Objectives
document the benefit in a generic way
document the comsumption in a generic way
Provide a mechanism to increase the performance to calculate the balance per insuree - currently full table scans. It will be used by both modular BE and REST API.
Solution
schema:
benefit_provided
benefit_package_details_id
date_from
date_to(nullable)
qty
recipient
type: insuree / group / user …
id
benefit_package_details
type
numberOf
amount
periodicity
benefit_definition(visit hospital … )
Type
product_item
product_service
cash
other limits (visits, hospitals … )
id
id of item/service
null for other limit
value
insuree (only for limits that are personnal)/individual
benefit package id (policy)
balance (actually approved)
provisional (submitted claim)
temporary (draft claim)
limits
CoreMIS
benefit_package_details table (existing ?) and benefit_provided should be created
list of benefit will come from benefit_provided
“hardcoding“ or rework of Benefit package definition to create the benefit_package_details with the cash benefit
MVP
Initial update
For all policy,
for all insuree covered by policy
get all claim details covered by policy (column in item and services)
update the common limits
update the individual limit
save limits for item and service that have limits (date or number , 2 limits if both)
save all cached enquiry
Schedule task to update
For all claims updates since the last run
get all policy details covered by claims (column in item and services)
get all the member of the policy
update the common limits
update the individual limits
save all cached enquiry