Assess the risk
Medical underwriting for the Individual and Small Group Markets will be eliminated in 2014. In the interim, medical questionnaires can still be leveraged, and it is important for carriers to grow their business with as many underwritten lives as possible while they still can. Carriers will also expand and improve their wellness and care management programs in preparation for the elimination of medical underwriting.
Significant dollars are being appropriately invested into disease management and wellness programs. The future with guarantee issue will be about managing risk versus underwriting and avoiding risk. It will be even more important to gather information about prospective members so carriers can appropriately intervene to improve care and prevent hospitalizations. Carriers can use this information for early intervention, disease management assistance, and ultimately to the best path for quality care.
The institution of guarantee issue, collapsing the age band to 3 to 1, elimination of lifetime limits, no annual limits on dollar value of coverage, limiting waiting periods, elimination of pre-existing condition limitations, and covering dependent children to age 26 will all impact the rating and will necessitate creation of new rate structures which will then have to be supported in administration and distribution systems. Many of these plan changes will also impact grandfathered plans and will necessitate rate level changes and plan document modification.
Connecture can help
Making rate decisions based on health history will be eliminated, but the gathering of medical information will not. An automated workflow, and smart enrollment applications and medical questionnaires will assist consumers to select the right plans and aid carriers in managing this risk. This information can be leveraged for care management, disease management, wellness programs, and treatment protocols.
Flexible technology solutions will allow carriers to respond to reform in various ways: get new and adjusted products to market quickly, change their rates as necessary, market to the new individuals looking for coverage, and empower their brokers to do more in less time. Technology will also allow carriers to implement new workflows and take advantage of straight-through processing, reducing the cost required to sell in the Individual Market.
eCommerce has evolved, and the consumer demand for responsiveness and improved customer service means that insurance carriers will no longer be able to take up to, and sometimes longer than, 30 days to process an incoming application for insurance. With the elimination of medical underwriting by 2014, carriers will need to provide real time responses to requests for insurance. Carriers need to leverage a platform such as InsureAdvantage that is virtually no-touch. This platform not only enables faster response times in the sales cycle, but also gives consumers the post-sale ability to manage their plan, such as adding new family members, changing coverage, and requesting a new ID card. A flexible marketplace-to-back-end system will dramatically reduce administrative costs, improve customer service, and increase sales.