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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

eBenefits NetworkSales Training for InfinisourceFebruary 2014

Today s topics
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 Ebenefits Network?


What is ebn
What is eBN?






Employee Enrollment Data

  • Cloud-based

  • Automated

  • Employee enrollment data exchange

401k, FSA



Key capabilities
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


How ebn works
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
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
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
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
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
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
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
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
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


Market segmentation
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
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
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
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
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 guidelines to meet customer oe start dates
eBN Ordering Guidelinesto Meet customer OE Start Dates

Santeon ebenefits network

Santeon eBenefits Network

Taking the Mystery Out Of

Electronic Benefit Carrier Connections

Why automate carrier enrollment reporting
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
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 burden1
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
The New Way: Automated Electronic Benefit Carrier Connections

Key capabilities1
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 improve open enrollment performance
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
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
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
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
    eBenefits Network ROI - Example

    < 3 months payback possible


    Ebn helps improve the employee experience
    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



    • Carrier Set-up (each carrier connection)

    • Monthly recurring (PEPM)


    How to place the ebn order
    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
    Marketing & Sales Materials Available

    • Brochure

    • Carrier List

    • Industry Papers


    For more information

    For More Information…

    Caroline Guirguis, Account Manager



    Tom Tillman, Business Development