Within health insurance, a “Small Group” is generally considered to be any company with 2-50 full-time employees. While Small Group companies are not required to offer insurance to their employees, they will often see many benefits when they do, including attracting employment candidates, increased staff retention, and tax credits. Health insurance is considered an optional benefit that many employees consider when evaluating a company for employment. Additionally, some employers who decide to offer coverage choose to pay the full premium, thus offering greater value and benefit to employees.
Payors offering Small Group plans must evaluate the risk of the entire group when determining their pricing. In most cases, this can be done either based upon the number of employees falling within a specific tier or based upon the ages of the employees and their dependents. Examples of tiers may be:
It is necessary to collect the census, or the list of employees and their dependents who will be covered by the Employer’s plan(s), to calculate the monthly premium that Employers would be responsible for paying based upon the tiers or ages. Small Group insurance also requires the Payor to collect decisions made by the Employer, such as the amount that the Employer plans to contribute toward the Employee’s monthly premium and the waiting period (or number of days that a new Employee must wait before s/he is eligible to participate in the insurance plan).
Attentis implemented a Small Group for a Payor in the northeast U.S. who has a fully owned subsidiary in addition to the corporate parent company. One of the groups serviced the state of NY while the other group serviced the states of CT and MA. The groups used different, cumbersome processes that required their users to switch between applications to service and support their customers. Data was not seamlessly passed between these systems. Since the Customer Support team had to respond to calls from both groups, the internal team was inefficient while flipping from one system to another to assist customers.
Each of the states being serviced had rules that were distinctive. Additionally, the two entities applied some rules differently. The plan offerings for the three states were unique to each state and in some cases, such as Dental Plans, varied by group size. Brokers for one entity could split commissions amongst multiple agents within an agency, while brokers for the other entity did not require this functionality. Applying the different nuances of these business rules to each entity was challenging and the rules themselves were complex. Attentis delivered the Salesforce Industries’ Small Group solution using Health Cloud as the foundation and applied logic to distinguish between the different rules, branding, and screens when they were needed.
In addition to the Small Group Shop and Enroll solution that this project covered, a Broker Portal was implemented to allow Brokers the ability to manage their book of business with functionality such as seeing multiple quotes for a single customer, the status of a quote or application, and high-level details of each customer, to name a few. While it wasn’t specific to the Shop and Enroll solution, it was necessary to keep this in mind while configuring Shop and Enroll to ensure that the records being created in that solution would appear on the Broker Portal correctly.
Attentis has successfully implemented Salesforce Industries’ Small Group Shop and Enroll solution for many Payors nationwide. Unlike other Shop and Enroll solutions, Small Group solutions can vary quite a bit between projects, but still have a foundation of similar functionality across the industry. We have developed a proven, repeatable methodology to collect unique requirements for each project that builds on the components that we have seen previously. We use reusable artifacts that serve as the starting point for our implementations. We employ common components and utilize predefined user stories that are updated to meet the specific project requirements. Our solutions’ data dictionary was modified to adjust for the existing Sales Cloud implementation that this customer had in place. We worked alongside the Sales Cloud team to ensure that the designs of both the internal Sales Cloud and the Salesforce Industries Small Group Shop and Enroll solutions were in line.
Each Small Group must be evaluated for eligibility and that evaluation is used to determine which plans can be offered. This started from the first screen where a business’ location (zip code) was evaluated to ensure that it fell within the service area of the entity.
In another example, Small Groups must have between 2 and 50 employees. If they have more or less employees, they would be eligible for a different line of business of insurance (Individual & Family or Large Group). Some of the plans that were offered by this Payor were available to groups that have between two (2) and nine (9) employees while others were available if there were more than 10 employees. Each of these business rules were applied in the background to ensure that the Broker was automatically presented with the appropriate options.
Conditional logic was needed to deploy branding specific customization to each entity. The logic became more complex as the requirements for each entity diverged significantly. One such example of this was needed on the Small Group census page used for Quoting. One of the entities uses tier-based pricing while the other entity uses age-based pricing. With tier-based pricing, the requirements for a census are a bit simpler. One must only collect the number of employees who fall within each tier. For age-based pricing, one must collect each employee’s age as well as the ages of each dependent. Data capture requirements for these two pricing methods are very different. We used logic to identify which entity and, therefore, which pricing method should be applied and we presented the user with the appropriate screen to capture the required data.
In the Enrollment process, capturing the census was the same for both entities. In this case, we had to apply several business rules that were similar between the entities. For example, the status and product selection of the Employee was applied to each of his/her dependents as well as only one dependent can hold the relationship of Spouse/Domestic Partner for each Employee. The Employee product options were preselected by the Employer and were available for the Broker to select on the Census. This census screen also contained functionality to allow the Broker to upload the entire census, enabling him/her to gather the information in a spreadsheet, rather than having to enter it all directly into the Shop and Enroll screen. The goals of this functionality included automating some of the business rules while also making the Broker’s job easier.
Another piece of functionality that was included in the Small Group Shop and Enroll solution allowed the Broker to identify any other Brokers or Selling Agents who assisted him/her with the sale of the small group business. This allowed the commissions resulting from the sale of the plans for the Small Group, to be distributed appropriately when division was necessary. Business logic was included to ensure that 100% of the sale was accounted for among the parties. Finally, this was applied only to the entity that uses this method of distribution while not applying it to the other. When processing Small Groups, several documents are required to complete the enrollment process. Since the Brokers are well versed in the documentation that is required for each scenario, guidance was not needed to indicate which document was needed. The solution provided the ability for the Broker to upload the necessary documentation and store it with a distinctive naming convention.
The information that was collected throughout the Shop and Enroll process was stored in records found in the Sales Cloud. This enabled the Internal Sales and Service teams to reference and use the data when servicing each of the customers. Within one system, the Internal Sales team was able to respond to most of the questions that were asked. Additionally, reporting was available for management and other users of Sales Cloud which allowed them to monitor progress, track statistics, and identify areas needing attention.
The Payor of this success story was looking to streamline the systems that their users accessed to service their Small Group customers, improve the ease of use of the system for Brokers, and enable reporting capabilities across the platform. The charge was to implement a system within 6 months that would achieve all of these goals. Within six months, Brokers were able to obtain quotes for their customers by entering a minimal amount of data, upload census data needed to complete enrollment, and manage their pipeline and book of business from one place. Internal Sales teams were able to service and support the Brokers and Small Groups from two entities using one platform.
The Attentis Consulting Small Group Shop and Enroll accelerator and methodology offers a proven successful implementation approach to meet the varied and complex needs of a Small Group implementation, with an affordable and a quick path to delivery. Let us show you how we can partner for success.
