eBenefits Network
Sales Training for Infinisource
February 2014
Today’s Topics
● What is eBenefits Network?
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Overview
Key capabilities
Carriers
How it works
Set-up & production processes
Small group enrollment (SGE) support
Open Enrollment (OE) support
● Marketing & Selling
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Market segmentation
Target prospect profile
OE-driven buying cycle
Positioning benefits to customer (employer)
Marketing & sales materials available
WHAT IS EBENEFITS NETWORK?
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What is eBN?
Medical
Dental
iSolved
eBN
Life
Employee Enrollment Data
 Cloud-based
 Automated
 Employee enrollment data exchange
401k, FSA
Others
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Key Capabilities
• Secure end-to-end data exchange; HIPAA privacy compliance
• Large carrier network (over 300 health & non-health today)
• Supports all carrier data formats
• Supports hosted and on-premise deployments
• Automatic scheduling and file transmission
• On-going EDI/file management (including OE support)
• Initial and on-going customer and carrier communications
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Carrier Network (April 2013)
24Hour Flex
ACS
Admin Pro Advantage
AdminResources & Consulting
ADP
Advanced Benefits Strategies
Advantica
Aetna
AFLAC
Allegiance
Allied Administrators
Allied Benefit Systems
AmeriBen
American Specialty Health
Ameriflex
Ameritas
Anthem
Ascensus
Assurant
Avesis
Award Incentive Group
BB&T
BCBS
Benecard
Benefit Coordinators
Benefit Resource
BenefitFocus
Benefits Strategies
Beneflex
Beniversal
Blue Advantage
Blue Care Network
Blue Choice
Blue Cross
Blue Grass
Blue Shield
BMI KS
Bright Horizons
Cal Choice Plus
CareFirst
CareMark
CBIZ
Ceridian
Chard Snyder
Charles Schwab
CIGNA
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Citi Street
Clear Benefits Inc.
Colonial
Colonial
CommunityCare
Comp Benefits
Conexis
ConnectiCare
Connecticut General
Consult A Doc
Core-Flex
CoreSource
Coventry Health Care
Creative Benefits
Custom Design
Datapath
Davis Vision
Dearborn Financial
DeCare Dental
Delta Dental
Dental Care Plus
Dental Select
Direct Dental
Discovery Benefits
Diverisfied Benefits Services
Empire BCBS
Employee Benefit Mgmt (EBMS)
Employee Benefits Corporation
Employee Benefits Solution
Employer Dental Services
ESI
EyeMed Vision Care
Fidelity
First Choice Health
First Continental Life FCL
Flex Plan Services
Flex System
FlexCorp
Flores Associates
Florida Combined Life
FMH Benefits
Genesis Benefits
Genworth
Georgia Bankers Assoc
Gilsbar
Grace/Mayer
Great West
Great-West Health Care
Group Health
Group Resources
Guardian
Hart FMLA
Hartford
Harvard Pilgrim
Health Alliance
Health Mgmt Systems America
Health Net
Health Partners
Health Plan of Nevada
Healthcare Mgmt Admin
HealthNet
Healthsmart
HealthyRoads
HFS Benefits
Highmark
Hirsh Financial
HMA
Homeland Healthcare
Horizon BCBS
HR Simplified
Humana
Hyatt Legal
IGOE
Independence Admin
Independence Blue Cross
Infinisource
ING
Insurance Mgmt Admin
Integrated Benefits Admin
iVision
JAD Benefits
Job Trax
JSL Administrators
Kaiser Permanente
KMG America
KSPH
Lifewise Assurance Company
Lincoln Financial
Lincoln National Life
MedBen
Medica (UHC)
Medical Eye Services
Medical Mutual
MedTrak
Meritain
Merrill Lynch
MES Vision
MetLife
MGIS
Money Manager
Mountain States Admin
Murfee Meadows
Mutual of America
Mutual of Omaha
MVP Healthcare
MVP Select Care
My Cafeteria Plan
National Benefit Services
National Vision Admin NVA
NCAS
Nexcaliber
NGS American
Optum Health
Oxford
Pacific Benefits
PayFlex
PBS
PCMI
Personal Choice Accounts
PNC Advisors
Preferred Health Systems
Preferred One
Premera
Premier Access
PrePaid Legal Services
Presbyterian Health Plan
PrimePay
Principal Financial
Principal Life
Priority Health
ProBenefits
Professional Benefits Services
Progressive Benefit Solutions
Prudential
Regence
Reliance Standard
Rocky Mountain Admin
Rx Benefits
RxN'GO
Scott & White
Securian
Select Health
Self-Funding Admin
Sentinel Benefits
Shenandoah
SHL/HPN (UHC)
Sierra
Southern Health
Spectera
Spectera
SRC
Standard Insurance
StarMount/Always Care
Sterling
Summacare
SunLife
Superior Vision
T. Rowe Price
TASC
TelaDoc
The Advantage Group
The Loomis Company
The ODS Companies
Tufts
UCCI
UFCW National Health
UMR
Underwriters Services Corp
Unicare (Wellpoint)
United Benefits (FBMC)
United Concordia
United Healthcare
Unum (Unum Provident)
Vantage Financial Group Inc
Veritas
Vision Benefits of America
Vision Plan of America
Viverae
VSP
WageWorks
WDS
Wellmark BCBS
Wellpoint
Wells Fargo
Western Health Advantage
Workable Solutions
How eBN Works
customers (iSolved Users)
eBN Web Service
Extract employee
enrollment data
From iSolved system
Transmit to cloud server
Benefit Carriers
eBN Cloud Server
Data mapping,
translation & validation
Standard data formats
(HIPAA 834, etc.)
Workflow & business rules
Carrier-specific data
formats
Virtual connections
Scheduled, triggered, on-demand
Secure and Private
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Carrier File-out
All file types
eBN End-to-End Process
Pre Set-Up
Prepare
customer DB
(customer/Infinisour
ce)
Carrier Set-Up
Data
Mapping
(eBN)
Testing
Production
(eBN)
(eBN)
• Define plans
• Generate data set
• customer Test File
• Enter data
• customer Data
Analysis
• Carrier Testing
• Validate database
Regular Processing
• Data Reconciliation (customer &
• Carrier Business Rules
carrier)
• customer-carrier data
mapping configuration
• Complete Data
Transformation
Multiple test cycles may be required,
Based on qualify to customer’s data
8-10 weeks (estimate)
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• Transmission
Schedules
• Monitoring
transmissions
• Manage data
Discrepancies
• Performance
analytics
Small Group Enrollment (SGE) Support
● What is SGE Support?
o Intended for use with carriers that do not support EDI inputs from
employers due to small enrollment sizes.
o Instead the carriers may accept alternative inputs from these
“small group” employers
 Manual data entry via carrier-provided secure Web portal (becoming
more common)
o For SGE customers whose carriers support Web portal or
spreadsheet inputs, eBN…
 Automatically extracts the enrollment data from the iSolved system
 Performs the manual data entry into the carrier portal on behalf of the
employer
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How SGE Support Works in eBN
1. Enrollment data automatically extracted from iSolved per the
schedule.
2. Changes Report generated by comparing current data to last.
This identifies all adds/changes/terminations.
3. Work Order triggered to the eBN data entry team.
4. eBN staff log in to carrier portal (using employer-authorized log in
credentials) and manually enter the changes.
5. Email sent to employer confirming that the changes were
successfully entered.
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Guidelines for Selling eBN with SGE
● Many carriers have group size minimums that fall below
100 lives
● Check with eBN team before selling eBN to customers
with <100ee size
o Provide customer name & location
o Carrier names and contacts
● eBN will check if SGE can be supported by the carriers
● SGE support (if available) is included in regular iSolved
eBN pricing
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About Open Enrollment (OE)
● Most benefit carriers designate a “plan year start date” –
driven by health insurance – 66% Jan 1st
● Carriers need electronic submissions to be delivered 2-4+
weeks in advance of plan year start date.
● Employers offer a 1-4 week window each year in advance
of this date for employees to change/renew their benefit
elections for the new plan year.
● Employers often make changes prior to OE and new plan
year start
o Change plans and/or renegotiate rates with current carriers
o Add/drop carriers
o Replace carriers
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Aligning eBN with OE Process
customer:
3 wks
1 wk
2 wks
3 wks
Add/Change Carrier…
iSolved OE
Updated Start
OE
End
Elections
Approved;
Data to Carrier
(customer)
Plan Year
Start
~8 weeks from carrier negotiation complete
until plan year starts
eBenefits Network:
eBN ordering Guidelines:
Existing iSolved – 6 weeks
New iSolved – 12 weeks
(prior to OE start date)
6-8 weeks
iSolved
Updated
Carrier Connection
Tested & Approved
~8-10 weeks from iSolved ready
to approved carrier connection
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Elections
Approved;
Data to Carrier
(customer)
Plan Year
Start
eBN Open Enrollment Support
● Existing eBN customer Carrier
o Update carrier map with any changes
o Read the approved OE elections from iSolved
o Send the elections to carrier automatically on next scheduled postOE file
o Can over-ride auto schedule and send OE elections on-demand if
needed to meet a carrier deadline
● New or Add-On Carrier
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o
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Create the map for the new carrier
Coordinate testing approval to coincide with carrier’s deadline
Read the approved OE elections automatically and send to carrier
Can send a “one-time” enrollment file to carrier if testing approval
cannot meet deadline (if carrier supports)
Guidelines for Selling eBN with OE
● Determine customer’s OE dates:
o OE start and end dates
o Plan year start date
● Follow order submission lead-time guidelines:
o Existing iSolved user – 6 weeks before OE start date
o New iSolved user – 12 weeks before OE start date
● Be aware of the Fall OE “Season” and work closely with
eBN team to plan orders & implementations
o 66% of customer OE’s done in Sep, Oct, Nov for Jan 1st plan
years
o Some carriers may have cut-off dates for starting new
connections
o Carrier responsiveness may be slower during this time
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MARKETING AND SELLING
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Market Segmentation
U.S. Mid-Market Benefits Admin (100ee – 5,000ee)
75,000 Employers
85,000 Employers
In-house
53%
Outsource
47%
160,000 Employers
Outsource:
• HRO
• PEO
• Broker
• TPA
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Ben Admin
Alternatives/Competitors
To Your Solution
In-house:
• HRIS
• Payroll Services (HRIS)
• Ben Admin Platforms
Why Include eBN in Your Solution?
Over 50% of employers
consider carrier
connections to be “Very”
or “Somewhat” important
Sixth Annual Study of Employee Benefits: Today & Beyond.
Prudential Group Insurance, 2011
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Target Prospect Profile
● Administers employee benefits In-house
● Uses iSolved to administer benefits
● 100+ benefits eligible employees (FT active + LOA)
● You will likely find:
o 3+ carriers (medical, dental, vision, 401k, FSA, COBRA…)
o They do manual enrollment updates to their carriers
o They do manual carrier premium billing reconciliations in-house
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The OE-Driven Buying Cycle
● Annual Open Enrollment is the single largest challenge
and resource drain on the HR department every year.
● Every employer offers their workforce an annual 2-4 week
“open enrollment” period to select new plans and make
coverage changes.
● In the months leading up to OE, your customers are:
o
o
o
o
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Negotiating new plans and rates with their carriers
Selecting new carriers
Communicating with employees,
and … making benefits admin technology and service
purchasing decisions!
The OE-Driven Selling Cycle
Employer Annual OE Period
October – December for January 1st plan year
Oct-Dec
• 2/3 recently completed their 2012 OE
• The challenges of OE are fresh on their minds
• Beginning new planning & purchasing cycles for OE 2013
January - September
Jan-Sep
• 1/3 are gearing up for 2013 OE now
• In planning & purchasing cycles now.
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20
40
60
80
eBN Ordering Guidelines
to Meet customer OE Start Dates
2013 OE Start
Date
eBN Order
Existing iSolved User
iSolved with eBN Order
New iSolved User
(6 weeks from HR data ready to OE Start)
(12 weeks from iSolved sold to OE Start)
Mid-March
January
November
Mid-June
April
February
Mid-September
July
May
Mid-October
August
June
Mid-November
September
July
Mid-December
October-
August
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POSITIONING
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Santeon eBenefits Network
Taking the Mystery Out Of
Electronic Benefit Carrier Connections
Why Automate Carrier Enrollment
Reporting?
● Improve and simplify annual open enrollments
● Eliminate cost “leakages”
● Keep your enrollment data in synch with your carriers
● Improve employee benefits usage experience
● Simplify and reduce benefit admin burden on HR
● Comply with current and evolving legislative and
regulatory requirements
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The Old Way: Manual Burden
How do you report enrollment
changes to your carriers today?
• Write custom
reports/programs to isolate
and flag changes
• Enter changes manually into
carrier websites (as well as
into iSolved!)
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The Old Way: Manual Burden
How do you ensure that carrier’s
enrollment records are correct?
● Perform data reconciliation
analyses against carrier reports
(i.e., premium billing invoices)
o Manual process
o Time consuming
o Involves HR, accounting and IT
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The New Way:
Automated Electronic Benefit Carrier
Connections
Key Capabilities
One Internet connection to all your benefit carriers
Automated scheduled file transmissions, no user
intervention required
Complies with HIPAA privacy requirements
Connects over 200 benefit carriers today (med, den,
vision, drug, FSA, COBRA, life, LTD, STD…)
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eBN Helps Improve
Open Enrollment Performance
The “last mile” of the open
enrollment process:
• Getting your employees’
annual elections to your
carriers
• Short deadlines to make the
carrier’s cut-off for new plan
year
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eBN Open Enrollment “Back End”
Solution
The eBN service becomes part of your OE planning and delivery team to handle
carrier data-delivery tasks
OE Challenge
Same Carrier
Current eBN User
Replace or New Carrier
(Current or New eBN
User)
Benefit to eBN User
Coordinating plan details with
carrier (groups, plans, levels,
etc.)
• eBN updates your carrier file
map with any changes
• eBN reads the details
automatically from iSolved
• eBN creates the map for the
new carrier
• eBN reads the details
automatically from iSolved
• Minimal carrier coordination
needed
• Only set-up the details once
(in iSolved)
• No errors
Delivering the approved
employee elections accurately
and on-time to meet carrier’s
deadline for new plan year
start
• eBN reads the approved
elections automatically from
iSolved
• eBN sends the elections to
carrier automatically on next
scheduled post-OE file
• eBN can over-ride auto
schedule and send elections
on-demand if needed to
meet deadline
• eBN reads the approved
elections automatically from
iSolved
• eBN coordinate testing
approval to coincide with
carrier’s deadline
• eBN can send a “one-time”
enrollment file to carrier if
testing approval cannot
meet deadline
• New elections delivered to
carrier on-time
• No “missed enrollments” for
new plan year
• No enrollment errors
• No dual data entry (no need
to enter elections via
carrier’s portal)
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eBN Helps Reduce Costs
How do enrollment cost “leaks” occur?
• Enrollment errors due to multiple manual
data entry points
• Carrying terminated employees or
ineligible members on plans due to
reporting delays
eBN plugs these leaks via regular and automatic
enrollment reporting
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Reducing Health Plan Premiums
●The largest cost is group health premiums
 $10,251 average annual premium (workers contribute 23%)*
 $7,893 ($658/mo) employer cost per employee
●Enrollment errors impact costs and employee experience
 5% - 7%+ enrollment error rate impacting premium costs**
●$22,800 = 300 employee company potential annual
cost savings by eliminating these errors
 300 employees x 77% enrollment rate*** = 231 members on plan
 231 members x $658 = $151,998/mo employer premium
 $151,998 x 5% = $7,600/mo due to errors (12 employees
w/errors)
 $7,600 x 3 = $22,800 based on carrying the errors for 3 months
* Kaiser Foundation 2011
** GAO, Minnesota 2007, Arizona 2012
*** AHRQ 2004
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eBenefits Network ROI - Example
Savings Potentials
• Premium Errors
• OE improvements
• HR time Savings
• Employee Satisfaction improvements
Totals
eBenefits Network Investment
• Carrier Set-up
• Annual Processing (300 employees)
Totals
< 3 months payback possible
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Year 1
Year 2
Total
$22,800
?
?
?
$22,800
$22,800
?
?
?
$22,800
$45,600
?
?
?
$45,600
$1,200
$3,000
$4,200
$0
$3,000
$3,000
$1,200
$6,000
$7,200
eBN Helps Improve the Employee
Experience
Why might employees or
dependents be denied coverage at
point of service?
• No carrier record of employee or
dependent coverage
• Recent coverage changes not
processed by carrier
eBN catches “missed enrollments”
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PRICING & ORDERING
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Pricing
● Carrier Set-up (each carrier connection)
● Monthly recurring (PEPM)
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How to Place the eBN Order
● Key Info Needed
o
o
o
o
o
o
customer ID and contact information
Vendor (carrier) ID’s with carrier contact information
Types of plans carrier is providing (medical, dental, life, etc.)
# of employees
Open Enroll period (EO start & end dates)
Plan year start date
● Order Submission Notes
o Indicate Direct/Partner or Reseller Sale (include reseller info)
o Process order to Santeon promptly (delays while Partner
processes order must be avoided)
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Marketing & Sales Materials Available
● Brochure
● Carrier List
● Industry Papers
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Implementation Process
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Implementation Process
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QUESTIONS?
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For More Information…
Caroline Guirguis, Account Manager
813-333-9079
Caroline.guirguis@ebenefitsnetwork.com
Tom Tillman, Business Development
813-504-0414
ttillman@ebenefitsnetwork.com