Define evidence of insurability conditions

For certain levels of health coverage, employees are required to prove their insurability. This is usually done in the form of a document called Evidence of Insurability.

In this step, you enter the requirements for Evidence of Insurability (EOI) stated by your health plans.

Within each plan you can define which plan options require the employee to present EOI in order to be enrolled. You can also define the changes in election that require EOI.

You also decide the action the system should take if EOI is not present at enrollment. Grace periods for the employee to produce EOI are also entered here.

Example

The Standard Health plan stipulates that if an employee elects the Option II, EOI must be provided within 1 month of the participation. This is regardless whether this is a change in election or a new enrollment in the plan.

In this view, under 'Options which require proof', Option II is entered.

Under 'Action', the entry 'create pending record for desired option, and create active record for maximum possible jump.' is selected.

A grace period of 1 month from participation date is entered.

Activities

    1. Decide which of your health plans have options which require EOI for either enrollment or changes in options or both.
    2. Select New entries.
    3. Select the health plan you want to define EOI restrictions for.
    4. Enter validity dates.
    5. In 'Options which require proof' enter the appropriate plan options, and if relevant only for new enrollments.
    6. In 'Changes which require proof' enter the appropriate changes in elections.

If you enter an option and leave the dependent option field empty, ALL dependent options will be included by the system during EOI processing.

    1. In 'Action', enter which action the system should take, for ALL situations you have defined in 5 and 6.
    2. Enter the grace period, within which the employee should give EOI.
    3. Enter the date, which is the start of the grace period.
    4. Save your entries.
    5. Repeat steps 2-10 for each health plan.

Further notes

    1. If you enter an option under 'Options which require proof', there is no need to enter all jumps to this option under 'Changes which require proof'. It is sufficient that the option is only defined as requiring proof. Any employee changing TO this option will also be automatically required to give EOI.
    2. Under the 'Action' that the system carries out, in the event of no EOI being provided at enrollment, there are 4 fixed choices:

The action you choose here directs how the infotypes, which you create during enrollment, are attributed. This then drives how these employee enrollments are processed by the EOI Monitor .

-------------------------------------------------------
| | Action | Lock? | Reqd? | Provd? |
|------------------------------------------------------
| EOI Provided | n/a | | x | x |
|-----------------------------------------------------|
| EOI not | 1 | | x | |
| Provided | 2 | x | x | |
-------------------------------------------------------

In the EOI Monitor, you can process these enrollments. Enrollments are continually monitored, where EOI has not yet been provided. Locked (also known as 'Pending') enrollments can be unlocked (also known as 'activated').