REINSURANCE MANAGEMENT SYSTEM MEDICAL INSURANCE GENERAL INSURANCE LIFE INSURANCE TAKAFUL. Insurance Applications by Insurance People

Transcription

1 REINSURANCE MANAGEMENT SYSTEM MEDICAL INSURANCE GENERAL INSURANCE LIFE INSURANCE TAKAFUL Insurance Applications by Insurance People

2 THE SYSTEM

3 Private Medical Insurance System (PMI) Private Medical Insurance System (PMI) The first version of the system was launched into full production operation in December 1996 and was developed with input from several key players in the international medical insurance sector. Further developments took place to enhance the system to cater for additional business functionality including: Drug Controls Graphical Dental validations Integration of Imaging and SMS processing Takaful Version TPA Processing In 2008 a major technology change took place and a full Web enabled version of the system was completed and made available to the market..insurance applications by insurance people. 3

4 The System high level

5 Private Medical Insurance System (PMI) System Features The PMI system caters for the end to end processing of Medical Insurance and includes the following: Product Definitions Quotation Module Policy Module for Group and Individuals Member management including auto load and card production Integrated Claims management module Provider Management Integrated accounting module General Ledger interface Powerful reporting and on line enquiries Security System can be used for Direct business as well as TPA Processing.insurance applications by insurance people. 5

6 Products

7 Private Medical Insurance System (PMI) Product Administration The PMI system allows for the creation of new products and a reduced time to market. The system caters for standard products as well as tailored group schemes. Rules Various product rules are maintained that assist and control with Policy and Claims processing. Group Profiles The system allows for creation of profiles and for the set up of different Benefits and Benefit Limits, as well as varying premium rates and provider networks for the different profiles of insured members. (eg Different schemes for General Management Middle Management etc). Benefits Within the profile various benefits and sub benefits are maintained. The applicable limits and deductibles are also recorded..insurance applications by insurance people. 7

8 Quotes

9 Private Medical Insurance System (PMI) Quotation Processing Quotes can be produced for Groups and Individuals, with automatic production of Quotes advice. Additional discounts and loading can be applied to the quote subject to the product rules defined. When a quotation is accepted, the data is transferred to the policy record which reduces the amount of administration work..insurance applications by insurance people. 9

10 Policy

11 Private Medical Insurance System (PMI) Policy Management The policy module caters for Group and Individual business as well as new and renewal processing. Each member covered by the policy is allocated a separate member number to allow easy administration. Full details on the members are recorded including Names, Age, Sex etc as well as their relation to the Primary Insured. An automatic load facility for loading members from a spreadsheet is available. All member changes (eg Addition, leaving scheme. Change of date of birth) are recorded against subsequent endorsements. On line wizard processing assist the user with the policy set up..insurance applications by insurance people. 11

12 Claims

13 Private Medical Insurance System (PMI) Integrated Claims Management Module An integrated claims module makes use of the Product and Policy rules as well as the Member details to ensure the correct amount is settled. These can be either Client Reimbursement or Direct Settlement claims. Claim batches are maintained against the Providers and summary of the claims processed within the batch is available. Logical business rules are embedded in the processing to ensure claims are paid to only those on cover. The payments are also broken down against the various benefits/sub benefits and system checks ensure that the benefit limits are not exceeded. On line displays allow review of previous claim payments to allow a full review of the members history. Graphical dental validations also ease the identification of fraudulent claims. An optional Drug Control module caters for further control on drugs issued..insurance applications by insurance people. 13

14 Referrals

15 Private Medical Insurance System (PMI) Referral (Pre-Authorisation) Processing Prior treatment approvals are available through the referral module. Benefit limits are checked against claim payments already processed as well as any other approved referrals. The referral status indicates the position in the work flow (eg Approved, Treatment in Progress, Treatment Taken etc) When a claim is recorded as a result of a referral the pre approved details are copied to the claim payment to reduce administration..insurance applications by insurance people. 15

16 Provider

17 Private Medical Insurance System (PMI) Provider Network Management The PMI system incorporates a Provider module for the management of the provider network. Details on contract periods are maintained as well as the specialties and areas of expertise. Doctor details are available with automatic upload of list of Doctors, their specialty and timings. Procedure Prices are available with the download, upload and copy facilities making the administration of the agreed prices as straightforward as possible. Discounts against specific items such as diagnostics can be recorded for each provider and used in claims..insurance applications by insurance people. 17

18 Reporting

19 Private Medical Insurance System (PMI) Reporting The PMI system incorporates many reports that run at a variety of levels as well as a variety of frequencies. These include: On Line user requested reports and event driven Daily Daily control reports Weekly Weekly summary reports Monthly Monthly summary statistics and triangulation reports A powerful on line parameter driven reporting module allows the end user to select detailed claims driven statistics that can be down loaded into spreadsheets for further analysis. On line underwriting statistics provide an overview of the history of a policy, client or products. A powerful MIS module also allows drill downs into a variety of reports which are saved directly as spreadsheets..insurance applications by insurance people. 19

20 Miscellaneous

21 Private Medical Insurance System (PMI) Additional Modules Imaging Documents can be imaged and attached to Policies and Claims and can be viewed while using the PMI system via a common icon. The Policy and Claims folders are broken into sub folders to allow easy access to the images. Table Maintenance A separate module allows the end user to view and update (where applicable) reference tables. Member Load Automatic upload of member details from spreadsheets for ease of administration. Product rules are checked against the spreadsheet details to ensure integrity of the data. Procedure Pricing A simple on line enquiry to review specific procedure prices as well as a module that allows the export and import of the entire range of procedure prices for a provider..insurance applications by insurance people. 21

22 Security

23 Private Medical Insurance System (PMI) Access & Controls Role Based User roles are defined which control the access to the various modules available. New users are allocated to their specific role. In addition to the Insurance company staff, users can be clients, agents, providers with specific access areas. Authority Limits There are several user defined limits which include: Underwriting Limit Claim Limit Fast Track Claim Limit Referral Limit Override Approvals Based on specified business rules, manager override may be required to process some transactions (eg Duplicate Invoice Numbers). Users with this authority are defined and maintained. Audit Trail All transactions are retained and are stamped with details of the user and time created as well as user and time last updated..insurance applications by insurance people. 23

24 TAKAFUL SYSTEMS

25 Private Medical Insurance System (PMI) TAKAFUL ARIMA have developed a Takaful version of the PMI system. The system includes all of the processing requirements for the particular line of business:- Specification and Creation of Reinsurance Pools Mudaraba and Wakala terms Surplus Calculation Surplus Distribution.insurance applications by insurance people. 25

26 ARIMA TEAM

27 Private Medical Insurance System (PMI) ARIMA TEAM ARIMA have a dedicated team of professional software developers with a strong business background. The team includes qualified Project Managers, Business Analysts and skilled technical personnel. In additional a Help Desk is available to all clients which includes a 24hr 7x7 emergency number. Contact Details For more information on ARIMA and it s range of products please contact: Customer Services Manager ARIMA Insurance Software ARIG House, Diplomatic Area PO Box 15642, Manama Kingdom of Bahrain Tel: Fax: arima@arima.com.bh.insurance applications by insurance people 27

28