HCIactive Expands SmartBenefits.ai With New AI-Guided Member Experience Enhancements

COLUMBIA, Md.--(BUSINESS WIRE)--HCIactive today announced major enhancements to SmartBenefits.ai, the company’s AI-powered member experience platform designed to simplify benefits, accumulate values, eligibility, claims navigation, and personalized guidance.

The latest SmartBenefits.ai upgrade reinforces HCIactive’s AI First and AI Everywhere vision, focusing on a member-centric design that improves clarity, reduces friction, and boosts real-time decision support.

New Enhancements Include:

1. AI-Guided Benefit Navigation

SmartBenefits.ai now provides clear, conversational explanations of:

• Plan coverage
• Deductibles & out-of-pocket limits
• Copays & coinsurance rules
• Eligibility & benefit triggers
• Coordination of benefits
• Preventive care guidelines

Members get plain-language guidance that replaces confusion with confidence.

2. Real-Time Accumulator Visualization

Members can instantly see:

• Deductible progress
• Max OOP status
• Individual vs. family limits
• Remaining benefit allowances
• Prior authorization status

AI highlights what impacts them most — without digging through documents.

3. Claims & EOB Clarification

SmartBenefits.ai analyzes claims and explanations of benefits to explain:

• What was billed
• What was paid
• Why the numbers differ
• What the member owes
• Any action steps needed

This removes one of the biggest pain points in member communication.

4. Intelligent Task Routing

Members are guided to:

• The right provider
• The right service
• The right next step
• The right benefit program
• The right administrative workflow

AI triages confusion before it reaches call centers or HR.

5. Seamless Integration With HCIactive Platforms

SmartBenefits.ai now integrates natively with:

• AI Agency Manager
• VIRA Communicator
• VIRA Audit
• Healthspace Cloud^®
• Member portals + plan administration tools

This creates a unified ecosystem for members, employers, brokers, and TPAs.

Executive Statement

“Our mission has always been to simplify the member experience,” said Henry Cha, CEO of HCIactive. “With these enhancements, SmartBenefits.ai now brings real-time clarity to benefits, claims, eligibility, and financial responsibility — all powered by intelligent AI workflows.”

These enhancements will continue to roll out through 2025, with additional features planned for claims processing, smart recommendations, and expanded employer reporting.

For more information, visit HCIactive.com/virai-suite