Attachment L SBM Demo Use Cases for Round 2 .xlsx
XLSX spreadsheet 22 KB Posted
- Attached to
- Oregon State Based Insurance Marketplace Solution State and local contract opportunity
- Solicitation number
- S-DASOBO-00010624
- Issued by
- Marion County, Oregon
About this file
This document is an attachment to a state and local contract opportunity issued by the Oregon Health Authority and the Oregon Department of Administrative Services to procure a State-Based Insurance Marketplace (SBM) Solution Platform and related Customer Assistance Center. The attachment outlines use case demonstrations for various user types including consumers, insurance carriers, agents, assisters, and state staff. It covers functionality like shopping, enrollment, eligibility determination, communication management, and reporting. The related state and local contract opportunity is for the Oregon State Based Insurance Marketplace Solution, which has a scope including data migration, account transfer integration, and annual renewal processes.
The pricing terms, funding requirements, and other commercial details are not provided in this attachment. However, the attachment indicates that the solution will need to meet various functional and reporting requirements to support the operations of the Oregon State Based Insurance Marketplace.
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Text version
Sheet1
| USE CASE | DEMO | SANDBOX |
| A. Consumer – demonstrate the user interfaces and experience for consumers using the following interfaces. | ||
| 1. Show the ability to apply/shop/enroll, make first premium payment. (link to Carrier or premium collection function). | X | X |
| 2. Show the ability to designate an Agent. | X | X |
| 3. Show the ability to designate an Assister. | X | X |
| 4. Show the ability to de-designate an Agent. | X | X |
| 5. Show the ability to de-designate an Assister. | X | X |
| 6. Show the ability to provide eligibility - Not Eligible - Incarcerated - Single member. | X | X |
| 7. Show the ability to provide eligibility - Not Eligible - Non Citizen - Single member. | X | X |
| 8. Show the ability to provide eligibility - Not Eligible - CHIP Eligible - Single member. | X | X |
| 9. Show the ability to provide eligibility - QHP Eligible - APTC Eligible - Single member. | X | X |
| 10. Show the ability to provide eligibility - QHP Eligible - Not APTC Eligible and CSR Eligible - Single member. | X | X |
| 11. Show the ability to provide eligibility - Mixed Eligibility - One member Not Eligible - Incarcerated - One member APTC Eligible. | X | X |
| 12. Show the ability to shop – This could be demonstrated with anonymous browse. Provide a zip code with multiple plans and Carriers. | X | X |
| 13. Show plan recommendation functionality (show silver plans first, highlight standard plans, etc), including where user can select which plan qualities are most important. Show ability for state to choose some, all, or none of the recommendation functionality. | X | X |
| 14. Show the ability to only display CSR plans for CSR Eligible customers. | X | X |
| 15. Show the ability to only display AI/AN plans for AI/AN eligible customers. | X | X |
| 16. Show the ability to only display Catastrophic plans for those eligible Catastrophic plans. | X | X |
| 17. Show the ability to filter by Issuer. | X | X |
| 18. Show the ability to filter by Metal Level. | X | X |
| 19. Show the ability to filter by Network Type. | X | X |
| 20. Show the ability to filter by Provider (In Network/OON). | X | X |
| 21. Show the ability to filter by prescription drugs. | X | X |
| 22. Show the ability to shop without creating an account for the scenarios above. | X | X |
| 23. Show the ability to access the consumer’s inbox. | X | X |
| 24. Show the ability to generate ad hoc communication to consumers. | X | X |
| 25. Show how notices and other account documents such as 1095As can be revisited or accessed after the initial communication. | X | X |
| 26. Show the ability to manage consumer communication preference. | X | X |
| 27. Show the ability to resolve a data matching inconsistency. | X | X |
| 28. Show the ability to retain anonyomous shopping plan choices or "cart" when logging into, or creating, an account after shopping. | X | X |
| B. Issuer/Carrier/Plans – Demonstrate user interfaces and experience for insurance carriers logging into, and interacting with, the system. | ||
| 1. Show an Issuer Dash Board containing relevant information for issuers. For example: | X | X |
| a. number of enrolled consumers | X | X |
| b. list of certified plans (single issuer) | X | X |
| c. assessment owed | X | |
| d. outstanding service tickets/ consumer reconciliation information | X | |
| 2. Show the ability to view a consumer enrollment record specific to that Issuer. | X | X |
| 3. Show the ability to view plan information specific to that Issuer when the Issuer is logged in. | X | X |
| C. Broker/Agent – Demonstrate user interfaces and experience for insurance agents logging into, and interacting with, the system. | ||
| 1. Show the ability to view a consumer enrollment record specific to that broker/agent. | X | X |
| 2. Show the ability to see what information is needed from a consumer, specific to that broker/agent. | X | X |
| 3. Show the ability to manage a team of brokers as an agency. | X | X |
| 4. Show the ability for an agent to view their certification status and related records. | X | X |
| 5. Show ability to use (add/edit record) Find Help tool. | X | |
| D. Assister/Community Partner – Demonstrate the user interfaces and experience for assisters logging into, and interacting with, the system. | ||
| 1. Show the ability to view a consumer enrollment record specific to that Assister/Certified Enrollment Counselor. | X | X |
| 2. Show the ability to see what information is needed from a consumer, specific to that Assister/Certified Enrollment Counselor. | X | X |
| 3. Show the ability for an Assister/Certified Enrollment Counselor to view their certification record and associated documents. | X | X |
| 4. Show the ability to manage a team of Assisters/Certified Enrollment Counselors | X | X |
| 5. Show ability to use (add/edit record) Find Help tool. | X | |
| E. Oregon Staff – Demonstrated the use of the system by state staff to manage the functions and information in the following categories. | ||
| I. Carrier/ Plan Management | ||
| 1. Show complete list of all plans by Carrier. | X | X |
| 2. Show the ability to search for Plans. | X | X |
| 3. Show the ability to search for Issuer/Carrier. | X | X |
| 4. Show the process of setting the SERFF endpoint to vendor’s product. | X | |
| 5. Show backend plan data transfer process | X | |
| 6. Show ability to report Plan Data. | X | X |
| II. Agent/ Assister | ||
| 1. Show the ability to search for Brokers/Agents. | X | X |
| 2. Show Broker exchange history, Agent History. | X | X |
| 3. Show the ability to investigate and resolve Unauthorized Enrollments/Plan Switches. | X | |
| 4. Show the ability to search for Agencies. | X | X |
| 5. Show ability to use (add/edit record) Find Help tool. | X | X |
| 6. Show ability to see certification history and related documents for Brokers and Assisters. | X | X |
| 7. Show the ability to track Assister outreach and enrollment activities. | X | X |
| 8. Show the ability to search for Assisters and Assister Organizations. | X | X |
| 9. Show the ability to search for Agencies. | X | X |
| 10. Show the ability to certify Agencies. | X | |
| 11. Show the ability to certify Agents. | X | |
| 12. Show the ability to de-certify Agents. | X | |
| 13. Show the ability to search for Assisters. | X | |
| 14. Show the ability to de-certify Assisters. | X | |
| 15. Show the ability to certify Assisters. | X | |
| 16. Show the ability to manage yearly configurations. | X | |
| III. Consumer account interaction/ action | ||
| 1. Show the ability to support consumers issues (view what the consumer is viewing) in app. | X | |
| 2. Show the ability to generate ad hoc communication to consumers. | X | |
| 3. Show the ability to search for consumers. | X | X |
| 4. Show the ability to cancel enrollment. | X | |
| 5. Show the ability to reinstate enrollment. | X | |
| 6. Show the ability to override APTC amount. | X | |
| 7. Show the ability to re-send 834 transactions. | X | |
| 8. Show the ability to create tickets for consumers. | X | |
| IV. Administration/ Reporting | ||
| 1. Show the ability to generate CMS required reports. | X | X |
| 2. Show the ability to generate Non CMS canned reports. | X | X |
| 3. Show the ability to generate ad-hoc reports. | X | |
| 4. Show the ability to manage internal access. | X | |
| F. Contact Center – Demonstrate and explain some of the key functions of the contact center and mailroom | ||
| I. IVR/ CRM/ Solution integration | ||
| 1. Show automated call routing/ queueing features. | X | |
| 2. Show multilingual support options. | X | |
| 3. Show caller identification steps and screens with customer information from CRM/ tech solution. | X | |
| 4. Show process for state staff access to the CRM. | X | |
| 5. Show process to generate contact center reports. | X | |
| 6. Demonstrate or explain the process for determining staffing levels, and how the state staff and input are involved in those decisions. | X | |
| II. Mailroom | ||
| 1. Demonstrate or explain process for generating and mailing 1095As. | X | |
| 2. Demonstrate or explain process for accepting and capturing paper applications. | X | |
| 3. Demonstrate or explain process for generating and sending marketing mass mailings. | X | |
| G. Implementation and operations – Explain the planning and various processes for critical implementation and ongoing operations activities | ||
| 1. Explain process for data migration, including analysis, cleansing, harmonization, and validation steps. | X | |
| 2. Explain process for capturing and implementing requirements for account transfer integration with Oregon’s Medicaid system (ONE). | X | |
| 3. Explain process and mechanisms for Account Transfer to refer consumers that are APTC eligible but also eligible for state-managed public health programs. | X | |
| 4. Explain process for consumers to identify or claim accounts migrated from the FFM to the SBM for year one open enrollment. | X | |
| 5. Explain the annual autorenewal process. | X |
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