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This document provides an overview of the recommended acceptance testing process for the ADP Decision Support Tool.
ADP is pleased to provide you with the ADP Decision Support Tool – a valuable resource that helps your employees better evaluate their options and become more engaged and informed health care consumers.
Your benefits enrollment application is now enabled with Decision Support for your benefit options. In this guide we will walk you through what you will need to verify to ensure the Decision Support Tool is working as expected.
What You Will Need for Testing
In order to test the Decision Support Tool you will need the following. Please contact your Client Account Executive if you are missing any of these items or have questions.
Access to the Enrollment Application in UAT
A set of test participants, one for each distinct medical benefit eligibility group in your population
The Summary of Benefits and Coverage document (SBCs) for each medical option. Be sure these are updated to reflect the current benefit year.
A copy of the Decision Support Plan Settings document which contains the default plan settings which your ADP Decision Support lead has configured for each plan.
NOTE: The ADP Decision Support Tool works with all modern browsers as well as recent versions of Internet Explorer as follows: IE9, 10, 11. IE 8 is not supported.
Testing Scope and Time Requirements
As plan designs can be complex and may contain cost structures (deductibles/out-of-pocket maximums) or cost sharing rules (copays/coinsurance) that can be misinterpreted, it is most important for you, the client, to validate the plan design descriptions in the tool to confirm their accuracy. This is the most important step in the acceptance testing process. Your ADP benefits team has already tested the configuration of the plan options and how they appear in the Decision Support Tool including plan eligibility, coverage tiers and contributions.
On average, you should expect to spend 20-30 minutes reviewing the tool for each unique medical option you offer to your employees. For example, if you offer 6 unique plan options across your population you should expect to spend 2-3 hours testing the tools the first time they are released. In subsequent years, assuming the plan option designs do not change significantly, you should expect to spend approximately half of that time.
If you encounter questions or errors when you test Decision Support, you may use the testing feedback form within this document to capture your findings. ADP has provided a separate Decision Support Plan Settings document which captures medical plan provider search URLs, At-A-Glance settings and Access to Care settings used for each plan option. If you would like to make changes to these items, please record your changes in the Decision Support Plan Settings document.
Accessing Decision Support
The ADP Decision Support Tool can only be accessed through the enrollment application. You must access the enrollment application with a participant that is eligible for medical benefits and has an eligible event.
Begin the enrollment process for the user and navigate to the Medical Plan election screen. You should then see a banner or pop-up window that will invite the participant to get help choosing a health plan option. See figure 1.
Figure 1- Accessing Decision Support from Medical Election Page*
*The image above is a sample and your group’s enrollment tool experience may look different
Click on the link to help choose a plan option and a new browser window will open with the Decision Support Tool.
If you are on the medical election page and you do not see a banner image inviting the participant for help choosing a plan option, the Decision Support configuration may not be working properly. Contact your Client Account Executive.
Testing ADP Decision Support
ADP has conducted extensive testing of the Decision Support application and how your plan benefits appear in the tool. ADP populates the tool with your specific plan option designs using the final requirements document along with the plan Summary of Benefits and Coverage (SBCs) you have provided to ADP. Your primary role in acceptance testing is validating that the plan option designs, as they are appear in the tool, are accurate. The following is a guide for what to test as you walk through the application.
Your Coverage Page
Figure 2 - Your Coverage
This is the first page you will see in the tool. Here, the user is asked to provide some basic information about who they expect to cover in the coming year. The “icons” displayed on this page are designed to allow the employee to quickly choose the types of dependents they want to cover. Users then provide an age range and gender for themselves and each covered dependent.Users have the option to also add their name(s) as well.
What to Test Here
Verify the page is displayed and the “Next: Your Health Care Needs” button becomes enabled once you populate your profile.
If you have a population that is only eligible for limited medical coverage for dependents (i.e. only “self” coverage) the icons displayed should be limited to those dependents.
Page Customization Options
There are no customizable options on this page.
Your Health Care Needs Page
Figure 3 - Your Health Care Needs
Once the user has provided a coverage profile and clicked the next button, the user will be presented with default estimates of health care use. These defaults are initially based on benchmarks for users with similar demographic characteristics. Users have the ability to select a usage level (low, medium, high) and to further customize by providing specific estimated usage for commonly used medical services. Based on the estimated usage and the design of each available plan option, the tool accesses regionalized “allowed” cost data (seeded by the user’s ZIP code) to calculate the annual estimated cost for each plan option. This estimate includes the annualized employee paycheck deductions for the plan option plus the estimated out-of-pocket costs (deductibles, coinsurance, and copayments) based on expected usage.
Verify the page displays one “card” for each dependent included in the coverage profile.
You will note the estimated costs per plan option are updated as you change the estimated usage. You can validate the accuracy of these costs best from the Your PlanFit page (the last page).
Your Plan Preferences Page
After providing estimated medical usage, the user is presented with three key dimensions to consider when choosing a plan:
Easy access to care
Low financial risk
Figure 4 - You Plan PreferencesThe tool will ask the user to adjust the relative importance of these factors by indicating a preference between the dimensions. The cost dimension is presented twice; once comparing preference with access to care and the other with financial risk. The default ratings are based on benchmarks for users with similar demographic characteristics.
As the user adjusts these sliders, the relative importance of these weights are combined with the performance of each plan option on these dimensions (including cost estimates provided by the user) to calculate PlanFit.
Verify the page displays the sliders presented to the user.
Note the plan fit scores are updated as you change slider assumptions. The degree to which plans change PlanFit rank/order is dependent both on the slider positions and the relative difference of the plan options on these dimensions. If the plan options have little difference on one or more dimensions you may find that the PlanFit rankings change little.
There are no customizable options on this page.
The final page of the tool provides a summary of the plan options available to the participant, ranked by how well each plan meets their stated needs (PlanFit).
This page should include each medical option available to the user along with the following costs:
The employee per paycheck contribution
The estimated total plan option cost. This is the annualized per paycheck contributions + out-of-pocket costs (deductibles, copays and coinsurance) based on the estimated health care needs.
Low use estimate: an estimated annualized cost assuming no healthcare use (the annualized per paycheck contributions)
High use estimate: an estimated annualized cost assuming high healthcare use (the annualized per paycheck contributions + out-of-pocket costs if the user had a high level of health care use).
The page will also include At-A-Glance tags (quick descriptions of your plan options), a summary of network access rules, an explanation of how the plan option works and short comparative descriptions of covered benefits and cost sharing rules.
This page should be the primary focus of your testing.
Verify all of the medical options that should be available to the test user are included.
Note that the tool displays three plan options at a time.
If you offer more than three plan options, use the icon to navigate to additional plan options.
You can quickly verify plan options by selecting the “Available Plans” select list at the top and verifying all expected plan options are present.
Verify the Plan option names are accurate and consistent with the enrollment application.
Verify the per paycheck contribution values match those on the enrollment site for the selected coverage profile.
The paycheck contributions displayed in the tool are supplied directly from the enrollment application as the tool is accessed - the rates are not loaded separately into the tool. As such these values should exactly reflect what is displayed on the medical enrollment screen when the tool was launched.
Review the cost projections (low, expected, high) for each plan option.
The expected and high costs take into account your plan option design including deductible types and amounts, out-of-pocket maximum types and amounts and any applicable HRA or employer HSA contributions.
Estimated costs can be very difficult to manually calculate. ADP would recommend the client model three scenarios – low, moderate and high use (adjusting on the Health Care Needs page) for each coverage tier available to the user and spot check the cost projections.
ADP’s cost projections use the plan option designs as they are displayed in the “How the Plan Works” and Service Category cost sharing descriptions. If the deductible amounts or types in the descriptions appear incorrect (i.e. wrong values or showing as aggregate when it should be embedded) the calculations will be off. Communicate the correct values using the Client Testing Checklist.
Review the At-A-Glance tags assigned to each plan option
Your Decision Support lead has prepopulated these based on the plan option design.
You can choose up to 4 tags per plan option from a small library of tags. If you wish to change the tags displayed for any of your plan options, modify the Decision Support Plan Settings document (provided to you at the start of enrollment).
Review the Access to Care section for accuracy
Verify the provider search URL is what you would like to include.
Modify the Decision Support Plan Settings document with any changes to the URL or access to care settings.
Review How the Plan Works for accuracy
Verify the deductibles (medical, prescription), deductible type (individual, embedded or aggregate) and amount is correct for the coverage profile selected. Note that if your plan option offers an aggregate or embedded deductible but in the tool the user selects self only coverage, the description will reflect just the individual amount.
Verify the out-of-pocket maximums (medical, prescription), type (individual, embedded or aggregate) and amount is correct for the coverage profile selected.
Verify any HSA or HRA funding provided by the employer is correct. The amount displayed is based on the coverage profile selected by the user.
Review service category benefit descriptions for accuracy
ADP has a created a best practice format for displaying cost sharing descriptions to users. This format simplifies and standardizes these descriptions in an effort maximize understandability and engagement. The descriptions are not meant to be a full description of the coverage but are intended to be a high level summary that enables easy comparison between plans.
Services that are subject to the deductible will include a D icon after the description.
Review the plan website and phone number located on the bottom of each plan option for accuracy
Verify that the website URL and the phone number are accurate for each plan option.
The At-A-Glance tags, Access settings and plan designs can be modified for each plan option.
The benefit description formats are standard and cannot be modified.
The benefit categories included in the tool are standard and cannot be modified.
ADP Decision Support: Client Testing Checklist
Can access the tools: Yes ___ No ___
All plans are included in the tool: Yes ___ No ___
Plan Name, Settings, Cost Estimate & Plan Cost Structure Tests
[PLAN OPTION NAME]
Plan option name is correct
Paycheck & cost estimates appear valid: employee only
Paycheck & cost estimates appear valid: employee + spouse
Paycheck & cost estimates appear valid: employee + child(ren)
Paycheck & cost estimates appear valid: employee + family
At-a-Glance tags appear appropriate
(make modifications in Decision Support Plan Settings document)
Access to Care settings, provider search URL correct
Deductibles: types & amounts correct
Out-of-pocket maximums: types & amounts correct
Applicable HRA or employer HSA contributions correct
Plan Web Site & phone number correct
Service Category Cost Sharing Description Tests
Doctor visits cost sharing descriptions correct
Retail prescriptions cost sharing descriptions correct
Mail order prescriptions cost sharing descriptions correct
Preventive care cost sharing descriptions correct
Diagnostic tests cost sharing descriptions correct
Outpatient surgery cost sharing descriptions correct
Emergency care cost sharing descriptions correct
Inpatient hospitalization cost sharing descriptions correct
Mental health services cost sharing descriptions correct
Substance abuse services cost sharing descriptions correct
Maternity / pregnancy cost sharing descriptions correct
Decision Support Tool Client Testing: Frequently Asked Questions
Can the cost calculator be disabled?
The cost calculator cannot be disabled.
Can the cost calculator services be changed?
No, the services in the calculator cannot be changed.
Where does the cost and default usage data used in the cost calculator come from?
ADP works with Truven Health Analytics to create claim-derived benchmarks that help drive the Decision Support experience. Specifically Truven provides typical allowed cost data for the common services used in the cost calculations. This cost data is regionalized using proprietary algorithms that adjust typical costs to the participant's local region. In addition the cost data, Truven provides demographic cohort-based health care utilization data that is used to prepopulate expected health care use/cost for participants.
The benchmarks are derived from actual claims experience data included in Truven's MarketScan Research Database. MarketScan is the collection of individual claim records derived from Truven Health Analytics’ book of business. This fully de-identified data set contains nearly 40 million members’ worth of commercial lives from the prior year, collected from employers and health plans in the commercial space.
How is the PlanFit score determined for a plan option?
PlanFit uses a proprietary algorithm that assesses a plan option’s estimated yearly cost and the employees indicated preference weightings for lower cost, easier provider access, and lower financial risk to calculate plan rankings and a fit score. The rank and score is based on how well the plan meets the employees indicated preferences. PlanFit assesses the design features of each plan option and its estimated yearly cost to perform the calculation.
Benefits Decision Support Tool (r3.9)
Testing Guide for ClientsRL and the phone number are accurate for each plan option.
How is the PlanFit score determined for a