Patient Protection and Affordable Care Act

The Rush to Compliance

The Patient Protection and Affordable Care Act (PPACA) requirements for health insurers stated that:

  • All health insurers must provide a Statement of Benefits and Coverage (SBC) to members at the time of quote, enrollment or renewal, and upon request.
  • These must be in a particular, standard format so consumers can compare policies and better understand their coverage.
  • These were to have been available by the deadline of September 2012.

What did most insurers do to meet the requirement and deadline? To meet the ambitious deadline imposed by the PPACA, many health insurance companies recruited their internal resources. Task forces were created that involved diverse professionals from legal and compliance, IT, sales, marketing, and product administration; all worked together to devise a solution.

In the end, many plans decided on one of two approaches: Completely manual approaches involving spreadsheets and Microsoft Word documents, or technology-centric approaches to create new systems and semi-automated processes.

Unfortunately, while both approaches may have allowed plans to produce documents on time, both have significant disadvantages.

  • Many insurers rushed to comply, using either a completely manual approach, or in-house IT.

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

The bottom line? These approaches cause inefficiency. The manual approach is most burdensome. Each document is standalone and manually produced, and plan details are maintained only in spreadsheets. So, changes that affect multiple plans must be re-done on each document. This is a big waste of time, especially when you consider the multiple plan variations that occur with differences in prescription options or coverage riders.

The manual approach:

  • Wastes plan administrators and marketing personnel’s time
  • Increases the risk of mistakes and non-compliance
  • Causes re-work and corrections that create further waste
  • Requires additional time to organize and track documents

In addition, coverage example amounts must be calculated using either the government’s calculator or an in-house method, and then plugged in manually to each document.

  • A manual approach may have met the deadline, but is unsustainable long-term.

In-house technology approaches are more efficient than manual administration, but still may create intensive demands of support from IT personnel on an ongoing basis.

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


Save time and streamline SBC maintenance with a flexible, automated SBC creation system.

Why is the VUE Benefit Summary Tool better than a manual approach? Simply: its design. Each plan, along with its benefits, is stored in a database, separate from standard templates. Base plans are separate from coverage riders and prescriptions, for effortless creation of all combinations. Changes to a plan or template can be made once, and then impact all subsequent summaries created. There are multiple opportunities to preview the documents, so errors can be caught before the summary is created and distributed.

VUE Benefit Summary Tool is a better solution than a manual approach:

  • Reduce errors that lead to costly non-compliance issues
  • Streamline plan maintenance
  • Simplify the summary creation process

Another feature that saves a ton of time is the new Coverage Example Calculator module. Just pair plan benefits to inputs during setup, and then automatically calculate the “You Pay” amounts that go on page 7 of the SBC document, “Coverage Examples”. This feature alone is a huge time-saver, saving up to 15-20 minutes per document – and with hundreds, thousands, or even hundreds of thousands of documents to be created over the years, this time really adds up.

Additional time-saving features:

  • Copy existing plans and make changes to create new plans
  • Integrate the database and system with other in-house tools using Web services,
  • Generate PDFs in bulk
  • Report and search on existing summaries for quick reprinting and customer service

Is the VUE Benefit Summary Tool really better than our in-house IT approach?

The answer: it depends. If your IT approach is well-integrated with your current systems, is easy to maintain, and has a high level of automation, there would be no reason to seek an alternative solution. However, if the solution is piecemeal, time-consuming to maintain, still requires a lot of manual involvement, and is rife with errors, than VUE Benefit Summary Tool can help.

  • VUE Benefit Summary Tool is nearly always more efficient than a manual approach, and could be more efficient than your current IT solution.

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 for ongoing SBC maintenance.

The VUE Software Professional Services team would like to show you how our solution can help you establish long-term value and efficiency.

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.

Time is still ticking, even though the time constraint of a deadline has past. Every day spent relying on manual processes to manage SBCs is a day wasting time on an inefficient process. Contact us now.

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