Eligibility
Determines who can get insurance?
What is Eligibility?
This type of class might affect the premium rates on the policy if the following were altered: benefit amounts, age reductions, or contributions
What is a Rating Class?
This is the amount of time an employee must wait before benefits begin.
What is a Waiting Period?
These should always be written as “Month DD, YYYY” when they appear in Class Titles.
What are dates?
This is what QPS stands for.
What is Quote and Policy System?
“All Full-Time United States Employees working in the United States scheduled to work at least 30 hours per week.”
What is the Eligibility definition?
During implementation, you discover that executives won’t have a waiting period, but all other employees will have a ‘first of the month following 30 days’. This may indicate that you need to do this.
What is create/add additional classes?
Waiting Periods are generally calculated from the employee's Date of Hire or from this event
What is the date the employee moves into a benefits-eligible class?
Class titles cannot use abbreviations such as “VP,” “Mgr,” or “Dir.” Instead, these should be used.
What are the spelled-out titles?
QPS is the system used to do this with new policies.
What is generate new policies & being the system of record or Source of Truth?
When determining Eligibility, you can use scheduled hours, but you should not use this type of hours.
What are annual hours?
This type of class would not affect the premium rates on the policy if the following were altered: Eligibility, Waiting Period and Earnings definition.
What is an Admin Class?
30-day Waiting Period
the Date of Hire counts as one of the calendar days.
If the employee is hired October 1, the employees effective date for coverage is
What is October 31st
Which of these is an acceptable Class Title?
A. All Eligible Mgrs
B. All Eligible Management and above
C. All Eligible Hourly Employees
D. All Eligible VPs
What is C — All Eligible Hourly Employees?
This is where the most senior or highest responsibility job title is listed first.
What is hierarchy?
Eligibility can be written for employees in these two countries. Special ex-pat language may allow U.S. employees to be covered while temporarily working elsewhere.
What are the United States and Canada?
This is a category of employees who are grouped together as they receive a more generous Life benefit than the newly hired employees, who will only ever be eligible for a lesser benefit.
What is a closed class?
This Waiting Period provision means that if the specified calendar day lands on the first of the month, the employee becomes eligible that day rather than waiting until the following month.
What is “coincident with current month”?
A client asks for a Class Title based on employees earning at least $50,000 but less than $100,000 annually. This is an example of a class based on this variable.
What are annual earnings?
When you encounter a client scenario you're unsure how to handle, this resource should be used.
What is the Kiwi?
An employer wants to offer STD to Executives but not to other employee groups. This type of Eligibility provision may be used to identify the specific group receiving coverage.
What is a carve-out?
These are the three levels shown in the QPS class hierarchy, starting with the highest level.
What are Rating Group, Rating Class and Admin Class?
‘first of the month coincident with or next following 30 days’ Waiting Period
An employee is hired October 3. Under the coincident with current month provision, the effective date is November 1. Without that provision, the effective date is this.
What is December 1?
A client requests a Class Title that doesn't fit the normal supported formats, and you're unsure whether it can be supported.This team should be consulted.
What is Special Language?
Before trying to create your own solution for an unusual Eligibility or Class request, these resources/teams may need to be consulted.
What are the Job Aid, Collogues, Special Language and/or Underwriting?