Fully-Insured Group Customer Management

A fully-insured group health plan is the traditional way to structure an employer-sponsored health plan. In the fully-insured group health plan, the employer contracts an insurance company to cover the employees and dependents. The employer pays a premium to the insurance carrier. The premium rates are fixed for a year, based on the number of employees enrolled in the plan each month. The monthly premium changes during the year when the number of enrolled employees in the plan changes. The insurance carrier collects the premiums and pays the health insurance claims based on the coverage benefits outlined in the policy. The covered persons (i.e. employees and dependents) are responsible to pay any deductible amounts or co-payments required for covered services under the policy.

The system enables you to create customers and accounts for the fully-insured group health insurance business. This chapter explains how to create different entities involved in the fully-insured group health insurance business.

Related Topics

Parent topic: Oracle Revenue Management and Billing Insurance Business Processes