

3. Enter a Participation Requirement Percentage. The value must be a number from 1 to 100.

Establishing Eligibility Criteria

To establish employment type and benefit eligibility requirements for Retirement, Flexible Spending, Employer Match, or HSA Match plans, use the Eligibility Criteria panel.

If you are setting up a flexible spending plan and select the Use Benefit Groups option, this panel does not display. You must set up eligibility criteria in the Eligibility by Benefit Group form, accessible in the Actions menu.

To establish eligibility criteria:

1. Open the Eligibility Criteria panel.

2. Set the following parameters.

• Hire Date: The employee’s original hire date.
• Status Date: The Life Event Date. | Eligibility Date Used | The Eligibility Date Used determines how the system calculates the date employees meet eligibility requirements for this plan. - Calculated Eligibility Date: The first day of calculated eligibility. - First of Month after Calculated Date: The first of the month after the date of calculated eligibility. - First of Quarter after Calculated Date: The first day of the next quarter after the date of calculated eligibility. - First Semi-Annual after Calculated Date: The first of January or first of July after the date of calculated eligibility. - If Calculated is 1st of month, use that else next 1st of month: If the calculated date is the first of a month, the system uses that. If it is another day in the month, it uses the first of the following month. |
• Calculated Eligibility Date: The first day of calculated eligibility.
• First of Month after Calculated Date: The first of the month after the date of calculated eligibility.
• First of Quarter after Calculated Date: The first day of the next quarter after the date of calculated eligibility.
• First Semi-Annual after Calculated Date: The first of January or first of July after the date of calculated eligibility.
• If Calculated is 1st of month, use that else next 1st of month: If the calculated date is the first of a month, the system uses that. If it is another day in the month, it uses the first of the following month. | Auto Enrollment | Whether to override the flag at the plan level. If you select this option, you must enter the Auto Enrollment Percent. This field is disabled if a retirement plan is configured with the Employee Deferral Deduction Code flagged to Prohibit Deductions on the Retirement Plans form. > Note: Note: The Auto Enroll option applies only to Retirement and Employer Match plans. | | Auto Enrollment Percent | If automatic enrollment is enabled, this is the deferral percentage at which employees will be automatically enrolled. If you enter a value which is NOT >=3 and <=10, and the Auto Escalator field below is checked then you will get a warning message stating Auto Enrollment Percent must be between 3%-10% when using Auto Escalator. This field is disabled if a retirement plan is configured with the Employee Deferral Deduction Code flagged to Prohibit Deductions on the Retirement Plans form. However, if there is any existing value for the prohibited retirement plan, then the value is displayed but the field remains disabled. > Note: Note: The Apply Enroll Percent option applies only to Retirement and Employer Match plans. | | Auto Escalator | This field only displays if you enable the Auto Enrollment field for a Retirement Plan. > Note: Note the following: - Unchecked (default): Plans will not automatically escalate contributions annually. - Checked: In addition to auto-enrollment at a default contribution rate, plans will automatically escalate contributions by 1% each year until they reach a predetermined rate by the employer (between 10 and 15%). > Note: Note: When you deselect the Auto Escalator field and save the form, then the system checks for any active retirement plan enrollment records that have the Auto Escalation? field enabled on the Retirement Plan Enrollment form. Also, if there are any active retirement plan enrollment records a warning message displays, Auto escalator cannot be unchecked. There are employees using this auto escalator with active enrollments. Example: Employee Enrollment for Employee ID <Employee’s ID> and Effective Date <plan’s effective date>. |
• Unchecked (default): Plans will not automatically escalate contributions annually.
• Checked: In addition to auto-enrollment at a default contribution rate, plans will automatically escalate contributions by 1% each year until they reach a predetermined rate by the employer (between 10 and 15%). | Auto Escalator Max Percent | Enter any value between 10-15 (including up to two decimal places), which is the maximum predetermined benefit rate percentage decided by the employer for that client. Note: This field only displays if you enable Auto Enrollment. However, you can only edit the Auto Escalator Max Percent after enabling the Auto Escalator field. > Note: Note the following: - If you enable the Auto Escalator field, this field is mandatory. If you do not enter a value an error message displays, Auto Escalator Max Percent is required when using Auto Escalator. - If you enter a value outside the permitted range a warning message displays, Auto Escalator Max Percent must be between 10%-15% when using Auto Escalator. |
• If you enable the Auto Escalator field, this field is mandatory. If you do not enter a value an error message displays, Auto Escalator Max Percent is required when using Auto Escalator.
• If you enter a value outside the permitted range a warning message displays, Auto Escalator Max Percent must be between 10%-15% when using Auto Escalator. | Auto Escalate On | Defines when the auto escalation must occur at the client level. This field only displays if you enable Auto Escalator. This field has the following drop-down options: - –Select–: This option is automatically populated when you do not select any other options.(This option operates the same as Plan Anniversary After 12 Months (Default) option) - Plan Anniversary After 12 Months (Default): When this option is selected, then the calculated date for auto escalation should be the next Plan Anniversary Date which is equal to or greater than the Status Date (considered as Plan Anniversary date) assigned to the enrollment record (found on the Retirement Plan Enrollment form) plus 12 months. - Plan Anniversary: This option is considered to be the Start Date assigned to the Retirement Plan on the Benefit Plan Setup form. The plan enrollment uses the next Plan Anniversary Date as the calculated date for auto escalation. - Employee Enrollment Anniversary: This option is considered to be the Start Date assigned to the Employee’s retirement enrollment plan. |
• –Select–: This option is automatically populated when you do not select any other options.(This option operates the same as Plan Anniversary After 12 Months (Default) option)
• Plan Anniversary After 12 Months (Default): When this option is selected, then the calculated date for auto escalation should be the next Plan Anniversary Date which is equal to or greater than the Status Date (considered as Plan Anniversary date) assigned to the enrollment record (found on the Retirement Plan Enrollment form) plus 12 months.
• Plan Anniversary: This option is considered to be the Start Date assigned to the Retirement Plan on the Benefit Plan Setup form. The plan enrollment uses the next Plan Anniversary Date as the calculated date for auto escalation.
• Employee Enrollment Anniversary: This option is considered to be the Start Date assigned to the Employee’s retirement enrollment plan. ## Specifying Whether to Include Pay Codes

To indicate any pay codes that are a part of retirement earnings, use the Include/Exclude Pay Codes panel.

To indicate pay codes that are part of retirement earnings:

1. Open the Include/Exclude Pay Codes panel.

2. Set the following parameters.

Use this option — To define this

Type — Whether the pay codes are Included or Excluded as part of retirement earnings. You can also leave this field blank (the default setting).

Pay Code — Each Pay Code to include or exclude from the retirement deferral calculations, as determined by the type. The Description displays. The pay code selected applies only if the employee deferral is a percentage.

Defining the HSA Contribution Amount and Frequency

To establish the amount and frequency of the Health Savings Account client contribution, use the Company HSA Contribution panel. This is displayed only after you select Plan Class as HSA Contribution.

To set up the HSA contribution amount and frequency:

1. Open the Company HSA Contribution panel.

2. Set the following parameters.

• The HSA Contribution entered is an annual contribution, applied at the frequency specified in the HSA Contribution Frequency field.
• Select the Display Employer Amount in Online Enrollment check box to display the employer contribution amount during benefit enrollments, allowing employees to view the amount their employer contributes to the plan.
• The Effective Date of the contribution line.
• The high-deductible Benefit Plan ID.
• The Plan Type (coverage tier).
• The Percent of Tier amount to contribute.
• The actual Pay Date on which to calculate the scheduled contribution amount.
• Either the Lump-Sum Amount to be contributed on the specified pay date, or the Percent of Tier amount to contribute.
• The Effective Date of the contribution line.
• The high-deductible Benefit Plan ID.
• The Plan Type (coverage tier).
• The Fixed Amount to contribute for the plan ID and plan type.
• The amount of the One TimeContribution if appropriate. This option is available only if the Custom Feature Code ONE-TIME-HSA-MATCH is set in System Parameters.
• Select the Display Employer Amount in Online Enrollment check box to display the employer contribution amount during benefit enrollments, allowing employees to view the amount their employer contributes to the plan.
• The configuration of HSA contribution calculation that matches one employer dollar for each employee dollar allocated to the HSA plan.
• Selecting this option defaults the Contribution Applies To field to a read-only Contributing Employees Only option. | Contribution Applies To | To which employees the contribution applies to. You can select Contributing Employees Only or All HDHP Employees. The default is Select which means no option is selected. - If you do not select any of the options, then any employee with an HSA account added to their Flex Spending Account setup under Elections for the current Plan Year will receive the employer contribution. - If you select Contributing Employees Only, then any employee with an HSA account added to their Flex Spending Account setup under Elections for the current Plan Year and contributing more than $0.00, will receive the employer contribution. - If you select All HDHP Employees, then the Account Type field is enabled. - Account Type: Select the Employee’s Employee Flexible Spending Account setup configured on the given plan’s FSA types. |
• If you do not select any of the options, then any employee with an HSA account added to their Flex Spending Account setup under Elections for the current Plan Year will receive the employer contribution.
• If you select Contributing Employees Only, then any employee with an HSA account added to their Flex Spending Account setup under Elections for the current Plan Year and contributing more than $0.00, will receive the employer contribution.
• If you select All HDHP Employees, then the Account Type field is enabled.
• Account Type: Select the Employee’s Employee Flexible Spending Account setup configured on the given plan’s FSA types. | HSA Contribution | The HSA Contribution amount that the client contributes for any employee with a Health Savings Account. (If a different amount is entered on an employee’s account, that value overrides this amount. | | HSA Contribution Frequency | The frequency of the HSA contribution. The system defaults to pay period. | | Maximum Contribution Amount | Here, you can enter the maximum HSA contribution amount in dollar. It is a conditional field and is displayed only when you select Contribution Calculation Method to Dollar Match. |

3. Click Save to save the selected Plan ID record.

4. Click Delete to delete the selected Plan ID.

• You cannot delete a benefit plan using the Benefit Plan Setup form if there are existing benefit rules for that Plan ID for the client as this will orphan the associated benefit rules and can cause payroll errors along with other issues. If you try to delete a benefit plan from the Benefit Plan Setup form and if there are existing benefit rules for that Plan ID for the client, you will receive an error stating There are Benefit Rules assigned to this benefit plan. Please remove all rule references. You can only delete a benefit plan from the Benefit Plan Setup form if there are no existing benefit rules for that Plan ID for the client or after you have removed all the benefit rules for that Plan ID for the client.

• You cannot delete a benefit plan using the Benefit Plan Setup form if there are associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Active, Terminated, or COBRA as this will orphan the associated Employee Benefit Enrollment records and can cause payroll errors along with other issues.

• If you try to delete a benefit plan from the Benefit Plan Setup form and if there are associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Active, Terminated, or COBRA, you will receive an error stating This plan cannot be deleted. There are employees assigned to this benefit plan with enrollment history. Example: Employee Enrollment for Employee ID [XXXXX] and Effective Date [XX/XX/XXXX].

• If you try to delete a benefit plan from the Benefit Plan Setup form and if there are associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Pending, Waived, or Eligible, you will receive a warning stating There are employees assigned to this benefit plan with an enrollment status of pending, waived and/or eligible. Do you wish to continue?

• Click Yes to delete the selected Plan ID.

• Click No to return to the Benefit Plan Setup form with the selected Plan ID and associated data populated.

• You can only delete a benefit plan from the Benefit Plan Setup form if there are no associated Employee Benefit Enrollment records for the client for the selected Plan ID that have a status of Active, Terminated, or COBRA.

5. Click Cancel to clear this form at any time. All unsaved changes will be lost.

========================================================================

lrImporting Benefit Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import.htm Path: BA/Topics/Benefit_Rates_Import.htm

lrImporting Benefit Rates

Use this Benefit Rates Import form to initiate a new import or complete an existing import in progress of benefit rates (premium or billing) into PrismHR using a predefined benefit rates import template. You can also view completed benefit rates imports on this form. This benefit rates import process cannot be used to change or overwrite existing benefit rates.

Note: Note: This form does not use Client Access Group Security.

To access the form, on the Work Centers panel, under Onboarding & Benefits, click Benefit Imports & Reporting. Under Benefit Imports, click Benefit Rates Import.

[Image: screenshot]

You can also search for this form on the search box in the main navigation search bar.

[Image: screenshot]

This form has the following two sections:

• Imports in Progress

• Past Imports

Imports in Progress

When you access this form for the first time, all the tables will be blank and you should select the New Import button to proceed to the Benefit Rates Import Setup & File Import screen to define and begin a new benefit rate import.

[Image: screenshot]

User – This field is a dropdown. By default, the user id of the user who has logged in will display here. You can also select a different user from the drop-down.

This section displays all benefit rate imports that are not completed successfully for the selected user. This section will display the last 7 imports in progress at a glance on-screen for the selected user. In case there are more than 7 imports in progress for the selected user, you will see a scroll bar on the right. Scroll to view all the imports in progress for the selected user. The information is displayed in a table that has the following columns:

1. Name – This is the import name that was provided for that benefit rate import. If you click one of the names, it will take you to the Benefit Rates Import Setup & File Import screen for further action to complete the import.

2. Type – This is the benefit rate type that you are importing for the import. This will be:

3. Plan Used for Template – This is the Benefit Plan ID used for the import template.

4. Last Modified Date – This shows when this import was last worked upon.

5. Last Modified User – This shows the user id of the user who worked on the import last.

6. Status – This shows the status of the import in progress and can be any one of the following:

3. — Import Errors – When an import attempt has failed. This will produce a Benefit Rate Import Error Report

7. Error Report – When the Status above is either Template Defined or Ready for Import, this column will display a ‘-’ [dash]. When the Status above is Import Errors, then this column will display a link to open and view the error report for the corresponding import that was not successful. It provides a list of all the errors that this import encountered. You can correct these errors and try again to complete the import. Following is a sample Benefit Rate Import Error Report.

[Image: screenshot]

8. Actions – If you want to delete an existing import in progress, you can click the recycle bin icon. Click yes to confirm deletion.

New Import – If you want to initiate a new Benefit Rates Import using a predefined benefit rates import template, click this button which will take you to the Benefit Rates Import Setup & File Import screen. All the fields will be blank on that screen. You will need to fill in the necessary fields to set up and complete the import.

Past Imports

This section lists all the benefit rate imports completed successfully for the selected date range. By default, the date range is a calendar month ending on the current date. You can manually change the date range. This section will display the last 7 completed imports at a glance on-screen for the selected date range. In case there are more than 7 completed imports for the selected date range, you will see a scroll bar on the right. Scroll to view all the completed imports for the selected date range.

Past Imports that are older than one year (since completion date) are automatically deleted and no longer display in the table.

The completed imports are sorted first by Date Completed and then by Name. The latest imports are listed at the top.

[Image: screenshot]

The information is displayed in a table that has the following columns:

1. Name – This is the import name that you had provided for that benefit rate import.

2. Type – This is the benefit rate type that you imported. This will be:

3. Plan Used for Template – This is the Benefit Plan ID used for the import template.

4. Date Completed – This is the date when the benefit rate was imported into PrismHR.

5. Processed by User – This is the user ID of the user who completed the benefit rate import.

6. Import File – This is the benefit rates import file that was used for the import. Following is a sample import file used for Billing Rates plan type:

[Image: screenshot]

The headers will vary depending on the plan type you are importing.

7. Import Report – This link will provide you with the Benefit Rates Import Success Report for the import which shows a summary of Plans, records and line items imported that correlate with the total number of successful records imported as reported in the toast message.

[Image: screenshot]

The following is an example of the Benefit Rates Import Success Report.

[Image: screenshot]

========================================================================

Billing Rates Age Banded

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Age%20Banded.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Age Banded.htm

Billing Rates Age Banded

The following table provides at a glance the rate template for Age Banded Billing Rates.

1. Benefit Plan ID
2. Rate Group
3. Plan Type
4. Effective Date
5. From Age
6. To Age
7. Total Bill Amount
8. Employee Bill Amount
9. Dependents Bill Amount > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Plan Type, Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

1. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields in the import file must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — The initial From Age in the import file must be 0, otherwise you will receive an error message stating Initial From Age must be 0.

5. If the Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

6. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

7. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Plan Type and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

8. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

9. Total Bill Amount must equal Employee Bill Amount PLUS Dependent Bill Amount. If Employee Bill Amount is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Bill Amount must equal Total Bill Amount, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Bill Amount must equal Total Bill Amount.

10. If Dependent Bill Amount > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then the import will fail with an the error message stating Dependent Bill Amount > 0 is not allowed for Plan Type .

11. Dependent Bill Amount is a calculated amount based on Total Bill Amount minus Employee Bill Amount.

1. — If Dependent Bill Amount is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, the import will fail with an error message stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

2. — If Dependent Bill Amount is blank on the import file, then Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)

========================================================================

Billing Rates Composite Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Composite%20Rates.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Composite Rates.htm

Billing Rates Composite Rates

The following table provides at a glance the rate template for Billing Rates Composite Rates.

1. Benefit Plan ID
2. Rate Group
3. Plan Type
4. Effective Date
5. From Age (must be 0, will default to 0 if blank)
6. To Age (must be 99, will default to 99 if blank)
7. Total Bill Amount
8. Employee Bill Amount
9. Dependents Bill Amount > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values on the import. [Benefit Plan ID, Rate Group, Plan Type, Effective Date, Total Bill Amount and Employee Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file:

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. The Rate Group on the import file:

1. — must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

5. If employee Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plan form, you will receive an error stating Plan Type does not exist on the Plan ID .

6. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

7. Age Banded Medical Rates

2. — If import file is set up with more than one line for an effective date combo then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

3. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

4. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

8. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Plan Type and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

9. If the rate on the import file has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

10. If the rate is negative on the import file, you will receive an error message stating Negative amounts are not allowed.

11. For Plan Type with coverage class selected as Single (employee) coverage, if Employee Premium is on the import file, then Employee Premium must equal Total Premium. Else, you will receive an error message stating Plan Type has Coverage Class Single. Employee Premium must equal Total Premium. Refer to the Coverage Class field selection on the Group Benefit Plan Types form for details.

12. If your import file has Dependent Premium > 0 for a Plan Type with coverage class selected as Single (employee) coverage, you will receive an error message stating Dependent Premium > 0 is not allowed for Plan Type .

13. Total Bill Amount must equal Employee Bill Amount PLUS Dependent Premium. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

14. If Dependent Bill Amount is on the import file and Plan Type with coverage class is not selected as Single (employee) coverage, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, you will receive an error stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

Note: If Dependent Bill Amount is blank on the import file, then the Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)

========================================================================

Billing Rates Gender Banded

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Gender%20Banded.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Gender Banded.htm

Billing Rates Gender Banded

The following table provides at a glance the rate template for Billing Rates Gender Banded.

1. Benefit Plan ID
2. Rate Group (if applicable)
3. Network ID
4. Plan Type
5. Employee Gender
6. Effective Date
7. From Age
8. To Age
9. Total Bill Amount
10. Employee Bill Amount
11. Dependents Bill Amount > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premium field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premium. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premium Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values on the import. [Benefit Plan ID, Rate Group (if applicable), Network ID, Plan Type, EmployeeEffective Date, Total Bill Amount and Employee Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the benefit Plan ID on the import file;

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If employee Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plan form, you will receive an error stating Plan Type does not exist on the Plan ID .

6. The Rate Group on the import file:

1. — must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

7. Network ID on the import must exist under the section Plan Networks on the Group Benefit Plan form. If not import line fails with error message stating Network ID does not exist on Plan ID .

8. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

9. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

10. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Rate Group (if applicable), Network ID, Plan Type, Employee Gender and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

11. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

12. Total Bill Amount must equal Employee Bill Amount PLUS Dependent Bill Amount. If Employee Bill Amount is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Bill Amount must equal Total Bill Amount, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Bill Amount must equal Total Bill Amount.

13. If Dependent Bill Amount > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Bill Amount > 0 is not allowed for Plan Type .

14. Dependent Bill Amount is a calculated amount based on Total Bill Amount minus Employee Bill Amount.

1. — If Dependent Bill Amount is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, the import will fail with an error message stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

2. — If Dependent Bill Amount is blank on the import file, then Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)

========================================================================

Billing Rates Gender/Spouse Banded

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Gender%20Spouse%20Banded.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Gender Spouse Banded.htm

Billing Rates Gender/Spouse Banded

The following table provides at a glance the rate template for Billing Rates Gender/Spouse Banded.

1. Benefit Plan ID
2. Rate Group (if applicable)
3. Network ID (if applicable)
4. Plan Type
5. Employee Gender
6. Spouse Gender
7. Effective Date
8. From Age
9. To Age
10. Total Bill Amount
11. Employee Bill Amount
12. Dependents Bill Amount > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premium field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premium. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premium Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values on the import. [Benefit Plan ID, Rate Group (if applicable), Network ID, Plan Type, Employee Gender, Spouse Gender, Effective Date, Total Bill Amount and Employee Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the benefit Plan ID on the import file;

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Plan Type on the import file

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, you will receive an error stating Spouse coverage is not allowed for Plan Type .

6. The Rate Group for this import must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist. Also the Rate Group for this import must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

7. Network ID on the import must exist under the section Plan Networks on the Group Benefit Plan form. If not import line fails with error message stating Network ID does not exist on Plan ID .

8. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

9. If the Spouse Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Spouse Gender is not found.

10. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

11. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Rate Group (if applicable), Network ID, Plan Type, Employee Gender and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

12. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

13. Total Bill Amount must equal Employee Bill Amount PLUS Dependent Bill Amount. If Employee Bill Amount is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Bill Amount must equal Total Bill Amount, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Bill Amount must equal Total Bill Amount.

14. If Dependent Bill Amount > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Bill Amount > 0 is not allowed for Plan Type .

15. Dependent Bill Amount is a calculated amount based on Total Bill Amount minus Employee Bill Amount.

1. — If Dependent Bill Amount is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, the import will fail with an error message stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

2. — If Dependent Bill Amount is blank on the import file, then Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)

========================================================================

Billing Rates Tobacco Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Tobacco%20Rates.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Tobacco Rates.htm

Billing Rates Tobacco Rates

The following table provides at a glance the rate template for Billing Rates Tobacco Rates.

1. Benefit Plan ID
2. Rate Group (if applicable)
3. Network ID (if applicable)
4. Plan Type
5. Employee Gender (if applicable)
6. Spouse Gender (if applicable)
7. Effective Date
8. From Age
9. To Age
10. Non-Tobacco Premium
11. Tobacco Premium
12. Dependents (Spouse Non-Tobacco)
13. Dependents (Spouse Tobacco) > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premium field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premium. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premium Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Rate Group (if applicable), Network ID (if applicable based on plan setup), Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable), Effective Date, Non-Tobacco Premium, Tobacco Premium, Dependents (Spouse Non-Tobacco) (if applicable), Dependents (Spouse Tobacco) (if applicable)]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file:

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Plan Type on the import file

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, you will receive an error stating Spouse coverage is not allowed for Plan Type .

6. The Rate Group on the import file:

1. — must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

7. Network ID on the import must exist under the section Plan Networks on the Group Benefit Plan form. If not import line fails with error message stating Network ID does not exist on Plan ID .

8. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

9. If the Spouse Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Spouse Gender is not found.

10. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

11. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group (if applicable), Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable) and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

12. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

Tobacco rates have no calculations. Rates entered are what is used.

========================================================================

Billing Rates Vary By Network BOTH

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Vary%20By%20Network%20BOTH.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Vary By Network BOTH.htm

Billing Rates Vary By Network BOTH

The following table provides at a glance the rate template for Billing Rates Vary By Network BOTH.

1. Benefit Plan ID
2. Network ID
3. Rate Group
4. Plan Type
5. Effective Date
6. From Age
7. To Age
8. Total Bill Amount
9. Employee Bill Amount
10. Dependents Bill Amount > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premium field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premium. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premium Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Rate Group, Network ID, Plan Type, Effective Date, Total Bill Amount, Employee Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file:

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Network ID on the import file must exist under the section Plan Networks on the Group Benefit Plan form. If not import line fails with error message stating Network ID does not exist on Plan ID .

5. The Rate Group on the import file:

1. — must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

6. If the Plan Type on the import file

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, you will receive an error stating Spouse coverage is not allowed for Plan Type .

7. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

8. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

9. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID, Rate Group, Plan Type, and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

10. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

11. Total Bill Amount must equal Employee Bill Amount PLUS Dependent Bill Amount. If Employee Bill Amount is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Bill Amount must equal Total Bill Amount, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Bill Amount must equal Total Bill Amount.

12. If Dependent Bill Amount > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Bill Amount > 0 is not allowed for Plan Type .

13. Dependent Bill Amount is a calculated amount based on Total Bill Amount minus Employee Bill Amount.

1. — If Dependent Bill Amount is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, the import will fail with an error message stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

2. — If Dependent Bill Amount is blank on the import file, then Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)

========================================================================

Billing Rates Vary by Network

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Vary%20by%20Network.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Vary by Network.htm

Billing Rates Vary by Network

The following table provides at a glance the rate template for Billing Rates Vary by Network.

1. Benefit Plan ID
2. Network ID
3. Plan Type
4. Effective Date
5. From Age
6. To Age
7. Total Bill Amount
8. Employee Bill Amount
9. Dependents Bill Amount > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premium field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premium. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premium Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values on the import. [Benefit Plan ID, Network ID, Plan Type, Effective Date, Total Bill Amount and Employee Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the benefit Plan ID on the import file;

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If employee Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plan form, you will receive an error stating Plan Type does not exist on the Plan ID .

6. Network ID on the import must exist under the section Plan Networks on the Group Benefit Plan form. If not import line fails with error message stating Network ID does not exist on Plan ID .

7. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

8. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID, Plan Type and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

9. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file;

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

10. Total Bill Amount must equal Employee Bill Amount PLUS Dependent Bill Amount. If Employee Bill Amount is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Bill Amount must equal Total Bill Amount, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Bill Amount must equal Total Bill Amount.

11. If Dependent Bill Amount > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Bill Amount > 0 is not allowed for Plan Type .

12. Dependent Bill Amount is a calculated amount based on Total Bill Amount minus Employee Bill Amount.

1. — If Dependent Bill Amount is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Bill Amount PLUS the Dependent Bill Amount must equal the Total Bill Amount. Otherwise, the import will fail with an error message stating Employee Bill Amount PLUS Dependent Bill Amount must equal the Total Bill Amount.

2. — If Dependent Bill Amount is blank on the import file, then Dependent Bill Amount will be imported as a calculated amount. (Total Bill Amount minus Employee Bill Amount)

========================================================================

Billing Rates Wellness Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Billing%20Rates%20Wellness%20Rates.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Billing Rates Wellness Rates.htm

Billing Rates Wellness Rates

The following table provides at a glance the rate template for Billing Rates Wellness Rates.

1. Benefit Plan ID
2. Rate Group
3. Plan Type
4. Effective Date
5. From Age
6. To Age
7. Wellness Bill Amount
8. Non-Wellness Bill Amount
9. Dependent Bill Amount > Note: Note: You must have access to the Billing Rates Groups to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premium field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premium. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premium Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Rate Group, Plan Type, Effective Date, Wellness Bill Amount, Non-Wellness Bill Amount, Dependent Bill Amount]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the benefit Plan ID on the import file;

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Plan Type on the import file:

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, and there also exists Dependent Bill Amount you will receive an error stating Dependent Bill Amount >0 is not allowed for Plan Type .

6. The Rate Group on the import file:

1. — must be an existing Rate Group under the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — must be an active Rate Group under the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

7. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

8. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Rate Group, Plan Type, and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

9. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

Wellness rates have no calculations. Rates entered are what is used.

========================================================================

Premium Rates Age Banded

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Age%20Banded.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Age Banded.htm

Premium Rates Age Banded

The following table provides at a glance the rate template for Age Banded Premium Rates.

1. Benefit Plan ID
2. Plan Type
3. Effective Date
4. From Age
5. To Age
6. Total Premium
7. Employee Premium
8. Dependents Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Plan Type, Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

1. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

5. If the Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

6. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

7. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Plan Type and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

8. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

9. Total Premium must equal Employee Premium PLUS Dependent Premium. If Employee Premium is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Premium must equal Total Premium.

10. If Dependent Premium > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Premium > 0 is not allowed for Plan Type .

11. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

1. — If Dependent Premium is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, the import will fail with an error message stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

2. — If Dependent Premium is blank on the import file, then Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)

========================================================================

Premium Rates Composite Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Composite%20Rates.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Composite Rates.htm

Premium Rates Composite Rates

The following table provides at a glance the rate template for Premium Rates Composite Rates.

1. Benefit Plan ID
2. Plan Type
3. Effective Date
4. From Age (must be 0, will default to 0 if blank)
5. To Age (must be 99, will default to 99 if blank)
6. Total Premium
7. Employee Premium
8. Dependents Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plan form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Plan Type, Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file;

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. If the Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

5. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

6. Only one line of rates per Effective Date is allowed.

1. — If import file is set up with more than one line of rates for an Effective Date, then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

7. If a rate on the import file;

1. — has more than 2 decimals, you will receive an error message stating Only 2 decimal places are allowed for Rates.

2. — is a negative value, you will receive an error message stating Negative amounts are not allowed.

8. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Plan Type and Effective Date, you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

9. If Employee Premium is on the import file, and the Plan Type has Single (employee) coverage selected in the Coverage Class field on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium. Else, you will receive an error message stating Plan Type has Coverage Class Single. Employee Premium must equal Total Premium. Refer to the Coverage Class field selection on the Group Benefit Plan Types form for details.

10. If your import file has Dependent Premium > 0 for a Plan Type with coverage class selected as Single (employee) coverage, you will receive an error message stating Dependent Premium > 0 is not allowed for Plan Type .

• Total Premium must equal Employee Premium PLUS Dependent Premium. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

• If Dependent Premium is on the import file and Plan Type with coverage class is not selected as Single (employee) coverage, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, you will receive an error stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

• If Dependent Premium is blank on the import file, then the Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)

========================================================================

Premium Rates Gender Banded

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Gender%20Banded.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Gender Banded.htm

Premium Rates Gender Banded

The following table provides at a glance the rate template for Premium Rates Gender Banded.

1. Benefit Plan ID
2. Network ID
3. Plan Type
4. Employee Gender
5. Effective Date
6. From Age
7. To Age
8. Total Premium
9. Employee Premium
10. Dependents Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import..

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Network ID (if applicable based on plan setup), Plan Type, Employee Gender, Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Network ID on the import file does not exist under the section Plan Networks on the Group Benefit Plans form, you will receive an error message stating Network ID does not exist on Plan ID .

6. If the Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

7. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

8. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

9. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID (if applicable based on plan setup), Plan Type, Employee Gender, and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

10. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

11. Total Premium must equal Employee Premium PLUS Dependent Premium. If Employee Premium is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Premium must equal Total Premium.

12. If Dependent Premium > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Premium > 0 is not allowed for Plan Type .

13. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

1. — If Dependent Premium is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, the import will fail with an error message stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

2. — If Dependent Premium is blank on the import file, then Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)

========================================================================

Premium Rates Gender/Spouse Banded

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Gender%20Spouse%20Banded.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Gender Spouse Banded.htm

Premium Rates Gender/Spouse Banded

The following table provides at a glance the rate template for Premium Rates Gender/Spouse Banded.

1. Benefit Plan ID
2. Network ID (if applicable)
3. Plan Type
4. Employee Gender
5. Spouse Gender
6. Effective Date
7. From Age
8. To Age
9. Total Premium
10. Employee Premium
11. Dependents Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import..

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Network ID (if applicable based on plan setup), Plan Type, Employee Gender, Spouse Gender Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Network ID on the import file does not exist under the section Plan Networks on the Group Benefit Plans form, you will receive an error message stating Network ID does not exist on Plan ID .

6. If the Plan Type on the import file

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, you will receive an error stating Spouse coverage is not allowed for Plan Type .

7. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

8. If the Spouse Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Spouse Gender is not found.

9. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

10. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID (if applicable based on plan setup), Plan Type, Employee Gender, Spouse Gender and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

11. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

12. Total Premium must equal Employee Premium PLUS Dependent Premium. If Employee Premium is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Premium must equal Total Premium.

13. If Dependent Premium > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Premium > 0 is not allowed for Plan Type .

14. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

1. — If Dependent Premium is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, the import will fail with an error message stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

2. — If Dependent Premium is blank on the import file, then Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)

========================================================================

Premium Rates Rate Groups

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Rate%20Groups.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Rate Groups.htm

Premium Rates Rate Groups

The following table provides at a glance the rate template for Premium Rates Rate Groups.

1. Benefit Plan ID
2. Network ID (if applicable)
3. Rate Group
4. Plan Type
5. Employee Gender
6. Spouse Gender
7. Effective Date
8. From Age
9. To Age
10. Total Premium
11. Employee Premium
12. Dependents Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import..

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group, Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable), Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Network ID on the import file does not exist under the section Plan Networks on the Group Benefit Plans form, you will receive an error message stating Network ID does not exist on Plan ID .

6. If the Plan Type on the import file:

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form, you will receive an error stating Spouse coverage is not allowed for Plan Type .

7. The Rate Group for this import must be:

1. — an existing Rate Group on the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — on the Billing Rate Groups form with the field Premium Rate Group checked, otherwise you will get an error message stating Rate Group is not a Premium Rate Group.

3. — an active Rate Group on the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

8. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

9. If the Spouse Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Spouse Gender is not found.

10. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

11. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group, Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable) and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

12. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

13. Total Premium must equal Employee Premium PLUS Dependent Premium. If Employee Premium is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Premium must equal Total Premium.

14. If Dependent Premium > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Premium > 0 is not allowed for Plan Type .

15. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

1. — If Dependent Premium is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, the import will fail with an error message stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

2. — If Dependent Premium is blank on the import file, then Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)

========================================================================

Premium Rates Tobacco Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Tobacco%20Rates.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Tobacco Rates.htm

Premium Rates Tobacco Rates

The following table provides at a glance the rate template for Premium Rates Tobacco Rates.

1. Benefit Plan ID
2. Network ID (if applicable).
3. Rate Group (if applicable)
4. Plan Type
5. Employee Gender (if applicable)
6. Spouse Gender (if applicable)
7. Effective Date
8. From Age
9. To Age
10. Non-Tobacco Premium
11. Tobacco Premium
12. Dependents (Spouse Non-Tobacco)
13. Dependents (Spouse Tobacco) > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group (if applicable), Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable), Effective Date, Non-Tobacco Premium, Tobacco Premium, Dependents (Spouse Non-Tobacco) (if applicable), Dependents (Spouse Tobacco) (if applicable)]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Network ID on the import file does not exist under the section Plan Networks on the Group Benefit Plans form, you will receive an error message stating Network ID does not exist on Plan ID .

6. The Rate Group for this import must be:

1. — an existing Rate Group on the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — on the Billing Rate Groups form with the field Premium Rate Group checked, otherwise you will get an error message stating Rate Group is not a Premium Rate Group.

3. — an active Rate Group on the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

7. If the Plan Type on the import file

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form and the import file also has Dependents (Spouse Non-Tobacco) OR Dependents (Spouse Tobacco), you will receive an error stating Dependent Premium is not allowed for an Employee Only Plan Type..

8. If the Employee Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Employee Gender is not found.

9. If the Spouse Gender on the import file does not match up with system gender options (Male or Female), you will receive an error stating Spouse Gender is not found. Spouse gender is not applicable if the Plan Type being used is set up with a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form. If spouse is included on import file for such a plan type, you will receive an error message stating Spouse Gender is not required for Plan Type .

10. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

11. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID (if applicable based on plan setup), Rate Group (if applicable), Plan Type, Employee Gender (if applicable), Spouse Gender (if applicable) and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

12. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

Tobacco rates have no calculations. Rates entered are what is used.

========================================================================

Premium Rates Vary by Network

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Vary%20by%20Network.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Vary by Network.htm

Premium Rates Vary by Network

The following table provides at a glance the rate template for Premium Rates Vary by Network.

1. Benefit Plan ID
2. Network ID
3. Plan Type
4. Effective Date
5. From Age
6. To Age
7. Total Premium
8. Employee Premium
9. Dependents Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import..

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Network ID, Plan Type, Effective Date, Total Premium, Employee Premium]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. If the Network ID on the import file does not exist under the section Plan Networks on the Group Benefit Plans form, you will receive an error message stating Network ID does not exist on Plan ID .

6. If the Plan Type on the import file does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

7. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

8. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Network ID, Plan Type and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

9. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file;

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

10. Total Premium must equal Employee Premium PLUS Dependent Premium. If Employee Premium is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, then Employee Premium must equal Total Premium, otherwise the import will fail with the following error message:

1. — Plan Type Coverage Class can be found in Group Benefit Plan Types in the Coverage Class field.

2. — Plan Type has Coverage Class Single. Employee Premium must equal Total Premium.

11. If Dependent Premium > 0 is on the import file and Plan Type has Coverage Class selected as Single (employee) coverage on the Group Benefit Plan Types form, the import will fail with an the error message stating Dependent Premium > 0 is not allowed for Plan Type .

12. Dependent Premium is a calculated amount based on Total Premium minus Employee Premium.

1. — If Dependent Premium is on the import file and Plan Type has Coverage Class NOT selected as Single (employee) coverage on the Group Benefit Plan Types form, the Employee Premium PLUS the Dependent Premium must equal the Total Premium. Otherwise, the import will fail with an error message stating Employee Premium PLUS Dependent Premium must equal the Total Premium.

2. — If Dependent Premium is blank on the import file, then Dependent Premium will be imported as a calculated amount. (Total Premium minus Employee Premium)

========================================================================

Premium Rates Wellness Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup%20-%20Premium%20Rates%20Wellness%20Rates.htm Path: BA/Topics/Benefit_Rates_Import_Setup - Premium Rates Wellness Rates.htm

Premium Rates Wellness Rates

The following table provides at a glance the rate template for Premium Rates Wellness Rates.

1. Benefit Plan ID
2. Rate Group (if applicable)
3. Plan Type
4. Effective Date
5. From Age
6. To Age
7. Wellness Premium
8. Non-Wellness Premium
9. Dependent Premium > Note: Note: You must have access to premium rates form to perform this action.

Please make a note of the following errors to avoid while preparing your import file using this template:

1. For Plan ID

1. — You can only select an active plan for the import. If you select a plan that is terminated you will get an error message stating Plan ID is Terminated. Not valid for Import.

2. — If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is checked, then exclude family rated plans from the import. If not you will get an error message stating Plan ID has Family Rated Premiums. Not supported for Import.

3. — Medical, Dental and Vision plans are currently supported. If you select any other insurance class plans, you will get an error message stating Plan ID is [NAME] Insurance Class. Not supported for Import.

4. — Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plans form are excluded.

2. The following are required values for this import. [Benefit Plan ID, Rate Group (if applicable), Plan Type, Effective Date, Wellness Premium, Non-Wellness Premium, Dependent Premium (if applicable)]. If the import file is missing any required values, you will see an error message stating {Import Field Name} is required.

3. If the Benefit Plan ID on the import file

1. — does not exist in PrismHR, then you will receive an error message stating Plan ID does not exist.

2. — is more than 25 characters, you receive an error message stating Benefit Plan ID must be 25 characters or less.

3. — is NOT in the list of Benefit Plan IDs in the Template Builder you will receive an error message stating Plan ID is not in the Template Builder and cannot be included in this Rate Template.

4. Age Banded Medical Rates

1. — If the import file has more than one rate for the same Effective Date then you will receive an error message stating Plan ID is not setup as age banded. Therefore, only one age band is allowed (0 to 99).

2. — If the From Age and To Age fields are on the import file, then the From Age must be 0 and To Age must be 99. If any other value is entered, you will receive an error message stating From Age must be 0. To Age must be 99.

3. — If the From Age and To Age fields are blank on the import file, then PrismHR will import the values of 0 for the From Age field and 99 for the To Age field.

2. — If Age Banded Medical Rates = Yes, then multiple lines of age rates are allowed (For example: age 0 - 19, 20-39, 40-59, 60-99). However:

3. — If import file is set up with overlapping From Age and To Age for same Effective Date combination, you will receive an error message stating Age Bands cannot overlap.

2. — Import file should not have gaps between age bands. For example you cannot have age bands like 0-19, 20-29, 31-39 since the To Age of 29 and From Age of 31 have a gap. If there are gaps, you will receive an error message stating Age gaps are not permitted in Age Banded Rates.

3. — The From Age and To Age fields must be a whole number >=0, otherwise you will receive an error message stating [From Age/To Age] must be a whole number >=0 From Age or To Age = whichever is applicable to error.

4. — Initial From Age must be 0, otherwise the import will fail with an error message stating Initial From Age must be 0.

5. The Rate Group for this import must be:

1. — an existing Rate Group on the Billing Rate Groups form. Else you will get an error message stating Rate Group does not exist.

2. — on the Billing Rate Groups form with the field Premium Rate Group checked, otherwise you will get an error message stating Rate Group is not a Premium Rate Group.

3. — an active Rate Group on the Billing Rate Groups form i.e. the field Inactive must be unchecked. Else you will get an error message stating Rate Group is inactive.

6. If the Plan Type on the import file:

1. — does not exist under the section Plan Types on the Group Benefit Plans form, you will receive an error stating Plan Type does not exist on the Plan ID .

2. — has a Coverage Class of Single (employee) coverage on the Group Benefits Plan Types form and the import file also has Dependents (Spouse Non-Tobacco) OR Dependents (Spouse Tobacco), you will receive an error stating Dependent Premium is not allowed for an Employee Only Plan Type..

7. If the Effective Date on the import file is not in a valid US date format, you will receive and error message stating Effective Date must be in a valid date format.

8. If your import file has records which already exist in PrismHR having the same Benefit Plan ID, Rate Group (if applicable), Plan Type, and Effective Date, then you will receive an error message stating Effective Date <EFFECTIVE DATE.> already exists for this record. Updates cannot be imported. If a duplicate key exists on the import file, this validation will also present a line error for the second record and any subsequent duplicate records attempted to be imported.

9. The rate on the import file has to be a positive number with a maximum of 2 decimals. If the rate on the import file:

1. — has more than 2 decimals, then you will receive an error message stating Only 2 decimal places are allowed for Rates.

Wellness rates have no calculations. Rates entered are what is used.

========================================================================

Benefit Rates Import Setup & File Import

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rates_Import_Setup_and_File_Import.htm Path: BA/Topics/Benefit_Rates_Import_Setup_and_File_Import.htm

Benefit Rates Import Setup & File Import

Use this Benefit Rates Import Setup & File Import form to set up and import new benefit rates (premium or billing) into PrismHR using a predefined benefit rates import template. You also need to use this form to complete existing Imports in Progress.

Note:

• You can only access this form from the lrImporting Benefit Rates form. From the Benefit Rates Import form:

• You can click the New Import button to come to this form, OR,

• You can click the Name link of an existing Import in Progress to come to this form.

Using the New Import button

When you click the New Import button on the lrImporting Benefit Rates form, you come to this form. All fields on this form will be blank.

1. Complete the following fields:

• The name can have alpha-numeric characters but cannot contain special characters.

• The import name cannot contain spaces.

• Import names must contain at least 3 characters. | Which Rate are you Importing? | Select one of the following benefit rate types from the following: - Premium Rates OR - Billing Rates |

• Premium Rates OR

• Billing Rates | Plan ID | This link only becomes active after you select a benefit rate type above. This defines the import template for the rest of the procedure. You can enter the Plan ID manually or click the Plan ID link and select a plan as your template builder based on pre-defined defaults and selectable filters. > Note: Note: You cannot manually enter a Plan ID if the Manual Calculation field is set to Coverage Entered Manually in the Group Benefit Plans form for that plan. Since these plans do not have rate tables, there are no rates that can be imported in Group Benefit Plans, and they cannot be supported in the Benefit Rate Import. These plans will not show up when you are using the Select Benefit Plan selector. | Please note that:

• If you manually enter a Plan ID and try to save the form without entering a benefit rate type, an error message displays.

• You can only select an active plan for the import.

• If the Family Rate Premiums field under the Other Processing Parameters section on the Group Benefit Plans form is enabled, then you must exclude family rates plans from the import.

• Only Medical, Dental and Vision plans are currently supported.

• Plans where the Manual Calculation field is set to Coverage & Premiums Entered Manually in the Group Benefits Plan form are excluded.

• For Premium Rates import, the following is a sample selector which you can customize according to your needs:

[Image: screenshot]

• For Billing Rates import, the following is a sample selector which you can customize according to your needs:

[Image: screenshot]

2. Click Save to save your import template once you have provided a valid input for all the three required fields noted above. A line item is listed in the Imports in Progress section on the lrImporting Benefit Rates form. Upon save, the Import Name field and the rate type become read only. However, you can still edit the Plan ID field. A warning displays when you try to edit this field.

Please note that:

• Import Names must contain at least 3 characters.

• Rate type selection is required.

• The Plan ID field cannot be blank.

What is the import template builder?

Based on the benefit plan that you enter in the Plan ID field, you can import numerous benefit plans that have the same setup.

Example: If the Plan ID has Age Banded Medical Rates and Rate Groups for Premium Rates, then a plan with only Age Banded Medical Rates WOULD NOT be included in a Premium Rate Table but WOULD be included in a Billing Rate Table, since Rate Groups for Premium Rates is not used for Billing Rates. If BOTH plans do not have any values checked, then these are considered to match.

If you enter an age banded medical plan, any medical, dental and vision plan that is age banded can be imported together. Please note that the benefit plans need to be an exact match. Using the prior example, it cannot be age banded and tobacco banded.

Once you save your import template, the following section displays a list of all plans that match the setup as the selected Plan ID. This table is a reference for all the different possible setups. In the example above, we have selected a medical plan that is age banded, so that column is populated below.

Note: Note: If you try to change the Plan ID at this point, the system displays a warning that this action may affect the plans that can be included in this import. If an import file has been uploaded, it will be removed. If you select Yes, then the Plan ID changes and the table of available plans that can be imported based on the plan selection also changes. This would affect what can be included in the import file.

• The updated Plan ID is saved to the import definition template.

• The table of available plans is updated based on the newly selected Plan ID.

• The Premium and Billing Rate Template available via the links in the Import Template Builder is updated based on the new Plan ID.

• If there is an import file already uploaded, the file is removed from the import.

• Since this is a change to the import, the Imports in Progress table on the Benefit Rate Import form is updated with Last Modified User and Last Modified Date.

Obtaining, Editing, and Uploading the Billing Rates Template

In the example above, we are importing billing rates. In this case we would see a Billing Rates Template button.

[Image: screenshot]

1. Click the Billing Rates Template button to get the template.

• This is a .csv file that will be downloaded on your system.

• The template containers headers depending upon the benefit rate type selected for import.

• Headers are required for each field.

Prepare your import file by adding your import data to this template. For example, this template comes from our example for age banded medical plan:

[Image: screenshot]

These are all the fields required for this import. These headers will be unique to a particular type of import.

Note: If you are importing Premium Rates, then a Premium Rates Template button displays. The headers in the premium rates template are different from the billing rates template.

[Image: screenshot]

Once you click the Premium Rates Template button the .csv template file will be downloaded on your system. Following is a sample premium rates composite rates template:

[Image: screenshot]

2. Click Select File in the Upload Billing Rates section once you have created your import file.

[Image: screenshot]

3. Click Add Files in the Select files dialog box to select the relevant benefit rates import file for the import from your system.

[Image: screenshot]

PrismHR provides the following import templates based on the selected Benefit Plan ID. For each type of template the validations will vary and so will the error messages. Click on the template downloaded to see the validations required to create your import file.

• Premium Rates Composite Rates

• Billing Rates Composite Rates

• Premium Rates Age Banded

• Billing Rates Age Banded

• Premium Rates Vary by Network

• Billing Rates Vary by Network

• Premium Rates Gender Banded

• Billing Rates Gender Banded

• Premium Rates Gender/Spouse Banded

• Billing Rates Gender/Spouse Banded

• Premium Rates Rate Groups

• Premium Rates Tobacco Rates- Billing Rates Tobacco Rates

• Premium Rates Wellness Rates

• Billing Rates Wellness Rates

• Billing Rates Vary By Network BOTH

4. Click Start Upload once you have added your benefit rates import file for the import to upload it. Once the upload is complete click Close to close the dialog box.

[Image: screenshot]

5. The file name displays in the Upload Billing Rates section.

[Image: screenshot]

Note: Note: If you want to upload a different import file, click the recycle bin icon to delete the uploaded file.

6. Click Import Rates to import the benefit rates into PrismHR. This button is not visible until the import file is uploaded. A job progress window displays the processing steps.

1. — If the processing completes without errors, click Close to close the job progress window. When the import is successful, you return to the Benefit Rates Import form and receive a confirmation message. The import displays under the Past Imports section on the form.

[Image: screenshot]

2. — If the processing completes with errors, click Close to close the job progress window. The Benefit Rate Import Error Report displays for the import, showing all the errors preventing a successful import. You can correct all the listed errors in your import file, delete the existing import file on the system, upload the corrected import file and continue.

Note: Note: Click Close to close this form at any time. If you close this form before successfully completing an import, then the import will be listed under the Imports in Progress section on the Benefit Rates Import form with the appropriate Status. You can click that import anytime to resume your import from where you left off.

Using the Name link under Imports in Progress

If the Status of the Import is:

• Template Defined – Continue from Step 1 in the procedure above.

• Ready for Import – Continue from Step 5 in the procedure above.

• Import Errors – Make necessary corrections to your import file and continue from Step 1 in the procedure above.

To validate what was imported, go to the Group Benefit Plans form. Enter the Benefit Plan ID for which you had imported the rates. Select Actions and then select Premium Rates or Billing Rates whichever is applicable. Then complete the information on the form that matches what you imported.

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Benefit Rules

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rules.htm Path: BA/Topics/Benefit_Rules.htm

Setting Up Employee Enrollment Conditions

Use the Benefit Rules form to establish the conditions that employees of a client must satisfy to enroll in a benefit plan.

Note: To quickly access the Benefit Rules Import form, select Import Benefit Rules. You can use procedures to create the benefit rules import file and to import benefit rules information into PrismHR from a tab-delimited text file.

You can also access benefit-related features and settings using the Actions menu:

• Audit

• Clone Another Rule: Creates Company Benefit Rules records with any benefits found on the company you select- Copy Rule to other Benefit Groups: Copies a benefit rule to another benefit group

Creating Benefit Rules

You can define the benefit plan using the Benefit Rules form.

To create the benefit plan rules:

1. On the Work Centers menu, select Benefit Plan Maintenance, then Benefit Rules.

2. In Benefit Rules, specify the following information:

• You cannot delete the sole Benefit Rule Effective Date for a Benefit Group having a specified Benefit Plan if there associated Employee Benefit Enrollment records for the Benefit Group and that specified Benefit Plan with a status of Active or COBRA. This action will orphan the associated records and can cause payroll errors along with other issues. If you try to delete it, you will receive an error message stating This benefit rule cannot be deleted. There are employees using this benefit rule with active enrollments. Example: Employee Enrollment for Employee ID [XXXXX] and Effective Date [XX/XX/XXXX].
• If it is not the sole Benefit Rule Effective Date for that Benefit Group having that Benefit Plan, OR there are no active enrollments associated with the benefit rule, then you can delete it. | Contribution rule amounts made by Company or Employee | The person who makes the contribution for the benefit defined by this rule, either Employee or Company. | | Exempt take on employees from Minimum Days of Service Requirement | If selected, exempts imported employees from the minimum service requirement. | | Alternate Contribution Plan | The Alternate Contribution Plan if contributions are based on another plan’s billing rates. You can enter the benefit plan ID here or click the Alternate Contribution Plan hyperlink to open the Benefit Plan selector which displays the list of Group Benefit Plans offered by the client. You can use the various filters on the Benefit Plan selector to refine your search for example Plan ID or Name. You also use the following additional filters: - The default High Deductible Plan (HDHP) filter status is All. You can choose any of the following options: - All - The list will include both High Deductible Plans and plans that are not High Deductible Plans. - Yes - The list will include only those benefit plans which are High Deductible Plans. It is indicated with a status Y in the list. - No - The list will include only those benefit plans which are not High Deductible Plans. It is indicated with a status N in the list. - The default Status filter status is Active. You can choose any of the following options: - Active (Default) - The list will display only the active Group Benefit Plans offered by the client. - Terminated - The list will display only the terminated Group Benefit Plans offered by the client - Never Implemented - The list will display only the Group Benefit Plans offered by the client but were never implemented. |
• The default High Deductible Plan (HDHP) filter status is All. You can choose any of the following options:
• All - The list will include both High Deductible Plans and plans that are not High Deductible Plans.
• Yes - The list will include only those benefit plans which are High Deductible Plans. It is indicated with a status Y in the list.
• No - The list will include only those benefit plans which are not High Deductible Plans. It is indicated with a status N in the list.
• The default Status filter status is Active. You can choose any of the following options:
• Active (Default) - The list will display only the active Group Benefit Plans offered by the client.
• Terminated - The list will display only the terminated Group Benefit Plans offered by the client
• Never Implemented - The list will display only the Group Benefit Plans offered by the client but were never implemented. | Alternative Contribution Rate Group | The Alternative Contribution Rate Group if contribution calculations are based on a rate group other than the one defined in the Alternate Contribution Plan. An Alternate Contribution Plan is required before selecting an Alternative Contribution Rate Group. This information is also provided as a tooltip for this field on the form. If you try to enter a value in the Alternative Contribution Rate Group field when the Alternate Contribution Plan is blank, then you will get an error message stating An Alternate Contribution Plan has not been defined. The Alternative Contribution Rate Group will be cleared out. Click OK to acknowledge the message and you will be returned to the Benefit Rules form with all previously entered data populated except for the value in the Alternative Contribution Rate Group field which is cleared out. - When selecting the Alternative Contribution Rate Group hyperlink, the selector will only populate Rate Groups based on the Alternate Contribution Plan defined. - Any existing value in the Alternative Contribution Rate Group field will remain visible regardless of whether an Alternate Contribution Plan had been defined earlier or not. You can delete the existing Alternative Contribution Rate Group value. - If an Alternate Contribution Plan has been defined but you have not entered any value in the Alternative Contribution Rate Group field, upon Save, a message will display stating An Alternate Contribution Plan has been defined which requires an Alternative Contribution Rate Group to be selected. Click OK to acknowledge the message and you will be returned to the Benefit Rules form to enter a value in the Alternative Contribution Rate Group field. |
• When selecting the Alternative Contribution Rate Group hyperlink, the selector will only populate Rate Groups based on the Alternate Contribution Plan defined.
• Any existing value in the Alternative Contribution Rate Group field will remain visible regardless of whether an Alternate Contribution Plan had been defined earlier or not. You can delete the existing Alternative Contribution Rate Group value.
• If an Alternate Contribution Plan has been defined but you have not entered any value in the Alternative Contribution Rate Group field, upon Save, a message will display stating An Alternate Contribution Plan has been defined which requires an Alternative Contribution Rate Group to be selected. Click OK to acknowledge the message and you will be returned to the Benefit Rules form to enter a value in the Alternative Contribution Rate Group field. | Show Employees with Overrides | A list of employees who override the client’s regular benefit plan eligibility rules. | | Group Benefit Auto Enrollment (Client) | A conditional field which is displays only if you have a plan labeled as Auto-Enroll at the global or client level for you to easily enroll eligible employees in the plan. > Note: Note: While saving the form, if the plan is set to auto-enroll, an additional routine is called to check for employees within the selected client who meet the eligibility requirements of the plan but are not enrolled. A message stating We have identified X eligible employees who are not enrolled in this plan. Would you like to be taken to the Group Benefit Auto Enrollment (Client) form to enroll these employees? is displayed to notify you of the eligible employees. - Click Yes to save the changes made on the Benefit Rules form and open the Group Benefit Auto Enrollment (Client) form. - Click No to save the changes made on the Benefit Rules and remain on the same form. - Click Report to display the list of eligible employees who are not enrolled and review them. |
• Click Yes to save the changes made on the Benefit Rules form and open the Group Benefit Auto Enrollment (Client) form.
• Click No to save the changes made on the Benefit Rules and remain on the same form.
• Click Report to display the list of eligible employees who are not enrolled and review them.

3. In Contribution Rules, specify the following information:

• Percentage - The employee’s contribution towards the premium as well as the portion of the premium allocated for dependent coverage is calculated by percentage.
• Fixed - The employee’s contribution towards the premium as well as the portion of the premium allocated for dependent coverage is a fixed amount.
• Fixed EE, Percent DEP - The employee’s contribution towards the premium is a fixed amount, and the portion of the premium allocated for dependent coverage is calculated by percentage.
• Percent EE, Fixed DEP - The employee’s contribution towards the premium is calculated by percentage and the portion of the premium allocated for dependent coverage is a fixed amount. | Contribution EE Bill | The employee’s contribution amount towards the premium. This is either percentage or flat amount, depending on the Contribution Method. | | Contribution DEP Bill | The employee’s contribution amount towards the portion of the premium allocated for dependent coverage. This is either a percentage or a flat amount, depending on the Contribution Method. | | Max Contribution ()|Themonthlymaximumcontributiondollaramountthatcanbemadebytheemployeeoremployer(asapplicablebasedonthevalueshownintheContributionruleamountsmadebyCompanyorEmployeefieldofBenefitRulesetup).Amaximumcontributionamountcanonlybedefinedonagebanded, MonthlycostbasisplanswithaninsuranceclassofMedical. > * * Note : * * * * Note : * * TheMaxContribution() column displays but is disabled with N/A shown in the column when any following conditions are True: - The plan is not a Medical Insurance Class plan with Age Banded Medical Rates. - The plan has a Cost Basis of Weekly, Quarterly or Yearly on the Group Benefit Plans Premium Rates form. - The Contribution Method for the Plan Type in the “Contribution Rules” section of the Benefit Rules form = Fixed. - The Cafe Plan Eligible checkboxes in the “Group Benefits Setup” section of the Benefit Plan Setup form (Benefit Plan Maintenance > Group Benefit Plans (Client) > Benefit Plan Setup) is checked. - The HI 1.5% Rule Applies column in the “Hawaii 1.5% Rule” section of the Benefit Plan Setup form is set to Yes for the Benefit Group. - Any of the following checkboxes are checked in the “Other Processing Parameters” section of the Group Benefit Plans form (Benefit Plan Maintenance > Group Benefit Plans (Global) > Group Benefit Plans): - Premium Rates vary by Network - Family Rated Premiums - Tobacco Banded Rates - Gender Banded Rates - Spouse Gender Banded Rates - Wellness Banded Rates - The Billing Rates Vary by Network field in the “Other Processing Parameters” section of the Group Benefit Plans form is set to Yes or Both. | | Show Billing Information | Additional information (shown in the Billing Information panel) for benefit plans that calculate an exact premium and billing amount: - The Total Contribution is the total amount contributed. - The Contribution is the amount contributed by the employer. - The Total Billed is the total amount billed to the client for the plan. |
• The Total Contribution is the total amount contributed.
• The Contribution is the amount contributed by the employer.
• The Total Billed is the total amount billed to the client for the plan. Note: When you select the Do Not Allow EE Contribution checkbox on the Group Benefit Plans form, then under the Contribution Rules section, beside the Show Billing Information hyperlink, an informational text stating, This plan is set to not allow employee contributions, please ensure the contribution rules meet this requirement. is displayed to notify you that the plan is set up to disallow employee contribution so that you are aware while adding or updating the contribution rules.

4. In Eligibility Rules, specify the following information:

• Active
• On leave
• Terminated | Minimum Age | The minimum age required to be eligible for this benefit. | | Maximum Age | This field allows to set the Maximum Age value for eligibility in a given plan. | | Minimum Days of Service | The minimum days of service required to be eligible for this benefit. | | Eligibility Days From | Whether to count benefit rule eligibility days from the Hire Date or Status Date. - Hire Date - Eligibility is based on the employee’s latest hire date, regardless of the employee type at that time. - Status Date - Eligibility based on the date reflected in the Status Date field on the Employee Details record. |
• Hire Date - Eligibility is based on the employee’s latest hire date, regardless of the employee type at that time.
• Status Date - Eligibility based on the date reflected in the Status Date field on the Employee Details record. | Eligibility Date Used | The Eligibility Date Used determines how the system calculates the date employees meet eligibility requirements for this plan. - Calculated Eligibility Date: The first day of calculated eligibility. - First of Month after Calculated Date: The first of the month after the date of calculated eligibility. - First of Quarter after Calculated Date: The first day of the next quarter after the date of calculated eligibility. - If Calculated is 1st of month, use that else next 1st of month: If the calculated date is the first of a month, the system uses that. If it is another day in the month, it uses the first of the following month. > Note: Note: When you select the Mid-Month Coverage Dates field on the Group Benefit Plans (Global) form, then you can select only the Calculated Eligibility Date option. The other two options will be disabled with a tag, Not Valid next to the option names. |
• Calculated Eligibility Date: The first day of calculated eligibility.
• First of Month after Calculated Date: The first of the month after the date of calculated eligibility.
• First of Quarter after Calculated Date: The first day of the next quarter after the date of calculated eligibility.
• If Calculated is 1st of month, use that else next 1st of month: If the calculated date is the first of a month, the system uses that. If it is another day in the month, it uses the first of the following month. | Employment Type | Select the types of employment associated with this benefit rule. | | Exempt/Non-Exempt | The employee FLSA status required to be eligible for this benefit, or nothing if employees of all statuses are eligible. | | Network Availability Stop Date | An expiration date for the network attached to the benefit. |

5. Click Save to save the benefit rule.

6. Click Delete to delete the benefit rule.

• You cannot delete the sole Benefit Rule Effective Date for a Benefit Group having a specified Benefit Plan if there associated Employee Benefit Enrollment records for the Benefit Group and that specified Benefit Plan with a status of Active or COBRA. This action will orphan the associated records and can cause payroll errors along with other issues. If you try to delete it, you will receive an error message stating This benefit rule cannot be deleted. There are employees using this benefit rule with active enrollments. Example: Employee Enrollment for Employee ID [XXXXX] and Effective Date [XX/XX/XXXX].

• If it is not the sole Benefit Rule Effective Date for that Benefit Group having that Benefit Plan, OR there are no active enrollments associated with the benefit rule, then you can delete it.

7. Click Cancel to clear this form at any time. Any unsaved changes will be lost.

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Calculating Life Insurance Coverage for Commissioned Employees

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefit_Rules_Coverage_Commission.htm Path: BA/Topics/Benefit_Rules_Coverage_Commission.htm

Calculating Life Insurance Coverage for Commissioned Employees

PrismHR has a process for automatically calculating life insurance coverage for employees who are paid on a commission basis or who have a zero pay rate. If the employee Pay Method is set to Commission or their Pay Rate is set to zero on the Pay tab of Employee Details, the system automatically calculates the life insurance coverage amount by extrapolating the year-to-date amounts paid in either the previous or current year. Otherwise, the calculation is based on the employee’s Annual Pay.

If the employee was paid during the previous year, the system uses the amount paid during that year to extrapolate the employee’s annual pay:

• If the employee was employed during the entire previous year, the system uses the amount that was paid in that year for the annual pay amount and the life insurance coverage calculation is based on that amount.

• If the employee was paid during only part of the year, the system uses that amount to extrapolate the amount that would have been paid over the course of the whole year, and then the system uses that amount for the annual pay. For example, if the employee was paid $25,000 during the last six months of the previous year, the calculated annual pay amount would be $50,000.

If the employee was not paid during the previous year, the amount paid year-to-date in the current year is used to calculate the annual pay. If the employee was paid $25,000 for the first six months of the year and that is the year-to-date amount, then the calculated annual pay amount is $50,000.

If the employee was not paid in the current or previous year, the calculated annual pay is zero.

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Storing an Employee’s Benefits Per Hour

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Benefits_Per_Hour.htm Path: BA/Topics/Benefits_Per_Hour.htm

Storing an Employee’s Benefits Per Hour

Use the Benefits Per Hour form to store the employee’s benefits per hour record using the memo class of pay codes.

Note: Note: The benefits per hour record created here has no impact on payroll, which continues to use the benefit per hour rate stored in the Employee Details form.

Note: Note: If you enter a Pay Code that is not a memo pay code the following warning displays: Pay code must have a pay class of memo.

To access this form and store an employee’s benefits per hour:

1. Access the Employee Details form in the HR|Change menu.

2. Enter or select an employee.

3. Open the Actions menu [Image: screenshot] and select Benefits Per Hour. The Benefits Per Hour form displays the selected employee’s ID in the Employee field.

4. Enter or select the Pay Code. The Description displays.

5. Set the Status as Active or Inactive.

6. Enter the benefits per hour Amount.

7. Click Save.

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Setting Bond/EPLI Insurance Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Bond_EPLI.htm Path: BA/Topics/Billing_Rates_Bond_EPLI.htm

Setting Bond/EPLI Insurance Billing Rates

To set the billing rates for a bond insurance or EPLI (employment practices liability insurance) group benefit plan, use the Billing Rates form.

To set billing rates for a bond insurance or EPLI group benefit plan:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. In the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Rate Group — An option that displays when you select No or Both in the Billing Rates Vary By Network list in the Other Processing Parameters panel. The rates you enter apply only to this rate group. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. Saving rates according to the effective date allows you to view previous rates for reference purposes. The system calculates billing using the rates with the most recent effective date. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision.

Rate/Hundred — The billing rate for bond insurance expressed as an amount per hundred dollars of employee earnings. The rate relates to the Cost Basis field in the Group Benefit Plan form. For example, if the cost basis is Monthly, the rate represents monthly billing rates.

5. Click Save. The form clears so that you can enter the premiums for another plan type.

6. Repeat these steps for each plan type.

7. Click Close when you are finished.

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Setting Disability Insurance Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Disability.htm Path: BA/Topics/Billing_Rates_Disability.htm

Setting Disability Insurance Billing Rates

To enter the billing rates for a short- or long-term disability group benefit plan by age range, use the Billing Rates form.

To define disability insurance billing rates:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Rate Group — The Rate Group field displays when you select No or Both in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization may charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups. The rates you enter apply only to this rate group. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. Saving rates according to the effective date allows you to view previous rates for reference purposes. The system calculates billing using the rates with the most recent effective date. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision.

5. Define the following information for each year of age. If you need to create an additional age row, click + or press Tab. You can enter this information manually, or copy from the benefit plan’s corresponding Premium Rates record by clicking Copy from Premium Rates in the Actions menu.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

Premium Rate — Enter the premium Rate per ten dollars of coverage (short-term disability) or hundred dollars of coverage (long-term disability). If the plan’s rates are the same regardless of the employee’s age, enter an “all encompassing” age range, for example, 0-99.

6. Click Save. The form clears so that you can enter the premiums for another plan type.

7. Repeat these steps for each plan type.

8. Click Close when you are finished.

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Setting Disability Insurance Extended Precision Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Disability_Extended.htm Path: BA/Topics/Billing_Rates_Disability_Extended.htm

Setting Disability Insurance Extended Precision Billing Rates

To enter the billing rates using extended precision rates for a short- or long-term disability group benefit plan, use the Billing Rates form Extended precision rates enable you to enter any number of digits after the decimal place. The settings display when the LTD/STD Rate Tables banded by Salary option is selected in the Other Processing Parameters panel.

To define disability insurance billing rates by salary:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

• Yes - A list of existing rate groups for this Plan ID is listed on the form.
• No - The Select Rate Group dialog box opens and you can select from there. | Effective Date | The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. If you have selected an existing rate group above, you will a list of effective dates for that rate group on the form. You can select one or enter a new one. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision. |

5. Define the age range for each plan type:

Use this option — To define this

From Age — The starting age for the rate.

To Age — The upper age limit for the rate.

Rate — Enter the premium Rate per ten dollars of coverage (short-term disability) or hundred dollars of coverage (long-term disability).

Note: Note: If the plan’s rates are the same regardless of the employee’s age, enter an “all encompassing” age range, for example, 0-99.

6. Click Save to save the changes, close the form and return to the Group Benefit Plans form. Repeat these steps for each plan type.

7. Click Delete to delete the record.

8. Click Cancel to clear the form. The Benefit Plan ID field will not be cleared.

9. Click Close to close this form.

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Setting Disability Insurance Billing Rates by Salary

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Disability_Salary.htm Path: BA/Topics/Billing_Rates_Disability_Salary.htm

Setting Disability Insurance Billing Rates by Salary

To enter the billing rates for a short- or long-term disability group benefit plan by salary, use the Billing Rates form. The settings display when the LTD/STD Rate Tables banded by Salary option is selected in the Other Processing Parameters panel.

To define disability insurance billing rates by salary:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Rate Group — The Rate Group field displays when you select No or Both in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization may charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups. The rates you enter apply only to this rate group. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. Saving rates according to the effective date allows you to view previous rates for reference purposes. The system calculates billing using the rates with the most recent effective date. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision.

5. Define each salary range.

Use this option — To define this

From Annual Salary — The From Annual Salary amount. The first From Annual Salary value must be zero.

To Annual Salary — The To Annual Salary amount. Each subsequent value is one cent greater than the To Annual Salary in the previous band.

Premium — Enter the Premium amount for employees in this salary band.

6. Click Save. The form clears so that you can enter the premiums for another plan type.

7. Repeat these steps for each plan type.

8. Click Close when you are finished.

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Setting Family Rated Plan Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Family_Rated.htm Path: BA/Topics/Billing_Rates_Family_Rated.htm

Setting Family Rated Plan Billing Rates

To set up billing rates for a family rated group benefit plan, use the Billing Rates form. Use this form when the Family Rated Premiums and Age Banded Medical Billing options are selected in the Group Benefit Plans form and billing is done by rate group.

To set billing rates for family rated plans:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

• Yes - A list of existing rate groups for this Plan ID is listed on the form.
• No - The Select Rate Group dialog box opens and you can select from there. | Effective Date | The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. If you have selected an existing rate group above, you will a list of effective dates for that rate group on the form. You can select one or enter a new one. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision. |

5. When Family Rated Premiums is selected in the Other Processing Parameters panel, define the following information for each age. If you need an additional age row, click + to or press Tab.

6. Click Save to save the changes, close the form and return to the Group Benefit Plans form. Repeat these steps for each plan type.

7. Click Delete to delete the record.

8. Click Cancel to clear the form. The Benefit Plan ID field will not be cleared.

9. Click Close to close this form.

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Setting Family Rated Plan Billing Rates by Network

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Family_Rated_Network.htm Path: BA/Topics/Billing_Rates_Family_Rated_Network.htm

Setting Family Rated Plan Billing Rates by Network

To set up billing rates for a family rated group benefit plan with networks where billing rates vary by network, use the Billing Rates form. You use this form when the Family Rated Premiums and Age Banded Medical Billing options are selected in the Group Benefit Plans form and billing is done by network.

To set family rated plan billing rates by network:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — This option will be listed under the Actions menu on this form. If you select this option, then Age-range information from the Premium Rates record is copied for this benefit plan for Billing Rates record. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — The Benefit Plan ID. It is populated from the Group Benefit Plan form.

Network ID — The ID of the network. The system displays the Network field when Premium Rates Vary By Network is set in the Other Processing Parameters panel.

Plan Type — The list contains only the plan types defined for the group benefit plan.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. Saving rates according to the effective date allows you to view previous rates for reference purposes. The system calculates billing using the rates with the most recent effective date. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision.

5. When Family Rated Premiums is selected in the Other Processing Parameters panel, define each age. If you need an additional row age, click + or press Tab.

6. If Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans:

7. Click Save. The form clears so that you can enter the premiums for another plan type.

8. Repeat these steps for each plan type.

9. Click Close when you are finished.

========================================================================

Setting Family Rated Plan Billing Rates by Rate Group and Network

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Family_Rated_Rate_Group_Network.htm Path: BA/Topics/Billing_Rates_Family_Rated_Rate_Group_Network.htm

Setting Family Rated Plan Billing Rates by Rate Group and Network

To set up billing rates for a family rated group benefit plan that charges different rates by both rate group and network, use the Billing Rates form. You use this form when the Family Rated Premiums and Age Banded Medical Billing options are selected in the Group Benefit Plans form and billing is done by rate group and network.

To set family rated plan billing rates by group and network:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — The Benefit Plan ID. It is populated from the Group Benefit Plan form.

Network ID — The ID of the network. The system displays the Network field when Premium Rates Vary By Network is set in the Other Processing Parameters panel.

Rate Group — The Rate Group for the plan. This field displays when No or Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel. The rates you enter apply only to this rate group. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Plan Type — The list contains only the plan types defined for the group benefit plan.

Employee Gender — This option is available only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Spouse Gender — This option is available only when Spouse Gender Banded is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date allows you to view previous rates for reference purposes. The system calculates billing using the rates with the most recent effective date. For short- or long-term disability benefit plans, the effective dates indicate whether the rate is set to standard or extended precision. If you selected the LTD/STD Use Extended Precision Rates option in the main form, you can only choose an effective date with extended precision, otherwise you can only select a date with standard precision.

5. If Family Rated Premiums is selected in the Other Processing Parameters panel, define each age. If you need an additional row age, click + or press Tab.

6. Click Save. The form clears so that you can enter the premiums for another plan type.

7. Repeat these steps for each plan type.

8. Click Close when you are finished.

========================================================================

Setting Life Insurance Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Life_Insurance.htm Path: BA/Topics/Billing_Rates_Life_Insurance.htm

Setting Life Insurance Billing Rates

Use the Billing Rates form to enter the billing rates for a life insurance group benefit plan.

To set life insurance billing rates:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Rate Group — The Rate Group field displays when you select No or Both in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization may charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups. The rates you enter apply only to this rate group. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

5. Define the following information for each year of age. If you need to create an additional age row, click + or press Tab.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

6. If the benefit plan is set up as tobacco banded, enter the following information:

Use this option — To define this

Non-Smoker Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Smoker Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

NonSmoking Spouse Premium — The cost for covering an employee’s non-tobacco using spouse for this plan type and age group.

Smoking Spouse Premium — The cost for a spouse who uses tobacco products.

Dependents Premium — The cost for any dependents.

Note: Note: For a life insurance plan, typically you enter smoking and non-smoking rates. If the plan does not offer separate rates, enter the same rate for non-smoker and smoker. The rates are either per thousand dollars or a flat amount, depending on the Life Calculation Type defined for the Group Benefit Plan.

7. Click Save. The form clears so that you can enter the premiums for another plan type.

8. Repeat these steps for each plan type.

9. Click Close when you are finished.

========================================================================

Setting Health Plan Billing Rates by Network

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Network.htm Path: BA/Topics/Billing_Rates_Network.htm

Setting Health Plan Billing Rates by Network

Use the Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan with networks where billing rates vary by network.

Different fields display in the form depending on whether the benefit plan is set up as tobacco banded by selecting Tobacco Banded Rates in the Other Processing Parameters panel in Group Benefit Plans.

To set health plan billing rates by network:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Network ID — The Network field displays when Yes or Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel. > Note: Note: When a benefit plan is set up to use networks (for billing, premium or both) and a network is marked as Inactive, the inactive network now displays in the Network ID dropdown with ‘(Inactive)’ next to it. All inactive networks filter to the bottom of the list in the order that they appear on the networks grid. You cannot modify or add new rates for Inactive networks. However, you can view existing rates for Inactive networks. When an inactive network is selected, the table is disabled. The Save and Delete buttons are also disabled. A warning message displays stating The selected network is inactive. No modifications can be made. Click the OK button to acknowledge the message.

Plan Type — The list contains only the plan types defined for the group benefit plan.

Employee Gender: — The list displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Spouse Gender: — The gender of the employee’s spouse’s. The list displays only when Spouse Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

KJW: As of 1.2.2, this form does not support Copy from Premium Rates

5. Define each year of age. If you need to create an additional age row, click + or press Tab.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

6. If the benefit plan is set up as tobacco banded:

Use this option — To define this

Non-Tobacco Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Tobacco Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

Dependents (Spouse Non-Tobacco) — Enter the cost associated with covering an employee’s non-tobacco using spouse for this plan type and age group.

Dependents (Spouse Tobacco) — If covered, enter the cost associated with covering an employee’s tobacco using spouse for this plan type and age group.

7. If the benefit plan is not set up as tobacco banded:

Use this option — To define this

Total Bill Amount — The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount — The amount to bill the employee for this plan.

Dependents Bill Amount — The amount to bill the depending for this plan.

8. Click Save. The form clears so that you can enter billing rates for another plan type.

9. Repeat these steps for each plan type.

10. Click Close when you are finished.

========================================================================

Setting Health Plan Billing Rates by Network and Age

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Network_Age.htm Path: BA/Topics/Billing_Rates_Network_Age.htm

Setting Health Plan Billing Rates by Network and Age

Use the Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan with networks where billing rates vary by network and age.

Different fields display in the form depending on whether the benefit plan is set up as tobacco banded by selecting Tobacco Banded Rates in the Other Processing Parameters panel in Group Benefit Plans.

To set health plan billing rates by network and age:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Network ID — The Network field displays when Yes or Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel. > Note: Note: When a benefit plan is set up to use networks (for billing, premium or both) and a network is marked as Inactive, the inactive network now displays in the Network ID dropdown with ‘(Inactive)’ next to it. All inactive networks filter to the bottom of the list in the order that they appear on the networks grid. You cannot modify or add new rates for Inactive networks. However, you can view existing rates for Inactive networks. When an inactive network is selected, the table is disabled. The Save and Delete buttons are also disabled. A warning message displays stating The selected network is inactive. No modifications can be made. Click the OK button to acknowledge the message.

Plan Type — The list contains only the plan types defined for the group benefit plan.

Employee Gender: — The list displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Spouse Gender: — The gender of the employee’s spouse’s. The list displays only when Spouse Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

KJW: As of 1.2.2, this form does not support Copy from Premium Rates

5. Define each year of age. If you need to create an additional age row. click + or press Tab.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

6. If the benefit plan is set up as tobacco banded:

Use this option — To define this

Non-Tobacco Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Tobacco Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

Dependents (Spouse Non-Tobacco) — Enter the cost associated with covering an employee’s non-tobacco using spouse for this plan type and age group.

Dependents (Spouse Tobacco) — If covered, enter the cost associated with covering an employee’s tobacco using spouse for this plan type and age group.

7. If the benefit plan is not set up as tobacco banded:

Use this option — To define this

Total Bill Amount — The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount — The amount to bill the employee for this plan.

Dependents Bill Amount — The amount to bill the depending for this plan.

8. Click Save. The form clears so that you can enter billing rates for another plan type.

9. Repeat these steps for each plan type.

10. Click Close when you are finished.

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Setting Other Type Billing Rates

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Other.htm Path: BA/Topics/Billing_Rates_Other.htm

Setting Other Type Billing Rates

To enter the billing rates for an Other type group benefit plan, use the Billing Rates form.

To set billing rates for benefit plan of type “other”:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Rate Group — An option that displays when you select No or Both in the Billing Rates Vary By Network list in the Other Processing Parameters panel. The rates you enter apply only to this rate group. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

Cost per Employee — The billing Cost per Employee.

Note: Note: Saving rates according to the effective date allows you to view previous rates for reference purposes. The system calculates billing using the rates with the most recent effective date.

5. Click Save. The form clears so that you can enter the premiums for another plan type.

6. Repeat these steps for each plan type.

7. Click Close when you are finished.

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Setting Health Plan Billing Rates by Rate Group

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Rate_Group.htm Path: BA/Topics/Billing_Rates_Rate_Group.htm

Setting Health Plan Billing Rates by Rate Group

Use the Composite Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan that charges different rates by rate group.

The fields displayed in the form depend on whether the benefit plan is set up to have different rates for tobacco users or different rates by employee and spouse gender.

To set health plan billing rates by rate group:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. In the Actions menu [Image: screenshot] , click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form. This is a read-only field.

Rate Group — The rates that apply only to this rate group. This field that displays when you select No in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Plan Type — A list of the plan types defined for the group benefit plan.

Employee Gender — The employee’s gender. The Employee Gender list displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

5. Define each year of age. If you need to create an additional age row, click + or press Tab.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

Premium — The premium cost for that age.

Tobacco Surcharge — The surcharge for tobacco use, if any.

6. If the benefit plan is set up as tobacco banded:

Use this option — To define this

Non-Tobacco Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Tobacco Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

Dependents (Spouse Non-Tobacco) — Enter the cost associated with covering an employee’s non-tobacco using spouse for this plan type and age group.

Dependents (Spouse Tobacco) — If covered, enter the cost associated with covering an employee’s tobacco using spouse for this plan type and age group.

7. If the benefit plan is not set up as tobacco banded:

Use this option — To define this

Total Bill Amount — The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount — The amount to bill the employee for this plan.

Dependents Bill Amount — The amount to bill the depending for this plan.

8. If the benefit plan is set up as wellness banded:

Use this option — To define this

Wellness Bill Amount — The amount billed to the client for the plan type and age group.

Non‑Wellness Bill Amount — The amount billed to the client for the plan type and age group.

Dependents Bill Amount — If covered, enter the cost associated with covering an employee’s dependent for this plan type and age group.

9. Click Save. The form clears so that you can enter billing rates for another plan type.

10. Repeat these steps for each plan type.

11. Click Close when you are finished.

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Setting Health Plan Billing Rates by Rate Group and Age

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Rate_Group_Age.htm Path: BA/Topics/Billing_Rates_Rate_Group_Age.htm

Setting Health Plan Billing Rates by Rate Group and Age

Use the Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan that charges different rates by rate group and age.

The form displays various fields depending on whether the benefit plan is set up to have different rates for tobacco users or different rates by employee and spouse gender.

To set health plan billing rates by rate group and age:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Rate Group — The rates that apply only to this rate group. This field that displays when you select No in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Plan Type — A list of the plan types defined for the group benefit plan.

Employee Gender — The employee’s gender. The Employee Gender list displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Spouse Gender — The employee spouse’s gender. The Employee Gender list displays only when Spouse Gender Banded is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display. An error displays if there is no corresponding premium rate record.

5. Define each year of age. If you need to create an additional age row, click + or press Tab row.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Enter the age-range information for the benefit plan. You can enter this information manually, or copy from the benefit plan’s corresponding Premium Rates record by clicking Copy from Premium Rates in the Actions menu. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

6. If the benefit plan is set up as tobacco banded:

Use this option — To define this

Non-Tobacco Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Tobacco Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

Dependents (Spouse Non-Tobacco) — Enter the cost associated with covering an employee’s non-tobacco using spouse for this plan type and age group.

Dependents (Spouse Tobacco) — If covered, enter the cost associated with covering an employee’s tobacco using spouse for this plan type and age group.

7. If the benefit plan is not set up as tobacco banded:

Use this option — To define this

Total Bill Amount — The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount — The amount to bill the employee for this plan.

Dependents Bill Amount — The amount to bill the depending for this plan.

8. If the benefit plan is set up as wellness banded:

Use this option — To define this

Wellness Bill Amount — The amount billed to the client for the plan type and age group.

Non‑Wellness Bill Amount — The amount billed to the client for the plan type and age group.

Dependents Bill Amount — If covered, enter the cost associated with covering an employee’s dependent for this plan type and age group.

9. Click Save. The form clears so that you can enter the premiums for another plan type.

10. Repeat these steps for each plan type.

11. Click Close when you are finished.

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Setting Health Plan Billing Rates by Rate Group and Network

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Rate_Group_Network.htm Path: BA/Topics/Billing_Rates_Rate_Group_Network.htm

Setting Health Plan Billing Rates by Rate Group and Network

Use the Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan that charges different rates by both rate group and network.

Different fields display in the form depending on whether the benefit plan is set up as tobacco banded by selecting Tobacco Banded Rates in the Other Processing Parameters panel in Group Benefit Plans.

To set health plan billing rates by rate group and network:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Network ID — The Network option displays when Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel.

Rate Group — The Rate Group option displays when Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel.

Employee Gender — Displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Spouse Gender — The gender of the employee’s spouse. The list displays only when Spouse Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

5. Define each year of age. If you need to create an additional age row, click + or press Tab.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

6. If the benefit plan is set up as tobacco banded:

Use this option — To define this

Non-Tobacco Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Tobacco Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

Dependents (Spouse Non-Tobacco) — Enter the cost associated with covering an employee’s non-tobacco using spouse for this plan type and age group.

Dependents (Spouse Tobacco) — If covered, enter the cost associated with covering an employee’s tobacco using spouse for this plan type and age group.

7. If the benefit plan is not set up as tobacco banded:

Use this option — To define this

Total Bill Amount — The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount — The amount to bill the employee for this plan.

Dependents Bill Amount — The amount to bill the depending for this plan.

8. Click Save. The form clears so that you can enter billing rates for another plan type.

9. Repeat these steps for each plan type.

10. Click Close when you are finished.

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Setting Billing Rates by Rate Group, Network, and Age

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/Billing_Rates_Rate_Group_Network_Age.htm Path: BA/Topics/Billing_Rates_Rate_Group_Network_Age.htm

Setting Billing Rates by Rate Group, Network, and Age

Use the Billing Rates form to enter the billing rates for a medical, dental, or vision group benefit plan that charges different rates by rate group, network, and age.

Different fields display in the form depending on whether the benefit plan is set up as tobacco banded by selecting Tobacco Banded Rates in the Other Processing Parameters panel in Group Benefit Plans.

To set health plan billing rates by rate group, network, and age:

1. Start on the Group Benefit Plans form.

2. Enter the ID of the plan you want to edit.

3. On the Actions menu, click Billing Rates.

4. Set the following parameters.

Use this option — To define this

Copy from Premium Rates — Age-range information from the Premium Rates record is copied for the benefit plan. An error displays if there is no corresponding premium rates record. The Effective Date must be entered in the Billing Rates form for the Copy from Premium Rates option to display.

Benefit Plan ID — A value that is populated from the Group Benefit Plan form.

Network ID — The Network field displays when Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel.

Rate Group — The Rate Group field displays when Both is selected in the Billing Rates Vary By Network list in the Other Processing Parameters panel. Your organization might charge different clients at different rates for the same benefit plan. PrismHR allows you to define these different rates using rate groups. You can use as many rate groups as needed; see Rate Groups.

Plan Type — A list of only the plan types defined for the group benefit plan.

Employee Gender — The list displays only when Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Spouse Gender — The gender of the employee’s spouse. The list displays only when Spouse Gender Banded Rates is selected in the Other Processing Parameters panel in Group Benefit Plans.

Effective Date — The date when the rate goes into effect. Saving rates according to the effective date enables you to view previous rates for reference purposes. The system calculates premium costs using the premium rates with the most recent effective date.

5. Enter the following information for each year of age. If you need to create an additional age row, click + or press Tab.

Use this option — To define this

From Age To Age — The starting age for each line and the upper age limit. Unless the benefit plan is also set up as age banded by selecting the Age Banded Medical Billing option in Group Benefit Plans, you must enter a one-line “all encompassing” age range in the From Age and To Age fields. For example, 0-99.

6. If the benefit plan is set up as tobacco banded:

Use this option — To define this

Non-Tobacco Premium — The amount billed to the client for the plan type and age group for non-tobacco using employees.

Tobacco Premium — The amount billed to the client for the plan type and age group for tobacco using employees.

Dependents (Spouse Non-Tobacco) — The cost associated with covering an employee’s non-tobacco using spouse for this plan type and age group.

Dependents (Spouse Tobacco) — If covered, the cost associated with covering an employee’s tobacco using spouse for this plan type and age group.

7. If the benefit plan is not set up as tobacco banded:

Use this option — To define this

Total Bill Amount — The total amount to bill to the client for the cost of this plan. The Total Bill Amount is the sum of the Employee Bill Amount and Dependents Bill Amount. When you enter two values, the third calculates automatically. For example, if you enter a Total Bill Amount of 500 and an Employee Bill Amount of 300, the system populates Dependents Bill Amount with 200.

Employee Bill Amount — The amount to bill the employee for this plan.

Dependents Bill Amount — The amount to bill the depending for this plan.

8. Click Save. The form clears so that you can enter billing rates for another plan type.

9. Click Close when you are finished.

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Setting Coverage Rules

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/BR_Coverage_Rules.htm Path: BA/Topics/BR_Coverage_Rules.htm

Setting Coverage Rules

If the same insurance coverage amount or calculation method applies to each employee regardless of benefit groups or rules, you can define it in Group Benefit Plans. Otherwise, use the Coverage Rules panel in Benefit Rules to define the rules for life insurance, short-term disability, and long-term disability plans.

Define Life Insurance Coverage Rules

If you offer life insurance coverage for commission employees, see Calculating Life Insurance Coverage for Commissioned Employees.

To define life insurance coverage rules:

1. On the Benefit Rules form, locate the Coverage Rules panel.

2. Set the following parameters.

• Before: The system rounds up before multiplying.
• After: The system rounds up after multiplying. | Coverage Maximum | The Coverage Maximum allowed under this plan. | | Coverage Minimum | The Coverage Minimum allowed under this plan. | | Coverage Amount | The flat Coverage Amount. | | Add to Calculated Coverage | The flat amount to Add to Calculated Coverage. | | Years of Service | Years of Service as a full year value (for example, 1 for one year, 5 for five years). You cannot enter a fraction (for example 5.5 for five and a half years). If the amount of insurance coverage increases depending upon the employee’s years of service, Pay Multiplier can be based on Years of Service. |

3. Click Save.

Defining Disability Coverage Rules

To establish the coverage rules for age-banded disability insurance plans, Use the Disability Coverage Rules panel (or the Disability Salary Band Rules panel for salary-banded disability insurance plans.

To define disability coverage rules:

1. Locate the Disability Coverage Rules or Disability Salary Band Rules panel.

2. Set the following parameters.

• Average Last Calendar Year’s Earnings
• Average Last Two Years’ Earnings
• Average Prior Year Earnings | Maximum Coverage | The maximum insurance coverage amount or an amount based on Years of Service. | | From Annual Salary To Annual Salary | The salary range covered by the rule. | | Coverage | The Coverage amount for the rule. |

3. Click Save.

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Establishing Eligibility Rules

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/BR_Eligibility_Rules.htm Path: BA/Topics/BR_Eligibility_Rules.htm

Establishing Eligibility Rules

To establish employee eligibility rules for this benefit, use the Eligibility Rules panel in Benefit Rules.

To establish employee eligibility rules:

1. On the Benefit Rules form, locate the Eligibility Rules panel.

2. Set the following parameters.

• An employee hired on 3/2/2026 whose eligibility date is set as the first of the month on or following sixty days is eligible for this benefit on 5/1/2026 because the sixty days requirement passes on 4/30/2026.
• An employee hired on 3/2/2026 whose eligibility date is set as the first of the month on or following two months is eligible for this benefit on 6/1/2026 because the two months requirement passes on 5/2/2026. | Eligibility Days From | The day to use for calculating eligibility based on days of service: Hire Date or Status Date. - Hire Date - Eligibility is based on the employee’s latest hire date, regardless of the employee type at that time. - Status Date - Eligibility is based on the earliest date when the employee’s status was active, considering the employee type (for example, when the employee was also full- time). |
• Hire Date - Eligibility is based on the employee’s latest hire date, regardless of the employee type at that time.
• Status Date - Eligibility is based on the earliest date when the employee’s status was active, considering the employee type (for example, when the employee was also full- time). | Eligibility Date Used | The date used to determine how to calculate the date when employees meet eligibility requirements for this plan: - 1st of the Month After Calculated Date – An employee hired on 9/1/2026 with a two-month waiting period is eligible for this benefit on 12/1/2026, the first of the month following two months. - If calculated date is the 1st of the month, use that, else next 1st of the month – An employee hired on 9/1/2026 with a two-month waiting period is eligible for this benefit on 11/1/2026, the first of the month coinciding with or following two months. - Calculated Eligibility Date – An employee hired on 9/3/2026 with a two-month waiting period is eligible for this benefit on 11/3/2026, following two months. |
• 1st of the Month After Calculated Date – An employee hired on 9/1/2026 with a two-month waiting period is eligible for this benefit on 12/1/2026, the first of the month following two months.
• If calculated date is the 1st of the month, use that, else next 1st of the month – An employee hired on 9/1/2026 with a two-month waiting period is eligible for this benefit on 11/1/2026, the first of the month coinciding with or following two months.
• Calculated Eligibility Date – An employee hired on 9/3/2026 with a two-month waiting period is eligible for this benefit on 11/3/2026, following two months. | Employment Type | Each Employment Type that is eligible for this benefit. The Description displays. If employees of all employment types are eligible, you do not need to enter any types. | | Exempt/Non-Exempt | The employee FLSA status required to be eligible for this benefit, or nothing if employees of all statuses are eligible. | | Network Availability Stop Date | An expiration date for the network attached to the benefit. |

3. Click Save.

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Setting Contribution Rules

Source: https://tech-docs.prismhr.com/SP_help/Content/BA/Topics/BR_Employee_Contribution_Rules.htm Path: BA/Topics/BR_Employee_Contribution_Rules.htm

Setting Contribution Rules

You can set contribution rules for the following types of plans using the Contribution Rules panel:

• Medical, Dental, and Vision Benefit Plans

• Life, Disability, Bond/ELPI, or Other Benefit Plans

Setting Rules for Medical, Dental, and Vision Plans

To establish the contribution rules for medical, dental, and vision benefit plans:

1. Open the Contribution Rules panel.

2. Set the following parameters.