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Employer Groups Module

Employer group management for commercial health plans including group setup, census management, COBRA administration, and open enrollment processing.

6
Pages
5
API Endpoints
3
High-Priority Orgs
5
Requirements

Organization Relevance

Health Plan: High MCO: High TPA: High MSO: Low IPA: Low PHO: Low ACO: Low FQHC: Low

How It Works

The employer group module manages the lifecycle of employer clients from initial setup through ongoing administration. Census management tracks employee enrollment. Open enrollment periods are configured and managed. COBRA administration handles qualifying events and continuation coverage. Group billing generates invoices based on enrollment counts and rate structures.

Requirements

  • Employer group onboarding workflow
  • Census file processing
  • COBRA compliance engine
  • Open enrollment portal
  • Group billing engine

Target Audience

Group Account Managers, Employer HR Teams, COBRA Administrators, Enrollment Specialists

Pages (6)

PagePurposeKey Features
Employer Groups Dashboard Overview of all employer groups with key metrics and status Group directory, Enrollment counts, Renewal tracking, Financial summary
Group Billing Generate and manage employer group premium invoices Invoice generation, Payment tracking, Rate application, Billing history
Census Management Process and manage employer census files for enrollment Census upload, Validation rules, Discrepancy resolution, Historical tracking
COBRA Administration Manage COBRA qualifying events and continuation coverage Qualifying event processing, Notice generation, Payment tracking, Termination management
Open Enrollment Configure and manage employer open enrollment periods Period configuration, Plan options, Enrollment tracking, Completion reporting
Group Setup New employer group onboarding and configuration Group creation, Plan assignment, Contact setup, Billing configuration

API Integrations

  • X12 834 Group Enrollment
  • Census import API
  • COBRA administration API
  • Group billing API
  • Open enrollment portal API

Referenced Resources

  • COBRA Regulations (29 USC 1161-1168)
  • ERISA Requirements
  • ACA Employer Mandate
  • State continuation coverage laws

Expected Results

Efficient employer group administration with COBRA compliance, streamlined open enrollment, and accurate group billing.