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Streamline ACA Plan Management with AI-Powered Innovation.

Industry-leading ACA Plan Design, Configuration, Filing, and Compliance.
Accelerate ACA plan operations with AI-powered tools for plan design, configuration, QHP SERFF filings, and document compliance in one unified platform.
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Innovate and Solve Challenges in ACA Health Plan Operations

Connecting ACA Compliance, Enrollment, and Benefits Integration
Growth Enablement. Streamlined Compliance. Measurable Cost Reduction.

ACA Plan Configuration

Manage ACA Plan Complexity with Modular Tools

Modernize fragmented ACA portfolios with configurable tools to streamline operations, improve compliance, and simplify implementations.

  • AI-Powered Standardization
    Eliminate manual errors and create CMS-compliant plan designs using AI automation for clean audits and easily reproducible plan templates.
  • Unified Plan Repository
    Centralize medical, dental, vision, and auxiliary ACA benefits into one governed, easily accessible catalog for efficiency and consistency.
  • Advanced Compliance Integration
    Automatically sync ACA plan data with compliance grids, eliminating duplicate entries and ensuring real-time adherence to ACA requirements.

Regulatory Automation for ACA Filing

Simplify ACA compliance workflows, boost accuracy, and reduce administrative inefficiencies

Manage ACA compliance filings confidently with automation tools that reduce rework and eliminate manual errors.

  • Automated ACA Filings
    Automate creation of Plans and Benefits template – a key template submitted as part of QHP submissions to CMS without delays, minimizing human oversight risks.
  • 508-Compliant Output
    Produce audit-ready submissions and 508-compliant files aligned with updated CMS and State DOI guidelines—automatically mitigating filing discrepancies.
  • Template-Driven Workflows
    Ensure easy configuration with pre-built DOI-aligned templates and smart rules for faster plan submission.

Real-Time Insights and Filing Readiness

Drive year-over-year enrollment growth with fewer surprises.

Ensure readiness for ACA QHP launches during QHP filing proactively to identify risks and streamline operations in advance of critical deadlines.

  • Operational Dashboard Insights
    Access structured insights powered by AI to streamline plan configurations and compliance status updates.
  • Proactive Readiness Monitoring
    Automate annual enrollment cycle tracking with AI-driven alerts, ensuring pre-identified risks are mitigated promptly.
  • Cross-Team Collaboration
    Enable seamless collaboration across compliance, actuarial, product, and enrollment teams with centralized workflows and real-time communication tools.

End-to-End Integrations

Seamlessly Connect Plan Operations and Member Services

Deliver smooth operational transitions with integrations that improve accuracy while reducing administrative inefficiencies.

  • Enrollment Readiness
    Automate benefit plan data integration to expedite ready to enroll downstream processes using only the minimum necessary data—even while plan configuration is still in progress.
  • Member Benefits Inquiry Tools
    Enhance member satisfaction with AI-powered personalized responses to benefit inquiries across all communication channels.
  • Claims Integration
    Leverage integrated claims configuration updates directly with enterprise systems like TriZetto® Facets® and QNXT™, NASCO, and more to maximize system compatibility.

AI-Powered ACA Sales Enablement

Quote Faster, Configure Plans Smarter, and Retain Clients

Equip sales teams, brokers, and account managers to close new ACA enrollments faster with seamless automation.

  • Intelligent Plan Recommendations
    Leverage AI to recommend plans tailored to demographic data, reducing the back-and-forth decision-making process.
  • Instant Adjustments to Plan Pricing and Coverage
    Use conversational AI to update pricing, plan benefits, and configurations in real time for brokers.
  • Real-Time Proposal Creation
    Create branded proposals and pre-sale documents instantly to accelerate client enrollments and enhance pitch accuracy.
  • Sales Analytics Dashboard
    Track performance metrics across sold, quoted, and lost plans to identify trends and optimize renewal strategies.

Compelling Business Case. Proven Value.
ROI in Year One. Platform Advantage.

Benefits1™ is designed to align departments, reduce complexity, and improve efficiency, ensuring your organization achieves measurable outcomes across ACA plan operations.

Product

Streamline Plan Design and Validation

  • Simplify ACA product configurations with automated plan design—not manual build.
  • Eliminate file versioning issues, handoffs, and temporary staffing dependencies.
  • Improve transparency and quality control to scale flawlessly.
  • Achieve up to 30% cost savings  on configuration, validation, and submission processes.

Sales and Brokers

Empower Faster ACA Shopping Decisions

  • Enable brokers with self-service tools for quick ACA plan customization and proposals.
  • Improve membership growth and retention with targeted ACA benefits and offerings.
  • Achieve a 10+ NPS  (Net Promoter Score) improvement through user-friendly sales workflows.

Marketing and Compliance

Ensure ACA Compliance and Enhance Efficiency

  • Generate ACA-compliant documents and filings (e.g., SBCs and rate filings) through automated workflows.
  • Eliminate formatting bottlenecks and staffing constraints for document readiness.
  • Save up to 70%  on document management and compliance translations.

Finance

Increase Cost Efficiency for ACA Plan Management

  • Lower administrative costs while achieving measurable ROI in ACA plan operations during the first year.
  • Optimize TCO (Total Cost of Ownership): $1 invested = $9  in savings compared to internal/competitor manual handling costs.
  • Automate financial workflows tied to ACA filings and enrollment.

Operations

Fast-Track ACA Enrollment and Claims Management

  • Automate ACA claims configuration workflows to save operational time across enrollment cycles.
  • Improve service accuracy while reducing manual intervention and member inquiry escalations.
  • Achieve 80% faster implementation  of new ACA groups and renewal setups.

IT

Support Scalable ACA Operations with Advanced Integrations

  • Deploy a scalable SaaS platform, minimizing IT maintenance and support overhead.
  • Centralize high-value data on ACA products, filings, and member services.
  • Enable IT teams with a self-service integration toolkit for complete control of ACA compatibility in your system ecosystem.

Empower Benefits1™ with BNi (Ben-ny)
– Your AI Assistant for Smarter Plan Management

Meet BNi (Benefits1™ Native Intelligence)—an embedded AI assistant that enhances plan management through automation, insights, and context-aware guidance.
Tick Conversational AI Interface
Navigate plan configurations using intuitive, natural language commands.
Tick Document Intelligence
Search, compare, and summarize ANOCs, EOCs, SBCs, and other plan materials.
Tick Annual Readiness Monitoring
Track AEP milestones with real-time alerts to avoid delays and missed deadlines.
Tick Context-Aware Guidance
Surface plan-specific recommendations grounded in live configuration data.
Tick Proactive Design and Filing Insights
Receive strategic input on benefits design, actuarial data imports, and filing accuracy.
Tick Adoption Intelligence
Track feature usage, optimize workflows, and drive long-term platform value.
Experience a smarter way to manage benefits with BNi (Ben-ny). Read the Press Release

Leading Payers and TPAs Are Already Transforming Operations with the Platform Advantage

Across the industry, payers and TPAs are streamlining operations, accelerating delivery, and launching compliant health plans at lower operational expenses—powered by automation, AI, and a modern approach to ACA QHP management.

Leading Payers and TPAs Are Already Transforming Operations with the Platform Advantage

Across the industry, payers and TPAs are streamlining operations, accelerating delivery, and launching compliant health plans at lower operational expenses—powered by automation, AI, and a modern approach to ACA QHP management.

Trusted at Scale

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Recognized for Market Leadership

Simplify Healthcare is positioned in the Leaders Category of the 2023 IDC MarketScape for U.S. Health Plan Product/Plan Benefit Configuration Solutions.

Read the full IDC report
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Ready to Modernize Your Group Benefits Strategy?

Learn how leading payers are gaining a competitive edge by automating group benefits at scale—powered by AI, clean data, and modular workflows.

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Change What’s Possible in ACA Benefits

65+ health plans and TPAs didn’t wait for the future—they built it. With Simplify Healthcare, they moved fast, stayed compliant, and led with confidence.
Now it’s your move.
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Experience the Power of a Connected Ecosystem

Benefits1™ is just the beginning. Seamlessly integrate with Simplify Healthcare’s full suite of intelligent solutions—spanning product, provider, claims, benefits inquiry, documents, and custom app development—to ensure accuracy, efficiency, and compliance at every stage of the product, benefits, and provider lifecycle.

Simplify Provider Lifecycle

Streamline network adequacy, contracting, credentialing, roster files, data management, and claims config with an advanced, modular solution that delivers efficiency and effectiveness.

Explore Provider1™ →

Simplify Claims Configuration

Configure benefits and provider data directly into claims systems like TriZetto® Facets® and QNXT™ using intelligent automation.

Explore Claims1™ →

Simplify Benefits Inquiry Experience

Deliver accurate, consistent benefits information across all channels—powered by AI-enhanced guidance that improves member experience and boosts NPS.

Explore Xperience1™→

Simplify Document Management

Auto-generate 150+ mandated and marketing documents with built-in 508-compliance, translations, and integrated print fulfillment.

Explore Simplify Docs™ →

Simplify Custom App Development

Design and deploy custom apps faster with embedded AI and low-code development—tailored to your organization’s unique needs.

Explore SimplifyX™ →

We don’t just deliver software—we work alongside your teams to guide implementations, simplify adoption, and ensure sustained success.

Explore HealthConsult

Frequently Asked Questions (FAQs)

What our customers frequently ask about Benefits1™.ACA

How does your platform help with ACA plan standardization?

Our AI-powered solution enables ACA plan standardization by creating CMS-compliant templates for plan design. It minimizes retesting through automated workflows and maintains a unified catalog with 5,000+ attributes and smart configuration rules to ensure consistent plan accuracy. 

Can it centralize ACA benefit data in one place?

Yes. Our platform consolidates ACA-related benefits like medical, dental, vision, ancillary, and essential benefits (EHBs) into one unified repository. By eliminating the need for spreadsheets or multiple disconnected systems, it makes data access seamless for all departments. 

Does it automate ACA filings and document generation?

Absolutely. Our ACA platform automates the filing of SBCs, rate filings, and CMS-compliant documents like COIs and compliance reports. The platform ensures 508-compliant filings aligned with CMS standards – reducing risk and human error and ensuring audit-ready filing submissions. 

Is the platform integration-ready for ACA operations?

Yes. It integrates effortlessly with ACA-specific platforms like TriZetto® Facets® and QNXT™, NASCO, streamlining claims processing, ID card generation, and plan configuration across enterprises. Maximize operational accuracy in real-time workflows. 

How does it help with ACA compliance and visibility?

Our solution improves ACA compliance tracking with real-time updates, intuitive dashboards, and proactive alerts for filing submissions—eliminating dependency on manual QA processes ahead of CMS audits. 

How does it improve collaboration across ACA departments?

The platform replaces inefficient email chains with intelligent workflows, enabling all teams—compliance, product, sales, and operations—to collaborate seamlessly. It reduces delays, ensures accurate handoffs, and facilitates transparent communication. 

How does it improve coordination across departments?

Intelligent workflows and dashboards replace email chains—improving handoffs, reducing delays, and ensuring transparent collaboration across teams.

What sales enablement capabilities are available for ACA plans?

We offer advanced tools specifically designed for ACA plan sales, including AI-powered plan recommendations, census intake, competitor plan matching, real-time proposal generation, natural language customization, and renewal optimization. 

Can we track quoting and enrollment performance for ACA plans?

Yes. Built-in analytics monitor quoting accuracy, enrollment growth, and renewal rates. They help optimize team performance and inform ACA sales strategies year-over-year.