In Benefits Management, there are currently four different Contact Eligibility codes available: Relationship, Student, Overage dependent and Over-aged disabled dependents. Unfortunately, these four do not enable the creation of mutual exclusive selection criteria for Coverage options as only one option at the time can be used.

By having the ability to join different combinations of contact eligibility codes, the false positives in the selection of dependents for a Coverage option could be prevented. An alternative could be to open up the Custom field eligibility option under "Eligibility rules" to include the "Personal Contact" related entities.

Especially for the complex world of health insurance benefits, a myriad of options with financial cost shares between employer and employee are possible throughout the world which require a higher grade of granularity than which is currently offered for personal contacts (dependents).

A likely example scenario from a health insurance cover:

  • Child up to the age of 18 years is considered a dependent - XX% of the insurance premium is paid by employer (ER) and YY% by the employee (EE)
  • As of 18 years of age the child up to the age of 21 needs to be full-time studying to receive the XX% ER contribution
  • As of the age of 21 until the end of that calendar year the dependent becomes an adult for insurance purposes with an increase in premium, the XX% ER contributions remain while the dependent is still studying.
  • After the end of the calendar year in which the child turns 21, the dependent (young adult) is no longer considered for an ER contribution, but can still be insured under the insurance plan up to an age of 27 for a rate of 100% of the insurance premium paid by the EE.
  • A spouse/partner can also be insured. Based on salary levels of the spouse, the employee will receive either a 50% ER contribution or not.

In these very complex scenarios it is very difficult and unlikely that a false positive scenario can be prevented, which could potentially lead to wrongly setup benefits requiring additional checks that could have been prevented if more granularity or options would be made available.

Category: Benefits