VB Voice - April 2024

April 2024

Voluntary Benefits Voice M A G A Z I N E

Is Artificial Intelligence a Smart Move For Carriers?

EngageTech: Tech That Engages, Solutions That Deliver

Technology Changing the Industry

Jennifer Daniel Aflac

Key Contributors

Jack Holder EBIS

Rachel McCarter Mercer

Mark Rosenthal PwC

Steve Clabaugh CLU, ChFC

Editorial Staff Editors Heather Garbers | Trevor Garbers Marketing Director Marin Daniel For Media and Marketing Requests Contact: Heather@voluntary-advantage.com and Trevor@voluntaryadvantage.com

Advisory Board

Seif Saghri BenefitHub

Tim Schnoor Birch Benefits

Hunter Sexton, JD, MHA Sydney Consulting Group

Michael Stachowiak Colonial Life

FEATURED ARTICLES Technology Changing the Industry

Transforming Benefits Engagement: How Next Gen HR Tech Empowers Information Decision-Making Why Claims Integration Is A Crucial Part Of Any Supplemental Health Strategy

The Intersection of Technology & Long-Term Care

Relational Leadership Helps In Troubled Times

Is Artificial Intelligence A Smart Move For Carriers

EngageTech: Technologies That Engage, Solutions That Deliver

Advancing The Voluntary Benefits Industry

From the Editor...

Our 2nd Annual Virtual Conference was March 11-13th and WOW is all I can say. The theme was “Voluntary Benefits - The Next Generation” and we welcomed 48 different speakers in 34 sessions covering a wide range of topics. The presenters were tasked with coming up with content in a 30-minute session that was carrier/platform agnostic and would be educational for attendees on the distribution side of the industry, and they delivered!

Which session had the highest attendance? The “View From The Top” panel of Sarah Oliver, Dennis Leclair and Alex Faynberg, moderated by Mark Rosenthal, kicked us off and saw the highest rate of live viewers. A key takeaway for me was the discussion on creating value either on the front end or at time of claim, pushing back on the race to zero, not devaluing the plans and keeping our eye on enhancing value where we can for the benefit of the employees,.

The market trends discussion with the Voluntary Advantage Advisory Board received the highest rating on the post-event survey. Seif Saghri, Jack Holder, Jennifer Daniel, Trevor Garbers, Tim Schnoor, Rachel McCarter, Hunter Sexton, and Mark Rosenthal in a panel moderated by yours truly, gave attendees an insight into our monthly Advisory Board meetings as we shared multiple viewpoints in a live and unscripted discussion on important topics like the future of AI in our industry, leveraging data and how we are adapting our practices in 2024.

The session on Functional Medicine as a component of true “wellness” and driving down healthcare costs was a surprise showstopper and received the most requests for follow-up information. Dr. Guillory talked about the 4 Tenants of Functional Medicine – “Remove” anything that is making you sick, “Replace” anything that you are deficient in, “Repair” any damage that has been done, and “Reinoculate” with appropriate probiotics.

After the event, all registrants are able to view the recordings for any sessions they missed, what are they watching? “Employer & Employee Perspectives to Drive Increased Participation Results” from Eastbridge Consulting Group has had the most post-event views. Nick Rockwell and Danielle Lehman talked about why employers decide to offer voluntary benefits and why they decide not to offer voluntary benefits, how employees prefer to communicate and enroll in benefits, and so much more.

Heather Garbers

The Federal Triagency Ruling was a topic discussed by Eric Kohlsdorf and Jack Holder in their “Updates from NABIP” session, Bradley Knox and Jennifer Daniel in their “Legislative Updates” session, and Hunter Sexton in his “Federal Triagency Rule & the Chevron Silver Lining” session. It was interesting to hear how each of these stakeholders in our industry addressed the (what was) pending legislation in their discussion.

A key takeaway from each of those sessions was that we need to get involved as an industry with legislators. Many are voting on legislation that they don’t truly understand the implications of and so we need to use our expertise and voice to speak up.

I recap all of this for you because first, I hope you all join us next year! This is an event focused on bringing great content to help move the industry forward and help us all elevate our game. Second, because I am still re-watching the recordings myself and cannot believe how great every presenter was, and how open they were to share their expertise with attendees. How quickly the Voluntary Advantage community has grown and seeing the openness of our community to collaborate as competitors, partners, and friends, has never ceased to amaze us over the past couple of years.

And we’re just getting started.

APRIL 16 Join us April 16th at 12 ET / 11 CT / 10 MT / 9 PT as Jillian Mondaca and Amanda DeSousa with Prudential share how they are leveraging technology to create a better voluntary benefits experience from start to finish. They’ll discuss: Driving adoption with new enrollment capabilities and partnerships Helping employees maximize their benefits with less effort with a simplified, integrated claims experience Evolving for tomorrow with product and experience enhancements

Is Artificial Intelligence a Smart Move for Voluntary Carriers?

By Eastbridge Consulting Group, Inc.

Voluntary benefits carriers have been cautiously dipping their toes into new technology tools that help streamline operations and improve customer service. Eastbridge’s recent “Application Programming Interface and Artificial Intelligence Carrier Practices” Frontline™ Report shows nearly two-thirds of carriers support API data exchange, and most of the rest are building that capability or modernizing their systems to enable it.

But far fewer carriers surveyed say that they are using artificial intelligence, and even fewer are using AI specifically for their voluntary/worksite business. Carriers cite the newness and viability of the technology, evolving internal strategies for using AI, and the investments and resources needed to support it as reasons to keep their feet dry.

For now.

A strong majority (73%) of carriers not currently using artificial intelligence say they expect to use it in the future — most of them within the next 6 to 12 months, although a few say it’ll take 2 to 3 years.

How Carriers Use AI Carriers already using AI implement it most often in business areas, including claims, underwriting and customer experience. A handful of carriers use it for marketing or policy issue. None report using AI for voluntary benefits enrollment or product development purposes.

Working Smarter, Not Harder Most carriers using AI for claims say it has improved the claims filing or payment process through decreased processing, faster turnaround times and greater efficiency for claims examiners. Carriers surveyed say AI allows them to auto-adjudicate health and wellness claims, and even helps them identify additional potential supplemental health claims policyholders could file.

The jury isn’t all in yet on the ultimate benefit to their business, though. Two-thirds of carriers using AI say that it has increased their efficiency and accuracy, but a third say they don’t know yet. And only a few report that their increased speed and cost savings are differentiating them in the market.

Monitoring processes or performance evaluations for AI systems, including internal tests or checks before deploying AI capabilities and audits to ensure AI is reaching the correct outcomes or decisions are some of the ways carriers are hurdling that obstacle.

Caution With Customers Direct customer contact is an area where most carriers are still treading cautiously. Carriers using AI for customer support cite benefits including: seamless integration of benefit choices and decision-support tools, the option to interact with a virtual assistant for 24/7/365 service, and the ability to provide employees with unique, personalized recommendations and next actions.

Carriers also are still trying to find the best uses for AI versus human intervention. For example, using tools such as ChatGPT to create customer communications may not be effective, at least for now. The program’s website admits it can create errors: “ChatGPT is not connected to the internet, and it can occasionally produce incorrect answers.

It has limited knowledge of world events since 2021 and may also occasionally produce harmful instructions or biased content.” Even when the language it produces is accurate, it’ll likely need human tweaking to align with a company’s brand and to create a friendlier, more conversational voice.

However, only a few carriers say that customers interact directly with their AI system to get information or support, and all offer human assistance by giving customers the ability to transfer from a virtual assistant to a live representative by phone or online.

Overcoming Challenges The fast pace of innovation and the ability to quickly implement new uses of the technology are some of the challenges carriers cite with AI. Some carriers also express concerns about data accuracy from existing internal systems, brokers and employers, and the accuracy of outcomes or decisions based on AI.

Nick Rockwell President

Danielle Lehman Senior Consultant

Still, carriers surveyed say they expect to see greater use and integration of AI in all aspects of their business. It may be time for those who want to increase productivity and improve customer outcomes to start wading in the AI water.

Eastbridge is the source for research, experience, and advice for companies competing in the voluntary space and for those wishing to enter. For over 25 years, they have built the industry’s leading data warehouse and industryspecific consulting practice. Today, 20 of the 25 largest voluntary/worksite carriers are both consulting and research clients of Eastbridge.

Technology Changing The Industry

By Heather & Trevor Garbers

The impact of technology on the employee benefits industry has contributed to our significant growth in the marketplace, expanded our reach, and grown our impact. To quote Arthur C. Clarke, “Any sufficiently advanced technology is indistinguishable from magic”.

To help us gauge where we are today as an industry, and where we are going, we have interviewed leaders at a couple of AI-driven service providers to learn how they are helping to shape the future. Pauline Roteta (PR), CFA, CFP® is the Founder & CEO of Pasito and Yvonne Daugherty (YD) is the Global Head of Industries at Ushur.

You provide a unique solution in the marketplace - please tell us more about your services.

Pauline - Pasito is the leading digital provider of decision support, segmented engagement, and employee support for the voluntary insurance industry. Leveraging health plan data, API connections to HR systems, and proprietary AI models, Pasito helps carriers and consultants educate every employee year-round about the personal benefits of supplemental coverage.

Through our unique engagement approach, Pasito successfully increases employees’ knowledge of voluntary insurance, which leads to higher participation and helps employees get more value from these benefits. We do this by taking a marketing approach to benefits. We leverage an individual’s demographic, enrollment, and behavioral data; to deliver relevant text, email, and content campaigns throughout the year. For example, women in their 30s learn why hospital indemnity and disability insurance are a must, while men in their 50s hear about LTC, critical illness, and catch-up contributions for retirement.

Our personalized year-round education builds awareness ahead of enrollment and increases retention and lifetime value of voluntary elections.

During enrollment, our decision support sends every employee a recommendation. Employees and spouses can refine their recommendations with powerful tools that import health plan data, project medical expenses, and calculate the payout from voluntary coverage.

Our AI also eliminates busy work for consultants, enabling them to spend more time growing their book of business. Our broker features include: an AI benefits guide generator, central inbox and AI copilot for employee questions, and FAQ generator.

In essence, Pasito is an AI benefits counselor. We can work alongside enrollment firms to help them reach more employees, support cases that don’t offer access to 1:1 counselors, or provide ongoing support after an initial launch.

Yvonne - The voluntary benefits space is often challenged by a lack of effective, secure digital communication channels to augment traditional live on and offline channels for communications with employer groups, brokers and employees.

Ushur solves for this need by enabling supplemental and voluntary benefits carriers to automate end-to-end engagements. The Ushur platform empowers organizations to automate customer and broker engagements end to end, with purpose-built AI and machine learning for two-way conversations, email triage, intelligent document processing and data file transformation.

Our no-code platform and built-in enterpriselevel security makes it easy to quickly launch workflows that are HIPAA-secure, PCI-compliant, and HITRUST-certified. With verticalized large language models (LLMs) to increase accuracy, Ushur is widely trusted for transforming the voluntary benefits customer experience while improving operational efficiency.

Why did you decide to create a solution for the benefits marketplace?

Yvonne - The core thesis of Ushur’s inception was that the world has evolved, and consumers of regulated industries like insurance have evolved in terms of how they want to engage. The benefits market is experiencing transformational change with stakeholders looking for digitalization and AI-powered solutions to meet these goals, while also delivering data security for the exchange of sensitive data. Successful group benefits companies are focusing on driving significant operational efficiencies and better customer experiences despite the challenges they face, such as delivering a timely quote for all requests for proposal (RFP) during the busy season.

AI-powered automation technology can help streamline engagements across numerous channels – including phone, email, and text – to help benefits providers improve response times, reduce manual processing, and elevate the customer experience.

The benefits market is experiencing transformational change with stakeholders looking for digitalization and AI-powered solutions to meet these goals, while also delivering data security for the exchange of sensitive data.

Yvonne Daugherty, Ushur

Pauline - Pasito was founded after a family member went into debt from a hospital visit. Despite having a good job and the “best” medical plan, my relative was blindsided by a medical bill that could have been covered by voluntary insurance. This is not an isolated event. Health plans continuously cover less at higher cost, and no longer shield families from medical debt.

As a Certified Financial Planner® and engineer, I knew there was a better way to do benefits. By leveraging data, AI, and financial planning principles, companies can deliver a better benefits experience, while getting more families the coverage they deserve.

By leveraging data, AI, and financial planning principles, companies can deliver a better benefits experience while getting more families the coverage they deserve.

Pauline Roteta, Pasito

Source: Harnessing Growth and Seizing Opportunity: 2023 Workforce Benefits Study (2023), LIMRA and EY

While we are leaps and bounds ahead of where we were 10 years ago with regards to technology in the benefits industry, we are still behind many other industries (ie. auto / home insurance, online shopping). What are barriers in our marketplace to achieving the same level of innovation?

Pauline - The benefits industry faces several unique challenges that slow down innovation, including: Intermediated Market: This market is fascinating because of the number of opinions and incentives that technology must appeal to. In most other markets, developers have direct access to one user type and build for that user. In benefits, we have carriers, vendors, brokers, consultants, enrollers, HR teams, finance teams, employees and dependents.

When feedback is intermediated, a lot can get lost in translation and innovation slows down. We’ve worked hard to stay focused on our north star: improving the employee experience.

Legacy Systems: Incumbents have outdated infrastructure, which sets off a vicious cycle. The best engineers want to work on the latest tech stack and build not repair. Without attracting the best talent, it’s hard for incumbents to innovate and transition to new technology. Incumbents can get to the market faster and access the best talent by partnering with innovative partners that are unencumbered by legacy technology.

Yvonne - One barrier we see in the benefits industry is the ability to automate communications that are interactive and deliver data security for the exchange of sensitive information. More and more, employer groups, brokers and employees are expecting a shift to the digital self-service experience they are now accustomed to. Thankfully, advances in AI are bringing the benefits industry up to speed. For example, a delayed response to inbound quote requests can led to a missed opportunity and leave a poor first impression.

What can or should brokers and/or carriers be doing now to prepare for the future?

Yvonne - Data quality and cleanliness have an outsize impact on the effectiveness of automation solutions in any industry, and carriers can plan for the future by preparing and curating their data now. Not only are compliant and governed data stores a top priority and business differentiator for carriers, but they also benefit the brokers and admins who engage with this sensitive data on a daily basis.

Source: Harnessing Growth and Seizing Opportunity: 2023 Workforce Benefits Study (2023), LIMRA and EY

What if you could take the high-volume RFP quote intake process, and dramatically reduce response times, live agent operational burden and costs with AI? This is now possible with AI solutions that enable carriers to automatically classify and route incoming RFP requests, extract data, evaluate for completeness, and respond to the sender to request missing data–all within seconds.

Pauline - I attended a dinner recently with the CHROs of the largest employers on the East Coast.

The topic of conversation: AI in HR. The dinner guests agreed on very little except three things: (1) HR is facing intense budget cuts, (2) employees expect "consumer grade" tech in the workplace, and (3) if they don’t start at least experimenting with AI now, they will be pushed out by a new CHRO that does. AI is the only way to deliver a personalized employee experience at a lower cost, and carriers and brokers that embrace this new wave of technology will be rewarded by CHROs desperate for solutions to make their days and teams more efficient.

Yvonne Daugherty, Global Head of Industries, Ushur - Yvonne is the Global Head of Industries for Ushur and serves as the bridge between the Ushur team and the market to ensure alignment with evolving trends, regulations and requirements. She is also Ushur’s subject matter expert for customer engagement and activation best practices, working with clients to implement more effective omnichannel B2B and B2C communication.

Pauline Roteta, CFA, CFP®, Founder & CEO, Pasito - Before Pasito, Pauline was a Senior Investor and Portfolio Manager at BlackRock where she led private equity investments and developed risk analytics for private market investments. Pauline graduated from Vanderbilt University's School of Engineering, she's a Fulbright Scholar and a proud member of the Latinx community.

EngageTech: Technologies That Engage, Solutions That Deliver

By Ieena Aulakh

Employee benefits play a crucial role in attracting and retaining top talent while also fostering employee satisfaction and well-being. With the rapid evolution of technology, benefit enrollment processes have undergone a significant transformation, revolutionizing how employers manage benefits and also how employees enroll and access their benefits year-round. Advancements in benefit enrollment have reshaped the landscape of employee benefit administration including streamlining enrollment procedures, offering more personalized experiences, and increasing engagement in benefit plan decisions.

Streamlined Enrollment Process Traditionally, the benefit enrollment process involved cumbersome paperwork, lengthy forms, and manual data entry, often leading to errors and inefficiencies. With advancements in technology, paper-based processes have been replaced by streamlined digital platforms. These platforms enable employees to enroll in benefits online, eliminating the need for paperwork and reducing the administrative burden on HR teams.

Moreover, digital enrollment systems often feature intuitive interfaces and step-by-step guidance, making the process more user-friendly and accessible to employees of all backgrounds.

Key Features Include: Integrated core and voluntary product delivery platform Web-based case set-up and configuration tools Unique rules, eligibility, rates, and census for each employer group Counselor-assisted or self-service options Integration with existing products and applications Decision support tools for enhanced employee education Flexible deployment options

Personalization and Customization One of the most significant advancements in benefit enrollment technology is the ability to offer personalized and customizable benefits packages.

Employers can leverage data analytics and algorithms to analyze employee demographics, preferences and needs, allowing them to tailor benefit offerings to individual employees or specific groups within the organization. For instance, younger employees might prioritize student loan assistance or wellness programs, while older employees may prefer retirement planning options. Employers can enhance employee satisfaction and engagement by offering personalized benefits packages, leading to a more productive workforce.

Integration and Automation Integration with existing HR systems and automation of administrative tasks are other key features of modern benefit enrollment technology.

Integrated platforms seamlessly connect with payroll, time tracking, and other HR systems, ensuring data consistency and accuracy across various processes. Automation capabilities enable tasks such as eligibility verification, enrollment status updates, and benefits communications to be handled automatically, reducing the likelihood of errors and freeing up HR professionals to focus on more strategic initiatives.

Additionally, automation can help ensure compliance with regulatory requirements, such as the Affordable Care Act (ACA) or the Family and Medical Leave Act (FMLA), by automating reporting and documentation processes.

Enhanced Communication and Engagement Effective communication is essential for maximizing employee participation in benefit programs.

Benefit enrollment technology facilitates improved communication and engagement through various channels, including email, texting, mobile apps, and self-service portals.

These platforms enable employers to communicate important information about benefit options, deadlines, and policy changes in a timely and targeted manner. Moreover, interactive tools and educational resources can help employees make informed decisions about their benefits, leading to a greater appreciation and utilization of available offerings.

And, advancements in reporting capabilities allow employers to analyze the results and make immediate adjustments in their delivery.

Call Center Technology With remote workforces now the norm, it is imperative to have a method to allow employees to enroll using advanced call center features. We use the following in our call center: Artificial Intelligence (AI): AI allows account management teams to better monitor each benefit counseling session for an improved employee experience.

Metrics available through AI technology include: Pace and keyword monitoring Voice tone and reaction monitoring Interactive Voice Response (IVR): IVR call flow processes enable our call center to handle large call volumes efficiently while providing a customized experience. Live dashboards monitor and manage call volumes, call length, hold times, and more in real time. Paired with an online scheduling platform, data is leveraged to optimize intra-day effectiveness, while preparing for upcoming enrollment activities.

Custom Call Branding and Spam Remediation: Leveraging mobile carrier’s technology, outbound calls can be branded for each client. This technology significantly reduces calls that were historically branded as “Unknown” or “Potential Spam” increasing employees’ confidence in the reason for the call and reducing calls that go unanswered.

Mobile Accessibility In an age dominated by smartphones and mobile devices, ensuring that benefit enrollment platforms are mobile-friendly has become imperative. Mobile accessibility allows employees to access and manage their benefits anytime, anywhere, providing greater flexibility and convenience. Mobile apps enable employees to view their benefit elections, update personal information, and access support resources on the go, enhancing their overall experience and satisfaction with the enrollment process.

Conclusion The advancements in benefit enrollment technology represent a significant step forward in how organizations manage their employee benefits programs. By streamlining enrollment processes, offering personalized experiences, integrating with existing systems, enhancing communication and engagement, and embracing mobile accessibility, employers can create a more efficient, transparent, and employee-centric benefits administration process. As technology continues to evolve, the future of benefit enrollment holds even greater potential for innovation and improvement, ultimately benefiting both employers and employees alike.

Ieena Aulakh, Senior Director, Client Technology Solutions, EOI Service Company oversees the ongoing delivery of high-quality services for brokers, clients, and prospects.

Her career in technology has spanned over 20 years giving her the depth of knowledge and experience which enables her to consult and provide solution-oriented insights on Benefits Administration, Human Capital Management, and Enrollment Services. She has expert knowledge of benefit enrollment platforms, carrier/vendor management, and extensive experience with software implementations and solution best practices.

Advancing the Voluntary Benefits Industry Exploring the Evolution of Large Language Models and Their Impact on Insurance

By Carl Grafmuller

With the further rise of AI, especially the development of Large Language Models (LLMs), the voluntary benefits industry is on the cusp of a paradigm shift with the integration of AI into the industry. Building upon the foundation laid by the emergence of LLMs like ChatGPT, this article delves into how these innovations have evolved over the past year and their profound implications on insurance. Furthermore, it explores the dynamic landscape of customer interaction across industries, assesses the transformative potential of LLMs in insurance sales, and contemplates the future trajectory of AI in shaping the voluntary benefits landscape.

Over the past year, LLMs have undergone significant refinement, propelled by advancements in AI research and increased computational capabilities.

ChatGPT, the popular LLM developed by OpenAI, had version 4.0 released with rumors of version 4.5 or even 5.0 slated to be released by the end of 2024.

Of course, OpenAI isn’t the only company developing AI tools as pretty much every major tech company is pouring billions of dollars to develop their own in-house tools. These developments have enhanced their capacity to comprehend context, interpret nuances, and generate human-like text with unprecedented accuracy.

Plugins were developed as well, allowing LLMs access to various programs as well as the ability to scrape data from the web and take input that isn’t just raw text. As a result, LLMs have become indispensable tools across various sectors, including insurance, revolutionizing how businesses engage with customers and manage operations.

Beyond the insurance realm, LLMs have permeated diverse industries, catalyzing a fundamental shift in how businesses interact with customers. From retail and healthcare to finance and hospitality, organizations are leveraging AI-powered chatbots and virtual assistants to streamline customer service, personalize marketing efforts, and optimize operational efficiency. On a more technical side, the payments industry is beginning to utilize LLMs for fraud detection and of course, the finance industry is utilizing them for investment decisions. This crossindustry adoption underscores the universal applicability of LLMs and their capacity to redefine customer engagement paradigms in the digital era.

For the insurance industry in particular; LLMs will be transformative. While insurance traditionally relies on agents to sell policies, LLMs have the potential to augment and revolutionize this process.

Chatbots powered by LLMs can engage with customers in real-time, providing personalized policy recommendations, answering queries, and guiding them through the insurance buying process. This not only enhances customer experience but also enables insurers to reach a wider audience and cater to evolving consumer preferences. Furthermore, these LLM chatbots could also assist with the underwriting process, ingesting the various inputs about a customer and optimizing their chosen insurance product.

Where insurance products often necessitate a consultative sales approach, the integration of LLMs presents both challenges and opportunities. Unlike consumer goods that can be readily purchased online, insurance policies typically require informed decision-making and personalized recommendations tailored to individual needs.

Herein lies the crux of leveraging LLMs in insurance sales – striking a delicate balance between automation and human expertise.

While AI-driven chatbots can augment customer interactions by providing instant support and guidance, human agents remain indispensable for complex consultations and relationship-building.

Therefore, the key lies in orchestrating a synergistic interplay between LLMs and human agents to deliver seamless, value-driven customer experiences.

Looking ahead, the trajectory of LLMs in insurance holds immense promise, albeit with nuanced considerations. As these models continue to evolve, their efficacy in risk assessment, underwriting, and claims processing will undoubtedly improve, driving greater operational efficiency and cost savings for insurers. Moreover, the convergence of LLMs with other AI technologies, such as computer vision and voice recognition, will unlock novel applications in insurance, ranging from fraud detection to automated claims adjudication. However, amidst this wave of innovation, ethical considerations surrounding data privacy, algorithmic bias, and job displacement warrant vigilant oversight and proactive measures to ensure responsible AI deployment.

In conclusion, the evolution of Large Language Models heralds a new era of possibilities for the voluntary benefits industry. From enhancing customer interactions to redefining insurance sales strategies, LLMs are poised to reshape the dynamics of insurance in profound ways. As stakeholders navigate this transformative journey, collaboration between AI and human intelligence emerges as the cornerstone of success, where technology serves as an enabler rather than a substitute for human expertise. By embracing innovation with a human-centric approach and upholding ethical principles, the voluntary benefits industry can harness the full potential of LLMs to thrive in the digital age and deliver unparalleled value to customers.

Carl Grafmuller, Actuary, Sydney Consulting Group, LLC - supports pricing, modeling, and software development focused on the supplemental health space. Carl joined Sydney Consulting in 2020 after co-founding TripHappy, a location intelligence company that was acquired by Trivago in 2018. Carl brings over 10 years of industry experience in life insurance, machine learning, and artificial intelligence after serving in both actuarial and non-actuarial roles. Carl’s unique experience supports Sydney’s innovative approach to product development, valuation, administration, etc. functions within brokers, insurance carriers, and technology firms.

Transforming Benefits Engagement: How Next-Gen HR Tech Empowers Informed Decision-Making

By Greg DiFalco

For some, the pandemic emphasized the positive outcomes of opting into voluntary benefits and supplemental health plans, while many others felt the negative impact of not having these types of plans. And while we’re seeing employers increasingly offer new voluntary benefits, participation isn’t increasing at the same rate.[1] A major barrier is employees' lack of understanding about how these benefits can have a positive impact. Our research uncovers that on average, 58% of employees are unable to explain how supplemental health plans work, and 1 in 4 are unsure if their employer even offers them.[2] The increasing complexity of benefit options exacerbates the issue, leaving countless employees overwhelmed. To address this, many employee benefits consultants and brokers are looking for HR technology solutions that they can confidently bring to their clients. These platforms simplify enrollment, improve communication, and offer personalized recommendations. But they aren’t all created equal.

A proven-HR technology that helps drastically enhance employee benefits journeys is decision support tools (DST). Let’s dive into three key areas where DST can drive impact from enrollment to usage to re-enrollment.

Prioritize Communication & Comprehension When you combine complex insurance language with minimal guidance due to limitations HR teams face, it shouldn’t come as a surprise why non-benefit experts are confused when looking at their benefit options.

And with fewer than 4 in 10 worker[3] agreeing that their employer does a good job of educating them on their benefits, there is seemingly endless room for improvement. Delivering the right message, at the right time, through the right platform is a complicated yet critical aspect to drive impact. We’ve found that utilizing personalized communications alongside decision-support tools can enable employees to navigate their benefit options effectively.

WELCOME to your benefits enrollment...

Here are three things to remember when it comes to benefits communication and comprehension: 1. Multi-channel communications: Preferences about receiving benefit-related information can vary from workforce to workforce, so lean into what resonates with your employees, whether that’s SMS, email or in-office posters. We found that groups who enabled our email program saw upwards of a 200% increase in utilization compared to those who did not.[4] 2. Time-saving experiences: Attention spans are dwindling, so make the most of your employees’ time. Our DST takes an average of 10 minutes to complete, with some employees completing the survey and receiving a recommendation in as little as six minutes.[4] 3. Digestible information: Less is more. Think about how you can diversify the types of content you share about benefits. Maybe alongside your standard internal webinar you opt for a series of short videos, or create an interactive infographic.

Enhanced benefits technology can play a pivotal role in driving benefits comprehension — by leveraging digital tools to provide clear, accessible information and guidance, employers can empower employees to make more informed decisions about their benefits.

Drive Personalized Experiences With Data Just as consumers expect personalized recommendations in their everyday lives, employees increasingly expect the same level of customization when it comes to their benefits choices.

Decision support can enable employers to deliver personalized and tailored recommendations to employees based on their individual needs and preferences, all at scale. Powered by data sources from user-contributed content, external APIs, and census files alongside robust data analytics and machine learning algorithms, technology can analyze employees' benefits preferences and usage patterns to provide targeted recommendations for voluntary benefits and supplemental insurance coverage.

This not only helps employees make more informed decisions but also increases their likelihood of participation. Bringing together data to surface hyper-relevant guidance at scale is becoming table stakes.

After going through the experience, 75% of users agreed that our DST helped them be more confident in selecting their benefits.[4] Furthermore, users have shared their positive sentiments about their experience, like this: “This process made me feel like I was getting input from an experienced advisor. My confidence in my election was significantly higher than in past years.”

As employers adopt new HR technology platforms, it's essential to prioritize their workforce’s data security and privacy. Employees are understandably sensitive about sharing personal information, particularly with their employers. When assessing vendors, organizations must ensure that robust security measures are in place to protect employees' data and reassure them that their information will not be shared without their consent.

Reduce User Friction A consistent problem organizations are faced with is managing an increasing number of platforms and their disparate data sets as a result. It’s part of what makes providing holistic benefits guidance difficult. By utilizing technology that employees are familiar with and minimizing login credentials, you can reduce drop-off throughout the enrollment flow.

When assessing if a decision support technology can provide an optimal UX, keep these two questions in mind: Do they offer fully embedded integrations or SSO capabilities? Employees can have a more seamless and secure experience with either of these. In fact, during last year’s OE season, a carrier partner saw 69% higher engagement with our DST when SSO was enabled upon deployment compared to groups that forewent using SSO.[4] Do the recommendations take into account all lines of coverage offered? In order to understand the potential value of plans and the way they work together, employees need holistic recommendations. Ensuring ancillary benefits are contextualized helps them stand out more and clarifies the value that they can provide, which can drive increased likelihood of adoption. Our users on average participate in voluntary benefits at a 82% higher likelihood compared to the average voluntary benefit participation rate of Non-users.[4]

Partnering for Success Decision support tools are continuing to evolve alongside other HR technology, with the potential to revolutionize the way employees engage with their benefits programs. By providing a seamless user experience, driving benefits comprehension, and delivering personalized recommendations, these innovative platforms can result in an unparalleled employee experience that facilitates increased financial readiness and higher plan participation.

1. Voluntary Benefit Offerings In U.S. Rise 41 Percent During COVID-19 Pandemic, 2022 2. Benefits Eligible Employee Survey Conducted by Nayya, Nayya Health Inc., 2023 3. Benefits Optimization 2023, Guardian, 2023 4. Nayya NPS Survey, Nayya Health Inc., 2023

Greg DiFalco, Head of Strategic Partnerships at Nayya - With over 15 years of experience spanning Healthcare and the employee benefits space, Greg leads Nayya's Strategic Partnerships with brokers, consultants, carriers, and HCM platforms. He is focused on helping employers and employees navigate the complex and evolving landscape of benefits, wellness, and risk mitigation

Why Claims Integration Is A Crucial Part of Any Supplemental Health Benefit Strategy

By Randy Finn

Making claims integration work for members Among the most coveted benefits that employers are offering to attract and retain top talent are supplemental health plans like critical illness, accident, and hospital indemnity. Yet many employees struggle with understanding how to use their benefits and the challenges with the claimsfiling process.

This is where claims integration can help. Claims integration can drive meaningful improvement to the member's claim experience when leveraging medical claim data. We have been deploying claims integration capabilities with medical claims for voluntary supplemental health benefits for over a decade, and our experience gives us a unique perspective not only about where claims integration 1 has been, but also where it needs to go. Based on our experience, we have introduced a number of initiatives designed to modernize claims integration and improve claims incidence. These efforts have documented results showing that claims integration, when done correctly, can have a demonstrated impact on an organization’s supplemental health benefit strategy.

Under our Simplified Claims Experience TM we see 1.8x higher claims incidence & 1.24x higher claims payments for members with medical data compared to those without.[1] In this article we will share what we have learned from the past and how we see the future of claims integration. And we will show how plan sponsors can utilize new integration strategies to make their benefits packages more effective in attracting and retaining employees.

How Effective Claims Integration Solves The Problem One of the best ways to address the issue is through claims integration. Integrating claims from a member’s employer-sponsored health plan with their supplemental health coverage holds the power to simplify the member’s claims-filing experience and improve the value of voluntary plans in the eyes of members.

So, what is claims integration and how does it work?

In broad terms, claims integration means using “nonsupplemental health plan” claims data for initiating and/or processing a supplemental health claim in place of, or in addition to, a member’s submitted paperwork.

While claims integration can be deployed with a variety of different data, using medical claims data is the most powerful and most impactful method.

Utilizing claims integration capabilities with medical claims data drives higher utilization of claims.

Claims integration terminology and capabilities can vary significantly. It is important to understand in detail what aspects of claims reminders, submission processes and adjudication protocols are being implemented. With so many solutions being described as “claims integration,” simply deploying one of these tactics does not guarantee increased utilization of supplemental health plans. In short, different solutions lead to different claims utilization impacts.

For example, claims integration could involve communications sent to a voluntary member reminding them to submit their supplemental health claims based on an event. But this approach still requires significant action on the member’s part because in many cases they still have to upload medical documentation, which can present barriers to utilizing coverage.

Additionally, the data used to power a claims integration solution is extremely important.

Medical data is best because it includes all clinical events, no matter how major or minor the service.

Another important factor is determining for which individuals the solution has data. Is it all covered members, or just employees?

Where the data comes from can also influence the effectiveness of any claims integration solution.

While data from a third party may be fairly inclusive, a claims integration solution that relies on data from a third-party source could exclude important data sources like physicians’ letters or other clinical notes.

Another important issue is how often the data is shared. A medical carrier accessing its own medical system has near-real-time access to medical data—both pending medical claims and paid/denied medical claims. Using data from a third party not only can result in missing data, but it can also result in a lag in when the data is delivered. The longer the delay in getting the medical data, the less impactful that data is on the member’s experience.

Key data considerations of claims integration Source of claims data: Medical or non-medical Whose data is utilized: Employees only or all members Type of data available: Paid, pended, denied claims Frequency of data received: Daily, monthly, quarterly How the claims data is being utilized: Claim reminders, claim submission, claims processing and payment

For example, if there is a lag of one month from the date of a medical event to the date the data on the event becomes available, there could be significant consequences. A member could submit their supplemental health claim to their carrier after having visited the doctor but would still be required to provide all the paper documentation since the supplemental carrier would not yet have the medical claims data.

Collaborating To Put Benefits To Work As a medical carrier, we have direct access to the exact benefits payable based upon our medical data, but it is also important to combine claims integration capabilities with other plan sponsor medical carriers to enhance the experience of all employees, not just those on the medical plan. This is an important element in the ability to collect the medical data, which allows carriers to adjudicate claims based on the precise benefits utilized by members.

Just as importantly, we also work with plan sponsors to get the most out of all the benefits they provide. We want employees to maximize their utilization of benefits, because employees who do not use their benefits often do not value them.

And benefits that are not valued by workers are less likely to help attract and retain talent. That’s why claims integration is a critical part of any modern benefits strategy.

A Glossary of Key Terms Terminology and capabilities regarding claims integration can vary significantly in the market. It is important to understand in detail what aspects of claims integration, submission process and adjudication protocols are being implemented. The following glossary defines and provides crucial details about some important terms.

Claims Integration Using medical, disability or life insurance claim data (aka non-supplemental health data) for initiating and/or processing of a supplemental health claim in place of or in addition to a member’s submitted paperwork.

Medical: Employee and/or dependent data resulting from any medical treatment or service.

Disability: Employee-only data resulting from a qualified short-term or long-term disability event.

Life Insurance: Employee and/or dependent data resulting from a death or accidental dismemberment.

Claims Submission Approaches The carrier’s method for how claims can be submitted.

Online/Paper Claims Submission: Memberinitiated supplemental health claims with all supporting medical documentation provided to the carrier.

Simplified or “Integrated” Claims Submission: Member-initiated supplemental health claims without having to upload any supporting medical documentation.

Auto-Claims Submission: Carrier-initiated supplemental health claims based on review of medical claims data. Member takes no action to initiate the claim.

Claims Adjudication Protocols Carrier’s internal protocols used to process and pay claims in their system.

Manual-Adjudication / Semi-Automatic Adjudication: Member’s claim is manually entered by a claims processor into the carrier claims system and payable benefits are "selected" using medical codes and/or uploaded documentation.

The claims adjudicator is making decisions on payable benefits. On completion by the claims processor, the carrier’s system processes and makes payments to the member without further claims processor interaction.

Auto-Adjudication (100% system driven): Member’s claim is processed without any human claims processor involvement. Claim review and processing occurs in the carrier’s claims system by utilizing medical codes (i.e., IC10, rev codes, procedure codes, CPT codes) to make payment.

NOTE: The term Auto-Adjudication is often used in the market incorrectly to convey a carrier’s Claims Submission Approach.

Claims Adjudication protocols are very different from Claims Submission Approaches. The term Auto Adjudication should only be used to refer to the carrier’s internal claims processing approach, not how a member's claims get submitted.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to Aetna.com.

1. Based on Aetna Voluntary Results for 2021-2023

Randy Finn, Executive Director, Aetna - responsible for all business operations for Aetna’s Voluntary segment, which includes product development and claims integration solutions, pricing, underwriting, enrollment communications and strategy, billing, eligibility management and plan sponsor services. In 2014, he joined Aetna to build out their voluntary supplemental benefits portfolio (Accident, Critical Illness, and Hospital Indemnity), value proposition and capabilities.

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The Intersection of E R A C M Technology and NG TER LO Long Term Care

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Technology can help tell the long term care planning story and provide assessments regarding caregiver stress points. It can also emphasize the importance of comprehending care costs, then highlight solutions and personalize that experience.

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In the realm of long term care planning and caregiving, understanding the financial implications and pain points is crucial for individuals and families alike. With the aging population on the rise, the need for long term care services and caregiving assistance has become a pressing concern for many. Benefit brokers and employers are in a unique position to help more Americans understand the need for long term care planning, regardless of whether an actual long term care benefit is offered. They are also able to help more employees better manage their caregiving responsibilities. Fortunately, advancements in technology have provided us with tools that can aid in planning and preparing for these eventualities. These tools can help tell not just the why story, but the how.

Genworth’s Cost of Care Survey 2023

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By Gretchen Barry

Understanding the Cost of Care: Why It Matters Anyone who has been a caregiver, as many employees are experiencing now, the cost of long term care can be staggering, and it's often underestimated by those who may eventually require these services. According to the Genworth Cost of Care Survey 2023, the annual national median cost of an assisted living facility has risen to $64,200. This underscores the importance of early and informed planning.

Understanding these costs is vital for several reasons: 1. Preparation for financial impact: Knowing the potential costs allows individuals to prepare financially, whether through savings, insurance, or other means.

2. Informed decision making: Awareness of costs aids in making informed decisions about the type of care and location, balancing quality and affordability.

3. Estate planning: It can facilitate estate planning, ensuring that assets are allocated appropriately, and legacy wishes are fulfilled.

4. Understanding government programs: It can educate people about their eligibility for government assistance programs, which often have financial thresholds.

Genworth Cost of Care Report Tool: A Closer Look The Genworth Cost of Care report tool is an invaluable resource for those seeking to understand the landscape of long-term care expenses. The tool provides a breakdown of costs by state and care setting, offering insights into the median costs today and projections for the future. For instance, the cost of a home health aide has increased by 10% to an annual median cost of $75,500. This tool not only helps in current planning but also in anticipating future expenses, allowing for a more robust long term care strategy.

The example in the chart from the Genworth Cost of Care Survey tool show the monthly median costs in Kansas City, MO. You can change locations and time periods that show hourly, daily, monthly, or annual costs.

The Role of Technology in Personalizing Long-Term Care Planning Technology's greatest strength lies in its ability to personalize the process, whether it’s caregiving or long term care planning. With tools like the Genworth Cost of Care report, the experience meets people where they are and gives them tailored information and projections. This personalized approach ensures that each person's unique needs and preferences are considered, leading to a more accurate and effective way of planning for a long term care event.

The long term care journey of caregiving and planning for your own care is complex and multifaceted. However, with the aid of technology, brokers and employers can help employees navigate this path with more information and clarity.

As we continue to embrace these technological advancements, the story of long term care planning becomes one of preparedness and foresight, rather than uncertainty and apprehension. This can be done at the individual level and at the group/employer level.

Providing employees with a base long term care benefit increases the likelihood that the planning conversation is happening with more families. That makes it more likely that an employee will explore additional coverage.

This article aimed to provide an overview of how technology interfaces with long term care planning and caregiving, highlighting the critical role of understanding care costs and the innovative tools available to aid in this endeavor. As we look to the future, technology will continue to play a pivotal role in shaping our approach to long term care, offering solutions that enhance our ability to plan effectively and with confidence.

Gretchen Barry - is Chief Marketing Officer for BuddyIns, a technology, education, sales, and marketing company specializing in long-term care planning. With over 20 years of marketing leadership experience, Gretchen has built an extensive marketing portfolio.

Gretchen works closely with the BuddyIns team and partners to identify ways to advance the company's brand, partnerships, and mission. With first-hand experience as a caregiver, Gretchen understands the inherent challenges and unlimited opportunities facing the company and the LTCi industry. Gretchen can be reached at gretchen@buddyins.com.

Relational Leadership Helps in Troubled Times

By Steve Clabaugh, CLU, ChFC Almost every week I hear from business leaders about the unique challenges of our current culture and economy. Some of these issues include: Deteriorating social skills behavior exacerbated by the effects of the pandemic Issues of Diversity, Equity, and Inclusion The remote work versus return to the office debate.

Attracting the right employees in a highly competitive employment environment Keeping the right employees on the team with so many opportunities available to them Geopolitical conflicts and seemingly endless wars seen 24 hours a day in the never ending news cycle Unprecedented sharp cultural conflicts dividing co-workers, families and friends Many of these issues are substantially different than anything we have faced before in our country.

Unfortunately, there is no “how to” guidebook telling us how to deal successfully with them.

While today’s difficulties are new to our generation, and are undeniably painful to address, the challenge of facing unprecedented issues is not new. In fact, every generation has to face and address its own set of unique challenges.

During my childhood in the 1950’s and 1960’s our nation’s focus was dominated by the challenges brought about by 3 major cultural upheavals: the post-WWII societal transition, the Korean War, and the struggle for racial equality. Businesses and all types of institutions were forced to address these issues and to respond to the cultural phenomenon of women being pushed out of the workplace by men returning from the war; an Asian war without a clear purpose and racial equality demonstrations both peaceful and violent.

The stories that dominated the 1960s were about Rosa Parks, Martin Luther King, Jr., the passage of the Civil Rights Act of 1964, the Voting Rights Act of 1965, the forced integration of public schools, and the assassination of Martin Luther King Jr., John Kennedy and Robert Kennedy.

The Vietnam War dominated the 1970s with protests and marches; the draft and draft-dodgers; 4 students killed at Kent State University by Ohio National Guard soldiers; and then Watergate and the resignation in disgrace by the President of the United States.

Most of you learned about these events in history class but my generation experienced them as current events!

These are just brief mentions of some of the major cultural challenges that knocked our nation off balance and caused many pundits to predict the demise of our country and way of life. Somehow, although it was awkward and painful, we made it through, though not without some deep scars.

And we could add the unique struggles of the 80’s, 90’s and early 2000’s. The point is – each generation has its own set of unique cultural upheaval issues to deal with and each generation has to find its own solutions. Rather than being discouraged by this reality, I happen to think there is good reason to have confidence that we will face up to and overcome even today’s challenges.

Now you may ask, “what in the world does this have to do with relational leadership?”

Over the next 18 months we started to get some traction around relational leadership among the officers and managers. Then our country was rocked by what turned out to be the deepest recession since the Great Depression. Suddenly I understood why CEO’s get paid the “big bucks”. Our customers were folks hard hit by the recession, so they weren’t likely to be making many buying decisions beyond the basic necessities of life.

Our leaders and I had to answer some really tough questions that impacted the livelihoods and financial security of many fine employees and some great producers.

How could we expect to increase sales and profits in such an environment?

Should we put our plans about relational leadership on hold?

Should we pull back on plans for growth until the economy improved?

I’m glad you asked.

I believe relational leadership can be an effective tool helping business and other types of organizations face up to and overcome today’s difficulties while achieving ever higher levels of positive results.

Here’s why I believe.....

In mid-2007 I was hired as President/CEO of a small midwestern life insurance company. The company’s primary market was selling payroll deduction life and critical illness insurance to government, postal and small business employees. The company had experienced a period of some 20 years with very little growth. My mandate was to double the company’s sales and profits over the next 5 years.

I was excited, and more than a little nervous, about having the opportunity to build an organization based on the principles of relational leadership. It didn’t take long to see an impact. At my first meeting with our officers, I shared with them the basic concepts of relational leadership with a focus on the 6 principles of Championship Team Behavior. The results were almost immediate as 2 of them announced their retirement and a 3rd simply resigned, telling me he didn’t believe in what I was doing and so didn’t fit on the ideological bus I was driving.

I shared these concerns with a trusted mentor, and his response was immediate and unequivocal. “You’ve worked your entire career to have the opportunity to build an organization on the principles you believe in.

This is not the time to back down – it's time to go all in.”

“When written in Chinese, the word ‘crisis’ is composed of two characters. One represents danger and the other represents opportunity.”

John F. Kennedy, 35th U.S. President.

And so, we did!

The results were that we doubled sales and tripled profits in 4 ½ years instead of 5. This happened because our remaining leadership team and those who joined us committed to implementing the practices and principles of relational leadership. I will always be grateful for and proud of that outstanding team of men and women. I’m also very proud of the fact that a number of those leaders occupy very important leadership positions in our industry today. They will, no doubt, have a significant impact on the future of how voluntary benefits continue to meet the real needs of real people who really need us.

It is my hope that leaders, like you, will help to influence our current work culture by introducing and practicing relational leadership in all types of organizations. As always, please feel free to contact me to discuss the needs of your organization or that of your clients.

Steve Clabaugh, CLU, ChFC - started his career in insurance as a Field Agent, moving on to Sales Manager, General Manager, Regional Manager, Vice President, Senior Vice President, and President/CEO. A long time student of professional leadership, Steve created the Relational Leadership program that has been used to train home office, field sales associates, mid-level managers, and senior vice presidents.

RELATIONAL LEADERSHIP EXPERIENCE Can it Help Your Employer Clients?

Your employer clients are facing new and different challenges in today’s business environment including: Remote Work - Returning to Office Diversity - Equity - Inclusion Geopolitical Uncertainty - Cultural Conflicts

The timeless principles of Relational Leadership can help your employer clients navigate these issues as they grow and prosper their business.

Relational Leadership Experience helps your clients: Create and build high-performance teams Select and train the right employees Implement effective mentoring Develop positive conflict management Determine and implement the best outcomes Achieve ongoing growth and success In-person, online and combination programs available to meet the needs of your employer clients.

To learn more about Relational Leadership Experience Contact:

Steve Clabaugh, CLU, ChFC at sjcsr@hotmail.com or 910-977-5934

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