Through a 1332 waiver, a state may opt to implement an EDE-enabled exchange. EDE, Enhanced Direct Enrollment, is a set of APIs provided by healthcare.gov, which enable web-based entities to build consumer-facing user interfaces that allow consumers to perform most of the functions required to apply for subsidies and enroll in qualified health plans (QHPs). EDE-enabled exchanges can mirror the FFM implementation as closely as possible, so as to enable web-based entities who have been approved and currently operate on the federal platform to offer the same services in a given state, with minimal change.
GetInsured’s EDE implementation puts the power of service in the hands of enrollment partners, brokers, and carriers. These approved entities can enroll consumers during the Open Enrollment period and experience increased agent efficiency due to the integrated EDE workflow, their own customer relationship management, our proven support platform, and integrated support provided by level two call center.
Figure shows the implementation of the GetInsured EDE and integration with the underlying health insurance enrollment platform.
The GetInsured EDE implementation allows enrollment entities to:
- Have visibility into the existing book of business, post initial migration of data from FFM
- Send notices generated by the GetInsured platform and have a record of the interactions with consumers
- Manage marketplace documentation on behalf of their client such as downloading 1095 tax forms
- Easily process life changes, special enrollment period (SEP) enrollments, and renew coverage in year two
- Process all enrollments, including complex enrollment cases
- Effectuate client plans by integrating payments (allowing consumers to pay the initial premium at the time of enrollment)