Eligibility Rules

The following forms comprise the sub-system for creating the rules for an eligibility plan. This information is typically entered once for each plan. All the information listed is available on the forms via context sensitive help.

ELIGIBILITY This form is used to enter eligibility rules information for an eligibilty plan.

Elig Plan

PLAN NAME The name and description of the eligibility plan.
PLAN DATE The date that this plan is effective.
PLAN END DATE The ending date of this plan.
ELIGIBLE COVERED PERIODS The number of eligibility periods in each plan year.
ELIGIBLE COVERED PERIODS The number of periods of coverage earned by each period of eligibility.
GAP COVERAGE Enter a 'Y' if gap coverage is used by this plan. Otherwise enter an 'N'.
MIN BNK HRS The minimum number of bank hours that must be earned in an eligibility period before remaining hours can be used to add to bank hours.
MAX BNK HRS The maximum number of bank hours that an employee can accumulate.
MIN BNK AMT The minimum bank amount that must be earned in an eligibility period before remaining amounts can be used to add to bank amounts.
MAX BNK AMT The maximum amount that an employee can accumulate in his bank.
CARRY BANK HRS IF BELOW MIN Enter a 'Y' if the system should zero bank units when they fall below the minimums. Otherwise enter an 'N'.
REDUCE BNK HRS When the plan calls for hours to be reduced or forfeited because of failure to work minimum required hours, enter the number of reduction hours.
REDUCE BNK AMT When the plan calls for amounts to be reduced or forfeited because of failure to earn minimum required amounts, enter the reduction amount.
REDUCE FREQ Enter the number of times per year that this reduction should occur.


INITIAL COVERAGE This form contains the rules for calculating initial eligibility.

Inti Elig

MINIMUM HRS REQUIRED The minimum number of hours required to meet initial eligibility requirements.
MINIMUM AMT REQUIRED Minimum amount required to meet initial eligibility requirements.
MAXIMUM MONTHS ALLOWED TO AQUIRE MINIMUMS The maximum number of months allowed to acquire the hours or amounts entered as minimums.
NO. WIAT MONTHS BEFORE INIT COVERAGE BEGINS The number of credits earned if an employee works the minimum hours.
COVERAGE BEGINS x MONTHS AFTER WAIT PERIOD The minimum number of months that must elapse after the wait period before coverage begins.
ALT 1 Alternate rule to meet initial eligibility.
ALT 2 Alternate rule to meet initial eligibility.


PARTIAL COVERAGE This form contains the rules for calculating partial eligibility.

Part Elig

MIN HRS REQUIRED The minimum number of hours required in each period to continue partial eligibility.
MIN AMT REQUIRED The minimum amount earned in each period to continue partial eligibility.
NO. MONTHS TO COVER WHEN MINIMUM IS MET The number of months of coverage earned with partial eligibility. This may be a decimal value such as .5.


CONTINUING COVERAGE This form contains the rules for calculating continuing eligibility.

Cont Elig

MIN HRS REQUIRED The minimum number of hours required in each period to continue full eligibility.
MIN AMT REQUIRED The minimum amount earned in each period to continue full eligibility.
MAXIMUM MONTHS ALLOWED TO AQUIRE MINIMUMS The maximum number of months allowed to acquire the hours or amounts entered as minimums.
NO. MONTHS AFTER PERIOD TO TERM COVERAGE The number of months after the end of an eligibility period that coverage will continue if eligibility is not met in a period.
ALT NO. PRIOR MONTHS The number of months prior to the ending date of the current eligibility period to test for an alternate condition in which eligibility may be met.
MIN HRS REQ The minimum number of hours that must be worked in the designated prior months.
MIN AMT REQ The minimum amount that must be earned in the designated prior months.


REINSTATEMENT COVERAGE This form contains the rules for calculating eligibility reinstatement.

Elig Rein

MIN HRS REQUIRED The minimum number of hours required in each period to reinstate coverage.
MIN AMT REQUIRED The minimum amount required in each period to reinstate coverage.
MAXIMUM MONTHS ALLOWED TO AQUIRE MINIMUMS The maximum number of months allowed to acquire the hours or amounts entered as minimums. If this field is zero then no reinstatement rules will apply.
OVER LAP PERIODS If the plan allows the periods prior to the last termination date to be accumulated to test for minimums enter a ‘Y’ in this field.
MIN WAIT PERIODS The number of wait periods between reinstatement and the beginning of coverage.
NO REINSTATE AFTER x PERIODS The number of months that must lapse after which reinstatement is not allowed.