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

• The specific reimbursement item’s eligibility terms, followed by

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

The Reimbursement Item’s 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”

• 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.

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.

An employee’s 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 employee’s 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 employee’s 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 employee’s 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.

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.

• If the employee’s 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 employee’s 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.

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

 

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 dependent’s 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 dependent’s balance to be combined with the employee’s balance, the amount /quantity in this common balance must suffice.

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”

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 employee’s 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