Product refactoring : Benefit program

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In order to use openimis beyond health, the Product must be more generic, justification/use case could be found here : openIMIS beyond health features needs

 

Proposed Model

General

image-20240123-134310.png

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

 

image-20240123-144644.png

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

image-20240123-145946.png

create a benefit package that could group:

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Model (outdated)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

 

 

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