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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 openIMIS allows scheme operators to manage beneficiaries, contracts, products, premiums, providers, claims and accounting in a single platform. It also connects seamlessly with other open source products, such as DHIS2 and openMRS.
Business processes
openIMIS supports the following business processes for health insurance:
Beneficiary management
Collecting and managing contributions
Issuing membership ID cards to beneficiaries
Verifying scheme membership
Health service claims generation and submission
Medical review of selected claims
Processing and payment of claims
Benefits
For beneficiaries, openIMIS simplifies enrolment procedures, reduces the number of ‘touch points’ (therefore saving both time and money), and makes it easy to verify one’s coverage status at point of care. For health facilities, it streamlines the processes associated with a health financing scheme and makes it easy for them to receive reimbursements. For scheme operators it reduces operational costs and allows for better monitoring and analysis of the scheme’s overall performance. For decision makers, data from openIMIS can enhance policy making and planning related to health service delivery
Example workflow
Current implementations
Further information
Visit the wiki page or download the factsheet for this solution: