Adding a Medical Plan
Article on what information and steps are required in adding a medical plan in iSolved
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When adding a medical plan, there is some required information to set the plan up correctly and to generate accurate deductions. This article will walk you through the steps of providing the necessary information needed to add a medical plan in iSolved.
Basic Plan Information
- Is the medical benefit pre-tax or post-tax?
- What is the plan name?
- What company is the provider?
- Is there a plan ID number (primarily used for carrier feed integration)?
- Is this plan COBRA eligible?
- Is your plan considered Creditable Coverage?
- Does this plan include RX Coverage?
- Is this plan self-funded?
- Is this plan considered a conditional offer of coverage for the spouse?
- Does this plan qualify as ACA Minimum Essential Coverage?
- Does this plan qualify as ACA Minimum Value?
- Is proof of insurability required?
Dates and Schedule
- When does the plan start?
- Are deductions pulled based on the pay date or the pay period end date?
- Is there a new hire probationary period? ex. First Day of the Month Following 30 Days After the Hire Date
- If an employee is terminated, when does this benefit end for them? ex. Last Day of Employment
Pay Items and Eligibility
- Is there an employer contribution to the plan?
- Do these deductions or employer contributions need to be mapped to a specific GL account for reporting purposes?
- Is a primary care physician required to enroll in the plan?
- Do dependents age out of the plan?
- When is age measured? ex. Age as First of the Month Following Birthday; As of Jan 1; As of Beginning of Plan Year
- When do they age out?
- When do they age out if they are a full-time student?
- Who is eligible for this benefit plan? ex. All Full-Time Internal Employees
- Is this plan dependent upon the employee being enrolled or not enrolled in another benefit plan?
- Would you like the system to automatically calculate the employee and employer contributions?
- You will need to provide a rate table: Common Rate Structure for Medical Plans
- Would you like to use an external party to calculate the employee and employer contributions?
- You will need to provide import files with this information, manually enter rates on the employee's record, or keep track of them some other way