What are the different types of ceilings configured in the product page and how do they affect claims?

Owned by Siddharth Srivastava
Last updated: Dec 21, 2022 by Marco Kalin
2 min read

This article explains the different types of ceilings in the product configuration page and their use during claims processing.

Explanation

Ceilings (total amount to be covered by the insurance scheme) can be set per Treatment, per individual/Insuree or by Policy (that covers everyone part of a family/group). You can have a product with a maximum family size and a maximum ceiling for the family. In cases where families might be larger than the defined maximum family size you can indicate the "Extra Member Ceiling" that indicates the amount by which the family ceiling will increase for each additional member added but only upto a maximum amount ("Maximum Ceiling") beyond which members can be added but family ceiling would not further increase. Detailed description of each field in the product page is here: https://openimis.readthedocs.io/en/latest/web_app_vb_user_manual.html#product-page

After the review of a claim by a reviewer, when the claim is processed forward to the Valuated state the calculations of ceilings are applied to give the amount to be paid against the claim. The remaining ceiling after deduction of what is to be paid against a claim is also calculated so the ceiling can accordingly be applied to subsequent claims of the same person (Insuree) or Family (Policy).













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