Plan Advisor

Assisting members find the right plan while comparing with competitors by equipping them to estimate their upcoming out-of-pocket expenses.

Challenge

Members often struggle to understand health insurance plans because of confusing jargon, complex cost sharing structures, plan variability and hard to understand coverage details. This makes it challenging for individuals & families to decide which plans are the ones best meeting their health needs and budgetary constraints. There is a big need for a Plan Advisor that lays it all out in simple language with common healthcare usage scenarios. StudioAI’s AI powered Plan Advisor explains plan benefits in simple terms, analyzes a family’s current plan and makes plan recommendations along with easy to read cost comparisons across alternative health plans

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About the Solution

Virtical introduces the Dynamic Plan Advisor, a sophisticated AI-powered solution designed to help prospects and members navigate the complexities of health insurance plans and anticipate care usage effectively. This platform addresses the challenge of selecting the most suitable and cost-efficient insurance plans by thoroughly analyzing a user's current plan and actual healthcare utilization. It employs advanced AI algorithms to compare this information with a comprehensive database of market plans, subsequently identifying and recommending the most appropriate alternative.

  • AI-based Plan Benefits Understanding
  • Out-Of-Pocket Cost Estimator
  • Compare Plans
  • Plan Recommendation
  • Benefit highlighting and ordering

Virtical Apps integrate seamlessly with the Simplify Platform platform, across Sales, Service, Health, and Experience Clouds. Virtical's User Experience (UX) layer is integrated with Simplify Platform and blended into business processes such that the insights derived from our AI models are delivered to your users in the right place at the right time. Moreover, Virtical offers configuration tools that allows in-house customization of these Prebuilt apps as per the unique needs of your business. These ready-to-use, yet tunable applications fast-track digital transformation, freeing up your team to focus on more strategic tasks. Integration of Virtical with Simplify Platform is therefore not just an optimized solution for the health insurance sector, but also a catalyst for bringing about technological innovation within your organization.