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Topic: Carriers

What makes a health insurance carrier broker friendly?

Posted on by Ideon

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 Top Five Questions Carriers Ask About ICHRA

Posted on by Ideon
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.

Lightening up the year-end blackout period for employee benefits

Posted on by Dan Langevin

Ideon ends the hassle of changing current-year plan details during open enrollment.


By Dan Langevin, co-founder and chief technology officer of Ideon

Towards the end of every fall, as 1/1 renewal dates loom, insurance carriers, brokers and members work diligently to ensure that upcoming plan elections go off without a hitch. Meanwhile, life goes on in the current plan year, and life events that affect enrollment need to be addressed. Simultaneously managing the current plan year changes and the upcoming elections is often a tricky ordeal.

The fact is, most carrier systems struggle to manage coverage across plan years—regardless of the carrier’s backend data ingestion system (EDI 834, API or a custom format). When you consider that enrollment elections for the next plan year begin at least a month before the effective date and that changes can continue to be made retroactively for 60 days, cross-plan-year changes can actually be a problem for three months a year.

To this point, the “state of the art” solution has been manual one-off processes. Carriers require specialized, custom formats (different from their regular EDI 834, API requests or flat files) or specially timed delivery of changes for the prior plan year that differs from the regular file delivery day. In practice, most brokers and operations teams at BenAdmin platforms handle these changes manually, by contacting the carrier or by entering the data into the carrier’s portal. This isn’t exactly ideal. Nor is it ideal for the carriers, as their cost-saving automation is bogged down by so many extra manual touches.

This is a major systemic shortcoming. How can we realize full digital connectivity if for 25% of the year we require a separate manual process to handle basic changes?

Eventually, the underlying limitation will be resolved. Carriers will upgrade their internal systems, data models and processes to seamlessly handle cross-plan-year changes. But, as with many things technology-related at large national carriers, the investment required to accomplish that will be large and the timeline long. The market wants a solution today.

Enter Ideon’s Blackout Period Change Management. We have worked diligently with our carrier partners to develop cross-plan-year, change-management processes that eliminate the need for one-off manual changes. The result: the effective elimination of Blackout Periods.

From the BenTech platform or broker’s perspective, data is sent to Ideon’s APIs per standard operating procedure. Our data model has the concept of different plan years baked in. The differences between how transactions are handled with each carrier are entirely transparent. It “just works.”

From the carrier’s perspective, cross-plan-year changes remain less than ideal. Most carriers need to do some level of system acrobatics to process them. That can mean tasks as manual as employees processing a custom Excel doc with every requested change. That said, knowing that they are getting clean data in a consistent format from multiple BenTech platforms gives them back some of the leverage they reap from automation the other nine months of the year. Further, as the carrier upgrades the efficiency of their internal systems (to standard file feeds or, ultimately, to APIs), it will have a partner who understands the idiosyncrasies of cross-plan-year changes and can help to develop a technical integration and business process.

This fall, we piloted our Blackout Period Change Management process with a large customer that covered tens of thousands of lives across hundreds of groups and four carrier partners. The feedback from all sides was extremely positive. That success has made us that much more excited for a broad rollout across all of our carrier and BenTech partners.

Ideon’s mission is to make insurance and employee-benefit data flow freely between member-facing tech platforms and insurance companies. We know that APIs will be a big part of that solution. In the short term, though, we will also provide innovative, tech-enabled business processes that bridge the gap between where we think we should be and the realities of what exists in the ecosystem today. 

Contact us to learn more!

Covid is forcing a reckoning for the health insurance industry—and that’s good

Posted on by Dan Langevin

By Michael Levin
Co-founder and CEO, Ideon

The Covid-19 pandemic is a once-in-a-lifetime stress test of the healthcare system. And while most of the attention has rightly been focused on front-line healthcare delivery, the provision of employer-sponsored health insurance has also been substantially disrupted. Those carriers, brokers, and employers who respond with speed, creativity and flexibility will emerge from this crisis with more modern, efficient, and resilient systems than ever before. Those who don’t, I believe, will regret their failure to seize the moment.

Until Covid, a great deal of the health insurance sales cycle has involved face-to-face contact. Brokers met with employers, often using paper presentations to compare various options. Then, in open enrollment, many employees would explore their options by meeting in a cafeteria or conference room with carrier or broker reps. A lot of administrative details were still processed through paper forms.

Today, much of this interaction has gone digital, via video calls, webinars, micro sites, and apps. For some clients, this forced transition has meant a loss of intimacy and trust. But in general, those people who had been reluctant technology users have discovered the speed and convenience of online interaction. 

At the same time, the pandemic has spurred some in the industry to modernize anachronistic practices. For example, some carriers have scrambled to figure out how to accept credit cards, as some business clients were no longer working in offices where they could easily cut checks.

We can expect a good deal of this behavior to continue and even expand after the pandemic subsides, further reducing costs and improving service quality throughout the industry. 

But there are also more subtle changes that accompany these shifts from in-person to online interaction. To serve employers remotely, brokers are now providing access to online marketplace tools that allow such customers to compare plans  and rates  from multiple carriers. 

To be sure, many insurance companies have long been ambivalent about the rise of new technology-driven,  multi-carrier, distribution platforms. They would prefer to have direct interaction with brokers and clients, if not through their sales force than at least through proprietary online systems. Being just one item on a menu of carriers, they fear, neutralizes their differentiation, and focuses competition on price. Now, though, the market has been refocused by COVID, with brokers and employers alike demanding the transparency and efficiency of these platforms. As such, carriers are increasingly open to partnering with InsureTech companies.  

Carriers have faced similar choices about how to inform customers of expanding coverage for telemedicine and testing, relaxed policy rules, and other changes in response with Covid. Some have largely restricted this information to their own sites and apps, offering a rich stream of communication to the tiny fraction of their customers who use those channels. But others have partnered with brokers and technology companies to distribute their content—finding that what they lose in control is more than matched by gains in reach. 

This dilemma is neither new nor exclusive to the insurance industry. Airlines would rather sell tickets on their own sites than through Expedia. Banks would prefer you check your balance on their app, not Mint. But these companies have come to understand that they need to do business in the ways their customers want. 

The insurance industry must continue to absorb this lesson. And I believe it will. Indeed, if the new Covid vaccines are as effective as initial reports suggest, I suspect that a year from now we will start to see a significant restructuring of the health insurance industry. 

Because there’s no going back.

That is, a lot of customer behavior will already have permanently changed. Fewer people will work from offices, limiting the revival of face-to-face sales calls and common-area recruitment sessions. And many of even the most resistant to new technology will have learned to use digital tools for buying and managing their health insurance. Nobody will want to go back to filling out paper forms.

Most significantly, employers and plan participants will think back and remember how well—or how poorly—they were treated by their insurance companies. 

Were they able to get information and handle transactions easily and efficiently? 

Which companies responded creatively and with flexibility to the rapidly changing world—and which were stuck in an irrelevant past?

It’s a stress test for the entire industry. Not all will pass, but those that do will ultimately be grateful for the reckoning brought on by an otherwise awful pandemic.