4 Things Members Expect from Enrollment and Eligibility

Whether they’re enrolling in a plan for the first time, re-enrolling, or adding life events, enrollment can be a frustrating process for your members. 

Filling out paper forms and submitting them to HR is a pain. Because they’re so tedious to fill out, few people tackle them right away. Inevitably, those forms often get lost in the shuffle. And when people have to actually mail them in, the completion rate drops even lower. Even when payers make enrollment more convenient by allowing members to complete forms electronically, the challenges of eligibility can create new problems.

Consumerism is changing the way your members think about healthcare. With the rapid  evolution of technology, people have come to expect better experiences from the organizations they interact with. That means you need digital solutions that can address the challenges of enrollment and eligibility while meeting consumer expectations.

Here’s how your members want online enrollment to work—and how you can accommodate them.

1. A simple enrollment process

When people fill out forms online, they have some pretty basic expectations:

  1. The form will make it clear when something is required. If you can “complete” a form without filling in a field, that field is optional.
  2. The business logic behind the form won’t let you choose options that don’t apply to you. If you can select a plan and start the application, that means you’re eligible for it.

Unfortunately, that’s not always the way enrollment works. Many payers don’t have the functionality to prevent members from enrolling in plans and benefits they aren’t eligible for. And many payers can’t keep people from submitting incomplete applications.

This can delay your members’ coverage and benefits, force them to start the process over, and/or create time-consuming headaches for HR representatives who have to track down the missing information. And worse, it makes a terrible impression on the member at a time when their impression of your organization matters most.

To deliver the simplicity your members expect, you need a way to make it clear what information is required, and you need to hide options people aren’t eligible for—or at least prevent people from selecting them. Hx Eligibility Management addresses this with “rules” that let you define the plans and benefits people are eligible for based on your data. Once implemented, your rules automatically prevent members from selecting plans or benefits they aren’t eligible for, or from submitting incomplete applications.

2. A seamless experience (across channels)

Suppose someone starts their enrollment application on their lunch break at work? Partway through, they realize they don’t have all the information they need on hand—it’s at home in a filing cabinet, a desk drawer, or on the counter.

Imagine how frustrating it would be if they had to start all over when they got home. Consumers today desire an omnichannel experience. They want to complete transactions like enrollment from whatever device they prefer and they expect you to let them pick up where they left off—even if they log in from another device.

Additionally, your members want to receive progress updates in a way that’s most convenient for them. Some people prefer to get alerts and notifications via email, where they can keep important communications in a folder so it’s easy to find them later. Others prefer text, so they know the moment enrollment is complete, their benefits are active, or ID cards are available. And of course, your members expect you to use their preferred channel to tell them if any information is missing, so they can address it as soon as possible.

It’s not good enough to simply facilitate online enrollment. You need to give your members the flexibility to continue their progress across devices, and to receive updates through the channels they use the most.

3. A better way to choose a plan

Whether a senior is exploring Medicare Advantage plans, an employee is evaluating the options provided by their employer, or someone is simply shopping the marketplace, people want a convenient way to research and compare the plans available to them.

Unfortunately, the information consumers need to make decisions is often gated behind accounts, which creates a barrier to engagement.

Healthx helps payers work around this issue by providing the self service tools needed to control what content is made private or public.  This gives potential members the information they need to make decisions. And with the addition of our Salesforce Connector, you’re also able to capture leads and opportunities in your CRM. This allows you to nurture leads with additional content about your offerings until a consumer decides to become an enrolled member.

One of the biggest ways these solutions serve consumers is by providing a simple way to compare plans. If someone wants to compare a Preferred Provider Organization (PPO) plan to a Health Maintenance Organization (HMO) plan, they don’t have to write everything down or jump back-and-forth between tabs—they can compare plans side-by-side. This makes it that much easier for people to make informed decisions about their healthcare.

4. Self-service options

Life doesn’t operate on a 9–5, Monday through Friday schedule. When someone has a baby, gets married, loses a loved one, or has another major life event, the last thing they want to worry about is updating their benefit information according to your schedule. 

Members need self-service options to handle demographic changes and life event updates on their own timeline, in a way that’s most convenient for them.

The same is true for enrollment and re-enrollment. People don’t want their lives to revolve around your business hours and availability. They want to use the time they have to take care of the tasks and complete the forms they’re responsible for.

And from your perspective, when a member has to call to have an administrator walk them through an enrollment process they could handle on their own, you’re incurring unnecessary costs.

Give your members the enrollment experience they want

Right now, many payers still don’t support fully self-service enrollment, simple comparison shopping, or an omnichannel experience. Their tech simply isn’t there yet. But as consumerization continues to drive changes in healthcare, innovative solutions like Hx Eligibility Management will become the norm—because this is what your members want.

Want to see Hx Eligibility Management in action?

Schedule a demo.