FIELD OF THE INVENTION
The present invention relates to a method and system for administering life cycle of Health insurance policy Holder, in particularly a web-based solution for managing complete life cycle of Health insurance policy holder.
BACKGROUND OF THE INVENTION AND PRIOR ART
Medical Insurance in India is in premature state having greater business opportunity. Current business model for the medical insurance are not very effective as they are not customer friendly and too cumbersome to avail.
Individual policies are sold through call centre or through notified agencies appointed by the companies, where as group policies are being sold through registered brokers. Few of the new generation insurance company sell the policies through their portals, which has lot of process deficiency. The hospitalization for a policy holder and tracking the treatment is through a manual process. The claim settlement is through TPAs, which involves multi commission structure resulting huge cost off flow. Because of the above draw backs in the current business model, all the insurance companies catering to the health insurance segment are running under financial losses.
Current Insurance Products available in the market are providing a web interface for the subscription of insurance policy, displays available product. Beyond subscription all the other activities are handled manually or through TPA. None of the touch points like Agents, corporate or call center are supported on web.
There are few hospital management systems are available which concentrates around managing the hospitals. However applications developed in the instant invention concentrates around managing the treatment for the patient, enabling cashless claims, supports medical standards with ICD/CPT and cross walk feature to plug the errors during diagnosis and treatment.
The claim settlement process offered by other insurance products is completely manual resulting in delay and involves lot of manpower cost.

The transactions between Hospitals, Drug store and claim settlement agency is completely manual resulting in process lapses, delays and cost. Instant invention provides completely process driven interface with no loose ends, supported by robust software. The drugs prescription and dispensing refers to the drug database provided by MIMS with no scope for any errors.
Some of the limitations and disadvantages of currently available product are explained below with their type of transaction.
Payment for the subscription and renewal of the policy - Few of the available products are providing payment through credit card interface; however most of the insurance products do manual payment collection.
Cancellation and refund - Current products follow completely manual process for refund.
Addition deletion of family members to the existing policy - Addition or removal of family member is completely manual for the existing product.
Settlement of claims submitted by hospital for cashless treatment - Completely managed by TPAs, which is manual process.
Reimbursement of claims submitted by the insured person for treatments which are not covered under cashless treatment - The current products shall process the reimbursement upon submission physical copies of the claims to the insurance company. The process is completely manual and involves lot of man power over heads and time consuming processes.
Reimbursement of claims by drug store by dispensing the medicines - None of the current product shall support this feature
Payment to the appointed service touch points like surveyors authorizing claims, surveyors conducting clinical tests during subscription - None of the current product supports this feature

Commission payment to the agents - The current products do the commission payments through manual process.
The proposed solution shall introduce efficiency in the process and driven by a robust application which makes the complete process totally automated, coupled with efficient processes reducing the man power dependency , lesser fraud and easy to use. The business model is designed to reach the mass through efficient internet media and agent network. The proposed solution is designed to break the traditional rules and serving the Indian customer need. This unique model enables user friendly processes and service, perfect coupling between insurance and various components of health industry enable growth not only for insurance also for entire health industry.
OBJECTS OF THE INVENTION
The primary object of the present invention is to overcome aforementioned limitations and disadvantages of current insurance products by providing automated solution.
Yet another object of the present invention is to provide web-based interface for managing complete life cycle of Health insurance policy.
Still another object of the present invention is to provide automated solution for subscription of a health insurance policy, managing the policy, availing the policy benefits, settlement of claims electronically, claim settlement & fund transfer for all the connected agencies of health insurance.
Still another object of the present invention is to provide an interface for renewal of policy, subscription/managing the policy from various business touch points like agents/ brokers, corporate.
Still another object of the invention to Facilitate interfaces for view/avail/delivery of services by the hospitals/ surveyors/clinics/drugstores and manage their claims and commissions.

Still another object of the present invention is to provide Electronic storage of the medical history documents, electronic settlement of funds for all the committed business points and built-in Fraud management system.
STATEMENT OF THE INVENTION
Accordingly, the present invention provides for a web based method for managing complete life cycle of health insurance policy holder, said method comprising acts of registering subscriber to policy through web-interface and availing planned hospitalization and an appointment with interested doctor by the insured person; prescribing clinical tests for the insured person based on the predetermined clinical observations by the appointed doctor using Order entry web interface of order management application; performing the prescribed tests and updating the test results using the web-interface by the lab assistant upon receipt of the prescribed tests on Lab Assistant interface of the order management application; commencing the treatment by admitting the patient based on the test results using treatment application module and entering details of medications to be provided to the patient; generating discharge summary upon completion of the treatment and thereafter generating complete billing information by billing module after confirmation on discharge of the patient; and forwarding claim documents along with discharge summary to the surveyor interface for claim approval, and also provides for a computing system for managing life cycle of health insurance policy holder, comprising: a user interface with a plurality of data input modules which comprise data input fields for inputting data relating to the object of managing life cycle of health insurance policy holder, wherein said user interface is operable for insured person by means of terminals via a telecommunication network; stored data rules assigned to the data input fields and validation means for checking data values input via the data input fields on the basis of the assigned data rules, a server having storage space connected to the user interface via the telecommunication network, and a control means for controlling payment transaction on the network.

BRIEF DESCRIPTION OF ACCOMPANYING DRAWINGS
The features described in this disclosure are set forth with particularity in the appended claims. These features and attendant advantages will become apparent from consideration of the following detailed description, taken in conjunction with the accompanying drawings. One or more embodiments are now described, by way of example only, with reference to the accompanying drawings wherein like reference numerals represent like elements and in which:
Figure 1 shows block diagram which diagrammatically represents a computing system for managing life cycle of health insurance policy holder, the computing system being connectable to terminals of service users via a telecommunication network.
Figures 2, 2a, and 2b show a flowchart which diagrammatically represents the process flow of life cycle of policy holder.
Figures 3, 3a, 3b, and 3c shows a flow chart which diagrammatically represents the process flow of agent module.
Figures 4 and 4a shows a flow chart which diagrammatically represents the process flow of corporate module.
Figures 5 and 5a shows a flow chart which diagrammatically represents the process flow of drug store module.
Figures 6 and 6a shows a flow chart which diagrammatically represents the process flow of surveyor module.
DETAILED DESCRIPTION OF THE INVENTION
The primary embodiment of the present invention A web based method for managing complete life cycle of health insurance policy holder, said method comprising acts of registering subscriber to policy through web-interface and availing planned hospitalization and an appointment with interested doctor by the insured person;

prescribing clinical tests for the insured person based on the predetermined clinical observations by the appointed doctor using Order entry web interface of order management application; performing the prescribed tests and updating the test results using the web-interface by the lab assistant upon receipt of the prescribed tests on Lab Assistant interface of the order management application; commencing the treatment by admitting the patient based on the test results using treatment application module and entering details of medications to be provided to the patient; generating discharge summary upon completion of the treatment and thereafter generating complete billing information by billing module after confirmation on discharge of the patient; and forwarding claim documents along with discharge summary to the surveyor interface for claim approval.
In yet another embodiment of the present invention the registering subscriber to policy through web-interface comprise steps of receiving predetermined data for enrollment of policy for the subscriber; determining requirement of clinical checkup for the subscriber and processing the payment for medical checkup; authenticating payment for the policy to be enrolled and displaying the clinical checkup details; and processing the payment authenticated and issuing policy to the subscriber upon successful completion of clinical checkup.
In still another embodiment of the present invention the insured person receives e-policy upon successful registration and optionally receives an e-mail or SMS with complete information about the policy.
In still another embodiment of the present invention the subscriber register to the policy using plurality of channels selected from a group comprising user friendly web-interface, insurance company agents registered with the policy provider, an automated call center or self-service driven corporate web interface for all corporate customers for subscription and managing the policies for their employees.
In still another embodiment of the present invention the subscriber undergo clinical checkup depending on medical history, age group and type of insurance product.

In still another embodiment of the present invention the details of medical checkup comprises location, contact person, contact details, online location map to guide the subscriber and said details optionally provided to the subscriber through e-mail and SMS.
In still another embodiment of the present invention the insured person is capable of renewing the policies through the online web interface and the payment towards renewal fee is accepted through one of the payment modes selected from a group comprising credit card, debit card or online banking account.
In still another embodiment of the present invention the web interface provides the user an ability to add and/or delete family members, delete the policy completely or modify the contact information based on product configurations.
In still another embodiment of the present invention the web interface provides pre-populated screen with information about the insured person from insurance database during the hospitalization and generates registration card with unique patient registration ID to be used for tracking all the future transactions.
In still another embodiment of the present invention the treatment application module provides user friendly GUI interface for viewing patient records, entering treatment details and to choose particular treatment from the list of treatment methods.
In still another embodiment of the present invention the treatment modules are selected from a group comprising medical treatment, surgical treatment, physiotherapy and any other suitable treatments for the patient.
In still another embodiment of the present invention the medical treatment module provides interface to enter details of the medications to be provided to the patient and said details captures "name of the medication", "type of the medicine", "SIG", "number of days", "quantity" and "start and end date".

In still another embodiment of the present invention the surgical treatment module comprises an interface to search the procedures to be performed to the patient based on the clinical results.
In still another embodiment of the present invention the search option on the web interface is based on keywords, starts with, ends with and is linked to master database containing all the standard approved medical procedures.
In still another embodiment of the present invention the procedures are mapped to at least one diagnosis through another search interface and mapping is verified through the application using international medical standards database, and said procedures are mapped to primary and secondary diagnosis in case of multiple diagnosis mapping.
In still another embodiment of the present invention the patient treatment and instructions are captured through the web interface upon admission of the patient to the hospital.
In still another embodiment of the present invention web interface comprises submenu's for capturing daily progress note, general instructions, vital instruction with viewer, pre¬operative surgical instruction, post operative surgical instruction, ICU instruction, procedure details and discharge note.
In still another embodiment of the present invention the billing charges are mapped to each of the service in the configuration module and computed charges are available on web interface for viewing by the authorized user.
In still another embodiment of the present invention the claims approved by the surveyor is submitted to fund transfer module and the funds automatically transferred to the banking accounts of the respective hospitals.
Another important embodiment of the present invention is a computing system for managing life cycle of health insurance policy holder, comprising: a user interface with a plurality of data input modules which comprise data input fields for inputting data relating to the object of managing life cycle of health insurance policy holder, wherein

said user interface is operable for insured person by means of terminals via a telecommunication network; stored data rules assigned to the data input fields and validation means for checking data values input via the data input fields on the basis of the assigned data rules, a server having storage space connected to the user interface via the telecommunication network, and a control means for controlling payment transaction on the network.
In still another embodiment of the present invention the plurality of data input modules are selected from a group comprising insurance module, agent module, corporate module, admin module, drug store module, surveyor module and combinations thereof.
In still another embodiment of the present invention insurance module comprises plurality of sub menu options for the insured person selected from a group comprising
i. renewal menu for displaying renewal date of the policy ;
ii. hospitalization menu being configured to display list of organ based diseases and/or list of hospitals which provide treatment based on diseases selected; and
iii. other services menu comprises
a. view/edit/cancel policy menu;
b. view transaction;
c. view promos/products;
d. view network hospitals;
e. reimbursement form; and
f. feed back on hospital menu.
In still another embodiment of the present invention the system automatically calculates the refund amount to be rolled back and auto credits the refund amount to the insured person upon cancellation of the policy.
In still another embodiment of the present invention the agent module is capable of handling agents' activities selected from a group comprising registration process for the agents, subscribing or renewing a policy for a prospective insured person, view

transaction and commission, pending renewals of the prospective insured persons registered by the agent, registering insured person for hospitalization.
4 In still another embodiment of the present invention the corporate module provides for registering individual or group of employees for availing insurance facility; view/modify corporate user policy data; utility for bulk uploads of data in a predetermined format; utility for bulk deletion; and corporate employee user interface to view transaction and register for treatment.
In still another embodiment of the present invention the corporate employee user interface enables addition of family members to the policy by the employees through self help portal.
In still another embodiment of the present invention the admin module manages plurality of activities selected from a group comprising "insurance employee user profile", web insured person, agent user, corporate user, plans, surveyor, hospitals, claims, policies, Revenue accounting, approve drug store user registration, Create office profile, "Physical verification of details of the hospitals, surveyor, drug store, agent", commissions, Refund module, creating new policies, modification of the policies and combinations thereof.
In still another embodiment of the present invention the drug store module provides GUI based User friendly interface for viewing requests submitted by hospitals for dispensing the medicines; GUI based interface for entering the details against medicines requested and dispensed; and Online payment settlement upon the approval by the surveyor.
In still another embodiment of the present invention the drug store module comprises sub modules for Registration of drug store user, View and Edit Drug store User profile, View Dispense requests, Dispense Medicine, Billing Details, Online payment settlement., "Inventory control module configured for Medicine Entry, Medicine Stock Check, Request for Quotation, Purchase Order, Invoice Entry", Report module and vendor management module.

In still another embodiment of the present invention the surveyor module having secured web interface to insurance application to view the treatments in progress, treatments completed and claims submitted for verification and approval.
In still another embodiment of the present invention the system provides a nurse interface for nurses to view instructions, perform predetermined activities and to confirm the completion of activities.
In still another embodiment of the present invention the nurse interface provides an option for searching the patient using at least one of the criteria selected from a group comprising IPD number, patient ID, patient name, room number, doctor name and date of admission.
In FIG. 1, the reference symbol 1 designates a computing system for managing life cycle of health insurance policy holder. The computing system 1 is operated by the service provider, insured person and comprises one or more computers with in each case one or more processors. As is shown diagrammatically in FIG. 1, computing system 1 is connected to various terminals 3 a, 3 b and 3 c of the service users via a telecommunication network 2. The telecommunication network 2 comprises a landline network and/or a mobile network. The landline network is, for example, the public switched telephone network, an ISDN (Integrated Services Digital Network) network or preferably the Internet or an intranet. The mobile network is, for example, a GSM network (Global System for Mobile communication), a UMTS network (Universal Mobile Telephone System) or another, for example, satellite-based mobile network, or a WLAN (Wireless Local Area Network). The reference symbol 3a designates a terminal which is constructed as PC (Personal Computer), the reference symbol 3b designates a terminal which is constructed as mobile notebook or laptop computer, and the reference symbol 3 c designates a terminal which is constructed as mobile radio telephone or PDA computer (Personal Digital Assistant). The computing system 1 comprises a communication module 10 for the communication, that is to say for the data exchange, with the terminals 3 a, 3 b, 3c. The communication module 10 is, for example, adapted to set up in each case a virtual private network (VPN) with the terminals 3a, 3b, 3c via the telecommunication

network 2 and to communicate with the terminals 3a, 3b, 3c via this virtual private network.
As shown in FIG. 1, the computing system 1 comprises a database 18 to store the report at various stages of the life cycle of policy holder and a number of functional modules and parts, namely a control module 11 to control the plurality of work flows used in the instant invention, validation means 12, evaluation means 13, and a user interface module 15.
The user interface module 15 comprises the program code for a user interface to the computing system 1 which can be operated by service users by means of the terminals 3a, 3b, 3c via the telecommunication network 2. The user interface is provided, for example, via so-called browser programs or as API (Application Programming Interface). The expert will understand that the user interface can also be constructed as GUI (Graphical User Interface) in client server architecture. As is indicated by area 151 in FIG. 1, the user interface module 15 comprises a number of data input modules. The data input modules in each case comprise data input fields which, in particular, are used for inputting data relating to the object of managing life cycle of health policy holder. Depending on the construction of the user interface, the data input modules 151 in each case comprise one or more displayable windows or GUI images ("screens") or a scrollable form. The data input modules 151 are preferably assigned to various paths of a workflow. The user interface can also be provided with a voice recognition module for the data input.
The system shall explained in terms of work flow management system to support the functionalities, Business Logics to capture the transactions, Business intelligence to take automated decisions, third party systems to support the business decision functionalities. The further description starts with the above approach and later supported by the elaborated description about each of the modules.

Workflow Management for an insured Person is illustrated in figures 2, 2a and 2b:
A Prospective insured person can subscribe through multiple channels.
User friendly web interface, through which user can log-on and register himself for an insurance policy. Depending on the type of insurance product registered, business rules around the product definition, age group of the insurer and the pervious medical history, the user shall either be issued with the e-policy upon successful payment transaction on the web through credit card/debit card/banking accounts, or shall be redirected for a medical check up to a doctor who is supported with a clinic for conducting the test. Depending on the clinical test results and business rules defined for the particular product, insurance policy shall be the registered user of insurance policy. The entire transaction covering the redirection to a doctor, medical checkup/entry of results, and decision on issue of policy is completely driven by automated processes and interfaces to reduce the manual intervention and errors. E-policy shall be issued to the insured person and an email/SMS shall be sent with the complete information about the policy. User credentials shall be issued to the insured person, which can be used to access the policy details in future and registering/availing the services through web interface or for identifying himself while availing the services with various touch points.
User friendly Agents: A prospective customer can approach the insurance company agents, who are well trained and aware of available products and shall be in a better position to guide the customer depending on his health records, type of benefits and family background. The agents shall guide the customer through the process of subscription and arrange for the issue of policy through a web interface provided to an agent. The agents shall maintain electronic deposit account with the insurance company and the transaction shall primarily happen through the deposit account with unique cut and pay commission model. The cut and pay commission model shall enable agents availing the commission at the time of subscription of the policy. However Agents can also make the payments against policy subscription through credit card/debit card/banking account. The agent shall access the information about the subscription

details, status of the policy, renewals and commissions through a user friendly web interface.
Call Centre: An automated call center, through which customer can get the details about the available insurance products, gets guided on the best suited policy for him and on the subscription of policy. State of the art IVR system shall be available for online payment submission and guiding the policy subscription. The customer can get the information about the status of policy during subscription. User can also get the policy details from the call center upon clearing necessary verification details.
Corporate Interface: Completely self service driven web interface shall be available for all the corporate customers for subscription and managing the policies for their employees. The corporate administrator can enroll with the insurance company for availing the insurance services for their employees through a user friendly web interface. Upon successful registration, the corporate administrator user shall be issued with user credentials, which shall be used to access the corporate web interface. The admin user can enroll individual/bulk employee users on the system and attach available corporate policies to the employees. Upon registration, each employee user shall have unique user credentials which can be used for identification while availing services. Employees can view the transactions of claims, medical history through web interface. Employee user can enroll additional family members on to the same policy (Who are not part of the corporate plan) with the concurrence of the employer and avail the benefits of the corporate plans. Suitable business rules are built to track the policies issued to the corporate employees in case employee changes the profession and both the employers have subscribed for the same insurance company policies and agree for transfer of policy benefits.
Availing Clinical tests: The customer registered for the subscription of the insurance policy may have to undergo medical checkup depending on the medical history, age group and type of insurance product. The customer at the time of registration through web interface shall be informed about the details of medical checkup - location, contact

person and contact details, guided by the online location map. All the above details shall also be sent through e-mail and SMS to the customer.
The Doctor attached with a clinic who has enrolled with Insurance Company for rendering the clinical test service, shall have a secured web interface to view the registered customer details enrolled for the medical tests and who are assigned to his clinic for undergoing the medical test. The Doctor shall arrange for the list of medical tests which are defined by the insurance company, through his own clinic or through a network clinic which was declared by the Doctor at the time f enrollment to the insurance company. The results of these tests shall be entered through secured web interface. The back end application shall verify the results with medical standards, issues e-policy on compliance of the standards. On non-compliance of the one or more parameters, the request shall be forwarded to insurance administrator for the final decision. In case of rejection of application, necessary intimation shall be sent to the applicant through e-mail and SMS.
Renewal of Policy: Insured person can renew the policies through the online web interface. The payment towards renewal fee shall be accepted through credit card/Debit card/online banking account. Insured person can add/delete family members to the policy, if the insurance product subscribed shall permit these changes.
Modify/Cancel Policy: Insured person can able to add/delete family members, cancel the policy completely or modify the contact information's through the web interface. The charges against the addition/deletion of members or cancellation of the policy shall be based on the product configurations.
The refund charges shall be directly payable to the credit card used at the time of registration or send through pay order as per the business rules defined.
Availing Hospitalization: The insured person, who would like to avail planned hospitalization, can search for available hospitals, which can provide the required specialty treatment either near to his address, declared during subscription of policy or near to his current location, guided by the visual road map. The insured person can call

the respective hospital using the contact details available on the web interface and book an appointment with any of the network hospitals.
Availing treatment:
Registration: The insured person who would like to avail planned hospitalization and booked the appointment can approach the hospital receptionist (front end desk) for registration. The secured web interface upon keying the policy ID, shall provide pre-populated screen with information about the insured person from the insurance database, avoiding the re-entry of insured person data. The registration card with unique patient registration ID shall be generated which shall be used for tracking all the future transactions.
Appointment: The insured person shall request for the appointment of specialist doctor with the front desk. The front desk executive shall access secured web interface to search for the appointment of request specialist and book the time slot requested. The web interface shall also provide functionality of appointment rescheduling/cancellation. An appointment slip shall be issued to the insured person containing appointment details and direction map to the consultant room.
The specialist doctor shall view/manage the appointment details through secured web interface. The referral letters if any, can also be viewed by the doctor using the web interface.
Clinical Details: The consultant doctor shall enter the clinical observations for the patient onto the web interface. Doctor can also view the past clinical details on the same web interface. All the clinical observations shall be entered and stored in the standard healthcare practice format.
Order Management: Doctors shall prescribe clinical tests for the patient based on the clinical observation using Order Entry web interface of order management application. The Order entry standards comply with international CPT/IPD and cross walk standards. In case of any exception to these standards involve Doctors filling ABN (Advance beneficiary Note) to support the additional clinical tests. The application shall be built

with third party interfaces to support the functionality of ICD/CPT and Cross walk standards.
Doctors can update or cancel the tests through the order management interface before the collection of Specimen sample.
The prescribed orders containing multiple tests for a patient can be viewed by the lab assistant through the "Lab Assistant" interface of Order management module. The lab assistant shall perform the requested tests and updates the status of tests upon completion of each tests. The test results shall be entered by the lab assistant using the web interface. The entered test results can be viewed by the doctor using the order management web interface. The Doctors can review and sign the results electronically on the web interface. Treatment: On viewing the lab test results, Doctor shall commence the treatment for the patient using treatment application module, which shall provide user friendly GUI interface for viewing patient records and enter treatment details. The Doctor shall decide on type of admission as either ICU or Regular depending the patient conditions.
Doctor shall have to choose from list of treatment methods from a web interface. The treatment methods shall be "Medical Treatment", "Surgical Treatment", 'Physiotherapy". In addition to this, there shall be "Admission request" menu to submit request for admission of the patient. Doctors shall select one or more menu items depending on the type of treatment to be provided to the patient.
The Medical treatment module shall provide interface to enter details of the medications to be provided to the patient. The details of medications shall capture "Name of the medication", "Type of Medicine", "SIG", "Number of Days", "Quantity", "Start and End date". The entered details shall be forwarded through automated application to Drug store module and the request shall be displayed on the drug store web interface. The interface shall also provision for printing the physical copy of the prescription.
The patient shall approach the drug store ,to which the request has been forwarded electronically , for the collection of drugs. Upon presentation of the physical copy of the prescription, the drug store user shall verify the patient credentials (Insurance card) and

ID proof and dispense the medicines as per the list available on the web interface. There shall be unique order ID to identify the drug prescription event and same reference ID shall reflect in all the documents. The drug store user shall check the medicines dispenses with all the relevant details and details of the dispensed medicines with charging details shall be transferred automatically to the billing module.
The Surgical Treatment module shall have an interface to search the procedures to be performed to the patient based on the clinical results. The search option on the web interface shall be based on keywords, stars with, ends with and shall be linked to master database containing all the standard approved medical procedures. The procedures shall be mapped to one or more diagnosis through another search interface. The mappings shall be verified through the application using international medical standards database .The procedures shall be mapped to primary and secondary diagnosis in case of multiple diagnosis mapping.
After completion of searching the procedure and attaching with Diagnosis, the Doctor shall schedule the surgery. The scheduler interface shall allow selection of Doctor, department and search for the availability of doctor for the scheduled surgery date and time. After confirming the availability of specialist doctor, the interface shall provide option for searching the availability of operation theater. The availability of the one or more operation theaters are mapped to the surgeon's availability through the web interface and schedule for the operation shall be fixed.
After fixing the operation schedule, the doctor shall be redirected to a web interface for creating admission request to the patient into ICU/Regular ward. On submission of the request by the doctor, the details shall be directed to the front desk (Receptionist) module. The patient/patient care taker shall approach the front desk to complete the formality of admission.
Admission of Patient: The admission of the patient to the ward /rooms shall be done based on the request for particular category of rooms/wards, eligibility depending on the insurance product subscribed by the patient and availability of requested category of rooms. The application shall provide an interface to search, locate the type of room

requested and book for the number of days requested by the patient. Generates admission slip containing admission details and map to locate the room. A unique IPD ID shall be generated, which shall keep track of the treatments carried out in the IPD section. The web interface shall also provide the facility to change category of rooms and cancel admission. The charging details shall be automatically populated in the interface and shall be tightly integrated with the billing module.
In Patient services: Capturing the treatment details given to a patient and instructions given by the doctor to the Nurses for performing scheduled activities. Upon admission to the ward, the patient treatment and instructions shall be captured through a web interface. The web interface shall have submenu's for capturing following details
1. Daily Progress Note
2. General Instructions
3. Vital Instructions with viewer
4. Surgical Instructions- Pre-operative and Post -operative
5. ICU Instructions
6. Procedure Details
7. Discharge Note
Daily progress note shall capture the details of the visiting doctor, prescriptions of medicines, procedures performed, equipments connected to the patient. The Prescribing Doctor can electronically request for a visit of consultant doctor through referral web interface. All the data related to prescriptions, medicines and equipments search shall be supported by back end database, so that data shall be automatically populated and doctor shall select through a drop down menu or word search option. Doctor shall be able to view all the previous visit data pertaining to the patient treatment in a user friendly GUI format. The visiting doctor's visit can be flagged as regular/Visiting/emergency visit.
General instructions interface captures instructions and comments entered by the doctor during his visit. Date and time of entry shall be captured by the interface. Doctors can view details of all the general instructions entered for the patient in a user friendly GUI format.

Vital Instructions entry web interface shall capture all the vital details of the patient entered by the doctor during his visit. Doctors can view details of all the vital details entered for the patient during their previous visits, in a user friendly GUI format.
Surgical Instructions web interface shall capture all the pre-operative and post-operative surgical instructions. Checks are built in the system to allow capture of post operative instructions only after the entry and saving the data in preoperative section. The date and time of entry of data shall be captured and stored.
ICU Instructions web interface shall capture the instructions and comments entered by the Doctor after examination of the patient during his visit in the ICU ward. The interface shall also capture the details of the visiting doctor, prescriptions of medicines, procedures performed, equipments connected to the patient. All the data related to prescriptions, medicines and equipments search shall be supported by back end database, so that data shall be automatically populated and doctor shall select through a drop down menu or word search option. Doctor shall be able to view all the previous visit data pertaining to the patient treatment in a user friendly GUI format. The data entered by the doctor can be viewed by the Nurse using the Nurse Module web interface.
If the patient undergoes any surgical procedure, the details of the procedures are captured comprising of following details.
• Procedure Start date and time
• End date and time
• Anesthesia details

> Type of anesthesia
> Anesthetist

• Operative notes
• Post operative observations
• any complications during surgery
• Assistant Surgeon
• Procedure status

(The status can be Planned or performed, when the procedure is prescribed it would be in planned status and when completed would have Performed status)
The web interface also captures the entry of items consumed during surgery. The list of items shall be selected from a drop down menu or from a word search option linked to the database. If the items are consumed from the in-house store of hospital, the consumed data shall be populated on the drug store interface, so that patient can reimburse the consumed items.
Nurse Interface: There shall be a web interface for the Nurses to view the instructions, perform the activities and confirm the completion of activities. Upon successful login by the Nurse on the web interface, the page shall display the list of patients admitted in the ward , who shall be serviced by the Nurse. The Nurse shall have the option of searching the patient on the web interface using one of the following search criteria.
• IPD number
• Patient ID
• Patient name
• Room number
• Doctor name
• Date of admission
The search result shall contain all the above fields displayed in a grid format.
The Nurse shall be able to select one of the patient records and view the instructions for
the following modules depending on which module is applicable to the patient.
ICU Instructions: By selecting this menu option, nurse shall view the ICU instructions
along with comments entered by doctor in Inpatient services. The Nurse shall update a
flag confirming the completion of the instruction assigned to her.
Nurse shall also view the Instructions related to the equipments (attach or detach) ,
perform the activities and record the timings. The back end application captures the
activity timings, calculates the charging and transfers the charging data to the billing
module

Vital Instructions: By selecting this menu option, nurse shall view the Vital instructions entered by the doctor for the Inpatient Services. The Nurse shall update a flag confirming the completion of the instruction assigned to the Nurse. For example, If Doctor has instructed monitoring the BP of a patient after every 6 hours then four check boxes shall appear dynamically for a day schedule and depending on the activities performed, the Nurse shall update the check boxes.
The nurse shall also enter the Vital details on the web interface comprising of Date, Time, IPD ID, Patient ID, Name(all these fields auto- populated), BP, Pulse (/min), Temperature (in F), Height in cm(if not captured in Clinical Details section), Weight in Kg, Respiration (/min), comments. The saved record shall be viewed in a grid format containing all above details.
Medicines Instructions: The Nurse shall view the instructions regarding the medicines along with SIG information. The Nurse shall update a flag confirming the completion of the task. If medicine is required to be taken 2 times a day , two check boxes shall appear dynamically for a day schedule which shall be checked by the Nurse to indicate completion of the task.
Surgical Instructions: The Nurse shall view and confirm the completion of Pre-Operative and Post-Operative instructions entered by the Doctor through the Doctor's Interface.
General Instructions: The nurse user shall view and confirm the completion of the General instructions assigned by doctor through Doctor's Interface.
Nurse shall also view the Instructions related to the equipments (attach or detach), perform the activities and record the timings. The back end application captures the activity timings, calculates the charging and transfers the charging data to the billing module
Thus the complete treatment of the patient shall be driven through well defined processes and software. The application captures the complete medical treatment history of the patient. The access to the information shall he controlled according to the healthcare industry standards.

After completion of the treatment of the patient, certified by the prescribing Doctor, the discharge summary shall be generated. The discharge summary shall be generated in the following format and can be viewed on the web.
The interface shall be display following fields
Patient ID
IPDid
Patient Name
Date of admission
Date of discharge
Age
Gender
History of Present Illness
Primary Care Physician:
Referring Physician
Consulting Physician(s):
Provisional diagnosis at admission
Procedures
Complications
Lab result
Discharge diagnosis
Condition upon discharge
Diet
Date of next appointment
Consultant for next visit
List of medications
Issues to be addressed at follow up

The back end billing application captures all the charging points. The charges shall be mapped to each of the services in the configuration module. The computed charges shall be populated in the billing module and shall be available on web for viewing by the authorized users.
The billing application keeps track of the current charges, the insurance claim limit, Charges towards ICD/CPT cross walk exception treatments, Charges to be borne by the patient.
From the insurance claim perspective, the cashless claim shall be valid for the IPD treatments and the treatments 30 days prior to hospitalization and 60 days post discharge. For all the practical reasons, the cashless transaction shall start only after the generation of IPD ID , which shall be a unique identifier for the IPD treatments. Patient shall have to pay in advance to the hospital for all the treatments prior to the IPD ID generation for the planned treatment. There shall be a reimbursement web interface module for the submission of the claims pertaining to the treatments prior to the IPD admissions. However for emergency admissions, most part of the treatments shall be cashless as the IPD ID shall get generated immediately after emergency admission.
The billing module shall generate the complete billing information after the confirmation on discharge of the patient. Claims documents shall be generated automatically and documents along with discharge summary shall be forwarded to the surveyor interface. Surveyor is an authorized agency, nominated by the insurance company for verifying the claims submitted by the hospital against insured person treatment. Surveyor shall registers with the insurance company through web interface for providing the services and on mutual consent insurance company shall authorize surveyor to carry out treatment verification and approval on behalf of the insurance company as per the medical standards and business rules defined by the insurance company.
The surveyor shall logon to the secured web interface to the insurance application, after proper authorization, views the treatments in progress, treatments completed and claims submitted for verification and approval. The surveyor can sought for clarification from

hospitals on the treatments. The surveyor shall keep a tab on all the treatments pertaining to a patient assigned to him for monitoring by the insurance company. The surveyor shall have all the privileges to view the consultant reports, clinical tests and treatments carried out for the assigned patient.
The claims approved by the surveyor shall be submitted to the fund transfer module and the funds shall get automatically transferred to the banking accounts of the respective hospital. The online banking account details shall be submitted by the hospitals at the time of registration with the insurance company.
The subsequent description provides elaborated description of each module described in the foregoing specification.
1. INSURANCE MODULE
This will be the entry point to buy an insurance policy. This module provides two options in the beginning such as
Option 1: View Products
This should display the products as a menu. On selection of a product, the product details should be displayed on the page itself. The page shall have the selection options for
1. Calculate premium and subscribe
2. Subscribe
Option 2: Subscribe the best plan -Policy Advisor
The page shall provide the option for the entry of details of the subscriber similar to the calculate premium work flow.
On submission of the details by the user, system should display the most suitable product for the user depending on the input, with two other best product options.
Calculate premium and subscribe:
1. On selection of Calculate premium and subscribe menu option, the user shall have the provision to calculate the premium. By default the premium calculation

option shall be for an individual subscription. Premium calculation shall be based on the age group, sum to be insured and the pre existing illness if any. There shall be a provision to calculate the premium for family on selection of the Family option. The calculator for the family option should be able to handle multiple member inputs. On clicking subscribe button, the prospective insured person should be redirected to subscription policy page. The data captured in the premium calculation page should be transferred to the subscription page. 2. On selection of subscribe option the user should be redirected to subscription policy interface.
Subscription of policy
The user should be redirected to this page as shown in figure 2, on selecting subscribe
option on the home page or selecting Subscribe option from the calculate Premium page
or from the Policy Advisor page. This page shall capture the details of the prospective
insured person. There shall be a provision to select Individual/Family.
If family is selected then there shall be provision to select number of family members.
The maximum number of family members that can be included for the selected product
shall be auto populated. The pages should dynamically refresh depending on the
selection.
On capturing all the data the page shall display the premium amount.
There shall be "continue" option and upon selection the page shall display Declaration of
Conditions of Health form.
Terms and conditions should be shown at the bottom of the page. The content should be
configurable through admin module.
On submission of details, request shall be redirected to the payment page. If the user
closes the browser or does not carry out payment transaction, there shall be a pop up
message "Dear customer, your profile details has been saved and a username/password
has been sent to your email id. If you wish to continue transaction in future, please use
the user credentials received in the email".

MENU selection on logon
On logon the user has to be redirected to appropriate menu as per the business logic.
• The insured person who is due for renewal within a month, shall be displayed an
option to choose between Renewal/ Hospitalization /Other services as depicted in
figure 2a. The Renewal button should be prominent. If the insured person has
multiple policies, all the policy numbers should be displayed with Renewal/
Hospitalization /other services. The list of other services should be shown
(probably a dropdown list) which the user should be able to select. The other
services are
o View/Edit/Cancel Policy o View Transaction o View Promos/products o View network hospitals o Reimbursement form o Feed back on hospitals
• If policy is pending renewal and the user selects the option other services. There should be an intermediate page displaying the consequences of not renewing the policy. Pop up should be provided to select option of renewal.
• The insured person, who would like to avail the services, should be redirected to Services Interface.
• If the user is registered and the payment is not done, the user shall be shown his profile and prompted for payment.
VIEW/edit/cancel policy
Here, the user can view the policy details and edit.
This is the redirection from the MENU SELECTION page on selecting VIEW/EDIT/CANCEL POLICY option from other services list. This functionality flow is illustrated in figure 2b.
The details of the policy shall be auto populated. The following fields can be edited by the user:

Contact details like phone number, address, mobile number, email id etc.
User should not be able to edit Name, DOB and gender.
If it is a family insurance the family details should be displayed like name, age group and
sum insured. There shall be provision to add or delete family members from the policy
before the renewal date.
Deletion of family member:
In case of deletion of family members the premium amount corresponding the remaining period of policy shall be calculated based on the configuration made in the admin module and shall be refunded.
Addition of family member:
The premium amount corresponding to the remaining period of the policy shall be calculated as per the configuration and policy holder shall be redirected to the payment page to make the payment.
Change sum insured:
The difference in the charges shall be calculated based on the new sum insured premium for the remaining period and existing sum insured premium for the availed period.
Cancel: upon selection of this menu item there shall be a pop up confirming cancellation of the policy and consequences of cancelling the policy. The refund option shall be enabled in case the insured person canceling the policy or deleting a member is eligible for refund.
Refund:
Upon cancellation there shall be an option to roll back the amount to the original credit card which is used during initial subscription of the policy or demand draft shall be issued depending on the option selected by the policy holder.
View transactions
This should display the transaction by the insured person. This is the redirection from the MENU SELECTION page on selecting VIEW TRANSACTION option from other

services list. The page should display all the hospitalization data pertaining to the insured person in ascending or descending order of the date. The insured person should be able to select and view the transaction for particular date range. The macro level data shall contain the date of transaction, hospital name ,the amount incurred .The insured person shall able to select each of the entries and drill down to micro level data which shall give his treatment history details like the diseases treatment, medicines, allergies and all pathology reports. There shall also be display of transactions like premium paid, date, and next renewal date etc. There shall be disclaimer at the bottom of the page saying "This is a policy holder initiated document. The insurance company is not responsible for any of the change/discrepancy claims arising out of this document"
View promos/products
This page should display the products, promotions and discounts available for the insured person. Upon selection the user should be able to view the details and subscribe.
Interface to Avail medical Facility and hospitalization:
On selection of "Hospitalization" sub menu in Menu selection interface, the insured person shall be redirected to this page.
Workflow details:
Referring now to figures 2, 2a and 2b, Display the policy or policies in case of customer having multiple policies with a provision to select any one of those. There should be provision to see the details like benefits, special features etc of the policy. In policy containing multiple members there shall be a provision to select the single or multiple names from the policy. The insured person shall be asked to select the current location either as "Address mentioned in the policy" or "Other location". On selection of other location there shall be provision to select Country, State, City and Pin Code and date.
Complete address shall be displayed and the order of the display shall be address, PIN code, city, state and country.

The insured person shall be given an option to select from the list of organ based diseases. When the user selects other location, there shall be provision to enter the PIN code/city/state. Upon entry of the PIN code the city and state shall be auto populated.
A list of hospitals which provide treatment to the illness selected, and nearby to the location selected, shall be displayed, and user should be able to select from the list of hospitals.
On selecting the hospital, the contact details of the hospital shall be displayed. Insured person can call the hospital to confirm the admission.
In case of emergency the insured person shall rush to the nearest hospital where the company has the tied up. The customer data shall be entered in the hospital module by the hospital administrator after admitting the insured person. The same data shall get populated into the insurance user module.
Feed back on hospitals
On selection of "Feedback on hospitals" sub menu in Menu selection interface, the
insured person shall be redirected feedback page.
On submission, the details shall be available to the insurance admin. And the page shall
display "Thank you for your feedback".
Payment interface:
This interface provides an option to capture payment details and process payment.
Details of workflow:
User should be given provision to select one of the modes of payment. 1. Modes of payment shall be: I. Credit card II. Debit card III. Banking account
1) On selection of Credit card option the page should capture the following details:

1) Credit card holder information
• First name
• Last name
• Company name
• Address
• City
• State
• Pin number
• Country
2) Credit card information:
• Credit card number
• Card Expiration date
• Card type
3) Masters/ISA
• CVV number
Required interface to be build to handle the interaction with the payment gateway and passing the response back to this page.
The user shall have 3 tries to enter the Credit card details.
1) On selection of Debit card option, the request shall be forwarded to Debit Card banking URL with a transaction ID. The response from the banking URL shall be displayed on this page.
2) On selection of banking account the process should be same as that of Debit card.
2. AGENT MODULE
This module shall handle following agents' activities:
1. Registration process for the agents.
2. Subscribing/renewing a policy for a prospective insured person.
3. View transactions and commission, pending renewals of the prospective
insured persons registered by the agent.
4. Registering insured person for hospitalization.

Flow chart of aforementioned activities and agent module functionality is illustrated in figures 3, 3a, 3b and 3c.
Agent registration page:
The prospective agent can register with the insurance company using this interface.
Agent's menu
When agent logs in from the insurance home page shall be redirected to this page.
On Agents menu page, the agent can do following activities:
1. Register a prospective insured person.
2. Renew a policy.
3. Modify a policy.
4. Agents dashboard.
5. View commission.
6. Register for hospitalization for an insured person.
7. Recharge deposit account

7. Make payment
8. Modify agent profile
9. Corporate User registration
Guidelines for online training FOR AGENTS
1. The prospective agent shall undergo at least 120 hours' (since test after every chapter is mandatory) practical training in general insurance business, where such applicant is seeking license for the first time to act as an insurance agent. The training material has been compiled and presented in the Training syllabus enclosed.
2. The training duration should be minimum 24 days for 120 hours' training. The total hours per chapter is mentioned in the syllabus.
3. The training material for market survey and insurance company product is covered in a separate syllabus.

4. The attendance record (login and logout time) of the prospective agent should be maintained by application. After the training, the attendance record should be available in the system for inspection purpose.
The training tracking record shall be shown in the following format:
Start Date End Date No. of Days Left Maximum Hours Total Hours Spent Total Hours Left Current Chapter No Current Chapter Name Minimum hours to be spent Hours spent
5. There shall be a module to register the queries raised by the prospective
agents. There shall be an interface to view and respond to the queries by the
insurance consultant appointed by the company. The prospective agent shall
be able to view the answers to his queries.
There shall be Provision for following modes of interaction between the prospective agent and the insurance consultant appointed by the insurance company
• Through e-mail
• Chat-room/Open forum
• Off-line queries
6. There shall be a link to display certificate of accreditation to impart training
issued by the Authority at the training institute and also IRDA Registration
number should be made available in the home page of the portal.

7. Database should be maintained in the system giving details of agents who have completed their training, name of the insurance consultant who solved the on-line user's problem during the tenure of the training. The record of results of the examination (test) at the end of the training whether passed/failed must be recorded in the database.
8. There shall be a provision to issue separate user name/password to the IRDA as a user (candidate) as well as administrator to monitor the web site (on line portal).
9. There shall be an interface for the insurance consultant or admin to modify the portal contents and answer to the queries.
10. On-line Agents training portal should be hosted in a separate domain and the portal should be exclusive for on-line agents training.
11. There shall be tracker to monitor minimum time to be spent on every chapter
12. IRDA registration number is displayed boldly in the home page.
13. There shall be FAQ Section (contents are in the syllabus module)
14. There shall be an interface to display Progress card containing the following details with provision to print the same

• Module name
• Chapter No.
• Test
• Marks obtained
• Maximum marks
• Time (Hour/Minutes) spent.
15. During the practice test, there should be facility to alert the users after certain
time intervals.

16. The session shall be closed if the session is idle for more than 7 minutes.
17. There should be a mechanism for reporting user problems to web administrator using following options-

• By Mail
• By posting queries.

18. There shall be a link to User manual (contents of user manual are enclosed in the syllabus).
19. Search facility must be on the page so that user can find the desired information.
20. A section containing the details of Faculty, Web-administrator, Head of the Institute, along with their address, e-mail id, phone numbers etc. should be made available on the site.
21. Interface for IRDA user to view
> Batch No, Duration, No of Student, Name of the insured
person sponsoring the course, no of student cleared the course; the no
of students cleared the exams and % of result
> Facility to see the progress of the Individual student
> Facility to print the progress report of the Institute (report format shall be similar to that of off-line training Institute)
Registering a prospective insured person by the agent
This shall be the redirected page after selecting the first option Register a prospective insured person from the agent activity page. This is the page which will capture the details of the prospective insured person. There should be a provision to select Individual/Family.

If family is selected then there should be provision to select number of family. Upon submission of the details user shall be redirected to the payment page. Upon successful submission of the payment details the policy shall be generated. The agent user shall have the option of using deposit account/Credit card/Debit card as payment options.
Renew a policy
There shall be a provision to enter the policy number.
The request shall be redirected to renewal page if the policy number is valid one and
pending for renewal. Else a suitable error message shall be displayed.
modify a policy
There shall be a provision to enter the policy number.
The request shall be redirected to VIEW/EDIT page if the policy number is valid one and
pending for renewal. Else a suitable error message shall be displayed.
View commission
This shall have date range selection option (date of subscription of policy).
On submission of request the commission details shall be displayed.
Register an insured person for hospitalization
On selecting this option the agent shall be redirected to the Interface to avail medical
facility and hospitalization.
Recharge deposit account
Upon selection of this menu the request shall be redirected to net banking page.
Upon successful response from the net banking URL, the agent's account shall be topped
up with the respective amount.
Make payment
There shall be provision to enter policy number or profile id. If the entered data is valid then the request shall be redirected to agent's payment page .Otherwise it shall display proper message.

agent's Payment page
The page shall display the following details.
First name
Middle name
Last name
Agent ID
User should be given provision to select one of the modes of payment. Modes of payment shall be:
1. Agent deposit account
2. Agents credit card
3. Customer credit card.

1) On selection of deposit account option, there shall be display of current balance in the deposit account, the policy amount and balance after payment.
2) On selection of Customer Credit card or agents credit card option the page should capture the following details:
Credit card holder information
• First name
• Last name
• Company name
• Address
• City
• State
• Pin number
• Country Credit card information:
• Credit card number
• Card Expiration date
• Card type Master/VISA

• CVV number
Required interface to be build to handle the interaction with the payment gateway and
passing the response back to this page.
The user shall have 3 tries to enter the Credit card details.
On successful payment transaction
• The page should display the policy.
• The agent should be able to print.
• The agent should be able to save on the local hard disk.
• The page should also display the message "The policy has been sent to insured person Email ID".
• There should be Short Message Interface to send the details of the policy p the insured person.
• A copy of policy should be sent as an email.
• The username and password of the policy holder shall be sent to the policy holder's email ID.
agent's dash board
On selection of the option Agents' Dash Board from the agent's activity page the user
shall be redirected to this page.
There shall be display of options as below.
1. Prospective insured persons pending for medical approval
2. Policies pending for renewal.
3. Policies rejected.
4. Search policy.
Modify agent's profile
On selection of Modify Agent profile from the agent menu the agent shall be able to
modify his contact details.
Corporate User registration

On selection of this menu option the agent/broker shall be able to register a corporate user with the insurance company.
3. CORPORATE MODULE
The corporate module is capable of handling the activities mentioned below. The work flow of the corporate module is illustrated in figures 4 and 4a.
1) Register individual or group of employees for availing insurance facility.
2) View/Modify corporate user policy data.
3) Utility for bulk uploads of data in a specified format.
4) Utility for bulk deletion.
5) Corporate employee user interface to view transaction and register for treatment.
Login page
This is the redirection from the home page when the user selects the corporate user on the
insurance home page.
There shall be option for existing user login and new user registration.
corporate admin user registration page
This is the redirection from the login page when the user selects the New User option in the login page. A corporate user shall be able to register with the insurance company. On submission of data a message shall be displayed in forming the corporate admin user "Your registration is successful. You shall receive a user credentials through email/SMS within 24 hrs".
Menu page
After successful login the corporate admin user shall use the following menu:
1. Create corporate employee users
2. Create employee profile
3. Modify Admin profile
4. View transactions
5. Recharge deposit account
corporate admin interface

The functionalities to be supported by this interface:
1. Create corporate employee users
• Individual
There shall be an interface to enter following fields:
Employee ID Primary Key
Name (First name, middle name, last name)
Date of Birth
Gender
Nationality
Email ID
Policy name-list of policy names shall be populated based on the list of policies attached
against the corporate id in the admin module.
Upon submitting the details, system shall generate user credential. Username shall be displayed on the screen and an email shall be sent to the individual corporate employee user.
• Bulk:
There shall be a utility to upload bulk user details in an excel format. Upon submission of the data, system shall generate the user credentials and display username on the screen. The same information shall be sent as an email containing the username and passwords to the corporate admin user email ID.
2. Create employee profile:
• Individual
There shall be provision to enter the details of the employee. There shall also be a provision to select between Individual/Family. If family is selected the user shall be given provision to enter family members' details. On submission the policy will be generated which user can view on the screen with user name and password. And also an email shall be sent to the employee email id.

• Bulk
There shall be an upload facility in an excel format. Upon submission the bulk policy generation utility which generates policies, user name and policy number which can be saved in an excel format on to the local hard disk. There shall be an email to the administrator containing the details for all the users for which policy is generated and mails to individual policy users. There shall be email intimation to the individual user and admin upon the successful generation of the policy.
Modify Admin profile
This page shall display the admin profile
View transaction:
This menu shall have the following options:
1. View/approve user registrations
2. View user claims
• View user registration:
This shall allow the administrator to view the details of the user registrations based on parameters-department, name, city name and date range and employee id. There shall be an option to generate the policy.
• View user claims:
This shall allow the administrator to view the details of the user claims based on parameters- department, name, and city name and date range and employee id.
• Recharge deposit account
Upon selection of this menu the corporate admin shall be redirected to the net banking menu. Upon successful transfer of funds to the bank, the corporate shall be able to do the financial transactions for policy generation and renewal.

Corporate employee user
Upon login from the insurance home page, if the user profile is individual corporate, the
request shall be redirected to the corporate user page.
The page shall contain the following options
1 .Create profile-this shall facilitate the creation of user profile.
2 .Edit profile-the user shall be able to edit the profile.

2. Request for hospitalization
3. View transactions 3.5.1 CREATE profile
The user shall able to enter his details. If family is selected the user shall be given provision to enter family members' details.
EDIT profile
On selection of this option the user's profile shall be displayed. The user shall be able to
edit the policy.
REQUEST for hospitalization
On selection on this option the user shall be redirected to Interface to avail medical
Facility and hospitalization.
View transaction
On selection of this option the user shall be redirected to the VIEW TRANSACTION
page.
4. ADMIN MODULE
Home page: This page is the entry point for the user to login. There shall be provision to enter username and password. On valid entry of the username and password there shall be redirection to Admin page.
Admin page
The admin page shall have the following menu options:
1. Manage user profile

2. Manage web insured person
3. Manage agent user
4. Manage corporate user
5. Manage plans
6. Manage surveyor
7. Manage hospitals
8. Manage claims
9. Manage policies
10. Revenue accounting
11 . Manage drug store user....Approve drug store user registration
12, . Create office profile
13, . Physical verification of details(of the hospitals, surveyor, drug store, agent)
14, , Manage commissions
15. Refund module
MANAGE user profile
The page shall display the following options:
1. Create user (admin user/other users).
2. View Users/Approve/assign rights to users.
3. Manage user rights assign/remove.
4. Modify user.
5. Disable user.
CREATE user
This shall have 2 options
1. Employee user.
2. Other user.
On selection of this option the menu shall contain following sub option
1. Create agent
2. Create surveyor
3. Create corporate user

4. Create drug store user
5. Create Hospital user
Employee user
This is the redirection when the user selects Admin user option from the CREATE USER page. On submission an entry shall be made in the View Users/assign rights to users.
Other user
Create Agent:
This is the redirection from admin page when the user selects the Create agent option.
Create surveyor:
This is the redirection from admin page when the user selects the Create surveyor option.
There shall be an option to select
1. Specialist Doctor (for monitoring treatments at hospital)
2. Specialized clinics (for prospective insured person medical examination and upload of data)
3. Specialist doctor with clinical support. (For both medical examination and monitoring treatment at hospitals).
On selection of any of these options the page should dynamically populate the relevant
fields.
Create Corporate user:
This is the redirection from admin page when the user selects the Create Corporate user
option
Create drug store user:
This is the redirection from admin page when the user selects the Create Drug store user
option
After creation of the users an email containing the profile id, username and password shall be sent to the user.

View users/approve users/assign rights to the users This shall have the following options:
1. Employee
2. Surveyors
3. Agents
4. Corporate user
5. Drug store user
6. Hospital user
On selection of any of the above options the list of users who are pending for approval shall be displayed. On selection any of the users from the list the details of the user and physical verification details shall be displayed.
The approve option shall be enabled only if the physical verification details are entered in the system.
Manage user rights assign/remove.
This page shall allow the admin to modify employee user rights.
Modify user
This page shall allow modification of certain fields for all the types of user. There shall be provision to enter the unique identification number assigned to the user or user id .On submission of the request edit page for the user details shall be displayed.
1. Surveyors: On selection of this option the request shall be redirected to Modify profile page of Surveyor.
2. Agents: On selection the request shall be redirected to Modify Agent's Profile Page.
3. Corporate user: On selection the request shall be redirected to corporate admin user profile edit page.
4. Drug store user: On selection the request shall be redirected to Modify drug store user profile.

5. Hospital user: On selection the request shall be redirected to Hospital user profile edit page.
DISABLE user
The admin shall be able to search the user based on the user id, department or user
identification number .Upon selection of the user there shall be provision to disable the
user.
MANAGE web insured person
This page shall have the following menus:
1. View insured person
2. Modify insured person
3. Register for hospitalization.
4. Renew a policy.
5. Approve new registrations.
6. View transaction.
View insured person
On selection of View Insured person option from the menu the page shall display the details of the insured person based on the search criteria. The display shall be always on the date of activity (either ascending or descending). On selection of any of the policies user shall be able to view the policy details.
Modify insured person
There shall be a provision to enter the policy number. On submission of the request the policy details containing the Policy number, name of the person, date of subscription and policy status shall be displayed. Upon select the user shall be redirected to modify insured person page.
Register for hospitalization
There shall be a provision to enter the policy number. On submission of the request the
policy details containing the Policy number, name of the person, date of subscription and

policy status shall be displayed. Upon select the user shall be redirected to Interface to Avail medical Facility and hospitalization.
Renew policy
There shall be a provision to enter the policy number. On submission of the request the
policy details containing the Policy number, name of the person, date of subscription and
policy status shall be displayed. Upon select the user shall be redirected to Renew Policy
Page.
Approve new registration
By default the page shall contain the registrations pending for approval for last 24 Hrs. However there shall be a provision to select the registrations based on the date range. Upon selection of the registration records the page shall display the details of the insured person, medical checkup records with all the parameters and all the values. The admin user shall either approve or Reject the profile based on the business rules defined.
On approval of a policy registration, If payment mode is credit card, payment gateway transaction shall be fired for debiting insurance premium amount from the insured person's credit card. If the credit card transaction fails, the policy shall be cancelled and necessary intimation shall be sent to the insured person for making the payment.
On rejection of the policy,
• If the payment mode is credit card, the pre auth on the credit card shall be withdrawn and policy shall be cancelled.
• If the insured person has used payment mode other than credit card necessary refund request shall be sent to the payment gateway, and intimation shall be sent to the insured person's contact details.
There shall be intimation through Email and SMS to the insured person.
View transaction
There shall be provision to enter the policy number. On submission of the request the
policy details shall be displayed. There shall be option to select

Insurance details
Hospitalization details
On selection of Insurance Details the data shall contain the history of insurance policy. On selection of Hospitalization details the page should display all the hospitalization data pertaining to the insured person in ascending or descending order of the date.
MANAGE agent user
This interface shall have the following menu options:
1. View agents
2. Modify agent profile
3. Upload payment to deposit account
4. View agent transaction
View agents
On selection of View Agents option from the menu the page shall display the details of the agents depending on the search criteria. The display shall contain list of agents. Each row in the list shall contain Agent ID, Agent Name, and City. On selection of agent name the display shall contain the agent's details.
Modify agent profile
There shall be provision to enter the Agent ID number. On submission of the request the
user shall be redirected to Modify Agent's Profile page in the agent's module.
Upload payment to deposit account
There shall be provision to enter agent ID number .On submission of the request there
shall be an option to upload the payment to an account of a valid Agent.
View agent transaction
This interface is to view the agent transaction for particular agent, date range and city as
selection parameters.

MANAGE corporate user
This interface shall have the following menu items
1. Create corporate user.
2. View/modify corporate user.
3. Approve corporate user registration.
4. View/modify policies of a corporate user.
5. Assign /de assign insurance plans to corporate user.
6. Disable corporate user.
CREATE CORPORATE USER
Upon selection of the menu option the request shall be redirected CORPORATE USER
REGISTRATION PAGE.
View/modify corporate user.
There shall be a provision to enter Corporate ID number. On submission of the request
the user shall be redirected to Modify Admin profile in corporate module.
Approve corporate user registration
Upon selection of this menu a list of corporate user registration requests which are pending for approval shall be displayed. There shall be option to search the requests based on Corporate ID number, City, Date range and Company name. The display shall contain Corporate ID number, corporate user ID, Company name, City and date of registration. The display shall also include the requests which are pending for approval after modification. Admin can navigate through the registration details and approve. The details shall contain the broker ID if any, in case of registration of the corporate by a broker. There shall be a commission field which shall display the default commission value assigned to the broker ID. Admin user can change the value of the commission as per the business deals for a particular corporate. The commission structure which can be configured, shall be same as that is available in the configure commission menu.

View/modify policies of a corporate user
There shall be option to view and modify the policies of corporate users based on Corporate User ID, Company Name and city. Upon submission for the modifications of the policy the request shall be redirected to Edit Profile of Corporate module.
Assign /de assign insurance plans to corporate user.
This interface shall facilitate assign and de assigning of active insurance plans to a
corporate. There shall be selection criteria to enter the corporate ID number, verify for the
validity of the ID, Display available insurance plans and assign one or more insurance
plans.
Disable corporate user
This interface shall allow changing the status of the corporate user. There shall be a provision to enter corporate user id to validate and display. Upon selection the user status can be changed from active to inactive or vice versa.
MANAGE plans
There shall be interface to enter the benefits and details of the benefits and the create
plans
The interfaces shall be:
1. Interface to enter the benefits
2. Interface to add/modify the age group and pre existing illness
3. Interface for co relation matrix for age group, pre existing illness , tests to be conducted and additional premium
4. Interface to configure insurance plans(base module)
5. Refund rules
6. View/ modify insurance plan
7. Interface to configure city based additional premium and sum insured correction
INTERFACE for configuring the tests to be conducted in the surveyor module This module shall enable the entry of tests (test name, permissible limits, threshold limits) to be conducted during medical examination of the prospective insured person.

The module shall allow configuring add/modify/remove the test and parameters. The logic defined based on the above variables shall decide the type of tests to be conducted on an insured person.
View/ modify insurance plan
This option shall enable modification of all the active insurance plans.
INTERFACE to configure additional premium and sum insured correction
This interface shall facilitate configuration of additional premium and sum insured
correction.
MANAGE surveyor 1 .Create surveyor
2. Approve surveyor registration
3. View /modify surveyor profiles
4. View surveyor transaction
5. Manage commissions. 4.7.1 create surveyor
On selection of this option the request shall be redirected to Registration Page of the Surveyor Module.
Approve surveyor registration
The registrations request submitted by the surveyor shall be populated on selection of the menu. The requests submitted for modification of profile shall also be populated for approval. There shall be provision to search the surveyors based on surveyor profile ID, date of registration and city. The admin shall cross check the physical verifications done for the surveyor and approve the registration.
View modify surveyor profile
On selection of this option the user shall be redirected to Modify profile page in the surveyor module. After submission of the modification request, the modified profile shall be saved. An email and SMS intimation shall be sent to the surveyor.

View surveyor transaction
This interface shall display the surveyor transactions depending on the search criteria.
The search result for the type of transaction -Insurance subscription shall contain
surveyor ID, Name of the surveyor, City, Policy number/Profile ID, name of the clinic,
status of medical test (successful/threshold/failed)
The search result for the type of transaction- Hospitalization shall contain surveyor ID,
name of the surveyor, city, policy number, name of the hospital," patient's status
(Admitted/Discharged). Selection of policy ID shall have the provision to view the
hospitalization details.
Manage Commissions
This page shall provide an option to search surveyor transactions based on search criteria.
MANAGE hospitals
1. New hospital registration.
2. Modify hospital profile.
3. Approve hospital profile.
4. Monitor hospital transactions
New hospital registration
On selection of the option the request shall be redirected to page "Registration for
hospitals" in hospital module.
Modify hospital profile
On selection of this option the request shall be redirected to Modify hospital profile in
Hospital module.
Approve hospital profile
There shall be an interface to view the pending requests for approval of
registration/modification for the hospitals depending on search criteria. By selecting the
hospital ID the admin can view hospital registration details and physical verification
details.

Monitor hospital transactions
This interface shall be used to monitor the hospital transaction. The admin can view the
details by selecting the hospital id key.
MANAGE claims
1. View claims and authorize fund transfer to hospitals.
MANAGE policies
1. View policy
2. For registration of new insured person after submitting the medical reports
3. Modify policy.
4. Renew a policy
5. Disable a policy.
MANAGE Drug store user
1. Drug store registration
2. Approve drug store user registration.
3. Approve drug store user transaction vetted by the surveyor.
4. View reports.
• Drug store registration
On selection of this option the user shall be redirected to Registration of drug store user in drug store module.
After successful registration and email and a SMS intimation shall be sent to the drug store contact person.
• Approve drug store user registration
On selection of this option the page shall display the pending requests for approval of Drug Store registration. The search criteria shall be based on date range, city, profile id and drug store name. The user can drill down this details and physical verification details on selection of Profile ID. Upon approval there shall be an intimation sent to the drug store contact person.

• Approve drug store user transaction vetted by the surveyor
This module shall enable the admin to view and approve the drug store user transactions which are verified by the surveyor. The search criteria shall be based on Drug Store ID, Hospital ID, and date of request, surveyor ID, Policy number and hospital identification Key. By default the page shall contain the transactions pending for approval for the current date. The admin can select individual or bulk transaction for approval. The admin can view the details of drugs dispensed by selecting the individual transaction.
• View reports
This module shall provide an interface to view the following basic reports:
1. View summary parameters drug store ID, date , city ,hospital ID
This report shall display the total amount of transactions date wise for a period of month for the above variable.
Create office profile
This module shall facilitate creation of profile for insurance offices at different places.
There shall be provision to enter the profile details of the particular location.
PHYSICAL verification module
This shall provide an interface for entering the details of following entities upon physical
verification
1. Hospital: the address and the available facilities and specialties shall be verified.
2. Drug store : Address verification
3. Surveyor (clinical lab): Address and available facilities shall be verified.
MANAGE commissions
This module shall contain the following options:
1. Configure commissions
2. View/authorize commission payment.
Configure commissions
This module shall facilitate configuration of commissions for agents, brokers and
surveyors (medical test/ monitoring the treatment)

View/authorize commissions
This module shall enable the administrator to view and authorize commission payment to
the surveyors.
REFUND module
This module shall have the following menu items:
1. Interface to view refund.
2. Interface for sending refund requests.
Interface to view refund
This menu shall display details on the list of refunds which are processed, under
processing, pending and rejected.
The user shall be able to extract reports based on one or more above selection criteria. There shall be an option to select a transaction and process the refund request. Upon selection the request shall be redirected to Process Refund Request page
INTERFACE for processing refund requests
This interface shall enable processing of refund against cancellation or deletion of family members. Upon selection of DD/cheque there shall be an option to enter the DD/cheque details and the dispatch details.
Hospital Management System
Hospital management application shall help in capturing the complete treatment history
for the insured person.
Application concentrates around managing the treatment for the patient, enabling
cashless claims, supports medical standards with ICD/CPT and cross walk feature to plug
the errors during diagnosis and treatment.
The ICD/CPT and crosswalk feature built in the Hospital Management Application shall
help doctors to select right mapping of tests and procedures against diagnosis
Online submission of claims, verification of claims and electronic transfer of funds shall
reduce human dependencies, thus increasing agility in the entire insurance claim handling
process.

The hospital management system shall have the following modules: Registration: The insured person who would like to avail planned hospitalization and booked the appointment can approach the hospital receptionist (front end desk) for registration. The secured web interface upon keying the policy ID, shall provide pre-populated screen with information about the insured person from the insurance database, avoiding the re-entry of insured person data. The registration card with unique patient registration ID shall be generated which shall be used for tracking all the future transactions.
Appointment: The insured person shall request for the appointment of specialist doctor with the front desk. The front desk executive shall access secured web interface to search for the appointment of request specialist and book the time slot requested. The web interface shall also provide functionality of appointment rescheduling/cancellation. An appointment slip shall be issued to the insured person containing appointment details and direction map to the consultant room.
The specialist doctor shall view/manage the appointment details through secured web interface. The referral letters if any, can also be viewed by the doctor using the web interface.
Clinical Details: The consultant doctor shall enter the clinical observations for the patient onto the web interface. Doctor can also view the past clinical details on the same web interface. All the clinical observations shall be entered and stored in the standard healthcare practice format.
Order Management: Doctors shall prescribe clinical tests for the patient based on the clinical observation using Order Entry web interface of order management application. The Order entry standards comply with international CPT/IPD and cross walk standards. In case of any exception to these standards involve Doctors filling ABN (Advance beneficiary Note) to support the additional clinical tests. The application shall be built with third party interfaces to support the functionality of ICD/CPT and Cross walk standards.

Doctors can update or cancel the tests through the order management interface before the collection of Specimen sample.
The prescribed orders containing multiple tests for a patient can be viewed by the lab assistant through the "Lab Assistant" interface of Order management module. The lab assistant shall perform the requested tests and updates the status of tests upon completion of each test. The test results shall be entered by the lab assistant using the web interface. The entered test results can be viewed by the doctor using the order management web interface. The Doctors can review and sign the results electronically on the web interface.
Treatment: On viewing the lab test results, Doctor shall commence the treatment for the patient using treatment application module, which shall provide user friendly GUI interface for viewing patient records and enter treatment details. The Doctor shall decide on type of admission as either ICU or Regular, depending upon the patient conditions. Doctor shall have to choose from list of treatment methods from a web interface. The treatment methods shall be "Medical Treatment", "Surgical Treatment", 'Physiotherapy". In addition to this, there shall be "Admission request" menu to submit request for admission of the patient. Doctors shall select one or more menu items depending on the type of treatment to be provided to the patient.
The Medical treatment module shall provide interface to enter details of the medications to be provided to the patient. The details of medications shall capture "Name of the medication", "Type of Medicine", "SIG", "Number of Days", "Quantity", "Start and End date". The entered details shall be forwarded through automated application to Drug store module and the request shall be displayed on the drug store web interface. The interface shall also provision for printing the physical copy of the prescription.
The patient shall approach the drug store to which the request has been forwarded electronically, for the collection of drugs. Upon presentation of the physical copy of the prescription, the drug store user shall verify the patient credentials (Insurance card) and ID proof and dispense the medicines as per the list available on the web interface. There shall be unique order ID to identify the drug prescription event and same reference ID shall reflect in all the documents. The drug store user shall check the medicines dispenses

with all the relevant details and details of the dispensed medicines with charging details shall be transferred automatically to the billing module.
The Surgical Treatment module shall have an interface to search the procedures to be performed to the patient based on the clinical results. The search option on the web interface shall be based on keywords, stars with, ends with and shall be linked to master database containing all the standard approved medical procedures. The procedures shall be mapped to one or more diagnosis through another search interface. The mappings shall be verified through the application using international medical standards database .The procedures shall be mapped to primary and secondary diagnosis in case of multiple diagnosis mapping.
After completion of searching the procedure and attaching with Diagnosis, the Doctor shall schedule the surgery. The scheduler interface shall allow selection of Doctor, department and search for the availability of doctor for the scheduled surgery date and time. After confirming the availability of specialist doctor, the interface shall provide option for searching the availability of operation theater. The availability of the one or more operation theaters are mapped to the surgeon's availability through the web interface and schedule for the operation shall be fixed.
After fixing the operation schedule, the doctor shall be redirected to a web interface for creating admission request to the patient into ICU/Regular ward. On submission of the request by the doctor, the details shall be directed to the front desk (Receptionist) module. The patient/patient care taker shall approach the front desk to complete the formality of admission.
Admission of Patient: The admission of the patient to the ward /rooms shall be done based on the request for particular category of rooms/wards, eligibility depending on the insurance product subscribed by the patient and availability of requested category of rooms. The application shall provide an interface to search, locate the type of room requested and book for the number of days requested by the patient. Generates admission slip containing admission details and map to locate the room. A unique IPD ID shall be

generated, which shall keep track of the treatments carried out in the IPD section. The web interface shall also provide the facility to change category of rooms and cancel admission. The charging details shall be automatically populated in the interface and shall be tightly integrated with the billing module.
In Patient services: Capturing the treatment details given to a patient and instructions
given by the doctor to the Nurses for performing scheduled activities.
Upon admission to the ward, the patient treatment and instructions shall be captured
through a web interface. The web interface shall have submenu's for capturing following
details
1. Daily Progress Note
2. General Instructions
3. Vital Instructions with viewer
4. Surgical Instructions- Pre-operative and Post -operative
5. ICU Instructions
6. Procedure Details
7. Discharge Note
Daily progress note shall capture the details of the visiting doctor, prescriptions of medicines, procedures performed, equipments connected to the patient. The Prescribing Doctor can electronically request for a visit of consultant doctor through referral web interface. All the data related to prescriptions, medicines and equipments search shall be supported by back end database, so that data shall be automatically populated and doctor shall select through a drop down menu or word search option. Doctor shall be able to view all the previous visit data pertaining to the patient treatment in a user friendly GUI format. The visiting doctor's visit can be flagged as regular/Visiting/emergency visit.
General instructions interface captures instructions and comments entered by the doctor during his visit. Date and time of entry shall be captured by the interface. Doctors can view details of all the general instructions entered for the patient in a user friendly GUI format.

Vital Instructions entry web interface shall capture all the vital details of the patient entered by the doctor during his visit. Doctors can view details of all the vital details entered for the patient during their previous visits, in a user friendly GUI format Surgical Instructions web interface shall capture all the pre-operative and post-operative surgical instructions. Checks are built in the system to allow capture of post operative instructions only after the entry and saving the data in preoperative section. The date and time of entry of data shall be captured and stored.
ICU Instructions web interface shall capture the instructions and comments entered by the Doctor after examination of the patient during his visit in the ICU ward. The interface shall also capture the details of the visiting doctor, prescriptions of medicines, procedures performed, equipments connected to the patient. All the data related to prescriptions, medicines and equipments search shall be supported by back end database, so that data shall be automatically populated and doctor shall select through a drop down menu or word search option. Doctor shall be able to view all the previous visit data pertaining to the patient treatment in a user friendly GUI format. The data entered by the doctor can be viewed by the Nurse using the Nurse Module web interface.
If the patient undergoes any surgical procedure, the details of the procedures are captured comprising of following details.
• Procedure Start date and time
• End date and time
• Anesthesia details

> Type of anesthesia
> Anesthetist

• Operative notes
• Post operative observations
• any complications during surgery
• Assistant Surgeon
• Procedure status
(The status can be Planned or performed, when the procedure is prescribed it would be in planned status and when completed would have Performed status)

The web interface also captures the entry of items consumed during surgery. The list of items shall be selected from a drop down menu or from a word search option linked to the database. If the items are consumed from the in-house store of hospital, the consumed data shall be populated on the drug store interface, so that patient can reimburse the consumed items.
Nurse Interface: There shall be a web interface for the Nurses to view the instructions, perform the activities and confirm the completion of activities. Upon successful login by the Nurse on the web interface, the page shall display the list of patients admitted in the ward , who shall be serviced by the Nurse. The Nurse shall have the option of searching the patient on the web interface using one of the following search criteria.
• IPD number
• Patient ID
• Patient name
• Room number
• Doctor name
• Date of admission
The search result shall contain all the above fields displayed in a grid format.
The Nurse shall be able to select one of the patient records and view the instructions for the following modules depending on which module is applicable to the patient.
ICU Instructions: By selecting this menu option, nurse shall view the ICU instructions
along with comments entered by doctor in Inpatient services. The Nurse shall update a
flag confirming the completion of the instruction assigned to her.
Nurse shall also view the Instructions related to the equipments (attach or detach) ,
perform the activities and record the timings. The back end application captures the
activity timings, calculates the charging and transfers the charging data to the billing
module
Vital Instructions: By selecting this menu option, nurse shall view the Vital instructions entered by the doctor for the Inpatient Services. The Nurse shall update a flag confirming

the completion of the instruction assigned to the Nurse. For example, If Doctor has instructed monitoring the BP of a patient after every 6 hours then four check boxes shall appear dynamically for a day schedule and depending on the activities performed, the Nurse shall update the check boxes.
The nurse shall also enter the Vital details on the web interface comprising of Date, Time, IPD ID, Patient ID, Name(all these fields auto- populated), BP, Pulse (/min), Temperature (in F), Height in cm(if not captured in Clinical Details section), Weight in Kg, Respiration (/min), comments. The saved record shall be viewed in a grid format containing all above details.
Medicines Instructions: The Nurse shall view the instructions regarding the medicines along with SIG information. The Nurse shall update a flag confirming the completion of the task. If medicine is required to be taken 2 times a day , two check boxes shall appear dynamically for a day schedule which shall be checked by the Nurse to indicate completion of the task.
Surgical Instructions: The Nurse shall view and confirm the completion of Pre¬operative and Post-Operative instructions entered by the Doctor through the Doctor's Interface.
General Instructions: The nurse user shall view and confirm the completion of the
General instructions assigned by doctor through Doctor's Interface.
Nurse shall also view the Instructions related to the equipments (attach or detach),
perform the activities and record the timings. The back end application captures the
activity timings, calculates the charging and transfers the charging data to the billing
module
Thus the complete treatment of the patient shall be driven through well defined processes and software. The application captures the complete medical treatment history of the patient. The access to the information shall be controlled according to the healthcare industry standards.

\fter completion of the treatment of the patient, certified by the prescribing Doctor, the lischarge summary shall be generated.
I. SURVEYOR MODULE
Surveyor is an authorized agency, nominated by the insurance company for managing the nedical checkup at the issue of policy or/and verifying the claims submitted by the hospital against insured person treatment. Surveyor shall registers with the insurance company through web interface for providing the services and on mutual consent insurance company shall authorize surveyor to carry out medical checkup and /or treatment verification and approval on behalf of the insurance company as per the medical standards and business rules defined by the insurance company.
Surveyor who is authorized to conduct the clinical tests shall view the list of registered prospective insured persons who need to undergo medical checkup and carry out the clinical tests and enter the results in the web interface. The entire work flow of surveyor module is diagrammatically explained in the figures 6 and 6a.
The surveyor who monitors the treatment shall logon to the secured web interface to the insurance application as shown in figures 6, after proper authorization, views the treatments in progress, treatments completed and claims submitted for verification and approval. The surveyor can sought for clarification from hospitals on the treatments. The surveyor shall keep a tab on all the treatments pertaining to a patient assigned to him for monitoring by the insurance company. The surveyor shall have all the privileges to view the consultant reports, clinical tests and treatments carried out for the assigned patient.
The claims approved by the surveyor shall be submitted to the fund transfer module and the funds shall get automatically transferred to the banking accounts of the respective hospital. The online banking account details shall be submitted by the hospitals at the time of registration with the insurance company.
5. DRUG STORE MODULE
Functionalities:

• GUI based User friendly interface for viewing requests submitted by hospitals for dispensing the medicines
• GUI based interface for entering the details against medicines requested and dispensed
• Online payment settlement upon the approval by the surveyor
The work flow of the drug store module is diagrammatically explained in the figures 5 and 5a.
This module shall have following list of menu items:
1. Registration of drug store user.
2. View and Edit Drug store User profile
3. View Dispense requests
4. Dispense Medicine
5. Billing Details
6. Online payment settlement.
7. Inventory control module.
a. Medicine Entry
b. Medicine Stock Check
c. Request for Quotation
d. Purchase Order
e. Invoice Entry
8. Report module.
In the foregoing specification, the invention has been described with reference to specific exemplary embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention as set forth in the appended claims. Accordingly, the specification and drawings are to be regarded in an illustrative rather than a restrictive sense.

We claim:
1. A web based method for managing complete life cycle of health insurance policy
holder, said method comprising acts of:
a. registering subscriber to policy through web-interface and availing planned
hospitalization and an appointment with interested doctor by the insured person;
b. prescribing clinical tests for the insured person based on the predetermined
clinical observations by the appointed doctor using Order entry web interface of
order management application;
c. performing the prescribed tests and updating the test results using the web-
interface by the lab assistant upon receipt of the prescribed tests on Lab Assistant
interface of the order management application;
d. commencing the treatment by admitting the patient based on the test results using
treatment application module and entering details of medications to be provided
to the patient;
e. generating discharge summary upon completion of the treatment and thereafter
generating complete billing information by billing module after confirmation on
discharge of the patient; and
f. forwarding claim documents along with discharge summary to the surveyor
interface for claim approval.
2. The method as claimed in claim 1, wherein the registering subscriber to policy
through web-interface comprises steps of;
i. receiving predetermined data for enrollment of policy for the subscriber;
ii. determining requirement of clinical checkup for the subscriber and processing
the payment for medical checkup; iii. authenticating payment for the policy to be enrolled and displaying the
clinical checkup details; and iv. processing the payment authenticated and issuing policy to the subscriber
upon successful completion of clinical checkup.

3. The method as claimed in claim 2, wherein the insured person receives e-policy upon successful registration and optionally receives an e-mail or SMS with complete information about the policy.
4. The method as claimed in claim 1, wherein the subscriber register to the policy using plurality of channels selected from a group comprising user friendly web-interface, insurance company agents registered with the policy provider, an automated call center or self-service driven corporate web interface for all corporate customers for subscription and managing the policies for their employees.
5. The method as claimed in claim 2, wherein the subscriber undergo clinical checkup depending on medical history, age group and type of insurance product.
6. The method as claimed in claim 2, wherein the details of medical checkup comprises location, contact person, contact details, online location map to guide the subscriber and said details optionally provided to the subscriber through e-mail and SMS.
7. The method as claimed in claim 1, wherein the insured person is capable of renewing the policies through the online web interface and the payment towards renewal fee is accepted through one of the payment modes selected from a group comprising credit card, debit card or online banking account.
8. The method as claimed in claim 1, wherein the web interface provides the user an ability to add and/or delete family members, delete the policy completely or modify the contact information based on product configurations.
9. The method as claimed in claim 1, wherein the web interface provides pre-populated screen with information about the insured person from insurance database during the hospitalization and generates registration card with unique patient registration Id to be used for tracking all the future transactions.
10. The method as claimed in claim 1, wherein the treatment application module provides user friendly GUI interface for viewing patient records, entering treatment details and to choose particular treatment from the list of treatment methods.
11. The method as claimed in claim 10, wherein the treatment modules are selected from a group comprising medical treatment, surgical treatment, physiotherapy and any other suitable treatments for the patient.

12. The method as claimed in claim 11, wherein the medical treatment module provides interface to enter details of the medications to be provided to the patient and said details captures "name of the medication", "type of the medicine", "SIG", "number of days", "quantity" and "start and end date".
13. The method as claimed in claims 2 and 11, wherein the surgical treatment module comprises an interface to search the procedures to be performed to the patient based on the clinical results.
14. The method as claimed in claim 13, wherein the search option on the web interface is based on keywords, starts with, ends with and is linked to master database containing all the standard approved medical procedures.
15. The method as claimed in claim 14, wherein the procedures are mapped to at least one diagnosis through another search interface and mapping is verified through the application using international medical standards database, and said procedures are mapped to primary and secondary diagnosis in case of multiple diagnosis mapping.
16. The method as claimed in claim 1, wherein the patient treatment and instructions are captured through the web interface upon admission of the patient to the hospital.
17. The method as claimed in claims 1 and 16, wherein web interface comprises submenu's for capturing daily progress note, general instructions, vital instruction with viewer, pre-operative surgical instruction, post operative surgical instruction, ICU instruction, procedure details and discharge note.
18. The method as claimed in claim 1, wherein the billing charges are mapped to each of the service in the configuration module and computed charges are available on web interface for viewing by the authorized user.
19. The method as claimed in claim 1, wherein the claims approved by the surveyor is submitted to fund transfer module and the funds automatically transferred to the banking accounts of the respective hospitals.
20. A computing system (1) for managing life cycle of health insurance policy holder, comprising: a user interface with a plurality of data input modules (15) which comprise data input fields (151) for inputting data relating to the object of managing life cycle of health insurance policy holder, wherein said user interface is operable for insured person by means of terminals via a telecommunication network (3 a, 3 b,

3 c); stored data rules assigned to the data input fields and validation means (12) for checking data values input via the data input fields on the basis of the assigned data rules, Storage space (18) connected to the user interface via the telecommunication network (3a, 3b, 3c), and a control means for controlling payment transaction on the network.
21. The system as claimed in claim 20, wherein the plurality of data input modules (15) are selected from a group comprising insurance module, agent module, corporate module, admin module, drug store module, surveyor module and combinations thereof.
22. The system as claimed in claim 21, wherein insurance module comprises plurality of sub menu options for the insured person selected from a group comprising
i. renewal menu for displaying renewal date of the policy ;
ii. hospitalization menu being configured to display list of organ based diseases
and/or list of hospitals which provide treatment based on diseases selected;
and iii. other services menu comprises
a. view/edit/cancel policy menu;
b. view transaction;
c. view promos/products;
d. view network hospitals;
e. reimbursement form; and
f. feed back on hospital menu.
23. The system as claimed in claim 22, wherein the system automatically calculates the refund amount to be rolled back and auto credits the refund amount to the insured person upon cancellation of the policy.
24. The system as claimed in claim 21, wherein the agent module is capable of handling agents' activities selected from a group comprising registration process for the agents, subscribing or renewing a policy for a prospective insured person, view transaction and commission, pending renewals of the prospective insured persons registered by the agent, registering insured person for hospitalization.

25. The system as claimed in claim 21, wherein the corporate module provides for registering individual or group of employees for availing insurance facility; view/modify corporate user policy data; utility for bulk uploads of data in a predetermined format; utility for bulk deletion; and corporate employee user interface to view transaction and register for treatment.
26. The system as claimed in claim 25, wherein the corporate employee user interface enables addition of family members to the policy by the employees through self help portal.
27. The system as claimed in claim 21, wherein the admin module manages plurality of activities selected from a group comprising "insurance employee user profile", web insured person, agent user, corporate user, plans, surveyor, hospitals, claims, policies, Revenue accounting, approve drug store user registration, Create office profile, "Physical verification of details of the hospitals, surveyor, drug store, agent", commissions, Refund module, creating new policies, modification of the policies and combinations thereof.
28. The system as claimed in claim 21, wherein the drug store module provides
i. GUI based User friendly interface for viewing requests submitted by hospitals
for dispensing the medicines; ii. GUI based interface for entering the details against medicines requested and
dispensed; and iii. Online payment settlement upon the approval by the surveyor
29. The system as claimed in claim 28, wherein the drug store module comprises sub modules for Registration of drug store user, View and Edit Drug store User profile, View Dispense requests, Dispense Medicine, Billing Details, Online payment settlement., "Inventory control module configured for Medicine Entry, Medicine Stock Check, Request for Quotation, Purchase Order, Invoice Entry", Report module and vendor management module.
30. The system as claimed in claim 21, wherein the surveyor module having secured web interface to insurance application to view the treatments in progress, treatments completed and claims submitted for verification and approval.

31. The system as claimed in claim 20, wherein the system provides a nurse interface for
nurses to view instructions, perform predetermined activities and to confirm the
completion of activities.
32. The system as claimed in claim 31, wherein the nurse interface provides an option for
searching the patient using at least one of the criteria selected from a group
comprising IPD number, patient ID, patient name, room number, doctor name and
date of admission.
33. A web based method and a computing system for managing complete life cycle of
health insurance policy holder is substantially as herein above described with
reference to the accompanying drawings.