Structure, arrange and customize Groups and Sub-Groups. Streamline the administration and management of Group information: drill down, track and configure details at a granular level. Easily manage situational, time-based and conditional eligibility and benefit information.
The Group Configurator is the information hub for group enrollment covering all aspects of administrative information: Benefit and Program Information, Eligibility, Rating and Billing, Id Cards, Broker and Enrollment just to name a few. The intuitive web-based user interface simplifies the group setup, automates many - typically time-consuming - setup tasks. Pre-built and custom rules ensure the consistency and validity of group data and ensuring that the appropriate approvals have been obtained for non-standard group options. The Group Configurator helps reduce the error rate and accelerate the account setup. Inbound electronic interfaces ensure that sales, underwriting and proposal data is automatically carried over into the group configurator. After a group setup or group change outbound interfaces are triggered to ensure that dependent activities are automatically initiated such the creation of contracts and Id cards, enrollment and re-enrollment of members, claims setup, billing, etc.
*Plan information is retrieved from the Plan Configurator.
Key Features
Group Administration
A wide array of different group types are supported (Small Group, Midsize, Large Groups and Jumbo/National Accounts).
Explicit support of List Bill, Association, Retiree and Individual business with additional mass-maintenance features (see below).
A group can be organized into multiple sub-group structures using flexible criteria. This flexible features ensures that you never have to create multiple group records again because you are not tied to strict hierarchical group structure.
A wide range of administrative information can be stored on a group and sub-group level right out-of-the-box.
Benefit Information including internal and external programs:
- Utilization and Disease Management Programs, Gym Membership, etc.
- Rate and Billing Information
- Enrollment Rules specific to subgroups and coverage level
- Eligibility and Waiting Periods by product and coverage level
- Contact and Broker Information
- Id Cards and Contract Forms
- Network Setup
- Group-specific inclusions and exclusions
- ERISA Custom data fields can be attached to group and subgroup information
Group Maintenance
The Group Configurator supports a variety of maintenance functions:
- Renewal updates of group by changing benefit information across the entire group or multiple groups
- Benefit changes imposed by state and federal regulators can be centrally pushed out to multiple groups
- Changes to eligibility, enrollment, billing or other administrative information does not require manually restructuring the group
Workflow Support
The setup of a group is governed by the embedded workflow component. Workflow rules can be defined that control who has to signed off before a group can be moved into production. Multiple approvals might need to be obtained depending on the size and nature of a group setup.
Group History
- Group data history is fully captured to support an ever evolving group setup without losing audit capabilities. Multiple users can update group information. Each change is kept in draft status before moving changes into production.
- Group transactions are stored in a transaction log table and each transaction can trigger subsequent processes
- Group history is available to every authorized user; changes are displayed from one version of the group record to the next
- Multiple versions of a group can be compared to each other
Output
- Group data can be exported in XML format
- Benefit Summaries and contracts can be saved and printed as MS Word or PDF documents
External System Integration Options
- API: Open Interfaces allow for retrieval, creation and update of group information
- Data Extracts for data warehouse consumption
- The Group Configurator is fully web-service enabled
