On the Group Side, the platform allows insurance carriers and health plans to distribute their products through a private exchange, enabling tighter management and control over eligibility and invoicing functions. Capabilities of the private exchange include eligibility enforcement, consolidated invoicing across multiple product lines, premium collection, payment reconciliation, and disbursement of commissions to brokers. The platform also provides their clients (employers and brokers) a robust portal for capturing employee enrollments, either admin-directed or self-service.
On the Individual side, the platform allows insurance carriers and health plans to market and sell their products directly to consumers through an intuitive shopping site, which is informative and enables rich search and compare functionality. Best of all, the platform invoices the individual directly and tracks all payments. The end result is a delighted consumer.
Key Capabilities and Benefits
Health plan or insurance carrier may build a master catalog of their plans with attributes, pricing, and eligibility rules
The plans are then 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, the employers’ define their level of contribution to the benefit’s cost vs. their employee’s contribution
Enrollments may be entered into the system through various 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
EDIs 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