| Incomparable, Comprehensive, and
Flexible Administration System Features and Benefits Overview
Apex Data Systems offers complete insurance administration systems that allow you to control every aspect of your individual, group, or voluntary payroll deduction enrollments as well as ongoing administrative needs right from your desktop PC. It's easy, fast and accurate. The functional features of our complete administration solutions include: Plan Building Premium Rate Calculations Enrollment Issue Output Pending and Correspondence Premium Billing Cash Receipts, Posting, and Collection Agent Commission Calculation and Payment Extensive Internal Reporting System
as well as Ad-hoc Capabilities Each area of our consolidated administration systems offer extensive support for fully-insured and self-funded group and individual contracts, with multiple coverage types including Term Life, AD&D, Voluntary Life/AD&D, Long and Short Term Disability, Catastrophic Illness, Long Term Care, Medical (Basic, Comprehensive, Superimposed Major Medical, and Dual/Triple Option PPO), Dental, Vision, Prescription Drug, Short-term Medical, Legal, Travel Accident, and others.
Flexible Plan Building and Underwriting Support
Our administration software systems offer an easy parameter-driven approach to establishing new plans. By working through a series of screens, users can easily set up new products without the need for additional programming. As a result, new plans can be established in minutes and made available for appropriate rating and enrollment of new groups (together with their associated employees and dependents) or individuals (with their dependents).
Both our Geronimo and Cognac*Express solutions offer an unsurpassed level of flexibility in offering plans to insureds. Individuals may enroll for any benefit array, and similarly, multiple variations of the same type of plan may be offered to a group, allowing employees to select the specific plans they want, thus supporting true cafeteria-style benefit packages. For example, an employer might offer a noncontributory basic medical plan, and then offer supplemental plans paid for by the employee. Additional medical plans could be offered as buy-ups. Similarly, an Association might make multiple plans available to its members, and selection can be on an individual level.
Rating
Solutions from Apex Data Systems provide a variety of ways to establish and maintain rates. Tables can be established using individual ages or age-bands. Composite and Manual rates are also an option. An expiry function can be used to automatically adjust benefits and rates based on either nearest or attained age. Other factors, which can be used in determining rates, include sex, geographic area factors, and group factors (such as number of employees, group specific loads/discounts, etc.).
The rating system is able to handle complex calculations while remaining simple for a user to understand. Using multiple data elements and a specific product coding system, unit-based, composite, or manually data entered rates for a wide variety of products can be developed to fit your specific needs.
Rates can be calculated using defined parameters alone or in combination including elements such as effective date, gender, age (attained or nearest birthday), salary (hourly to annual), job classification, volume, premium increment (set dollar purchases varying volumes), geographic area, number of employees and underwriter discretion.
Individual rating occurs as soon as an applicant is entered into the database. Average rating for group business may be postponed until all employees have submitted completed enrollment application materials meeting with underwriting approval.
Renewals are automatically reviewed for rate adjustments. Renewal Letters to agents and insured individuals or groups are created and rates are rolled as of the effective date of the rate change whether actually performed in advance or in retrospect. Previous rate data is maintained and used automatically for circumstances such as rescissions and back bills and credits.
Underwriter rate discretion is captured in a detailed table of load and discount factors for each rate action, and each action is maintained as part of the overall account history. A Notepad capability is included to allow free-form information to be made available to underwriters or staff to highlight important file information and provide alerts.
Pending and Correspondence System
Both Geronimo and Cognac*Express offer state-of-the-art pending systems that track all applications throughout the approval process for individuals, groups, employees, and even specific dependents. Several of the unique capabilities of the pending system are the capability to add or delete new applications, the creation of daily reports of pending records with status, letter code, underwriter code, pending reason, and review date, the generation of user-approved letters and automatic follow-ups, e.g., requests for further information, evidence of insurability, etc., and the ability to send different letters to multiple addresses for different reasons.
Our complete and sophisticated pending and correspondence modules automatically produce user-defined letters to handle any type of situation and request for information. The pending module allows for letter quality standard forms and letters to be generated by the system upon request. These are user developed and maintained in such a way that output can be personalized to the needs of the Plan. Specific data is merged into these letters from the database or can be entered as freeform user input. Processed applications may be pended for any number of reasons. The user may apply the pending status, for example, while gathering additional information (such as evidence of insurability, or other incomplete information necessary for underwriting the case). Pending reports show all cases that are pended, along with a reason code with either a system generated or user-defined pending reason description.
The system will automatically generate appropriate follow-up letters on the schedule established by the user. The pending system also incorporates a complete management review system including various reports, which show all cases pended and the reason. Our systems track pended and denied applications on a group basis, individual participant basis, and on specific dependents. This data is retained and is available automatically for review should the applicant again submit enrollment materials at a later date. This capability is critical should an applicant attempt to resubmit with modified data.
Notification letters for numerous reasons are generated from the letter module of the pending system. Notifications can be generated along with follow-ups as defined by the user. The system provides an easy-to-use letter creation program, which enables authorized staff members to define hundreds of letter series, each series having up to nine follow-up letters. The user defines the content of the letters, as well as the number of letters in the series and the frequency between automatic follow-ups. Once the letters have been created, they can be accessed through the pending program.
Enrollment
The enrollment process makes use of Plans, Rating, Pending, and Underwriting routines, and captures Name & Address, Master, and Coverage data. Our unique software solutions are designed so that each enrollment form can be immediately inventoried to the system upon receipt. Both direct entry and electronic receipt can be accommodated. Enrollments can retain a user defined pending status during the underwriting process that may be modified as the review progresses. The system will automatically generate initial and follow-up letters should additional information be required. The system tracks the underwriting process through issue for each group, employee, dependent and individual policyholder. In addition to a variety of management reports, the system offers online freeform notepads for detailed underwriting notes. These notes can be retained and in a consolidated system environment, are available for claims personnel during the adjudication process. Coverage may be accepted or declined for any applicant down to the specific dependent, and may be issued with exclusionary riders as determined necessary by the Underwriter.
The system offers the flexibility to enroll coverages specific to primary insureds or dependents. Each insured and dependent has his or her own Master and Coverage records with their unique data. A participant may be entered into the system as an individual policyholder or a member of a group, be it an employer group, association or other. Each participant coverage record, (i.e., medical, dental, etc.) has an indicator as to the dependent level of coverage, if any. This indicator both advises the user if dependent coverage is for spouse only, child only, full family, etc., and limits the enrollment process to those eligible dependents. The system can capture each specific dependent with name and address, master and coverage records. These are linked to the participant in two ways. The first is by use of the participant's social security or other assigned numeric key and the addition of a unique dependent sequence number. The second is by the use of the same numbering schemes for the policy, including association, client and certificate numbers. Name and Address:
Enrollment begins with Name and Address information. Name and Address records are maintained for employers, employees, individuals, dependents, agents, insurance companies, providers, and others. For selected record types optional and alternate addresses may be available. Names are cross-referenced for alpha search engines. Based on the product, these allow for either an alpha SOUNDEX "sound-alike" search routine or a Windows-type direct character search. Either of these would display keys (that may be a user assigned ID, or a social security or tax-ID number, plus a dependent sequence number) to access the Name and Address records.
Group:
Each group can be automatically assigned a Group Number followed by specific Name and Address data, general group data and more specific coverage data. Effective dates, paid-through dates, status codes and descriptions are carried in each record. For example, a group can be active/issued while one coverage is held pending until enrollment materials have been thoroughly reviewed by the underwriter.
Employee:
Each employee is automatically assigned a certificate number followed by specific Name and Address data, employee master data and specific employee coverage data. Once again, all levels of records contain specific dates, rates and codes. The pending system allows for the group to be approved and issued, excluding individual employees, dependents, or plans until that person or coverage is approved.
Individual:
An individual may be enrolled for direct billing or as part of a voluntary list-bill program. As above, information is maintained for Name and Address, Master, and Coverage.
Agent:
Agent information can also be created at the time of enrollment. Agent information is entered in Name and Address records, as well as in the agent master or contract records, or in demographic and hierarchy tables, based on your commission approach. Multiple contracts or master records are available for each agent giving flexibility by state, insurance company, product, and other parameters.
Updates and Temporary Records:
All data fields may be updated or changed during the enrollment process as well as at any later time. Discounts are automatically calculated and adjustments for deposit check under or overpayments can be added for the billing process. Temporary records to cover back bills or back credits, are automatically created as necessary.
Once enrollment is complete, both the Policy Issue and Billing Departments begin their specialized tasks. Flexible and User-definable Issue Output
While the Geronimo and Cognac*Express solutions have taken slightly different approaches to issue output, both products produce certificates, stickers, ID cards and other output. Materials such as booklet face pages, schedules of benefits, declaration pages, riders, and waivers can be customized to fit specific needs. Other output can include mailing and file folder labels, lists of attachments, and welcome and procedure letters, and in addition to the variety of base system formats that are available, Apex Data Systems can also offer customized layouts tailored to our users' requirements or preferences.
Certificates are generated from a freeform file which can create single or multi-page output describing schedules of benefits for all coverages including data specific to the participant and his or her dependents. Stickers are generated in standard formats for a selection of forms and may be customized to the user's needs. Certificates and stickers can be automatically generated upon underwriting approval and are automatically regenerated upon certain changes in coverage, (i.e., change in volumes, dependent status, etc.) Routinely, users rely on automatic daily generation of standard output for that day's accepted new business.
Premium Billing, Cash Receipts, Posting, and Delinquencies
The premium billing capabilities of the Geronimo and Cognac*Express systems are extensive. Bills can be generated at any time the user decides to create invoices, even daily, if desired. Standard billing periods supported include monthly, quarterly, semiannually and annually. Additionally, special frequency billing capabilities are also available as part of our voluntary benefits and worksite sales module. Our special frequency billing capabilities include weekly, two times per month, every two weeks, and every four weeks. Additionally, individual policyholders may be group list billed to a payroll department. Billing:
The systems supports list bills, self-bills, direct bills, electronic payroll formats, and EFT with support for pre-authorized checks or credit cards. List bills can be issued with or without employee detail, based on user preference. Our systems offer a number of different hard and soft formats, including for example, Cognac*Express' three different list bill layouts, two summary/self bill layouts and two individual policyholder bill layouts. Bills may contain a variety of data fields. Standard elements might include name (employer/employee or policyholder), certificate/ID numbers, premiums by coverage or multiple premiums combined, volumes, multiple coverages for cafeteria/flex benefit plans (e.g., 3 separate term life policies and 5 medical alternatives), user-defined messages, adjustments, balance forwards, discounts, payment mode, and others. Further user definition in the bill formats can always be achieved with customized support tailored to the user's exact printing specifications.
Detail or Summary:
Detailed or Summary bills may be requested on demand. Supplemental bills can be generated to bill those employees whose effective dates are in the middle of a billing period. This is used when the billing period is greater than one month.
Cash Receipts, Posting, and Collection:
The systems allow payments to be entered in a suspense file so that the cash may be deposited while payment amounts are being verified and processed. Payments that match what is due are automatically applied by the system during the posting process. Payments that do not match are processed in a variety of ways, depending on the business practices of the user. First, a tolerance can be established which will automatically accept any payment falling within the pre-established tolerance, immediately creating the necessary adjustments for the next month's bill. For payments which are outside of tolerance (or if the tolerance feature is not being used), a manual adjustment may be made to the system to allow the payment to be accepted. The balance forward debit/credit will appear on the next invoice with no further action. A third option is to determine why the payment is over or short, and to adjust the enrollment data as required for terminations, changes, or new additions. If specific employee or dependent coverages were terminated for example, by reflecting these changes in the system the program will automatically recalculate the payment due. If the resulting bill matches the payment received, the payment would be accepted. If it still does not match, the payment may still be processed automatically if it falls within tolerance, or may be handled manually, otherwise.
Delinquency tracking is completely automated and maintained online. Once a billing has been issued, late notices and cancellation notices are automatically generated if necessary, based upon due dates and schedules particular to each policyholder or group. These schedules are user defined and flexible to your methods in managing your business, even giving specific consideration for key accounts. The system generates late notices and cancellation notices to clients, as well as notices to agents, plus a variety of reports based on user-defined schedules. The system provides a means for the user to develop late notice schedules that fit their needs. For example the first letter might be scheduled for 10 days after due date, the second at 20 days, and the cancellation notice at 30 days past due. Cancellation notices routinely show not only the amount past due, but also the next billing period's premium that would be required for reinstatement. Our expanded capabilities allow the user to enter their own verbiage for late and cancellation letters.
Transaction Registers:
When a premium payment is received, whether by mail, lockbox, or EFT, it is immediately logged into a suspense account. The payment is then available for posting or remains in the suspense account if reconciliation is necessary. All incoming premium is handled through a transaction register and all moneys that are in Suspense, along with their appropriate codes and dates, are reported daily to the Premium Receipt Department. This provides daily control of funds for all dollars in and out.
Adjustments:
Adjustments to policyholder, employee, dependent and group records may be necessary to match the billing to the premium amount actually received. This is an on-line process and immediately updates the policyholder or group's billing amount. Once in balance, the account is reconciled and the premium amounts are automatically removed from suspense and become available for posting.
System Updates:
Once premium has been posted, all paid-through-dates in each record are automatically updated. If necessary, temporary records are created for the subsequent billing, and any adjustments for prior under or over-payment are "rolled" (changed in sign) for the next billing period. Premium Reports
All reports concerning premium and agent commissions can be requested down to the policyholder- or employee-coverage level of detail. Reports include information about the raw data, accounting information, and detailed analyses of trends and the flow of cash. Premium Register:
Daily Premium Registers are produced for the purpose of reconciling with bank accounts and Transaction records. Monthly Premium Registers are in summary form for reporting to carriers. These reports may be sorted using a wide variety of parameters, including division, product type, and agent.
Insurance Company Billing Summary:
Insurance Company Billing Summaries report premium by coverage and product, which can then be sorted in the same manner as Premium Registers. These are especially useful for reporting reinsurance or primary coverage by an insurance company, self-insured or third party administrator.
Billing Summary and Transaction History:
The billing Summary Report reflects the bottom line summaries of each policyholder or group's current billing amount. The Transaction History shows the complete premium and adjustment history, by policyholder or group, with dates and dollar amounts. This provides a great case history and audit trail. Agent Commission Processing & Payment
Our complete administration solutions provide comprehensive agent commission modules offering a significant range of flexibility in tracking agents and brokers, and in calculation and payment options. Agent commissions are calculated following payment posting. The framework of agent Master and Commission records offers extensive support for any number of agents, and there is no limit to the number who may be maintained on the database. The commission systems offer the highest level of flexibility and allow for payments of user-defined flat and graded arrangements. Standard graded calculations are based on a stair-step scheme by premium volumes and/or policy duration, agent hierarchy and override schedule, and plan of coverage. Commissions can also be based on a per capita calculation. Special commission processes also allow for variations in commissions by policyholder's age, and other parameters.
The system can also calculate retroactive commissions in a fully automatic manner with no user intervention. The system will automatically pay the agent for commissions that are due, and will also charge against his or her account any refunds that may be required due to retroactive premium refunds or other situations.
Standardly, agents are paid under a contract arrangement, and agents may have as many as 99 differing marketing arrangements with multiple override capabilities. Commissions may vary by coverage for a policyholder or employee, and splits of commissions on a single case can be made for up to 9 different levels and overrides may apply to each split. Commissions may be assigned, temporarily held, or permanently held. Special features of the commission module also allow for payments by agent demographics with controls on product type, state, and status. Escrow processing is also available, and in addition, advanced commissions with interest application for unearned amounts, and bonus options based on volumes and persistency are also supported on a custom basis. Commission Checks, Registers & Reports:
Commission checks and registers are automatically produced as part of the complete commission output. Detail of the commission calculations is generated for the agent as statements that accompany the check. Alternatively, we can interface our agent commission system to any consolidated corporate agent commission system you may be using, if desired.
A variety of agent reports is also available, and allow for review of data using user-definable fields such as zone, region, division, profit center, insurance company, and others. Year-end reporting includes automatic issuance of 1099's and electronic transmission for the IRS. | |
