Preparing for 2019 Open Enrollment: Softheon Enhanced Direct Enrollment (EDE) delivers a better consumer experience and enables new consumer self-service policy management capabilities

As health plans consider implementing and launching an EDE solution for ACA 2019 Open Enrollment, it’s become clear that EDE is much more than an improvement to the Marketplace (or on-exchange) enrollment process and post- enrollment policy management for consumers – it’s the beginning of a real-time, API driven service to promote an improved healthcare consumer insurance benefit shopping experience with online self-service updates.

Many health plans are adoption EDE for 2019 Open Enrollment. Most health plans are choosing to partner with entities like Softheon, instead of building their own solution, due to the initial iterative development, testing and certification demands (ex. FedRAMP) as well as the ongoing technical, security and audit support challenges and expense. 

Although the main goal of EDE is to provide enhancements for individuals and families to shop and enroll in coverage in a health plan branded environment, it also encourages the private sector to innovate by creating a real-time framework that accesses the CMS “backend.” EDE ambassadors are developing and certifying EDE shopping portals that far exceed the current HC.gov customer experience to bring members the logical, intuitive experience they’ve come to expect from their other digital interactions outside of healthcare.  

Enhanced Direct Enrollment has expanded the functionality of its foundation, or “DE Classic”, taking it beyond that initial application into an all-encompassing benefit shopping and policy management portal that is used year-round by the consumer, not just for initial enrollment.  

The EDE API-based platform allows the EDE technology partner (ex. Softheon) to exchange data with CMS in real-time so a consumer (or agent/broker) can: 

• Enroll in a new policy 
• Change their address a month later 
• Add a spouse or newborn mid-year 
• Retrieve CMS-based documents 
• Renew coverage (and setup auto-renew preferences) 

The EDE generated transactions will still use CMS as the system-of-truth for eligibility validation, but the logic is happening behind the scenes in real-time message, not using file-based services. To the consumer, EDE becomes their health plan branded all-purpose Marketplace engagement portal for maintaining their policy. 

In our whitepaper, we discuss EDE as a unified enrollment experience, the evolution of CMS’ Direct Enrollment initiatives, and ways health plans and agents/brokers can improve establishing and maintaining direct relationships with consumers using EDE.  

As a member of CMS’ EDE Alpha team and a leading web-based enrollment entity, Softheon is working closely with officials to make the EDE pathway to enroll subsidy eligible and non-eligible consumers into exchange plans a reality in 2019.   

Softheon’s EDE solution is a Software-as-a-Service, health plan branded enrollment solution that offers consumers the ability to shop for and enroll in ACA coverage directly from their insurer, make binder and premium payments, report file changes, and renew their coverage seamlessly. Softheon EDE aligns with our mission of making healthcare affordable, accessible, and plentiful.  

To learn more, email info@softheon.com  

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 marketing@softheon.com.