Benefit Exceptions

An employee can opt to enroll for, and claim a particular benefit. Enrollments and claims are time bound, and there is a chance that one of the following instances may occur:

● Employee misses the time limit (Claims and Enrolment)

● New hire of employees after the enrollment window has closed

● Change in the employee's grade/job level which makes him eligible for a benefit, and which can be enrolled.

To enable such enrollments and claims after the deadline is over, the administrator should have the capability of providing an exception to employees and opening the system for them to enroll or claim for a fixed period.

You can grant the exception to an employee in the following scenarios:

● Enrollment – Some benefits require an employee to enroll in to a benefit in order to avail it. Due to some reason if the enrollment window is closed, as an exception, the system opens an enrollment window for the employee to enroll.

The system allows the admin to provide an exception to the user for an enrollment period of a particular benefit, even when there is a new enrollment period open for the same benefit at the same time.

For example, in case of yearly enrollments, consider the scenario:

2015 enrollments are ongoing. For 2016 enrollments, the benefit enrollment window ends in November 2015.

Consider some new hires in November 2015. These employees should be able to do the following:

○ Enroll for 2016 benefit enrollment

○ Enroll for 2015 ongoing benefit enrollment via exceptions

If the enrolment period for a benefit ends in November 2015. And the enrolment period for the same benefit for the next year is open. In this case, if an employee needs to enroll for the closed period, the admin can give exceptions.

● Adjustment Amount – An employee can have a change in eligible amount for a particular claim / enrollment. In this case, the adjustment amount will be added/deducted to the entitlement amount.

5.11.1 Create Benefit Exception

This section explains the handling of exceptions which you must grant to an employee, in case of Enrollments and Claims.

To configure the benefit exception in your system, perform the following steps:

1. In Admin Center, search Benefits Admin Overview. System opens the Benefits Admin Overview screen. Select Create New - Benefit Exception.

2. Enter the data in the following fields:

○ Worker ID: Enter the employee's ID for whom you want to grant the exception.

○ Exception For: Select the category for which you want to grant the exception. You can either select Enrollment or Claim.

○ New Exception Window Required: Select either Yes or No.

If you select Yes, the system displays two additional fields, Exception Start Date and Exception End Date that you must maintain. In this case the exception given to benefit is valid only during this period.

If you select No, the system calculates the exception based on the existing benefit schedule.

Note

Currently the system displays this field only if you have selected Enrollment in Exception Category field.

○ Exception Start Date: Specify the date from which the exception will be valid for enrolling in a particular benefit program or benefit.

○ Exception End Date: Specify the date until which the exception is valid for enrolling in a particular benefit program or benefit.

○ Benefit Program Exception Details: Maintain the relevant exception details for the benefit program . This section is displayed only if you have select Enrollment in Exception Category field.

○ Benefit Program: Specify the Benefit program for which you want to open an enrollment window through exceptions for the employee to enroll.

○ Relevant for Benefit Period: Select the relevant schedule. This field displays all the existing schedule(s) for the corresponding benefit.

In case you are giving exception for a enrollment period, enter the period for which enrollment window has lapsed

In case you are giving exception only for the amount,enter the existing benefit period

○ Selected Period : Displays the schedule that you have selected in Relevant for Benefit Period field.

○ Adjustment Amount: Specify the amount that you want to adjust against the program entitlement amount.

You maintain this field in case an employee is eligible for a special entitlement amount or proration. Based on the adjustment that you want, you must either enter a positive value or a negative value.

In case you enter a positive value, the system adds this value to the entitlement amount for the employee.

In case you enter a negative value, the system deducts this value from the entitlement amount for the employee.

○ Benefit Exception Details – Maintain the relevant exception details for the benefit such as:

○ Benefit: Specify the Benefit for which you want to open an enrollment window through exceptions for the employee to enroll.

○ Lapsed Period or Ongoing Period: Enter the required period.

In case of enrollment, enter the lapsed enrollment window period for which the exception is given.

In case of claim enter the period for which you want to adjust the claim amount.

○ Adjustment Amount: Specify the amount that you want to adjust against the entitlement amount for the benefit.

For example, consider an employee, Carla Grant, joins the organization in the month of July, and wants to avail Meal Allowance benefit. All the employees of the organization are entitled for 12000 INR worth meal coupons annually. Since Carla Grant joined the organization mid-year, she is not eligible for the full entitlement amount. Based on the pro rata basis, her eligible entitlement amount is 6000 INR instead of 12000 INR. To make this adjustment to the entitlement amount of Carla Grant, you must enter -6000 value in this field.

You maintain this field in case an employee is eligible for a special entitlement amount or proration. Based on the adjustment that you want, you must either enter a positive value or a negative value. In case you enter a positive value, the system adds this value to the employee's entitlement amount. In case you enter a negative value, the system deducts this value from the employee's entitlement amount.

Note

In addition to the standard workflow for benefits and claims, you also have the option to create and associate an exception workflow. For further information refer To associate the workflow with a exception scenario section in Set up and Associate Workflow.

Related Information

Set up and Associate Workflow [page 36]