Plan Catalog Management

Have a centralized product repository for all plan data combined with an intuitive user interface for creating, editing, and exporting issuers' product offerings.

Plan Catalog Management

Softheon's Plan Catalog Management (PCM) solution will assist Health Plans to overcome several challenges they are facing with Patient Protection & Affordable Care Act (PPACA). Softheon's PCM offers Health Plans the opportunity to utilize a single repository of Products and Plans to act as its source of reference. With this repository, Issuers will be able to reduce data redundancy and streamline their Qualified Health Plans (QHP) and Summary of Benefits & Coverage (SBC) processes.

Major Components of Softheon Plan Catalog Management include:

 

Centralized Repository of Products and Plans

  • Import QHP SERFF Templates
  • Create or modify products and plans
  • Audit all changes to the data including version controls
  • Export new or modified changes to existing products and systems

QHP Process

  • Plan certification
  • Plan compliance monitoring
  • Monitoring changes in plan availability
  • Plan recertification
  • Plan decertification

Rating Status

  • Real-time Rate calculations for instant online quotes
  • Calculate multiple premium adjustments
  • Any number of configurable rating factors (e.g. zip code, age and tobacco status)

Opportunities and Benefits:

HIMs are major new, nationwide markets for health plans. Softheon Plan Catalog Management will present opportunities and benefits for health plan issuers, including:
  • Meet plan management formulary requirements and release regulated health plans in the individual and small group markets in real time
  • Provide SBCs in multiple languages, based on the demographic characteristics of areas served
  • Leverage current processes and previously approved fillings to create and submit plans for QHP certification through SERFF and HIOS
  • Supply the full range of QHP data needed for certification and eventual inclusion
  • Respond to questions, objections and requests for additional questions from HIMs accordingly
  • Eliminate the need to enter or upload the same data in multiple places
  • Reuse company and plan components, such as networks and benefit structure
  • Strengthen local presence, improve relationships with state and community based organizations
  • Serve diverse, low and moderate income populations in a cost-effective manner