Softheon's Enhanced Direct Enrollment (EDE) software empowers health plans to provide a comprehensive, end-to-end shopping and enrollment experience directly on their own websites. This solution eliminates the need for members to be redirected to external marketplaces like HealthCare.gov, thereby reducing competition and improving member satisfaction. For Federally Facilitated Marketplace (FFM) states, it ensures accurate plan matching and a unified enrollment process. In State-Based Exchange (SBE) states, it allows health plans to effectively promote off-exchange plans and offer a cohesive digital journey across various lines of business, including Qualified Health Plans (QHPs), Dental, Vision, Supplemental, Group, and Medicare Advantage. The platform simplifies plan catalog management, allowing health plans to easily present their offerings in a single interface. It aims to reduce human error in critical workflows, expedite processes, and minimize manual interventions. By integrating payment options and enabling immediate first payments post-enrollment, it increases effectuation rates and encourages member retention through autopay. The guided shopping experience assists members in selecting the ideal plan with quote-to-card functionality, including 'Help Me Choose' features that recommend the 'Lowest Price' or 'Best Option' based on estimated usage, provider lookups, and subsidy calculations. It also facilitates daily exchange enrollment and reconciliation by managing outbound 834 files and leveraging integrated data to maximize subsidy revenue. For ACA markets, it offers a streamlined connection to Exchanges, allowing members to complete their entire journey on the health plan's site, thus lowering operational costs and preventing payment delays or lost opportunities.

Features & Benefits

• Phase 3 Enhanced Direct Enrollment (EDE): Enables members to shop, enroll, and effectuate plans directly on the health plan's white-labeled site.
• Unified Shopping Experience: Supports multiple lines of business (QHPs, Dental, Vision, Group, Medicare Advantage) in SBE states and a seamless journey in FFM states.
• Plan Catalog Management: Simplifies stocking and managing plan information through a powerful, centralized interface.
• Guided Shopping & Plan Comparison: Assists members in choosing the right plan with tools like 'Help Me Choose', provider/prescription lookups, and comparison of up to 3 plans.
• Automated Enrollment & Reconciliation: Handles 834 outbound files and integrates enrollment/payment data for subsidy maximization and daily reconciliation.
• Payment Integration & Effectuation: Reduces payment-related friction by offering expected payment options and increasing effectuation rates through immediate payments and autopay.