Dive Into Contracts and Enrollments

Learning Objectives

After completing this unit, you’ll be able to:

Describe the relationship between contracts and enrollments.
Identify key information in a contract.
Explain member enrollment and policy creation.

From Contract to Enrollment

Whether it’s creating a contract or enrolling members, you can do it quickly with Contract and Enroll on the Digital Insurance Platform.

Justus has been working hard on the insurance solution at Cumulus to improve how they create contracts and support enrollments. He’s now ready to share news with the group admins on how they can quickly and easily manage contracts and enrollments with his new Salesforce solution.

Justus, triumphant

Justus explains to the admins, “After you agree on a quote, you use the service console to create a contract directly from the quote. Then, you use that contract as the basis for member enrollments.” The group admins are loving it, but they want to know more.

From Quote to Card

Here’s how it works with the Salesforce solution.

Corresponding process diagram with steps, records, and users

Group admins work smarter and faster with streamlined steps.

Create the final quote, contract, and application: The group admin quickly initiates contract creation based on the agreed quote. The process can prompt the admin for any changes before automatically generating the final quote and the contract. It also creates an application record to store information not in the contract, such as answers to eligibility questions.
Generate and email the contract document: The group admin or broker generates the contract in their chosen file format, such as a Word or PDF document. Then they email the contract to the group for signing.
Enroll members and create their policies: After signing the contract, it's time to enroll members. Using bulk upload, a benefits admin uploads a census that includes details for members and dependents, along with their plan selections. From the data, policies are created. Alternatively, policyholders self enroll.
Generate information for member ID cards: Enrollment is complete, so ID card information is available. Next, it’s time to create ID cards and issue them to members.

Contracts

With the Digital Insurance Platform, creating a contract starts from the chosen quote with a simple click of the Create Contract button.

Sample of small part of a contract record in Salesforce, showing Create Contract action button

The insurance solution pulls all the relevant information from the quote to build the contract. There’s no need to manually recreate all the data in another system.

Next, you step through the process to verify the chosen plans and make any desired changes. Here you can provide additional group information, specify employer contributions, and answer eligibility questions. For example, indicate whether the group employs union and nonunion members. And there you have it: a final quote, an application, and the contract itself.

The final quote includes any changes made to the quote details and any extra information collected from the application, like the answers to eligibility questions.

And, here’s the star of this show, the contract. It has key details like:

Contract start and end dates
Enrollment start and end dates
Contract line items for products/plans chosen, which determine the list used for enrollment

After contract creation, you can click to download or email a contract document to an employer. With that done, the contract is now the basis for member enrollment.

Enrollments

Let’s dive into enrollments. Plans available for enrollment are determined by the contract. Group members can self-enroll in plans offered, or the group admin can enroll members using bulk enrollment.

Member Self Enrollment

The new system for Cumulus includes an online member portal where members can go and enroll themselves in plans. It’s simple: Members click an Enroll Now button and see the plans made available by the group.

Selections made from available choices

Members love to see their plan choices, compare them, make their selections, and enroll. Let’s look at a screenshot from a member portal where a member is choosing between medical plans.

A sample view of a member portal shows two plans to choose from.

During enrollment, this member’s choices include the Medical HDHP Premium plan and the Medical HDHP Standard plan. The portal shows important differences, for example, the standard plan costs $0 a month, whereas the premium plan is $53. In addition, the premium plan has a deductible of $3000, while the standard plan has a higher deductible of $3500. This member weighs their options and chooses the premium plan.

Once the member finishes enrollment, they can use the portal to get answers to their questions or view their policy details.

Summary in employee portal with premium and policy information

This policyholder wants to confirm their premium, so they log in to the portal and see that they have five plans with an overall monthly premium of $778.10. Their statement is available, plus they can get information on their policies. For example, one of the policies is a dental plan with policy number 000621 and a premium of $16.

Bulk Enrollment

As a group admin, you can also use bulk enrollment to enroll multiple members and their dependents in a plan. You just need a census with the member details, details of any dependents, and the plan selections. Right from the account, you can kick off bulk enrollment by clicking an Add Members button. Then upload the census to enroll all the members at once.

After uploading the census, you see a summary, including the total number of members and a list of the data uploaded. Next, you see employees are automatically created along with their policies. As a group admin, after completing the bulk enrollment process, you see member enrollment details with the group account record.

A summary of the total number of members and total premium with a list of members, including their gender, plans, and premiums

This group’s account record page shows the results of a completed bulk enrollment with 63 members, including Michael Clarke and his four chosen plans. As a group admin, you have access to many handy enrollment capabilities.

Group Account Page: View relevant group data, such as quotes, policies, and member enrollments.
Bulk Enrollment: Enroll all the group members in bulk with one click.
Plan Selections: View all the enrolled plans for each member.
Members and Dependents: View members, their dependents, and relationships.
Enrollment Summary: View the total number of members enrolled, total premium collected, and expiration date of the policies.

With all that the Digital Insurance Platform can do to eliminate paper and speed up contracts and enrollments, you’re set to bring the insurance solution into the digital age. Let’s look a little more into digital transformation.