People
Benefits and enrolment
Who is covered, under what, from when — and why claims are deliberately somebody else's job.
A plan is something the organisation offers: medical cover, life assurance, a pension. An enrolment records that a particular person — or one of their dependants — is on it, from when, and under what status.
This answers eligibility, not claims
An HR system of record answers who is covered, under what, from when. Adjudicating and paying a claim is an insurance function with its own actors, its own regulator and its own data. Each enrolment can carry an external reference pointing at whatever the insurer uses, and that is the whole integration.
One live enrolment per person per plan
Enforced, because *are they covered* must not be answerable two ways. Ending cover and starting it again is two dated enrolments, not two live ones — the same effective-dating every other time-varying record here uses.
The statuses, and the one that matters
| Status | Means |
|---|---|
| Pending | Offered and not yet started |
| Active | Covered |
| Waived | Offered, and they declined it |
| Unavailable | Cover could not be offered to this person or dependant at all |
| Ended | Cover has finished |
Unavailable is a record, not an absence
It is what pairs with an allowance paid in lieu — somebody an insurer would not cover, given money instead. Recorded as nothing at all, the allowance on their pay looks unexplained, and the first person to audit it has no way to find out why. An enrolment can be marked as carrying an allowance in lieu for exactly this.
Dependants
An enrolment can name a dependant rather than the worker, because cover is commonly extended per person rather than per family. Their eligibility and their residency run on their own schedules — see Dependants.
Where it meets pay
It does not, directly. A benefit somebody receives in kind still carries a value for tax, and that is recorded as an allowance with a provision mode saying the company provides it rather than paying it out. The enrolment says they are covered; the allowance says what it is worth. Neither is derived from the other, because a plan can cover somebody at no cost to them and an allowance can exist with no plan behind it.