Product and benefit establishment

Complex products can be fully customised by users

• Products are defined for a particular underwriter
• Benefits defined with associated rules to drive automated claims adjudication and policy management
• Rate card controls premium calculation

Group set up

Group can be set up of different products or groups of products from different underwriters

• Easily defined groups, divisions and locations
• Assigned premium calculation methods, billing methods and frequency
• Members' details loaded into OMNIQ Group Health using standard policy upload interface
• Automatically creates policies and calculates initial instalment and annualised premium
• Multi-step group renewal process and premium recalculation

Policy updates

Online updates of member and policy information by administrator

• Detailed audit maintained
• Ability to update member policy details including billing, receipt details, banking details for claim payments and direct debit receipts

Multiple Underwriters

Supports multiple underwriters and for different products to be defined by an underwriter

• Security settings to limit amount of information the user wishes to provide
• Underwrite can run and download account and data warehouse extracts on line
• Underwriters can review and authorise pre-approvals, claims and medical invoices

Claims Management

Manages claims and prior approvals for hospital and primary care

• Automatic claim generation from authorised prior approval
• System steps through adjudication process against a series of defined checks
• System calculates for each member and product total premium, tax, instalments and risk portion based on member demographics using list of rate cards for products and underwriters

Billing

Billing tool handles full range of billing option and combinations with flexibility to cover various premium rates and frequencies from weekly to annual including:

• Full employer subsidy
• Partial employer subsidy
• Payroll deductions
• Direct Debit
• Credit Card

In addition OMNIQ offers:

• Automatic direct debits and payments matched against premiums raised
• Option to calculate credit billing and rebilling for retrospective changes to policy or premium

Receipting / Cash Matching / Group Reconciliation

Sophisticated electronic cash matching and group reconciliation module

• Designed to handle the complexities of various group billing options
• This is an area where major bottlenecks frequently occur in most other group systems.

Debtors

Monitoring of group and individual debtors

• Creates individualised overdue payment letters
• Calculates commission for ongoing payments to suppliers and can be customised for advisor management
• On line review of employee information and benefits
• On line claims and updates by members
• Business intelligence and management reporting