Prudential Builds Supplemental Health Claims Process from the Customer’s Perspective

The insurer has solved the perennial problem of under-utilization by simplifying a difficult claims process and going the extra mile to detect when employees may be eligible for a benefit they haven’t claimed.

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When Prudential (Newark, N.J.) approached the launch of its supplemental health offering in 2019, it was confident in the quality of its products. However, the company still wondered if it had created the best overall solution for employers and their employees. After an analysis of the entire customer experience, the insurer developed a simplified claim experience backed up by Medical Claims Monitoring to enable proactively contacting employees who had not taken yet advantage of coverage available to them. As a result, individuals receiving a serious medical diagnosis are able to make claims that were previously extremely difficult—and Pru takes the extra measure to reach out to them if, in the anxiety of receiving bad news, they had not prioritized filing a claim.

The purpose of supplemental health insurance—which in the case of Prudential’s offering, means critical illness, accident and hospital indemnity—is to protect employees from unexpected medical expenses. For example, if an employee has a $2,000 deductible on his health insurance, the added coverage can provide protection. But it can go well beyond that, explains Tim Weber, VP, Head of Voluntary Benefits Distribution, Prudential Group Insurance. In the event that someone gets a cancer diagnosis, they may have travel and childcare costs associated with their treatment, along with a variety of other incidental costs. “There’s a lot of expense for someone faced with an unexpected medical event,” he comments.

Tim Weber, VP, Head of Benefits Distribution, Prudential Group Insurance.

Unfortunately, employees often fail to take advantage of their coverage. Under-utilization is a problem in human terms, but it’s also a business problem. Employers choose supplemental coverage—and employees pay for it—to provide value. Also, according to Weber, brokers increasingly look to carriers who provide greater overall value rather than just making decisions based on plan features and premium alone.

Historically, the insurance industry has assumed that employees forget that they have supplemental coverage. However, Prudential’s research identified a different reason. “We found that the actual reason utilization is low is because it’s very hard to submit a claim,” Weber says. “Americans are not used to submitting claims—the doctor’s office usually takes care of that.”

Complex Claim Submission Process

The supplemental health claims process has typically begun with the employee logging on to their account and downloading a multi-page claim form. After printing it out, they are challenged to understand the medical jargon, answer many questions and secure medical records to provide proof. “You then have to assemble all that and send it to the carrier—after the bad news you just got,” comments Weber. “The core issue we felt we had to address was the complexity of the claim submission process.”

When preparing to launch supplemental health, Prudential decided to build its offering “from the ground up” to make it extremely easy for individuals to submit claims, Weber relates. There was an early internal discussion about reducing the number of pages in a claim form from 10 to six. “We challenged that and said, ‘That’s an improvement from our eyes, but put yourself in shoes of customer who just got that bad news; maybe we should just get rid of claim forms’—which we ultimately did,” Weber relates.

Prudential sought to automate the claim submission process, while also including person-to-person contact. “Our goal is to get the supplemental health benefit to the employee as soon as possible after an unexpected diagnosis,” Weber relates. “The fastest way to get the payment is the minute you leave office you pick up phone and within a matter of days we can get it to you.”

Medical Claims Monitoring ‘Safety Net’

However, recognizing that even with a vastly simplified claim process individuals might be too preoccupied with their diagnosis and related issues to make the claim, Prudential build in a Medical Claims Monitoring capability as an extra measure to ensure that employees receive the value of their coverage. Having secured consent from the employer and employee, the insurer monitors claims from employer-sponsored health insurance.

“We monitor medical claims to identify any potential supplemental health claims that haven’t been submitted, and if that’s the case we reach out,” Weber explains. “We don’t want this to be standard, as it takes more time, but in case they are distracted, this serves as a safety net to make sure they get the financial benefit.”

When reflecting on this solution to the perennial problem of underutilization of supplemental health benefits, Weber suggests that while the industry exercised due diligence in its management of products, it didn’t do a great job of understanding the difficulties faced by customers. “I’m proud that we put ourselves in the shoes of the customer,” he comments. “We decided the most important thing was to make it easier for them first, and then as the carrier, we’ll do the hard stuff.

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Anthony R. O’Donnell // Anthony O'Donnell is Executive Editor of Insurance Innovation Reporter. For nearly two decades, he has been an observer and commentator on the use of information technology in the insurance industry, following industry trends and writing about the use of IT across all sectors of the insurance industry. He can be reached at [email protected] or (503) 936-2803.

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