Group Products

FIMMAS features simplify the entry of new groups and streamline the enrollment process:

• User-defined defaults for division, class, and employee entry.
• User-defined defaults for data entry of repetitive fields.
• Optional system-assigned group and certificate numbers.
• Ability to "clone" standard information (classes, offerings, class offering tables, etc.) to speed up the process of setting up a new group.
• Multiple classes for groups / divisions.
• Census entry via electronic transfer.
• Entry screens tailored to forms / products.
• A comprehensive group / division database that keeps all detail on-line as long as you need it for inquiry and reports.

FIMMAS provides extensive user flexibility in defining, maintaining, and applying rules for rating and valuation calculations. Product rules and ratebook information are designed to be maintained by non-technical personnel using standard screens. Rate tables may be imported into FIMMAS from spreadsheets. Rate tables support age rated/banded and composite premiums. 

FIMMAS allows each group to be associated with multiple writing agents. FIMMAS supports commission processing for all product lines and supports regressive scale commissions for group. The commission master files include agent master information, hierarchy information, agent financial information and statements, commission rate files, and commission history files. Commission rates can vary by plan, marketing organization, age, duration, agent level, face amount band, date range, substandard rating, premium type, agent situations, and group. FIMMAS prepares an agent statement for each agent, listing all commission transactions including totals on premiums and commissions for the statement period, year-to-date totals, debit balances, etc. FIMMAS readily interfaces with an existing check writing or Accounts Payable system to produce checks. FIMMAS captures information needed for 1099 reporting and to produce W2's.  A commission statement contains all commissions for an agent per period regardless of whether the commissions are from individual or group contracts.

FIMMAS Billing for group creates billing extracts, prints notices, and updates group and certificate records, based on user-maintained rules for billing. Billing rules include the frequency, number of notices per billing cycle, the timing of notices, and opportunity for adding adjustements or fees to the bill.  The billing process automatically supports retroactive changes to certificates and bills for the appropriate number of moded for each certificate in the bill.  Group billing can be run on an ad hoc basis by group, upon user request, or as part of regularly scheduled processing. The reconcillation process allows for re-billing and change processing of the certificates based on the changes provided by the group.

Claims handling in FIMMAS consists of four elements:

1. Claims entry and determination of eligibility
2. Claims adjudication (calculation of payment)
3. Disbursement processing
4. Claims tracking, inquiry and reporting

FIMMAS handles all four of these elements and provides an interface to specialized systems for claims adjudication for health products if desired. In other words, FIMMAS manages claims for all types of products. Once FIMMAS has calculated the payment amount a disbursement recore is created then allocates the disbursement to appropriate General Ledger accounts, and updates the client database to reflect the payment. The FIMMAS database then retains all transaction detail for tracking of claims history and payment history. All detail is available for inquiry and reporting. Detail records are retained on-line until you decide to archive or delete them.  All claims can be viewed through the group level.

Group enrollment provides functions for streamlined entry of information about new employees or members.  Either through entry screens or the importing of census files, employee benefits are automatically built based on the class/offering table the group is linked to.  The employee benefit records are then passed through the New Business module to validate and verify the eligibility of the benefits and calculate the premiums.  Once the validation process is complete, certificates are automatically generated and placed inforce.  A Guarantee Issue matrix is utilized in this process to insure that no amounts are automatically issued that exceed the guaranteed issue limits.  Full underwriting support exists for amounts the exceed the limits.

Policy Administration includes those functions that enable customer service personnel to provide assistance to a group administrator, certificate holder, agent or beneficiary.

FIMMAS has a very comprehensive set of group change processing rules for mass change capabilites either automatic or ad-hoc.

Individual processing changes at an employee/member level is also supported to handle benefit and premium related changes to a certificate.

Reinsurance tracking is part of the FIMMAS base system. FIMMAS will support either individual reinsurance at a employee/member level, or bulk insurance at a benefit level.  At the individual level,it determines the total amount of insurance inforce by insured Social Security number. The amount of existing coverage plus the amount applied for can be compared to the company's retention limit, to check for the need to reinsure a case. FIMMAS easily calculates the amount of insurance and reinsurance inforce on existing policies. FIMMAS also provides an optional module for the administration of reinsured contracts. The reinsurance module includes net reinsured amount, age, substandard ratings, risk class, sex code, and other variables to compute the reinsurance premium. The module also calculates allowances. Each benefit, rider, or supplemental coverage can be reinsured with one or more carriers under multiple treaties. FIMMAS can also interface with an external reinsurance system. 

FIMMAS has an inherent reporting module or you can use any third-party reporting tool that is ODBC-compliant. The FIMMAS Correspondence Link provides an interface to the full-function capabilities of standard word processing packages. Data from FIMMAS can be integrated with user defined templates to create custom correspondence.  FIMMAS has a complete ad-hoc and automatic correspondenced capability.  Through the use of event triggers, you can link any correspondence template to an event trigger and generate correspondence automatically to as many individuals as necessary.  Both automatic and ad-hoc letters can have variable paragraphs or variable languages base on user defined rules.  FIMMAS also supports email distribution of correspondence and reports.

Group underwriting for non guarantee issue coverages is supported just like individual policies with the following features:

• Automatic determination of underwriting requirements based on plan, age, amount, and other user-defined variables
• Application status tracking
• Checking of approvals and licensing
• Automatic follow ups and reminders on pended items
• Underwriting instructions and referrals to support staff
• Underwriting notes and comments
• Underwriting analysis reports
• Automatic generation of forms and letters
• System calculation of premiums
• Interface with mainframe-based MIB and other vendor system
• Security for personal health information
• Online access to reinsurance database