This document summarizes the openIMIS features related to beneficiary enrollment. These features are spread into the Persons & Families, Policies and Contributions modules.
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JLN Processes Beneficiary Management | JLN Processes Premium Management | ||||||
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Insuree Enquiry Warning: 2 stored procs:
QUESTION: which one holds the truth ?? | x | ??? Today, inquiry “by provider” seems to be managed via insurance product scope (down to district only - not HF level) QUESTION: does the openIMIS enquiry take the user’s registered HF (/location) into account?? | x (note: openIMIS makes a distinction between medical service and medical item) | NOT COVERED by openIMIS (validation only at claim submission) | |||
Find Family | x | x | |||||
Family/Group Overview | x | x | x | ||||
Family/Group Page | x | ||||||
Adding a Family | x | ||||||
Editing a Family/Group | x | ||||||
Changing a Head of Family/Group | x | ||||||
Moving an Insuree | x | ||||||
Deleting a Family/Group | |||||||
Find Insuree | x | x | |||||
Insuree Page | x | x | |||||
Adding an Insuree | Partially:
| PCP (called FSP in openIMIS) is at insuree level and managed (entered/updated) by clerck/enrolment officer (not the beneficiary himself) | |||||
Editing an Insuree | |||||||
Deleting an Insuree | |||||||
Find Policy | x | ||||||
Policy Page | x | ||||||
Adding a Policy | Note: includes policy value (premium composition) calculation Partially:
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Editing a Policy | |||||||
Deleting a Policy | |||||||
Find Contribution | Partially: openIMIS allows to record a contribution (and updates policy status accordingly) Process foresees invoice sending, reports (due premiums,…). Warning about bill sent to beneficiary (not from the web app!) | ||||||
Contribution Page | |||||||
Adding a Contribution | |||||||
Editing a Contribution | |||||||
Deleting a Contribution | |||||||
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Policy renewals via SMS/mobile (cfr. Policies module) … note: also includes insuree photo renewal (to will be relocated in insuree module ?)
Payment (premium collection) matching (cfr. Contributions modules)
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along Policy renewal via SMS/mobile data, Policy renewal can also be achieved via printout report (with preview in the “Policy renewal screen”) sent to Enrollment officers (QUESTION: via email or real printout ?)
Out of scope of this migration:
?? Funding via fictive policy / insuree family??
reports from the reports menu entry of openIMIS are out of scope: pending insurees, contribution distribution,…
Payments (all sorts of) from payers (insurers) to providers (claims, capitation payments,…)
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