Coverage code and Coverage group code in PeopleSoft Benefits

Coverage code and Coverage group code in PeopleSoft Benefits

Coverage code

coverage code that defines who can be covered by a benefit, use the Health Coverage Codes (COVERAGE_CODES) component.

You define and manage coverage codes for your benefit programs using the Coverage Code table. You will attach these coverage codes to your benefit plan options on the Benefit Program table.

PeopleSoft Manage Base Benefits delivers nine basic coverage codes for which you define a minimum and maximum allowable for each eligible covered person type. These delivered coverage codes are described in this table:

You should create a new Coverage Code or modify your existing Coverage codes as appropriate to include the Covered Person type of Adult Child.

COBRA Coverage Set

A 2-character code that is used to group coverage codes together for COBRA eligibility purposes. When an individual experiences a COBRA event, the system must adjust the range of coverage codes available to each qualified beneficiary. By restricting itself to a specific set of coverage codes, COBRA processing can more accurately determine which benefit options to present to a participant who is eligible for COBRA coverage. If COBRA coverage sets are not established, then COBRA processing may encounter multiple equivalent coverage codes, and eligibility determination may fail.

Understanding Coverage Group Codes

Life insurance and accidental death and dismemberment (AD/D) plans use coverage group codes to establish the maximum lifetime coverage allowed.

For example, if you define a coverage group code with a 500,000 USD maximum, then enter that coverage group code for a supplemental life plan and a group life plan, and associate both benefit plans with a benefit program. If you were to enroll an employee in both of those plans, the system would ensure that the employee's total coverage by both plans does not exceed 500,000 USD.

If the total coverage for a participant exceeds the coverage maximum, the system reduces the total coverage to meet the coverage maximum. When the system processes the deduction, it accumulates the coverage amounts and begins reducing coverage when the coverage group maximum is reached. The system processes plans in order of deduction priority, and if more than one plan has the same priority, it processes in increasing plan type order.

In this case ABC is the new coverage code with coverage Maximum of 10000000USD.Enter the maximum total life and AD/D coverage.

This amount applies to all the life and AD/D benefit plans that you associate with the coverage group code and that you associate with one benefit program. You connect a life or AD/D plan with a coverage group code using the Life and AD/D Plan table.