Welcome to the first installment of Ideon Insights, a new monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In our first episode, we sat down with one of our technology partners, Lyle Griffin, president of Selerix, a leading benefits administration solution for brokers, employers, and carriers.
In this Q&A, Lyle shares his thoughts on the LIMRA Data Exchange (LDEx) standards, how the industry can facilitate more LDEx adoption, and how benefits data exchange will evolve over the next few years. Selerix and Ideon are both members of the Data Exchange Standards Committee tasked with developing the LDEx standards for the workplace benefits industry.
For Lyle’s complete thoughts on all-things LDEx, APIs, and data connectivity, watch the video here.
Below we’ve highlighted five key moments from the conversation.
IDEON: What’s the current state of LDEx adoption?
LYLE GRIFFIN, SELERIX: There are probably a dozen or so carriers that have stepped up and implemented LDEx in a really robust way. We’ve also been pleasantly surprised at the number of technology platforms that have been involved in developing the standard. That dialog between platforms and carriers is something that has been very refreshing.
What are the benefits of LDEx?
One, is just the speed of implementation, being able to set up your data connections quickly. Knowing that they’ll work as advertised is also very important.
As we move to API engagements, you’re really going to see the benefits. If we can move to something where we’re exchanging data in real-time, or as close to real-time as possible, the benefits back to the client or end-user are incredible.
Why is Selerix an advocate for data standards?
We’ve been very committed to implementing the standards since Day 1. What my team is telling me — the people who set up EDI connections with carriers — they’ve been very adamant that LDEx is good for them. They like it any time they can engage with people using the standard because it’s a concise way to start that dialog with the carrier. Having a common language really helps expedite the process.
How does Ideon help carriers and technology platforms use the LDEx format?
One of the most important things that [Ideon] brings to the table, is a fully formed view of how that data exchange ecosystem should work. Having a robust way to work with people on error resolution, initial engagement, data intake, being able to connect with an API or by exchanging files — I can see where this would be a very attractive proposition, not to have to build all of your business processes from scratch to take advantage of what a company like Ideon has to offer.
What’s the future of data exchange in the benefits industry?
In the long run, I think everyone’s vision is one of an interconnected ecosystem, an interconnected market, where trading partners exchange data more frequently and much more reliably than they do today. That’s what this is all about. As an industry, we’re still talking about this stuff, we’re still working on these challenges. So I think it’s going to take a while to realize that vision.
Stay tuned for new episodes of Ideon Insights each month. Subscribe to our newsletter below to stay in-the-know about Ideon and receive our latest content directly to your inbox.
By Jashan Ahuja Group Product Manager – Enrollment
In Part 1 of a series detailing our enrollment API’s features and capabilities, Ideon’s product team examines error reporting and management — how it works, what benefits platforms can expect, and the advantages of a centralized workflow.
Historically, it’s been an operational and technical nightmare for benefits platforms to exchange group and employee enrollment information with medical and voluntary carriers. No matter the carrier’s method of data exchange — EDI, API, portals, etc. — getting data from platform to carrier was rarely a simple task.
But once connected, it’s smooth sailing, right? Not quite. As benefits platforms’ operational teams know all too well, sending data is only part of the equation. The carrier must accept and confirm the change, and that’s where things start to get really complicated. Usually, the biggest challenge is handling and rectifying enrollment data errors—every carrier sends discrepancies in a different format, and their error reports are rarely human-readable.
At Ideon, we’re powering a new era of connection between carriers and tech platforms. One that’s better, faster, and more secure than the industry status quo. In this blog, we explain Ideon’s error-handling features, from standardizing carrier error messages to resolving errors via API, and how they create a far more efficient and accurate enrollment experience.
What are enrollment discrepancies?
It’s hard to find someone with experience in benefits who doesn’t think that data errors and discrepancies are a problem. Some examples include account set up issues, incorrect employee demographic information (social security number, birth date, etc.), coverage date errors, and more.
Today, most carriers report errors in non-standard formats, often via email and spreadsheets. These reports are usually delivered on a weekly basis, and the information they contain is rarely easy to understand. The result is a slow, manual, and resource-intensive error-handling process that poses a challenge to benefits platforms and their operations teams.
What’s the impact?
We analyzed the data from hundreds of groups and thousands of members and found that about 8% of employee enrollments have a critical coverage issue, i.e. incorrect coverage dates, plan information, or birth date, or they’re missing entirely from either the carrier or platform system. Importantly, more than 80% of groups with 20+ members have critical errors.
And these errors have significant ramifications for the entire benefits ecosystem – from carriers and benefits platforms, to brokers, employers, and employees. The downstream impact ranges from lost revenue and broker commissions, to operational inefficiencies and employee experience issues.
Carriers are missing out on millions in potential premium. In one recent migration of about 200,000 employees onto the Ideon platform, our technology identified errors resulting in nearly $1 million in lost premium for the carrier.
For the employers in that migration, we saved more than 30K employees from potential coverage issues — all from one migration of approximately 200K lives. Ultimately, inaccurate data can cause serious problems for employees. Everyone in our industry can relate to the countless access-to-care issues that occur during open enrollment because of erroneous data. Or, imagine a life insurance claim for an employee who wasn’t enrolled accurately — there would be an emotional and financial impact on a grieving family, while the employer and platform would likely suffer reputational harm.
The processes outlined above remain the industry status quo: manual error handling through spreadsheets and emails, inconsistent carrier formats, and a barrage of harmful errors that affect all stakeholders.
At Ideon, we’ve developed a revolutionary alternative for benefits platforms where enrollment discrepancies are centralized, standardized, and actionable. Here are three ways our solution differs from the typical process:
Many-to-one – Ideon translates all of the enrollment “errors” generated by carriers into a uniform and ingestible format.
Standardized messaging – Each enrollment discrepancy has a “message,” which is a standardized version of the carrier error translated into a human-readable format.
Centralized communication – Benefits platforms view and resolve all enrollment discrepancies, from multiple carriers, directly through Ideon’s API endpoint, allowing for a streamlined and centralized user experience and eliminating the need for other communication (e.g. e-mails and slack messages).
Centralized error management via Ideon’s API
Ideon’s error reporting solution helps platforms prioritize and rectify discrepancies by providing insight into the severity of each discrepancy and who’s responsible for fixing it.Regardless of the carrier or the original data source, platforms get a consistent, simple API experience.
In this section, we examine Ideon’s key error management features and highlight how platforms interact with our API.
(Image: Example of an API response sent from Ideon to a benefits platform. The response details an unresolved enrollment discrepancy, the party responsible for rectifying the issue, and other pertinent information.)
Severity – For each enrollment discrepancy we expose a Severity (“Info”, “Warning”, or “Failure”) that highlights the impact of the issue. A “Failure” enrollment discrepancy indicates a blocker to a member’s enrollment, whereas “Info” and “Warning” enrollment discrepancies provide visibility into informational updates or future changes required, for example when a dependent is due to age out in a couple of months.
Assignment – Each enrollment discrepancy has a Responsible Party and can be assigned to “Ideon” or “Partner”. This provides visibility into enrollment discrepancies that are currently being managed by our Enrollment Operations team and allows users to easily identify enrollment discrepancies that they need to address.
Status – Enrollment discrepancies have a status of “Unresolved”, “Resolved”, or “Returned”. This allows our teams to stay in-sync on each individual enrollment discrepancy. When we initially surface an enrollment discrepancy, it is in an “Unresolved” status. The status is updated to “Returned” when any comments are added and “Resolved” when a resolution message is provided.
Resolution – Partners are able to add a resolution message to an enrollment discrepancy via a simple API endpoint. This updates the status of the enrollment discrepancy to “Resolved”. If the issue still remains when the carrier re-attempts to process the data then the enrollment discrepancy can be reverted back to an “Unresolved” status so the history is retained.
Comments – Partners are able to interact with our operations team entirely via the enrollment discrepancies API endpoint by threading comments directly on the original enrollment discrepancy. This allows for efficient interaction between our respective Operational teams without needing additional tools or e-mails.
API and webhook transmission – Partners can pull down enrollment discrepancies directly from our API via a GET endpoint. We also provide enrollment discrepancies via Webhooks or a standard periodic CSV report.
(Image: Example of an API response sent from Ideon to a benefits platform. The response details a RESOLVED enrollment discrepancy.)
In summary, managing and rectifying enrollment data errors and discrepancies is a critical aspect of the benefits workflow. At Ideon, we understand the pain points of the industry and have developed a solution that streamlines the process by: standardizing error messaging; delivering a centralized resolution experience for benefits platforms; and helping them prioritize and, ultimately, resolve each discrepancy. Platforms can easily manage enrollment discrepancies, from multiple carriers, directly through our API endpoint, allowing for a streamlined experience without back-and-forth email communication.
Coming soon — Part 2: Auto reconciliation overview
Standardizing errors is a big step forward, but did you know Ideon can proactively identify them whether or not the carrier actually reports them? In the next blog in this series, we’ll dive into Ideon’s auto reconciliation feature, an industry-first capability that automatically compares data in the carrier and platform systems, surfacing discrepancies in near real-time.
Want to learn more about how Ideon works? From the ultra-technical to the more thematic, Ideon CTO Dan Langevin answers it all in this ’Ask Me Anything” session.
HMO or PPO? Copay vs. coinsurance? What’s the cost-sharing structure for out-of-network specialist visits, mental health services, and home health care? Shopping for a health insurance plan is a notoriously painful process — whether you’re seeking individual coverage, choosing between plans offered by your employer, or examining your Medicare Advantage options, it’s often difficult to identify the plan that best matches your specific requirements. And it’s certainly not getting any easier: more carriers are offering more plans than ever before.
Like modern shopping experiences in other industries, the bulk of health plan selection now occurs online, via digital health insurance exchanges of both the public and private variety. For these digital platforms, used by consumers, seniors, brokers, and businesses alike, it’s critical to deliver intuitive, data-driven user experiences that provide full transparency into the rates, cost-sharing, subsidy estimates, and other features of all available health plans. However, a robust plan library, side-by-side plan comparison, and a modern quoting interface are insufficient to meet the needs of today’s users.
Shop-By-Doctor: provider-centric plan selection
To many consumers, there is no more significant determinant than whether a plan offers in-network coverage of their preferred providers, hospitals, and facilities. This has become even more important in recent years, as out-of-pocket maximums have increased and high-deductible plans have gained prevalence. To avoid the potentially high cost of out-of-network care, most consumers begin their plan shopping process with one question: “Which plans cover my family’s doctors and our local hospitals?”
Multi-carrier digital platforms have made answering this question far simpler than when paper SBCs and carrier-specific portals ruled the plan selection and enrollment landscape. Today, many multi-carrier exchanges and state-based marketplaces have integrated shop-by-doc functionality — the ability to filter available plans to show only the options that cover users’ preferred doctors and providers — into the plan shopping process.
Offering shop-by-doc has material benefits. Consumers avoid out-of-network fees and purchase a plan based on what’s actually important to them. Ideon, currently powering shop-by-doc functionality on several leading private marketplaces and state-based exchanges, has found that about 70% of consumers shopping for health plans will add their providers as a search criterion. For health insurance platforms, shop-by-doc is no longer an optional feature — it’s an essential component of a modern, integrated, fully-digital plan shopping experience.
Integrating shop-by-doc functionality into the shopping experience
Despite shop-by-doc’s obvious benefits, there remain some holdouts among consumer and broker-facing platforms. Adding this functionality was, traditionally, a near-impossible endeavor. The industry lacked a centralized, standardized source of provider-network data from which platforms could power provider-centric plan shopping features. Acquiring this information, in a usable format, from hundreds of health insurance carriers was beyond their operational and resource constraints.
But that technical barrier no longer exists. Ideon has transformed shop-by-doc into a simple addition to any existing platform, by building APIs that enable platforms with quoting functionality to integrate shop-by-doc into their system, without acquiring and maintaining the underlying provider-network data. These APIs are a bridge to better user experiences, and, ultimately, better-informed health and financial decisions and a smoother enrollment process for all.
If you’re interested in delivering shop-by-doc functionality to your platform’s users, reach out to learn how Ideon’s data solutions enable tech companies to build robust decision support experiences.
Executives and decision-makers at benefits-technology (BenTech) companies—HCMs, benefits administration systems, HR platforms, etc.—have a tough job: every few years, new industry trends force these vendors to shift their sales, product, and partnership strategies to align with the latest needs of brokers, employers, and employees.
One trend that has dominated the BenTech ecosystem in recent years: the rise of voluntary benefits. While employers have offered core benefits like medical, dental, and vision insurance to employees for decades, voluntary products are a more recent phenomenon. Voluntary benefits, as a category, includes a broad scope of services, including:
long-and-short-term disability
mental health support
financial-wellness programs
identity theft protection
accident insurance
cancer insurance
hospital indemnity insurance
critical illness insurance
legal services
pet insurance
life insurance
These products, for which employees pay at least part of the cost, are increasingly a standard component of competitive, modern benefits packages. In 2021, 55% of voluntary benefits brokers reported higher sales compared to 2020 and 54% reported increased enrollment activity, according to BenefitsPro. Further, LIMRA predicts the nonmedical benefits market will grow 20% over the next few years. And it’s not only that more employers are offering voluntary benefits — employee participation is growing, too.
So what’s a BenTech to do? Platforms that simplify the benefits experience for employers and employees—from choosing benefits products to enrollment and administration—will be best positioned to take advantage of the voluntary trend.
Here are three ways BenTechs can enhance their voluntary experience:
1. Offer the voluntary benefits employees desire. It’s no secret that today’s employees want flexible, personalized benefits packages that supplement core products—medical, dental, and vision insurance—with newer offerings. BenTechs that stay abreast of employee needs and offer the most popular voluntary products will undoubtedly have a leg up on their competition.
And what, exactly, do modern employees want? According to a recent survey by Buck, it’s all about financial wellbeing and supplemental health coverage: hospital indemnity insurance, critical illness insurance, accident insurance, long-term care insurance, and personal loans are among the fastest-growing voluntary benefits. On average, employers offer 12 voluntary benefits, Buck’s survey revealed.
2. Provide decision-support tools for a better enrollment experience. Gone are the days of employees selecting benefits by skimming printed collateral materials. Today’s workers expect an Amazon-like enrollment experience: easy product comparison, tech-enabled assistance at the click of a button, and personalized recommendations based on data and individual needs.
Leading BenTechs have significantly upped their capabilities in recent years, empowering employees to make more informed decisions and better understand voluntary products. PlanSource, for example, offers employees side-by-side plan comparison and helps calculate per-paycheck cost estimates, while its DecisionIQ feature provides personalized recommendations powered by AI and machine learning technology.
3. Focus on operational excellence to make enrollment and administration a breeze. Offer in-demand products? Check. Build an industry-leading, digitally-advanced enrollment experience? Check. But the final step for forward-thinking BenTechs is to make operational greatness and smooth client service core priorities.
A major operational challenge is the transferring of voluntary benefits elections from a BenTech platform to carrier systems, and confirming groups and employees are enrolled accurately. This is an essential task: data errors can cause critical coverage issues for employees, billing problems to be rectified, and, ultimately, reputational harm and client turnover. That’s why many leading BenTechs now leverage APIs to streamline data exchange with carriers. Indeed, according to Guardian, API-enabled benefits administration can save employers up to 200 hours per year and cut down on data errors.
For BenTechs, building a better voluntary benefits experience won’t happen overnight. But there are ways to make serious progress, without using significant development and operational resources. For more information about how Ideon can help, contact us here.
In today’s world, data quality drives results—for good or bad. And for all the progress that’s been achieved harnessing data in the health insurance and benefits ecosystem, data problems are rampant.
We speak to you from the trenches, which is to say that Ideon is in the business of not only data connectivity, but also data accuracy. And in our experience, about 10% of employee enrollments have existing data problems—from incorrect social security numbers to inaccurate effective dates—that can and often does cause significant issues for members, employers, and carriers.
The fallout of poor data throughout the ecosystem includes:
Members are arriving in doctors’ waiting rooms, only to be told their coverage is not in place. Scenarios like these are all too common. And while these problems are solvable retroactively, they cause undue frustration and time-wasting for members.
Employers are paying for coverage for employees who have long ago jumped ship, when termination is not done properly. And new employees may resent their employer when their benefits experience is rife with coverage issues.
Brokers and consultants are often responsible for ensuring coverage is intact. They also may be the ones charged with entering enrollment data into a broker portal or enrollment platform. So when there’s a data issue, they often bear the brunt of the blame. Aside from fielding calls from irate HR managers, brokers often take home lower commissions when enrollments are incomplete owing to data issues.
Carriers have been forced to set up costly systems and processes—such as large customer service operations—to deal with the consequences of poor data quality. Bad data can also mean significant premium leakage. And importantly, while many look to insurers to solve all data problems, it’s impossible for them to do so without the help of all the other entities involved.
Bottom line: The industry’s “dirty data” problem is pervasive, with detrimental ripple effects at scale. Consider: In our estimation, nearly 9 million employees in the U.S. could have a coverage issue.
What’s being done? Not enough. Many constituencies in the industry see data issues as unavoidable and insurmountable, resigning themselves to addressing the symptoms, not the disease.
We get it: These issues are daunting. They’ve been institutionalized to a startling degree. But with industry-wide collaboration, they’re also eminently solvable.
At Ideon, we have some thoughts on how this can be done. You can learn more about them here.
“Ideon cleans up the big mess the industry has built”
With the agency management software Benelinx, employee benefits brokers access health insurance quotes from multiple carriers in a flash. The company was started by Rachel Zeman, who formerly ran a brokerage and was frustrated with the redundancies and errors that were par for the course in the space.
In contrast to the traditional, broken model, brokers using Benelinx’s quoting engine have to enter a client’s parameters just once to quote and compare medical plans from numerous carriers.
Backstage, Ideon’s APIs quietly power Benelinx’s quoting tool through seamless data exchange. (We’re the strong, silent type.)
Benelinx
Helping agencies compete nationwide.
The Benelinx system, with data from Ideon, allows brokers to get accurate health insurance quotes from multiple carriers, saving hours on every proposal.
Ideon makes it easy for Benelinx to expand into new states and offer additional products without the need to negotiate with and connect to additional carriers.
Background
Rachel Zeman built RiteHealth Solutions into a thriving benefits brokerage based in Boulder, Colorado In 2019, she sold that company and started Benelinx to offer other brokers access to the customized software platform she had built for her own firm. Benelinx relies on Ideon to make it easier for brokers to provide quotes that compare rates from multiple carriers.
Q&A
Tell us more about why you started Benelinx
When I ran a brokerage we had become increasingly frustrated with the industry’s archaic systems, which are littered with redundancies and errors that don’t make sense in the modern world. We’d ask, “Why do we have to enter the same client information five times into five different systems?” And there was never a good answer. So we decided to streamline the process and built applications on the Salesforce platform. I knew this was something the market needed and it wasn’t available.
What problems do brokers face getting quotes for health insurance?
Most agencies are still running their entire business on Excel spreadsheets. If they want to make a proposal for clients, they have to go to the websites of four, five, six carriers, and upload the employee census to each, then download a quote. Then they have to compare them because every carrier’s rates and requirements are different. The only practical alternative they had was to work with a general agent that had relationships with multiple carriers, but as brokers get larger they often want to bring more in-house.
How does Benelinx make that easier?
The broker just enters the parameters for a particular client and uploads the census one time. Then all we have to do is ping Ideon, and we get back everything that is available to the client based on each carrier’s underwriting requirements. Every time we demo the quote function to a broker they are blown away.
Why did you decide to use Ideon to power your quoting engine?
The only other option would be to go to all of the carriers directly. It would have been very painful. When we started, we tried to get carriers to give us their rates electronically, and most wouldn’t give us the time of day. If they did agree, the data they sent would have to be cleaned, verified, and put into a standard format. Every carrier uses its own system and way of transferring data. Ideon cleans up the big mess the industry has built.
Can you describe the experience of integrating Ideon into your system?
My developers would say they have had nothing but amazing support, starting when we were integrating Ideon into our system. The customer service was great, and all their technology was up-to-date.
What’s the biggest advantage of working with Ideon?
Ideon has made it easy for us to grow. They are adding new products, like level funded plans. That’s something our clients have been asking for so now we can plug it into our system. It’s so simple. We’ve also been able to expand nationally. If we didn’t have Ideon we would have to go state by state and convince every carrier to give us rates. I can’t fathom what that would look like.
How does your story fit into the broader industry picture?
Our industry is in the middle of a huge consolidation, and that makes it difficult for many brokers. There is nothing more important than maintaining boutique brokers that can help smaller-size businesses make complicated and expensive decisions about healthcare. Ideon is helping us offer a very affordable solution that lets brokers of all sizes compete.
Up to 9 million employees may have a coverage issue
Over the past two years, as we have scaled our enrollment and member-management solution, we’ve been surprised less by the data problems we have seen than by the resignation among various constituencies that such problems are inevitable and unsolvable. As an industry, we’ve institutionalized issues that undermine the protection of covered members, not to mention the great experiences that we’ve become accustomed to in other industries.
The data problems we see include incorrect identifiers (e.g. Social Security numbers), birth dates, effective dates, classes, divisions, addresses, phone numbers and more. Some of these are less critical than others, but many create coverage issues.
How broad are these issues? Overall, we see existing problems with approximately 10% of subscribers we migrate on to the Ideon middleware platform. Importantly, we regularly see coverage issues with 8% of the lives we migrate onto the Ideon platform. The members in this 8% are either missing coverage for which they enrolled, or are still enrolled when they should have been “termed.” Fifty-six percent of all groups we migrate on to Ideon have pre-existing, critical (coverage) errors. And substantially all large groups have such errors.
To put this into perspective: 110 million employees in the U.S. have employer sponsored health insurance and employee benefits. So if our experience holds true to the broader base, almost 9 million employees could have a coverage issue. Are we surprised? Doesn’t matter. What’s more important is that we pull on this thread to see the impacts across our ecosystem.
Let’s start with the employee, or member. Stories of arriving at the doctor only to find the coverage for yourself, or your child, is not in place are rampant. Although bad enough, this can be solved (albeit retroactively). But what about someone who dies and wasn’t properly enrolled in life insurance? Imagine the impact on the family. These are not trivial issues.
So now let’s look to the employer. Both sides of the coverage coin adversely affect the employer. If an employee is not properly terminated, the employer will continue to pay for their coverage. Worse are instances when an employee is not covered and should be. Nothing undermines employee benefits goodwill like coverage issues. Imagine a new employee whose spouse visits the doctor with a sick child only to discover the child is not covered.
Brokers and consultants are likewise not immune from the impact of coverage issues. Their responsibility often extends to open enrollment and making sure coverage is correct. This is exacerbated when they are the ones actually responsible for entering enrollment data into a broker portal or enrollment platform. The broker/consultant is often the first call from an angry HR manager. At the same time, incomplete enrollments may mean lower commissions. In a recent migration of one BenAdmin we found data issues preventing coverage that aggregated more than $1 million in premium. While certainly not all with one broker, commissions on this business were absent because of these data issues.
Which brings us to the carrier. Many put the onus on insurers to fix all issues, but they simply cannot do so without the help and cooperation of all the above entities. Unfortunately, and in the absence of solving the problem, carriers have been forced to allocate substantial resources, and develop systems and processes (think member operations and customer support), to deal with the symptoms of these issues: the unhappy member, employer and/or brokers. And as noted above, the premium leakage affecting the carriers can be substantial.
The frustrating aspect of all of this is that these problems are solvable—but it takes a village.
A role for every stakeholder
Fixing our industry’s data problems will require contribution from many stakeholders. No single party can solve these issues alone. The good news is that the benefits of resolving these issues accrue to all.
Carriers: The most important step toward resolving these issues and keeping the data clean over time is for carriers to expose group structures and censuses through some kind of repeatable digital process. With this data, the same data from the employer, through their BenAdmin, can be compared and differences surfaced. Today, very few carriers make it easy to access these data on a regular basis. This is one reason we at Ideon have written that the most important API a carrier should develop is a census API.
Middleware: The role of middleware encompasses far more than connecting carriers, BenAdmins, and other industry participants. Middleware, such as Ideon, also plays a key role in cleaning up data discrepancies and keeping employee benefit data accurate. Middleware’s role is to 1) identify discrepancies between the various parties; and 2) normalize, structure, and deliver those errors to the appropriate party to adjudicate. While the first role is obvious, the second is less so. The reality today is that each carrier describes, and delivers, the same error differently. Some may use plain language “the social security number is invalid” while others may use a code to describe that error. Many of these errors are sent by email, while some carriers send these errors in files, and a very few through APIs.
Middleware’s role of normalizing and structuring this data is critical to delivering great experiences for all of the parties who ultimately need to fix the errors. If brokers, employers and members need to parse through emails and files for errors from different carriers and/or interpret what the error is, we will never create an environment conducive to fixing these problems and keeping them fixed.
The industry-changing potential of middleware was evident in one recent migration of about 200,000 employees onto the Ideon platform, all enrolled with a large national carrier. During that migration, our technology identified errors impacting more than 16% of the employees, resulting in nearly $1 million in lost premium for the carrier—and, we expect, lost broker commissions.
In summary: we found $1 million in additional premium for the carrier, and we saved more than 30K employees from potential coverage issues. All from one migration of approximately 200,000 employees. Projected across the industry, we can safely assume carriers are leaving tens, if not hundreds of millions of dollars on the table.
BenAdmins: BenAdmins play a critical role in creating a path for these errors to be addressed. While we, as middleware, can surface these problems, we cannot adjudicate many of them. As such, BenAdmins need to build into their solutions a means of directing each error to the appropriate party. A demographic error can be sent directly to the employee. But class, division and other such errors need to be addressed by the employer. Still other information may need the broker or consultant to weigh in.
Ideon triages, classifies, and structures these errors allowing for easy and repeatable direction of errors to the responsible party.
Brokers: For some employers, especially smaller companies who may not be using a benefit administration system, the responsibility for fixing the errors falls on the broker. Once surfaced, brokers have a responsibility to fix the data discrepancies. At first this can be daunting when confronted with the sheer number of problems that need to be addressed. This is especially true as we all set on a path to clean up pre-existing problems. Fixing Social Security numbers, birth dates, effective dates and the like is self-evident. But some may be inclined to dismiss errors in addresses, or such demographic data. But ultimately a great member experience relies on these data being right. Whether it is for receipt of plan materials, or a claim check, this often-ignored data is critical.
The good news is that once the heavy lift of cleaning-up existing problems is complete, very little ongoing work by the broker should be required to keep the data clean.
Employers: Employers too have a role to play. It is incumbent upon the employer to make sure enrollment and effective dates are corrected and to address any inconsistencies around an employee’s classification including assignments to certain divisions, departments etc.
The first step: A shift in mindset
If the above framework feels daunting — I get it. Fixing a deeply embedded, decades-long problem is always challenging, made more difficult in a complex industry with numerous stakeholders and competing priorities. But we must start somewhere.
As a starting point, I hope to see the industry to coalesce around—and be inspired by—these three convictions:
1) It’s a problem worth fixing. 2) It’s solvable. 3) It requires industry-wide collaboration.
If we as an industry can shift our mindset and unite behind these three beliefs, we’ll be on our way to eliminating inaccurate benefit data—and its harmful impact.
“Ideon does all the heavy lifting—cleansing, filtering, refining all that data from carriers—and then they output a single, consistent data format that’s really easy for us to consume”
PerfectQuote is a SaaS solution for employee benefits brokers and agents, founded in 2017 on the hypothesis that there had to be an alternative to the manual spreadsheeting of benefits and rates. And indeed there was. With PerfectQuote’s software, benefits brokers in the large group space can now quote, analyze, compare, and present plans from carriers in all 50 states.
But what of the small-group space, you ask?
Powered by Ideon, PerfectQuote now offers one of the industry’s leading small group quoting experiences. Want an inside look at how PerfectQuote expanded its platform? See below.
Perfect Quote
Helping Employee Benefits brokers and their teams sell more, faster and better
Ideon’s data powers the small-group side of PerfectQuote’s Group Insurance CPQ software.
Ideon’s data helps PerfectQuote eliminate thousands of hours of labor that would otherwise be devoted to sourcing, normalizing and presenting plan and rate data.
Background
Since 2017, PerfectQuote has provided quoting, analysis and presentation software to group brokers and general agents, with the goal of supporting plans for small (ACA) and large-group medical in all 50 states, alternative-funded and ancillary lines of coverage.
To understand how the company works with Ideon, we spoke with Aaron Snyder, president and co-founder, and Curtis Kadohama, head of product. Their answers have been consolidated and edited for clarity.
Q&A
What’s the cocktail party version of PerfectQuote? Aaron Snyder: PerfectQuote’s CEO and co-founder, Justin Sylvester, was an employee benefits consultant. Around 2013 he started thinking that there had to be a better way to support brokers and their teams in the manually intensive process of spreadsheeting benefits for clients. He developed the initial push of the idea and in 2017, we started to collaborate. The next year we came out with our first product, called PerfectQuote, with the proposition that we could eliminate the laborious data entry that had been required to sell and renew insurance for brokers in the large group space. While brokers had some options for small group, PerfectQuote was designed to allow brokers to upload any quote file, from any carrier, for any size group. From this point, they would have the ability to analyze and present employee benefits options quickly and easily and without error.
How does Ideon enter into this? Aaron Snyder: As I mentioned, one of our main differentiators is that we support the large-group portion of a broker’s book of business, with plan and rate data that we get directly from carriers. But on the small-group side, which involves many more carriers, we didn’t have a solution that could support a broker’s entire book of business. So, like any nimble start-up, we developed our small group module and quickly figured out that Ideon could be a single source of truth for small group data,and eliminate some of the friction we experience within the other side of the platform. Ideon provides a very essential function for us.
Why is it such an essential function? Curtis Kadohama: The easiest way to understand the value of Ideon is to compare our small group and large group data workflows. In the large group market, every carrier has its own format for quote files, each of which may also vary by state. So we’re constantly having to adapt to new file formats, new layouts, new ways of carriers interpreting and illustrating benefit values. It’s highly manual and time intensive. Compare that to our small-group workflow. Ideon does all the heavy lifting—cleansing, filtering, refining all that data from carriers—before they output a single, consistent data format that’s easy for us to consume.
Can you quantify the savings in time or effort from using Ideon as your small-group data source? Curtis Kadohama: We’ve done some rough analysis. Let’s say there’s a new PDF quote file we receive from one carrier for one state covering one plan. We estimate it would take us 15 hours in terms of scraping, mapping, analyzing, developing, QAing, and refining before we can say, “Okay, it’s ready to use by our brokers.” Now compare that to what happens with Ideon. We’ve already done our integration with them, which took some development time—and each year we’ll spend a little dev time on updates—but for a given employer group, depending on the state, our application could give a broker 700 or 800 plans to present to his or her client, in a matter of seconds. In contrast, a broker’s offering to a client is typically limited to how many spreadsheets of plans can be manually created using carrier documents and PDFs. It’s a pretty drastic difference.
Are there benefits to partnering with Ideon beyond time savings? Curtis Kadohama: Having a dependable source of data helps on the inbound side, in terms of knowing that we’re receiving reliable information. It allows us to consistently and confidently display information in our application and in our Excel exports to customers. Compare that, again, to our large-group side, where the data we receive is both inconsistent in terms of categorization of information and challenging in terms of quality, with missing decimal places, dollar signs, percentage signs. It’s a difficult experience for everyone, from the people on our team processing that data to the end brokers who have to interpret it. Ideon basically removes those challenges from the small-group side of our business—and to the extent that there are questions or complexity to clarify, which is inevitable, the Ideon team is highly responsive.
