Hi all! So, a great question came up at one of Lynn’s Learning Series about Open Enrollment and dependents. More specifically, what happens if an employee chooses an option for a Family plan but doesn’t pick any dependents. What happens in Sage HRMS Employee Self Service (ESS)? What flows back to Sage HRMS? What is the secret of life and why are we here?
All good questions! I thought I would write up a blog breaking them down and answering them for you (well, except for the “secret of life” question…you are on your own with that one.) Plus, it also gives me a chance to show off the new look and feel of ESS for subscription users. Because it is purty.
Let’s take some time to walk through how this all plays out. First up, when setting up your Benefits, you create and/or define your Election Codes. For typical Health plans, this will be options like: Employee Only, Employee + Spouse, Employee + Children, Family, etc.
So far, so good? Great! Okay, from here you continue setting up your Benefits as normal and eventually get to the Benefit Elections portion of your Open Enrollment Setup.
Let’s add these election codes to the HMO Medical plan and walk through the process.
What we are interested in is the second step of the wizard: General. From here, you can choose who is covered by the plan and what dependents are covered. And here is where it gets interesting and we can begin to answer our first question: what happens when an employee chooses the “Family” election code but doesn’t choose the correct number of dependents?
Let’s take a look at the “Indicate who is covered” section.
- Employee Only: Pretty self-explanatory. The coverage will only cover the employee
- Dependents Only: Again, pretty on the nose. This plan will only cover the employee’s dependents.
- One Choice Employee with Dependents: This is the most typical coverage type and what you are probably most used to. The employee selects a single option that covers both them and their dependents. Plans that have Employee + Spouse and Family plans fall into this category and this is definitely where some of the confusion around Open Enrollment elections comes in. We will spend more time talking about this later.
- Employees and Dependents – Separate Elections: An odd one that you probably won’t run into that often, this option is where the employee makes their selections and then chooses the selections for Dependents separately. This is for more specialized plans and won’t come into our discussion today.
Okay, still with me? Great! Now let’s talk about the Dependents section.
This is where you can choose which dependents are covered by the plan and if they are optional or required. Again, pretty self-explanatory but we do want to keep this section in mind so I did want to mention it.
With the basics down, let’s take a look at our HMO Medical Plan and how it is set up.
In most cases, you will find yourself with a setup close to what we have above: “Indicated who is covered” will be “One Choice Employee with Dependents” and you will mark the covered dependents as optional. Why optional? Well, if the employee chooses “Employee Only” and you have the dependent selection as required, the employee will be stuck. They will either have to run out and find some dependents or they will be unable to complete their enrollment. Not a good deal either way.
Let’s move on to the next section in the wizard:
Looks about right. We are matching to the correct rate table and have our employee selections for Employee Only, Employee + Spouse, Employee + Children, and Family. Everything is as right as rain.
This looks good too. Everything is matched up nicely.
Now that we have everything set up correctly and it all looks good, it’s time to start our Open Enrollment and answer the question: what happens if an employee picks “Family” but only covers themselves or themself and a single dependent?
Let’s find out!
Here we are in the middle of an Open Enrollment and good ‘ol Hugh Allen is making his selections. Let’s check in and see how he’s progressing.
So far so good. Hugh does have a spouse and two children so this makes perfect sense.
Wait, did Hugh only choose to cover his spouse? So many questions. So. Many. Questions. But aside from that, he picked Family as his plan but only chose to cover his spouse. So, the big question is: what will flow back over to Sage HRMS? Will it only show him covering his spouse or because he picked the Family plan will all of his dependents be automatically selected in Sage HRMS?
(Now in all honesty, this is exactly the type of thing that the Benefits Admin should pick up on prior to approving the enrollment but let’s pretend this was completely missed.)
Here we are in Sage HRMS and we can tell right away that the enrollment information has been moved over from ESS.
Now for the big question: what about the covered dependents? Let’s head over to the Covered Dependents tab and see what came over from ESS. Drum roll please!
Well would you look at that. Even though Hugh chose the Family plan, he only picked his spouse to be covered, so only the spouse will be covered in the new year with the “Employee + Spouse” rate coming over from ESS. While selecting the Family plan from the dropdown menu is a user-friendly way to help the employee with the enrollment, it is the actual dependents that are picked that flow back to Sage HRMS.
Nice, right? Mystery solved. This is why it is so important to run those Open Enrollment reports and make sure the selections match before approving them and sending over to Sage HRMS!
Bonus “But What If” Section
But what if you wanted to create a plan that would require you to pick your dependents? Well, while it won’t be 100% foolproof and you will still need to check the results, the best way I can think of is to break the plan into an Employee Portion and a Dependents Portion and then mark the dependents as required.
Again, while the employee could still make the same mistakes as Hugh with this setup, they would at least get an error message if they didn’t pick any dependents at all. Pretty cool, huh? And that is our blog post on Sage Employee Self Service Open Enrollment. Just an FYI, that the information from this class comes from our "ES - Sage Employee Self Service (ESS) Benefits Enrollment: From Start to Finish" class so check it out if you want a thorough course on everything Open Enrollment.
So what do you think? Are there better ways of setting up a plan requiring dependents? Let me know in the comments below and thanks for the read!