For most employees, choosing benefits feels like a high-stakes guessing game.
- “Should I pick the high-deductible plan and hope I don’t get hit with a big bill?”
- “Do I really need hospital indemnity insurance? Or is that just another thing I’ll pay for and never use?”
- “What if I pick the wrong plan and regret it later?”
These are real concerns. And the truth is, most people don’t make the best choices for their situation. They pick plans based on gut instinct, what a coworker recommends, or whatever feels safest—even if it costs them more in the long run.
As a broker or HR professional, you’ve probably seen it firsthand: Employees struggling to understand their options, clients worried about low benefits engagement, and open enrollment decisions that leave money on the table. And most decision support tools spit out a generic recommendation based on basic inputs: salary, family size, and expected medical usage. But that just barely scratches the surface.
That’s where ALEX comes in, helping employees ditch the guesswork and make smarter, more informed healthcare choices. ALEX looks at what people actually do, not just what they say, with a perfect blend of claims data, AI, and behavioral science.
ALEX uses both aggregate and personal claims data for smarter guidance
Until now, most benefits tools relied on aggregate claims data—looking at broad patterns of healthcare usage across millions of employees. While that’s helpful, it doesn’t always reflect what an individual employee actually spends on healthcare. That’s why ALEX now uses both aggregate and personal claims data to eliminate the guesswork and deliver smarter, more confident guidance.
Aggregate Claims Data
ALEX analyzes healthcare costs across a massive, anonymized dataset. This helps employees see how “people like them” (similar age, family structure, and health conditions) use their benefits and estimate their likely expenses.
Personal Claims Data
Now, ALEX can take it one step further by incorporating an employee’s actual healthcare spending. If they choose to share their insurance details (like member ID and deductible progress), ALEX can give them a more tailored recommendation based on their real claims history.
Why does this matter?
- Removes guesswork: employees don’t have to estimate how much they spent on healthcare last year—ALEX shows them real numbers.
- Makes plan recommendations even more precise: ALEX still considers broad data trends, but now it can layer in actual spending patterns for a more accurate projection.
- Builds trust: employees feel more confident making benefits decisions when they know they’re based on their real spending, not just industry averages.
The most important part? None of the claims data that ALEX uses is publicly available, so it’s not something that any other service or platform has access to. That means that employees are getting more accurate benefits recommendations with ALEX than they’d get anywhere else.
ALEX leverages AI to turn data into predictions
Next up, ALEX uses artificial intelligence (AI) to identify patterns and relationships in those large sets of claims data, predicting what’s most likely to happen in future scenarios.
That means ALEX can look at millions of data points and say, “Based on other folks like you, here are the benefits decisions that will be most valuable for you and your own personal background.”
For example, let’s say you have an employee who has diabetes, is seeking mental health support, and is planning to have a child this year. By comparing that employee with claims data from other people just like them, ALEX can predict how many doctor visits that employee can expect to take this year, how many prescriptions they’ll purchase, and how long their hospital stays will be.
From there, ALEX shows employees how much they’ll expect to pay in premiums and out-of-pocket expenses for each plan and recommends the one that will offer the best coverage at the most affordable price.
Behavioral models help ALEX understand what matters to employees
National data and AI alone aren’t enough to determine which plans are the best for each individual employee. We also have to understand each user’s behavior and personality, factoring in how they’ll respond to uncertainty.
ALEX accounts for these differences by asking two key risk-related questions:
Risk Aversion
Are you willing to take on financial risk to save money? Or would you rather overpay a little bit for the peace of mind that you’re covered? This is a psychological trait that’s independent of someone’s financial situation. Some people dislike financial uncertainty, no matter how much money they have.
Financial Wellness
How much financial risk are you currently prepared for? Would you be able to cover a $1,000 surprise medical bill? ALEX assesses whether a plan could expose an employee to costs that exceed their ability to pay and prioritizes plans that minimize that risk.
While employees respond along a spectrum, ALEX groups them into four broad personas for reporting purposes. This helps HR teams and brokers understand the benefits needs of their employee groups.
ALEX's Recommendation
ALEX asks you about your coverage and financial preferences to categorize you into a risk persona.
- Anxious Avoiders: People who are both risk averse and have a low capacity to pay (28% of ALEX users)
- Adventurous Unprepared: People who have a low capacity to pay, but they are not very risk averse. (21% of ALEX users)
- Cautious Planners: People who are risk averse, but they have a high capacity to pay. (21% of ALEX users)
- Risk Optimizers: People who have a high capacity to pay and low risk aversion. (30% of ALEX users)
Why this matters for brokers & HR
Seeing how an employee group is distributed across these personas helps HR teams and brokers:
- Understand employees’ benefits needs and whether they tend to favor financial security or premium savings.
- Structure benefits communications more effectively based on risk tolerance and financial ability.
- Ensure plan offerings meet the needs of different risk profiles, improving overall employee satisfaction and plan engagement.
ALEX doesn’t just recommend the lowest deductible plan for risk-averse employees or automatically push HDHPs for cost-conscious ones. It looks at the full picture—comparing the likely out-of-pocket costs against the price of coverage to ensure employees get the best value for their situation.
Smarter benefits. Less stress. No guesswork.
At the end of the day, ALEX isn’t just about picking a plan. It’s about helping employees feel good about their benefits—before, during, and after enrollment.
Because the best benefits package isn’t just one with great options. It’s one that employees actually understand and use.
