Data Model

Policy

A policy is an agreement between the insurance carrier and the that defines a certain coverage or set of benefits in exchange for a premium. Group accounts (referenced by policies) are described in the Enrollment implementation guide. Data access groups (referenced by policies) are described in the User Access implementation guide.

Field	Description
Code	The code of the policy
Version	The version of the policy
Gid	The global unique identifier of the policy (this identifier is automatically issued when entering a new policy and it remains the same for all versions of the policy)
Status	The status of the policy: Edit, In Process, Pended, Approved or Canceled
Line of Business	The line of business that the policy belongs to
Brand	The brand that the policy belongs to
Data Access Group	The data access group used to differentiate over user access rights
Calculate on Cancellation?	Indicates if the policy will be (re)calculated when it is canceled; calculating the policy as part of the cancellation process is required for scenarios that include cancellation fees (an example is provided in the Cancel Policy section of the HTTP API Operations guide)

Constraints:

• It is not allowed to have multiple policies with the same code and version; the same applies for multiple policies with the same gid and version

Policyholder

A policyholder is the person who is legally accountable for the duties that stem from a policy. In case of health insurance often an employee will be the policyholder, with the employee, spouse and children as insured persons on the policy. In case of a P&C insurance often the owner of the object is the policyholder. A policy has a single policyholder at any point in time, but the role of the policyholder can be transferred to another person.

Field	Description
Policy	The policy that the policyholder holds
Person	The person that holds the policy
Start Date	The start date of the policyholder
End Date	The end date of the policyholder

Constraints:

• It is not allowed to have an overlap in time validity for policyholders with the same policy

Policy Broker Agent

Brokers and agents are described in the Brokers and Agents section of this document. A policy has a single policy broker and/or agent at any point in time, but the policy can be transferred from one broker and/or agent to another.

Field	Description
Policy	The policy that the policy broker agent is intermediary for
Broker	The broker that serves as intermediary
Agent	The agent that serves as intermediary
Start Date	The start date of the policy broker agent
End Date	The end date of the policy broker agent

Constraints:

• At least one of broker and agent must be specified

• It is not allowed to have an overlap in time validity for policy brokers agents with the same policy

Policy Calculation Period

A policy calculation period defines the premium calculation period for a specific policy. A policy can have one or more policy calculation periods.

Field	Description
Policy GID	The global unique identifier of the policy
Reference Date	The date that is used to evaluate time active variables in the calculation, such as the rate or the member’s age
Calculation Date	The date that is compared to the parameter date in the calculate premium activity to determine if the period is taken up for calculation. Periods having the same calculation date are considered to be part of a single collection cycle are are calculated together.
Days	Number of days used to calculate premium for this period. Can be set to a fraction, e.g. to achieve an even distribution of premium over periods that represent months.
Ind Generated?	Indicates if the policy calculation period is generated by the Generate Policy Calculation Periods activity
Ind Monthly	Indicates if the policy calculation period is generated by the collection setting having calculation period UoM as month or is unspecified (as the default behavior is month)
Pay Date	The payment due date
Start Date	The start date of the policy calculation period
End Date	The end date of the policy calculation period
PCP Span Start Date	The start date of the policy calculation period span
PCP Span End Date	The end date of the policy calculation period span

Constraints:

• It is not allowed to have an overlap in time validity for group client collection settings with the same group client

Policy Contract Period

A policy contract period specifies the length and the reference date of the policy’s contract. A policy can have one or more policy contract periods.

Field	Description
Policy	The policy that has the contract period
Reference Date	The date that is used as a look-up date in premium calculation
Start Date	The start date of the contract period
End Date	The end date of the contract period

Constraints:

• It is not allowed to have an overlap in time validity for policy contract periods with the same policy

Policy Group Account

A policy group account specifies the group account a policy belongs to at a certain moment in time. Group Accounts are described in the Enrollment implementation guide.

Field	Description
Policy	The policy that belongs to the group account
Group Account	The group account the policy belongs to
Start Date	The start date of the time period the policy belongs to the group account
End Date	The end date of the time period the policy belongs to the group account

Constraints:

• It is not allowed to have an overlap in time validity for policy group accounts with the same policy

Policy Message

A policy message is the message that is stored during the processing of the policy. A policy can have one or more policy messages.

Field	Description
Policy	The policy that has the message
Message	The message that specifies severity and the static part of the message text
Value 0 through Value 9	The parts of the message text that are determined at run time
Process Step	The process step in which the message was attached to the policy

Policy Pend Reason

A policy may pend for external intervention, usually because a human operator needs to work on the policy before it can continue to be processed. Whenever a policy pends, one or more reasons are attached to that policy, explaining why the policy pended. Policy pend reasons store only the current pend reasons, that is, they are discarded once the policy is submitted after resolving pends. The full history of pend reasons is stored in a separate entity named 'Policy Pend History' (specified below).

Field	Description
Policy	The policy that is pended
Pend Reason	The pend reason that explains why the policy is pended
Process Step	The process step in which the pend reason was attached to the policy

Constraints:

• It is not allowed to have multiple policy pend reasons for the same policy with the same pend reason and process step

Policy Status History

The policy status history keeps track of all status transitions, so that it is possible to trace back how a policy flowed through the processes and how long it took to complete certain steps within the process.

Field	Description
Policy	The policy that has the status history
Gid	The global unique identifier of the policies that the history belongs to
Status	The status of the policy at date time
Date Time	Date and time when the policy entered the status

Policy Pend History

The reasons why a policy pended are stored as a detail of a policy status history that logs a Pended status.

Field	Description
Policy Status History	The policy status history under which the pend reason was active
Pend Reason Code	The code of the pend reason
Pend Reason Description	The description of the pend reason
Process Step Display Name	The display name of the process step in which the pend rule was executed
Process Step Sequence	The sequence of the process step
Pend Date Time	The date and time when the pend reason was attached
Resolved By	The user who resolved the pend reason
Resolved Date Time	The date and time when the pend reason was resolved

Policy Output History

The policy output history keeps track of all output that was generated for the policy or a person or object on the policy.

Field	Description
Gid	The global unique identifier of the policies that the history belongs to
Version	The version of the policy
Status	The status of the policy
Insurable Entity	The person or object for which output was generated
Output Definition	The output definition for which output was generated
Cause	The cause of the generation (set to 'Periodic Output Generation', 'Manual Output Generation' or if applicable transferred from the cause of the mutation)
Generation Date Time	The date and time when the output was generated

Policy Bulk Update History

The policy bulk update history keeps track of all the bulk updates that are applied to a policy, so that it is possible to trace back who applied the update to the policy.

Field	Description
Gid	The global unique identifier of the policies that the history belongs to
Version	The version of the policy
Bulk Update Definition	The bulk update definition in which policy was included
User	The user who applied the bulk update on the policy
Bulk Update Date Time	The date and time when the bulk update was applied

Policy Fee History

The policy fee history keeps track of all fees that were generated for the policy or a person or object on the policy.

Field	Description
Gid	The global unique identifier of the policies that the history belongs to
Version	The version of the policy
Status	The status of the policy
Insurable Entity	The person or object for which a fee was generated
Fee Definition	The fee definition for which a fee was generated
Cause	The cause of the generation (transferred from the cause of the mutation)
Generation Date Time	The date and time when the fee was generated

Policy Activities and Calculation Results

The premium calculation is started by executing an activity. A policy can have one or more policy activities. When executed, these activities create calculation results. The calculation result is a snapshot of the premium calculation process. It holds the outcome of a premium calculation at the policy level for a contract period. A calculation result can have one or more calculation result lines that are related to policy enrollment products. These entities are described in more detail in the Premium Calculation implementation guide.

Policy Events and Mutations

A policy event stores the information that a policy related change should lead to recalculation and/or regeneration of output which is then transferred into policy mutations. A policy can have one or more policy events and policy mutations. This is described in more detail in the Premium Calculation implementation guide.

Policy Enrollment

A policy enrollment specifies a person or object participating in a policy. A policy can have one or more policy enrollments.

Field	Description
Policy	The policy that the person or object is enrolled to
Insurable Entity	The person or object that participates in the policy
Enrollment Type	The enrollment type that applies to the policy enrollment

Enrollment Type

An enrollment type specifies the enrollment of a person or object in a policy. Examples of enrollment types are 'Adult' or 'Child'.

Field	Description
Code	The code of the enrollment type
Display Name	Te display name of the enrollment type
Dynamic Fields	The non time valid dynamic fields defined to capture additional information about the enrollment type

Policy Enrollment Product

A policy enrollment product specifies a person or object being enrolled for a specific enrollment product on a policy. A policy enrollment can have one or more policy enrollment products. Enrollment products and group account products are described in the Enrollment implementation guide.

Field	Description
Policy Enrollment	The policy enrollment that has the policy enrollment product
Enrollment Product	The enrollment product that the person or object is enrolled to
Group Account Product	The group account product that the person or object is enrolled to
Premium Amount	The amount of the premium that acts as override
Premium Amount Currency	The currency of the override premium amount (will be the same as the premium currency specified on the related enrollment product)
Commission Percentage	The percentage of the enrollment product premium that is payed out as commission to either the broker or agent
Commission Amount Interpretation	The way amounts are interpreted (per Calendar Year, per (system) Calculation Period or Specific (number of days))
Comm. No of Days	Number of days for which the commission is specified when Amount Interpretation Specific is chosen (must and may only be specified if the amount interpretation is Specific)
Commission Amount	The commission amount
Commission Amount Currency	The currency of the commission amount (will be the same as the premium currency specified on the related enrollment product)
Start Date	The start date of the policy enrollment on a product
End Date	The end date of the policy enrollment on a product

Constraints:

• If the policy belongs to a group account a group account product must be specified that is configured for the specific group account, else an enrollment product must be specified

• It is not allowed to have an overlap in time validity for policy enrollment products with the same policy enrollment, enrollment product and group account product

• Both commission amount and percentage cannot be specified

Policy Add-on

A policy add-on specifies a person or object being enrolled for a specific add-on to an enrollment product on a policy. A policy enrollment product can have one or more policy add-ons. Add-ons are described in the Enrollment implementation guide.

Field	Description
Policy Enrollment Product	The policy enrollment product that has the add-on
Add-on	The add-on that the person or object has
Start Date	The start date of the add-on
End Date	The end date of the add-on

Constraints:

• It is not allowed to have an overlap in time validity for policy add-ons with the same policy enrollment product and add-on

• It is not allowed to specify an add-on that is not configured on the enrollment product or group account product

Policy Enrollment Insurable Class

A policy enrollment insurable class specifies a person or object being enrolled on a policy in a specific role, for example spouse or dependent Insurable Class and Enrollment products are described in the Enrollment implementation guide.

Field	Description
Policy Enrollment	The policy enrollment in which the person or object is enrolled
Insurable Class	The insurable class in which the person or object is enrolled on the policy
Start Date	The start date of the enrollment in a specific role
End Date	The end date of the enrollment in a specific role

Constraints:

• Only one policy enrollment insurable class can be valid at a certain moment in time.

Parameter Value

A policy enrollment product can have one or more parameter values for parameter aliases. The parameter alias serves as a reference for providing a name for a parameter. The parameter aliases are described in the schedule definition chapter of the premium configuration guide. The parameter value is the value of a parameter alias in the context of a policy enrollment product.

When a schedule dimension is of the type parameter, the parameter alias provides the name to the dimension and its dimension values are evaluated against the parameter values.

A parameter value has the following attributes:

Field	Description
Parameter Alias	The parameter alias
Start Date	The start date of the validity of the parameter value for the policy enrollment product
End Date	The end date of the validity of the parameter value for the policy enrollment product
Policy Enrollment Product	The policy enrollment product to which the parameter value applies
Amount	The value (amount) of the parameter (only for parameter aliases of type Amount)
Currency	The currency of the amount (only for parameter aliases of type Amount; it will automatically be set to the parameter currency that is specified on the enrollment product)
Percentage	The value (percentage) of the parameter (only for parameter aliases of type Percentage)
Number of Units	The value (number of units) of the parameter (only for parameter aliases of type Number)
Service Days	The value (service days) of the parameter (only for parameter aliases of type Service Days)

Constraints

• The value (amount, number of units, percentage or service days) that matches the type (amount, number, percentage or service days) of the parameter alias is required and the other values are not allowed

Policy Collection Settings

A policy collection setting specifies how often the premium is collected. A policy can have one or more policy collection settings.

Field	Description
Policy	The policy that has the collection setting
Span Reference Date	The date to determine the start of a span of calculation periods
Advance Length	Length of a span of calculation periods
Advance UoM	Unit of measure for a span of calculation periods (Days / Months / Years)
Policy Calculation Periods	Indicator that defines whether policy specific calculation periods are used in this policy
Policy Calculation Period Length [1]	Length of the generated calculation periods
Policy Calculation Period UoM ![1]]	Unit of measure for the generated calculation periods (Days / Months / Years)
Collection Method	The reference to the method of collection e.g. direct debit, invoice based
Start Date [2]	The start date of the collection setting
End Date	The end date of the collection setting

Constraints:

• It is not allowed to have an overlap in time validity for policy collection settings with the same policy

• Both Advance Length and Advance UoM (unit of measure) have to be set or both have to be unspecified

• Both Policy Calculation Period Length and Policy Calculation Period UoM (unit of measure) have to be set or both have to be unspecified

Policy Billing Accounts

A policy can have one or more policy billing accounts. A policy billing account is an account that is used for billing purposes on a policy. Note that the allocation of a bill to a policy billing account is configured within the policy premium bill allocations and bill receivers setup (described in the Policy Premium Bill Allocations section).

Field	Description
Policy Gid	The global unique identifier of the policy that the billing account belongs to (a policy billing account does not belong to a specific version of a policy; it applies across policy versions)
Code	The code of the policy billing account (unique across billing accounts)
Description	The description of the policy billing account
Billing Contact	The billing contact (relation) for the billing account
Default?	Is this the default billing account for the policy? (if set to Yes, this billing account will be the default bill receiver if not specified otherwise on the Policy Premium Bill Allocations and Policy Bill Receivers)

Constraints:

• There can be only one default billing account for a policy

• A policy billing account must refer to an existing policy gid

Policy Premium Bill Allocations

A policy can have one or more policy premium bill allocations. A policy premium bill allocation stores the specification on how to allocate the premium bill on an individual policy.

Field	Description
Policy	The policy that has the policy premium bill allocation
Insurable Class	The insurable class for which the policy premium bill allocation is defined
Schedule Definition	The schedule definition for which the policy premium bill allocation is defined
Premium Schedule Type	The type of premium schedules for which the policy premium bill allocation is defined
Enrollment Product	The enrollment product for which the policy premium bill allocation is defined
Enrollment Product Category	The enrollment product category for which the policy premium bill allocation is defined
Add-on	The add-on for which the policy premium bill allocation is defined
Start Date	The start date of the policy premium bill allocation
End Date	The end date of the policy premium bill allocation
Active	Is the premium bill allocation currently active?

Constraints:

• It is not allowed to have an overlap in time validity for policy premium bill allocations with the same policy, insurable class, schedule definition, premium schedule type, enrollment product, enrollment product category and add-on

• Only one of enrollment product or enrollment product category can be specified

• Only one of schedule definition, premium schedule type or add-on can be specified

Policy Bill Receiver

A policy premium bill allocation can have one or more policy bill receivers. The policy bill receiver defines who pays what percentage of the policy premium.

Field	Description
Policy Premium Bill Allocation	The policy premium bill allocation that applies
Relation	The relation (person or organization) that is the bill receiver
Billing Account	The billing account that is the bill receiver (this can be a billing account of the policy or a billing account of the group client in context)
Percentage	The percentage of the premium that this bill receiver has to pay

Constraints:

• A relation or a billing account (only one) must be specified

Brokers and Agents

A broker is a company that serves as an intermediary between the payer and the policy holder. An agent is an employee of a broker company.

Broker

Field	Description
Code	The unique key that is used to identify the broker
Name	The name of the broker

Broker Address

A broker can have one or more addresses.

Field	Description
Broker	The broker that has the address
Street	The street of the address
House number	The house number of the address
Number Addition	The house number addition, such as a floor or apt. number
City	The city where the address is situated
Postal Code	The postal code of the address
Country	The country in which the address is situated
Country Region	The region of the country in which the address is situated (can be used for , for example, States and Departments)
Additional Part 1	Used for additional (country specific) address information
Additional Part 2	Used for additional (country specific) address information
Additional Part 3	Used for additional (country specific) address information
Start Date	The start date of the address
End Date	The end date of the address

Constraints:

• It is not allowed to have an overlap in time validity for addresses for the same broker

• The country and the country region of an address should match

• If the upper indicators (specified on country level) for street, city, number addition and the additional parts are true, the values should be entered in uppercase

• The address parts should comply with the dynamic logic for address parts that may be specified at country level

Agent

Field	Description
Code	The unique key that is used to identify the agent
Initials	The abbreviation of the first names of the agent
First Name	The first name of the agent
Middle Name	The middle name of the agent
Prefix	The prefix to the last name of the agent
Name	The last name of the agent
Suffix	The suffix of the agent
Gender	The gender of the agent
Name Format	The dynamic logic function that is used to format the name

Agent Address

Agents can have one or more addresses. The same model (including the constraints) applies as for brokers.

Attached Policy Data

Attached policy data provides the ability to write additional information to a policy without affecting its status, so no (re)processing is needed. Examples are fields that reflect the policyholder’s payment status.

The information that is written to attached policy data is the process information related to enrollment that may play a role in the finalization of a policy, but the information lifecycle of the attached data has no (retro)active consequences to premium calculations and or output. This information does not introduce the need for reprocessing the policy. Without the existence of attached policy data, adding information to an approved policy would lead to the creation of a new policy version and the need for reprocessing.

The attached policy data entity serves as an umbrella for dynamic records and dynamic fields that can be configured at the user’s discretion. The entity itself does not have any attributes that are exposed to the user.

Fields	Description
Policy Gid	The global unique identifier of the policies that the attached policy data belongs to
Manual?	Did the policy enter the system through manual entry? (note that this indicator is automatically set and it is not visible in the user interface)
Ignore Bulk Update?	If checked, this policy is automatically excluded from bulk updates, unless the bulk update definition is configured to ignore this indicator.
Date Paid To	The date up to which the coverage is purchased
Dynamic Fields and Records	The dynamic fields and records defined to capture additional information about the policy
Last Processed Message ActivityID	This stores the activity id of the last processed message and gets stamped at the time a message is created. Whether or not the id gets stamped depends on the connector configuration.

The attached policy data record is created automatically along with the policy. The attached policy data can be manipulated through the Attached Data IP or through the View and Edit Policy page. Attached policy data is also accessible from the dynamic logic (through the policy object).

Notes

Notes are used to maintain a proper record of history of policies. Furthermore, the document discussions, conversations, actions carried out and advice given to policyholders can be recorded in the form of notes. A policy can have one or more notes.

Field	Description
Policy Gid	The global unique identifier of the policy that the note belongs to
Version	The version of the note (when an existing note is updated a new version of that note containing the updates is created; existing records of notes are never updated)
Note Text	The text of the note

Policy Accounts

Policy accounts provide the ability to store savings based on a policy.

Policy Account

Fields	Description
Account Number	The account number of the policy account
Policy GID	The GID to which the policy account belongs to Note that the policy account does NOT refer to the policy version.
Policy Account Definition	The policy account definition for this account
Person	The person for whom the account is set up
Dynamic Fields	The time valid dynamic fields defined to capture additional information about the policy account

Policy Account Definition

Fields	Description
Code	The code of the policy account definition
Descr	The description of the policy account definition
Display Name	The display name of the policy account definition
Period	The period of the policy account definition
Account Level	The level of the policy account definition
Currency	The currency to be used for policy accounts of this definition
Function Dynamic Logic	The dynamic logic function that defines how to generate an account number for the policy account
Function Dynamic Logic	The dynamic logic function that defines how to generate a transaction number
Function Dynamic Logic	The dynamic logic function that defines how to generate a general ledger event
Dynamic Fields	The time valid dynamic fields defined to capture additional information about the policy account definition

Enrollment Product Account Definition

Fields	Description
Enrollment Product	The enrollment product
Account Definition	The account definition
Autocreate Account?	Is a policy account of this definition automatically created for this enrollment product?

Policy Account Transaction

Fields	Description
Code	The code of the policy account transaction
Descr	The description of the policy account transaction
Transaction Datetime	The date of the transaction
Amount	The amount of the transaction
Reversed?	Is the transaction reversed?
Reversal Datetime	The date the transaction was reversed
Currency	The currency of the transaction
Policy Account Transaction Type	The policy account transaction type of the transaction
Person	The person for whom the transaction is. This field is, for example, to be used if the account definition is on Policy level but the person for whom an amount is used must be stored for documentation purposes
Dynamic Fields	The non time valid dynamic fields defined to capture additional information about the policy account transaction

Policy Account Transaction Type

Fields	Description
Code	The code of the policy account transaction type
Descr	The description of the policy account transaction type
Manual?	Are transactions for this transaction type entered manually?
Create GL Event?	Should a transaction of this type lead to a GL event?
Dynamic Fields	The time valid dynamic fields defined to capture additional information about the policy account transaction type

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1. When unspecified for a collection setting with the indicator policy calculation period set to 'Yes', the system considers policy calculation period length and UoM as 1 Month.Note - Modifying the collection setting after policy calculation period generation may result in inconsistency, it is recommended that periods are re-generated if the collection setting is modified.

2. With negative calculation date offset - The collection setting must start on or before the span reference date + calculation date offset. This is to ensure that system finds a valid collection setting to generate periods when the calculation date is set to be before the period start date.