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eBenefits Network Sales Training for Infinisource February 2014. Today’s Topics. What is eBenefits Network? Overview Key capabilities Carriers How it works Set-up & production processes Small group enrollment (SGE ) support Open Enrollment (OE) support Marketing & Selling
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eBenefits NetworkSales Training for InfinisourceFebruary 2014
Today’s Topics • What is eBenefits Network? • Overview • Key capabilities • Carriers • How it works • Set-up & production processes • Small group enrollment (SGE) support • Open Enrollment (OE) support • Marketing & Selling • Market segmentation • Target prospect profile • OE-driven buying cycle • Positioning benefits to customer (employer) • Marketing & sales materials available 2
What is eBN? Medical Dental iSolved eBN Life Employee Enrollment Data • Cloud-based • Automated • Employee enrollment data exchange 401k, FSA Others 4
Key Capabilities • Secure end-to-end data exchange; HIPAA privacy compliance • Large carrier network (over 300 health & non-health today) • Supports all carrier data formats • Supports hosted and on-premise deployments • Automatic scheduling and file transmission • On-going EDI/file management (including OE support) • Initial and on-going customer and carrier communications 5
How eBN Works customers (iSolved Users) Benefit Carriers Employee enrollment data eBN Cloud Server Carrier File-out eBN Web Service Data mapping, translation & validation Standard data formats (HIPAA 834, etc.) Carrier-specific data formats All file types Extract employee enrollment data From iSolved system Transmit to cloud server Workflow & business rules Virtual connections Scheduled, triggered, on-demand Secure and Private
eBN End-to-End Process Pre Set-Up Carrier Set-Up Regular Processing Production (eBN) Testing (eBN) Preparecustomer DB (customer/Infinisource) Data Mapping (eBN) • Generate data set • customer Data Analysis • Carrier Business Rules • customer-carrier data mapping configuration • Complete Data Transformation • customer Test File • Carrier Testing • Data Reconciliation (customer & carrier) • Transmission Schedules • Monitoring transmissions • Manage data Discrepancies • Performance analytics • Define plans • Enter data • Validate database Multiple test cycles may be required, Based on qualify to customer’s data 8-10 weeks (estimate) 8
Small Group Enrollment (SGE) Support • What is SGE Support? • Intended for use with carriers that do not support EDI inputs from employers due to small enrollment sizes. • Instead the carriers may accept alternative inputs from these “small group” employers • Manual data entry via carrier-provided secure Web portal (becoming more common) • For SGE customers whose carriers support Web portal or spreadsheet inputs, eBN… • Automatically extracts the enrollment data from the iSolved system • Performs the manual data entry into the carrier portal on behalf of the employer 9
How SGE Support Works in eBN • Enrollment data automatically extracted from iSolved per the schedule. • Changes Report generated by comparing current data to last. This identifies all adds/changes/terminations. • Work Order triggered to the eBN data entry team. • eBN staff log in to carrier portal (using employer-authorized log in credentials) and manually enter the changes. • Email sent to employer confirming that the changes were successfully entered. 10
Guidelines for Selling eBN with SGE • Many carriers have group size minimums that fall below 100 lives • Check with eBN team before selling eBN to customers with <100ee size • Provide customer name & location • Carrier names and contacts • eBN will check if SGE can be supported by the carriers • SGE support (if available) is included in regular iSolved eBN pricing 11
About Open Enrollment (OE) • Most benefit carriers designate a “plan year start date” – driven by health insurance – 66% Jan 1st • Carriers need electronic submissions to be delivered 2-4+ weeks in advance of plan year start date. • Employers offer a 1-4 week window each year in advance of this date for employees to change/renew their benefit elections for the new plan year. • Employers often make changes prior to OE and new plan year start • Change plans and/or renegotiate rates with current carriers • Add/drop carriers • Replace carriers 12
Aligning eBN with OE Process customer: 3 wks 3 wks 2 wks 1 wk Add/Change Carrier… OE End iSolved Updated OE Start Elections Approved; Data to Carrier (customer) Plan Year Start ~8 weeks from carrier negotiation complete until plan year starts eBenefits Network: 6-8 weeks eBN ordering Guidelines: Existing iSolved – 6 weeks New iSolved – 12 weeks (prior to OE start date) Elections Approved; Data to Carrier (customer) Plan Year Start Carrier Connection Tested & Approved iSolved Updated ~8-10 weeks from iSolved ready to approved carrier connection
eBN Open Enrollment Support • Existing eBN customer Carrier • Update carrier map with any changes • Read the approved OE elections from iSolved • Send the elections to carrier automatically on next scheduled post-OE file • Can over-ride auto schedule and send OE elections on-demand if needed to meet a carrier deadline • New or Add-On Carrier • Create the map for the new carrier • Coordinate testing approval to coincide with carrier’s deadline • Read the approved OE elections automatically and send to carrier • Can send a “one-time” enrollment file to carrier if testing approval cannot meet deadline (if carrier supports) 14
Guidelines for Selling eBN with OE • Determine customer’s OE dates: • OE start and end dates • Plan year start date • Follow order submission lead-time guidelines: • Existing iSolved user – 6 weeks before OE start date • New iSolved user – 12 weeks before OE start date • Be aware of the Fall OE “Season” and work closely with eBN team to plan orders & implementations • 66% of customer OE’s done in Sep, Oct, Nov for Jan 1st plan years • Some carriers may have cut-off dates for starting new connections • Carrier responsiveness may be slower during this time 15
Market Segmentation 75,000 Employers 85,000 Employers 160,000 Employers • Outsource: • HRO • PEO • Broker • TPA • In-house: • HRIS • Payroll Services (HRIS) • Ben Admin Platforms Ben Admin Alternatives/Competitors To Your Solution 17
Why Include eBN in Your Solution? Over 50% of employers consider carrier connections to be “Very” or “Somewhat” important Sixth Annual Study of Employee Benefits: Today & Beyond. Prudential Group Insurance, 2011
Target Prospect Profile • Administers employee benefits In-house • Uses iSolved to administer benefits • 100+ benefits eligible employees (FT active + LOA) • You will likely find: • 3+ carriers (medical, dental, vision, 401k, FSA, COBRA…) • They do manual enrollment updates to their carriers • They do manual carrier premium billing reconciliations in-house 19
The OE-Driven Buying Cycle • Annual Open Enrollment is the single largest challenge and resource drain on the HR department every year. • Every employer offers their workforce an annual 2-4 week “open enrollment” period to select new plans and make coverage changes. • In the months leading up to OE, your customers are: • Negotiating new plans and rates with their carriers • Selecting new carriers • Communicating with employees, • and … making benefits admin technology and service purchasing decisions! 20
The OE-Driven Selling Cycle Employer Annual OE Period • October – December for January 1st plan year • 2/3 recently completed their 2012 OE • The challenges of OE are fresh on their minds • Beginning new planning & purchasing cycles for OE 2013 • January - September • 1/3 are gearing up for 2013 OE now • In planning & purchasing cycles now.
Positioning 23
Santeon eBenefits Network Taking the Mystery Out Of Electronic Benefit Carrier Connections
Why Automate Carrier Enrollment Reporting? • Improve and simplify annual open enrollments • Eliminate cost “leakages” • Keep your enrollment data in synch with your carriers • Improve employee benefits usage experience • Simplify and reduce benefit admin burden on HR • Comply with current and evolving legislative and regulatory requirements 25
The Old Way: Manual Burden How do you report enrollment changes to your carriers today? • Write custom reports/programs to isolate and flag changes • Enter changes manually into carrier websites (as well as into iSolved!) 26
The Old Way: Manual Burden How do you ensure that carrier’s enrollment records are correct? • Perform data reconciliation analyses against carrier reports (i.e., premium billing invoices) • Manual process • Time consuming • Involves HR, accounting and IT 27
The New Way: Automated Electronic Benefit Carrier Connections
Key Capabilities • One Internet connection to all your benefit carriers • Automated scheduled file transmissions, no user intervention required • Complies with HIPAA privacy requirements • Connects over 200 benefit carriers today (med, den, vision, drug, FSA, COBRA, life, LTD, STD…) 29
eBN Helps ImproveOpen Enrollment Performance • The “last mile” of the open enrollment process: • Getting your employees’ annual elections to your carriers • Short deadlines to make the carrier’s cut-off for new plan year 30
eBN Open Enrollment “Back End” Solution The eBN service becomes part of your OE planning and delivery team to handle carrier data-delivery tasks 31
eBN Helps Reduce Costs How do enrollment cost “leaks” occur? • Enrollment errors due to multiple manual data entry points • Carrying terminated employees or ineligible members on plans due to reporting delays eBN plugs these leaks via regular and automatic enrollment reporting 32
Reducing Health Plan Premiums • The largest cost is group health premiums • $10,251 average annual premium (workers contribute 23%)* • $7,893 ($658/mo) employer cost per employee • Enrollment errors impact costs and employee experience • 5% - 7%+ enrollment error rate impacting premium costs** • $22,800 = 300 employee company potential annual cost savings by eliminating these errors • 300 employees x 77% enrollment rate*** = 231 members on plan • 231 members x $658 = $151,998/mo employer premium • $151,998 x 5% = $7,600/mo due to errors (12 employees w/errors) • $7,600 x 3 = $22,800 based on carrying the errors for 3 months • * Kaiser Foundation 2011 • ** GAO, Minnesota 2007, Arizona 2012 • *** AHRQ 2004 33
eBenefits Network ROI - Example < 3 months payback possible 34
eBN Helps Improve the Employee Experience eBN catches “missed enrollments” • Why might employees or dependents be denied coverage at point of service? • No carrier record of employee or dependent coverage • Recent coverage changes not processed by carrier 35
Pricing • Carrier Set-up (each carrier connection) • Monthly recurring (PEPM) 37
How to Place the eBN Order • Key Info Needed • customer ID and contact information • Vendor (carrier) ID’s with carrier contact information • Types of plans carrier is providing (medical, dental, life, etc.) • # of employees • Open Enroll period (EO start & end dates) • Plan year start date • Order Submission Notes • Indicate Direct/Partner or Reseller Sale (include reseller info) • Process order to Santeon promptly (delays while Partner processes order must be avoided) 38
Marketing & Sales Materials Available • Brochure • Carrier List • Industry Papers 39
Questions? 42
For More Information… Caroline Guirguis, Account Manager 813-333-9079 Caroline.guirguis@ebenefitsnetwork.com Tom Tillman, Business Development 813-504-0414 ttillman@ebenefitsnetwork.com