Using Coverage Associations to Show Employees the Plans They’re Actually Eligible For

Did you know Vista has a tool you can use to show employees only the plans they’re actually eligible for based on their contacts? In the 2014 Summer Release, PDS introduced Coverage Associations. Coverage Associations allow you to define Coverage Types (specific dependent combinations) and enforce eligibility based on those types. For example, if your Family Coverage Type requires a spouse and at least one child, associates who only have a spouse in their contacts list won’t be eligible for plans with the Family Coverage Type.

Nelnet was eager to explore this tool to make the open enrollment process simpler for both our associates and benefits team. Refining the list of available plan options makes Open Enrollment choices easier for our associates since they no longer have the “clutter” of plan options that don’t apply to them. Our benefits team has been able to eliminate several audit reports (and the resulting corrections) that evaluated whether the dependents enrolled in a plan matched the plan type during our open enrollment process. We’re looking forward to using the Current Benefits Enrollment wizard when we apply the latest PTF so coverage associations will keep those enrollments cleaner, too. And with ACA reporting coming up, we’ll take all the help we can get to keep benefits and dependent records clean!

If you’d like to simplify your process with Coverage Associations, there are a few things you should plan before beginning your setup in Vista.

1. What person types do you need? You’ve probably already defined your person types. These are the options in the “Relationship” section of the Contacts page. Review how these relate to your plans. Do you need to make any special distinctions like domestic partner vs. spouse?

2. What association groups do you need? Association groups allow you to combine different person types into a single category. Do you have “child,” “step child,” and “handicapped adult child” person types that can all be considered children on your plans? You can create an association group to work with them as a single entity.

3. What coverage types do you need? Each coverage type is a unique combination of dependents. A family coverage type might require a Spouse person type and a Child association group while a domestic partner coverage type would require only a Domestic Partner person type. Define your combinations and the person types/association groups needed for each.

Once you’ve defined your Coverage Association needs, you can begin your Vista setup. The “2014 Summer Release System Enhancements” document includes setup instructions, so I won’t reinvent that particular wheel.

These additional tips are based on some of the “aha” moments we had while completing Nelnet’s setup.

Know When to Use Individual Rules and Group Rules

You can create Coverage Associations using Individual association types (based on person type) or Group association types (based on your association groups). In some cases you’ll want to use both.

For our family plan, we needed to specify that there must be only one spouse/common law spouse and additional dependents that could fall under several person types. To do this, we used both an individual association rule and a group association rule.

The individual association rule sets up the requirement for one spouse or common law spouse:

Then we flagged the person types that could be included in the family plan as part of our Family group association (shown by the “F” in the Assocgroup Code column):

By creating a Family group association, we could create a group association rule that looks at all these person types. Since our family plan requires a spouse and at least one child, our group association rule requires that the associate have two or more contacts with the person types included in the Family group association:

By combining the individual rule with the group rule, we ensure that an associate with a spouse and child in their contact list will be eligible for the Family plan. However, an associate with two child contacts would not be eligible. While they would meet the group rule requirement, they do not meet the individual rule requirement.

Know When Not to Flag “Enforce Eligibility for Dependent Associations”

As we started working on Coverage Associations we got in the mindset of finding the right combination for all our plan options. But we had a hard time getting our Employee Only option to work. After several different rule configurations, we remembered that once an associate meets the basic plan eligibility rules they should always be eligible for the Employee Only option regardless of their contact list. So we didn’t need to activate Coverage Associations on that plan option!

Double (or even triple!) Check Your Testing Statement

If a plan should be available for an associate and isn’t in the eligible plans, start by taking a look at your testing statement. Each rule’s testing statement has three parts.

The Combine part establishes whether all rules must be true, whether any (at least one) must be true, or whether none must be true.

The Operator part is the evaluation of the count.

This is where we tended to find mistakes. Consider our family plan group rule above; the number of contacts who would be in the Family group association must be “Greater Than or Equal to” 2. So an associate with a spouse and child would be eligible.

However, if you change the rule to “Greater Than” 2, that same associate is no longer eligible.

Finally, make sure the Count is correct. It’s easy to hit neighboring keys and suddenly a requirement for 1 spouse becomes a requirement for 12.

Don’t Forget to Run Benefits Processing

In order for an associate’s eligibility to update after changes are made to either the Coverage Associations or Contacts, Benefits Processing must be run.

This is especially important if you allow associates to edit their Contacts or use the Dependents/Beneficiaries dialog box (EWZ Validate Dependents) at the beginning of your enrollment wizard.

Fortunately, there is a database option you can use to automatically run Benefits Processing when the Contacts page is changed. You can set “contact benelig mode” so Benefits Processing always runs (A), or runs only if there is a plan flagged to “Enforce Eligibility for Dependent Associations” (D).

Nelnet set up our Coverage Associations for Open Enrollment last fall. At that time, we only flagged “Enforce Eligibility…” on our Open plans. This enforced the new rules for open enrollment elections without affecting our Current plans. When we copied Open to Current, the flags went into effect for the 2015 plan year. This approach made a very easy transition into using Coverage Associations.

And, even though no one specifically said, “Thanks for getting rid of those extra plans,” we definitely had fewer questions and corrections during open enrollment, which is our favorite sort of feedback!

Gretchen Schmidt
Sr. Payroll and Benefits Specialist
Nelnet, Inc