The Medical Claims module manages administration of medical benefits for various levels of entitlements based on employee groups and levels. Claims are checked against entitlements for each financial period. This module allows grouping of different types of medical entitlements into a policy, and setting of user-definable eligibility rules for each policy. Unlimited types of medical claim can be defined in the system for tracking purposes. Within each medical policy, a cap can be applied to each benefit and the overall policy for the financial year. The cap for each benefit can in turn be further defined for each claim and/or total claim for the financial year. If co-payment is allowed, reimbursable amount can be set according to a percentage for each claim subject to the cap for each claim and the overall cap for the financial year. The module can also track multiple policies for each employee (if applicable) regardless of the period of financial year. Information on treatment for each claim can also be captured. Any necessary documentation(s) in relation to the claim can be attached to each claim record. Amount to be reimbursed can be transferred to payroll module for processing of pay out together with payroll.

Standard reporting available to capture the details of claims processed. A listing of no claims can also be generated.

Screen shot / example:

Screenshot 1.0: Multiple Medical Types


Screenshot 1.1: Medical Policy


Screenshot 2.0: Medical Claim Main Screen


Screenshot 2.1: Medical Treatment Detail


Screenshot 2.2: Medical Claim Detail


Screenshot 2.3: Medical Status Detail

................................................................................................................................................................................................

................................................................................................................................................................................................