Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

Enhanced direct enrollment eliminates ‘double redirect’, establishes new policy management strategy

In June 2018, the Federally-Facilitated-Marketplace (FFM) is expected to launch new technology known as Enhanced Direct Enrollment (EDE) – which will allow consumers and agent/brokers to shop, enroll, and manage policy changes to Marketplace health products, without ever having to create an application on Healthcare.gov or contact Marketplace Customer Service. 

EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.  

In our new whitepaper former Executive Director for Aetna’s Exchange program and Founder, JGood Advisors, Jane Good discusses Enhanced Direct Enrollment (EDE) and this new policy strategy.

Inching toward a new policy strategy  

Direct Enrollment Proxy (DEP) rolled out during the 2017PY Open Enrollment. Behind the scenes, however, CMS and its Direct Enrollment partners were hard at work designing requirements for a more comprehensive data exchange process – Enhanced Direct Enrollment (EDE) – finally creating a true-end-to-end policy management portal for insurers.  

Managing a member’s policy in the FFM has required a shared responsibility between the issuer and the Centers for Medicare & Medicaid Services (CMS), since the introduction of classic direct enrollment. However, because CMS owns eligibility processing, both applications and policy changes must be processed by the Marketplace and transmitted to the issuer.  

As a result, the issuer manages billing, payments, and benefits, while the makeup of the policy is managed by CMS. This shared responsibility causes member confusion and operational challenges for issuers who have traditionally managed everything about a member’s policy post- enrollment. 

Brokers  

40% of brokers used the Direct Enrollment Pathway (DEP). Most brokers do not just work with Marketplace members, but also serve consumers enrolling in Medicare and non-Marketplace Individual private health coverage. Assisting between 1-49 consumers, according to Healthcare.gov, brokers have voiced the need for personalized support and “Help on Demand” for 2019 OE.   

The EDE process will drastically simplify enrollment for brokers and members alike. This is especially true when combined with Softheon’s streamlined portal. Through Softheon’s Enhanced Direct Engagement process and intuitive portal, brokers be able to give their clients the most streamlined enrollment experience from start to finish.  

Sources 
  1. https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Guidance-for-the-Proxy-Direct-Enrollment-Pathway-for-2018-Individual-Market-Open-Enrollment-Period.pdf  
  2. https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Third-party-Direct-Requirements.pdf 

The views and opinions expressed by the authors on this blog website and those providing comments are theirs alone, and do not reflect the opinions of Softheon. Please direct any questions or comments to research@softheon.com. 

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