State Health Plan of North Carolina Example
Before using Benefitfocus software, the State Health Plan of North Carolina provided paper-based enrollment for nearly 400,000 state employees and 165,000 retirees throughout 270 agencies. Processing benefits on paper forms led to errors, duplication of efforts, and claims errors as administrators had to try to enforce the carrier’s business rules manually. Mailing these forms to insurance carriers proved extremely time-consuming and costly. The main reason the State Health Plan needed to change was due to a state wellness mandate which changed eligibility rules for employees.
The State Health Plan chose Benefitfocus to help them with their enrollment processes. Benefitfocus provided the State Health Plan with online enrollment through employee self-service software. Employees can log into the BENEFITFOCUS® Platform Member role and enroll in all of their benefits, allowing administrators to focus more on HR. This is especially important during their busy open enrollment season.
The Platform supports state wellness initiatives with online questionnaires that drive eligibility, so administrators don’t have to figure out complex business rules. The Platform also automatically updates State Health Plan payroll systems with employee paycheck deductions. In addition, each State Health Plan agency can self-manage a branded employee self-service portal for a unique experience.
Simplified Benefit Enrollment
The BENEFITFOCUS® Platform provides a simplified enrollment process and enforces complex eligibility and business rules, taking the employee’s specific scenario into account. For example, different rules can apply for new hire enrollment, open enrollment, life events, terminations, rehires and so on.
The Platform automates the collection of all enrollment information. Employees don’t have to fill out paper forms, so data transactions are processed quickly and accurately for all types of benefits.
HR Administrators can:
- Make benefit elections or corrections for employees
- Change employee and dependent demographic information
- Cancel employees’ benefit elections
- Approve benefit elections or changes made by employees
- Add, terminate and rehire employees
- Manage login IDs or passwords
- Run census, benefit and change history reports
- Access earnings information
- Edit benefit dates
- Change an employee’s categories
Employees can:
- Maintain personal information
- View important benefit information
- Specify language preference
- Compare plans
- Make initial and open enrollment elections
- Initiate changes to benefits throughout the year
- Update beneficiary information
- Maintain Primary Care Provider information
- Watch educational videos
- Manage account information
Underwriters and Membership Representatives can:
- View HR and Member roles to see the application from their perspective
- Review employer group setup information
- Initiate an enrollment or demographic change at member’s request
- Troubleshoot and research issues with a particular member
- Perform transactions that violate employer business rules
- Evaluate employee health statements
- Approve or deny requests for coverage
- Approve elections that were held for carrier approval
Brokers can:
- Access all employer groups assigned to agency or agent
- Make benefit elections or corrections for employees
- Change employee and dependent demographic information
- Cancel employees’ benefit elections
- Approve benefit elections or changes made by employees
- Add, terminate and rehire employees
- Manage login IDs and passwords
- Run census, benefit and change history reports
- Access earnings information
- Edit benefit dates
- Change an employee’s categories
Customizable Employee Self-Service
Employees can easily enroll in their benefits online using a "One-Thought-Per-Screen" design that feels much like an interview. Carriers can customize the employee experience to create a unique look and feel by applying their corporate colors, fonts and styles. They can also incorporate their logo and other information in the header and footer.
Employers can incorporate custom pages into the enrollment process as well as custom messages by adding HR notes on specific screens and reports. The notes are a great way to draw attention to tasks employees must complete, extra instructions from HR or any other related information, including hyperlinks to websites. The flexibility in the employee self-service tool makes it easy to apply custom branding and messaging to ensure the best possible experience for employees.
Benefit Administrator Wizards
HR Administrators use the Platform to simplify complex transactions with wizards that guide them through the process with easy-to-follow, step-by-step procedures. Examples of wizards include:
- Add new hires
- Process employment terminations and rehires
- Mass approve/decline employee changes
- Perform eligibility changes for one employee or multiple employees at one time
- Make salary changes and automatically adjust salary-based benefits
- Copy benefit enrollment information from one plan year to the next
Eligibility Rules
Behind the scenes, the Platform is working hard to enforce business rules, so carrier membership representatives no longer need to manually verify information. Users don’t see and don’t have to worry about setting up these complicated configurations. They simply log in to the Platform and perform the tasks they need to complete, and the Platform automatically enforces date rules, enrollment periods and eligibility requirements.
The Platform uses employee categories (such as location, division, classification and so on) to configure benefit eligibility, users, plan rates and new hire rules. For example, suppose a new, full-time hire starts working on 2/5. For full-time employees, the wait period is one month. Then, benefits begin the first day of the following month. In addition, the employer contributes one month after the employee is hired. Here's an illustration of what the contribution wait periods would look like:
