Benefits Terminology

We must understand the basic terminology used in Base Benefits or Ben Admin Setups/Processes before going further in detail. You will come across different terms like Plan Type, Benefit Program, and Benefit Plan etc.

Benefits Terminology:

Benefit Program:

A collection of benefit plans i.e. it contains a set of benefit plans.
Benefit programs are used to group the set of benefit offerings provided to a specific group of employees. For example, you might have one benefit program for hourly employees, another for salaried employees, and a third for executives.


Plan Type:

The first component of the benefit plan is the plan type. They group individual plans or options that may be elected by an employee for a particular type of benefit, such as basic life insurance or medical. Plan types are groupings that allow PeopleSoft to process benefit requests systematically. You use plan types to describe a category of benefits such as health plans, dental plans, savings plans, disability plans and vacation plans;

Plan types are two-character codes that are defined in Translate Table (PSXLATITEM) and PeopleSoft offers a set of predefined benefit plan types. You can change or add new plan types, but do not delete the delivered plan types.

PeopleSoft adds plan types starting from the beginning of the alphabet; you should start with Z and work backward to A.


Benefit Plan

Benefit plans are the benefits you want to offer to your employees. A benefit plan is a code that represents like medical plan, HMO plan, dental plan, life insurance plan, etc. A benefit plan option is a specific benefit option within a plan type.

Benefit plans are associated with benefit programs and can be linked to any number of benefit programs. Each benefit plan has associated costs, calculation rules, and coverage codes. After choosing a plan, employees make additional decisions to determine their coverage. During benefit enrollment, you enter the options that employees select into PeopleSoft.

If your company offers 25 possible PPO or HMO plans, each may require a separate benefit plan code to identify it. Look at the below table:

Event Maintenance:

Before we understand what event maintenance is, we want to know how PeopleSoft defines an event:

A change in employee data within PeopleSoft that may affect an employee’s status. I.e. Events are the changes performed to an employee’s job record that can affect employee benefit options


Three types of events affect Benefits Administration: job events, non-job events, and passive events.

Job events are effective-dated events related to changes in an employee’s job, such as regular/temporary, full/part time status, pay group, employee type, standard hours, hourly rate, and annual rate.

Non-job events are changes in an employee’s personal or demographic information that might affect eligibility or elections. These include a change in marital status, state or postal code, dependent or beneficiary, and union code.

Passive events are based on an employee’s ate of birth or service date. These can be set up to automatically trigger events for Event Maintenance.

Now coming to event maintenance, In order to process changes i.e. different events during the plan year, you need to schedule Event Maintenance at intervals based on your operational requirements.

For example, you might perform Event Maintenance every day, twice a week, or three times a month-whatever you think is necessary. You base your schedule on how frequently you want to process new hires, enrollment changes, and updates of payroll benefit deductions.

Event Maintenance identifies eligible enrollments and defaults for new hires and participants with changes (terminations, transfers, etc.), and calculates prices, credits, and coverage.

So, Event Maintenance is a Process that you use to enroll new employees and to track and react to employee benefit changes during the plan year, such as those resulting from a marriage or termination of employment.

Open Enrollment:

Open Enrollment is the period of time employers set up to allow employees to choose from the plans available to them. I.e. Open enrollment is when employees have the ability to change their plans or coverage level each year.
This time period happens on an annual basis. It’s easiest to coordinate with your providers to make sure that open enrollment for each coverage plan falls at the same time of the year, rather than have different open enrollment times for every plan. Most plan providers won’t let you or your employers make a change unless there’s a qualifying event.
The main qualifying event is defined by the IRS as an event that:

Marriage;
Birth;
Adoption;
Divorce or legal separation;
Death of spouse or dependent.

So, Open Enrollment is a Process that you use to enroll or reenroll participants in appropriate benefit programs and plans during the annual enrollment window (For Example Nov 1, 2009 to Nov 21 2009) during the open season periods for health benefits, life plans, and savings plans.