Benefit Plan (User Manual)

Benefit Plan this sub-module is responsible for managing the definition, structure, and rules of health or social protection benefits provided under a scheme or program. It enables administrators and implementers to configure what services, goods, or entitlements are covered, under what conditions, and with what limitations.

1. Benefit Package Definition
   Administrators can create detailed benefit packages, which may include:

   • Services (e.g., outpatient care, maternal services)

   • Goods (e.g., medicines, diagnostic tools)

   • Cash or in-kind benefits (in the context of social protection programs)

2. Coverage Rules and Conditions
   The sub-module allows definition of:

   • Eligibility rules (e.g., age, condition, vulnerability criteria)

   • Coverage ceilings (e.g., maximum amounts or limits per period)

   • Service-level restrictions (e.g., specific treatments only in certain facilities)

3. Modular Design
   The sub-module is part of the modular openIMIS core, meaning it can be extended or adapted to different contexts and integrated with other modules (e.g., claims, enrolment, contribution collection).

4. Versioning and Audit Trails
   Changes to benefit plans are tracked to maintain historical accuracy and accountability.
   
   

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