Ebenefits network sales training for infinisource february 2014
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eBenefits Network Sales Training for Infinisource February 2014 PowerPoint PPT Presentation

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eBenefits Network Sales Training for Infinisource February 2014. Today’s Topics. What is eBenefits Network? 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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eBenefits Network Sales Training for Infinisource February 2014

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eBenefits NetworkSales Training for InfinisourceFebruary 2014

Today’s Topics

  • What is eBenefits Network?

    • Overview

    • Key capabilities

    • Carriers

    • How it works

    • Set-up & production processes

    • Small group enrollment (SGE) support

    • Open Enrollment (OE) support

  • Marketing & Selling

    • Market segmentation

    • Target prospect profile

    • OE-driven buying cycle

    • Positioning benefits to customer (employer)

    • Marketing & sales materials available


What is Ebenefits Network?


What is eBN?






Employee Enrollment Data

  • Cloud-based

  • Automated

  • Employee enrollment data exchange

401k, FSA



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


Carrier Network (April 2013)

How eBN Works

customers (iSolved Users)

Benefit Carriers

Employee enrollment data

eBN Cloud Server

Carrier File-out

eBN Web Service

Data mapping,

translation & validation

Standard data formats (HIPAA 834, etc.)

Carrier-specific data formats

All file types

Extract employee enrollment data

From iSolved system

Transmit to cloud server

Workflow & business rules

Virtual connections

Scheduled, triggered, on-demand

Secure and Private

eBN End-to-End Process

Pre Set-Up

Carrier Set-Up

Regular Processing





Preparecustomer DB


Data Mapping


  • Generate data set

  • customer Data Analysis

  • Carrier Business Rules

  • customer-carrier data mapping configuration

  • Complete Data Transformation

  • customer Test File

  • Carrier Testing

  • Data Reconciliation (customer & carrier)

  • Transmission Schedules

  • Monitoring transmissions

  • Manage data Discrepancies

  • Performance analytics

  • Define plans

  • Enter data

  • Validate database

Multiple test cycles may be required,

Based on qualify to customer’s data

8-10 weeks (estimate)


Small Group Enrollment (SGE) Support

  • What is SGE Support?

    • Intended for use with carriers that do not support EDI inputs from employers due to small enrollment sizes.

    • Instead the carriers may accept alternative inputs from these “small group” employers

      • Manual data entry via carrier-provided secure Web portal (becoming more common)

    • 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


How SGE Support Works in eBN

  • Enrollment data automatically extracted from iSolved per the schedule.

  • Changes Report generated by comparing current data to last. This identifies all adds/changes/terminations.

  • Work Order triggered to the eBN data entry team.

  • eBN staff log in to carrier portal (using employer-authorized log in credentials) and manually enter the changes.

  • Email sent to employer confirming that the changes were successfully entered.


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

    • Provide customer name & location

    • 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


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

    • Change plans and/or renegotiate rates with current carriers

    • Add/drop carriers

    • Replace carriers


Aligning eBN with OE Process


3 wks

3 wks

2 wks

1 wk

Add/Change Carrier…









Data to Carrier


Plan Year


~8 weeks from carrier negotiation complete

until plan year starts

eBenefits Network:

6-8 weeks

eBN ordering Guidelines:

Existing iSolved – 6 weeks

New iSolved – 12 weeks

(prior to OE start date)



Data to Carrier


Plan Year


Carrier Connection

Tested & Approved



~8-10 weeks from iSolved ready

to approved carrier connection

eBN Open Enrollment Support

  • Existing eBN customer Carrier

    • Update carrier map with any changes

    • Read the approved OE elections from iSolved

    • Send the elections to carrier automatically on next scheduled post-OE file

    • Can over-ride auto schedule and send OE elections on-demand if needed to meet a carrier deadline

  • New or Add-On Carrier

    • 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:

    • OE start and end dates

    • Plan year start date

  • Follow order submission lead-time guidelines:

    • Existing iSolved user – 6 weeks before OE start date

    • 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

    • 66% of customer OE’s done in Sep, Oct, Nov for Jan 1st plan years

    • Some carriers may have cut-off dates for starting new connections

    • Carrier responsiveness may be slower during this time


Marketing and Selling


Market Segmentation

75,000 Employers

85,000 Employers

160,000 Employers

  • Outsource:

  • HRO

  • PEO

  • Broker

  • TPA

  • In-house:

  • HRIS

  • Payroll Services (HRIS)

  • Ben Admin Platforms

Ben Admin


To Your Solution


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

Target Prospect Profile

  • Administers employee benefits In-house

  • Uses iSolved to administer benefits

  • 100+ benefits eligible employees (FT active + LOA)

  • You will likely find:

    • 3+ carriers (medical, dental, vision, 401k, FSA, COBRA…)

    • They do manual enrollment updates to their carriers

    • They do manual carrier premium billing reconciliations in-house


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:

    • 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

  • 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

  • 1/3 are gearing up for 2013 OE now

  • In planning & purchasing cycles now.

eBN Ordering Guidelinesto Meet customer OE Start Dates



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


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!)


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)

    • Manual process

    • Time consuming

    • Involves HR, accounting and IT


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…)


eBN Helps ImproveOpen 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


eBN Open Enrollment “Back End” Solution

The eBN service becomes part of your OE planning and delivery team to handle carrier data-delivery tasks


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


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


    eBenefits Network ROI - Example

    < 3 months payback possible


    eBN Helps Improve the Employee Experience

    eBN catches “missed enrollments”

    • 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


    Pricing & Ordering



    • Carrier Set-up (each carrier connection)

    • Monthly recurring (PEPM)


    How to Place the eBN Order

    • Key Info Needed

      • 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

      • Indicate Direct/Partner or Reseller Sale (include reseller info)

      • Process order to Santeon promptly (delays while Partner processes order must be avoided)


    Marketing & Sales Materials Available

    • Brochure

    • Carrier List

    • Industry Papers


    Implementation Process

    Implementation Process




    For More Information…

    Caroline Guirguis, Account Manager



    Tom Tillman, Business Development



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