This tutorial provides step-by-step instructions for setting up a health insurance scheme in openIMIS. We will use a contributory health insurance scheme as a basis for these instructions, and go through the various steps required to configure the scheme in openIMIS.

Scheme Description

The Yaya State in Country XYZ has established the Yaya State Health Insurance, which aims at providing financial coverage for select health services and drugs for their citizens. The scheme is designed to be family based, and is to begin from 01.10.2022, with families required to contribute yearly.

The contributions have been set at Y$1000 per year per family of 4. For each additional family member, an additional contribution of Y$300 is required. The yearly contributions are to be paid as a single instalment, with 10% discount provided to renewals that are done at least 2 months before the renewal date. A family can decide to enroll in the insurance at any time during the year - however they will have to wait for 1 month after enrollment for the policy to be active.

While insured, beneficiaries can avail of health services from 3 public health facilities (one in each district of Yaya state). The insurance will cover the costs for all Out Patient Care, as well as for some pre-defined medicines. Insured beneficiaries need only to show their insurance card at the reception for availing services - no payments are required from beneficiaries. The health facility, after providing services to the beneficiaries, will claim for reimbursement to the Yaya State Health Insurance Agency.

Each family is entitled to a maximum of Y$100,000 worth of medical services through the insurance coverage.

Scheme Detail Summary