Digital Square D1 proposal: Support for Formal Sector schemes and Configurable Claims Workflow in openIMIS
Teams:
Objectives
This project aims to develop the "Formal Sector" features requested by institutions in charge of developing health financing schemes in Nepal, in particular the management of enrolment of the insuree as part of an insurance group.
Here are the high-level use cases to be covered by this design:
Manage group insurance
UC1 - The Scheme Administrator wants to manage the policy holder insurees and their policy entitlement. (includes UC2 from the proposal)
UC3 - The Scheme Administrator wants to manage the policy holder contract.
UC4 - The Scheme Administrator wants to manage the policy holder contract payment.
UC5 - The Scheme Administrator wants policy holders insuree policies covered by a contract to auto activate based on policy holders contract payment.
UC7 - The Scheme Administrator wants to manage policy holders.
Contribution Plan and Contribution Plans Bundle to manage the Policy Value
UC8 - The Scheme Administrator wants to add a Contribution plan (pricing rules linked to an insurance product).
UC9 - The Scheme Administrator wants to be able to configure the calculation parameters in the Contribution plan.
UC10 - The Scheme Administrator wants to add a Contribution Plan Bundle.
UC11 - The Scheme Administrator wants to enable some Contribution Plan Bundles per policy holder.
Policy holder Portal
UC12 - The policy holder wants to manage its policy holder insurees and their policy entitlement.
UC13 - Policy holder wants to manage its users.
UC14 - Policy holder wants to manage its contracts.
Not Functional
UC16 – Manage the calculations
Modules
The following module are part of the Formal Sector scheme management: