This tutorial provides step-by-step instructions for setting up a health insurance scheme in openIMIS. We will use a contributory health insurance scheme as a basis for these instructions, and go through the various steps required to configure the scheme in openIMIS.
Scheme Description
The Yaya State in Country XYZ has established the Yaya State Health Insurance, which aims at providing financial coverage for select health services and drugs for their citizens. The scheme is designed to be family based, and is to begin from 01.10.2022, with families required to contribute yearly.
The contributions have been set at Y$1000 per year per family of 4. For each additional family member, an additional contribution of Y$300 is required. The yearly contributions are to be paid as a single instalment, with 10% discount provided to renewals that are done at least 2 months before the renewal date. A family can decide to enroll in the insurance at any time during the year - however they will have to wait for 1 month after enrollment for the policy to be active.
While insured, beneficiaries can avail of health services from 3 public health facilities (one in each district of Yaya state). The insurance will cover the costs for all Out Patient Care, as well as for some pre-defined medicines. Insured beneficiaries need only to show their insurance card at the reception for availing services - no payments are required from beneficiaries. The health facility, after providing services to the beneficiaries, will claim for reimbursement to the Yaya State Health Insurance Agency.
Each family is entitled to a maximum of Y$100,000 worth of medical services through the insurance coverage.
Scheme Detail Summary
Scheme Name | Yaya Contributory Health Insurance |
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Scheme Code | YAYA001 |
Scheme Start Date | Now |
Scheme End Date | |
Time | 1 year |
Geographic area | Yaya region |
Family/Single | Family Based |
Enrollment dates | Rolling enrollment; |
Administrative period | 1 month |
Family Details | |
Default Family Size | 4 |
Maximum Family Size | 10 |
Contribution Information | |
Number of instalments | 1 |
Contribution required (default family) | Y$1000 |
Additional Contribution (per additional person beyond default family size) | Y$300 |
Grace period for contribution collection | No |
Grace period for renewal | No |
Benefit Package | |
Medical Services Covered | Out Patient Care (OPD) |
Medical Items Covered | Paracetamol, Ibuprofen |
Service ceiling | Y$100,000 |
Deductables | 0 |
Health Facilities empaneled | Hospital 1 (District 1) |
The first task in configuring a scheme in openIMIS is to enter in the details of where the geographic area that the scheme is valid in. In our case, the 3 districts of the Yaya State.
Instructions
| 1 | Navigate to Administration > Locations | 
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| 2 | a. Click '+' next to Regions to add YAYA State. b. Provide a unique Code, and ‘YAYA State' as Name c. Click Save
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| 3 | a. Once back to the Locations screen, refresh the Regions using the refresh button. b. Select REG-YAYA - YAYA State c. Add a District using the '+' button. | 
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| 4 | Add at least 3 districts.
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| 5 | Success! You should have now defined Yaya State and Three districts within it. | 
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This page in other languages
Language | Link |
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FR |
Next step is to configure the medical services covered by the scheme in the openIMIS configuration.
Instructions
| 1 | Navigate to Administration > Medical Services | 
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| 2 | a. Click the '+' button on the bottom right of your screen to add a new Service. b. Fill in the details of the Medical Service as shown.
For a detailed description of the options present in the screen, please refer to https://docs.openimis.org/en/develop/user_manual/register/medical_service.html#medical-service-page | 
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| 3 | Success! You have now added a new medical service in an openIMIS instance. | 
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This page in other languages
Language | Link |
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FR |
Next step is to configure the medical items covered by the scheme in the openIMIS configuration.
Instructions
| 1 | Navigate to Administration > Medical Items |  |
| 2 | a. Click the '+' button on the bottom right of your screen to add a new Item. b. Fill in the details of the Medical Item as shown.
For a detailed description of the options present in the screen, please refer to Medical Items — openIMIS documentation | 
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| 3 | Success! You have now added a new medical item in an openIMIS instance. | 
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This page in other languages
Language | Link |
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FR |
You can define the details an insurance, or other health financing scheme, in openIMIS as a Product. A Product bring together the various aspects of a health financing scheme related to beneficiaries, contributions, the services and items available through the scheme, as well as details such a deductibles and relative pricing.
Detailed documentation on the various options for defining a Product can be found at https://docs.openimis.org/en/latest/user_manual/register/product.html
Instructions
The following steps can be followed to realize the above-mentioned contributory health insurance scheme in openIMIS (you can try it out on openIMIS Demo Server as well!)
| 1 | Navigate to Administration>Products | 
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| 2 | Click on the + on the bottom right to add a new Product. | 
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| 3 | Fill in the form according to the scheme details above, focusing: Administrative Information
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| 4 | Continue to fill in the remainder of the form Insurance Details TAB: CONTRIBUTION PLAN
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| 5 | Continue to fill in the remainder of the form Medical Items
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This page in other languages
Language | Link |
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FR |
This page in other languages
Language | Link |
|---|---|
FR |