InsPro Enterprise

InsPro Enterpriseā„¢ is an end-to-end policy administration suite that helps you administer a full spectrum of products, expedite new product launches, and serve customers, members, and agents more efficiently. Engineered to be highly flexible, the system comes fully loaded with preconfigured, product-specific templates that allow configuration analysts to perform everyday tasks. InsPro Enterprise includes system functions that are core (for operational areas) or cross-functional (to support or extend core functionality). Although the system provides a total solution, it also accommodates clients who prefer to interface with their current third-party or homegrown solutions (for example, claims, agent compensation, or portals).

Policy Administration

The Policy Administration function helps you accomplish the following business tasks associated with policy lifecycle activities:

  • Review the Policy Abstract to access policy details and link to source documents, plans, and other records from one location
  • Update Billing information and generate new bills for individual policies
  • Update person records that require changes because of things like tobacco use or change of address
  • Perform Beneficiary Maintenance to keep beneficiary names, addresses, and demographic data up to date
  • Designate a policy Owner or Assignee
  • Perform Coverage Maintenance (or Quotes) as necessary to increase or decrease benefits/coverage, drop or add coverage, and drop or add covered persons
  • Reverse payments by amount to manage insufficient payments
  • Reverse payments by date to process policy maintenance changes that result in an adjustment to premium (such as tobacco usage or age corrections)
  • Request Schedule Pages for a specific policy (or a group of policies, based on Company, Client, and Plan)
  • Quote, process, and maintain Loans
  • Register external policies for just in time claims or port processing (for example, to support Third Party Administration)
  • Terminate policies

The Policy Administration functionality includes the following review capabilities:

  • 3-tiered policy search criteria
  • Name or number searching
  • Coverage summaries
  • Detail inquiries
  • Suspense inquiries
  • Financial and non-financial history

Product & Plan Configuration

The Product & Plan Configuration function lets non-technical configuration analysts define insurance plans, subsequent product offerings, and the variety of rules and attributes associated with each. You can use this functionality to capture all pertinent plan variables, benefits, and rules, then enable companies to create products for sale and administration based on the initial plan. This allows companies to avoid having to re-file plan addendums or new plans each time marketing wants to introduce a specific option. There is no limit to the number of plans and subsequent products you can configure for writing companies. InsPro Enterprise fully supports multi-company processing.

The Plan Structure database is key to these capabilities and contains the following information:

  • Underwriting and actuarial issue rules for each plan
  • Rating Directives and Rate Tables
  • Automatic activity scheduling for the life of the contract (for premium changes, value changes, anniversary processing, and notifications)
  • Scheduled benefit changes
  • Product factors (tax, GAAP, STAT, cash values, and dividends)
  • Supplemental and Joint benefits
  • Riders

InsPro Enterprise leverages wizards for Plan and Product configuration. These wizards lead you through straight-forward panels, simplifying the process of defining an insurance product, regardless of complexity.

The wizards orchestrate all aspects of plan and product design, including the following:

  • Plan characteristics
  • Plan features based on applicant age
  • Cash Value/Paid-Up options
  • Premium/Benefit Schedules
  • Special processing rules for Waiver, ROP, Joint Coverage and Later Anniversary Persistency
  • State Variations
  • Benefits available after issue
  • Actuarial information
  • Participating Dividend factors
  • NFO/Loan Information
  • Product offering information including the company, campaign, client, issue state, product, reporting categories, insurance type, benefit definition type, and worksite
  • Product offering processing rules including effective date, documents, free months, periodic increases, eligibility ages
  • Agent commission schedules and splits
  • New business formatting selections for required and optional information (including the ability to make items not applicable so they do not display on applications)
  • Worksite eligibility and underwriting rules by relation
  • Billing methods allowed at new business
  • Benefit choices, definitions, and packages (including LTC and NFO specific options)
  • Product offering state variations
  • Product offering form definitions
  • Individual and Group Rating
  • Rating directives specify and test multiple pricing scenarios before finalizing premium rates

New Business & Underwriting

The New Business & Underwriting function supports life and health guaranteed issue and underwritten products. The new business batch procedure controls the number of applications and cash-with-application amounts, while providing immediate database updates.

When you submit an application, the underwriting functionality generates an underwriting score. The system considers factors including gender, date of birth, issuing state, height, weight, occupation, and medical history based on product and plan set up. You can configure the system to automatically approve and decline applications or place applications in pending underwriting status as a result of the underwriting score.

You can access real time reviews of applications within the new business function or open summary style views of applications to review the following:

  • Application status
  • Selected Benefit package
  • Primary insured information
  • Underwriting answers
  • Billing information
  • Agent information
  • Beneficiary and lapse recipient designations
  • Controlled and system controlled requirements

You can also access requirements history to view the following:

  • Items that hold up issue
  • Open and close dates
  • Comments
  • Final decisions
  • Explanations for declined applications

Billing and Collections

The Billing and Collections function includes a scheduler that examines each policy to determine the timing of events during billing, follow up (reminder notification), and lapse processing.

The system examines the following information for event determination:

  • Billing mode
  • Billing method
  • Billing format
  • Number of billing lead days
  • Special bill distribution
  • Messages included with the bill

The system supports a variety of billing methods including EFT, credit card, salary deduction, direct bill, self-administered, and list bill.

The collections functionality processes cash and non-cash transactions as they relate to specific policies and billing methods. The system processes the following types of collection transactions:

  • Online payments
  • Lockbox
  • Credit card payments
  • Credit card rejects
  • Manual application of premium payments

Agent Management & Commissions

The Agent Management & Commissions function fully supports both agent management and commission payments including verification of agents on policy issuance, calculation of commission payments, generation of agent statements, and generation of checks.

You can perform the following tasks using this functionality:

  • Add, delete, or modify agents
  • Track agent licensing
  • Configure agent appointments
  • Define agent contract relationships and hierarchies
  • Create commission payment schedules
  • Calculate commission payments (including advances, splits, and periodic commissions)
  • Generate agent statements and checks or interface with a corporate commission system

In addition, a single ID for each agent across multiple promotions, products, or plans, lets you consolidate and reconcile commission Statements.

Claims

The Claims function supports the entire claims processing lifecycle, including the following:

  • Claim set up
  • Adjudication
  • Preventative care exceptions
  • Underwritten policy diagnosis check lists
  • Claim eligibility check lists (activities for daily living and audit rules for correspondence)
  • Mutually exclusive benefits and services
  • Preview and authorization of repeat payments
  • Adjustments
  • Stop payment and void check functions
  • Claim work queues
  • Claim audit queues

The Claims functionality also provides full claims history with payment details. While InsPro Enterprise automatically calculates benefits payable based on plan setup, claims processors with appropriate security profiles can override or waive system calculations.

You can define the types of benefits and services eligible for payment using plan setup and control them to satisfy person or plan deductibles, coinsurance ranges, maximums, and fourth quarter carryover. You can define eligible services to include lifetime, calendar year, or specific benefit period elections, as well as maximum amounts or number of events payable.

Document Management

The InsDoc document management function is a Microsoft Word based document creation, generation, and archiving application. The design and implementation of all InsDoc documents is based on client requirements. You can import existing documents to InsDoc and use data collections to create personalized correspondence by merging variable data from insurance records with document prototypes. You can use the system to distribute correspondence via email or print correspondence for delivery via traditional mail.

The InsDoc function also archives correspondence, so you can reprint customer letters as needed. You can reprint archived documents on demand, regardless of whether the original document was printed in batch or online.

Data Mart

The InsPro Enterprise data mart provides a single source for all policy and claim data. The system populates the data mart with all available data (and associated history) so you can create the custom reports you need. You can also create ad-hoc reports by leveraging the data mart and any third-party reporting tool you select (for example, Microsoft SQL Server Reporting Services, Crystal Reports, or Cognos).

Web Services

InsPro Enterprise has hundreds of web services. This functionality reduces the time and costs associated with traditional interface projects, and provides additional opportunities for data presentation.

You can expose the vast majority of InsPro Enterprise data via the web services to web portals (either out-of-the-box agent and policyholder/member portals or homegrown/third-party portals). For self-service, your customers can login and perform basic policy maintenance (like address and contact information updates), check on the status of a claim, and review or update any other information you decide to expose to the portals.