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Many countries are working to extend social health protection as part of the drive to achieve Universal Health Coverage. Health insurance schemes can protect people from the financial consequences of paying out-of-pocket for needed health services and reduce the risk of impoverishment due to ill health.
openIMIS offers a range of functional modules which can be combined into tailored solutions for the delivery of specific social protection schemes. The health insurance solution powered by openIMISallows scheme operators to manage beneficiaries, contracts, products, premiumscontributions, providers, claims and accounting in a single platformsoftware. A key strength of openIMIS is its capacity to support the digital creation, submission and review of claims, including AI-supported review. It also connects seamlessly with other open source products, such as DHIS2 and openMRS, using FHIR standards.
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Supported processes
openIMIS supports the following business processes for health insurance:
Beneficiary Employer/employee management
Collecting and managing contributions
Benefit package design/configuration
Issuing membership ID cards to beneficiaries
Verifying scheme membership
Health service claims generation and submission
Medical review of selected claimsClaims review and management
Processing and payment of claims
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Current implementations
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Visit the wiki page or download the factsheet for this openIMIS use casesolution:
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