Our Solutions


Health plans that serve the individual market face particular challenges to stay ahead in today’s competitive and dynamic marketplace.

Keeping pace with the innovation of the exchanges while at the same time providing seamless integration – these are key requirements.

HealthEdge’s HealthRules solution suite enables health plans serving individual markets to tackle critical imperatives including:

  • Enrolling large numbers of new members successfully and accurately
  • Meeting the specific needs of individual members easily with a variety of rapidly configured plans
  • Increasing member satisfaction with transparency of real-time information
  • Delivering a superior customer experience that retains members and increases engagement
  • Reducing administrative cost significantly by automating everything
  • Participating in exchange business profitably with the agility to adapt to changes quickly

HealthEdge customers with individual business achieve greater levels of operational efficiency, lower costs, and deliver enhanced levels of transparency and customer service with the HealthRules product suite. They can  use standard integrations that enable accurate reporting and information exchange and are highly configurable for rapid implementation. HealthRules products allow easy self-service for members, promoting high levels of engagement.

Real World Examples: Zombie Health Plans

Kimberly Branson, Vice President of Business Architecture and Strategy at Medica, a Minnesota-based health plan, tells the remarkable story of how, in just two weeks time, Medica was able to quickly resurrect and bring to market more than 80 distinct benefit plans followings a sudden regulatory shift under the ACA.

The HealthRules platform is the only modern, enterprise-class software suite for all types of health and specialty insurers. Regular software updates deliver new capabilities, ensuring continued compliance with industry standards, allowing health insurers to stay current and competitive with the latest market developments, and drastically reduce both IT and operational costs.