health insurance exchanges

You’ve Selected an Active Health Insurance Exchange Service Provider—Now What?

Active health insurance exchanges are growing in popularity.

Although adoption rates for active health insurance exchanges (HIX) have not yet reached the levels predicted when these delivery models first hit the market, steady growth continues as employers evaluate health & welfare benefit administration delivery strategies. The Kaiser Family Foundation and the Health Research & Educational Trust 2016 Employer Health Benefits Survey showed that twenty-eight percent of employers with 5,000 or more employees are considering HIX models to more effectively deliver benefits and manage costs.

The HIX marketplace is evolving

The HIX marketplace continues to evolve with enhanced delivery models, new service providers and expanded offerings. Evaluating the merits of adopting a HIX strategy and selecting the service provider best positioned to deliver on this strategy can be challenging. Desired outcomes will be diminished without a meticulous focus on building a solid foundation through one of the most critical phases of the process—implementation and effective change management.

Based on multiple years of experience leading clients though the steps necessary to effectively introduce new delivery solutions, Curcio Webb built a deep understanding of what it takes to execute on these projects accurately and on time.  As a result of our extensive experience implementing these projects, we developed a number of key tenets for our clients to consider as they embark on a complex project of this type.

Health insurance exchange implementation considerations

  • Know what you bought. The entire Benefit/HR team should be well versed in the final scope of services. Some team members may not be involved in every step of the evaluation process; however, the entire team will likely be engaged in implementation. A common understanding of the delivery model, the scope of services commitment and your team’s role will go a long way toward ensuring a smooth transition.
  • Understand how your account will be serviced. HIX delivery models may be supported across many groups within a service provider’s organization. Your service provider should clearly identify administration delivery, exchange management, consulting and any third-party vendor resources involved in the project and help clarify how that team will work together to support your implementation and ongoing management. Make sure the HIX service provider account team is committed to educating your team—administrative processes, carrier relationships and plan design are all changing and the implementation process will enhance your team’s understanding of how this new program will operate.
  • Line up your internal resources. There are some activities that require more time than a traditional H&W administration implementation, particularly when multiple medical, dental and vision carriers may be part of the HIX model. This will affect the amount of time needed to review contracts, set up banking arrangements, review carrier materials and perform comprehensive user acceptance testing.
  • It’s not just medical. During the evaluation process, medical coverage is a key area of focus, but most HIX delivery models consist of other benefits including dental, vision, life, disability, and voluntary benefits. Plan for carrier transitions for these lines of coverage as well—this includes transition of care; evidence of insurability and guarantee issue requirements; handling of open disability cases; and pharmacy formulary and mail order transitions.
  • Implementation of non-HIX populations. If you are implementing a population that is not on the HIX platform but will have H&W benefit administration outsourced, such as a union group, the process could be experienced as two implementations as custom plan design and administrative processes may be built in parallel with standard HIX delivery. Internal resources will be needed to support this piece of the implementation.
  • Plan to communicate. Base communications are typically included in the HIX model; however the breadth of communication materials and customization options will vary. Be prepared to budget for staff and financial resources related to supplemental materials, particularly if you have non-HIX eligible populations (e.g., union groups) or if you are offering any non-HIX plan options (e.g., utilizing current life or disability plans and carriers).
  • Manage messaging and communications throughout the organization to facilitate change management. The thread that ties all these requirements together is change management. HIX solutions only work if there is appropriate attention to managing and communicating change to Leadership, HR business partners, employees, and dependents. Detailed project plans that include goals, timing, and communication requirements are essential.

How Curcio Webb can help

Curcio Webb has an extensive track record of supporting over 50 clients with benefit administration implementation projects, including active and retiree private health exchanges. The level of support we provide is always targeted and customized for each of our clients based on their unique resource needs and level of complexity. Levels of support can range from providing initial reviews of project plans to serving as an extension of our client’s team as the overall project manager.

Selecting a service provider is just the first step. Building a fully accessible, operational, high quality delivery solution to support employee decision making and ongoing consumerism is critical to achieving proposed savings through HIX delivery solutions… and Curcio Webb is here to help.

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