C. Enrollment of Beneficiaries for the Plan

1. Applications for Enrollment in the Insurance / Benefit Plans will be obtained through
   a) Internet
   b) Surface Mail
   c) Bulk enrollment through:
   i. Brokers
   ii. Agents
   iii. TPA's
   d) Client Representative.
   e) Its Own Representative.
   
   
2. The data will be entered individually, where needed and validated through validation program for accuracy and completeness.
   
   
3. The approved list will update in the Master list of affected tables.
   
   
4. The rejected list will be sent to the applicant / the forwarding agency for resubmission or rejection.
   
   
5. Where the applications are received through Internet, a confirmation letter will be sent to the Applicant on hard copy for his /her authentication and return. The Plan becomes effective only after the receipt of the signed copy.

1. Premium may be received from Individual Beneficiary through Check, Demand Drafts, Money Order, Pay Order or Credit or Debit Card Authorization.
   
   
2. Corporate Clients may send the details of Premium Cutting as a separate file or as part of their combined Pay Roll.
   
   
3. Groups may send their Premium Payments through a separate file.
   
   
4. There will be a necessity to Import the above into the master files of the legacy database as each Client/ Group may have their own established data formats.
   
   
5. Import definitions for each of the Clients / Groups should be customized.
   
   
6. The Imported data will be reconciled for short, missing, invalid or overpayment against actual due and the Client notified accordingly.
   
   
7. After reconciliation, the premium payment will update individual running ledger entry.

1. Individuals prefer Claims against Products.
   
   
2. These are required to be settled by the Carriers as per the entitlement.
   
   
3. Claims are validated by Program as well as by the Claims Staff who are trained Claims Settlers.
   
   
4. The Program does the validation for Effectiveness of the Claim, limits of liability.
   
   
5. The Settlers verify authenticity of the Beneficiary and the supporting documents. In case of Life, Property and Vehicle Insurance legal documents may be required to authenticate the claim and the claimant.
   
   
6. Once the Claim is processed, it is passed for Payment or Rejected.
   
   
7. The Payment Order would be generated and sent to the Beneficiary or the Rejection slip with reasons.

Insurance and Benefits Management Business Processes:

a) Publicity and Promotion of Products.
b) Product Evaluation.
c) Enrollment of Beneficiaries for the Plans.
d) Receipts and Accounting of Premiums.
e) Processing and Settlement of Claims.
f)  Payments Processing and Settlement of Accounts with Vendors.
g) Payments Processing and Settlement of accounts with Agents/ Brokers.
h) Routine and Exception Reporting for Management Control.
i)  Customer Relations Management with Beneficiaries and Vendors.
j)  Accounting and Audit.
System Administration.

Case Studies:

• Cook Children's Health Care System, U.S.A.
• Claim Management Services Inc., U.S.A.
• Memorial Hermann Health Network Providers., U.S.A.