By Michael Volpe
Unlike health insurance companies, group and voluntary/worksite carriers don’t have an equivalent to the HIPAA 834 enrollment EDI standard specification, so each carrier is left to create its own proprietary format. For employers and enrollment firms that work with many carriers, creating and maintaining data feeds is expensive. Unlike health insurance benefits, group and voluntary/worksite benefit plan designs are not always straightforward tier-based coverages. Therefore, carriers and enrollment firms spend significant resources to ensure proper configuration of business rules and validity of election data.
At the recent 2017 Enrollment Technology Strategy Seminar, InAh Chambers of LIMRA announced the formation of a workgroup to tackle the EDI issues. This workgroup was created in 2016 from a group of carriers that represent a majority of the employer benefits marketplace. The next phase will expand participation to include benefits technology companies that supply the majority of the data to the carriers. The standards are intended to cover a wide variety of group and worksite benefits, including life, disability, accident, critical illness, and emerging voluntary benefits such as pet insurance and identity theft protection.
However, carriers and enrollment partners still face other challenges, especially with the business rules regarding plan design and evidence of insurability (EOI). One of the panelists from an enrollment vendor stated that his primary challenges when working with carriers boiled down to “EDI and EOI.” With an increasing diversity of enrollment channels, including employers’ own HR systems, there is no simple solution on the horizon.
In another panel discussion, representatives from two different carriers described working with more than 120 different enrollment platforms each. A sidebar discussion reinforced last year’s closing keynote: in order to survive in the long run, enrollment and EOI must be modular parts of an “ecosystem” of diverse technologies through syndication (system-to-system integration that uses single sign-on and APIs).
Since 2006, the SS&C BRIX™ Employee Benefits Administration platform has helped several top-ten carriers syndicate both enrollment and online EOI across a wide array of enrollment platforms and private exchanges. To learn how we can help you, contact us at 1-800-234-0556 or firstname.lastname@example.org or download our whitepaper or brochure.