Benefits Features

The Advantage HRM system allows you to set up benefit programs in which employees can enroll themselves. You can set up benefits programs by defining benefits type class and benefits type sub-class codes. A Benefit Type Class is a broad classification for a Benefit Program within which many benefit type sub-classes are defined. Use the Benefit Type Class (BTCL) page to define a Benefit Type Class and Benefit Type Sub-class (BTSC) page to define Benefit Type Sub-Class.

Note: An employee can only enroll into one benefit plan associated with a Benefit Type Class.

The Dependent Profile (DPND) page allows you to define employees' dependent profiles in the system. Dependents are defined in the system to be enrolled into benefits or benefit program in which the employee is enrolled.

You can create a new dependent profile, modify an existing dependent profile and delete a dependent profile in the system.

Use the Benefits Enrollment (ENRL) page to enroll employees into benefits programs.

You can also use the Benefits Summary Landing (MEIBEN) page to enroll employees in to the benefits programs.

Note: You can enroll an employee's dependents into only those benefits programs where the employee is enrolled.

The Benefits Summary Landing (MEIBEN) page features enables you to enroll an employee and/or an employee’s dependents into benefits programs by gathering all pages related to Employee Benefits into one place. For example, instead of going to the Benefits Enrollment (ENRL) page to enroll an employee in a benefits program and then going to the Dependent Profile (DNPD) page to enter that employee’s dependents into the system, you can simply use the  Benefits Summary Landing page to perform both tasks.

Using the Benefits Summary Landing page, you can access the following pages. The Benefits Summary Landing page provides you a carousal, from where you can select the desired tile related to benefits.

• Benefits and Deduction Summary

• Manage Benefits

• Manage Dependent Profile

• Manage Dependent Coverage

• Manage Beneficiary Designation

• Manage Deductions

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) was passed to ensure that workers and their families continue to get health benefits coverage when their coverage through their employer ceases. The Federal Government has identified a specific set of events that qualify an employee for COBRA coverage. Under COBRA, the normal period of coverage is either 18 or 36 months. An 18 month period of continuation coverage is available to covered employees and their spouses and dependents in cases where coverage has been lost due to the employee’s termination or reduction of hours. For employees who have been physically disabled, the limit increases to 29 months. In cases where the spouse and or dependents have lost the benefits coverage due to the entitlement to Medicare, divorce or legal separation, or death, the mandated coverage period is 36 months. This 36 month continuation period also applies to cases where dependent children reaching maximum age limit for the coverage under an employer’s plan.

In addition to Federal Government requirement specification, several states have developed legislation that is similar to the federal version of COBRA. These laws typically require that a continuation of coverage option be included in group health policies, just like the federal version. However, some states specifically require that state mandated continuation coverage be offered only after the expiration of any Federal coverage period has expired. CGI Advantage HRM supports these differing timing requirements through the use of tables, which allows different stages to be defined as well as through the COBRA activity monitoring logic.

Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. The Advantage HRM system allows users to produce HIPAA certificates and related reports either upon request or when certain triggering events have occurred. Many of the same triggering events that are utilized in HIPAA reporting are also handled by Advantage HRM through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

HIPAA was created to ensure that any person is able to get health care coverage that matches the health care coverage for which the person is no longer eligible due to a HIPAA Triggering Event. In order to receive a HIPAA Certificate, two things must take place. First, an event must be entered into the HR system that will create a HIPAA Trigger. Once a HIPAA Trigger has been created, a second process will determine if an employee was enrolled in a HIPAA Qualifying Benefit at the time the triggering event took place.

On a monthly basis, the Dependents Losing Coverage (HB07000M) procedure should be executed to create HIPAA Triggers for any dependents who will soon reach the COBRA Age Limit for creditable coverage. If your site participates in COBRA, this procedure should already be a part of your Monthly processing.  HIPAA Triggers will be created based upon the same Age Limit and ‘Tickler Days’ currently identified in the HB07000M job.

The COBRA Coverage Ending – HIPAA Program (HH07100M) procedure should be added as part of your Monthly processing. This batch job creates HIPAA Triggers for any employees currently enrolled in COBRA whose COBRA Coverage will soon be coming to an end. HIPAA Triggers will be created for all employees currently enrolled in COBRA whose coverage will be ending or has ended during the range of dates provided in the job setup.