Product comparison: that’s fair – only so much you can fit in an announcement post. We completely agree it is difficult to compare benefits (even for competent HR departments) but it is even more confusing for individuals. We try to make this clearer and transparent when working with employers during the quoting process. Benefit coverage gets boiled down to “actuarial value” and quantified as a number relative to the benefits mandated under the Affordable Care Act. This is presented alongside the financial quote and compared to competing bids. It also helps to actually read through our Schedule of Benefits Coverage– even at the individual level it is apparent what the differences are in our benefit plan vs every other SBC we have seen.

If you were to judge the quality only by price (all else equal), underwriting for this segment is done at the employer level – so savings can vary significantly from company to company. We’ve had quotes that matched other bids, and we’ve presented offers as much as 35% less (on a cash basis, not actuarial) than other insurer’s annual price hikes.

Overall, I cannot agree more with your comment that comparison is hard. There is not a lot of transparency in this market segment because of the unique considerations that go into underwriting each group. Plus, a lot of the companies (startups included) that people find appealing are playing games with coverage, especially playing around with deductibles and copays. It’s currently very difficult to make it super clear without just sitting down with the person/employer and talking through the benefits.

Regarding product comparaison it is possible to build a computable model of your policy and the major competitor, and from there automatically benchmark them to find key difference in coverage (what is the maximum delta) or running them through a set predefined claim scenario. It will however require ~3-5 day of work per policy to build the models. Beyond the marketing effort this models can also be reused for risk management / claim management / leakage prevention if implemented right.

Yes it would be possible - and I know of a couple of benefits consultants that have tried to do this, but bias and independence is a vexing issue. Keep the ideas coming!

> How do you plan to maintain this cost down once you extend to new states / product /over time, to keep this cost advantage?

You are correct that the legacy insurance industry struggles with tech and compliance. I've had the fortune (misfortune?) of being a part of writing and managing policy, claims, rating, and other insurance systems. It is common for a large, legacy insurer to have tens of policy systems and tens of claims systems operating in parallel due to many years of acquisitions and mergers.

Technology is a huge part of our cost advantage, but it isn’t the only factor. We also benefit from our product design, underwriting, provider network structure, etc.

Technology automation and efficiency allows us to a) lower G&A about 10 points and pass through the savings to our customers, and b) reduce delays and duplications in care.

The pure technology cost actually decreases for us over time, on a PMPM basis, as we grow membership. Adding new states and products doesn’t require new systems for us. We just have to make some configuration additions. Architecturally, we’ve built a federation of micro-services and we host on a cloud provider (Azure).

For B2B, it’s worth noting that most Americans still receive their health coverage through employers, and this is especially true for the 200-2,000 company size segment. Meeting the majority of people where they are seems to be a reasonably impactful way of starting change. We can make a considerable impact for companies with 100 employees. We can make a massive impact for companies with more than 400. We currently are not geared to do much for individuals, but we’ll get there. https://www.kff.org/other/state-indicator/total-population/

B2B is scalable for launch, giving us access to information and leverage that is not achievable in the individual space without significant expense and economic loss. Starting in this market segment gives us a profitable platform to expand into other coverage areas and consider adjacent market segments. That said, we believe our approach which is intensely focused on quality will drive cost savings that satisfy employers. The 3-year rate-lock option helps to demonstrate results and builds confidence in our approach without demanding changes to plan designs that may be injurious to the employee’s long-term health.

I’m not sure I completely follow your question about changing coverage to keep an employer to keep the company afloat. Our plans are approved by the state and we cannot change benefits during the year. We cannot slash benefits to reduce costs to keep a client. That would be detrimental to the employer’s business model too because it would severely impact their ability to attract and retain talent. Trying to reduce benefits would have the opposite effect and increase costs, like the delays caused by high deductibles.

Thanks for your answer. I'm not American so not really familiar with your health system. Agreed that B2B will be easier to scale given acquisition cost. However scaling with corporate client limit you in your ability to do good risk selection as I believe you will have to accept all employees.

Underwriting a whole group actually gives us protection from risk selection and creates a more population based risk which is more stable. Yes there will be individuals that have extreme expenses, which is why we have reinsurance. It is the principle of risk pooling and credibility.