The Home Page is the first screen of the system and contains menus that provide access to the different system applications: The Home Page body is built of desktop widgets, specialized GUI applications that provide some visual information and access to other functions. Those widgets can be customized, that means, to add new ones from a pool of widgets or to remove them.

The Planner manages the different application cases and is aimed to organize the personal tasks of the users. The Planner is designed specially with UI like Microsoft outlook. This design makes it very easy to adopt by users. The planner verifies all processes are being completed in the most efficient way. At the due course of work the users can create follow up tasks to a later due date or transfer the task to a general mail box such as underwriting in-box or to another user personal mail box.

The Customer Management module is the repository of person or organization data through the management processes. The person or organization may play many roles. Customers are indeed parties with different roles: Insured Company, Agent, or Providers. The party may be directly related to the agreement or be a third-party, such as a service provider. The contact information includes postal addresses, telephone, fax numbers and e-mail addresses. The Customer information varies according to the role. Each role has a different set of specialized information such as Company Agreements data for an employer or Agent Permit Number and license authorization kinds for an agent.

The system is fully web enable and the customer can communicate with the company through mail, fax, web, or telephone. Apart from those usual procedures Ensure contains special and full web enabled services for the customers (Self service) and for companies (e-services).

The customers can receive information about the policies, billing and payment history and claim status and data. They are able to update certain data such as address, phones, email or credit card information. There are also customer services such as messages, list of providers, forms download, and relevant information.

Companies can receive information about their agreements, verify information about their employees, add or remove employees. In case of a new employee the system will create a new policy automatically. If the agreement contains a non conditional underwriting the process will be completed and the policy issued. Otherwise a representative will call to complete the process.

Ensure has the ability to upload customers data from files. Apart from the possibility of updating the employee's data through the e-services, companies can also send data in XL, TXT or XML formats. The Uploaded data can include personal details, details of the family members, phones, address, and others. As in the case of e-Service, new employee will create a new policy in a similar way.

If the Party is an Agent, the Customer System will also contain the agent's commission agreement details, the agent type, discounts, commissions and others.

The Lead Management System manages the whole process from the first contact with the potential client, through Quotes until the issuance of the policy.

The Lead Process objective is to transform the lead into a policy. In order to accomplish this, the lead owner must complete the personal data, ask for phone numbers and address, go through the quote process, fill with the applicant the medical questionnaire, the payer

data and at the end go through the "must list".

Ensure is built for marketing. The entry point of the package is the Marketing Module, integral part of the Leads Management system. The Leads Management system is aimed for generating, processing and distributing leads. The module also comprises a leads processing engine for receiving customer requests, creating leads based upon the customer requests, and administrating the lead processing by the salesperson. The marketing module, as the whole system, is totally web enabled. In fact, Ensure is fully built in the advanced techniques of .net that enables total interoperability on the Web 2.0 or any web environment.

The leads can be grabbed from internet sites, telemarketing, TV or Radio campaigns, or insurance agents.

The Marketing Module includes:

• e-Marketing generator The e-marketing generator is aimed to develop internet and telemarketing campaigns. It consists of questionnaires generator, based on the selection of health product components, features and parameters that are chosen for a specific telemarketing tasks or a for a web site campaign.
• Campaign Management.
• Automatic update of the planner and the Lead Management system.
• Reports.

The Leads Management system includes quotes, rates, and administration of the lead ownership.

The Lead is transferred to a pool of salespeople. The salespeople select the lead and they "own" it till they finish processing it by issuing a policy, returning it to the pool for further process or annotation that the insured declines. Each salesperson can own only one lead at a time. In order to be able to process another lead (and receive the commission) they must finish the lead process.

Web based quoting engine is an integrated application that allows the agent to process a quote and issue insurance policies. It is the robust and easy to use marketing tool. The quote is based on pre-defined characteristics from the Product Configuration such as policy type, benefit type, currency, rates and others. The engine allows issuance of multiple quotes in order to compare the results.

The system will automatically send an e-mail to the potential client and the case will be aggregated to the Planner enabling follow up task management.

The medical questionnaire application is embedded in the lead process. The concept is based on optimization of the time of the potential client and of the salesperson.

There are three phases:

• Preliminary Questionnaire With the presentation of the quote there are two medical questions to any of which a positive answer immediately disqualifies the applicant.
• Preliminary Personal details With the preliminary personal details (that includes weight and height) the system calculates the BMI. At this point age or an abnormal BMI can disqualify the applicant or send him to a manual underwriting process.
• Medical Questionnaire After the Personal Details Complementation, the system issues a medical questionnaire. The questions vary according to the product. If all the answers are NO or under normal bounds, the process will continue automatically.

The Product Management automates the product implementation process. It enables minimum time to market, reduces the maintenance expenses of product introduction.

The creation of a new product is done by defining a combination of plan components, and connecting it to a price list, reinsurance data and medical questionnaire.
It is possible to create a product by copying and changing the data of an existent product.
The versioning of the product is done by creating new product groups reflecting the changes in parameters or validations over time.
There are four product definition levels:
Group Type (Line of Business).
Policy Type.
Policy Group.
Plan/Rider.

Products system interfaces with Sales, Policy Issuance, Billing and Claims. Products data linked to Reinsurance, Questionnaires, and Price List.

There are different policy types including ASO (Administrative Services Only) – the Company or MGA acts solely as claims administrator

A Policy Group is the essential entity of the definition of a product and consists of the definition of the benefit plan and the riders.

A Policy Group is defined as a set of Plan Benefits and Riders, each one defined by a set of components:
Insurer
Plan Benefit

The medical benefits that are covered can be, for example:
Inpatient treatment
Out-Patient
Emergency Services
Office Visit
Physical Therapy
Medication (for outpatient only)
Ground / Air Evacuation
Pregnancy and Childbirth
Mental Health
Wellness/ Routine Check Up
Durable Medical Equipment
Transplant
Nursing Services
Dental Care
Special Benefit

For each benefit there is a definition of the coverage details:

• Co Pay The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service.
• Plan Ceiling Cover limits, the specified maximum dollar or utilization limit for any single year (Annual Limit) or over the insured’s life
• Reimbursement
• Exclusions
• Special services – (not in use)
• Waiting periods
  The date of inception of the Insurance and during which the Insured will not be given the medical treatment within the framework of the insurance cover pursuant to the Policy Reductions, discount
  Constant product discount
  From date to date
  For more than a certain numbers of persons in the family
• Discounts allowed to sales people (and at their discretion) in order to close deals
• Risk Pricing

The price list contains the variable premiums in accordance with the different parameters. The Table will be revised by the Insurer at the end of each calendar year.

Parameters:

• Age groups
• Sex
• Smoker / nonsmoker
• Price
• Sub price

The Sub Price option is, in fact, a mini rule engine that enables to define a discount or a premium increase according to certain conditions. The discount can be an amount or a percentage and the condition can be based on the value of any field of the database.

Ensure has different management options to process claims - direct processing or through different combinations of TPA agreements.

The Sub Price option is, in fact, a mini rule engine that enables to define a discount or a premium increase according to certain conditions. The discount can be an amount or a percentage and the condition can be based on the value of any field of the database.

The Health insurance claim form is received by fax or e-mail and the data entered into the claims system including Insured information, policy information, diagnosis, procedure, services and suppliers.

For multiple procedures or services the system will break the claim into sub claims for each provider. The calculations are done in the sub claim level taking into consideration the whole status of the claim, the policy and the totals of all the policy claims.

The approval of the payment is done by two authorized empowered users.

The system works also with TPA's. In this case system procedures varies according to the TPA contract and services and in general is restricted to giving and receiving information through specialized interfaces.

At Claim processing the system includes the Insured policy information validation process, insurance plan, insurance coverage, conditions and exclusions, diagnosis, list of procedures, services and suppliers and the Provider information. Ensure works today with the standard ICD-9, CPT (American Medical Association), UCR (Usual, Customary and Reasonable) cost tables and NDC codes (Drugs Code).

The Billing and Collection provided by Ensure comprehends the whole spectrum need for Health Insurance solutions.

It includes:

• Debit / Credit management
• Billing calculation and notification preparation
• Billing process
• Invoices
• Debit notes
• Bill notification to be paid on the bank
• Bill collection through agents or brokers
• Collective bill collection through the employer
• Employees lists recording
• Employees lists received through the internet (e-services)
• Automatic bank withdrawn
• Credit card
• Handling of retroactive update or billing cancellation
• Multi currency
• Automatic daily currency update
• Integrated view of customers billing and collection ledger

Ensure provides full security services that cover all the aspects of protection, privacy and authorization. For all security groups it is possible to define default authorizations and then each user will inherit the properties. When needed, it is possible to override the authorization for a particular user.

The default group's definition describes the hierarchy of the departments in the company such as:

• Sales Manager
• Sales
• Customer Service Manager
• Customer Service
• Administration
• Underwriter
• And others

The security utilities enable the definition of the user and group profile in a multi layer mode:

• Configuration of the application databases that a user is allowed to access
• Configuration of the permissions which a user can access in an application
• Constricting the user to a specified flow of application forms
• Types of authorizations
  o Read / write
  o Read only
  o Restricted

Ensure includes a Reporting System and a Pivot Analysis Module. The Reporting System has full capacity of creating reports, queries and graphs and drill down view.

The Pivot Analysis Module enables the view of the data according to selected parameters (OLAP).

The system retains the full history of the records. Nothing is erased and there are widgets with the function to display the whole history of policies and customers.

The Audit Trail and reporting module of the system provides full log and data journaling and stores full information of all operations that have updated the database.

Adequate transaction and reporting response time
Ensure is web based and thus response time is less then 2 seconds, providing standard internet infrastructure.

Centralized system sharing one hosted application with several instances for each entity
The system is indeed centralized built on web interface and accessible from anywhere (according to security policies).

Document process and management integrated module
Ensure includes a document management module that includes the creation of forms and templates of documents and mails that can be used by the system users.

Multi Lingual
The system is built according to the fundamentals of .net that is fully compliant with the needs of a multi language system.

Multi Currency
The system is multi currency. For example, Customers may pay the premium in Israeli Shekel, pay co-pay doctors and drugs in all sorts of currencies and are reimbursed in dollars. The whole currency values are constantly updated in the system.

Interfaces
Ensure is constructed on the principles of .net and has fully capability of inter-operate with any WEB 2 or web services applications. The system inter-operates today with different systems such as General Ledger, Currency providers, banks, Insurance companies and others.

Integration

Implementation Method

As Ensure is fully web enabled, it allows us to implement the system worldwide from one place. All the system servers will be installed in a computer room in Israel and will be operated from one place, no matter the amount of the companies Archimedes will operate. In each company we will install a proxy that will allow the users in each company to work in a good response time with the system.

The center of operations in Israel will monitor, support and provide backups and DRP procedures to the system for all the companies.

This mode of operation will save Archimedes a large part of the expense in each country. (e.g. only one backup machine/ media/ procedure/ operator, will be used for all companies).

As we are experienced with both methods of work, we are ready to provide full outsourcing services, or a T&M service or a combination of both. We believe we can decide on this together with you.

The project team in each country will be built in such a manner that geographic barriers will be eliminated, by using both domain experts from DSG and Local Champions (explained in detail below) from the companies themselves.

Training

Since we are dealing with implementation in different countries and different cultures, our method will be train the trainer. In each company in each country we will choose a small team that will serve as champions of the system, we will train them and they will train there colleagues. This team will be trained to know every inch of the system, and will have a close connection with the product development team in Israel. This will enable them to be independent in their country, and have immediate contact to developers in Israel for adjustments and changes they will need along the way.