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• Every period (monthly in case of Nepal), a contract will be created between the policy holder and each enterprise.

  • The periodicity will depend on the contribution plan and therefore will be configuration

  • The same insurance product could have different contribution plan therefore different contribution periodicity

• Every covered employee will be mentioned in the contract along with the list of insurance product that will be part of their coverage.

• once the contract validated and paid, the policy of the emöployee and their family will be activated for the period covered by the contract

  • the period of the contract doesn’t have to be the period of the policy: this will enable having coverage limits (max amount, max surgery …) that could be shared for several periods

In case of a insuree have multiple employers, the system will activate only one policy per product.

insuree should be able to move between the formal and informal sector

Objectives

This project aims to develop the "Formal Sector" features requested by institutions in charge of developing health financing schemes in Nepal, in particular the management of enrolment of the insuree as part of an insurance group.
Here are the high-level use cases to be covered by this design:

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