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S YSLIFT A M ANAGEMENT I NFORMATION S YSTEM F OR M ICRO I NSURANCE Designed by Health Developed by.

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Presentation on theme: "S YSLIFT A M ANAGEMENT I NFORMATION S YSTEM F OR M ICRO I NSURANCE Designed by Health Developed by."— Presentation transcript:

1 S YSLIFT A M ANAGEMENT I NFORMATION S YSTEM F OR M ICRO I NSURANCE Designed by Health Developed by

2 2 Software developed by Tieto Enator for Micro- Insurance Units Meant for community based organizations/branches gathered together under a Federation Can be used by any Micro insurance model (mutual or partner agent) Syslift

3 Syslift - MIS 3 MicroInsurance Management Information System. Reporting customized for various levels of decision. Strong capacity for Health Insurance. Comprehensive Database for statistical research. Tracking & understanding of contributions and members’ data. Risk management indicators for managing Insurance Management. Capacity to handle infinite products under 3 categories : Health - Accident – Property User Friendly : Fully open to Development specification suggestions. SYSLIFT IS A Freeware offered to micro insurance units sharing their database with all other user-MIUs.

4 1. To maintain information about products, policyholders, dependants, policies and claims. 2. To monitor Micro-Insurance portfolios. 3. To monitor quality data encoding. 4. To faster the claim settlement process – cashless systems. 4 To Provide MIU’s with data from a Centralized Database for easing their activities management, and helping their clients/members to have a better behavior related to the concerned risk. Syslift Objectives

5 Operational Processes Syslift Software for Policy Making Portfolio management Claims Processing & Decision Makings Statistics and reporting 5 Community A Community B Reporting

6 6 Syslift Overview Syslift Security Roles & Database Support Functionalities Data Models Pl click on buttons

7 Complete DB security Complete User Configuration User Logins & Roles Physically data deletion not possible, logically possible to hide or unhide – Administrator Right 7 Security Roles

8 Back End – Database - SQL Server Front End – Application - Visual Basics Client Server 8 DB support User Role Limited accessPurpose / Work PrinterNo Field EditableTo read any data. EncoderRight of Policy/ Claims Creation before validations To do all type of encoding only. Claim Adjuster Limited Fields editable on Claims For Claim Trials. Controll er Finalized Decisions can’t be changed /edited. Right of Decision making Adminis trator Works thru different User Roles. Responsible for Data security & quality. User Operate through its limited User Property Use Me

9 Policy Category - 3 Types of Insurance Policies 9 Syslift Functionalities Policies & Products Health Insurance Policies Accidental – Life Insurance Policies Property – Asset Insurance Policies Products - Possible to handle Infinite no of Products under Policy Category Called as “Policy Products”.

10 Policy Factor Catalog Fixed Factors & Variable Factors – Formula Writing possible 10 Product Definitions Product Definitions – Includes Factors. Responsible for Automatic Premium Calculations.

11 Partner/Policy Search Names or Branch Name or Policy Nr etc. 11 Policy Management Partner/Policy Creation

12 Policy Information available at a glance - One Policy Holder (or family) with Many types of Policies or Products. Policy Shift/ Selection from One policy to other Possible. 12 Policy Selection Policy Details like Policy Number, Categories, Products, Start dates, End dates etc.

13 For Balance Payments / Premiums Warning message for balance of premium not paid 13 Policy Validations Policy Validations For Factors Value Checking Contribution Details & Encoded Data should match

14 Information of Multiple Claims on One policy – available on One Window. 14 Claims Management Claims Details – family or Individual Claim Benefit Category & Max Limit - Doesn’t allow Claim amt higher than its Max Limit Extensive Data of Expenses Billed

15 Inter-National Classification of Diseases (ICD) by WHO – Upto 3 rd level 15 Claims Management Amounts Related to Claims - Total Expenses Billed - Amt. Claimed Amt Claimable Amt Disbursed Additional Benefit Amt.

16 16 Reporting From Syslift No Limited In-built reports Reports Development using Crystal Reports Report Association Possible Choice of Filters – Parameters Settings Export Facility – Excel, Crystal Reports, DIF, CSV

17 All Quantitative & Qualitative reports possible. 17 Reporting From Syslift Technical Report with – Important Ratios – Claim Ratio Frequency Ratio etc. Fund balances Claim Paid Amount Insured Members Claims to be processed Health Insurance Indicators Use Me

18 Data Model Features Security: Login with password and various possible user roles. 3 Types of policy Categories and an infinite number of possible policy Products. 5 Levels of portfolio consolidation (Community – Fed). Extensive Claim Information Management: Health Events chosen from the ICD (WHO) Any Bill or Expenses are sorted per Hospital Data Model including Policies, Persons, Families, Socio economic and personal health information, International Diseases Catalogs (WHO).  Various reports and Wide potential for statistical studies. 18

19 19 Data Model – Data Tables Partner : Contains Partner’s Data Partner No, First_Name, Middle_Name, Last_Name, Area, Branch, Income, Birth_Date, Religion, Address Etc. Program : Contains Federations Structure, (E.g. Federation  Distri ct  Village  Group) Business_Code : Contains Business codes, and description, (E.g. Self Employed, business name, Govt. Employed, type of work, etc) Policy Table : Contains All Information about Policy of partner like Policy Number, Type, Policy Holder, Premium, Start Date, End Date, Enrollment Date. Policy Receipt Table : Has Information about Policy Receipts. Receipt SrNo. Receipt_Date, Encode_Date, Encoder, Collector. Policy Dependents Table : Stores info about all dependents of policy. Like Policy ID, Policy holder, Relation, etc Policy Claim Table : Holds Claims Information about Policy claims of partners like Claim_Number, Start Date, End Date, Enrollment Date. Policy Claim Details : Has details about Claims. Claim_Number, Bill Date, Claim_Expense Details, Hospital Name, Doctor In Charge, Normal Market Price, Expenses billed, Amount Claimable, Indemnity

20 Data Model – Catalogues Kat_ICD : Contains ICD List (International Classification of Diseases) ICD Code, Description, Kat_Policy_Type : Contains Policy Types (Personal, Accidental, Property) Kat_Medical condition : Contains Business codes, and description, (E.g. Self Employed, business name, Govt. Employed, type of work, etc) Kat_Relation : Contains All relations in it Father, Mother, Brother, Sister, Spouse, Father In-Law. etc Kat_Claim_Status : Stores Status of Claim (Opened, encoded, enquiry, Ready for Settlement, Settled. Kat_Document_Type : Has details about document types needed for claims. Member ID Card, Claim application document Doctor’s Checking Report, prescription. etc Kat_Expenses : Stores Status of Expenses for claims : (Expense Code, Policy Type).

21 Partner Information – Partner Window 21 Partner & Policy Windows Family Information – Policy Details Window Policy Details Personal Details Medical Conditions Relations etc

22 Status of Processing of Claims Opened Encoded Enquiry & Ready for Settlement. Decision Making Status – Settled Unpaid Settled Paid & Settled Guidance Only 22 Policy & Claims Status Expire Status – Expired Policy Cancel Status – Cancelled Policy Open Status – Ongoing Policy

23 Portfolio levels upto 5 th level are available. Helps to study closely the smallest possible unit Also, useful for Consolidated studies & Analytical studies Study of regional differences Health trends & parameters etc. 23 Data Models – 5 Levels

24 User Creation Shift to Community – Easy shift of partners from one Branch to other Report association Policy receipts Policy Expiration Contribution Statistics.. – Technical Report with Health Insurance Indicators 24 Administrative Catalogs Catalog Editor - Organizational Structure – levels of Portfolio Medical Condition – Attached to Partner Business types and Relations Expenses types & Expenses – For Claims Document type & Claim Benefit Category – Attached to claims Policy factor & Product – Product Definition

25 Plans For 2007 To configure the software for Cash less claim settlement. Online download – Web based software. Licensing of Software To develop Centralize DB systems. Health care pricing lists and Hospitals’ agreement stored and comparable. Multi Scripts Multi lingual 25

26 How to get the Software? Pl Contact us at: UpLift India Association Phone: 020-26051013/ 9225528127 26

27 THANK YOU! 27


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