Plans, versions, variations and clauses

Version 2 adds depth to products: plans with their own rates and benefit tables, product versions with effective dates, variations by channel or segment, a clause library, test mode and scheduled launches. All of it is under Policies > Products.

Plans

A product sold in plans (Silver, Gold, Platinum) carries no base premium of its own: each plan has its own pricing, limits and benefit table.

1. On the product, switch on Sold in plans and save.
2. On the Plans tab, Add plan with its code, name and how its premium is set: per member by age band (health), a rate of the sum insured, or a flat premium per policy.
3. Open the plan (Rates and benefits). Add the age bands: the yearly premium for one member of that age. A band may name a gender or a relationship; the most specific band wins. Set the annual limit per member and, if you want, per family, and the provider network the plan accepts direct billing from.
4. Fill the benefit table: one line per benefit (in-patient, out-patient, maternity, dental...) with its annual limit, per-visit limit, copay, coinsurance, waiting period, pre-existing condition rule, and whether it needs pre-authorisation or is covered in network only. Add the standard benefits gives you the usual list to fill in.

Coverages can belong to one plan only (Only in plan), and each coverage has a kind: core (always included), rider, add-on or optional benefit (chosen quote by quote).

On a quote for a plan product, choose the plan; a member can sit on another plan of the same product, line by line. Each member is priced by age band; the premiums per member print on the schedule and on the group invoice.

Versions

Publishing a product freezes its configuration as version 1, in force from the date you give. From then on, quotes are priced with the version in force on their start date.

Changes you make later (a rate, a rule, a benefit) are kept on the product but not used for quotes until you release them with Release new version, giving the date they come into force. Quotes starting before that date keep the previous version; the Versions tab shows what each contained and when it applied. The product page warns you when there are unreleased changes.

At renewal, the product's rule decides: renew on the current version, or keep the version the policy was issued on.

Test mode lets you try a configuration before releasing it: only users who may edit products see the product when quoting, their quotes are marked as tests, cannot be issued, and always use the live configuration, released or not.

On sale from publishes a product now for a launch later: quotes before that date are referred to an underwriter, and the product team is told on launch day.

Variations

On the Variations tab, a product can differ by customer type, sales channel (direct, agent, broker, bancassurance, online) or branch: a premium adjustment, a commission rate, other sum insured limits, or not available at all. The most specific variation that matches a quote applies. The channel of a quote follows its agent or broker.

Clause library

Policies > Clause library holds your exclusions, conditions, warranties and wordings, written once. Attach them to a product on its Clauses tab; the default ones are pre-selected on every quote, the others are ticked quote by quote. The wording is frozen on the policy and printed on the schedule, with {customer_name}, {policy_number}, {sum_insured} and {start_date} filled in.

Code rules (health)

On a health product, the Code rules tab keys rules on diagnosis (ICD-10) or procedure codes: exclude a family of codes, require pre-authorisation, send to medical review, cap the allowed amount, or apply a waiting period. A pattern such as C* covers every code starting with C. The rules run on pre-authorisations and on claims.