Insurance

mediguard

Mediguard is an application targeted at helping Health Management and Maintenance organizations seamlessly and effectively manage their business.

FEATURES

POLICY ACTIVATION

  • The system allows for set up of various policies per client group. These policies are set up based on the product being bought and the job levels of the enrollees that the plan is being bought for.
  • The system captures the start date, tenure, premium, as well as the limits on the benefits to be enjoyed by enrollees on each policy.
  • Once policies are activated, the system can be used to generate ID cards with which the enrollees can assess health care.
  • Expired policies can be closed or renewed.
  • Policies that are almost expiring can be renewed ahead of time to facilitate the enrollees getting their ID cards just at the start of the new policy year.
CLAIMS PROCESSING

  • Bills received from providers can be batched on a monthly basis for each provider; the system generates bill codes for each batch.
  • The system captures the number of sheets (number of enrollees) received per batch and the date received.
  • For each sheet, the system captures the enrollee, the diagnosis and the drugs or procedures rendered.
  • The system can be used to vet the bills; it cross checks each drug or procedure to ascertain if the amount quoted is in line with the earlier agreed tariffs (the system can capture treatments and their costs per provider).
  • Bills vetted ok can also be forwarded to higher personnel for authorization. Once authorized, they can be forwarded for payment.
PRE-AUTHORIZATION 

For services that require authorizations, the system allows for capture of such against a pre –authorization code. Authorizations could require approval or not; the system handles both. During claims processing, such that have pre-authorizations can be indicated.

ALTERATIONS

The system can capture enrollee’s change of provider and restrict provider change within a specific period of days; the minimum number of days for provider change can be set up in the system. It allows for outright termination of a client group from the scheme and handles the refund aspect. It allows for the inclusion of new members e.g. new staff to an already running policy and calculates the premium to be paid. It handles enrollee change from one policy to another and also sorts out the differences in premium where applicable.

ENCOUNTER PROCESS

The system captures all enrollees’ visits to the hospitals, the diagnosis investigated and the services rendered.

ACCOUNTS

All payments received and made from the system are handled by this module: Premium received from client groups as well as payments made to the providers.


CAPITATION GENERATION

The system allows for set up of capitation payments. This could be at policy set up, at provider set up or per enrollee. Depending on the set up, the system calculates how much is to be paid to each provider based on the number of enrollees attached to the provider.

BENEFITS

  • Interface capabilities with third party applications: Galaxy, Tetra Sage, Sun Accounting System, Globus, CPAS, NSE etc. (It also comes with full accounting functionalities).
  • Easy claims and capitation payment.
  • It is designed for the exceptional Nigerian environment with international standards.
  • User-friendly with clear workflow processes defined.
  • Robust reports with user-defined capabilities.
  • Seamless interface with Business Intelligence tool [Crystal Report].
  • Seamless interface with Business Intelligence tool [QlikView].
  • Providers can capture their bills online; enrollees can register on line and view their benefits.
  • It also comes with automatic sms / email alert system. Capitation letters can be sent via mail.

multiplan

Multiplan is a Life Insurance Software designed to effectively manage the administration of Individual Life Insurance business from inception to policy maturity. It handles the necessary calculations involved, prompts on when payment is due, and alerts on wrong posting of payments.

FEATURES

UNDERWRITING PROCESS

The Underwriting is concerned with the assessment of application for life Insurance and explicitly captures the insurance contract between the insurer and the insured.

This process allows users to:

  • Capture customer details
  • Capture the plan details
  • Proposals are tied to production week which help to generate a report detailing proposals that came in within a particular production week.
  • At the point of capturing policy contract details, the system generates the premium, sum assured or allows users to key in the sum assured or premium. This depends on the product/plan definitions.
  • Policies are tied to agents for easy computation and generation of commission.
  • It takes into account all payment types: Cash, Cheque, Direct Debit, Payroll, Standing Order, and Commission Debit. (The commission debit is usually used for agents that have running policies and would want their premiums to be deducted from their commission).
  • It takes into account policies that have additional benefit.
  • Proposals captured can be reviewed by higher authority.
  • The underwriting modules also help in DECISION MAKING.

DECISION

Based on the information filled-in in the insurance contract proposal form and medical result, the underwriter can make decisions whether to ACCEPT, DEFER, ACCEPT WITH LOADING, REFUSE OR NOT TAKEN UP.

PRINTING OF POLICY DOCUMENT

For policies that are accepted or activated, the system generates policy documents which are sent to various agencies. This module helps to track policy documents that are delivered and not delivered and this is based on the acknowledgement reports from various agencies. This helps to know the status of all the policy documents sent out.

AGENCY MANAGEMENT

This aspect of the software handles everything that has to do with Agency. It keeps a detailed register of all agencies under the company.

Unit Offices:  Captures in details information about unit offices under various agencies.

Agent Master: This captures all the information about agents which are tied to the agencies they belong. This module also allows you to view agent productions, commission for each business, and generates production reports. Agent promotion can also be done under this menu.

FINANCE/ACCOUNT
The finance/ Account menu is the module designed for receipt collections. These receipts which could be premium, loan repayment and other forms of receipt can be entered individually depending on the number of receipts to be captured or uploaded as a batch using a given format. Other benefits of this module are as follows:

VERIFICATION OF RECEIPTS
This is to ensure that all information captured about the receipts is correct
TRANSFER OF RECEIPTS TO DEPOSIT
This allows you to transfer money/ receipts already cleared as premiums or loans to be reversed and transferred to deposit. This money could be refunded to customers or be re-utilized for its correct purpose.
AUTOMATIC POSTING OF RECEIPT

The system is designed such that uploaded receipts are auto cleared; this saves the user a lot of time.

The system automatically utilizes the receipt(s) such that it clears and updates the customer’s record.

RECEIPT REVERSALS

This reverses uploaded receipts.

POLICY SERVICES

This aspect of the application handles endorsement process.

  1. Alterations(Technical and Non-technical)
  2. Revival of Paid Up Policies
  3. Reinstatement of Lapse Policies

CLAIMS PROCESSING

This handles the calculation of claims payable based on the contractual agreement on the policy in question. However, it’s the responsibility of the insurer to scrutinize and verify the validity of any claim. The system is not in a position to determine this. It allows you to do the following:

DEPOSIT REFUND

The deposit refund allows you to refund money in customer’s deposit account.

The following types of claims are also processed under the claims module

  • Matured Policies: initiation, processing and approval of matured polices are possible under this module and the system effectively calculates the due claim.
  • Policy Surrender:  initiation, processing and approval of policy surrendered are possible under this module and the system effectively calculates the due claim.
  • Death Claims: initiation, processing and approval of death claim are possible under this module and the system effectively calculates the due claim.
  • Joint Death Claims: initiation, processing and approval of joint death claim are possible under this module and the system effectively calculates the due claim.
  • Partial Maturity: initiation, processing and approval of partially matured policies are possible under this module and the system effectively calculates the due claim
  • Staggered Benefit: initiation, processing and approval of  staggered benefit are possible under this module and the system effectively calculates the due claim
  • Annuity: processing and approval of annuity are possible under this module and the system effectively calculates the due claim.

DISBURSEMENT

The disbursement module allows you to raise requisitions to account, print payment voucher and disburse all forms of claims. This module also helps to track all cheques issued out.

COMMISSION

The commission menu effectively calculates commission due for agent. Commission statement can as well be generated.

POLICY LOAN

The policy loan is designed to capture loan request made by policy holder. The loan amount can be verified by higher authority and also approved. The system effectively calculates the surrender value, loanable amount and also generates loan offer letter. For the approved loans, the system generates repayment schedule showing the paid, unpaid loans and outstanding balance.