Use cases served by openIMIS - overview

openIMIS is a versatile open source software which supports the administration of various schemes related to health financing and social protection. Designed in accordance with industry standards for interoperability, openIMIS offers a standardised but adaptable way to manage information flows related to various forms of health insurance, employment injury insurance as well as other social protection schemes by bringing together beneficiary, service provider and scheme operator data into a single platform. Some key use cases of openIMIS are highlighted below.

Use cases in health financing

Health insurance

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

Current implementations

Tanzania - Mainland

Cameroon - BEPHA

Nepal - Health Insurance Board

Tanzania - Zanzibar

Use cases in social protection

Employment injury insurance (EII)

openIMIS supports the following business processes for EII

• Enrolment

• Accident reporting

• Health service utilization

• Health service claims generation and submission

• Claims review process

• Processing and payment of claims

Current implementations

Employment Injury Insurance - Social Security Fund Nepal

Unconditional Cash Transfer

openIMIS supports the following business processes for unconditional cash transfers

• Registration of beneficiary households

• Registration of payment service providers

• Definition of payment criteria and generation of payroll

• Disbursements of payments to beneficiaries

• Data analysis

Current implementations

The Gambia / Unconditional Cash Transfer

Gambia: Scheme workflows and openIMIS adaptation