Are you prepared to generate PPACA-Compliant
Summaries of Benefits and Coverage?


Patient Protection and Affordable Care Act

What is the PPACA?

The Patient Protection and Affordable Care Act (PPACA) requires all individual health insurers to provide a Statement of Benefits and Coverage (SBC) to members at the time of quote, enrollment or renewal, and upon request. Federal law will require a particular, standard format so consumers can compare policies and better understand their coverage. The mandate creates significant efforts for health plans who are using manual processes or homegrown systems to generate SBCs.


The National Association of Insurance Commissioners (NAIC) received a mandate from the U.S. Department of Health and Human Services to implement the PPACA’s provision for SBCs. After developing an SBC prototype, the NAIC proceeded with third-party testing to help ensure the format’s readability, usefulness and effectiveness. Unfortunately, testing and completion procedures are causing delays in establishing the final SBC standard. Now, the deadline has been delayed until further notice.


There are separate SBC templates for individual and group policies and the deadline for implementing both will be finalized soon. While the NAIC is still working to complete the final standard health carriers are given the difficult task of starting a journey without a clear destination. Time is short, and all but the most technologically agile health carriers will be challenged to meet the deadline.


What does this mean for Health Plans?
As we have evolved our product portfolio and responded to PPACA-required changes, it has been invaluable for us to have a tool that has templates as its basis.



What Health Plans need to Consider

Impact on Health Plans

Already overburdened with day-to-day processing activities, technology limitations and other impending legislative requirements, most health plans would rather not face this new hurdle of implementing a new format by a certain deadline.


The following are some concerns carriers have regarding the SBC format:

  • Strict legal requirements for the template: Uniformity requirements extend to details such as font, colors, standard language, presentation of variable information and accuracy, so there is little room for error.
  • Added resource requirements: Business-as-usual must proceed, so additional assistance will be needed for the labor-intensive and time-consuming task of implementing and testing this strict format.
  • Tight deadline: Insurers must scramble to put the right format in place, and with limited time for planning, SBC creation might integrate poorly with other processes and introduce inefficiencies.
  • Technology barriers: Carriers must either implement new tools or make costly, time-consuming adjustments to current tools.
  • Need for data availability, quality, accuracy and consistency: Carriers that either rely on manual benefit summaries or store data in disparate locations using various formats and systems will face data-related challenges.
  • Potential for additional changes: As with many regulatory measures, the requirements could change at various times in the future and require further SBC modifications.

The degree of difficulty in meeting the SBC requirements varies based on the current state of the insurer’s system. Those using manual or homegrown systems will likely have greater difficulties. However, even organizations with technology from a top vendor can have difficulty if their system fails to separate the SBC content from the presentation.


Is there a Solution?
It was essential for us to select a solution that would meet our current needs and be flexible to adapt to our evolving requirements as well. The VUE Software suite offered such solution. Equally important was the expertise of the VUE Software team in delivering solutions in a very short period of time, which will allow us to meet our aggressive implementation timeline.


Streamline Creation of Benefit Summaries

Solution

A flexible, automated SBC creation system will separate the carriers that implement the new format stress-free from those that don’t.


  • Immediate Solution: Meeting SBC Format Requirements -
    VUE Software offers a packaged software solution to meet the near-term SBC formatting requirements. With VUE Benefit Summary Tool an insurer can save months of expended resources with an accurate and tested system that is fully compliant and ready for your organization’s data.
  • Long-Term Solution: Automating Summaries and Streamlining Enrollment -
    VUE Benefit Summary Tool extends its SBC formatting capabilities to include concurrent use and storage of a variety of automated formats and templates. The Tool also reduces manual involvement, facilitates sales and enrollment and improves agent satisfaction. There are numerous advantages for insurers seeking a long-term solution:
    • Built-in compliance with legal regulations combined with the ability to incorporate state requirements and company-specific preferences into templates
    • Included annual updates to keep the system current and compliant
    • Easy-to-use, web-based features that empower salespeople to work independently
    • Elimination of key-person dependencies and workflow bottlenecks
    • Separate administrator and user functions with enhanced role-based security
    • Optional integration with Active Directory or the organization’s network security application for single sign-on
Be Prepared
The VUE Software team’s professional, hands-on approach to understanding our requirements and integrating them into the core system reflects CSSI’s substantial insurance expertise.


Schedule your Free Assessment

We Can Help

VUE Benefit Summary Tool helps carriers increase efficiencies and strengthen business processes while being prepared well before the deadline.


The VUE Software Professional Services team would like to show you how our solution can help you prepare for the deadline while delivering long-term value to your plan.


We’d like to provide a FREE, NO COMMITMENT assessment of your processes and SBC readiness. You’ll speak with our enrollment experts and see the VUE Benefit Summary Tool first-hand.


You'll also be able to access our exclusive white paper on the PPACA and the Benefit Summary Tool.

Bonus White Paper

Register today and receive our white paper: The Intelligent Approach to Beating the Deadline for PPACA-Compliant Summaries of Benefits and Coverage

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