SOFTWARE REVIEW EOLAS' INSURANCE MANAGEMENT SYSTEM
Microinsurance
Information Systems
An online inventory of technologies for
microinsurance
MIN Technology Working Group 1-2-2010
Index
2010
2
1 About the “Online inventory of technologies for microinsurance” ...2
The Review Process ...4
2 About EOLAS' IMS ...5
2.1 Product Summary ...5
2.2 Functionality and Scalability ...6
2.3 Usability ... 15
2.4 Reports... 16
2.5 Financial Standards and Compliance ... 17
2.6 System Administration and Technical Support ... 18
2.7 Technical Specifications ... 19
2.8 Position of technologies and classification of the products and services. ... 22
2.9 Company Profile ... 23
The information contained in this document is for general information purposes only. The information is provided by Berende Consulting and while we endeavour to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the document or the information, products, services, or related graphics contained the document for any purpose. Any reliance you place on such information is therefore strictly at your own risk.
About the Inventory
2010
3
1
About the “Online inventory of technologies for
microinsurance”
The purpose of the online inventory of technologies for microinsurance is to provide the microinsurance community with an overview of systems applicable to microinsurance. The reports, which will be posted on the Microinsurance Network Website and the website of MIF-FOMIN (in Spanish), should offer software vendors a platform for their product(s) on the one hand, and on the other hand they should provide a place where the microinsurance community can find various software solutions for microinsurance. Both decision makers and IT specialists in the microinsurance community should benefit from the platform as the inventory provides information that is relevant to the interests of both parties.
Two types of Software Review reports have been written
The general review document should provide information at a glance which is useful to the management of the organization in need of software.
General Product Description
The detailed review document should provide a product description which is required by the people / departments responsible for IT within the MFI / Microinsurer or other supporting persons / institutes. The product description will give insight into adaptability to other existing systems within the organization, and make estimates regarding the need for extra investments such as hardware, infrastructure, training needs, support, etc.
Detailed Product Description
The reports are not intended to replace the due diligence process required by a microinsurance organisation to identify appropriate Information System (IS) software. Rather, the individual reports, combined with the comparison charts, are intended to propel an organization further along in their selection process without having to expend a great deal of staff time on conducting an initial scan of available options.
About the Inventory
2010
4
The Review Process
The review process follows 5 main steps
1. A Request For Information is sent to a software provider to gather data about the product under review and the company.
2. A demonstration of the software product. This takes place (online) using a desktop sharing tool or similar method and with contact by phone or Skype at the same time.
3. Writing the review document of the software 4. Validation of the review document
5. The review document is posted on the website of the microinsurance network
Once the report is written, members of the Microinsurance Network Technology Working Group which is comprised of individuals with extensive experience in microinsurance, systems development, and software evaluation, should review the report for consistency, fairness, and transparency.
Given the limitation on time, the evaluation design, available resources for the project, the desire to review the most currently available version of the software, and the need to keep the information as up-to-date as possible, it was not possible to evaluate all the features of each software application. Again, the core purpose of the report is to provide microinsurers with a strong position from which to begin a due diligence process. A core set of features is reviewed for all applications.
Evaluation Dates: June 2009 – April 2010 Evaluation Author: Michiel Berende
Insurance Management System | EOLAS 2010
5
2
About EOLAS' IMS
Eolas is a global management consulting, technology services and outsourcing company providing software solutions and services since 2003. Initially, Insurance Management System (IMS) is designed to meet the administrative requirements found in most health insurance providers, including Third Party Administrators - TPA.
IMS includes a variety of modules which cover the all the processes and operations of any health insurance company (Policy – Collections – Claims – Reimbursement). It is designed to support the Electronic Data Interchange requirements of Health Insurance Accountability and Portability.
This system offers real-time processing features for TPA and others to help better serve clients and business partners and to aid internal functionalities.
2.1 Product Summary
Insurance Management System (IMS)
Product version 9
Work Station Operating System
Windows 2000,Windows 2003, Windows XP
Networks Supported LAN, WAN & Internet
Software Language(s) English
User interface language(s) English
Database Oracle9i
Server Operating System Windows 2000,Windows 2003
Minimum Hardware Requirements
Pentium Class IV 1.8 MHz or Higher Processor, 384 MB RAM
40 GB / 80 GB Hard Disk, Input Device: Scanner, Output Device: Printer, Optical Device: CD
Base Price (US $) Variable based on the demand of the client Table 1: Product Summary Insurance Management System (IMS)
Insurance Management System | EOLAS 2010
6
2.2 Functionality and Scalability
2.2.1 Functional completeness, appropriateness and integration
IMS is an integrated version of the following modules:
• Data Repository System (DRS)
• General Insurance System (GIS)
• Hospital Scheme Management System (HSMS)
• Treatment Guidelines (TG)
• Claim Processing System (CPS)
• Finance Management System (FIMS)
• Reporting
2.2.2 Data Repository System (DRS)
DRS is used to maintain the details of insurance clients and their employees with dependents, the data available in the DRS will be used by the GIS to create the Policy and HSMS will be used to allocate the scheme and the ceiling limit details. The DRS covers the following functionalities:
1. Client Creation
2. Membership Enrolment
3. Membership Activation and Termination 4. Client Activation and Termination
Features
• The user can categorize the Clients (Company) under various company types
• It has the capability of classifying the Members under various Branches and Groups.
• Generates a unique member ID for the main member and for the dependents based on the Client Prefix available in the Client data.
• Any dependent or the entire family or the entire Client Group can be activated or de-activated.
Insurance Management System | EOLAS 2010
7
Figure 1: Client profile entry
2.2.3 General Insurance System (GIS)
GIS helps the insurer to manage the policy data of clients who are insured under the various policy types and ranges. The existing active policies can be endorsed and can be renewed for the next new period. Ceiling limits for the Hospital departments can only be set in the Hospital Scheme Management System (HSMS) after the creation of the company policies. Each underwriting creates either a Debit Note/Credit Note and makes them available in the Finance Management System (FIMS) for posting. The GIS covers the following functionalities.
1. Policy Creation 2. Policy Endorsement 3. Policy Renewal
Features
• It has the option of creating Policies under various policy types
• In the case of Medical Insurance, each company group can have an Individual policy
• The option of adding any number of ranges (category of employees who use the various schemes) into one policy with different sum-insured and Premium values.
• The option of managing OP and IP Sum insured and the OP and IP premium separately.
• A provision to add other government charges like Stamp Duty, V.A.T. etc. on each policy document.
Insurance Management System | EOLAS 2010
8
• The agent and broker commission will be calculated automatically based on the commission percentage defined in the agent master data.
• The existing polices can be endorsed (addition of lives or reduction of lives) or be renewed for the next period
• Until the confirmation of a particular policy (New, Endorsement or Renewal) it will be not treated as an active policy.
• Policies can be edited until confirmation
• During confirmation of each policy, the system generates a Policy Schedule Note, Debit Note or a Credit Note according to the type of confirmation.
• The option of using various currencies while creating the policies
• Generating Debit Notes and Credit Notes is available in FIMS for verification and posting to update outstanding entries.
Figure 2: Policy creation
2.2.4 Health Scheme Management System (HSMS)
HSMS is one of the core modules in the IMS system which maintains the medical master records such as Diagnosis, Consultation, Drugs, Investigations, etc. It also handles the details of each Service Provider (i.e., Hospitals, Hospital - Departments, Pharmacies and Doctors). The health scheme data such as Client Scheme and Ceiling Limit details for the policy are handled by this module. Smart Card entries of the personalized ceiling limit data for an insured member is also included in this module as an additional feature.
Insurance Management System | EOLAS 2010
9
Figure 1: Smart Cards application
HSMS covers the following functionalities: 1. Master Medical Records
2. Service Provider Management 3. Scheme Management
4. Client Scheme Mapping 5. Scheme Ceiling Mapping 6. Smart Card Personalization 7. Fingerprint Capture
Features
• All mandatory medical master data such as Diagnosis, Investigation, Consultation, Generic and Drugs details can be maintained in the system.
• The service provides basic information and the agreed treatment costs (Consultation, Investigations and Drugs) are maintained in the system.
• Provision for periodic updates of the agreed treatment cost (Consultation, Investigations and Drugs).
• The insurer can design the medical insurance product with various combinations of Service Providers, Investigation, Generic, and Diagnosis which help the insurer to limit and manage claim processing
• The system has the feature to allocate schemes under Individual and Family ceilings.
• A feature to maintain different ceiling limits for a same scheme for different clients based on the premium defined in the policy.
• The policy with various ranges can be mapped with various schemes with different ceiling limits for each hospital department for each membership relation.
Insurance Management System | EOLAS 2010
10
• From the total available membership data of the client, members can be mapped with any one of the available scheme ceilings (Membership Scheme) of that particular policy.
• Smart Card personalization updates the Personal and Scheme data on the chip, which act as the mandatory identity for treatment access.
• The system captures the fingerprint of each insured member, which acts as an additional verification protocol during treatment access.
• Smart Card Personalization and the Fingerprint Capture feature are available in Claim Processing System (CPS) which is installed at the service provider’s end.
• Any main member or dependent can be deactivated from the scheme and can be reactivated.
• The Active Membership Scheme can be endorsed to add new members who join and to remove members who are discontinued from the policy based on the endorsement occurring in GIS.
• Authorization of an insured member who is admitted to the hospital for treatment has to be approved in the system via the Pre-Authorization screen.
• The Pre-Authorization function shows the available limit of the member and it will capture the Service Provider, Diagnosis, expected treatment cost, ICU required, Surgery Required and expected No. of days, which helps the insurer to verify the limits available and also to verify the particular claim after treatment.
Insurance Management System | EOLAS 2010
11
2.2.5 Treatment Guideline (TG)
TG is integrated with the HSMS and CPS systems to maintain the updated version of Treatment Protocols approved by the local government health department. Based on the diagnosis available in the treatment protocol, each and every claim will be verified. During the claim entry process the system checks the comparison report against the treatment prescribed by the consultant. TG covers the following functionalities.
1. TG Protocol Settings 2. TG validation with Claims
3. Marking treatment and medicines that are outside the TG.
Features
• Function to set up the covered ailment treatment guidelines according to WHO
• The system has a function to set up the treatment protocol based on Gender and Age Range
• The TG captures the generic as well as investigations covered under each ailment.
• During Claim processing, each claim is validated against the TG to ensure the right treatment for members and to avoid over-prescriptions and over-charges.
• The system can view the WHO ailment standards and information about the selected ailment.
2.2.6 Claims Processing System (CPS):
CPS is installed in the Check-In-Desk location to verify the valid insured patients for the treatment at the service provider end. CPS has various verification methods such as Smart Card, Finger Print and Photo Identification to validate the patients. The valid patient will go for treatment after completing the OP/IP registration in the system. The treatment bill provided by the Service providers will be entered into the CPS. During claim processing, the system validates the ceiling limit availability and treatment protocol set in the TG system against the claim. CPS covers the following functionalities:
1. In Patient (IP) Registration 2. Out Patient (OP) Registration 3. Claim Processing
Features
• The validation of the patients has to be performed by the smart card and finger print methods during the registration (OP/IP).
• The system restricts invalid members from accessing the treatment.
• The system picks up the membership and scheme data from the Smart Card, which speeds up the registration and claim processing.
Insurance Management System | EOLAS 2010
12
• There are schemes to allow registration of the patient at the service provider end only if the scheme is mapped with the service provider.
• The scheme for the member is decided by the facility he or she can use at the service-provider end.
• OP Registration is not allowed for members who have already registered for the treatment. They will allow for registration once they close the treatment.
• Any number of claims can be processed against the OP Registration.
• IP Registration is allowed only for the members with approved Pre-Authorization and is available in HSMS.
• Multiple claims can be processed for the IP Registration until the members discharge date is captured.
• Option to verify the fingerprint of IP patient during the discharge.
• Claims processing is only allowed for members whose OP/IP data is available.
• The system lists the medical data such as Diagnosis, Investigation, Consultation, Drugs, etc. based on the scheme of the member.
• The claims processing screen captures the ceiling limit details from the smart card and validates it against the treatment bill.
• The system rejects entry of the medical expenses once the used amount reaches the ceiling limit.
• To provide quality health care and to avoid treatment malpractice, the system automatically verifies each item of medical data against the treatment protocol.
• The system populates the agreed cost of each medical expense, and charges that exceed the agreed cost will not be added to the claim amount.
Insurance Management System | EOLAS 2010
13
Figure 4: Claims processing
2.2.7 Finance Management System (FIMS)
FIMS is able to create new Ledgers, Account types and Charts of Accounts. The user can post GIS Credit and Debit notes and HSMS Credit notes. The posting of Sales invoices and purchase invoices (Taxable and Non-Taxable) can be done in FIMS. General Vouchers are created for Advance Payment, Advance Receipt, GIS – Collection & Payment, HSMS – Payment, Sales Invoice Collection and Purchase Invoice Payment. The system can generate all the standard financial reports such as TB, P&L, BS and Outstanding reports. Functionalities include: 1. Chart of Accounts 2. Debit/Credit Notes 3. Policy Collection 4. Policy Settlement 5. Tax Invoice 6. Supplier Invoice
Features
• Default account types are provided in the system
Insurance Management System | EOLAS 2010
14
• The capability to create and maintain any number of charts of accounts under different account types.
• The ability to link Service Providers, Clients and Brokers chart of accounts with their master data, to avoid duplication and update the journal data automatically.
• Other vendors, parties, income and expense chart of accounts can be maintained.
• The option to activate and de-activate the existing charts of accounts
• Customized Journal Type Definitions feature.
• Customized Policy posting templates to avoid the manual data entry errors when posting debit and credit notes.
• Premium collection function to collect multiple debit notes with partial or full payment modes, which automatically generate journals and update the outstandings.
• Service Providers claim values will be automatically updated as journal entries during the claim closure process in HSMS.
• HSMS Closed Claims will be available in FIMS for the payment; functionality to pay multiple and partial claim payments, which automatically generate journals and update the outstandings.
• A Tax/Non-Tax Invoice can be generated from the system to maintain other income types. Collection and refund of the Invoice is also available.
• The system enables the insurer to maintain transactions with other vendors through the Supplier Invoice, Supplier payments and Supplier Debit Note.
• The provision to pay the Service Provider and Other Vendors in advance, which will be matched against the upcoming invoices.
• General entries can be made through the Journal Entry option.
• The system generates all kinds of default accounting reports such as Trial Balance, Accounts Book, Profit & Loss, Balance Sheet, etc.
Insurance Management System | EOLAS 2010
15
Figure 5: Account details
2.3 Usability
2.3.1 The friendliness of the user interface determined by the
navigational architecture of the software along with
consistencies across screens and menus
IMS is a system that would need extensive training and support to understand the various modules, each of which has its specific way of handling. But once that is provided, the insurer will be ensured of having a proper system for maintaining not only its critical insurance processes but also to have access to all kinds of information that is required to operate as a professional insurance company.
The interface contains drop-down menus where needed. Clicking on boxes containing data allows the user to intuitively drill down into the system for more detailed information. Eolas provides workflow scenarios for each sub-process through a detailed product presentation.
2.3.2 The quality and availability of user training, support and
resources, both online and in print
Eolas' training staff co-ordinates with each module administrator (basically the department head(s) of the insurance company) and subsequently selects the users who are to be trained in the system. Once the trainees are selected, the Eolas trainer presents the entire functional
Insurance Management System | EOLAS 2010
16
flow of the system to the user team as a demo. With this, the trainer supports the team in understanding the system and its integration in the insurance process. The trainer then starts to work with each module team and helps the team to get familiar and to understand the system. The number of days required for training depends on the capacity of the individual user. Eolas also provides a manual which is an additional aid.
2.4 Reports
The REPORTS Module provides the various reports based on the combination of input parameters provide by the user. The IMS reporting module has various reports; the additional report will be added into the system based on the requirements of the user.
Insurance Management System | EOLAS 2010
17
Figure 7: Supplier account statement
2.5 Financial Standards and Compliance
The earlier described module "Financial Management System" FIMS provides functionality to create new Ledgers, Account types and Charts of Accounts. The user can post GIS Credit and Debit notes and HSMS Credit notes. Sales Invoice and Purchase Invoices (Taxable and Non-Taxable) can be posted in FIMS.
The system generates all kinds of default accounting reports such as Trial Balance, Accounts Book, Profit & Loss, Balance Sheet, etc.
Insurance Management System | EOLAS 2010
18
Figure 8: Trial balance
2.6 System Administration and Technical Support
2.6.1 Security
Through various user account types, IMS prevents conflicts of roles in the insurance processes and modifications to the data. Only the administrator is able to access all levels in the software. The user authentication is done by defining various user roles and assigning the passwords for login roles to the users.
2.6.2 Production Support
Eolas has a well-defined and mature production support management process which allows the effective capture, reporting, tracking and resolution of issues. This process supports a well-distributed delivery environment in which work responsibilities can be effectively divided between the various organizations depending on the request / problem levels. Each of these activities will be governed by SLAs.
• Request / problem management
• Management of incidents
• Processing of incidents
• Workaround
• Resolution
• Deployment of patches
Insurance Management System | EOLAS 2010
19
Interaction Support level Role Functionality
Level 1 Initial troubleshooting and diagnosis
Level 2 Technical support group and operations applications
support team
Level 3 Specialist team and application development team
Level 4 Interaction and coordination with third party vendors
Table 1: Support level roles
We are capable of providing the following production support services to customers for the business critical applications with stringent SLAs for response, workaround & resolution of issues.
24 hours X 7 Days a week 16 hours X 5 Days a week 08 hours X 5 Days a week
2.6.3 Installation and conversion version control and upgrade
strategies
Installation
IMS installation starts with the configuration of the Oracle DB by creating table space, oracle users and importing the blank database with default table values. Simultaneously, the local networking and installation of the client version of Oracle 9i is done in all the user systems. The setup of the IMS application proceeds once the Oracle user is connected to the server. The configuration of Oracle DB takes approximately four hours. The IMS installation and configuration in each user system takes two hours.
Conversion
Eolas finds the conversion of existing data into the IMS challenging, but gets this done by coordinating with the client to provide the data from the existing system as predefined Excel templates which are later exported to the IMS system. This reduces the data entry load for the users. The quality of the exported data is verified by the system and the module administrator before implementing it.
2.7 Technical Specifications
2.7.1
Microsoft Technologies
Eolas' solutions and services are built around Microsoft technologies, including enterprise project management, platform migration, .NET architecture consulting, and application integration.
Insurance Management System | EOLAS 2010
20
2.7.2 Oracle 9i & Above Database
The database is Oracle9i, providing secure data management for high-end applications such as high-volume on-line transaction processing (OLTP) environments, query-intensive data warehouses, and demanding Internet applications.
2.7.3 MS SQL 2000 & Above Database
Microsoft SQL Server is comprehensive, integrated data management and analysis software that enables organizations to reliably manage mission-critical information and confidently run today’s increasingly complex business applications. SQL Server allows companies to gain greater insight from their business information and achieve faster results for a competitive advantage.
2.7.4 RFID
Radio Frequency Identification (RFID) technology is garnering considerable attention in the market as the leading edge of automated identification technologies. Eolas is working with clients in Health Care, Hospitals and General Insurance in helping them to assess and implement RFID programs for compliance and beyond.
2.7.5 GPRS/GSM
GPRS (General Packet Radio Service) is a packet-switched service that allows data communications to be sent and received over the existing Global System for Mobile (GSM) communications voice network. GPRS complements existing GSM services such as circuit switched phone connections and Short Message Service (SMS). With GPRS, the user will experience data rates that are significantly faster than a GSM circuit switched data connection. The network operator gains the efficiency of packet data, so that more users can be connected simultaneously. Eolas proposes this technology to clients who have their check-in desk check-in remote areas and who need to transfer data between the head office and check-check-in desk and vice versa.
2.7.6
A “biometric” technology is an automatic method for identification, or identity verification, of an individual based on physiological or behavioural characteristics. Biometric systems function to identify individuals by matching a specific personal characteristic, the biometric identifier, with one that has been previously recorded. Researchers have determined that fingerprinting is the only biometric technology that can currently meet all the application criteria. Biometric details are stored on smart cards which are supported by IMS.
Biometric Identification / Smart Card
2.7.7 Near Future Technology
Eolas is planning to provide Hand Held Device and Touch Screen solutions for its clients wherever they are applicable. Eolas also wants to introduce its software applications in other regional languages.
Insurance Management System | EOLAS 2010
21
2.7.8 Research and development
According to Eolas, they have an application development process which comprises the complete Systems Development Life Cycle (SDLC) from business case analysis to warranty support of the application. This process supports a distributed delivery environment in which work responsibilities can be divided between the delivery teams spread across the globe. Each of the development phases can be defined with metrics and subsequently tracked with the web-based tools that can be used by Eolas customers.
The application development methodology can be used for:
• New application development
• Existing application enhancement
• Application consolidation
• Application migration
Eolas provides complete application development lifecycle management that includes
• Project Scope Definition
• System Requirements Definition
• Application Design & Architecture
• Quality Assurance Architecture
• Software Development & Quality Testing
• System Implementation
• Knowledge Transfer
Insurance Management System | EOLAS 2010
22
2.8 Position of technologies and classification of the
products and services.
1. Customer Interface a. Distribution Channels
☑
b. Front-end Tools☑
2. Transaction Processing a. Connectivity Layer☑
b. Production Layer☑
3. Data Analysis & Processing a. Enterprise Layer☑
b. Support Layer☑
Insurance Management System | EOLAS 2010
23
2.9 Company Profile
Address A3, “Malles Roy Enclave”
#7, Central Avenue road Kodambakkam, Chennai – 24 India
Company Type Private Limited
Core Business Technology - Software development & consultancy
Time in Business 7 years [since June 2003]
Client Profile General Insurance Companies, Health Scheme
Providers, Hospitals, MFIs.
Client Base Health & General Insurance
Active Number of Clients 3
Location of Clients Uganda, Kenya
Location of Technical Assistance (TA) Offices
Chennai, Kampala Number of Employees / Number of
TA Staff
Employees 12 TA: 8
Medium of TA Available 1
Training Online, at location, Manuals (English)
TA Staff Experience Project Head - 7 years, Technical Head - 10 years,
Programmers - 2 to 4 years
Number of Software Implementations 7
Demo At location and/or Online demo available on request
Users Group General & Health insurance Companies,
Microinsurance Operators, ILO, World Bank
Summary of Costs
Additional Software Tools
2.9.1 Variable according to the demand of clients
Training Fees Dependent on the size of the requirement for Training
Consulting Services Dependent on the size of the requirement for
Consulting
Maintenance Contract Variable according to specific services