Functional Requirement Specifications (FRS)

ABC Health Insurance Company

TABLE OF CONTENT
1 Statement of Work
1.1 Purpose 1.2 The Organization 1.3 Existing Technology

2 Scope of Work, Specifications and Requirements

2.1 Underwriting Module 2.2 Claims Module 2.3 Actor 2.4 References

3 Business Rules
3.1 Business Rules for Quotation Module 3.2 Business Rules for Premium Rating 3.3 Business Rule for Underwriting Module

1. Statement of Work
1.1 Purpose
The purpose of this FRS is for the understanding of the clients requirement. Conveying the same to the developers of IT vendor. The FRS provides vendor with the relevant operational, performance, application, and architectural requirement of the system.

General Information 1.2 The Organization

ABC Health Insurance is one of the emerging general insurance companies in India. They are about to launch Health Insurance products, for which they require IT System for policy administration. The system will cover the whole policy life cycle. The Company wants the system to be used from 200+ branches at various locations, 10+ division offices, 4 regional office and corporate office.

1.3

Existing Technology

Following is the list of existing technology environment. Telephony hardware Software: Broadband Connection Server Operating System: As per Vendors Requirement Desktop Operating System: Windows XP.

2. Scope of Work, Specification & Requirements

Functional requirements of various departments of ABC Health Insurance from the system

2.1

Underwriting Module for Underwriters

2.1.1 Policy Entry 2.1.2 Premium Calculation 2.1.3 Endorsements 2.1.3.1 New Business 2.1.3.2 Change in Sum Insured 2.1.3.3 Pro Rata Cancellation

2.2

Claims Module for Claims department

2.2.1 2.2.2 2.2.3 2.2.4 2.2.5 2.2.6 2.2.7 2.2.8 Loss Notification(Create Claim Id) Add Loss Data Claim Registration Add Claim Data Report Etc. Claim Settlement Claim Closure Reopen Claim Record Edit Claim Data

2.3

Actor

Someone or something outside the system which interacts with the system Actor are Branch level Employees/Agents Division level Employees and above. Online Customer

2.4

References

Proposal form of Health Insurance Company. (Annexure I) 2.4.1 Data Entities to be covered in the Underwriting Module 2.4.1.1 NAME OF THE INSURED PERSON 2.4.1.2 ADDRESS & TELEPHONE NO. / MOBILE NO. / E-MAIL ADDRESS 2.4.1.3 PERMANENT ACCOUNT NO. (ISSUED BY INCOME-TAX AUTHORITIES) 2.4.1.4 NAME - ADDRESS & TELEPHONE NO OF FAMILY PHYSICIAN 2.4.1.5 DETAILS OF ANY OTHER INSURANCE 2.4.1.6 CLAIM DETAILS IF ANY OF INSURED 2.4.1.7 HEALTH QUESTIONARE 2.4.1.8 DETAILS OF DISEASES/ ILLNESSES/INJURIES DEFORMITIES 2.4.1.9 PRE-EXISTING DISEASES / ILLNESS/ INJURIES SUFFERED 2.4.1.10 DETAILS OF EXISTING MEDICLAIM POLICY 2.4.1.11 NOMINEE DETAILS 2.4.1.12 PROPOSED DATE & PERIOD OF INSURANCE

3. Business Rules
3.1
Field AGE

Business Rules for Quotation Module

Range Above 65 Validation Policy cannot be issued Age> 65 Action Quotation not Generated

3.2
Field Age

Business Rule for Premium Rating

Sales Channels Agent Agent Agent Online Online Online Premium 1000+ 15%(1000) 2000+ 15%(2000) 3000+ 15%(3000) 1000- 15%(1000) 2000- 15%(2000) 3000- 15%(3000) Action Add commission to Agent Account Add commission to Agent Account Add commission to Agent Account Discount to customer Discount to customer Discount to customer

Range 0-20 Years 21-50 Years 50-65 Years 0-20 Years 21-50 Years 50-65 Years

3.3

Business Rule for Underwriting Module

Range Rs 0-100000 Rs 100000-200000 Authorized Actor Branch Officer Divisional Officer

Field Premium Amount