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Plans & Carriers

Overview:

The Plans & Carriers tab in the Benefits Administration app should be used to reference plan details by carrier & line of coverage. These plan details populate after adding carriers and building plans in the Open Enrollment flow and launching the enrollment event to your company. In this section of the app, Admins and/or Brokers are able to view and/or edit plan & carrier details after Open Enrollment closes. Admins and/or Brokers are able to view the carrier & plan information for past, current, and future enrollments (e.g. plans and carriers for the previous plan year, or pending plan year before the Open Enrollment effective date occurs). Additionally, Admins and/or Brokers are able to access the contribution set-up by clicking the “Contribution” link on the top-right-hand corner of the benefits page.

Plan(s) & Carrier(s):

The carrier details section will list high level information for your carrier & carrier-related plans. All fields that you are able to edit on your carrier are accessible by clicking the pencil icon, on the top right hand corner of the carrier card. All plans for the specified carrier & line of coverage will be listed in the Plans section; in order to make edits to plan details, you must click the “View” button next to the plan in question.

Carrier Section:

  • Line of Coverage & Carrier Name
  • Contract Length
  • Termination Policy
  • Waiting Period
  • Effective & Renewal Date
  • Self-Administered
  • Plan Mapping

Plan(s) Section:

  • Plan Name(s)
  • Plan Type(s)
  • Policy Number(s)
  • Documents
  • Other Details
  • Plan Details

View Plan Details (Medical, Dental, Vision)

Basic Information:

  • Plan Name(s)
  • Policy Number(s)
  • Apply policy number to all plans
  • HSA compatible
  • SBCs
  • Plan State
  • Available Out of State
  • Available States

Plan Design /SBC:

  • In/Out of Network - Individual Deductible (M/D)
  • In/Out of Network - Family Deductible (M/D)
  • In/Out of Network - Pharmacy Deductible (M)
  • In/Out of Network - Individual Out of Pocket Max (M)
  • In/ Out of Network - Family Out of Pocket Max (M)
  • Deductible Included in Out of Pocket Max (M)
  • Deductible Reset Schedule (M)
  • Network of Providers (M)
  • Annual Benefits Maximum (M/D)
  • Lasik (V)
  • Retail Discount Available (V)

*M=Medical, D=Dental, V=Vision

Rates:

  • Rates changes will become effective on the effective date of the plan
  • If your group uses a COBRA partner in Zenefits, the information will be sent to the COBRA TPA.
  • Deduction adjustment notifications will be generated for groups with Zenefits payroll or synced payroll. Payroll reporting will be updated to reflect the corrected deduction and contributions if your group does not use Zenefits payroll or have a payroll sync.

View Plan Details (Life & Disability)

Basic Information:

  • Plan Name
  • Policy Number
  • Apply Policy Number to All Plans (yes/no)
  • SBC
  • EOI

Rates:

  • Age banded rates will be listed in descending order based on the following criteria: Enrollee Type (Employee, Spouse, then Child) and Min/Max Age.
  • Rates changes will become effective on the effective date of the plan
  • Deduction adjustment notifications will be generated for groups with Zenefits payroll or synced payroll. Payroll reporting will be updated to reflect the corrected deduction and contributions if your group does not use Zenefits payroll or have a payroll sync.

Amounts:

Plan amounts relate to the amount of coverage an enrollee is able to elect based on the plan style, enrollee salary, etc. These fields are only editable during Open Enrollment; please reach out to Customer Care if you need to make changes to these fields.

  • Plan Amount Style
  • Incremental Units
  • Plan Min Amount
  • Plan Max Amount (dollar cap)
  • Plan Max Amount (earning multiplier)

Guarantee Issue
Benefits Reduction

Contributions

Contribution schemes are only editable when:

  • The group Open Enrollment window is still open.
    Example: If you launch Open Enrollment for a 4 / 1 /2020 effective date, and all employees are to make elections between 3 / 1 /2020 - 3 /14/2020, the last day the scheme would be editable would be 3 /14/2020.
  • The contribution scheme is “Upcoming” status, meaning that it is a future scheme that will be applied to your new plans & carriers.
    NOTE: If you have multiple carriers and/or effective dates, the Upcoming contribution scheme will also include rules for those existing plans & carriers.
  • The contribution scheme was NOT carried over from your previous plan year.

Once Open Enrollment closes, all changes to the contribution set-up must be directed to Zenefits’ Customer Care team.

Need more information on contribution schemes? Check out our FAQ on the different types of schemes Zenefits supports.

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