Benefits Management App Overview

Benefits Management

1. What it is

Benefits Management lets you create benefit plans, run enrollment periods, process qualifying life events, administer COBRA continuation coverage, track ACA hours, and transmit enrollment data to carriers — all from one app.

• Enablement: requires a license. An administrator enables it from Admin → Apps → All Apps; it is off by default.
• What it is not: Benefits Management does not maintain its own employee roster. It reads the same employee record the rest of the platform uses. A deactivation or employment-status change ends enrollments automatically on each plan’s coverage-end rule.

2. Standing it up

1. Go to Admin → Apps → All Apps and enable Benefits Management. This creates the app tile and the admin tabs.
2. Go to Benefits Management → Plans and create at least one benefit plan. Choose a category (Medical, Dental, Vision, Retirement, FSA, HSA, Life, Disability, Supplemental, or Other), how it is priced (One price for everyone, A price per person covered, or A price per coverage level), and set the monthly costs. A plan with no cost fields is valid but will show $0 to employees.
3. Go to Benefits Management → Enrollment Periods and create an Open Enrollment period with a start date, end date, and the plans it covers. The period must be active and within its date window before employees can enroll.
4. (Optional) Go to Benefits Management → Settings → Enrollment Settings to require approval of elections or configure the plan year, and to Benefits Management → Settings → Automation to enable election rollover.
5. (Optional) Go to Benefits Management → Plans → open a plan → Manage → Eligibility Rules to restrict a plan to employees who match criteria such as employment type, tenure, department, location, or role. With no rules, every active employee is eligible.
6. Confirm it worked: employees with access to the app see My Benefits, the current enrollment period, and the plans they are eligible for. Admins see enrollment counts on the Plans page.

Silent-until-paired: a plan with eligibility rules does nothing until you also create an enrollment period that includes that plan. The plan exists, the rules pass, but employees cannot act on it without an open window.

3. How it fits together

Plans are the core record. Each plan belongs to a category, a plan year, and a pricing model. Plans can be active or inactive; only active plans appear during enrollment. A plan with enrollments cannot be deleted — deactivate it instead.

Enrollment periods are the windows during which employees can make elections. Three types exist:

• Open Enrollment — company-wide, with a start and end date. When activated inside its window, an announcement email goes out to all employees.
• New Hire — opened for a specific employee. The default enrollment window is 30 days from the hire date.
• Qualifying Event — opened for one employee after a life event is approved.

An enrollment period can be restricted to a subset of plans. An empty eligible-plans list means every active plan is available.

Enrollments connect an employee to a plan. Each enrollment carries a status: Eligible, Pending Approval, Enrolled, Not approved (an approver turned the election down; the employee can re-elect while the window is open), Waived, or Terminated. An employee cannot have two active enrollments on the same plan. Per-member elections let the employee cover themselves, one or more dependents, or both — but not nobody (waivers are the explicit “none” path).

Worked example: an admin creates a plan “Comprehensive Health 2026” (Medical, priced as “A price per person covered”, plan year 2026) with monthly costs of $150 employee / $450 employer / $80 spouse / $60 child. They create a “2026 Open Enrollment” period running November 1–30 that covers this plan. An employee opens My Benefits during that window, sees the plan and per-member cost breakdown, and enrolls with spouse coverage. The enrollment records $150 + $80 = $230 employee cost and $450 employer cost. A plan priced as “A price per coverage level” works differently: it charges the one rate set for the level chosen (Employee only, Employee + Spouse, Employee + Child(ren), or Employee + Family), with nothing added per person.

Dependents are people an employee covers: Spouse, Domestic Partner, Child, Stepchild, or Other. A dependent starts as Pending when their relationship type requires verification (then Verified or Rejected), otherwise Verified, and can have documents attached. Required documents are configured per relationship type — for example, a spouse requires a marriage certificate, while a child requires a birth certificate. The default dependent age limit is 26, matching the ACA standard.

Beneficiaries are named by the employee under My Benefits → My Beneficiaries. A beneficiary can be linked to one plan or to all eligible plans. The system sends a reminder to life, disability and supplemental enrollees who have not designated one.

Life events let employees change coverage mid-year. Supported events: Marriage, Divorce, Birth, Adoption, Death, Loss of Coverage, and Other. Each event type has a policy that sets whether documentation is required and how many days the enrollment window stays open, counted from the event date (30 days for most events, 60 for loss of coverage — or the filing limit under Settings → Enrollment Settings → How late a life event may be reported, when that is longer). An approved life event opens a special enrollment period for that employee.

Approval routing is optional. When enabled, enrollment elections go to an assigned approver before taking effect. Routing can be global (one approver for all), by org unit, or by plan type. If no approver is configured for the relevant route, the enrollment auto-approves and is listed under Admin → AI Operations → Action History. The default approval SLA is 48 hours, with auto-escalation at 72 hours.

4. Running it

Reviewing and approving enrollments

1. Go to Benefits Management → Approvals. Pending enrollments show the employee, plan, coverage level, and cost.
2. Approve or reject the enrollment. On approval the status changes to Enrolled and the employee is notified. On rejection the employee receives the rejection reason.

Processing a qualifying life event

1. An employee submits a life event from My Benefits → Life Events, attaching documentation if the event type requires it.
2. The admin reviews the event at Benefits Management → Enrollments → Life Events. Approve to open a special enrollment window, or reject with a reason.
3. No life event an employee reports auto-approves by default (the app itself records an approved “Other” event when HR changes an employee’s employment status). To approve some types without review, pick them under Settings → Enrollment Settings → Auto-approve these life event types.

Administering COBRA

1. Go to Benefits Management → Enrollments → COBRA Administration. Eligible participants can be auto-detected from offboarding or added manually.
2. Select the participant, choose one or more benefit plans, and optionally send the initial-rights notice on creation.
3. From the participant page: generate and send notices (initial rights, election form, payment due, payment overdue, termination), record payments, and review the audit log.
4. The administrative fee surcharge defaults to 2% and is clamped to the federal 0–2% range.
5. COBRA file downloads (audit CSV/PDF and notice PDFs) require identity re-verification because they contain PII.

Running ACA compliance

1. Go to Benefits Management → Reports → ACA Tracking. Hours are tracked per employee per month.
2. The app detects full-time status based on a configurable threshold (default 130 hours per month).
3. Go to Benefits Management → Reports → ACA Forms to generate employee 1095-C forms for a tax year. Forms are produced as PDFs. Use Bulk Download to download all completed forms as a zip file.
4. 1095-C downloads also require identity re-verification (they contain SSNs).

Transmitting to carriers

1. Go to Benefits Management → Settings → Carrier Connections and create a connection. Choose 834 EDI or CSV as the connection type, map your plans, and configure SFTP credentials through an integration provider.
2. From the connection page, use Transmit Now to send the current enrollment file. Each transmission is logged with a success rate.

Generating reports

Reports are available at Benefits Management → Reports for enrollment, cost, compliance, and census data. Each report can be exported as CSV or PDF. PII-bearing exports (census, enrollment, and payroll reports) require identity re-verification; the cost report does not, because its rows are per-plan aggregates.

A carrier-ready census export with reorderable columns is available separately. Payroll deduction exports include pre-tax/post-tax treatment by category.

Scheduled reports can be configured at Benefits Management → Settings → Scheduled Reports with daily, weekly, or monthly frequency.

Setting up plans with AI document parsing

When creating a plan, upload a carrier document (PDF, DOCX, or image up to 20 MB). The AI parser extracts text and returns suggested values for the plan name, category, provider, coverage type, and monthly cost tiers. Review and adjust the suggestions before saving — nothing is written until you confirm.

5. Settings

Settings are organized across six pages under Benefits Management → Settings.

Setting	Page	Default	What it changes
Require approval of elections	Enrollment	Off	When on, elections employees make themselves wait for their assigned approver before taking effect
Allow mid-year changes	Enrollment	Off	When on, employees can change coverage level outside an enrollment period or life event window
Plan year start month	Enrollment	January	The month that defines the start of the plan year
How late a life event may be reported	Enrollment	30 days	An employee cannot report a life event whose date is older than this; the enrollment window itself runs from the event date
New hire enrollment window	Enrollment	30 days	How many days from hire date a new hire can enroll
Eligibility waiting period	Employees	60 days	How many days a new employee waits before becoming eligible
Dependent age limit	Employees	26	Age limit for child and stepchild dependents. The employee is sent a notice about six months before a child or stepchild reaches it; coverage is not removed automatically
Allowed relationship types	Employees	All on, verification required	For each relationship (Spouse, Child, Domestic Partner, Stepchild, Other): whether employees can add it, and whether it requires document verification
Benefits notifications (email and in-app)	Notifications	On	Master switch: turning it off stops every benefits email and in-app notification except COBRA notices. COBRA notices are not stopped by this switch; each automated COBRA reminder has its own switch under COBRA Notifications on the same tab. The Inbox asks for life events and overdue approvals still arrive
COBRA administrative fee	Compliance	2%	Surcharge applied to COBRA premiums (clamped to federal 0–2% cap)
ACA tracking enabled	Compliance	Off	Enables per-employee monthly hours tracking and full-time detection
ACA affordability safe harbor	Compliance	Rate of pay	Method used for the ACA affordability calculation. Rate of pay is the only affordability safe harbor the app computes today.
Auto-rollover elections	Automation	Off	Whether unchanged elections carry forward when a new open-enrollment period is activated
Plan comparison tool	Automation	On	Whether employees see a side-by-side plan comparison during enrollment
Approval routing mode	Advanced	Global	How enrollment approvals are routed (Global, By org unit, or By plan type)
Approval SLA	Advanced	48 hours	Hours before an unanswered approval triggers a warning
Escalation Trigger (Hours)	Advanced	72 hours	Hours before an unanswered approval auto-escalates
Data export enabled	Advanced	On	Whether reports can be exported as CSV/PDF
Enable Scheduled Reports	Automation	On	Whether automated report delivery is available
Enable Benefits Agent	Advanced	On	Whether the Benefits Agent in Ask AI can answer benefits questions and elect or decline coverage for the asker (it asks them to confirm first)

6. More help

• Benefits Management FAQ — specific setup, operating, and troubleshooting questions
• Ask AI — the assistant answers questions about Benefits Management from these articles.