What makes a health insurance carrier broker friendly?

Brokers and agents want to generate quotes and service customers within software they already use—and with the least amount of manual data entry

For health-insurance carriers, it is the moment of truth: A broker, having learned a client’s needs and researched available options, now must recommend a plan. To get the business, it’s not enough for a carrier to offer a competitive price, an optimized network, and desired plan features; several carriers will likely meet that hurdle. It’s also not simply a matter of brand strength, personal relationships, or commission structure either. Increasingly, the moment-of-truth differentiators for brokers is which carrier a) most successfully reduces their administrative burden, and b) uses automation that simplifies the experience of brokers, members, and—for business plans—employers.

For carriers, meeting brokers’ changing expectations requires a significant shift in mindset and a handful of inexpensive, simple strategic moves. The reality of today’s marketplace is that carriers that share data and technology with brokers win more business than those that maintain barriers—deliberate or inadvertent—that keep agents from the information they need to close sales. When all things are equal, a broker will choose the carrier that enables the tools brokers are already using. But this reality is hardly a burden for carriers. Technology that makes things easier for brokers generally reduces administrative costs for carriers. 

With this new reality in mind, here are four concrete steps carriers can take to become—and be seen as—true digital partners with their brokers:

  1. Connect with brokers where they work. Carriers work hard to differentiate themselves from competitors, and many ask brokers to use their broker portals to quote so they can highlight their unique benefits. This go-it-alone approach does create a distinct impression. More often than not, though, it drives business away. Here’s why: Most agencies have automated the process of gathering rate and plan information, comparing options and generating proposals. Carriers that only share plan data on their website throw a wrench into brokers’ machines, forcing them to copy information, reformat it and enter it into their quoting system (effectively doing the very thing carriers try to avoid, i.e., being “spreadsheeted”). Broker-friendly carriers, by contrast, distribute their data to the brokers’ quoting tools and agency management systems, empowering an agent to do all the work of creating a quote for customers in a single environment.
  2. Give brokers all the network information they need to help clients make smart decisions. Easy access to information about which providers participate in a carrier’s network is as important—when it comes to decision support—as rate data. Clients want insurance with a network that includes the doctors they use, and employers want to choose plans that meet the needs of most of their employees. Some carriers are burdened with legacy technology that can put technological roadblocks in front of brokers who are doing the time-consuming work of creating a disruption analysis for a business client that shows how many of their employees would need to switch providers under each plan. They require the broker to log into a proprietary website to check each provider manually. Carriers that publish detailed and up-to-date network information in standard electronic formats can save brokers hours of work on every proposal.
  3. Remove the excess manual work from enrollment and member management. If data is already in electronic form, brokers shouldn’t have to enter it again. This is especially exasperating for brokers when they upload a complex census of member information to underwrite a group plan, then have to re-enter all the same data when it’s time to enroll new members. Carriers that integrate with the systems the brokers are already using can create a seamless path from quote-to-card with no duplicate entry. This automation also makes the process faster and less error-prone, to the benefit of all. 
  4. Support brokers’ digital distribution channels. Brokers themselves are rapidly changing how they service their individual and business clients, all of whom expect to have access to self-service tools for information and transactions. Some brokers go to market primarily through online experiences, allowing customers to shop, buy and service plans through websites and apps. Others offer digital channels that complement traditional face-to-face service. In the group market, brokers also want to leverage benefit administration systems that are increasingly used by businesses. But, too often, broker websites and apps are digital front end to an otherwise manual process. A plan participant might add a new baby to their broker’s app on Monday only to discover at the pediatrician’s office on Friday that the coverage has yet to be updated. Behind the app’s sleek façade is the broker’s back office that has to retype the information about the new dependent into a form that the carrier takes days to process. Carriers that can handle transactions electronically (and provide rapid confirmation) not only save money on back-office staff, they also improve member satisfaction overall, increasing the probability of group renewal.

Of course, the majority of insurance companies aren’t oblivious to the pressures that brokers face. Most are working on their own digital transformations, but these take time. In addition, many carriers have prioritized other projects ahead of building more robust digital connections to brokers. That’s a risky strategy in a market in which brokers can easily shift business to carriers that support their automation and minimize the back office work that keeps them from serving clients.

Smart carriers aren’t waiting until they’ve completely rebuilt their systems to support their brokers. They are finding ways to connect systems they already have to the software used by brokers and employers. Even if they don’t have the complete real-time functionality they may eventually want, such “hacks” can do a lot to reduce the burden on brokers, drive cleaner data to the carrier and to deliver better experiences to the member. Such efforts may be all that is needed in the short term to ensure that a carrier is top of mind the moment a broker recommends the best plan for a client.

Ideon enables the modern, efficient—even delightful—experiences that brokers, employers and members have come to expect. We connect carriers to broker and employer automation systems, without carriers having to build new technology or otherwise incurring capital expenses.

Contact us and we will gladly explore the state of your systems and distribution network to help find ways to delight your brokers without upending your technology roadmap.

The Future of Benefits Administration Platforms: Centralizing the Employee Experience

Basic health insurance ✅
401(k) ✅
Paid time off ✅

Employee benefits, once mostly a collection of must-check boxes, have transformed into multifaceted rewards programs, customizable to meet the needs of each employee and a key differentiator in recruitment and retention. Ancillary benefits such as pet insurance, gym memberships, and financial assistance programs are becoming the norm, fueling higher expectations for what employees receive, beyond compensation, from their employers. The enhancement and personalization of employee benefits, however, has caused a ripple effect throughout the world of benefits administration (BenAdmin) platforms.

The ways in which BenAdmins have adapted to this new dynamic offer a predictive glimpse into the future of this crucial sector. Just the basics—health insurance enrollment, management of paid time off (PTO), etc.—will no longer cut it. Instead, forward-thinking BenAdmins are preparing for the future: all-in-one platforms that integrate all elements of the employee experience into a centralized system.

From payroll, dental insurance and 401(k)s to FSAs, wellness programs, retirement plans, stock options and student loan repayment, BenAdmins of the future will consolidate all relevant information within one central platform. Those who succeed will not only be incredibly agile—easily adding the hottest non-core benefits of the day—they will be perceived as incredibly agile, representing a major differentiator. They will possess personalized data and insights to share with employees so they can make more-informed decisions about health and benefits products. 

So what is the future of benefits administration? In a word, unified. A single system to rule them all. No employee—and, for that matter, no broker or employer—wants one system of record for health insurance, another to manage stock options, and still another to review HSA balances and employee assistance programs (EAP).

Although tying all of these components together into a single platform will become an essential differentiator between BenAdmins, certain features are gaining in popularity and will ultimately be expected by employees. Here are three trending features that will be an important part of all future BenAdmin platforms:

  • Healthcare concierge services help employees navigate the complexities of our healthcare system, from recommending providers and facilities based on quality and cost, to minimizing healthcare spend by redirecting employees to, for example, an in-network urgent care facility. 
  • BenAdmins of the future must consider employee wellness a vital piece of the benefits package. Mental health assistance, financial wellness programs, and telehealth services should be easily accessible and integrated into the centralized employee experience.
  • Personalized ancillary benefits provide employees with the opportunity to select the non-core benefits that best fit their needs and interests. Some might prefer a gym membership and pet insurance to an HSA, and others may deem student loan assistance a prerequisite for any job offer. More choices, more benefits, more customization—that’s a key pillar of the future of benefits administration.

The future of benefits administration is truly limitless, but it can only reach its unified, all-in-one potential if, on the back-end, BenAdmins have agility and connectivity. Agility because, inevitably, new benefits options—perhaps even entirely new benefits categories—will become popular as younger employees enter the workforce and expect benefits packages to align with their interests. To remain competitive, BenAdmins will need a scalable method to integrate these benefits quickly and efficiently.

Connectivity enables BenAdmins to exchange group and employee-level data with carriers and other benefits providers, such as telehealth, gyms and wellness companies. BenAdmin connectivity is the first step in bringing the full employee benefits experience onto one platform, allowing employees to enroll in and manage benefits across a variety of carriers, lines of coverage, and products. Historically, carrier and benefit provider connectivity has been technically and operationally challenging for BenAdmins. But today, APIs offer BenAdmins a lifeline to simplified, flexible and scalable connectivity with multiple parties.

To learn more about how APIs can streamline connectivity in the benefits ecosystem and prepare BenAdmin platforms for the future, contact Ideon for a consultation.

Vericred Raises $23M in Oversubscribed Series B Funding Round

**NOTE: Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

Aquiline Technology Growth-led funding round and board additions to fuel rapid staff expansion and product development.
Benefits infrastructure leader extends its position as industry standard for health and supplemental insurance connectivity, efficiency. 

NEW YORK, April 12, 2021 — Vericred, the innovative data services platform powering digital quote-to-card experiences in health insurance and benefits, today announced the completion of a Series B round of funding totaling $23 million and the addition of two new members to its board of directors. Aquiline Technology Growth led the oversubscribed funding round, which included participation from new investors Echo Health Ventures, MassMutual Ventures, Guardian Strategic Ventures, and existing investors Riverside Acceleration Capital, FCA Venture Partners and First Health Capital Partners. 

Vericred will use the new capital to expand its teams in New York, NY and Omaha, NE, further build its marketing and sales functions, and exponentially grow the community of participants on its market-leading platform, laying the foundation for a united, digitally connected benefits ecosystem. 

“Today’s announcement showcases the market’s clear endorsement of Vericred’s critical innovations in health insurance and employee benefits. We are proud to have attracted the highest caliber of venture and strategic investors, surpassing the goals we initially set out for this fundraise,” said Michael W. Levin, CEO and Co-founder of Vericred. “We are excited to partner with these leading investors who share our vision for building a simplified way for all participants in the benefits ecosystem to connect, communicate, and exchange data rapidly and accurately.”

Vericred offers a full suite of APIs across medical, life, dental, vision and other lines of coverage that power quoting, enrollment, member management, and renewals on multi-carrier InsurTech and BenTech platforms. Vericred’s solutions simplify the complex process of exchanging data with multiple partners. By effectively removing a critical barrier to industry-wide digital transformation, Vericred enables a true digital quote-to-card experience. 

More than 300 carriers, including industry leaders Cigna, Guardian, Humana, MetLife, Principal, Kaiser and 100+ InsurTech companies including Rippling, Gusto, Ease, and Namely have joined Vericred’s platform, creating a powerful network effect and establishing an important channel to bring new products and innovation to market. 

In connection with this funding round, Vericred welcomes two additions to its board of directors: 

Max Chee leads Aquiline Technology Growth (ATG), which is managed by Aquiline Capital Partners, and seeks to invest in early and growth stage FinTech companies. Max brings over 20 years of experience investing in FinTech and enterprise software. 

Jessica Zeaske, PhD is a Partner at Echo Health Ventures, identifying and investing in emerging and growth-stage health care companies. Previously, she invested with GE Ventures and Lemhi Ventures and has a career-long focus on thesis-driven investing.

“Aquiline’s investment in Vericred is rooted in our shared vision of a fully digitally connected employee benefits ecosystem, where plan quoting, enrollment, and renewal is a seamless experience, much like booking travel or applying for a new credit card online,” said Chee. “We’re pleased to add Vericred as a portfolio company, as we view its infrastructure offerings for benefit administration platforms, along with their carrier partners, as a catalyst for the digital transformation of the industry.”

“At Echo Health Ventures, we seek to drive systemic transformations of the health care system through hands-on, purpose-driven investing. Vericred is an ideal investment aligned with that vision and we look forward to partnering with them as they scale their platform” said Zeaske. “As a Board member, I am excited to help Vericred as they continue to modernize the way health insurance and employee benefits are quoted, sold, enrolled, managed, and used.”

About Vericred

Vericred is the way health insurance carriers and employee benefits providers connect with new technology partners to deliver seamless quote-to-card consumer experiences. We are not the websites or apps you use to choose a plan or find a doctor. We are infrastructure. We are the ‘pipes’ that simplify the complex exchange of quoting, enrollment and eligibility data between carriers and the technology partners responsible for delivering health and employee benefits to hundreds of millions of Americans everyday. Our APIs transmit billions of data points between InsurTech and insurance carriers, powering digital distribution across the insurance industry. Come join the community of insurance geeks creating a seamless digital quote-to-card experience. Visit www.vericred.com

About Aquiline Technology Growth

Aquiline Technology Growth (ATG) seeks to invest in early- and growth-stage technology companies that are bringing innovation to the insurance and financial services ecosystems. ATG is managed by Aquiline Capital Partners, a private investment firm based in New York and London investing in businesses globally across the financial services and technology sector. The ATG team has experience in technology and financial services and is supported by its colleagues at Aquiline, strategic partners, and an active group of industry Executive Advisors. For more information on ATG, visit: www.aquiline.com.

About Echo Health Ventures

Echo Health Ventures drives systemic health care transformation through hands-on, purpose-driven strategic venture capital and growth equity investing. Echo brings together USAble Corporation, Cambia Health Solutions and Mosaic Health Solutions to accelerate health care innovation on a national scale and support meaningful health care impact. For more information, please visit www.echohealthventures.com.

The Top Five Questions Carriers Ask About ICHRA

New to ICHRAs? Download our primer for health insurance executives.

Individual Coverage Health Reimbursement Arrangements (ICHRAs) burst onto the employee benefits scene on Jan. 1, 2020, spawning a new paradigm in group health insurance that shifts the plan shopping and administration responsibility from employer to employee. Now, more than one year into ICHRA’s arrival, insurance carriers are increasingly interested in capitalizing on ICHRA.

To that end, Ideon recently hosted two webinars aimed at helping health insurers in both the group and individual markets understand how they, too, can join the ICHRA revolution. While most carriers are aware of ICHRA’s existence and the legislation behind it, we found that there are still several topics on which carriers have critical questions. In this blog post, we’re sharing, and answering, the most common questions we heard during our webinars.

Is ICHRA adoption among small groups more prevalent in certain geographic areas?
Yes, ICHRA adoption varies by state, and even by county. ICHRAs work best in areas with robust individual markets, affordable plans from name-brand carriers, network options similar to what employees find in the group market, and competitive pricing between individual premiums and their group-plan equivalents. Where’s the next ICHRA hot spot? Check out our interactive map to find rate-favorable states for small groups to shift to ICHRAs.

If the contribution is deemed unaffordable for the employee, can they go to the ACA exchange and receive a subsidy?
A key facet of ICHRAs is affordability. Specifically, large employers (typically those with 50 or more employees) must offer an “affordable” ICHRA or face penalties. Small employers, on the other hand, can offer either an affordable ICHRA or an “unaffordable” version. According to ICHRA legislation, an employer contribution is “affordable” if the remaining amount an employee has to pay for a self-only silver plan on the Exchange is less than 9.83% of the employee’s household income.

The ability to offer an unaffordable ICHRA is an opportunity for small employers. When a small-group ICHRA is “affordable,” employees are not eligible for government subsidies. If small employers offer “unaffordable” ICHRAs, employees can “opt out” and go to the exchange to get their premium tax credit, more commonly known as a subsidy.

How do you address the fact that individual plans do not generally have the same broad networks as group plans do?
One of the benefits of an ICHRA is that employees now have the expanded choice associated with the individual market, where they have more opportunity to find a carrier, plan, and network in which their preferred doctors and providers participate. Provider-centric plan shopping is an essential part of the employee decision process: about 70 percent of consumers, according to Ideon’s internal data, add their doctors as search criteria. When transitioning an employee to an ICHRA, it’s not necessarily about finding the broadest network, it’s about selecting the plan and network that best meets each individual’s needs.

How will ICHRA impact the role of the broker?
Group brokers have a critical role in the ICHRA process, from helping employers evaluate whether ICHRA is the best option for their company, to guiding employees through the individual plan shopping experience. Their role as essential advisors, trusted and valued for their industry expertise, will not change with ICHRA.  

Smaller groups already struggle to understand benefits. Are there tools to help them do the calculations around tax credits and ICHRA affordability?
Yes. Several digital platforms and exchanges have built innovative tools to help employers, brokers, and employees determine whether ICHRA is right for them. From digital affordability calculators to instant subsidy estimates, tech-driven decision-support tools are simplifying the decision process in year two of ICHRA. As an example, our partners Flyte HCM, Gravie, Savvy, and Take Command Health are platforms with ICHRA functionality.

Contact us to learn how Ideon helps carriers navigate the shift toward ICHRAs and provides access to new distribution channels via one central connection.

The Effect of Increased Competition on Premium Changes in the Individual ACA Market

Veristat: A Data-Driven Look at Today’s Insurance Markets

During the early years of the ACA individual plan, premiums rose steadily and often steeply, not least because of carriers’ decisions to exit various markets. But now that uncertainty has receded and the risk pool is better understood, carriers are changing course. Bright, Oscar, Centene (Ambetter) and Cigna have all aggressively expanded their footprints, and in 2021 UHC re-entered the individual market in five states.  

To evaluate the impact of this increased competition we looked at premium changes in individual ACA plans over a three-year period, from plan year 2019 to plan year 2021.  

Over that time, state-average, lowest-cost Bronze plan premiums fell in real dollar terms in 94% of states with increased competition (from new entrants), compared with 54% of states without such an increase. State-average, lowest-cost Silver plan premiums fell in 88% of states with increased competition, compared with 54% of states without. And state-average, lowest-cost Gold plan premiums fell in 81% of states with increased competition, compared with 60% of states without. In all, 16 states welcomed new entrants or increased competition; of these, only Louisiana failed to realize real-dollar reductions in Bronze plans over the past three years.

Premiums dropped in the nation as a whole during the same period—with or without increased competition. The nationwide average of each state’s average lowest-cost Bronze plan dropped by 9.4% in states where competition increased, and by 2.7% in those where it didn’t. Similarly, the nationwide average of each state’s average lowest-cost Silver plan dropped by 12% in states where competition increased, and by 5.2% in those where it didn’t. And the nationwide average of each state’s average lowest-cost Gold plan dropped by 25% in states where competition increased, and by 6% in those where it didn’t. 

In short, the news is good. Not only is increased competition expanding consumer choice. It’s accelerating a decrease in individual premiums, too.

Vericred Analytics: Rate Favorable States for Small Groups to Shift to ICHRAs

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

ICHRAs are the hottest topic in employer-sponsored healthcare. We at Vericred are tracking a number of plan attributes that could accelerate or retard this shift from small group coverage to the individual market. Here, we look at one of them: premium changes between 2020 and 2021.

In 2021, there are five new states (Maryland, Maine, Mississippi, New Hampshire and Washington) where individual plan premiums are equal to or less expensive than small group premiums. Interestingly, increased competition was not the driver of these lower individual premiums: only one of the states, Maryland, welcomed a new carrier to its individual market. (Note: Two states—New Jersey and North Dakota—saw small group premiums become less expensive than individual plan premiums.)

In aggregate, the average (across all of a state’s counties) lowest-cost Bronze individual plan premium was equal to or lower than the small group equivalent in 19 states; that’s up from 16 in 2020 and 11 in 2019. The average lowest-cost Silver individual plan premium was equal to or lower than the small group equivalent in 13 states, up from 11 in 2020 and six in 2019. And, the average lowest-cost Gold individual plan premium was equal to or lower than the small group equivalent in 12 states, up from seven in 2020 and five in 2019. Overall, the number of ICHRA premium-friendly states has roughly doubled over the past two years.

Click here to view an interactive version of this map.

More broadly, the disparity between small group and individual rates has attenuated over the same period. In 2021, the average Bronze plan premium differential between individual and small group markets across all states is down to just 10%, from 15% in 2020 and 25% in 2019. Similarly, the average Silver plan premium differential is down to 23%, from 28% in 2020 and 42% in 2019. And, the average Gold plan premium differential is down to 25%, from 32% in 2020 and 45% in 2019.

Since the launch of the ACA, much has been made about the annual rate increases, particularly in the individual market. More recently, though, the opposite appears to be the case. From 2019 to 2021, state-average individual plan premiums actually went down in real dollar terms in two thirds (67%) of the country. Small group rates, on the other hand, fell in only 12-20% of the states, depending on metal level. The data has spoken: Individual rates are falling.

Eight Reasons ICHRAs May Transform Employer-Sponsored Health Insurance

Predictable employer costs and coverage transportability are just the tip of the iceberg.

Change is afoot in the insurance world. Rules enacted in 2019 spawned a new iteration of employer-sponsored health insurance: Individual Coverage Health Reimbursement Arrangements (ICHRAs).

You can think of ICHRAs as the health insurance equivalent of 401(k) plans (which transformed employer-sponsored retirement savings). That is to say, with this new offering employers can reimburse employees for their insurance costs rather than purchasing policies for them.

The process typically looks like this: 1. An employer designs an ICHRA, with a range of options tailored to meet its needs and those of its employees; 2. employees choose a plan; and 3. employees submit paid expenses to employers for reimbursement. (Expenses might include premiums, claims or both, depending on the design of the ICHRA.)

Whether the shift toward ICHRAs will be as tectonic as the shift to 401(k)s remains to be seen. But there are many reasons to think it might. From an employer’s perspective, the main benefits of ICHRAs include:

  • Reduced and predictable costs: ICHRAs allow employers to set a reimbursement rate that means they never have to pay more.
  • No minimum participation rates: Fully insured plans often require 50% or 75% participation; ICHRAs do not.
  • Less onerous benefit administration: ICHRAs shift the burden of managing benefits to the employee.
  • Something rather than nothing: Some small employers would like to contribute to employees’ health insurance costs but can’t afford traditional fully insured plans. ICHRAs provide a way to provide some help.
  • Different solutions for different classes: ICHRAs allow an employer to move certain classes of employees into the individual market. This may allow the employer to provide coverage, or better coverage, to certain classes.

Likewise, employees will find a lot to like about ICHRAs, such as:

  • Choice: A healthy, single 25 year old has different needs than a 45 year old with children or someone with a chronic condition. ICHRAs give employees the choice of tens, or even hundreds, of health plans, allowing them to find one that best matches their needs.
  • Transportability: ICHRAs make it possible for individuals to leave an employer and still keep their plan. The more ubiquitous ICHRAs become, the more likely it will be that an employee could keep their plan over time.
  • Broader range of covered costs: ICHRAs can be used to pay for certain approved medical expenses in addition to premiums.

Of course, the extent to which ICHRAs become the common currency of employer-sponsored health insurance will dictate their effect on carriers, brokers, insurtech operators and other interested stakeholders.

For a deeper dive into the subject—including potential obstacles to widespread ICHRA adoption—download our latest Ideon Report: The ICHRA Revolution—A New Model for Employer-Sponsored Health Insurance