Massachusetts Health Connector Case Study

About the Massachusetts Health Connector

The Massachusetts Health Connector is a state-based health insurance marketplace that makes shopping for affordable health and dental coverage more accessible for individuals, families and small businesses in the Commonwealth of Massachusetts.

Situation

On February 8, 2007, Mosaic Insurance Exchange’s affiliate, the Small Business Service Bureau (SBSB) , was selected through a competitive bidding process to function as the “Sub-Connector” for one of Massachusetts’ two exchange programs, Commonwealth Choice. By law, the Commonwealth Choice program was required to go live in time to begin offering and supporting effective coverage on July 1, 2007, the day the Commonwealth of Massachusetts’ individual mandate went into effect.


As this deadline was “hard-wired” into the state’s landmark health care reform legislation, timely delivery on the commitments promised by Mosaic/SBSB was critically important. Given the time required to enroll and collect premiums in advance of July 1, Mosaic/SBSB had just three months to build staff and program capacity, complete training and begin the operations for Commonwealth Choice.

Solution - Why the Massachusetts Health Connector Chose Mosaic Insurance Exchange

Jon Kingsdale, former director of the Massachusetts Health Connector explains why Mosaic/SBSB was selected as the sub-connector for the Commonwealth Choice program: "With more than 40 years of experience selling and servicing individual and small-group insurance in Massachusetts and other states, Mosaic/SBSB had demonstrated the ability to meet all the technical requirements, competitive pricing, and willingness to invest in start-up expenses necessary to make the Commonwealth Choice program a success." Additionally:

  • Mosaic/SBSB had a unique understanding of the marketplace and administrative processes required to serve Commonwealth residents and small businesses.

  • Mosaic/SBSB provided a plan for servicing Massachusetts Health Connector customers in a manner consistent with the Massachusetts Health Connector’s brand, a vision for automation and streamlined business processes, and top-notch customer service.

  • The Mosaic/SBSB team worked well with the Massachusetts Health Connector’s staff, partners, brokers and health plans.

Together Mosaic/SBSB and the Massachusetts Health Connector succeeded in implementing a successful exchange on time and on budget. The exchange has operated well from day one and grown steadily with each month’s additional enrollment.

Key services Mosaic Insurance Exchange provides the Massachusetts Health Connector are:

  • Technology Platform – Mosaic Insurance Exchange adapted its technology platform for health plan rating, comparison shopping and online enrollment and payment tools to fit into the back end of the Massachusetts Health Connector’s Commonwealth Choice portal. (It is still in use in 2015 to support the ACA-compliant SHOP exchange.)

  • Pre- and Post-Enrollment Customer Service – Mosaic Insurance Exchange provides customer service to individuals, employers, employees and brokers prior to and during enrollment into the Massachusetts Health Connector. This includes distributing enrollment and health plan informational materials, responding to inquiries, and generating quote proposals that detail the cost of the available health plans. Mosaic Insurance Exchange also provides customer service on a telephonic, email and walk-in basis to enrolled individuals, employers, employees and brokers regarding eligibility, enrollment and premium payment issues.

  • Eligibility and Enrollment – Mosaic Insurance Exchange distributes and collects individual, employer and employee enrollment forms through a range of mediums; verifies that enrollment forms are completed correctly; verifies individual, employer, and employee eligibility; processes applications; and transmits appropriate eligibility and enrollment information to participating health plans. Mosaic Insurance Exchange handles the development and ongoing management for 834 and 820 EDI transmissions.

  • Premium Billing, Collection and Remittance to Carriers – Mosaic Insurance Exchange precisely bills both individuals and employers for premium contributions due for enrollees; collects and reconciles premium due; and remits funds to participating health plans, the Massachusetts Health Connector, and, when applicable, to brokers. This requires accuracy in managing a broad range of coverage transactions and in completing complex reconciliations.

  • Section 125 Program Support – Mosaic Insurance Exchange facilitated the establishment and maintenance of Section 125 plans by participating employers for premium-only plans.

  • Notifications – Mosaic Insurance Exchange submits all necessary notifications to the participating health plans regarding the enrollment and premium payment status of participating members. Mosaic Insurance Exchange provides notifications of enrollment and premium payment status – including delinquency notices and cancellation due to non-payment of premiums. 

  • Reporting Requirements – Mosaic Insurance Exchange creates and distributes reports on the activity and status of members enrolled through the Massachusetts Health Connector. These reports are generated on behalf of, and provided to, the Massachusetts Health Connector and participating health plans and brokers.

  • Relationship with Brokers – Mosaic Insurance Exchange works closely with brokers in Massachusetts to facilitate the distribution and sale of coverage through the Massachusetts Health Connector to eligible employers. As such, Mosaic Insurance Exchange distributes sales and enrollment materials, including quote proposals to brokers, and the support and tools to enhance the ability of brokers to enroll small groups and their employees into the Massachusetts Health Connector’s Qualified Health Plans.

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