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The register of insurance products contains all insurance products in the health insurance scheme. There may be several insurance products available for distribution/selling in a territory, e.g. one basic product and one or several supplemental insurance products. The insurance products may at the different levels. For example that basic insurance product may be at the national level whereas the supplemental insurance products may be at the regional level. Administration of the register of insurance products is restricted to users with the system role of Scheme Administrator or with a role including an access to Administratiom/Products. Pre-conditionsAn insurance product may only be added or thereafter edited, after the approval of the management of the scheme administration. NavigationAll functionality for use with the administration of insurance products can be found under the main menu Img. 51 Navigation Products Product Control PageClicking on the sub menu Img. 52 Product Control Page The Search PanelThe search panel allows a user to select specific criteria to minimise the search results. In the case of Products the following search options are available, which can be used alone, or in combination with each other. Product Code Type in the beginning of; or the full Product Name Type in the beginning of; or the full Date From Type in a date; or use the Date Selector Button, to search for products with a Date To Type in a date; or use the Date Selector Button, to search for products with a Region Select the The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide products and all regional products relating to the selected region will be found. If no district is selected then also all district products for districts belonging to the selected region will be found. District Select the The list will be only filled with the districts belonging to the selected region. All nationwide products, all regional products relating to the selected region and all district products for the selected district will be found. Show Historical Values Click on Img. 53 Historical records - Result Panel Search Button Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel. Result PanelThe result panel displays a list of all products found, matching the selected criteria in the search panel. The currently hovered record is highlighted in grey (Img. 54). The leftmost record contains a hyperlink which if clicked, redirects the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record. Img. 54 Result Panel Information PanelThe Information Panel is used to display messages back to the user. Messages will occur once a product has been added, updated or deleted or if there was an error at any time during the process of these actions. Product PageData EntryGeneralProduct Code Enter the product code for the product. Mandatory, 8 characters. Product Name Enter product name for the product. Mandatory, 100 characters maximum. Region Select the region in which the product will be used, from the list by clicking on the arrow on the right hand side of the lookup. The option National means that the insurance product is nationwide and it is not constraint to a specific region.Note The list will only be filled with the regions assigned to the current logged in user.` Mandatory. District Select the district in which the product will be used, from the list by clicking on the arrow on the right hand side of the lookup.Note The list will only be filled with the districts assigned to the selected region and assigned to the current logged in user. Maximum of Members Enter the maximal number of members of a household/group for the product. Threshold Members Enter the threshold number of members in product for which the lump sum is valid. Insurance Period Enter duration of the period in months, in which a policy with the product will be valid. Mandatory. Administration Period Enter duration of the administration period in months. The administration period is added to the enrolment date/renewal date for determination of the policy start date. Recurrence Enter duration of the period in months after which registration fee/lump sum is applied again for a renewal. The period starts with the expiry date of the policy to be renewed. Date From Type in the date to provide the date for which underwriting for the insurance product can be done from. Date To Type in the date or use the Date Selector Button to provide the date until which underwriting can be done to. Mandatory. Conversion Select from the list of products, a reference to the product which replaces the current product in case of renewal after the Selecting the current product will prevent the record from saving, and cause a message to be displayed in the Information Panel. Account Code Remuneration Enter the account code of the insurance product used in the accounting software for remuneration of the product. 25 characters maximum. Account Code Contribution Enter the account code of the insurance product used in the accounting software for paid contributions. 25 characters maximum. Contribution PlanImg. 55 Contribution Plan Tab Lump Sum Enter the lump sum contribution (an amount paid irrespective of the number of members up to a threshold) to be paid by a household/group for the product. If the lump sum is zero no lump sum is applied irrespective of the threshold members. Decimal up to two digits. Contribution Adult Enter the contribution to be paid for each adult (on top of the threshold number of members). Decimal up to two digits. Contribution Child Enter the contribution to be paid for each child (on top of the threshold number of members). Decimal up to two digits. Max Instalments Enter maximal number of instalments in which contributions for a policy may be paid. Mandatory. Registration Lump Sum Enter the lump sum (for a household/group) for registration fee to be paid at the first enrolment of the household/group. Registration fee is not paid for renewals of policies. Assembly Lump Sum Enter the lump sum (for a household/group) for additional assembly fee to be paid both at the first enrolment and renewals of policies. Registration Fee Enter the registration fee per member of a household/group. If registration lump sum is non zero, registration fee is not considered. Registration fee is not paid for renewals of policies. Assembly Fee Enter the assembly fee per member of a household/group. If assembly lump sum is non zero, assembly fee is not considered. Assembly fee is paid both at the first enrolment and renewals of policies. Enrolment Discount percentage Enter the enrolment discount percentage for the insurance product. The discount percentage is applied on the total contributions calculated for a policy underwritten earlier than Enrolment Discount Period Enter the enrolment discount period of the insurance product in months. Renewal Discount Percentage Enter the renewal discount percentage for the insurance product. The discount percentage is applied on the total contributions calculated for a policy renewed earlier than Renewal Discount Period Enter the renewal discount period of the insurance product in months. Grace Period Payment Enter duration of the period in months, in which a policy has a grace period (not fully paid up) before it is suspended. Mandatory, although it is by default and can be left at zero. Grace Period Enrolment Enter duration of the period in months after the starting date of a cycle (including this starting date), in which underwriting of a policy will still be associated with this cycle. Grace Period Renewal Enter duration of the period in months after the starting date of a cycle (including this starting date), in which renewing of a policy will still be associated with this cycle. Covered Medical ItemsImg. 56 Medical Items Tab List all items covered in this product. You can add new items by clicking on Actions Using the pen you can edit the row to edit its values, the bin will remove this item from the product and the floppy disk will finish the edition of the row (But the product still need to be saved to apply changes). Code Displays the code for the medical item Name Displays the name of the medical item Type Displays the type of the medical item Package Displays the packaging of the medical item Price Displays the default price of the medical item Limit Indicates the type of limitation of coverage for the medical item. This may be adjusted per medical item, select between Co-Insurance and Fixed amount. Co-insurance means coverage of a specific percentage of the price of the medical item by policies of the insurance product. Fixed amount means coverage up the specified limit. Co-insurance is the default value. Limit O is used for claims having the type of visit Other, Limit R is used for claims having the type of visit Referral and Limit E is used for claims having the type of visit Emergency. Origin Indicates where the price for remuneration of the item comes from. This may be adjusted per item, the options are:
Adult Indicates the limitation for adults. If the type of limitation is a co-insurance then the value is the percentage of the price covered by policies of the insurance product for adults. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for adults by policies of the insurance product. Default is 100%. Adult O is for Other, Adult R is for Referral and Adult E is for Emergency claims according to the type of visit (Visit Type). Child Indicates the limitation for children. If the type of limitation is a co-insurance then the value is the percentage of the price covered for children by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for children by policies of the insurance product. Default is 100%. Child O is for Other, Child R is for Referral and Child E is for Emergency claims according to the type of visit (Visit Type). No Adult It indicates the maximal number of provisions of the medical item during the insurance period for an adult. No Child It indicates the maximal number of provisions of the medical item during the insurance period for an child. Waiting Period Adult Indicates waiting period in months (after the effective date of a policy) for an adult. Waiting Period Child Indicates waiting period in months (after the effective date of a policy) for a child. Ceiling Adult It indicates whether the medical item is excluded from comparison against ceilings defined in the insurance product for adults. Default is that the medical item is not excluded from comparisons with ceilings.
Ceiling Child It indicates whether the medical item is excluded from comparison against ceilings defined in the insurance product for children. Default is that the medical item is not excluded from comparisons with ceilings.
Covered Medical ServicesImg. 57 Medical Services Tab List all services covered in this product. You can add new services by clicking on Code Displays the code of the medical item Name Displays the name of the medical item Type Displays the type of the medical item (Curative or Preventive) Package Displays the packaging of the medical Item Price Displays the default price of the medical item Limit Indicates the type of limitation of coverage for the medical service. This may be adjusted per medical service, select between Co-Insurance and Fixed amount. Co-insurance means coverage of a specific percentage of the price of the medical service by policies of the insurance product. Fixed amount means coverage up the specified limit. Co-insurance is the default value. Limit O is used for claims having the type of visit Other, Limit R is used for claims having the type of visit Referral and Limit E is used for claims having the type of visit Emergency. Origin It indicates where the price for remuneration of the item, comes from: This may be adjusted per medical item, the options are: [P] Price taken from the price list of a claiming health facility, [O] Price taken from a claim and [R] Relative price, the nominal value of which is taken from the price list and the actual value of which is determined backwards according to available funds and the volume of claimed services and medical items in a period. [R] is the default value. Adult It indicates the limitation for adults. If the type of limitation is a co-insurance then the value is the percentage of the price covered for adults by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for adults by policies of the insurance product. Default is 100%. Adult O is for Other, Adult R is for Referral and Adult E is for Emergency claims according to the type of visit (Visit Type). Child It indicates the limitation for children. If the type of limitation is a co-insurance then the value is the percentage of the price covered for children by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the service is covered for children by policies of the insurance product. Default is 100%. Child O is for Other, Child R is for Referral and Child E is for Emergency claims according to the type of visit (Visit Type). No Adult It indicates the maximal number of provisions of the medical item during the insurance period for an adult. No Child It indicates the maximal number of provisions of the medical item during the insurance period for a child. Waiting Period Adult It indicates waiting period in months (after the effective date of a policy) for an adult. Waiting Period Child It indicates waiting period in months (after effective date of a policy) for a child. Ceiling Adult It indicates whether the medical service is excluded from comparison against ceilings defined in the insurance product for adults. Default is that the medical service is not excluded from comparisons with ceilings.
Ceiling Child It indicates whether the medical service is excluded from comparison against ceilings defined in the insurance product for children. Default is that the medical service is not excluded from comparisons with ceilings.
Deductibles and CeilingsImg. 58 Deductibles & Ceilings Tab NoteIt is possible to specify only one of the following ceilings –per Treatment, per Insuree or per Policy. If ceilings per category of claims are specified together with ceilings per Treatment, per Insuree or per Policy than evaluation of claims may be dependent under special circumstances on the order of claimed medical services/items in a claim.` Ceiling Discrimination Specify whether Hospital and Non-Hospital care should be determined according to the type of health facility (select Split Ceilings & Deductibles Wether you would like to split ceilings & deductibles for Hospitals/Non-Hospitals or not. Ceiling Type Specify wether the deductibles and ceilings are per insuree, treatment or policy. Treatment Deductibles and Ceilings for treatments may be entered for general care ( Insuree Deductibles and Ceilings for an insuree may be entered for general care ( Policy Deductibles and Ceilings for a policy may be entered for general care ( Extra Member Ceiling Additional (extra) ceiling for a policy may be entered for general care ( Maximum Ceiling Maximal ceiling for a policy may be entered for general care ( Ceilings Table Maximal amount of coverage can be specified for claims according to the category of a claim. The options are claims of the category Number Maximal number of covered claims per an insuree during the whole insurance period according to the category of a claim. The options are claims of the category Note
Pooling ManagementStart Cycles (1 to 4) If one or more starting dates (a day and a month) of a cycle are specified then the insurance product is considered as the insurance product with fixed enrolment dates. In this case, activation of underwritten and renewed policies is accomplished always on fixed dates during a year. Maximum four cycle dates can be specified. Distribution Type Wether the system has to calculate relative prices for general health care (Enabled) or for (non-)hospital care (Split). This system is disabled if the user selects Disabled. Distribution Periods Select from the list of distribution periods (NONE, Monthly, Quarterly, Yearly), the period that is to be used for calculation of the actual value of relative prices for the insurance product. Relative Pricing Table Distribution periods may be entered for general care ( It is not required to enter a value in each period, zero values are accepted. Once all the percentage values have been entered, click on the button OK to submit the values to the respective grid. Clicking on the button SavingOnce all mandatory data is entered, clicking on the Mandatory data
Cancel
Adding a ProductClick on the When the page opens all entry fields are empty. See the Product Page information on the data entry and mandatory fields. Editing a ProductClick on the The page will open with the current information loaded into the data entry fields. See the Product Page for information on the data entry and mandatory fields Deleting a ProductBecause of potential problems with synchronization of data between off-line and on-line version, it is not possible delete insurance products currently. |
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