Need to Add Dependent(s) to Existing Employee-Only Coverage?
Many clients have recently contacted us to ask how best to add Dependents to a Health Benefit Record. This is usually an uncomplicated task when adding new coverage for both the Employee and the Dependents at the same time. But what should you do when the Employee has already been enrolled for some time, and now wants to add his Dependent(s)?
Let’s use the following scenario as a reference:
Employee 1000 has been enrolled in Self-Only Coverage since July 1, 2018. At your recent Open Enrollment, he added four children to his coverage starting July 1, 2019. The Medical Plan is Self-Insured, and only charges him for three Dependents. The cost for each Dependent is $100.00 per month. The Hour Eligibility Report is run monthly to determine eligibility for coverage.
Let’s take a look at the existing Health Benefit Record first:
Note that his coverage Ending Date has already been updated to 07/31/2019. A quick glance at his 1095-C indicates the months that the Benefit Record shows he was enrolled. See below:
First, we need to enter information for the enrolling Dependents. In the HRM Software, go to the Employee Entry window. Enter the Employee account number, then click on the Dependents tab. Click the Add button to add your first Dependent. The following window will open:
- Enter the First Name of the first child, then press Tab.
- Enter a Middle Initial, if known, or press Tab again.
- The Last Name will auto-populate with the same last name of the employee.
- If this is correct, press Tab again to move to the S. S. #., or correct the Last Name entry.
- If you have the correct S. S. #, enter it now.
- If it is unknown, enter a temporary S. S. #.
- Indicate the Sex.
- Enter the Date of Birth.
- Indicate the Relationship of the Dependent to the Employee.
- Finally, select the Insurance checkbox and click Save.
- This popup will ask if you want to add another Dependent:
Click Yes and continue entering Dependents until all four children have been added. When you are finished, the list of all four Dependents will appear in the grid.
Now let’s return to the Health Benefits Tab. Remember, we need to correctly indicate on the 1095-C which month(s) the Employee and his Dependents receive coverage. To do this we will first edit the existing Health Benefit record. Since the Dependents will begin coverage on 07/01/2019, we will change the Ending Date for the Employee-Only Coverage to 06/30/2019. We will also deselect the Active checkbox. The record should now look like this:
Now we will Save this record and Add a new record. In the new record, use the Select Plan button to choose the same Medical Plan. Enter the 07/01/2019 Starting Date and 07/31/2019 Ending Date of coverage. Now select the Children Insured checkbox. Notice the Depend Cost is only $300.00 per month, even though four children are being covered.
You should now ensure that the Dependents are enrolled through the preferred method of your Carrier or Third-Party Administrator (TPA.) If you generate an electronic enrollment file within the HRM Software and then upload it to the Carrier or TPA, the Dependent information is automatically included in the file.
If we assume that the Employee continues to work Full Time hours of service for the remainder of the Plan Year, his coverage Ending Date will continue to move forward when the Hour Eligibility Report is used. At the end of the calendar year, Part III of the 1095-C will now correctly indicate which month(s) the Employee and his Dependents received coverage.
Note: Part III of the 1095-C is only completed when the employee is enrolled in a Self-Insured plan.
These instructions are provided with the understanding that you are using best practices in your HRM Software operations. If you operate under a different scenario than what is explained above and are unsure how these instructions apply, please contact Datatech Support for assistance.
Phone: (800) 833-8824 Email: email@example.com