National Sales and Account ManagementMay 2013

End to End SBC processSummary of Benefits and Coverage

2

Fundamentals by Role

EAM AAM/ATS National Contract

Administration

NA RAM NA RAAM Regional SBC Team

Capture the group Benefit Election and SBC needs

Capture SBC Group Personalization needs in SBC

Track, Report and Audit

Support NA RAAM in validation and in meeting group deadlines

Validate benefits displayed in the SBC

Create compliant (Federal / State) documents

Obtain confirmation of groups’ benefit selection

Communicate and escalate SBC issues with group/ consultant as requested

Capture and document SBC personalization requests

Report SBC Progression status

Complete approved SBC formatting and personalization changes

Process approved edit requests (from group)

Finalize SBC with group

Storage of finalized SBC in SalesConnect

Tracking of SBC progression

Manage SBC translation requests

Transition support

Auditing of SBCs Storage of SBCs

in Sharepoint Communicate

SBC related updates to National Accounts, Regional SBC Teams

Review and confirm all SBC cost share, including maximums/ limitations, discovered by NA RAAM

Lead to resolution on any discrepancies as needed

Escalate as needed

Validate the SBC is displaying the correct cost sharing, including maximums/limitations

Report SBC Progression status

Advise of cost share discrepancies

Compose compliant SBCs, reflecting documented personalization

Report SBC Progression status

Process SBC corrections on cost sharing values

Process SBC edit requests (from group) that require compliance or regulatory review

Storage of finalized SBCs in regional storage solutions (for reprints)

3

Step Process Accountable Individual/Role

Others Involved Actions How

1 Group/consultant informs EAM team of final benefit selection

EAM AAM, ATS Obtain confirmation of final benefits from group/consultant

Inform AAM, ATS, and NA UWC of benefit selection

Engage with group/ consultant to finalize benefit selection

2 Discuss SBC personalization requests with group/consultant, document in National Universal Request Form (NURF)

AAM ATS, EAM, Complete NURF with personalization detail

Engage with group/ consultant; reference previous years SBC as needed/appropriate

3 Distribute NURF to Regional SBC partners

AAM ATS, Regional SBC Teams, NA RAAM, NCA

Save completed NURF in SC WHQ using required naming convention

Email NURF, NPS packets and Benefit Summaries to Regional SBC Teams, cc NA RAAM,ATS, and SBC-NA-Intake (NCA) using the subject line: National SBC Request [Group Name]

Regional SBC team emails can be found in the NURF

For CA – Request CRTS from NA RAAM for any sold alternate plan designs. This can be a 2-3 day process

For CO and GA – Request from NA RAAM or pull from RFP folders/files the blue and white Benefit Summaries for all sold plans

4 Create SBC(s) and any applicable state supplemental documents are created.

Regional SBC Team

NCA, NA RAAM, NA RAM, AAM

Email completed Regional SBC to NA RAAM , cc NA RAM, SBC-NA-Intake; and AAM

As defined by the Regional process

SBC created in editable Word 2010 format, with personalization components added)

5 Benefit cost shares are validated against group confirmed sold benefits

NA RAAM NA RAM RAAM will validate all cost shares, including maximums/limitations, on Regional SBC

Reference NPS packets and regionally specific documents

End-to-end Process DesignSBC Process

4

Step Process Accountable Individual/Role

Others Involved Actions How

If discrepancies are found during validation (follow steps 6-7):

6 Document benefit inconsistencies on the Regional SBC using track changes on the function in Word 2010

RAAM Regional SBC Teams, NA RAM, AAM, NCA

Save and /or print marked Regional SBC for your teams records

Email saved document to Regional SBC teams using subject line of: National SBC Edit Request [Group Name] for editing, cc SBC-NA-Intake, AAM and RAM

Communicate with AAM or ATS on recommended changes

Engage NA RAM, as needed

NA RAM to escalate as needed

7 Correct the SBC to match the selected plan design, updating coverage calculator results if applicable

Regional SBC Team

NA RAAM, NA RAM, NCA

Email revised Regional SBC, in Word 2010 format, to NA RAAM, cc: NA RAM and SBC-NA-Intake

As defined by the Regional process

8 Distribute validated and approved Regional SBC to EAM Team

NA RAAM AAM, ATS Regional SBC Team, NA RAM, and NCA

Save approved Regional SBC on SC in Regional Record in Notes / Attachments section using applicable naming convention (found in NURF instructions)

Email validated/accurate Regional SBC, in Word 2010 format, to AAM with cc to ATS, NA RAM, Regional SBC email box and, SBC-NA-Intake

End-to-end Process DesignSBC Process

5

Step Process Accountable Individual/Role

Others Involved Actions How

9 Review all Regional SBC’s requested in Step 3

AAM EAM, ATS, Peer AAM

Validate benefits, including maximums and limitations, formatting and requested personalization fields

Update editable fields for consistency/accuracy

Request peer review of SBC from ATS or peer AAM

Reference NPS packets and regionally specific documents along

Communicate/confirm with group as needed

10 Complete peer review and validation of SBC in Word 2010 format

ATS Group EAM or AAM

SuperUser NCA, NA RAAM

and NA RAM

If accurate, email all SBC’s to AAM with a cc: to EAM

If errors are found, use track changes to record found errors and email to AAM with a cc: to EAM, SBC-NA-Intake, NA RAM, NA RAAM

Reference NPS packets and regionally specific documents along with any additional information provided by AAM

Save peer review checklist in SC

11 Convert all SBC’s from Word format to PDF Format

AAM ATS Save all Regionally approved and accurate SBC’s in PDF Format

See PDF job aid on SC Content for assistance as needed.

12 Deliver all reviewed and validated Regional SBC’s. in PDF format, to group/consultant for their review and approval

AAM EAM, ATS, NCA Email to Group/Consultant with a cc :to EAM, ATS and bcc: to SBC-NA-Intake

Save on local drive in group folder (assuming we already have this functionality)

End-to-end Process DesignSBC Process

6

Step Process Accountable Individual/Role

Others Involved Actions How

If edits to SBC requested (by group/consultant)

12a Review all group requested SBC changes and determine next steps; use previously converted Word 2010 Regional SBC’s to track group requested SBC requested changes

Confirm with group/consultant the expected group delivery dates for revised SBC’s

AAM EAM, ATS, NCA, NA RAAM, NA RAM, SME’s, SuperUsers

In scope, repeat steps 9 - 11

Out of scope, email back to Regional SBC team with cc: to SBC-NA-Intake, NA RAM and NA RAAM using subject line of: National SBC Edit Request [Group Name]

Save on local until group approval / confirmation of SBC is received

If escalation is needed; communicate with Super User and escalate further as needed

12b Review group requested out of scope changes, make edits as appropriate or provide rationale as to why edit cannot be made

Regional SBC Team

NA RAAM, NA RAM and NCA

Email revised Regional SBC, in Word 2010 format, to NA RAAM, cc:SBC-NA-Intake and NA RAM

If escalation is required notify NCA of possible delay in delivery of SBC

12c Convert all SBC’s from Word format to

PDF Format AAM ATS Save all Regionally

approved and accurate SBC’s in PDF Format

See PDF job aid on SC Content for assistance as needed.

13 Email all Regional SBC’s, in PDF format, and all state required documents to group/consultant

AAM EAM, ATS, NCA, NA RAAM and NA RAM

Email group/consultant cc: to EAM, ATS and bcc: to NA RAAM, NA RAM and SBC-NA-Intake

14 Confirm agreement and approval of all Regional SBC’s with group/consultant

AAM EAM. ATS Confirm with group/consultant by email/phone/in-person

Record approval as a task in SC WHQ record

End-to-end Process DesignSBC Process

7

Step Process Accountable Individual/Role

Others Involved

Communication Requirements How

15 Store SBC in SalesConnect AAM ATS, Regional SBC team, Regional AAM, NCA

Save final SBC, in PDF format, in SalesConnect (under WHQ) using required naming convention

Email reviewed and approved SBC’s, in PDF format, to all Regional SBC teams with a cc: to NA RAAM, NA RAM and SBC-NA-Intake

See PDF job aid on SC Content for assistance as needed

16 Final SBCs are loaded in regional storage solution

Regional SBC Team NCA

Receive email from AAM with all regional SBC’s in PDF format

Regional SBC teams will store final and approved SBC’s in regional storage solution NCA stores in Sharepoint

If Translation is Requested16a Once final English version is

approved - initiate SBC Translation Request (may require further approval)

AAM NCA, ATS Threshold languages: Email final SBCs (in Word 2010 format) to SBC-NA-Intake

Non-threshold languages, request approval from NA Director and, if approved, Email final SBC’s (in Word 2010 format) to SBC-NA-Intake

NCA will drive, manage and provide oversight on the translation request with a single source NA vendor

Thresholds are established based on HHS requirements. and noted on the Renewal Confirmation Form and on SC Content

16b Deliver all final translated SBC’s

NCA AAM, ATS and EAM

Email translated SBCs to AAM, with a cc: to ATS and EAM, in PDF format

Using translation process, obtain alternate language SBCs and deliver to AAM

16c Deliver SBC to group/consultant AAM EAM, NCA Repeat Steps 14-16 AAM sends translated SBCs to group by email, notifies NCA at SBC-NA-INTAKE, then stores them on SC

End-to-end Process DesignSBC Process