Ethics in a Digital World

By Jennifer Daniel

Ethics can be a tricky subject as definitions of right and wrong vary by person, situation, and of course regulations. It’s easy to say, “just do the right thing” until there are different versions of “right”. With the majority of enrollments taking place on digital platforms today, the subject of ethics and technology has become a common one.

Decision Support Tools:

Let’s start with the topic of using AI, specifically related to decision support tools. The use of AI in helping employees make decisions about their voluntary benefit elections can offer many benefits, including increased efficiency, accuracy, and personalization. However, there are also several ethical considerations that employers should keep in mind when choosing a Decision Support Tool including:

1. Transparency: Platforms should be transparent about how AI is used to make decisions about Voluntary Benefit elections. This includes explaining the algorithms and data sources used, as well as any potential biases that may exist. Who creates the algorithm? Can the employer influence the recommendations to drive certain benefit decisions? It is important to make sure the Decision Support Tool is providing factual recommendations unique to each individual, not recommendations based on the potential to drive revenue.

2. Privacy: Platforms should ensure that employees' personal information is protected and used only for the purposes for which it was collected. This includes obtaining consent from employees to use their data for AI-based decision making. Many of these tools ask for personal information that the employer may not have access to (nor want), how is that data being used and protected? 3. Human oversight: AI-based decision making should not be fully automated, and there should be human oversight to ensure that decisions made using AI are appropriate and ethical.

Claims Auto-Adjudication

Claims auto-adjudication is a hot topic in the market today. With auto-adjudication, the claims division of an insurance company leverages AI, industry data, and pre-set rules/algorithms to determine whether a claim is covered under the policy, how much should be paid out, and automatically paying it as well. This is ideally done with minimal involvement from the employee filing the claim.

Auto-adjudication has several benefits, starting with less paperwork and hassle for the insured. It also offers increased accuracy, faster processing times, and lower costs due to automation. However, auto-adjudication can also raise some ethical concerns.

Failure to get employee permission. Is the employee aware that the insurance company is gathering this data on their behalf from 3rd parties?

Lack of transparency. What access does the employee have to see what data has been gathered, where the claim is in the process and when it will be paid?

Review of data. Technology can definitely help employees get claims filed faster. That being said, it is important for insurers to ensure that their auto-adjudication process and systems are fair, accurate, transparent, and that they provide a mechanism for human review and intervention when necessary.

Platform Subsidy Payments

Platform fees are often paid by a carrier to support the enrollment of their products on a specific platform. Generally, the platform is doing work on behalf of the carrier for a mutual client. These fees go by many names: tech credits, technology investments, marketing fees, subsidies and sometimes commissions or overrides.

These fees are not regulated in most states and vary greatly in different situations. Because of this, they pose some possible ethical issues that should be considered:

What is it paying for?

Who is the subsidy being paid to?

Transparency

Weight of subsidy payment in carrier selection.

As the insurance industry continues to leverage technology solutions, making ethical decisions around these topics is very important. Technology can help move us forward, but we still need humans to drive ethical decision making and ethical choices.

Jennifer Daniel, National Vice President Broker Distribution Strategy and Partnerships at Aflac. Jennifer is a proven leader in the insurance industry specializing in benefits technology and strategic partnerships. In her current role she is responsible for leading multiple teams that drive Aflac’s strategic sales efforts around benefits technology, premier broker relationships and enrollment partnerships. In addition she works internally at Aflac to drive innovation and sales growth.