Managing Group Policies

This chapter describes how to manage group policies. It includes the following topics:

About Group Policies

Group policies are insurance policies sold to a group on behalf of its members. The group is the insured party and can be an employer purchasing insurance for its employees, a group of employers who are purchasing insurance together, or an association or club purchasing insurance for its members.

Each group policy can offer many products. Group insurance products include group life, supplemental group life, group disability, group health, vision, and dental.

Some group policies, especially those for larger groups, offer different products to different employee classes of group members. Examples of employee classes are salaried employees and hourly employees.

Group members have the option to accept coverage that is available for their class. Group members who accept coverage are enrolled in the policy and are considered the primary member of the policy. Enrolled members are usually referred to as members (for health insurance) or policyholders (for other kinds of insurance).

Primary members can choose products for themselves and for family members or dependents. Usually, different products are available for primary members and for other policy members.

The Group Policies screen allows users to manage group insurance. Specifically, it allows end users to generate proposals, create policies and quotes, add employee classes, design plans, enroll members, and provide service for the policy.

Note: In order to generate proposals from the Group Policies screen, you must purchase the Siebel Proposals & Presentations module.

Common Policy Views

The following table describes views common to all policy screens.

Table Common Policy Screen Views

View Tab	Description
Summary	Displays a summary of key data associated with a policy in a single view.
Rate Model	Applicable to auto and property policies. Allows users to select coverages and limits for an individual policy.
Claims	Displays claims recorded for an individual policy.
Proposals	Allows for the creation and retrieval of quotes prepared for a customer associated with an individual quote or policy. Proposals would normally show up in the quote process, but not later.
Underwriting Reports	Allows users to collect and manage underwriting information associated with an application. These reports are sometimes ordered during the application process and sometimes after an application is submitted.
Documents	Allows users to collect and manage documents associated with an application.
Third Parties	Applicable to auto and property policies. Allows users to collect and manage information describing other parties who have an interest in insured property. Examples include a loss payee for an automobile loan or a mortgagee on real property.

For more information on other Insurance policy views, see Managing Auto Policies Managing Life and Annuity Policies, Managing Property Policies and Managing PUL Policies

Scenario for Group Policies

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 an insurance agent. The insurance broker has called on behalf of a prospective customer who wants to offer insurance to its employees at group rates.

In Siebel Insurance, the sales representative adds a policy record for the company, which automatically assigns a unique policy number to the company. Then he imports census information for the company using the electronic file he received from the broker (alternatively, the broker might import the census himself through the Siebel Agent Portal). Next, he sets up employee classes, and adds a plan design by adding products for the policy. The plan design information and census data can be sent to the insurance company’s rating engine to generate a quote for this policy.

Next, he uses a template to generate a proposal, which he then sends to the prospect.

Two weeks later, he receives an email message from the broker indicating that the prospect has called back and will probably purchase a policy, but requires a revised proposal. He selects a group insurance plan according to the needs of the prospect. Next, he schedules an activity as a reminder to return the call with the revised premium information.

The prospect accepts the revised proposal. Now the sales representative needs to complete the procedures necessary to issue a policy. This includes collecting information about group members and about billing and payment preferences. He follows the procedures implemented by his company to submit the policy for issuance and billing.

Process of Managing Group Policies

This topic details sample tasks often performed by administrators and end-users when managing group policies. Your company might follow a different process according to its business requirements.

Administrator Procedures

The following list shows tasks administrators typically perform to manage group policies:

Note: Only those with Siebel administrator responsibilities can change entries in the Insurance Administration and Product Administration screens.

End-User Procedures

The following list shows tasks end users typically perform when managing call group policies:

Adding Group Insurance Products and Product Lines

As an administrator, you can add products to the Siebel database. This section describes the procedure for setting up products and product lines in general terms.

You can also specify that a product line is one that your company contracts agencies to sell, or that the state licenses agencies to sell, or both.

For more information about adding product and product lines, see Siebel Product Administration Guide and Siebel Applications Administration Guide.

To add a group insurance product

Set up the product class structure, including product class attributes.
Add the products in the Product Administration screen and associate them with the appropriate class.
In the Category field in the Products form, select Group Insurance.
Include the product in a product line.
Specify a product line type:
1. From the application-level menu, choose View, Site Map, Application Administration, and then Product Lines.
2. In the Product Line list, select one or both of the following fields:
  - Contracting. To specify that the product line is one that your company contracts agencies to sell. This product line will appear to end users as a choice in the Lines of Business dialog box in the Partners, Contracts view tab.
  - Licensing. To specify that the product line is one that agencies can be granted a state license to sell. This product line will appear to end users as a choice in the Lines of Business dialog box in the Partners, Licenses & Appointments view tab.
    A check box appears in the middle of the field.
3. Click in a blank check box to select the product line type or click the X in a check box to clear it.
Set up the Customization Product by defining configuration rules and specifying the user interface.
For more information, see the section on creating customizable products in Siebel Product Administration Guide.

Adding Group Insurance Rate Bands

After you add a product in the Product Administration screen, you can use the Insurance Administration screen to associate a rate band with a product. A rate band is pricing information about the deductible, the premium, and the payroll deduction for each insurance product.

To add a rate band

From the application-level menu, choose View, Site Map, Insurance Administration, and then Health and Group Products.
In the Products list, select a product.
In the Rate Bands list, add a record and complete the necessary fields.

Defining Activity Plan Templates for Group Policies

Activity Plan Templates allow you to create and manage activities related to group policies. You define templates using the Administration - Data screen Activity Templates and Activity Template Details views.

To create an activity plan template

Navigate to the Site Map, Administration - Data, and then Activity Templates.
In the Activity Plan Templates list, add a record.
In the Name field, type a name for the template.
In the Type field, choose FINS Group Policy.
Complete the remaining necessary fields.

For more information, see Siebel Applications Administration Guide.

Creating Activities for the Template

Use the following procedure to create activities for the template.

To create activities for the template

Navigate to the Site Map, Administration - Data, and then Activity Templates.
In the Activity Plan Templates list, select a template.
Click the Activity Template Details view tab.
In the Activity Template Details list, add a record.
Complete the necessary fields for each activity assigned to the template.
From the drop-down list, choose an activity type.

Note: Repeat Step 2 through Step 6 to add activities to the template.
Save the activity.

Defining Proposal Templates for Group Policies

Proposal Templates with a particular definition allow you to create and manage proposals related to group policies. You define templates using the Administration - Document screen Proposal Templates view.

To create an proposal template for group policies

Navigate to Site Map, Administration - Document, and then Proposal Templates.
In the Proposal Templates list, add a record.
In the Name field, type a name for the template.
In the Category field, select Insurance Proposal.
Complete the remaining necessary fields.

For more information, see Siebel Applications Administration Guide.

Adding Group Policy Records

Adding a group policy record is the first step in generating a policy proposal or issuing a group policy. After end users add a policy record, they must set up employee classes, add a policy plan design, and generate a policy proposal. If the customer accepts the proposal, they add eligible members, enroll members who elect coverage under the plan, and set up policy payment plans.

To add a policy record

Navigate to the Group Policies screen.
In the Policies/Quotes list, add a record and complete the necessary fields.

Importing Census Information

Insurance companies often receive group insurance census information from external sources. For example, an insurance broker collects this data and provides it to the insurance company as a comma separated text file.

End users can use the Group Policies Census view to import the census data into Siebel Insurance.

Note: Census data can also be imported from the Companies Census view.

Both detailed and segmented census data can be imported for each census. Usually, either only detailed or segmented census information is added for a company. However, both types of census information can be added.

Census data can also be imported by the originators, such as insurance brokers or employer groups, using Siebel Agent Portal or Siebel Group Portal. For more information about these two products, see Siebel Partner Relationship Management Administration Guide.

Census data can also be entered manually. See Adding Census Information in the Group Policies Screen.

To import detailed census data

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on a policy.
Click the Census view tab.
Click New to create a new census record and complete the fields.
In the Census list, from the view link list, select Detailed Census.
Scroll down to the Employee list and click Import.

In the Import dialog box, locate the file from which to import data and set the remaining parameters.

Some parameters are described in the following table.

Parameter	Description
Input Format	Select either comma separated text or tab delimited text file type.
Input Source	Select Auto Mapping.
Conflict Resolution	Choose how to handle data conflicts. Defaults to Overwrite Existing Record.

The field mappings appear in a dialog box showing how each import field maps to the Siebel field. By default fields with matching labels are mapped to each other.

To add or change a field mapping:
1. Highlight the field in the Import Field list
2. Highlight the field to map to in the Siebel Field list
3. Click Update Mapping
To remove an existing field mapping:
1. Highlight the field in the Import Field list
2. Highlight <ignore this field> to disregard the import field
3. Click Update Mapping
Click Next.

Importing Segmented Census Data

The census data is imported into the Siebel application and appears in the Employee List.

To import segmented census data

Follow the steps in Importing Census Information except select Segmented Census in Step 5.
The census data is imported and appears in the Employee Count list.

Adding Census Information in the Group Policies Screen

End users can add census information for companies that request a quote or proposal for a group insurance policy. To add census information, end users must:

Add a policy in the Group Policies screen
Add census information using the instructions in the following procedure
Associate the census with the policy using the instructions in the Associating a Census with a Policy procedure

Census data can also be automatically imported. See Importing Census Information.

To add census information

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on a policy.
Click the Census view tab.
In the Census list, from the view link list, select Segmented Census or Detailed Census.
- Segmented Census. Add information for groups of employees.
- Detailed Census. Add information for individual employees.
  
  Note: Usually, either only detailed or segmented information is added for a single census. However, information can be added for both.
In the Census list, add a record and complete the necessary fields.
For a Segmented Census:
- Scroll down to the Employee Count list.
- In the Employee Count list, add a record and complete the necessary fields.
For a Detailed Census:
- Scroll down to the Employee List list.
- In the Employee List list, add a record and complete the necessary fields.

Associating a Census with a Policy

Use the procedure below to associate a census with a policy.

To associate a census with a policy

Navigate to the Group Policies screen.
In the Policies/Quotes list, select a policy.
In the Policy Census field of the Policies/Quotes form, click the select button.
The Pick Group Census dialog box appears, showing each census available for that policy.
In the Pick Group Census dialog box, select a census and click OK.

Adding Employee Classes for Group Policies

Some group policies, especially those for larger groups, offer different products to different employee classes of group members. Examples of employee classes are salaried employees and hourly employees. Each employee class offers a unique combination of products, product options, and product rates. Users can use the Classes view to add or make changes to employee classes.

To add an employee class

Navigate to the Group Policies screen.
In the Policies/Quotes list, select a policy.
Click the Classes view tab.
In the Classes list, add a record and complete the necessary fields.

Designing Plans for Group Policies

End users can design plans for group polices by adding information about products, product classes, and rate bands.

A rate band is pricing information about the deductible, the premium, and the payroll deduction for each insurance product.

The following lists are available in the Plan Design view:

Product Attributes. This view contains the Plan Design Product list and the Attributes list. Use the Plan Design Product list to associate a product with the policy that appears in the Group Policy form. Use the Attributes list to view attribute information and change attribute values.
Product Classes. This view contains the Plan Design Product list and the Classes list. Use the Classes list to select employee classes that you want to associate with the selected product.
Product Class Matrix. This view contains the Plan Design Product Class Matrix list. In this list, you associate an employee class with the selected product.
Product Class Rate Bands. This view contains the Plan Design Product Class Rate Band list. Use this list to associate a rate band with the selected product/class.

To add a plan design

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on a group policy.
Click the Plan Design view tab.
The Plan Design Product list appears, showing the selected policy.

Note: If you need to add a product, in the Plan Design Products list, click New and complete the fields.
From the view link list, select Product Attributes and scroll down to the Attributes list.
In the Attributes list, change the appropriate information.
From the view link list, select Product Classes and scroll down to the Classes list.
1. In the Classes list, click New to associate an employee class with the selected product.
2. In the Class Name field, click the select button.
3. In the Pick Class dialog box, select an employee class from the Class Name field and click OK.
Note: Only employee classes available for the selected product appear in the Pick Class dialog box. You can add employee classes to the list in this dialog box by using Adding Employee Classes for Group Policies.
From the view link list, select Product Class Matrix.
1. In the Product Class Matrix list, check the appropriate product column for each class.
From the view link list, select Product Class Rate Bands.
1. In the Product Class list, select a record with the appropriate product and class and scroll down to the Rate Bands list.
2. In the Rate Bands list, click New to associate a rate band with the selected product and class.
3. In the Rate Bands field, click the select button.
4. In the Pick Product Rate Bands dialog box, select a Rate Band and click OK.
Note: Only available rate bands for the selected product appear in the Pick Product Rate Bands dialog box. Rate Bands are created in the Administration - Insurance, then the Health and Group Products view. For more information about how to add Rate Bands, see Adding Group Insurance Rate Bands.

To generate a proposal for this plan, see Generating Proposals for Group Policies.

How Enrollment Waiting Periods Affect the Start of Coverage

You can control how Siebel Insurance calculates the start of coverage by defining the enrollment waiting period in the Group Policies screen. When you add a Plan Design (see Designing Plans for Group Policies), you define Product Classes that you then associate with a specific product. In the Classes list you can specify the Waiting Period, that is the number of days that must pass prior to the start of coverage. The actual start of coverage appears in the Effective Date field in the Group Policies, Enrollment view. The Waiting Period you specify in the Plan Design, Classes list directly impacts this Effective Date.

By default, Siebel Insurance has the following defined rules:

If a Waiting Period is specified, the Effective Date is set to the number of waiting days from today’s date.
If a Waiting Period is not specified, the application checks today's date. If that date is before the 15th of the month, the Effective Date is set to the first of the month. If that date is after the 15th of the month, the Effective Date is set to the first of the following month.

When a user enrolls a new member in the Group Policy, Enrollment view, the Effective Date field defaults to a value based on these two rules and the application sets the Status field to Waiting.

The FINS Member Enrollment Rules Workflow enforces these rules. Users can invoke this workflow by submitting a repeating component job request that repeats every 24 hours in batch mode. It checks the Effective Date of existing enrollment records and updates the Status from Waiting to Active if:

The Effective Date of a record is less than or equal to today’s date
The Status is still set to Waiting

For more information on component job requests, see Siebel System Administration Guide.

Reconfiguring Customizable Products in Plan Design

End users can dynamically reconfigure customizable products by using the Customize Plan button in the Product Attributes list. The Customize Plan button is only available if Siebel Configurator was installed and the selected product was created as a customizable product in Siebel Configurator. For more information, see the chapters about customizable products in the Siebel Product Administration Guide.

To dynamically reconfigure customizable products in plan design

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on a group policy.
Click the Plan Design view tab.
Select the Product Attributes view link.
In the Product list, click Customize Plan.
A configuration session launches and a selection page appears. The changes made in the configuration session are reflected in the line items in the Attributes list.

Generating Proposals for Group Policies

A proposal is a written quote for a policy. Before generating a proposal, end users must add the policy, set up classes, and add the policy plan design. Usually, the last step in adding the plan design is to activate the software program your company uses to rate policies. For more information, see Designing Plans for Group Policies.

Proposals are built off of pre-defined templates. For more information on creating proposal templates, see the chapter on proposals in Siebel Applications Administration Guide.

Note: Only those with Siebel administrator responsibilities can create or change proposal templates from the Administration - Document screen.

To generate a proposal

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on a policy.
Click the Proposals view tab.
In the Proposals list, add a record.
In the new record, select the appropriate template.
Click Generate Draft.

Managing Underwriting Information

End users can use the Underwriting Reports view tabs on the Group Policies screen to collect and manage underwriting information.

To add underwriting information

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on a policy.
Click the Underwriting Reports view tab.

In the Underwriting Reports list, attach the information and complete the necessary fields.

Some fields are described in the following table.

Field	Comments
Type	Type of underwriting report or information being requested.
Status	Status of the current report. Valid options include: Requested Received Submitted
Ordered	Date automatically generated by the application when a new record is created.
Received	Date the underwriting report was received.

Viewing Historical Underwriting Information

Use the procedure below to view historical underwriting information.

To view historical underwriting information

Navigate to the Group Policies screen.
Click the Group History view tab.
From the view link list in the Group History list, select a type of underwriting information:
- Rates
- Prior Insurance History
- Premium/Claim History
- Large Claimant History

Adding Eligible Members to Group Policies

After a customer accepts a group policy plan, end users can add or make changes to eligible members. Eligible members can accept or decline group policy coverages. Members who accept coverage can be enrolled in the plan.

To add an eligible member

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on the policy.
Click the Eligible Members view tab.
In the Primary Members list, add a record.
In the Add Members dialog box, select an existing record, or add a record and complete the necessary fields.

Note: During implementation, you will import the eligible members from the final census. For more information, see Importing Census Information.

Enrolling Members in Group Policies

Group members who accept coverage are enrolled in the policy and are considered the primary member of the policy. End users use the Enrollment view to enroll eligible members, including the primary member and dependents, who accept coverage in the plan.

To enroll a member

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on the policy.
Click the Enrollment view tab.
In the Primary Members list, select the primary member to enroll and scroll down to the Member Products list.
1. In the Member Products list, add a record and complete the necessary fields.
2. Repeat Step 4 for each product you would like to add for this primary member.
All the products related to this primary member’s enrollment are added.
Scroll down to the Insured Members list.
1. In the Insured Members list, click New to enroll the primary member and the dependents.
2. In the Last Name field, click the select button.
3. In the Pick Contacts dialog box, select the primary member that you would like to associate with the selected product and click OK.
4. In the Insured Members list, complete the remaining fields.
  
  Note: Add dependent members in the Pick Contacts dialog box by clicking on the New button and completing the fields.
Repeat Step 4 and Step 5 for each member you would like to enroll.

When you finish, all enrolled members, including the primary member, appear in the Insured Members list.

Adding Beneficiaries to Group Policies

Some group policies, such as group life insurance policies, require that members designate one or more policy beneficiaries. End users can use the Member Beneficiary view to add or make changes to group policy beneficiaries.

To add a beneficiary

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on the policy.
Click the Member Beneficiary view tab.
In the Member Life Products list, select a primary member record.
Scroll down to the Insured Members list and select a member for whom to add a beneficiary.
In the Beneficiary list, add a record and complete the necessary fields.

Setting Up Payment Plans for Group Policies

End users can set up payment plans, including details about payment methods, for group insurance policies.

To set up a payment plan for a group policy

Navigate to the Group Policies screen.
In the Policies/Quotes list, drill down on the policy.
Click the Payment Plans view tab.
In the Pay Plans list, add a record and complete the necessary fields.
Scroll down to the Payment Details form and update the statement information.
1. In the Last Name field, click the select button.
2. In the Pick Contact dialog box, select a name and click OK.