Employers, employees and benefits advisors alike have long struggled with the inefficient and largely paper-based approach to administrating benefits.
Advisors face long wait times for quotes, employers face the annoyance of a slow onboarding process that prevents employees from accessing their benefits immediately after enrolment and employees can have difficulty submitting claims and face confusion over what their plan actually covers.
Jeff Cox, chief executive officer and founder of third-party payer Simply Benefits, created a completely digital employee benefits portal for plan sponsors, members and benefits advisors to address those pain points.
“For us, it’s very important that we use our technology to deliver a better customer service experience,” he said during Benefits Canada’s 2022 Tech Insights conference in mid-April. “We really wanted to engage all three users and ensure that they felt like they were getting the information they wanted at any given time.”
The digital portal eliminates the need for paper and operates in real time. Plan members submit claims direct or digitally through their desktop or mobile app. After the Simply Benefits team adjudicates the health or dental claims in-house, plan members receive reimbursement through direct deposit within 48 hours.
Cox said Simply Benefits has a 48-hour service level agreement and is able to resolve 75 per cent of members’ calls on first contact.
The app has a digital drug card powered by Assure, so members can direct bill at the pharmacy. It’s also connected to the electronic dental system, which allows the company to auto-adjudicate dental claims.
The portal allows employees to see real-time claims data and usage tracking, broken down by each benefit, so they know how much coverage they have used and remaining for the year. If an employee files a health or dental claim that puts them over their yearly maximum, the platform will prompt them to claim the extra amount through their health-care spending account.
To help employees understand their coverage, the portal uses artificial intelligence-powered search tools. Members can type in questions or comments such as “I hurt my back” or “I need a crown” and be directed to the appropriate benefits coverage.
Simply Benefits is also preparing to launch its optional benefits program in-app in the summer of 2022. Plan members can purchase their optional benefits online, through a direct withdrawal from their bank account, in minutes.
Plan sponsors and administrators have the ability to deploy enrolments and view their invoices in real time. The portal also allows them to see active and pending enrolments and run reports that Cox said were commonly requested by employers, such as on their over-age members and dependants, benefits usage by members, HCSA and lifestyle spending account balances, taxable benefits, long-term disability and certificate listings.
“We really looked at everything that was challenging employers and said, ‘How do we get it on system and how do we give them access to it?’” he said.
The enrolment piece was critical, said Cox, noting it seemed to be the largest challenge employers faced in the benefits administration process. The process allows employers to email enrolments to employees — from there, it takes roughly seven minutes to fill out. The portal offers interactive messaging for employees’ ease, such as explaining what a common-law partner is or to waive certain benefits if they’re covered by another health plan.
Plan sponsors have the ability to label their portal with their internal branding, which Cox said builds employees’ awareness of what their employer provides for them. “We really feel like it helps with culture and the engagement with benefits.”
Advisors, meanwhile, can use the platform to build plan designs for new plan sponsor clients, run reporting on existing clients and track pertinent metrics.
Read more coverage from the 2022 Tech Insights conference.