The Affordable Care Act, or ACA as it is more commonly known, attempts to reform the healthcare system in the US. The ACA aims to provide quality affordable healthcare for all Americans by curbing spending. These impending changes will affect employers, insurance carriers and third party administrators (TPA’s).


Effect of the ACAIncreased Volume of Policies

According to data released, in 2013 over 15% of Americans were without health insurance. The high costs of insurance premiums price small business owners and families out of coverage. This creates worry for those affected that they can’t afford the care they need when they are ill. The ACA makes insurance premiums more affordable and aims to ensure 95% of Americans will be insured when it is implemented.

These impending changes will increase the volume of healthcare policies, adding pressure to already over stretched claims departments. A recent claims executive survey showed that only 5% of respondents plan on hiring new staff to deal with the increase in volume; instead, 77% of respondents are investing in new technology to improve the efficiency of claim processing.

Increased Complexity of Claims

The ACA is changing the way employers are offering benefits to employees. Employees are attracted to jobs based on lucrative benefits packages, so rather than offering basic benefits, employers are offering employee paid voluntary benefits at a price point usually only seen in group benefits.

These benefits can be offered in two ways:

  1. The employer will give the employee a lump sum in which they can purchase the benefits they feel are necessary for them
  2. Voluntary payroll deducted (VPD) programs

Voluntary payroll deducted programs increase the complexity of claim processing, as integration with payroll systems is required.

Legacy systems are hindering the future of claims processing with manual processes and multi user environments. Updated technology will undoubtedly improve claim-processing efficiency and decrease the complexity of claim processing, with improved workflow processes, automation and integration.

If you are considering a system upgrade to deal with these impending changes, contact us today.