Open Enrollment

Ideon handles the Open Enrollment and Blackout Period enrollment changes.

The Open Enrollment Process

Ideon handles the complex web of managing enrollments across plan years during the Open Enrollment (OE) period and beyond, when retro-active changes are still valid. Our goal is to ensure that no coverage election/change goes unsent and the steps below outline how we ensure that everything runs smoothly.

Approaching Open Enrollment

As the OE period approaches, typically two weeks before, our Enrollment Operations team will reach out to the Carrier to request the Account Structure for the new plan year. This document is used to configure the data Platform Partners send us so that the data we eventually deliver has the identifiers the Carrier needs to process the enrollments.

Using the API, our Platform Partner will create a Coverage Period, a representation of the new plan year, the Plans offered for the upcoming plan year, and add all of the enrollments elections made by members for that year.

Open Enrollment elections are always a bit in flux. Members change their mind and sometimes they're just late to make elections – and that's OK! For EDI, Ideon works with carriers to ensure that files have Term By Omission (TBO) off until the last communication missing elections don't cause issues.

Open Enrollment Elections

During OE, Ideon does the heavy lifting to ensure that elections get sent to the Carrier.

For EDI communications, our Enrollment Operations team sets up expected delivery dates with each Carrier for each OE file. Often this simply means we either replace the current year's weekly with the OE, or that we select a different day of the week to deliver the OE files. Generally, Carrier systems discern the difference between an OE file and a current plan year file by looking at the dates of coverage, as well as a few file header indicators.

For API connections, Ideon passes elections to the Carrier in "real time." That means that when Platform Partners send an OE election for a particular Subscriber, Ideon is able to directly pass that over to the Carrier, without the need to wait for a period file or to send the data alongside the rest of the company. Carrier system ability to handle of this data depends on their ability to manage plan years appropriately. Ideon works with our Carrier Partners to ensure that our systems are communicating correctly – each integration can be a little different but that's where the technical expertise comes in!

Retro-Period Elections and Black Out Periods

Members typically have a window where they are able to make retro-active changes to their insurance elections, wherein the length of that window depends on the plan agreements. The most common window is 60 days, but it can vary. What that means is, for example, if a company has a calendar year plan year and we're in February, a member who got married in December can actually claim coverage for their spouse going back to when they had the qualifying life event.

Retro-Period elections poses an interesting challenge in how best to communicate this with the Carrier. Typically, these changes need to be passed manually by Platform Partner teams, but that's an onerous process that is difficult and costly to maintain. Ideon solves this for Platform Partners by working with the Carrier to ensure we have a means of continuing to send elections for the length of the retroactive window.

For EDI connections, Carriers often impose what is commonly referred to as Blackout Periods, defined as a period in which the previous year can no longer be sent since the OE file was delivered. Ideon navigates these challenging data communication waters by working with the Carrier to establish a means to still support EDI file deliveries, even during the Black Out Period. At the agreed upon date, Ideon delivers the prior year file to the Carrier until the retro-period completes. This means that Ideon often delivers the prior year well into February to ensure that past year changes are processed by the Carrier.

For API connections, Ideon delivers both plan year elections to the Carrier, thereby ensuring that any change to the current and previous year is processed.

Example Open Enrollment Playbook

Date	Assignee	Step
Early-Late Nov	Ideon	Reach out to Carrier to get Account Structure
Late Nov - Early Dec	Ideon	(If EDI) Sets up file delivery schedules for OE and Blackout Period
Late Nov - Mid Dec	Platform	Sends new Coverage Period, Plans, and OE Elections to Ideon API
Late Nov - Mid Dec	Ideon	Sets up configuration of Coverage Period so data is ready to go
Mid-Late Dec	Ideon	Sends OE elections and current year elections to Carrier
Jan-Mar	Ideon	Sends current and prior year elections to Carrier

Want to learn more? Check out this blog post on by our co-founder Dan Langevin on how we support Open Enrollment:

Lightening up the year-end blackout period for employee benefits