The main objective of the entire Benefits Administration process is to enroll employees in the Benefit Plans. The basic prerequisites for enrolling an employee in the plan are the plan definitions and most importantly to see if he/she is eligible for the plan. The Benefits Eligibility Definition component helps the user to create a repository of Eligibility Profiles for Primary Participant (Employee) and the dependent of the employee. An Eligibility Profile is a collection of Eligibility conditions which the employee or the dependent need to fulfill in-order to be enrolled in the plan. The following activities comprise this component,

• Creating Eligibility Profile

• Create Dependant Eligibility definition

• Edit Participant Eligibility Profile

• Edit Dependant Eligibility Profile

• View Participant Eligibility Profile

• View Dependant Eligibility Profile

Creating Eligibility

This activity enables the user to create eligibility profiles of the participants for enrolling in various plans. Specific criteria have been laid down for enrollment in all the plans. These criteria’s constitute an eligibility profile. This activity allows you to specify the eligibility profile required for enrolling in a plan. In order to create an eligibility profile the user needs to specify the following,

• A unique code and description of the eligibility profile

• Various attributes of the employee like, age, period of service, nature of employment etc.

• Specification of other eligibility criteria like standard working hours, actual hours per week, compensation etc.

• Applicability to various organization units.

Create Dependant Eligibility Definition

This activity enables you to create eligibility profiles for dependants of a participant for enrolling in a program/ plan/ plan type. In order to create a dependant eligibility profile the user needs to specify the following,

• A unique code and description to identify a dependant eligibility profile

• Various attributes of the dependant like age, marital status, student status etc.

• Applicability to various organization units

Edit Participant Eligibility Profile

This activity enables you to edit the participant’s eligibility profile that had been created in the “Create Participant Eligible Profile” activity. Modification of the record can be done by specifying the search criteria. Apart from modifying the records the user can also delete the records, provided those records have not been used in any of the screens.

Edit Dependant Eligibility Profile

This activity enables you to edit the dependant’s eligibility profile that had been created in the “Create Dependant Eligibility Definition ” activity. Modification of the record can be done by specifying the search criteria. Apart from modifying the records the user can also delete the records, provided those records have not been used in any of the screens.

View Participant Eligibility Profile

This activity enables you to view the participant’s eligibility profile that has been created in the “Create Participant Eligibility Profile” activity. In order to view the records the user needs to specify the search criteria based on which the records are retrieved by the system. The following details can be viewed,

• Code, Short and Long Descriptions

• Attributes of the eligibility profile like age, period of service, marital status, disability etc.

• Applicability to various organization units

View Dependant Eligibility Profile

This activity enables you to view the dependant’s eligibility profile that has been created in the “Create Dependant Eligibility Profile” activity. In order to view the records the user needs to specify the search criteria based on which the records are retrieved by the system. The following details can be viewed,

• Code, Short and Long Descriptions

• Various Dependants eligible for enrollment

• Eligibility criteria for the dependants

• Applicability to various organization units

An employee can be enrolled in a plan only if he is eligible for enrollment. Primary participant eligibility profile mapping is mandatory while dependent eligibility profile can be made based on the need of the plan.

Getting familiar with the activities inside