Overview

Date: 20.05.2020

Objective: Align scope and roadmap for Formal Sector Integration

...

Presentation

Minutes

Entities

• Contribution plan instead of regime (is that what FHIR calls insurance plan?: http://hl7.org/fhir/insuranceplan.html)

• Policy (= contract http://hl7.org/fhir/contract.html)

• Policy holder (=Employer)

• Insuree (also Group of Insurees = Families)

• Contribution (= Premium) , Contribution collection → list of employees & their parameters

Workflows

• Enrolment:

  • Employer can directly add an insuree. → FHIR interface required from familly ? not required in NEPAL.

  • How to deal Employee without ID, should we document dummy insuree ?

  • Bulk upload of the employee list might be required (Which format ?)

  • other countries / schemes: employee registers himself at a branch office of the scheme operator

• adding insuree in openIMIS

  • No change is foreseen in that concept but if there is a portal to add the insuree (checking process might be required)

• Premium collection

APIs

• FHIR coverage: list of employees

• FHIR paymentNotice: is this the same as claim payment?

  • PaymentNotice: "This same resource may be used by employers and insurance exchanges to advise payers that premium payments have been issued and settled."

• FHIR contract: contribution collection

• FHIR organisation: policy holder

Dependencies

• Policy module migrated

• Payment module migrated

• Contribution module migrated

Questions - Challenges - Issues

• add your question & thoughts here

• need to plan which openIMIS components/modules/DB-tables need to be touched when

• create wiki pages as soon as possible on formal sector entities & workflows to allow cross-linking (e.g. to JLN, FHIR, glossary, modules etc)

Additional Resources

• Support for formal sector schemes - Incubator page in this wiki

• http://hl7.org/fhir/financial-module.html - FHIR R4 objects (financial Module)

...