Pre & Post Enrollment Materials Updates: 10 Solvable Workflow Challenges for 2016 Enrollment Season

The publicized problems that have plagued the health insurance exchange projects are illustrative of the challenges health insurers have long faced in regard to generating information for their members. Billions of dollars are spent annually to ensure members receive the communications needed to enroll for services, legally notify them of coverage changes, and help them to understand and use plan benefits. In both scenarios, there is government mandated language along with deadlines for its availability. For health insurer that offer Medicare, Medicaid, and hybrid government sponsored plans, the regulations established by the Centers for Medicare and Medicaid Services (CMS) run deep. In the case of printed correspondence, plans are required to follow CMS published models that define how and where information is formatted on the page. Penalties imposed by CMS for non-compliance with published models and delivery dates are costly.

CMS guidelines apply to all the materials mentioned above however this paper segments them into two categories based on the frequency of the required updates. Documents updated once each year in preparation for the Annual Enrollment Period (AEP); and materials that require monthly revisions to provide members with up-to-date information related to their coverage.

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