Benefits administration is software that runs the health plans and other benefits that American employers give their staff. It handles the yearly window in which employees choose a health plan, the tax-free health accounts, health cover after an employee leaves, and the reports that American law requires. It is used mainly in the United States. There, most working people get health insurance through their employer, not from the state. Much of this software is built in Bengaluru, Delhi NCR and Chennai.
The year has a fixed rhythm. Each autumn, there is a window of a few weeks called open enrolment. In it, every employee chooses next year's health plan, and adds or removes family members. Outside this window, a plan can be changed only after a life event, such as a marriage or a birth. When an employee leaves, a law called COBRA lets them keep the employer's health plan for a while, if they pay for it themselves. The software sends them the required notices. At the end of the year, it prepares the forms that the employer must file to show that it offered cover.
Take, for example, a logistics company in Georgia, in the United States, with 3,000 employees. In November, each employee logs in to the benefits portal. The portal shows three health plans, with the monthly cost to the employee for family cover under each one, such as $350, $550 or $750. A warehouse supervisor picks the middle plan for himself, his wife and their son. He also chooses to put $100 a month into a health account. The portal checks his choices and records them.
The software then sends the results to two places. It sends his deductions to the company's payroll: $550 a month for the plan and $100 for the health account, both taken from his salary before tax. It also sends a file of every enrolment to each insurance company, so that his family's cover starts on 1 January.
Choosing a plan is hard, so many portals now include benefits decision support, which recommends a plan. Some of the money in health accounts is spent with a debit card that runs on a card network.
India works differently. An Indian employer usually buys one group health insurance policy that covers all its staff. Employees rarely choose between plans. Cashless hospital claims under such policies can pass through the National Health Claims Exchange (NHCX). Many employers in both countries also add an employee wellbeing platform.