Health Plans

Quadrant 4 offers multiple solutions to help Health Plans and Insurers better compete in the crowded insurance space.

Quadrant 4’s Individual Marketplace Solutions enable health insurers to offer a broad range of health and voluntary products to individual consumers with a seamless e-commerce experience for shopping, enrollment, billing, payment and ongoing administration. Providing an outstanding experience enables insurers to cultivate member-for-life relationships.

Quadrant 4’s Private Exchange and Billing Solution allows health plans to distribute their products to employers through a private exchange.  With that, health plans are able to enforce consistent eligibility controls, ensure plan information is delivered consistently to each group, and bill based on actual premium rather than estimates or self-reported participation. Simply provide the tool to employers and brokers to key or upload their data. Employers may also share the portal with employees to directly input their elections.

Key Features of Individual Marketplace Platform

  • Increase sales by providing an intuitive shopping and enrollment experience for health and voluntary products on and off the exchange
  • Engage consumers step-by-step with anonymous shopping that lets them provide information as they choose to facilitate lead conversion
  • Help individual consumers shop wisely with clear information about subsidies, premium costs, benefits and coverage
  • Generate bills and process all forms of payment for individual subscribers
  • Personalize using payment preferences, utilization expectations, provider preferences, and formulary preferences
  • Capture individuals as they transition out of group coverage with a seamless process
  • Reduce administrative burden and costs associated with manual enrollment and updates processing
  • Help consumers assess eligibility and apply subsidies for purchase of qualified health plans

Key Features of Private Exchange & Billing

  • Health Plan or Insurance Carrier may build a master catalog of their plans with attributes, pricing, and eligibility rules
  • Plans may be distributed through the platform to employer groups, individual consumers, or both
  • As plans are distributed to each employer group and/or consumer, each plan’s master pricing and eligibility rules are applied
  • From the master pricing, employers define their level of contribution to the benefit’s cost vs. their employee’s contribution
  • Enrollments may be entered into the system through many methods: Employee Self Service, Admin Directed, Consumer Self Service, or File Feed
  • Invoicing is automated and based on real-time membership information
  • Payments are collected through ACH and go through reconciliation prior to payment posting
  • EDI’s may be established to external vendors if necessary
  • Tools available to allow employer groups and brokers to process and track employee changes including new hires, terminations, and status changes
  • Multilingual capabilities include Spanish, French, German and any other Western alphabet-based languages

Press Release

TriZetto Leverages QHIX to Deliver a Consumer-Centric Experience to the Health Insurance Marketplace for their Health TranZform™ Solution Suite

“Quadrant 4 is powering a user-friendly shopping and enrollment capability that supports the TranZform suite’s ability to help healthcare organizations develop new ways to compete and deliver a consumer-centric experience in the health insurance marketplace.”

– Jude Dieterman, President & Chief Executive, TriZetto

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