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Scenario for Health Insurance Quote and Application

This scenario features sample tasks performed by a licensed sales representative. Your company might follow a different workflow according to its business requirements.

In this scenario, a licensed sales representative for an insurance company is on the phone with a prospective customer who has called to request a quote for individual health insurance.

The sales representative adds information about the prospect and the prospect's dependents (including coordination of benefits). The prospect requests a quote for PPO coverage, dental insurance, and vision insurance. The sales representative adds the products and reviews the product attributes. Next, he asks the prospect for enough information to provide an initial premium quote to the prospect. He gives the prospect a verbal quote and ends the conversation.

One week later, he receives an email message that the prospect has called back and would like to purchase a policy. In Siebel Healthcare, he adds information about coverages for each applicant according to the needs of the prospect. In this case, one of the dependents will receive both dental and vision coverage. Another will receive vision coverage only. Therefore, he associates the first dependent with both vision and dental, and the second dependent with vision only. Next, he schedules an activity as a reminder to call the prospect back with the revised premium information.

During the second call, he gathers information from the prospect in order to process the application. First, he performs a health risk assessment for each applicant. Then he adds billing and payment arrangements. Finally, he follows the procedures implemented by his company to submit the policy for issuance and billing.

In this scenario, end users are a sales representatives who manages customer requests. They enter information to:

• Generate customer quotes
• Add an applicant
• Perform a health risk assessment
• Convert a quote to an active policy
• Associate a policy coverage with an applicant
• Add a service request
• Set up a payment plan
• Add detailed payment information for a payment plan