How to setup Interim Coverage (Coverage Restriction)

Requirement:
You want to restirct a participant's coverage, in an insurance plan, that can be selected without a certificate. Untill the person provides the certificate you want him/herto receive a restricted coverage (interim).

Navigation:
Plan Enrollment Requirements > General > Plan > Coverage > Coverage Restrictions

Setup:

1. Set the Restrict Change Based On to

• Benefit Restrictions Applies: If the interim is to be setup based on the coverage amount selected
• Option Restrictions Applies: If the interim si to be setup based on the option included in the plan (e.g. cases where coverage is setup as multiple of salary)

2. Set the Change Restrictions to NULL

3. Define the Values based on which the restriction are to be imposed

• No Min check box: Select if there is no minimum for the plan
• Min: Select if you have not selected the no min check box. Enter the min coverage amount that should always be selected
• Min Rule: If the min amount is determined dynamically enter the name of the rule that returns the min amount
• No Max check box: Select if there is no maximum for the plan (very unlikely)
• Max: If you have not selected the No Max check box, enter the max coverage amount that can be selected (without certificate)
• Max Rule: If the max amount is determined dynamically enter the name of the rule that returns the max amount
• Max with Certifications: Enter the max amount that a person can ever select with a certificate.

4. Enter the details in the Interim region

• Assign Code: Controls the interim coverage that is assigned, when a person elects an amount that is more than the max amount defined in step 3.e/3.f. There are various codes available that help's in handling situations where a person is already enrolled in the plan and is increasing coverage or when a person is newly electing the benefits. E.g: If the code selected was Current Same Option in Plan, Same; New, Default. For an existing participant the interim would be same as his previous enrollment. For a new participant the default option would be set as the interim
• Unsuspend Code: Select the code that determines when coverage in the interim plan ends

5. Increases Region: Use only setting up Benefits Restrictions. Applies when an existing participant is increasing coverage

• Max: Control the maximum increase a person can make on his existing coverage. Setting this to 0 would not allow a person to increase coverage
• Max with Certification: Controls the max increase allowed with certification

6. Multiple Increases: Use only if you setting up Options Restrictions. Applies when an existing participant is increasing coverage

• Max: Controls the maximum permitted option levels jump. Level are determined based on the seq in which options are entered in a plan
• Max with Certification: Controls the max option level jump allowed with certification.

This setups can also be made specific to a life events by clicking on the life event button andentering the data on the form. This provides a finer control over interim coverages across life events.