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About Us

Benefitfirst is a private, cloud-based benefits eligibility management product that automates and supports an employer's complete benefits cycle with an unmatched focus on accuracy. Customized to each client and each employee, Benefitfirst is business rules driven and includes routine exports to carriers/TPAs and standard weekly audits – ensuring an eligibility error rate of less than 1 percent. Benefitfirst also significantly reduces administration time by as much as 80%. Administrators can save up to 40 minutes per life event for their employees.

At Benefitfirst we value our customers that is why we deployed the use of a Net Promoter Score (NPS) survey to gauge our customers' satisfaction. NPS is one of the most recognized ways to measure a company's customer satisfaction. NPS is a measure used to gauge customer loyalty, satisfaction, and enthusiasm with a company that's calculated by asking customers one question: "On a scale from 0 to 10, how likely are you to recommend Benefitfirst to a friend or colleague?" Aggregate NPS scores help us improve upon product offering, customer support, delivery, etc. for increased customer loyalty.

So ask yourself what is a good NPS score? Given the available -100 to +100 range, any score above 0 reads as 'good' because it indicates that a business has more promoters than detractors. Top-notch companies generally have an NPS of 70 and above.

Our NPS at
Benefitfirst = 86

Our Founding Roots

From the beginning, Benefitfirst has been different. It was created by insurance professionals – a successful life, accident and health insurance brokerage – to solve a large hospital client's eligibility problems. The hospital's eligibility errors were causing them to pay erroneous claims on employees no longer eligible for coverage.

The first step in eliminating these errors was to create an auditing system to compare the client's payroll data to the carriers' eligibility data. The next step was to provide a weekly eligibility audit report to the client and transmit accurate eligibility and enrollment data to the carriers. The result? More than $2 million savings in erroneous claims.

Benefitfirst Today

With those founding roots in employee benefits, technology and consulting, Benefitfirst has evolved into a robust benefits eligibility management tool that audits and transmits millions of eligibility updates to hundreds of carriers and vendors each year. It’s nimble and easy to modify because we’ve always understood how much benefits can vary and how often they change. Our deep industry knowledge enables us to deliver innovative solutions tailored to each client.

We innovate constantly. We stay on top of industry changes and emerging trends. As technology advances and the marketplace changes, so does Benefitfirst. Our goal is to make benefits eligibility management easy on you and save you as much time and money as possible.

With Benefitfirst, you can rest easy knowing you have the right solution to reduce time and cost and increase accuracy and convenience.

Our Mission

To protect and promote the interests of our clients while providing innovative and cost-effective solutions with definable and measurable results.

Basic Benefitfirst Features:

Enrollment

The Enrollment Wizard uses rules-based eligibility parameters to guide employees step-by-step through the benefits that apply only to that employee and his or her family.

Benefitfirst simplifies enrollment for you and your employees. It can help educate your employees on their benefits with videos, benefits guides, personal benefits summaries and other communication tools available on- or off-line. It can also help increase your benefits participation rates by providing an easy and enjoyable enrollment experience.

Benefitfirst technology provides a website customized not only to your company but also to each employee, providing the greatest amount of convenience, accuracy and security in enrollment.

Routine Audits

Keeping errors out of your eligibility data is an ongoing process. Using weekly payroll and eligibility audits, Benefitfirst eliminates errors before they can affect your billing, deductions, claims and employee coverage.

Employee benefits are accompanied by a long and complicated list of eligibility requirements. With thousands of records and transactions and varying eligibility rules among multiple carriers, companies or even vendors that "reconcile bills" simply don't have the tools or the time to audit every record and every transaction against every eligibility rule every week like Benefitfirst does.

In fact, maintaining accuracy through Benefitfirst triples our workload. But it can reduce your administration time by up to 80%. Keeping errors out of your eligibility data is an ongoing process. Benefitfirst eliminates errors before they affect your billing, deductions, claims and employee coverage.

Benefitfirst Integrations

To ensure carriers always have the latest employee benefits data, Benefitfirst transmits electronic file feeds to your carriers/TPAs each week. And our routine exports to payroll/HRIS systems keep your payroll data, Benefitfirst's data and each carrier's data in sync.

Our proprietary export module provides clients total flexibility to select the vendors (Carriers, TPA, Payroll/HRIS) that meet their business needs. Whether proprietary file formats, HIPAA 834 or API's, Benefitfirst's approach ensures clients eligibility data is processed efficiently and accurate to the applicable vendor.

Billing Solutions

Our proprietary billing module supports self-administered or self-billed benefit plans leveraging our audited eligibility data. Additional options include consolidated billing and reconciliation services.

The Benefitfirst eligibility management system can generate audited self-bills for life and disability plans each month. And our weekly eligibility audits means you can greatly reduce or eliminate time-consuming bill reconciliation and costly billing errors for all your benefit plans.

ACA Compliance

Benefitfirst eligibility accuracy streamlines employers' compliance with state and federal regulations.

Our ACA Data Center provides the data management and reporting capabilities you need to stay in compliance with the Affordable Care Act (ACA), including W-2 reporting, PCORI reporting, employee notices, hours tracking and benefit declination tracking and reporting.

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Additional Service Options :

Payroll Connection

Seamless flow of employee data between payroll and Benefitfirst and deduction updates from Benefitfirst to payroll.

Seamlessly transfer employee data updates from your payroll system to Benefitfirst as well as deduction updates from Benefitfirst back to your payroll system. To make full use of the optional Payroll Connection, your payroll system must be capable of exporting and importing the required data fields in an Excel or delimited/flat file format.

Weekly payroll/eligibility audits
Automatic payroll-deduction updates
Routine exports to payroll or HRIS systems

Benefits Communication

Custom enrollment materials and fulfillment, including Benefits Guide, required employee notices and video.

We offer customized communications and enrollment services tailored to your benefits program. We will provide a customized enrollment packet to each eligible employee that includes:

A personal benefits summary
Easy-to-understand benefits guide
Consolidated election form (in case a paper enrollment method is needed)
Benefits worksheets
Also available are video and PowerPoint presentations for group meetings or online access, as well as a customized benefit website to educate employees on making the most of their benefit options.

For open enrollment, new hire enrollment or status changes, Benefitfirst makes benefit options clear and enrollment simple.

Customer Care Center

Trained benefits specialists for enrollment, benefit questions and bilingual support.

We're dedicated to first-call resolution for benefits questions, eligibility issues and enrollment support. The Benefits Customer Care Center is staffed with benefit specialists who are trained on your company's benefits. If an employee needs elevated assistance that the benefit specialist cannot provide, the specialist will direct the employee to your company's Human Resources department for assistance.

Voice-recorded enrollment elections
Call tracking and reporting
Bilingual (Spanish)

Wellness Tools

Health Risk Assessments and incentive data management.

Benefitfirst offers several wellness tools to help create, track and integrate employee wellness scores as part of your enrollment process. These tools seamlessly integrate with any wellness program you have in place.

Health Risk Assessment (HRA)

A Health Risk Assessment (HRA) is typically the first step in any modern multi-component wellness program. Through a strategic alliance, Benefitfirst offers a fully integrated HRA portal that allows your employees to self-assess their health on an HRA form. You can use the HRA as a requirement for wellness incentives, as well as to identify health risks and provide recommendations for improvement.

Wellness Incentive Management

Premium discounts are one of the most effective wellness program incentives. But tracking and applying incentive data is a common challenge for already swamped HR professionals.

Benefitfirst's Wellness Incentive Management product helps relieve that challenge by tracking employee wellness scores and applying premium discounts – accurately and on time. Benefitfirst allows you to track a wellness result for up to three activities using scores of 0, 1, 2 or 3. Wellness requirements can include completing an HRA, getting a biometric health screening, watching an online video – whatever you choose.

Variable-Hour Tracking

Tracking on average hours of variable-hour workers for ACA compliance.

Track and report on average hours of variable-hour employees to determine whether to offer or terminate health coverage for the upcoming stability period. Also tracks and reports on variable-hour employees trending toward eligibility for health coverage. (Also available as standalone product.)

ACA Employer Reporting

Completion and fulfillment of the IRS Forms 1095-C and 1094-C for ACA compliance.

Employers face multiple reporting, calculation and employee notification requirements with the Affordable Care Act (ACA) – all of which demand accurate, dependable and easy-to-retrieve benefits data. The Benefitfirst ACA Data Management Center offers data and reporting capabilities specifically designed to help you meet ACA reporting and tracking requirements:

W-2 reporting
PCORI reporting
Employer mandate
Variable-hour employee tracking
Employer ACA reporting

Federal COBRA / HIPAA Compliance

One-step process for notices, coverage offers, terminations and reinstatements.

With Benefitfirst, COBRA and HIPAA administration is a one-step process. Just terminate the employee or dependent and Benefitfirst will handle the rest. We will terminate the coverage with all carriers and offer COBRA to all eligible individuals, as well as Letters of Creditable Coverage for HIPAA compliance. If an eligible individual elects COBRA, Benefitfirst will reinstate coverage with each carrier and forward the premium to you.

Initial notices
Event notices
Employer mandate
Online reporting
Letters of Creditable Coverage

Dependent Eligibility Audits

Process to identify, report and terminate coverage for ineligible dependents.

The Dependent Eligibility Audit identifies, reports and terminates covered dependents who are not eligible for your organization's health plans. Industry trends show that 5-15% of dependents are ineligible for company-provided benefits. Ineligible dependents can translate to an erroneous annual claims expense of approximately $250,000 per 1,000 dependents on the plan. Our dependent audit service includes:

Comprehensive fulfillment
Response tracking and reporting
Call center support

Annual Benefits Statements

Annual employee benefits statements to illustrate employer's benefits investment.

A strong benefits package is key to attracting and retaining top talent - but only if employees know what you make available to them. Our Annual Benefits Statements illustrate employer contributions for all employee benefits, including major medical, life, accident, retirement, Social Security, Medicare, federal unemployment and workers' compensation. These benefit statements are a valuable way to help your employees understand and appreciate the true value of their "hidden paycheck."

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Last revised: April 2022