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Health

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The architecture of ACSEL and the component configuration fexibility provide insurers to be able to administer and manage any Health product and plan, tailoring packaged plans or customized plans, scales for medical and hospital services, agreements, etc., defining particular conditions as desired for any aspect of the value chain, whether regarding conditions for sales, networks and service providers associated with their life cycle, payments, terms and conditions, illnesses, accumulation, payment modes, etc. In short, it is a robust tool that allows clients to create and maintain products tailoring them to their business areas needs.

There are no limits to administer products and plans (both individual and group, as the case may be):

  • Hospitalization, Surgery and Maternity

  • Medical and major expenses

  • Reimbursements

  • Terminal illnesses

  • Complementary health insurance

  • Administered plans

  • Cancer insurance

  • Health care for specific illnesses

  • Travelers

Improve productivity and enhance customers satisfaction

The list below includes some of the various options offered by the system to configure and handle Health Insurance products and medical expenses, prepaid medicine, administrative plans, etc.

 

The system has a dynamic configuration tool that allows carriers to handle any field, table, formula or business rule in the Health value chain. There are preconfigured templates with different options. Some of the variables and functionalities include:

  • Configuration of group tables by age and relationship.

  • Deductibles, benefits, waiting periods, diagnosis, treatments, types of procedure, class of care.

  • Letter of Endorsement

  • Congenital diseases.

  • Plans with coverage abroad.

  • Type of access to service: Network, out-of-the network, or both.

  • Type of limit: Unlimited, amount, health-care agreement, based on the type of access to the service. 

  • Copayment.​

  • Consumption of the maximum benefit amount for various reasons.

  • Indicators to control service use.

  • Drugs, materials and supplies, with history of costs.

  • Benefits.

  • Benefit details (services).

  • Health Questionnaire.

  • Handling of scales, health-care agreements on costs per event and per procedure.

  • Handling of medical doctors and providers registered and not registered in the network.

  • Handling of a medical doctors network, with types of service fees.

The system also provides configuration of all business rules, formulas, requirements, conditions, etc. to process Health claims in all the aspects involved, including indemnity, reimbursement, service payment, etc.

  • Authorization and reimbursement.

  • Control of accumulation, including on coverage, benefits and use limits.

  • Online integration with external third parties systems and service providers for authorization and claim processing (also portals, IVR, etc.).

  • Indemnity to medical service providers, medical doctors and reimbursements.

  • Handling of billed, authorized, non-authorized, and indemnity amounts, as well as deductible values and copayments applied.

  • Indemnity for non-medical services (annuity and recovery, maternity assistance, burial).

  • Registration and control of unpaid amounts per authorization.

  • Itemization of clinical services, based on medical agreements.

  • Handling and control of partial payments per bill.

Need more details?

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