Leading Benefit Plan Management solution that creates an end-to-end single source of truth.
Highly configurable, modular and scalable solution.
Our market leading patent-pending SaaS solution for Benefit Plan Management that automates the end-to-end benefit product lifecycle. Creates single source of truth for benefits data and dynamically generates plan documents.
The only solution developed by health plan professionals.
Unlike other cross industry BPM and PLM solutions, eBenefitSync is the only solution developed specifically for health plans and TPAs by health plan professionals. Its Modular Approach allows you to implement any or all modules in the order of your most critical pain points and priorities.
House all your health plans in one solution.
eBenefitSync enables you to house all health plans (all LOB and market segments) and non-health product information in a single source of truth solution. This presents a significant strategic advantage to 'cross-serve' the groups, members, agents, brokers with products across all lines of business.
eBenefitSync improves speed-to-market, accuracy, and cost-effectiveness of benefit plan design.
eBenefitSync named "Sole Leader" in IDC's MarketScape.
IDC MarketScape: U.S. Health Plan Product/Plan Benefit Configuration Solutions
2016 Vendor Assessment of U.S. Health Plan Product/Plan Benefit Configuration Solutions.
Source: IDC, 2016
An end-to-end solution for eliminating disparate legacy systems and error-prone processes.
Simplify configuration of benefit plans with intelligent decision support for sales, product development and document generation teams
Comply with configurable guardrails for regulations, business policy via centralized business rules.
Flexibly capture ALL types of benefit plans:
Commercial and Government
Standard and Custom
Individual, Small Group and Large Group
Ancillary (Dental, Vision, Pharmacy, STD, LTD, Life etc.)
Engage all stakeholders via integrated use-case specific workflows vs. emails
Incrementally build benefit plans with inputs across teams
Annotate and track changes for regulatory and business communication content from single source
Robust audit trails enable compliance to regulatory agencies and external auditors
Generate all benefit plan communications document materials from the single source – SBC, SoBs, ANOC, EOC, Contract, SPD, Amendment, Rider, QHP
Seamlessly integrate benefit plan information via ETL, Web API or Batch files to/from:
CRM (Salesforce, MS Dynamics, Siebel)
CMS PBP for MA BIDs
Portals (Member, Provider, Customer Service, Broker, Agent)
Support future AI / Machine learning initiatives via real time benefit explanation
Frequently Asked Questions (FAQ's)
Please click on question to explore more
A. Health Plans often have thousands of benefits plans and products which they need to manage. Every year some new plans are created, and existing plans are updated to reflect competitive needs and regulatory requirements. Certain plan types, such as Medicare Advantage plans or Qualified Health Plans (QHPs) must be submitted to the government for approval by specific deadlines. All plans then need to have plan information fed to other systems to support claim payments, member support, group sales, etc. This end-to-end process of managing benefit plans is known as Benefit Plan Management.
A. Traditional benefit plan management processes can create a lot of issues that may lead to last-minute rush, significant manual efforts to manage and audit plans, and inaccuracies in data (and the downstream implications of these). Most of Health Plans maintain their benefit plan data in spreadsheets (aka benefit grids) and documents. During benefit plan configuration, these get emailed around in manual, error-prone process that frequently leads to version control problems. The traditional benefit plan management processes can lead to various challenges such as:
- Managing version control
- Core admin systems may require manual keying of the data introducing hard to find and costly errors
- Due to version control issues and other factors, key downstream applications get different versions of benefits information
- Manual processes make the benefit plan management slow, labor-intensive, expensive, and creates downstream errors
- Benefit teams lose the opportunity to perform more productive tasks such as analyzing the market and consumer trends to offer improved products.
A. With a benefit plan management solution like eBenefitSync™ – Health Plans can automate end-to-end benefit plan management process while improving their operational efficiency by up to 75%. With its unique capabilities, Health Plans can create a single source of truth for their benefits data and can generate various benefit documents in a single click. With a benefit plan management solution, a Health Plan can reduce their process backlogs, increase data accuracy, and improve their speed-to-market. Having a single source of truth solution means Health Plans can edit data at a single entry point and have it reflect across the entire benefit plan. This not just improves valuable benefit product turnaround time; it can also help Health Plans avoid losses due to incorrect data entry.
A. To help you streamline your benefit plan processes, eBenefitSync™ ingests your existing benefit grids to create the single Source of Truth for all benefits information. From here, you can configure your plans to comply with guardrails for regulations and business policies via centralized business rules. Its Modular Approach allows you to implement any or all modules in the order of your most critical pain points and priorities. eBenefitSync™ enables you to house all health plans (all LOB and market segments) and non-health product information in a single source of truth solution. This presents a significant strategic advantage to 'cross-serve' the groups, members, agents, brokers with products across all lines of business.
A. Simplify Healthcare’s solution, eBenefitSync™, is the only solution in the market built with a full understanding of the benefit plan management process in mind. eBenefitSync™ starts by ingesting your existing benefit grids and documents to create the single Source of Truth for all benefits information. From here, you can configure your plans to comply with guardrails for regulations and business policies via centralized business rules. With eBenefitSync™, you can collaborate with all stakeholders to manage your plans with the robust workflow capability including routing, notifications, and a logging function to track all changes. Then you can communicate needed information to members with required documents and to other parts of the health plan.
Large Health Plan Consortium: 70% Faster to Market
eBenefitSync improved their speed to market by 70% and reduced data redundancy by 90%.
Large TPA: Automating Onboarding and Renewals
eBenefitSync improved their speed to market by 70% and reduced customer service quality by 70%.
Mid-size Health Plan: Integrating with Core Admin
eBenefitSync improved data reusability by 98% and speed to market by 50%.