Viewing eligibility details of dependents

• Ensure that you are in the Enter Employee Claim page, and the dependent details are displayed in the multiline.

• Position the mouse pointer in the Relationship field in the multiline. When a grabber hand appears, click

• The Dependent Eligibility page appears.

• The system displays the following fields in the header

Date Format	The date format applicable to the login user. More details
Employee	The employee selected in the Select Employee page
Reimbursement Item	The reimbursement item selected in the Select Employee page
Reimbursement Group	The reimbursement group selected in the Select Employee page

• The multiline displays the following fields.

Dependent Name	The name of the dependent as defined in the Record Information on Family Members activity
Relationship	The relationship of the dependent to the employee
Eligibility Nature	The mode of eligibility that is applicable for the specific reimbursement item. See eligibility nature
Limit per Claim	The upper limit for each reimbursement claim, for the given item.
Opening Balance	The opening balance of the dependent, which is the amount or value brought forward from the previous Reimbursement Calendar
Total Balance	The total balance of the dependent, for the reimbursement item. This is the sum of
	The opening balance and
	The quantity/amount to which the dependent is eligible for the current reimbursement calendar
	Minus the total quantity/amount availed till date

• Select the Cancel icon in the toolbar above the multiline, to return to the Enter EmployeeClaimpage
  

6      Hyperlinked text below

 Page objective

Use this page to view eligibility details of dependents, details include relationship with employee, limit per claim and  total balance.

What you can do in this page

 What are the factors that influence my total balance?

How is an employees total balance calculated?

What is the maximum that I can claim?

Can I carry over my previous balance?

Can I claim for my dependents?

Can I apply for claims, on behalf of my clients?

Why dont all the reimbursement items appear in the multiline?

The full picture of an employees eligibility, for an item

Limit per Claim

Quantity or Amount

Parameter overview

Eligibility Rule that Considers the Parameter Values

Claim ID

Eligibility Value

Sanctioned Amount

What are the factors that influence my total balance?

An employees total reimbursement balance is determined by some or all of the following factors:

• The ceiling defined for each grade or grade set, for the calendar year; this could be Actuals or Limited. If the ceiling is Limited, the maximum quantity or amount that the employee can avail, for the reimbursement item, is defined as well. Alternatively, there could be a general eligibility rule, applicable for all the employees of the organization unit, with no grade-specific ceiling defined.

• The authorized amount for a claim ID, if the previous claims have been authorized until date. The authorized amount could be equal to or less than

• The upper limit, per claim ID; this will be applicable when the Eligibility is Limit

or

• The percentage of the claim ID value that can be sanctioned; this will be applicable when the Eligibility is Limit.

• The treatment of carryover balance. It can be carry forward, encashment or lapse, or a customized rule that will determine the treatment of the carryover balance. If it is carry forward, the balance from the previous reimbursement calendar is also added to the employees balance

• The Carry Forward/Encashment Limit; this is the maximum limit of the reimbursement amount / value that can be carried forward or encashed.

• If the eligibility nature is Common for All, the amount or quantity availed by dependents also affects the employees balance

• If the reimbursement item is in quantity, the quantity is converted into currency and paid to the employee through cash, payroll or check. See quantity or amount.The value of the deduction from the employees balance will depend upon the rate for conversion into money. The conversion rate is specified as a rule, during reimbursement setup. Example: The reimbursement item Conveyance is claimed in quantity, which is Liter. If an employee claims 15 liters under a Claim ID, the system converts it to x dollars, depending on the conversion rate specified.

How is an employees total balance calculated?

Carry forward (max limit) + item eligibility for current calendar authorized amount authorized amount for dependents.

Authorized amount for dependents is included in the calculation, provided

• Claims can be made for dependents and

• The eligibility nature is Common for All. 

Both these items of information are specified when a reimbursement item is created.

What is the maximum that I can claim?

• If the employees item eligibility is based on grade, the ceiling for the grade to which the employee belongs could be Actuals or Limited. Actuals implies that the eligibility is unlimited, and he or she is paid the actual expenses incurred. Limited implies that

• The maximum value that the employees under the gradeset/grade can avail is defined, for the reimbursement item.

• There is an upper limit for each claim ID, for the given item. This will be displayed in the Limit Per Claim field, in the Enter Employee Claim page

• Only a specific percentage of the claim value will be sanctioned

Note: If there is a conflict between the sanction percentage and the limit per claim, the system chooses the lesser of the two values. For instance, the limit per claim ID is $1500, and the sanctioned percentage of each claim ID is 75%. If an employee submits a claim ID worth $1800, the sanctioned percentage will be $1350. However, if the employee submits a claim ID worth $3000, the sanctioned percentage will be $2250, but the system will choose the limit per claim ID, which is $1500, to sanction.

• If the employees item eligibility is not based on grade, the maximum amount could be a general eligibility rule applicable for all the employees of the organization unit. It may or may not be specific to a claim ID.

Can I carry over my previous balance?

This will depend upon the treatment of carryover balance specified for the reimbursement item.

• If the eligibility for the item is grade-specific, the treatment can be carry forward, encashment or lapse for each grade. Carry forward implies that the balance will be carried forward to the next calendar year. A limit to the maximum amount or quantity that can be carried over will be specified, as well.

• If the eligibility rules are not grade-specific, a customized rule will determine the treatment of the carryover balance

 

Can I claim for my dependents?

This will depend on the following:

• Whether the claim can be made for the employee, dependents or both. This is defined for the specific reimbursement item

• The maximum number of dependents allowed, for the reimbursement item. This is defined for the specific reimbursement item

• Whether the dependents have been enrolled and their enrollment authorized, before their claims are entered

Note: An employee can only claim for dependents who are defined already as family members, through the Record Information on Family Members activity

• The sufficiency of the balance amount/quantity.

• If the eligibility nature requires the dependents balance to be maintained separately, there must be sufficient amount /quantity in this balance. Examples of independent dependents balance are Separate for dependents and "Separate for employee and common for dependent:

• If the eligibility nature requires the dependents balance to be combined with the employees balance, the amount /quantity in this common balance must suffice.

Can I apply for claims, on behalf of my clients?

This is possible, if the following conditions are met

• The external service provider has been defined in the Create Provider Details activity

• In the Payment To field of the Enter Claims page, the choice is set to External Service Provider

Why dont all the reimbursement items appear in the multiline?

The grade to which the employee belongs must be specified as eligible for the item, in the Create Reimbursement Item activity

Rule create item

An employees eligibility to each reimbursement item must be authorized already, in the Authorize Employee Eligibility activity, during reimbursement setup. Otherwise, the reimbursement items do not appear in the Enter Reimbursement Claim page when the employee logs into the Apply for Reimbursement activity

The full picture of an employees eligibility, for an item

The reimbursement claim value of an item, for an individual employee/dependent, is determined first by

• The specific reimbursement items eligibility terms, followed by

• The eligibility terms of the grade or gradeset to which the employee belongs. See picture

The Reimbursement Items Eligibility Terms: When a reimbursement item is created, the following information is specified:

• The applicability of the reimbursement items for dependents. The eligibility for a reimbursement item could be for the employee only, the dependents only or for both employee and dependents.

• The maximum number of dependents allowed for a reimbursement item

The Eligibility Terms of the Grade or GradeSet to Which the Employee Belongs: When a reimbursement item is defined, the following information is specified as well, for every grade or grade set in the organization unit:

• The permissible limit applicable for each grade or grade set; this could be Actuals or Limited. Alternatively, it could be a general eligibility rule applicable for all the employees of the organization unit. If Limit, the following are defined as well

• Sanction %. This is the percentage of the reimbursement claim value, which will be sanctioned for the item. This will be applicable when the Eligibility is Limit

Limit per Claim

• This is the upper limit for each reimbursement claim, for the given item. This will be applicable when the Eligibility is Limit

• The treatment of carryover balance. It can be carry forward, encashment or lapse, or a customized rule that will determine the treatment of the carryover balance

• The Carry Forward/Encashment Limit; this is the maximum limit of the reimbursement amount / value that can be carried forward or encashed.

Quantity or Amount

The eligibility for the reimbursement item is defined in the Create Reimbursement Item activity in one of the two forms:

• Quantity: this refers to the defining the value of eligibility in terms of consumables. Example, reimbursement of Fuel, which is a consumable, could be in terms of gallons or liters. When this choice is selected, you are to choose the unit of measurement in which the reimbursement will be provided

• Amount: this refers to defining the value of eligibility in terms of actual money spent. If this choice is selected, you are to specify the currency in which the reimbursement must be provided.

Parameter overview

Parameters: There may be various aspects about the reimbursement item, which influence the amount to be claimed. For example, when the reimbursement item is Tour, aspects such as mode of transport and hotel type will influence the amount that is claimed. These aspects are called parameters. A parameter is an aspect or attribute of a reimbursement item, which is used to compute the reimbursement claim amount of this item.

Values for Parameters: Using the example above, the item Tour has parameters such as Hotel Type, Mode of Transport, Distance Traveled, and Number of Days. Whenever an employees claim for Tour is entered, a value must be entered for each parameter as well. These values, together, determine the total claim amount. The parameter value can be numeric or character; and examples of the values are as follows:

• Mode of Transport Air, Car, Train

• Hotel Type Executive suite, Business Suite, A/C Double and A/C Single

• Distance Traveled Any numeric value. Unit of measurement = Kilometers

• Number of Days of Stay Any numeric value. Unit of measurement = Days

Eligibility Rule that Considers the Parameter Values

To make it possible for the system to compute the reimbursement claim value, after considering all the parameters, you are to define a stored procedure rule. The stored procedure rule will define the eligibility amount for each combination of parameter values. For example, you can define a stored procedure rule to the effect that when Hotel Type = Executive, Room Type = A/C Double and Number of Days of Stay = 3, the eligibility will be $1000 Per Day. (That is, 1000 * 3 = 3000).

For each Claim ID: Subsequently, when you enter a claim for Tours in the Apply For Reimbursement activity, the system will execute the stored procedure after you enter the parameter values. This eligibility value will be for each multiline in a claim ID.

For example, you entered the following parameters and values, for the first multiline row of the Enter Employee Claim page, with the date of expense as December 1 2001:

• Mode of Transport = Air, Hotel Type = Executive suite, Distance Traveled = 150 Kilometers, Boarding = Indian, and Number of Days = 2 Days

In the second row of the multiline, you can enter the same parameters and values, with the expense date as December 15 2001.

The system will execute the same stored procedure twice, one for each multiline record.

Within Eligibility Value for the Calendar Year: The system ensures that the sum of eligibility values for claim IDs for the reimbursement calendar does not exceed the eligibility value specified for the reimbursement calendar year, for the reimbursement item. The latter is specified in the Eligibility Value field in the multiline of the Create Reimbursement Item page.

Claim ID

A unique number / ID, to identify all the reimbursement claims that you entered in the Enter Employee Claim document before selecting the Submit pushbutton.

Parameter Values-Fields from the previous page

Reimbursement Claim Unit	Select the organization unit in which you must apply a reimbursement item Tell me more.
Claim ID	The unique claim number generated by the system in the previous page, to identify the reimbursement claims entered before the Submit pushbutton was selected.
Reimbursement Item	The reimbursement item selected in the Select Employee page
Claim For	Whether the claim was for the employee or his/her dependents. This was selected in the previous page
Bill No	The distinctive number of the bill submitted for reimbursement. This is selected in the previous page
Bill Date	The date of the bill submitted for reimbursement. This is selected in the previous page

Details of each parameter

Parameter Code	The code of the parameter
Parameter Description	The description of the parameter
Parameter Type	The type of the parameter
Unit of Measurement	The unit in which the measurement is made
Parameter Value	The value of the parameter

Eligibility Nature

This refers to the mechanics of eligibility applicable for the specific reimbursement item. This will depend upon the eligibility type

Example: If the Item Eligibility is Only for dependents, the eligibility nature can be either common for dependents or separate for dependents. See the table, which provides a complete picture. Given below is a description of each option.

•  "Separate for Employee & Separate for Dependents": The eligibility limit you define will be separately applicable for each of the dependants and for the employee.

•  Common for Dependents: The eligibility limit you define will be applicable for all the dependents put together.

•  Separate for Dependents: The eligibility limit you define will be applicable for each of the dependents separately.

• Common for All: The eligibility limit you define will be applicable for all the dependants and the employee put together.

• "Separate for employee and Common for dependent: The eligibility limit you define will be separately applicable for the employee. Also the limit defined will be applicable for the dependents put together.

•  Self: The eligibility limit you define will be applicable for the employee only.

Eligibility Value

The eligibility value for a grade, gradeset or combination of both could be one of the following:

• Actuals; this means there is no upper limit to the reimbursement value that can be claimed. In other words, the reimbursement value is unlimited. 

• Limited; this means the reimbursement value can be claimed upto a given limit. You are to specify this limit in the next multiline field Eligibility Value

This information is defined in the Create Reimbursement Item activity

Sanctioned Amount

The amount or quantity that the system sanctions for a claim ID will be the lesser of the following two values: Limit Per Claim and Sanction%.

• Limit Per Claim: This is the upper limit that can be sanctioned for a claim ID. The upper limit is defined for the reimbursement item, in the Create Reimbursement Item activity.

• Sanction%: This is the percentage of each Claim ID value, which can be sanctioned. This percentage is defined for the reimbursement item, in the Create Reimbursement Item activity.

Example: The reimbursement item is Medicines, and the upper limit allowed for a Claim ID is $400. In addition, the sanction % of 75% is defined for the claim ID.

When the employee submits the claims, the value of his claim ID is $550. Although the sanctioned 75% implies that $412.5 can be paid to the employee, the system pays him $400 only.