Benefit Service Center

Published: 10/26/2020

This Appendix defines a high-level overview of the functionality of the Software Services selected in the Order Form between Client and Benefitfocus. To the extent applicable, detailed functionality for the Software Services, subject to warranty claims, is defined within the current versions of the User Guide, Admin Guide and Report Guide, as provided to Client, and as updated with each new release.

Summary of Benefit Service Center (“BSC”):
1. BSC services - Benefitfocus will provide the following BSC services:
  1. Technology:
    1. To the extent Client has elected Extended hours, Benefitfocus will provide one (1) dedicated toll-free number for the purposes of receiving inbound calls from Authorized Users and to include live personalized service from 8:00 a.m. to 8:00 p.m. EST, Monday through Friday and subject to Daylight Savings Time rules (excluding Benefitfocus holidays)
    2. To the extent Client has not elected Extended Hours, Benefitfocus will provide one (1) dedicated toll-free number for the purposes of receiving inbound calls from Authorized Users and to include live personalized service from 8:00 a.m. to 10:00 p.m. EST Monday to Friday, subject to Daylight Savings Time rules (excluding Benefitfocus holidays)
    3. To the extent Client has elected Extended Hours (Open Enrollment Only), Benefitfocus will provide one (1) dedicated toll-free number for the purposes of receiving inbound calls from Authorized Users and to include live personalized service from 8:00 a.m. to 10:00 p.m. EST, Monday through Friday and 8:00 am to 3:00 pm EST on Saturday during Client’s Annual Enrollment (not to exceed two (2) consecutive calendar months) and subject to Daylight Savings Time rules (excluding Benefitfocus holidays)
    4. Benefitfocus will record Authorized User inbound calls for quality assurance and training purposes.
    5. Call recordings will be stored for one year following the call.
    6. Monthly performance reports to include average speed to answer, abandonment rate, email response time and category of call received
  2. Benefits Service Center Services:
    1. Dedicated email address for Authorized User inbound emails with personalized answers
    2. Live chat support through the Benefitfocus Benefitplace portal during the BSC hours of operation
    3. Documentation of Authorized User inquiries within client relationship manager software
    4. Benefit support to address benefit inquiries received from Authorized Users utilizing Client’s applicable business rules and processes (“Client’s Program Criteria”) and call transfer protocols
    5. Application support to address application inquiries received from Authorized Users including:
      1. Navigational application support
      2. Password reset and access assistance
      3. Application issue reporting
  3. Manage and monitor Interactive Voice Response (IVR), as implemented
  4. Foreign language services. Support from over the phone interpretive services. Benefitfocus associate speaks to the caller through the Benefitfocus provided interpreter, who interprets the conversation meaning-for-meaning.
  5. Telephonic enrollment. Benefitfocus benefit administrators will enter elections on behalf of Authorized Users directly within the enrollment application based on the specific requests of the Authorized User, consistent with Client’s program criteria:
    1. Benefitfocus benefit administrators will verify and/or update Authorized User information as provided by the Authorized User
    2. Benefitfocus benefit administrators will inform Authorized Users that they have access to the online enrollment portal and train them on how to use it if they are interested
  6. Evidence of insurability (“EOI”) application support, including:
    1. Update of Authorized User EOI information within the Benefitfocus Benefitplace according to Client’s Program Criteria
    2. EOI services are subject to the following assumptions:
      1. Client will coordinate with applicable carrier(s) and the BSC to grant access to the Carrier’s EOI online portal. If access to the Carrier’s EOI online portal is unavailable, Client will coordinate with Carrier(s) and BSC to ensure BSC has access to EOI approval and denial statuses.
      2. Carrier is responsible for providing the effective date for the approved coverage amount.
      3. Subject to the agreed upon business requirements with the Client or Carrier, if an Authorized User has exceeded ninety (90) days from the date of election, and has not been approved by the Carrier, Benefitfocus will removing the pending EOI election within the Benefitfocus Benefitplace.
  7. Appeal support, including:
    1. Benefitfocus will accept eligibility and enrollment appeals submitted by Authorized Users and process those appeals utilizing Client’s applicable business rules and processes (“Client’s Program Criteria”).
    2. Assumptions:
      1. Does not include claims appeals
      2. No paper fulfillment accepted or mailed