As the cornerstone of a successful health insurance exchange, carriers require a streamlined process and a user-friendly platform to easily help customers find and enroll in the plans that best meet their needs. State-based exchanges (SBEs) offer carriers enhanced functionality compared to the federally facilitated exchange (FFE), including increased configurability, decreased risk, and improved customer relations – all starting with a smooth and secure onboarding process.
Comprehensive Carrier Onboarding Process
At GetInsured, we understand that clear and direct communication, as well as support, are essential for carrier success. Our SBE solution prioritizes these elements, ensuring a seamless transition from the FFE and reducing risks associated with adverse selection. This leads to higher customer effectuation rates and increased retention, with auto-renewals consistently ranging from 95% to 99.9%.
Carrier onboarding begins nearly a year before the SBE launch, with GetInsured, the carriers, and the SBE staff meeting to review the implementation timeline. At this stage we also share a wealth of information including the 834 Companion Guide, the reconciliation guide, and key differences between the SBE EDI and the FFE’s. Below is a high-level overview of our onboarding process and timeline.
| Topic Area | Participants | When |
| Carrier Kick-Off Meeting | Carriers, SBE staff, GetInsured | Approximately 12 months before SBE go-live |
| Publish Onboarding Materials | Carriers, GetInsured | Approximately 12 months before SBE go-live |
| Initiate Carrier One-on-One Meetings | Carriers, SBE staff, GetInsured | Approximately 10 months before SBE go-live |
| Establish Carriers on The Testing Environment | Carriers, GetInsured | Approximately 7 months before SBE go-live |
| Initiate 834, RCNI, and PayNow Testing | Carriers, GetInsured | Approximately 6 months before SBE go-live |
| Establish Carriers on The Production Environment | Carriers, SBE staff, GetInsured | Approximately 3 months before SBE go-live |
Initial Implementation Phase
During the initial implementation phase, we support plan management by helping carriers upload, review, and approve their initial set of plans. This includes:
- Loading, previewing, and validating plan and rate information.
- Uploading plan crosswalks each year.
Our dedicated carrier portal plays a crucial role in this phase, providing a sandbox environment where carriers can interact with real-world data and explore the portal’s features before the Go-Live date. This early interaction helps carriers familiarize themselves with the platform and set the stage for a successful onboarding process.
Documentation and Testing Support
We offer extensive documentation and testing support during implementation, ensuring a smooth transition for carriers. This includes:
- Comprehensive technical documentation, such as the 834 EDI Companion Guide, Reconciliation Guide, and Pay Now redirect documentation.
- Automated test cases to simulate the customer shopping experience and validate plan data, rates, and EDI transactions.
- Setting up “Pay Now” functionality and on-going support.
- Ongoing collaborative support to help prepare carriers and the SBE to exchange data.
Our electronic data interchange (EDI) integration closely aligns with FFE standards, reducing the need for significant business process changes to minimize carrier burden. Our automated integration with the System for Electronic Rate and Form Filing (SERFF) ensures that only state-certified plans are transferred to an exchange.
Exchange and Carrier Operations
Through these efforts, our ongoing maintenance and operations (M&O) ensure that carriers can continuously make necessary adjustments to plan data, keeping all information up to date. This phase also maintains accurate enrollments, which are a top priority. We achieve this by:
- Regularly exchanging EDI transactions (834s) to maintain accurate enrollment data.
- Offering carriers a dedicated portal for managing plan data and communicating with partners.
- Providing tools for carriers and the exchange to routinely update provider and formulary directories.
- Working with the exchange to reconcile enrollment discrepancies using the innovative GetInsured Reconciliation Workbench.
- Performing quality assurance checks and making updates during recurring correction windows with the GetInsured plan management tools.
By seamlessly integrating these practices, we ensure that plans always reflect the most current information, providing customers with accurate and reliable shopping experience.
Proven Success
We have fully transitioned five states from the FFE to an SBE: Idaho, Nevada, New Jersey, Pennsylvania, and Virginia, with Georgia set to join this list in 2024. Throughout this experience, we have successfully onboarded over 120 carriers to our platform, demonstrating the reliability and effectiveness of our process.
“Our partnership with GetInsured was instrumental in ensuring a smooth transition from HealthCare.gov to the Commonwealth’s own Health Benefit Exchange. Their close collaboration with our health plan members minimized disruptions to business processes, ensured seamless renewals for consumers, and delivered exemplary service in plan management, reconciliation, and consumer issue resolution.”
— Doug Gray, Executive Director, Virginia Association of Health Plans
The Benefits of the GetInsured Approach
With GetInsured, carriers gain:
- An easy and collaborative onboarding process.
- Efficient and accurate plan management during both initial implementation and ongoing operations.
- Direct lines of communication for smoother interactions with both the SBE and customers.
- Maintain existing processes and innovative technologies that allow for smooth operations.
With our comprehensive set of tools and support, carriers can focus on their core mission: providing customers with high-quality health insurance coverage and increasing customer satisfaction. Our platform ensures that carriers are well-equipped to handle both the initial setup and ongoing maintenance of their plans, ultimately leading to a more successful and user-friendly health insurance exchange.
