InsureAdvantage for the Small Group Market

Transcription

1 InsureAdvantage for the Small Group Market

2 Individual Market Small Group Market Large Group Market InsureAdvantage: The Right Small Group Market Solution InsureAdvantage is compatible with current and future market dynamics It s built to be flexible and responsive to market needs, scalable to match your business requirements, and adaptable to reform and market changes. In other words, no matter what happens to the markets in the future, InsureAdvantage will be able support automating them.

3 InsureAdvantage Quoting By eliminating manual processes, InsureAdvantage Quoting helps accelerate your response time, increase your revenue stream, improve your workflow. It also reduces maintenance, support, and distribution costs for greater profitability. And because InsureAdvantage Quoting simplifies doing business with you, broker and employer relations are enhanced. because InsureAdvantage Quoting simplifies doing business with you, broker and employer relations are enhanced. Define your own quoting preferences Individual and shared profiles can be built for each product line to provide expedited quoting, allowing sales representatives or brokers to personalize and define their quoting preferences including plans and supplemental products quoted most frequently, default employer contribution percentages for employees and dependents, and proposal content to help increase adoption. Enhance your selling opportunities InsureAdvantage Quoting also creates cross-selling opportunities by offering multiple benefits for comparison including product details and benefit-level pricing to create a multiple-scenario quote. Easy census management The census management function allows users to maintain and update the census by manually entering or importing information. Census demographics can capture either detailed information or, for quick quotes and group census, banded data entry. Users can export census templates for broker use, and import information using a census-mapping tool. The system also handles member-level changes, including addition and/or deletion of employees; changes to demographic data-dependent detail; and search and filter. Quoting, simplified Generating quick, preliminary, or final quotes is simple. A quick quote is a fast and easy way to generate a large amount of plans and rates to groups that are just starting to look for coverage. From a single page, users enter in the minimum data required to generate a group quote. Users can select to view the rates online or generate a proposal, and then have the output delivered directly to themselves and/or to the group. A preliminary quote walks the user through capturing basic employee information; creating subgroups; comparing plans; and viewing initial rates. In addition, users can retrieve previously saved quotes, create new quotes, and indicate acceptance of a plan online. And in the final quote stage, rates are finalized by Underwriting, and final employee elections selected. Professional proposals are within reach You can also generate proposals with InsureAdvantage Quoting: real-time, professionally packaged proposals based on product recommendations and selected quotes. Supports any of the carrier s formats and templates, brokers and agents get the materials they need to differentiate themselves and your products.

4 InsureAdvantage Rating By streamlining the quoting, underwriting, and renewal process, InsureAdvantage Rating will improve your business operations reduce maintenance, support, and distribution costs increase accuracy by eliminating manual processes and duplicate efforts and improve consistency among users. A single system that does so much InsureAdvantage Rating is a single system to manage and maintain multiple rate algorithms and rate factors across all market segments and benefit offerings, and is maintained through real-time data manipulation via an administration portal and data uploads. It also supports carrier-specific rate tables, factor tables, look-ups, and zip code mappings. InsureAdvantage Rating is a single system to manage and maintain multiple rate algorithms and rate factors across all market segments and benefit offerings Accurate rates are ensured InsureAdvantage Rating can generate initial and final rates based on member demographics, plan and benefit assignments, business rules, and underwriters discretionary factors. It supports the configuration of your rating algorithms, allowing high-performance rate calculations that match to the penny. It generates composite, age-banded, and community rates, as well as banded rate tables. It can rate multiple locations, classes, and subgroups of employees, and generate and apply rate factors within regulatory limits and business rules.. It also supports final rating, including medical conditions, sales, and underwriting discretionary adjustments and overrides. In other words, with InsureAdvantage Rating, reliable calculations are ensured. You ve got control InsureAdvantage Rating provides a Web-based maintenance tool that puts control in the hands of the carrier for easy rate data management, allowing underwriting and actuarial personnel to easily update and maintain complicated and unique enterprise rate information. It also offers flexible, expansive functionality so your staff can apply rate factor and algorithm changes for multiple market segments, lines of business, and products so you can increase speed to market, improve service, and accelerate new business acquisition. Also offers direct import/export capabilities within Microsoft Excel. Seamless integration InsureAdvantage Rating seamlessly integrates with all InsureAdvantage modules and with any other quoting or thirdparty system. And it s been implemented for every health plan market segment and line of business. Update rates in just one place With all rating needs in one place, you won t have to update rates in multiple locations, thus saving time and eliminating errors. InsureAdvantage Rating ensures accurate rates throughout all of your distribution channels; supports both state-approved base rates and factors, along with underwriting factors with push-out to public, private, and other distribution channels. The best flexibility and scalability By supporting standard/base rate bands with medical underwriting, community rating, and adjusted community rating, InsureAdvantage Rating is simply the most flexible rating product on the market. And it can scale as your business grows.

5 InsureAdvantage Enrollment and Installation InsureAdvantage Enrollment and Installation makes online enrollment possible for employees and employers. It also provides end-to-end administration of and a more efficient process for the application and initial enrollment process, streamlining this time-consuming step. Everything you need for online enrollment Whether an employee or group, the online application process follows the same steps. As the enrollment proceeds, the application which applies your business rules to validate completeness changes dynamically as InsureAdvantage Enrollment and Installation is easily integrated with the most common administration and claims systems on the market information is entered, requesting only the information pertinent to the applicant, and to determine whether the applicant is eligible for the plan in question. Once the process has been started, users are able to access the applications at a later time to complete. The module provides esignature-capture capability; and can handle all enrollment scenarios, including an offline workflow option that utilizes the same automated processes as online enrollment. Manual enrollment is also an option To complete manual enrollment, applications can be downloaded, completed, and sent in. An online checklist for managing forms is provided; and, when paper applications are received, a feature-rich technology employing advanced data collection and validation techniques allows rapid data entry of offline applications, eliminating incomplete applications and incorrect data entry to help improve your sales-processing efficiency while reducing operating costs. Additional information that may be needed for case installation to your back-end systems can also be added at this time. Easily integrates with other systems InsureAdvantage Enrollment and Installation is easily integrated with the most common administration and claims systems on the market, including proprietary systems, so the time it takes to complete implementation is reduced including encompassing installation of the initial enrollment to your existing membership or core administration system, and data mapping to streamline integration. Access for everyone InsureAdvantage Enrollment and Installation provides access to employers, employees, agents, and brokers, as well as internal carrier representatives, allowing them to track progress and minimize cycle time. Straight-through processing By providing seamless integration with your back-end systems, InsureAdvantage Enrollment and Installation facilitates straight-through processing all information gathered during rating, enrollment, and underwriting is passed on to all your administration systems

6 InsureAdvantage Underwriting A note on the future of underwriting and InsureAdvantage Underwriting Connecture recognizes that underwriting will undergo dramatic changes in response to the Patient Protection and Affordable Care Act. The elimination of risk-based underwriting is coming, but there will still be a need to capture information to help direct members into care or disease-management programs prior to claims being incurred and InsureAdvantage Underwriting can be utilized for that purpose. In the meantime, underwriting is still in play for the next three years. Then, after installing InsureAdvantage Underwriting now, you can repurpose your investment. InsureAdvantage Underwriting fits in with your current business process as it improves your workflow. It enables screening questions, qualification, and eligibility rules to be defined and maintained by your staff to help expedite updates; and can be configured to execute a pre-defined rule set, allowing for unattended, straight-through processing of an applicant s medical questionnaire. In a word, it s flexible. InsureAdvantage Underwriting streamlines the typically lengthy, paper-intensive underwriting process Streamlines the process InsureAdvantage Underwriting streamlines the typically lengthy, paper-intensive underwriting process, and offers multiple automated decisioning tools to decrease the need for manual intervention. It can also generate an approval, administrative decline, exclusionary rider, or rate-up decision where statutorily allowed, to produce a final rate. By improving the quality and accuracy of information and risk assessment, the quality of the underwriting decision itself is improved, directly impacting your profitability. Assess health and assign debits With the Employee Health Assessment & Debit Assignment function, underwriters can search for, add, and view a list of condition, prescription, build, tobacco, and hypertension debits by applicant. Discretionary debits can also be added to an applicant s record on an as-needed basis.

7 The system also includes tools to help in the analysis and application of medical condition debit rules, allowing the underwriter to define automated underwriting adjustments based on indicated medical conditions and severity levels establish pre-qualification guidelines and eliminators and identify pend cases that need additional review. Accommodates multiple eligibility guidelines InsureAdvantage Underwriting also accommodates comprehensive eligibility guidelines support, including proprietary and third-party underwriting guidelines Milliman, Risk Concepts, or Reden & Anders, to name a few. Offers auto-debit underwriting In addition, the system s Auto-Debit Underwriting function lets you configure drill-down questions into the employee online enrollment, capturing pertinent information that allows automatic assignments of the appropriate condition, severity, and debit to each subscriber. Easy access to rate factors and risk tiers The Final Rates and Decision feature lets you view the rate factors and applicant risk tiers associated with a specific quote, with the ability to override any of them and enter the reason for the change. A detailed history of all changes is recorded and accessible, making it an ideal method for reporting and consistency tracking. One workflow With InsureAdvantage Underwriting you can completely underwrite a case through one workflow, ensuring that all underwriters follow the same process through checklist workflow management. Because it s intuitive, underwriters can move through the system quickly, increasing efficiency and decreasing administrative costs. It allows the underwriting manager to refer cases to other underwriters in the department, allowing you to get the right cases to the right underwriter. You can also automatically assign cases through the system based on pre-set rules, thereby saving time and reducing backload.

8 InsureAdvantage Policy Administration InsureAdvantage Policy Administration allows employers, employees, and producers to request changes and manage benefit information. It supports ongoing case maintenance and easily integrates with your existing eligibility and membership systems. The result? Improved service and enhanced customer satisfaction. The result? Improved service and enhanced customer satisfaction. Efficient management tools for internal users The system s management tools let users easily manage and maintain their accounts both individually and in batches, with a robust search functionality to quickly locate specific accounts or members. From the search results, authorized users can trigger workflow tasks, view account and member details, and perform additional account maintenance tasks. Users are also provided with tools to maintain and update detailed account information ranging from demographic data changes to off cycle and plan revisions. Group policy administration at your fingertips To manage profile information, the system provides the user with the ability to keep group demographics current. Modifying benefit period information is also easy, allowing users to update details when necessary. A method to terminate a group s coverage is also provided, which can eliminate needless billing cycles. In addition, you can view the current as well as upcoming benefit period plans and effective dates; and view and manage eligibility rules for benefit periods. Employee roster management The system allows producers and employers to track employee enrollment progress, allowing users to determine how the employee enrollment is progressing, view all employee demographic and coverage statuses on the roster, and add or delete employees from the roster. Employee Policy Administration Updating an employee s information is also easy, and can be completed by the group administrator, broker, or internal carrier representative. You can manage benefit elections and life/work events, and review requests for approval. Open Enrollment The open enrollment function lets you manage the annual enrollment process, eligibility rules, and view summary-level plans and rate information. And because approval processes are provided, InsureAdvantage Policy Administration ensures that the group benefits administrator, broker, or internal user verifies and approves changes.

9 InsureAdvantage Renewals InsureAdvantage Renewal manages all aspects of the renewal process. Its comprehensive functionality streamlines this business cycle reducing costs and enabling faster selling and retention. And its rich searching and sorting tools let producers and internal representatives view renewal plan details and alternative plan options, increasing customer retention. A complete renewal package InsureAdvantage Renewal creates and delivers complete renewal packages including renewal notices, current plans, alternate plans, marketing collateral, and quotes for all product reach your agents and groups faster to minimize the completion time of the renewal cycle. offerings confirmations online, letting you reach your agents and groups faster to minimize the completion time of the renewal cycle. Both online and paper renewal notices can be generated, with updated rates and an explanation of any changes in eligibility or costs, with plenty of lead-time to accept or request changes to the policy. Alternate plans can also be provided with the renewal notice to allow additional plan options to be viewed for selection. InsureAdvantage Renewal provides alerts to ensure brokers and groups are reminded of upcoming auto-acceptance dates and renewals, and also allows renewals to proceed through the renewal process and be renewed as is without user modification. One system, multiple uses Online progress tracking and acceptance can be performed by agents and internal staff. The system also supports the generation and distribution of renewal letters and rates, proposals in multiple formats for different distribution methods, re-quoting (off-cycle renewals or re-rates), communications and fulfillment, and the final renewal decision. Alternate and force plan mapping Included functionality lets you map what alternate plans will be automatically included on renewals based on the currentyear plan. When the current year plan is discontinued, functionality to force current-year plans to different renewal plans is also provided. Multiple features and functionality The system also offers auto-approvals and renewal release scheduling. InsureAdvantage Renewals can also factor claims experience analysis into the calculation of a final rate. And because renewal calculation and workflow management of the entire process is automated renewal review, adjustment, presentation, and acceptance your staff is freed from these administrative tasks, saving time and costs while increasing efficiency and accuracy.

10 InsureAdvantage ebilling InsureAdvantage ebilling lets groups decide how and when they would like to pay their bills making it easier to do business with their carriers. Bills are presented in a PDF format specific to the carrier s business needs, and delivery is easy. So is payment, and reconciliation with payment and membership systems. With InsureAdvantage ebilling, call-center activity and administration costs are reduced. Customer service is enhanced along with creating one-on -one marketing opportunities. An integrated solution The ebilling system enables easy workflow transitions between InsureAdvantage and a carrier s membership and billing systems, reducing the need to access several systems. With InsureAdvantage ebilling, users can perform detailed electronic billing and payment transactions, increasing their accuracy. Then, when transactions are complete, the data will be passed back to the carrier s systems, completing the process. Mail-in or online payment options For each billing cycle, printer-friendly invoices will be available online that include bill payment stubs for employers choosing to mail in their payments. In addition, a 12-month history of all bills presented will be maintained online for review. The system will also be able to notify groups via when new invoices are available for viewing. Customer service is enhanced along with creating one-on-one marketing opportunities. Or, if they prefer, employers can pay online, choosing between one-time or ongoing payments; select the account that will be used for online payment; change or modify the account; and set or disable any recurring payments. They ll then be sent a confirmation tracking number to track payment processing. The invoice payment-processing workflow also provides carrier-specific text and terms, extracts scheduled payments, and provides daily updates on roster adjustments and a history of all transactions and adjustments. Billing preferences Employers are given the choice to opt out of electronic billing at any time. If an employer doesn t want to receive invoices online, a paper bill will be provided. Users can also set up notifications to let them know when invoices were delivered or when payments are due. Online employee roster management and ID cards The system allows users to update and make roster change requests, keeping invoice presentment and payment current. They can view and edit existing employee information for example, add or remove dependents, modify and update employee demographics, modify effective dates, and add or remove employees. InsureAdvantage ebilling also allows user to request ID cards online, and print temporary cards another popular feature with clients. Payment notifications For current and past-due balances, ongoing communication between the carrier and the employer will be provided. Online and/or notifications will be sent and tracked within the system. And, when an employer is considered delinquent but before any delinquent notification is issued, the carrier can access the system to ensure there aren t any special circumstances to consider.

11 InsureAdvantage Sales Automation InsureAdvantage Sales Automation allows underwriters, sales teams, and brokers to effectively manage their work while providing a complete view into each account, offering quick storage, access to, and overview of contacts, cases, and current workload. In addition, its robust communication capability allows all users to send system- and manual-generated notifications based on specific events, proactively moving cases forward in the sales cycle for enhanced customer service. users can constantly update their dashboards based on the information they need at certain points in the business cycle. Dashboards For the sales, marketing, or underwriting user, the system allows immediate access to actionable data in text and graphics, with high-level snapshots of related reports. InsureAdvantage Sales Automation is user-adaptable, including drag-and-drop customizability. It also includes a KPI (Key Performance Indicator) library, so users can constantly update their dashboards based on the information they need at certain points in the business cycle. Me and Lead Generation Users can themselves quotes that have been generated through consumer quoting portals and shopping/ comparison tools. The information is then saved under leads, allowing carriers to mass market or convert leads to the quoting and enrollment process. And, in addition to containing all of the quote information, these carrier-branded HTML s also provide direct links to apply for coverage, allowing carriers to continue the shopping/engagement process beyond their website. User Administration & Hierarchy Management The User Administration tool lets an administrator control the functionality and data that authorized users can access within InsureAdvantage. The administrator will be able to: view a list of all users view/edit a user s profile and login information view/edit assigned roles and their status for a selected user and view/edit the user s assigned permission groups, granting specific users more or less functionality based on their roles and job descriptions, and enhancing existing roles to meet the carrier s specific needs. Hierarchy management allows internal managers to manage their groups daily workload as defined by department. Account Management The Account Management tool provides efficiencies and streamlines workflow by giving your sales team and the selling broker a complete view into each account including demographics, associated brokers and sales representatives, account status, and history. And, to maximize efficiency, customized work queues automatically display the tasks of highest priority. Communication Across All Involved Parties To provide the best customer service, the communication tool allows brokers, sales, underwriting, and account services to stay in touch with each other; and, based on events within the system, can send notifications to all involved parties to proactively move cases forward in the workflow.

12 InsureAdvantage CRM Connecture utilizes Microsoft Dynamics CRM to create a single-source sales automation and CRM solution specifically for the health insurance industry meaning you won t have to change your business processes in order to get the most out of the system. It s easy to implement, minimizes service and support response times for enhanced customer service, streamlines your marketing and sales management processes for greater operational efficiencies, and helps you target and expand into new markets while providing a seamless experience for the user. you won t have to change your business processes in order to get the most out of the system. The Integrated End-to-End Solution When implemented with InsureAdvantage, the system offers InsureAdvantage s robust functionality, along with all of the tools needed to create and maintain accurate records of prospects and customers, from first contact through purchase and renewal. Comprehensive Sales Process Automation InsureAdvantage CRM provides comprehensive sales process automation for better demand creation, sales management, and reporting increasing productivity while decreasing acquisition costs. You ll be able to: view and track the progress of leads in the pipeline, including tracking and monitoring conversion rates and individual sales performance create workflow and roles to facilitate the automation of follow-ups provide notifications when customers or producers updates contact information forecast to calculate close probability for each lead generate ad-hoc reports and dashboards to monitor sales and pipeline activity perform advanced data mining and customer profiling focus your resources on high-growth opportunities and proactively address underperforming areas. A Single Source to Manage All Your Business Relationships With InsureAdvantage CRM you ll be able to organize and manage relationships with all of your distribution channels - including agents, brokers, producers, and inside sales support staff with a built-in hierarchy that lets you easily track them. A single source lets you access, record, and maintain all pertinent data, including: appointment and licensure information commissions and incentives and producer demographic information. It also lets you track and report individual producer sales performance; and generate and deliver accurate producer performance management reports.

13 Streamline and Simplify Your Marketing Efforts InsureAdvantage CRM lets you manage your marketing campaigns efficiently and effectively and identify and capitalize on new opportunities quickly. You ll be able to perform and track multi-channel marketing campaigns, campaign costs, leads, quote requests, and sales by segment and geography compare results against forecasted budget auto-generate or follow-up alerts for in-house sales view overall campaign effectiveness by linking campaigns to enrollment results and create prospect segmentations. The result? Better use of your campaign dollars. Build Workflows to Match Your Business Process Based on trigger points that you define, the system will automatically produce reminders for users to update and/or perform various activities, reducing paperwork and streamlining processes. The result? New-business cycle times can improve dramatically leading to accelerated revenue growth. Reporting Capabilities The system offers a rich data pool for sales and marketing analysis. You can perform trend analyses on accounts and contact information generate ad-hoc reports and dashboards to monitor sales and pipeline activity and produce customized reports based on your business needs. In addition, any activity in InsureAdvantage automatically updates to CRM, so you can track activities in one seamless workflow, rather than in two separate systems. You can also track win/loss by different measures: over given time periods or by campaign effectiveness, for example. CRM also provides account, contact, and opportunity management, allowing you to view historical data on interactions with members and potential members. Customer Service and Call Center Integration With InsureAdvantage CRM you can streamline incoming calls and increase call center efficiency. You ll be able to see the effectiveness of each individual and the overall team at a glance. And CSRs will be able to view a caller s entire history while they re speaking with the member.

14 InsureAdvantage Prescription Profiling A note on the future of underwriting and InsureAdvantage Underwriting Connecture recognizes that underwriting will undergo dramatic changes in response to the Patient Protection and Affordable Care Act. The elimination of risk-based underwriting is coming, but there will still be a need to capture information to help direct members into care or disease-management programs and InsureAdvantage Prescription Profiling can be utilized for that purpose. In the meantime, underwriting is still in play for the next three years after which you can repurpose your investment. InsureAdvantage Prescription Profiling is a predictive modeling system that provides extensive, real-time prescription data via Ingenix s MedPoint or Milliman s IntelliScripts that, when combined with health questionnaires results in more accurate risk analysis. Automate the Underwriting Process as Far as You Want If desired, InsureAdvantage Prescription Profiling allows straight-through, automatic application processing, providing auto-decisioning without underwriter intervention. It makes underwriting less labor-intensive, increasing efficiency and decreasing administrative costs while allowing underwriters to focus on more complex cases. And reduced processing cycle times means enhanced service to your brokers and customers. makes underwriting less labor-intensive, increasing efficiency and decreasing administrative costs More Accurate Risk Assessments and Fraud Detection The MedPoint and IntelliScripts prescription data that s provided during the online application process includes over 7 billion pharmacy claims and more than 5 years of prescription histories for over 230 million covered lives so you ll have access to information that may have not been provided in the prospective member s application. The result? More accurate health assessments enhanced fraud detection and greater confidence in the profitability of your book of business.