Work with Contracts and Enrollments

Learning Objectives

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

Identify who works with contracts and enrollments.
List the jobs done with contracts and enrollments.
Describe a typical contract-and-enroll business process flow.

The People and What They Do

Several people play a part when it comes to contracts and enrollments, from the insurance carrier all the way to the policyholder. Let’s get an idea of some key people involved and the jobs they do.

The People

Group insurance involves several key people.

The group admin represents the insurance carrier, a broker works for the broker company, and a benefits admin represents the group.

Group admin: Represents the insurance carrier, which is also called the insurer. The group admin is responsible for arranging group policies and working with brokers, benefits admins, and others outside the carrier organization.
Broker: This role acts between the insurance carrier and the group to sell policies to businesses and manage the customer relationship. Variations of this role include producers and agents. We'll refer to this intermediary as the broker throughout this module. Sometimes there's no intermediary involved. In this case, the insurance carrier deals directly with the group.
Benefits admin: Often a member of the HR department, this role arranges and administers insurance plans for the employee group.

The insurance is offered to members of the group, so they’re key people too.

Group member: A person in the group, such as an employee.
Policyholder: A member of the employee group who gets an insurance plan. This role is the insured person who receives the benefits of the policy, which may also cover family members.

The Jobs

How do these people work with contracts and enrollments?

Persona	Tasks
Group admin	Create contracts with employers. Enroll employees in plans. Upload census data. Manage member and policy changes.
Broker	Work with groups to determine plans and negotiate rates. After quotes are finalized and underwriting is complete, send details to the insurance carrier for contract creation. Participate in steps like contract renewal. If there’s no broker involved, then the insurance carrier handles these tasks.
Benefits admin/HR	Provide census details to the carrier. Send details of the group members and their plan selections to the carrier for bulk enrollment, or alternatively, allow group members to enroll themselves.
Policyholder/ group member	Self-enroll in plans offered by the group. Update their policy details, for example, add dependents.

From Quote to Card

Let’s consider the standard business process of going from quote to card, which starts with the agreed upon quote and ends with member ID cards.

What happens after the group admin or broker agrees on the quote? A lot! The group admin prepares the contract and sends it to the customer, enrolls members, and then finally, it’s time for insurance cards. Let’s look at the diagram to learn what happens after quote agreement.

Corresponding process diagram with steps, records, and users

Once the quote is agreed, it’s time for contracts and enrollments.

Create the final quote and contract: The group admin creates the contract based on information in the agreed quote.
Generate and send the contract document: The group admin or broker must create the contract document and send it to the group for signing.
Enroll members and create their policies: After signing the contract, it’s time to enroll members. A benefits admin is responsible for handling enrollments, including identifying members and dependents along with their plan selections. The plans selected become the policies created.
Generate information for member ID cards: Enrollment is complete, but the group admin’s work isn’t done. It’s time to create ID cards and send them to policyholders.

You now have an idea of who does what and insight on the process from quote to card using Salesforce Insurance. Next, let’s dive deeper into contracts and enrollments and see how to make the tasks easier.