In order to use openimis beyond health, the Product must be more generic, justification/use case could be found here : https://openimis.atlassian.net/wiki/spaces/OP/pages/3024289830

Proposed Model

General

Open

Overall structure,

• Enrollment plan (aka contribution plan) are there but not attached to the new model

• Pool is a nice to have for financial reporting across program

• priority are only for claiming process to know which needs to pick he coverage use

Benefit Package

Open

Element

defined by modules that might comes with specific authorities

Elements class must inherit from the BaseElement abstract class

Element Bundle

2 possible usage:

if  the validity and price strategy are set on the list level then it creates "episode of care" package

else it just a way to define package that could be used by diferent product such as "legal" packages

create a benefit package that could group:

• benefit consumptions (https://openimis.atlassian.net/wiki/spaces/OP/pages/3542286337 ), replacement/extension of the insureeInsuree

• invoice (https://openimis.atlassian.net/wiki/spaces/OP/pages/2614362157 )

• beneficiary

• policyHolder ( beneficiacy or policyholder model)

upon the activation of the Benefit package the “benefit consumptions” will be filled

• just the policy

other benefit consumption limits will be created with the first consumption related to the limit

Prioritization of benefit consumption in claims:

1- if the claim specify a benefit plan, use this on first

2- if not benefitplan specified OR does not provide coverage, take the benefit with the higher priority

3- if there is several benefit with the same priority, use the most favorable for the beneficiary

Model (outdated)

Main model

• Generic Product that should be based on the HistoryBusinessModel

  • date_valid_from* (old date_from)

  • date_valid_to* old date_to)

  • replacement_uuid* (tbc old conversion_product)

  • is_deleted**

  • json_ext**

  • date_created**

  • date_updated**

  • user_created** (old audit_user_id)

  • user_updated**(old audit_user_id)

  • version**

  • history**

  • code: str

  • name : str

  • location : key to geo location, zone where the Benefit plan is available, nullable

  • acc_code_premiums

  • acc_code_remuneration

(*) inherited from HistoryBusinessModel

(**) inherited from BusinessModel

Benefit plan or Product json_ext

legacy fields that should go in Product json_ext Or Benefit plan (new type of plan)

• insurance_period

• ded_insuree

• ded_op_insuree

• ded_ip_insuree

• max_insuree

• max_op_insuree

• max_ip_insuree

• ded_treatment

• ded_op_treatment

• ded_ip_treatment

• max_treatment

• max_op_treatment

• max_ip_treatment

• ded_policy

• ded_op_policy

• ded_ip_policy

• max_policy

• max_op_policy

• max_ip_policy

• max_no_consultation

• max_no_surgery

• max_no_delivery

• max_no_hospitalization

• max_no_visits

• max_amount_consultation

• max_amount_surgery

• max_amount_delivery

• max_amount_hospitalization

• max_policy_extra_member

• max_policy_extra_member_ip

• max_policy_extra_member_op

• max_ceiling_policy

• max_ceiling_policy_ip

• max_ceiling_policy_op

• max_amount_antenatal

• max_no_antenatal

• ceiling_interpretation

Payment Plans

Legacy fields that should be move to Payment plan (already done)

• period_rel_prices

• period_rel_prices_op

• period_rel_prices_ip

• share_contribution

• capitation_level_1

• capitation_sub level_1

• capitation_level_2

• capitation_sub level_2

• capitation_level_3

• capitation_sub level_3

• capitation_level_4

• capitation_sub level_4

• weight_population

• weight_nb_families

• weight_insured_population

• weight_nb_insured_families

• weight_nb_visits

• weight_adjusted_amount

Enrollment plans

legacy fields that should go in enrollment_plan (aka contribution plan)

• administration_period

• lump_sum

• max_members

• max_installments

• threshold

• recurrence

• premium_adult

• premium_child

• grace_period_enrolment

• grace_period_renewal

• registration_lump_sum

• registration_fee

• general_assembly_lump_sum

• general_assembly_fee

• start_cycle_1

• start_cycle_2

• start_cycle_3

• start_cycle_4

• renewal_discount_perc

• renewal_discount_period

• enrolment_discount_perc

• enrolment_discount_period

services