New Opportunity for Health Plans to Improve Efficiency, Meet Regulatory Requirements


One area where many health plans can vastly improve their administrative efficiency is in the generation of health plan summaries of benefits and coverage (SBCs, or benefit summaries). These summaries are primarily member education and pre-enrollment documents that explain the benefits of plans with variable product options. The process is complex, since each benefit option multiplies the number of benefit summaries possible.  For example, a new product roll-out to the small group market of five plans with five prescription drug options each would yield 25 different benefit summaries.

Typically handled by the marketing, product development, sales or operations departments, health insurance companies vary widely in the processes used to create SBCs. While some larger companies have invested in costly internally-developed systems to automate the process, companies with smaller IT budgets have been forced to create documents manually using word processing software.

A manual approach has various sources of disconnection; for example, different versions of the statements may float around on different computers, making updates and uniformity difficult.  Even plans with internally-developed systems may struggle to make changes to summary formats, including the changes needed to implement upcoming NAIC rules for compliance with the Affordable Care Act’s readability standards for SBCs.

Making use of a web-based benefit summary tool allows carriers to maintain a database of plan elements to be combined into a particular package, eliminating the need to re-enter this information upon generation of each new summary. Plus, newer systems will already contain regulation-compliant formats and templates. A streamlined Benefit Summary Tool is one defense health plans have on their side in the struggle to improve administrative efficiency in the face of regulatory reform.

To learn more about the solution, visit the Benefit Summary Tool product page.


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