4 ways to be better prepared for open enrollment season in 2024

Another open enrollment (OE) season is behind us. With its challenges fresh in our memories, it’s a great time for ben-admins, HR teams, and carriers to take a breather, evaluate what went right, what went wrong, and figure out how to do better next season.

The administrative burden, technology snafus, employee questions, deadline pressures, and general complexities form a perfect storm. Many HR teams, benefits administrators, and employees dread OE season for employee-sponsored group benefits. That need not be the case.

The key to having a successful and trouble-free OE season is having the right systems in place to manage it. For years, ben-admins and others have been hampered by EDI-powered processes that limit the accessibility, visibility, synchronization, and general flow of data, as well as the ability to correct problems before they impact members.

The evolution of the industry from EDI to API technology opens a new world of interoperability, one in which data moves instantaneously between carriers and groups, allowing ben-admins to scale carrier connectivity faster and at a fraction of the cost of building direct integrations. That results in faster, easier, and more automated enrollment, with fewer errors.

Here are four API-powered systems that will make the 2024 OE season much more efficient.

1. Clean and synchronized data

The success of OE depends on the quality of the data used. Think about it as fuel in an engine. If it’s dirty or if it’s diesel in a gas motor, things break down.

For a smooth OE process, it’s essential that the carriers, brokers, and groups work from the same set of data on enrollment and related information. A centralized solution with insight into both carrier offerings and group expectations of coverage can detect misalignments before they become major problems.

For example, if a group states that it expects to join a new dental plan at the beginning of the year, a ben-admin should be able to automatically check with the carrier to see if that plan is in place for the group. If it’s not, the system automatically notifies the broker or group of the discrepancy so it can be resolved before coverage is set to take effect and enrollment information begins flowing to the carrier. This capability can flag thousands of potential mismatches for resolution before they impact members.

This immediate, two-way communication and a centralized dashboard for greater visibility by the ben-admin is made possible through the integration of APIs, as opposed to legacy EDI systems in which communication is slow, periodic, and one-way from groups to carriers. Because API-powered systems are proactive they detect problems earlier so they can be fixed before the group is aware of it.

2. Automated, real-time data access

Under EDI systems, data flows in one direction only and usually at weekly “batch” intervals, making it difficult to coordinate enrollment activities and identify and correct problems. An API system gives ben-admins automated, real-time access to carrier business rules on such matters as waiting periods, termination policies, renewal dates, and more.

Ben-admins can validate the data is accurate and aligned correctly with the information the carrier has on file. Essentially, it allows ben-admins the visibility to double-check the work before enrollment even begins.

This system also allows for audits before OE begins, so ben-admins can ensure the necessary coverage options are in place and available. Post-OE audits can confirm all transactions were completed and to verify the enrollment data. For even greater certainty and accuracy, during the months before and after OE, the system routinely runs carrier synchronizations. In addition, these audits can be performed at any time using real-time data.

3. Early error detection

Under EDI-powered systems, when a ben-admin sends enrollment information that is formatted incorrectly or that contains a mistake, such as a missing Social Security number or member date of birth, that error is likely to go undetected for a period. Correcting the mistake and resubmitting it can take weeks given the intervals between the once-a-week batch transfers.

By contrast, an API system automatically and immediately detects the inaccurate formatting or missing information and notifies the ben-admin so they can correct it and resubmit. This can prevent the worst possible outcomes for members – access-to-care issues. These are highly problematic as they typically happen when members try to use their benefits – very often when they need them the most – and the provider cannot verify coverage. This can result in the patient being forced to forego treatment or paying out of pocket and fighting later for reimbursement.

Additionally, with EDI a single error in a batch-processed file can halt enrollment for all members whose information is also included in that batch file. The lack of two-way communication can take more than a week to correct, which can also hurt other members and cause headaches for ben-admins. By contrast, an API system halts only the errored enrollment and lets all others in the group proceed.

4. Advanced tools for the operations team 

Ben-admins and carriers with API-powered systems can enjoy centralized functionality and tools such as an interactive dashboard to help them manage OE season. They have visibility into all the relevant information in one place, so they can easily check on such items as alignments in coverage, business rules, plans and group structures.

Imagine a group that waits until the last minute during OE season to renew or enroll with a new carrier, effective Jan. 1, 2025. A member has a can’t-miss medical appointment on Jan. 2, but doesn’t yet have their membership card and is worried about being denied coverage. Their ben-admin can go into the platform, verify enrollment and coverage with the carrier, and confidently let the member know they can keep the appointment.

Related: 5 generations of employees share their real open enrollment wants and needs

Less dread, better data

The key to a smooth OE in the coming year is adopting API technology and these four systems that allow carriers, groups, and ben-admins to switch from a reactive position to a proactive one. Rather than responding to the inevitable errors and miscommunications in a needlessly slow process, these systems can identify the problems immediately and initiate the necessary fixes before they affect enrollment and members.

With 2023 OE behind us, it’s time to adopt the API-powered systems that will make next year’s season more efficient with fewer problems, elevating the process and reducing all the worry.

Brian Taylor is Senior Manager of Operations at Noyo, a benefits data platform providing the modern data infrastructure to make frictionless employee benefits possible.