Create Benefit Eligibility Rules

Security: Set Up: Benefits
domain in the Benefits functional area.

Create the condition rules that Workday uses to identify:

An employee's eligibility for a benefit group.

They provide access to benefits for a group of employees. You can have only 1 eligibility rule per benefit group. Membership in a benefit group must be exclusive. Associate each worker with only 1 group based on eligibility criteria. Otherwise, Workday can't determine which benefit plans, coverage options, and event rules apply to that worker during enrollment events.

An employee's eligibility for a benefit plan.

Target specific benefit plans to a subpopulation within a larger benefit group.

A dependent's eligibility for benefits.

Employees you must evaluate for participation in the Affordable Care Act (ACA).

Example: You can create a medical EPO plan for members of the Salaried Employees benefits group. At the plan level, you can define a worker eligibility rule to limit enrollment to residents of California. You can also use a dependent eligibility rule to limit dependent coverage to children under age 26.

Access the

Create Benefit Eligibility Rule

task.

As you complete the task, consider:

Option	Description
And/Or	When 2 or more logical statements exist, set the And or Or option to control how the statements interact with each other. For the expression to be true: All conditions in an expression connected by And must be true. At least 1 of the conditions in an expression connected by Or must be true.
(	If you want to group 1 or more logical statements together, use the left-hand parentheses to indicate the beginning of the grouping.
Source External Field or Condition Rule	You can select from delivered Workday sources or from condition rules that you've already defined.
Relational Operator	Options depend on the data type.
Comparison Type	Indicate whether to compare the specified value to the report field or subrule.
)	If you want to close the grouping of 1 or more logical statements, select the right-hand parentheses.

Verify that the rules work as expected:

Verify that the rules are returning results with the

Benefit Eligibility Rules Audit

report.

Verify that the eligibility rules don't select workers for multiple groups with the

View Workers in Multiple Benefit Groups Audit

report.

View the list of workers who meet the selection criteria for the rules with the

View Eligible Workers

task. If workers are missing or there are workers in the group who you shouldn't include, then refine the condition rules.

View a rule and whether a specific employee meets the conditions of the rule with the

View Benefit Eligible Rule Results

task.

An eligibility rule that determines dependent benefit eligibility:

The relationship can be Spouse, Domestic Partner, or Child.

If the relationship is Child, then the child must have one of these statuses:

Disabled

A full-time student and 27 years or less in age

Less than 19 years of age

And/Or	(	Source External Field or Condition Rule	Relational Operator	Comparison Type	Comparison Value	)
And		Relationship	Any in the selection list	Value specified in this filter	Spouse Domestic Partner
Or	(	Relationship	Any in the selection list	Value specified in this filter	Child
And	(	Disabled	Equal to	Value specified in this filter	Select check box.
Or	(	Full-time Student	Equal to	Value specified in this filter	Select check box.
And		Age	Is less than or equal to	Value specified in this filter	26	)
Or	(	Age	Is less than	Value specified in this filter	19	))

Link the benefit eligibility rule to a benefit group, benefit plan, Affordable Care Are measurement period, or passive event rule.

You can only have one benefit eligibility rule per benefit group, benefit plan, Affordable Care Are measurement period, or passive event rule.

Steps: Set Up Benefits