Medical Plan Management
Supports PPO, HMO, EPO, and HDHP plans with tiered coverage rules, employer HSA contributions, surcharges, and per-paycheck cost preview.
Benefits Administration · Open Enrollment & Traditional Plans
Traditional Benefits Plan Administration
Controlled. Compliant. Enterprise-Ready.
Traditional benefits administration within Benefits Reimagined supports medical, dental, vision, life, and disability plans with consistent eligibility, workflow-driven governance, and audit-ready controls — built directly into the BR platform for complex organizations. Open Enrollment, new-hire windows, and life events run on the same rules, the same plan structures, and the same documentation framework, so an election is right before it reaches payroll or a carrier.
Medical · Dental · VisionLife · AD&D · STD · LTDActive & passive OESection 125
Reimagining Traditional Benefits Administration
"Traditional benefits break down when eligibility rules vary, changes arrive late, documentation is incomplete, and teams rely on manual workarounds. Benefits Reimagined consolidates fragmented processes into a unified operating model — eligibility logic, enrollments, life events, documentation, and approvals — through standardized rules and workflows, so Open Enrollment is the calm part of the year."
Rules-Driven EligibilityClass, hours, location, union, employment typeStandardized Plan StructuresVariation without fragmentationOpen EnrollmentGuided, validated, previewedLife Events & DocumentationValidated workflows, proof enforcedIssue TrackingTickets tied to benefit records
5plan families on one rules engine — medical (PPO, HMO, EPO, HDHP), dental, vision, life/AD&D, and disability
4steps in the employee life-event journey — what happened, who it affects, what changes, proof — with coverage dates derived by BR
1validation pass before submit: eligibility, tier, dependent coverage, EOI, and Section 125 change reasons checked on every election
0manual effective-date entry — start, end, and retroactive coverage dates are calculated from the event and the plan rules
From Eligibility to a Clean Carrier File
Follow a plan year from the rule that decides who is eligible, through Open Enrollment and a mid-year life event, to the documentation and case handling behind it — five controls that keep traditional plans predictable.
Rules-driven eligibility across workforce types
Eligibility is configured by class, hours, location, union status, and employment type — and enforced consistently across all traditional plans. The same effective-dated rule that places an employee in a benefit group also decides the waiting period, the plan options they see at Open Enrollment, and the tiers they may elect, so an invalid election cannot be built in the first place.
What it delivers
- Class-based eligibility logic per plan family — medical, dental, vision, life, disability
- Waiting period enforcement with dates derived from hire or class-change events
- Automated eligibility validation on every election, at Open Enrollment and mid-year
- Variable-hour measurement for hourly populations feeding ACA and plan eligibility together
Why it matters
Prevents incorrect enrollments and downstream compliance exposure.
The plan menu an employee sees is already filtered by rule — there is nothing to reject later.
Standardized plan structures with controlled variation
Medical, dental, vision, life, and disability plans are governed through structured configurations — allowing variation without fragmentation. Plan tiers, buy-up options, and coverage levels are defined once as plan structures and mapped to populations, so a new entity, a new union agreement, or a new carrier adds a variant, not a fork.
What it delivers
- Plan tier standardization — employee, +spouse, +children, family — across every carrier
- Controlled buy-up options for dental, vision, supplemental life, and disability
- Consistent plan mapping to carriers, payroll deduction codes, and GL accounts
- Cost rules per population with employee and employer shares kept separate, previewed per paycheck
Why it matters
Keeps benefits manageable as plans and populations grow.
Adding a Canadian entity in 2027 meant adding plan variants under the same structures — not a second configuration.
Open Enrollment that employees finish in one sitting
Open Enrollment runs as a guided journey: current coverage first, then plan comparison side by side, then an election per plan family with the paycheck impact shown before anything is submitted. BR IntelliSuggest recommends a plan from family situation, past usage, and cost patterns; Athena answers questions in place; and every election is validated against eligibility, tiers, dependents, and evidence-of-insurability rules before it is accepted. Active or passive, single window or rolling, the configuration is the administrator's — not a development ticket.
What it delivers
- Active and passive enrollment with default and rollover rules per plan family
- Side-by-side plan comparison with total-cost estimates for the employee's own usage
- Per-paycheck preview of every election — employee and employer shares never blended
- Validation before submit: eligibility, tier vs dependents, EOI thresholds, surcharge attestations, HSA eligibility
Why it matters
Consistent employee experience — clear, guided benefit choices, submitted right the first time.
Employees on leave get their own window; new hires get theirs from the waiting-period rule; nobody is missed by a campaign list.
Guided change management for employee events
Life events are processed through validated workflows with documentation requirements and approval logic embedded. An employee reports what happened — marriage, birth, adoption, divorce, loss of other coverage, a job change — and BR derives which plans may change, which proof is required, and the coverage date, applying Section 125 change-in-status rules without exposing them. Dependent verification and supporting documents are collected, reviewed, and approved within a controlled document framework.
What it delivers
- Event-based enrollment control — only the changes the event permits, within its window
- Documentation enforcement with OCR-assisted review through BR IntelliVerify and a secure Document Center record
- Automated effective dating — coverage dates derived from the event, never typed by the employee
- Audit-ready document history with validity periods, so proof is reused rather than re-requested
Why it matters
Reduces errors during high-risk benefit changes and strengthens compliance while cutting manual review.
The employee sees five plain questions; the administrator sees the rule, the evidence, and the date behind each one.
Built-in issue tracking and resolution
Benefits issues are managed through structured ticketing tied directly to benefit records and rules. A question about an election, a deduction, a dependent, or a carrier ID becomes a BR Resolve case with the employee's plan, event, and document context attached — routed to the right desk, answered with Athena-drafted guidance a person reviews, and closed with a resolution the next similar case can reuse.
What it delivers
- Integrated case tracking with the election, event, deduction, or document the case is about
- Resolution history reuse — similar cases surface their prior outcomes
- AI-assisted guidance: Athena drafts the answer from plan documents and the employee's record
- Escalations and SLAs on the Workflow Control Tower, with delegation cover during Open Enrollment
Why it matters
Lowers admin burden and ensures consistent outcomes.
During OE the queue is a worklist ranked by deadline impact, not an inbox sorted by arrival time.
Core Capabilities of Traditional Benefits Administration
Every plan family and every enrollment path on one rules engine — configured by administrators, validated before submit, and mapped cleanly to payroll and carriers.
Dental & Vision Administration
Manages preventive, major, orthodontia, and frequency-based coverage with buy-up plans and dependent tier validation.
Life & AD&D Coverage
Handles employer-paid and voluntary life with beneficiary tracking, guaranteed-issue thresholds, EOI routing to the carrier, and imputed income.
Disability Plan Support
Administers STD and LTD eligibility, waiting periods, elimination periods, pre- or post-tax elections, and coverage timing coordinated with Leave Impact.
Eligibility & Effective Dating
Enforces accurate start, end, and retroactive coverage dates derived from events and rules — with BR ReVerge computing retro deductions when a change lands late.
Carrier & Payroll Alignment
Maintains clean plan mapping for downstream integrations — 834 routes, payroll deduction codes, GL accounts — and confirms rather than assumes delivery.
Athena inside Open Enrollment
A Benefits Counselor for Every Employee, All Season
During Open Enrollment, Athena answers the questions that used to fill the benefits inbox — from the employee's own plans, dependents, and paycheck. For administrators, it watches the window: who hasn't enrolled, which validations are failing, which carrier hasn't confirmed, and what to send next.
- "Which plan is right for us?" — a comparison for this family's usage and the IntelliSuggest recommendation, with the reasons
- "What happens to my paycheck?" — the per-paycheck change for any election, employee share only, before it is submitted
- Election validation explained — why a tier, a dependent, or an EOI amount was rejected — and what fixes it
- Window monitoring — not-enrolled populations by plant, class, and language, with the next reminder proposed
- Carrier confirmation — which submissions are still unconfirmed and which employees to reassure
We're expecting a second baby in March. Should we switch to the HDHP now?
AthenaFor your family's usage — two well-child visits, one ER visit last year, and prenatal care ahead — HDHP + HSA costs about $1,120 less over 2027 than PPO Standard, including the employer HSA seed of $1,500. The March birth is a life event, so you can add the baby then without waiting for next OE. One thing to know: with the HDHP you'll pay the delivery costs up to the deductible before coverage takes over.
HDHP + HSA · EE + family$121.40 per paycheck
PPO Standard · EE + family$164.20 per paycheck
Show me the mathElect HDHP + HSAAsk about the deductible
Do I need to prove my spouse doesn't have other coverage?
AthenaYes — a spousal surcharge attestation, not a document. It's one question on the review step; answering it changes your medical cost by $100 a month if he has coverage available elsewhere. I'll show the impact before you certify.
Ask Athena about your enrollment…
What Traditional Benefits Administration Changes
Fewer enrollment errors
Eligibility rules prevent invalid elections upfront — the menu is already right.
Reduced compliance risk
Documentation and approvals are enforced by design, not by follow-up.
Lower admin workload
Automation replaces manual corrections, reminders, and re-keying.
Consistent employee experience
Employees see clear, guided benefit choices with the paycheck impact in front of them.
Cleaner payroll & carrier files
Accurate effective dating and mapping reduce downstream defects and rejections.
Audit-ready operations
Every election, change, and document is tracked and defensible.
Enterprise Governance & Scale
Traditional benefits administration within Benefits Reimagined is built for enterprise governance. Standardized configurations ensure consistency across business units, while embedded controls reduce reliance on manual oversight. As organizations grow, benefits remain compliant, predictable, and scalable — without increasing operational risk or administrative burden.
- Admin: plan year workbench — plan structures, rates, rules, and OE configuration versioned per plan year with an approval step before go-live
- Admin: OE command center — enrollment progress by population, validation failures, unconfirmed carrier submissions, and reminder waves from Communication HUB
- Admin: life event queue — events, required proof, IntelliVerify outcomes, and derived dates with exceptions routed to BR Resolve
- Employee: guided enrollment and life events — in the portal and the BR mobile app, with plan comparison, paycheck preview, and Athena in every step
- Analytics: Enrollment Intelligence — governed, as-of-dated enrollment mix, participation, and cost — pending elections never counted as enrolled
Bring control to traditional benefits
Bring your plan documents, your classes, and last year's OE issue log. We'll configure the rules, run an enrollment end to end with paycheck preview, process a life event with proof, and show the carrier file it produces.
Section 125 rulesDerived effective datesEOI routingSOC 2ISO 27001GDPR · PIPEDA
Open Enrollment & Traditional Plans FAQs
Traditional employee benefits plans include health insurance, dental, vision, life insurance, AD&D, and disability coverage. These plans provide financial protection and healthcare access. Companies use platforms like Benefits Reimagined to manage eligibility, enrollment, and compliance efficiently for large or multi-location workforces.
Streamlining involves automating eligibility, life event processing, documentation verification, and workflow approvals. Using a unified platform integrated with HRIS reduces manual errors, speeds up enrollments, and maintains audit-ready compliance.
As a guided journey: current coverage, side-by-side plan comparison with IntelliSuggest recommendations, an election per plan family with per-paycheck preview, validation before submit, and review and sign. Active or passive enrollment, defaults, and rollover rules are configured per plan family; employees on leave and new hires get their own windows from the rules.
Life events such as marriage, childbirth, adoption, or job changes are processed through guided workflows. The platform validates eligibility changes, captures required documentation, and applies accurate effective dates automatically — the employee never enters a coverage date.
Yes. Benefits Reimagined supports diverse employee groups, including hourly, salaried, union, faculty, and multi-location staff. Eligibility rules, plan variations, and approvals can be configured by class, hours worked, location, and employment type.
Dependent verification ensures only eligible dependents receive coverage. Benefits Reimagined uses secure document collection, OCR-assisted review through BR IntelliVerify, and workflow-based approvals to reduce errors, prevent ineligible claims, and ensure compliance — with verified evidence reused until it expires.
ACA compliance is maintained by tracking employee eligibility, monitoring full-time status, calculating measurement periods, and producing audit-ready reports. In Benefits Reimagined the ACA engine reads the same eligibility rules and employee record as enrollment, so automated validations reduce reporting errors.
Integration ensures data consistency, accurate effective dating, and real-time employee records across systems. It minimizes manual entry errors, streamlines payroll deductions, and allows centralized benefits management.
Reducing errors involves accurate plan mapping, eligibility enforcement, and validation of life event changes before reaching carriers. Benefits Reimagined enforces these rules, previews deductions per paycheck, confirms carrier submissions rather than assuming them, and reconciles enrollment, payroll, carrier, and invoice data four ways.
Bring Control to Traditional Benefits
Standardized configurations, embedded controls, and a guided experience — benefits that stay compliant, predictable, and scalable as the organization grows.