Enhanced Direct Enrollment (EDE)

Increasingly, States are taking control over their own destiny and building a State-Based Marketplace (SBM), lowering costs to the state in the process. EDE is an important step in that direction. It provides states with an alternative to relying partly or even entirely on the FFM. The process of moving to a State-Based Marketplace may be gradual, and a number of states started the process by taking over vital functions such as plan management. EDE provides additional opportunity to control the eligibility determination functions. Contact us to learn more.

Prior to the launch of the Affordable Care Act (ACA), consumers could call their carrier to get help with enrollment, payments, changes to their plan, and updates such as an address change. After the ACA was implemented in 2013, the customer service model changed, requiring consumers in FFM states to deal with HealthCare.gov. Since eligibility determinations are made on HealthCare.gov, any policy changes had to be processed through the FFM, while billing remained a responsibility of the carrier, leaving consumers not sure where to go for help.

But with EDE, the power of outstanding customer service is now back in the hands of the carrier. Consumers can once again interact directly with the carrier to:

• Shop for and enroll in on-exchange plans all on one branded experience;
• Submit required documentation to the marketplace, such as proof of income and citizenship status, the lack of which could cost a consumer their eligibility. A loss in consumer eligibility is ultimately a loss to the health plan;
• Make premium payments;
• Report life changes and update their information; and
• Easily renew their coverage during open enrollment.

Carriers can implement a cleaner, higher converting, plan enrollment experience on their own web properties, agent tools, and customer service portals, for a seamless branded customer experience.

With limited time to enroll consumers during the annual Open Enrollment (OE) period – which is typically shorter in states relying on FFM – precious time was lost to dealing with the complexity, downtimes, and slowed enrollment process when utilizing the double-redirect to HealthCare.gov.

EDE allows brokers to:

• Manage marketplace documentation on behalf of their client such as downloading 1095 tax forms, something previously unavailable to brokers.
• Easily process life changes, SEP enrollments, and renew coverage.
• Process complex enrollment cases like Native American enrollment with no redirect to HealthCare.gov.
• Effectuate client plans by paying initial premium.

With EDE, the power of service is once again back in the hands of the broker. With no redirect for all enrollment cases the enrollment process is faster, allowing brokers to enroll more consumers during the limited OE period. EDE can also be incorporated into broker tools such as GetInsured’s AgentExpress. Such tools are designed to increase agent efficiency by providing an integrated EDE workflow, customer relationship management and support platform.