Nava Benefits and Open AI partnered up to make healthcare easier to understand

AI's practical uses may just extend to where many employees need it most — understanding their healthcare benefits. 

Benefits brokerage Nava Benefits and Open AI have teamed up to launch Nava's AI benefits assistant, a tool that offers guidance on individual health plans and real-time updates on deductible and out-of-pocket maximum usage. While Nava's users have access to human benefits advocates (someone who can answer questions regarding their plan and resolve any claims or billing issues), this new AI tool featured on the Nava Benefits App is aimed at resolving comprehension-based questions and determining which problems need to be addressed by a Nava advocate. 

However, it's not lost on Nava that AI isn't a one-stop solution, especially when dealing with something as (needlessly) complicated as employee health plans. 

Read more: Supporting trans employees includes helping them navigate their benefits

"AI is really good at assessing that initial [problem]," says Brandon Weber, co-founder and CEO of Nava Benefits. "But to take action because we have an error that needs to be fixed by the [healthcare] provider or insurance carrier, that's where the human advocate has the experience. They're getting on the phone, connecting with the member and carrier."

For Weber, the AI assistant serves as a bridge between the member and advocate help. And since the tool is available 24/7, employees who need answers with more immediacy won't have to wait for a response, he points out. 

"Healthcare questions aren't a nine-to-five problem," says Weber. "As a father of two and a half year old, I've had emergencies happening at 11 p.m. that ended in a trip to urgent care or the ER. That comes with questions about what is in my network and what my insurance covers."

Read more: Sword Health's innovative approach to healthcare billing

Weber notes that AI is particularly good for sifting through large quantities of documents and data to identify solutions. For example, if a member has a question about what contact lenses or glasses are covered by their vision plan, Nava's AI assistant can get them an answer within a few seconds. The same goes for members checking if a certain cardiologist is in-network or what they should expect to pay after seeing a specialist. Employees can even take a picture of their medical bills to break down what they're paying, helping ensure they pay no more than necessary. 

"We're able to feed the [assistant] with the appropriate data for each member, given their benefit elections," says Weber. "We're doing that in a privacy-centric way, where no personally- identifiable information about the user is shared." 

Weber emphasizes that one of Nava's goals as a brokerage is to demystify healthcare benefits:  Consistent access to guidance means employees have a better chance of choosing healthcare providers, treatments and hospitals that are more cost-effective. 

Read more: Creating benefits that care for the whole employee

"Nava's focus has been about how we can make benefits brokers truly work for the employer and employee," says Weber. "How do we bring true technological innovation to the problems employees have around getting more out of their benefits spend? How do we support employees in making better healthcare decisions?"

According to Weber, their benefits assistant has been able to fully resolve 85% of questions so far, proving to the brokerage that the tech is valuable. As healthcare costs are destined to rise again in 2025, Weber underlines the importance of ensuring employees have benefits they can truly use. If employees aren't healthy while employers are spending more on benefits, then something needs to change. 

"Apply pressure to your broker to look outside the box," he says. "This is the year for you to truly evaluate alternatives to the status quo."