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.

  • 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.

  • UC6 - The Scheme Administrator wants to manage the policy holder 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:

General topics

Solution Architecture