Benefits Management FAQ
Answers to common setup and operating questions about Benefits Management.
For what the app is and how to set it up from scratch, see the
Benefits Management Overview.
Setup
Do I have to create an enrollment period before employees can enroll?
Yes. Employees can only submit elections during an active enrollment period. Three types exist: Open Enrollment, New Hire, and Qualifying Event. Open Enrollment and Qualifying Event periods require a start and end date. Without at least one active period, the enrollment form does not appear for employees.
What roles can manage plans, periods, and settings?
Admin, Super Admin, and anyone assigned as a Benefits Management app admin can access the admin-side screens (plans, enrollment periods, COBRA, ACA, settings). Managers can view their direct reports’ enrollment summaries under the Team tab. All other employees see only their own benefits in the My Benefits tab.
What happens if I turn on approval routing but have no approvers assigned?
The enrollment auto-approves and moves straight to Enrolled. Each election approved this way, without a reviewer, is listed under Admin → AI Operations → Action History. To avoid this, assign at least one approver under Benefits > Approvals > Assign Approvers before enabling approval routing.
Permissions and access
Why can’t an employee see any plans to enroll in?
Three things must all be true: the app must be enabled for your business, an active enrollment period must exist that covers today’s date (or targets that employee for a new-hire or qualifying-event window), and the employee must pass every eligibility rule attached to the plan. Eligibility rules can filter by employment type, tenure, hours worked, location, role, department, age, job title, or pay grade. If any single rule fails, that plan is hidden from the employee.
My manager says they can’t see the Team tab — what do I check?
The Team tab requires the Manager or above role. Verify the manager’s role in admin user settings. App-admin status alone does not grant the Team tab; the role must be Manager, Admin, or Super Admin.
Day-to-day
How do employees compare plans during open enrollment?
Employees open Compare Plans in the app’s menu — it is shown while Settings → Automation → Show Enrollment Comparison Tool is on — and see the plans they pick side by side with per-plan costs. For plans with a price per coverage level, it lists each level’s monthly price for them (Employee only, Employee + Spouse, Employee + Child(ren), Employee + Family); for plans with a price per person covered, it shows what the employee alone pays, and each covered dependent adds their own rate. To enroll, the employee presses View Details on a plan and then Enroll while an enrollment window is open to them. If approval routing is enabled, the election moves to Pending Approval until an approver acts.
What is election rollover, and how do I enable it?
Election rollover carries forward an employee’s current elections into a new open-enrollment period so they do not start from scratch. Enable it under Settings by turning on Auto-rollover elections. When a new open-enrollment period is activated, the system copies enrolled elections from the most recent prior open-enrollment period onto the plans the new period offers — the plan of the same name, else the closest-priced plan of the same kind. An election of a kind the new period offers no plan for is not rolled: it stays as it is, the rollover report to the admin who activated the period names the employee, and — when rollover notices are on — the employee is told to ask you what happens to that coverage. Dependents carry forward if Pre-populate dependents is also on.
What happens when an employee submits a qualifying life event?
The employee picks an event type (marriage, divorce, birth, adoption, death, or loss of coverage), enters the event date, and uploads any required documentation. The event waits for an admin to review it unless its type is one you picked under Settings → Enrollment Settings → Auto-approve these life event types (none by default). On approval, a special enrollment window opens. The window runs from the event date — 30 days for most events, 60 for loss of coverage — so time spent waiting for approval comes out of it. The employee can then change or add coverage within that window.
How does coverage termination work when an employee leaves?
Each plan has a coverage termination rule. The default is End of month of last day. Other options are Last day worked, End of the following month, N days after last day, and Do not automatically terminate coverage. When an offboarding event occurs, the system calculates the coverage end date using the plan’s rule and the employee’s last day. An election whose coverage has not started yet is cancelled instead of terminated, and shows as Cancelled.
I changed the approval SLA — does it affect pending approvals?
No. The SLA and escalation deadlines are stamped on each approval record when it is created. The default SLA is 48 hours and escalation fires at 72 hours. Changing the setting only affects approvals created after the change.
Dependents and beneficiaries
What is the dependent age limit, and can I change it?
The default dependent age limit is 26 (the ACA standard). Change it under Settings → Employee & Dependent Settings. The employee is sent a notice about six months before a child or stepchild reaches that age. Coverage is not removed automatically, and there is no student or disability exemption setting.
What verification statuses can a dependent have?
A dependent starts as Pending Verification when their relationship type requires verification, otherwise Verified. An admin can move a pending dependent to Verified or Rejected; a dependent nobody has reviewed shows Not reviewed. Dependents waiting on a verification are counted on All Dependents in the admin menu. Each dependent relationship type has its own required-document list — for example, a spouse requires a marriage certificate, a domestic partner requires an affidavit and proof of cohabitation, and a child requires a birth certificate. Verification documents are uploaded as attachments on the dependent record.
COBRA
How is the COBRA administrative fee calculated?
The fee is a percentage of the monthly premium, configurable under Settings > Compliance. The default is 2% and the maximum allowed is 2% (the federal cap for standard COBRA). The fee is computed once at enrollment and locked — changing the company-wide rate later does not retroactively change fees on existing members. An admin can override an individual member’s fee from the member’s page (0% to 2%), and the change cascades to all unpaid future payments.
What is the coverage duration for COBRA?
It depends on the qualifying event type. Termination and reduction in hours receive 18 months. Death, divorce, legal separation, loss of dependent status, and Medicare entitlement receive 36 months. The duration is set automatically when the member’s record is created.
An 18-month period can be extended to 29 months when Social Security determines that a member was disabled at some point in their first 60 days of COBRA coverage. The extension applies to everyone who lost coverage through the same event, so record it for the whole household: open the household from COBRA Administration, choose Extend for Disability (29 Months) from the More actions menu, and enter the date of the Social Security determination, with an optional note. The dialog lists each member and plan it extends, and each one it leaves and why (a 36-month period, coverage that has ended or been declined, one already extended). To extend one record only, use the same action from the More actions menu on the member’s record, or press it on the member’s row on the household page. Record it before the 18 months end. The law expects the member to report the determination within 60 days of it; a later date is still accepted, the dialog warns you, and the history records how many days after the determination it was reported. The new end date is the last day of the 29th month.
The added months (19 to 29) are billed at the plan’s Disability extension rate, a percentage of the plan’s full cost set on the plan’s form under COBRA Continuation: 102% unless you change it, and up to the 150% the law allows. The dialog and the confirmation say the rate and the monthly amount. A member who pays their own premium is billed for the added months at that rate; where one premium covers the household, the added months are billed on that premium. The rate is fixed when the extension is recorded, so changing the plan’s rate later does not re-price an extension already made, and a member’s administrative fee change leaves the added months at their rate. The extension is recorded in the household’s activity. An extension recorded by mistake can be undone with Undo Disability Extension, for the whole household from its More actions menu or for one record in the same places, while the original 18 months are still running and no bill for an added month has been paid, partly paid or otherwise acted on: the end date goes back to the last day of the 18th month and the unpaid bills for the added months are removed.
The months are counted from the day the member loses coverage under the plan, not from the qualifying event, and coverage ends on the last day of the final month. For example, if an employee leaves on March 10 and the plan covers them to the end of March, coverage is lost on April 1 and 18 months of COBRA run through September 30 of the following year. A household that was already set up before this rule keeps the end date it was given.
How does the COBRA payment schedule work?
When a member’s status changes to Enrolled, the system generates one payment record per month from the coverage start date through the eligibility end date. Each payment carries the monthly premium plus the administrative fee.
The first payment is due 45 days after the election, and that date is final — there is no grace period for the first payment. This follows the federal rule: a plan may not require the initial premium sooner than 45 days after the election, and the 30-day grace period applies to each payment after it (Treas. Reg. §54.4980B-8, Q&A-5). Months owed for coverage since the qualifying event fall due on the same date and follow the same rule. If the first payment is not received by then, continuation coverage never takes effect.
Every later payment is due on the first of its coverage month, with a 30-day grace period (configurable per member). Payments past the grace period are flagged as overdue.
A payment that is slightly short still settles the bill: if the shortfall across a household’s invoices for one coverage month is no more than the lesser of $50 or 10% of the amount due, the bill is deemed paid in full (Treas. Reg. §54.4980B-8, Q&A-5(d)). The amount forgiven is recorded on the invoice and in the audit trail.
Coverage is not ended the moment a deadline passes. An overdue warning goes out the following morning, and automatic termination for non-payment — when an operator has turned it on — waits five days after the deadline so a payment already in the post can still arrive. An administrator can end coverage for non-payment by hand at any point after the deadline.
When something looks wrong
“I enrolled but my coverage hasn’t started”
If approval routing is turned on, the enrollment sits in Pending Approval status until an approver acts. Check Benefits Management → Approvals → Enrollment Approvals. If no approvers are assigned, the enrollment should have auto-approved — look in Admin → AI Operations → Action History, where each election approved without a reviewer is listed. If approval is not required, verify the enrollment’s effective date; it may be set to First of next month or the plan-year start date rather than today.
“My cost looks wrong on my enrollment”
For one-price plans the cost is the plan’s price (an election made before the plan’s price last changed keeps the price it was made at until the price is next saved). For plans with a price per coverage level, the cost is the rate for the level chosen; for plans with a price per person covered, it is the employee’s rate plus each covered dependent’s. Whenever you save a changed price — the plan’s price on the plan form, a tier on the plan form, a rate in the Rate table, or converting a plan to per-person pricing — every election on the plan whose coverage has not ended is re-priced at once, you are told how many changed, and each employee whose own cost changed is sent their old and new amount, as their notification settings allow (nobody is told when cost-change notices are off in Settings, or about a sample plan). Removing or switching off the only rate someone is priced on, changing a rate’s tier or age band so it no longer fits them, leaving a covered dependent with no matching rate, or saving a one-price plan with no price, is refused. Switching the pricing model on the plan form does not re-price anyone until a price is next edited. No screen edits one election’s cost on its own.
“I submitted a life event but nothing happened”
Unless its type is one you auto-approve, the event waits in Pending Review status for an admin to review it under Benefits Management → Enrollments → Life Events. Once approved, the special enrollment window opens and the employee can change coverage. An event older than the filing limit (Settings → Enrollment Settings → How late a life event may be reported, 30 days by default) is refused when the employee submits it; raise that limit (up to 90 days) so they can submit it — raising it also lengthens every life event’s enrollment window to at least that many days — or have an admin make the coverage change for them under Enrollments → Manage Enrollments → Manage Coverage.
ACA and carrier connections
How does ACA hours tracking determine full-time status?
The system tracks hours worked plus PTO hours per employee per month, if both toggles are on in Settings. An employee is flagged as full-time when their total hours meet or exceed 130 hours per month (the configurable ACA threshold). Rate of pay is the only affordability safe harbor the app computes today; W-2 and Federal Poverty Line are shown in Settings as not yet supported.
Can carrier transmissions run on a schedule?
You can configure a schedule (manual, daily, weekly, monthly, or real-time) on each carrier connection, but only the manual option — the “Transmit Now” button — actually sends a file today. Scheduled automatic transmission is not yet implemented. Connection types are 834 EDI and CSV, and both send the same X12 834 file today — a separate CSV layout is not built yet. API connections are not available yet.
Licensing and limits
Does Benefits Management require a licence?
Yes. It is disabled by default and an administrator must enable it from Admin → Apps → All Apps. Benefits Management is part of the HR Operations suite and can also be licensed on its own.
Are there limits I should know about?
| What | Limit |
|---|---|
| AI document parse file size | 20 MB |
| Supported parse formats | PDF, DOCX, PNG, JPEG, WebP |
| Plan categories | Medical, Dental, Vision, Retirement, FSA, HSA, Life, Disability, Supplemental, Other |
| Pricing models | One price for everyone, A price per person covered (optionally by age), A price per coverage level |
| COBRA coverage duration | 18 or 36 months by event type, counted from the loss of coverage and ending on the last day of the final month |
| COBRA administrative fee | 0–2% of premium |
| COBRA first payment deadline | 45 days after enrollment |
| COBRA grace period (default) | 30 days |
| Default dependent age limit | 26 |
| Default eligibility waiting period | 60 days |
| Default new-hire enrollment window | 30 days |
| Life event enrollment window | 30 days from the event date (60 for loss of coverage) |
| Default approval SLA | 48 hours |
| Default escalation deadline | 72 hours |
| ACA full-time threshold (default) | 130 hours/month |
| Approval routing modes | Everyone (default), By department, By plan category |
More help
- Benefits Management Overview
- Ask AI — the assistant answers Benefits Management questions from these articles.