The Administrator Functionality

• Supports multiple Companies.
• Supports Health, Ancillary and Voluntary Carrier Products.
• Supports COBRA, Self-Funded and Non-Administered business.
• Keeps History details on Group Coverages, Group Coverage Rates, Group Commissions, Insured Coverages, Insured Coverage, PCP and COB data, Billing, Commissions and Payments.,
• Keeps history details on case level coverages, case level coverage rates, case level commission payments, employee and dependant level coverages, PCP and COB information, Employee level payment adjustments for adds, terms, deletes and commission transactions are all maintained in the appropriate data warehouse.
• Keeps Date Created, Last Changed and User of key files.

New Account Installation

• Defines Coverages, Classes, Coverage levels, Rates, Commissions at Group level.
• Supports Group/Coverage level Rules for Eligibility and Volumes.
• Keeps Effective Dates for Coverages, Rates and Commissions at Group level.
• Keeps Effective Date for Group Address.
• Lists/Searches Groups by BSI Group Code, Group Name or Carrier Group Code.
• Defines Bill Type, Bill Hold, Team, Status Group Level
• Defines Eligibility for new and current Employees
• For Life defines Salary, Salary Limit, Salary Mode, Max Vol, Min Vol., Max Benefit, Min Benefit, Rounding and Rounding Type.
• Defines Carrier Group# and Form Code.
• Defines Field at the Group level to define Group as Sego, Non-Sego, Self-Funded.
• Defines Group Policy Year (renewal) and Renewal Broker at Group Coverage level.
• Provides Skeleton Groups with Copy functions for Group/Coverage Commissions.
• Ability to track Group Activity. Triggers to Update Gold Mine.
• Supports Payroll Deduction. Need 1st Payroll Deduction Date and Pay Cycle.

• Provides Edits to reduce data entry errors.
• Ability to perform Terminations by Group or Insureds.
• Bulk Add or Term of Coverage across all Insureds in a Group.
• Calculates eligibility and volumes from Group Rules.   Allows entry of Enrollment during Open Enrollment period.  Needs a Date Range for Open Enrollment at the Group Coverage Code level
• Handles Rates Calculations of Retroactivity for Adds or Terms of Insureds.
• Sets Coverage level depending on Insured with Dependents.
• Keeps Salary, Hours worked and part-time for full-time.
• Ability to search by Social Security # across all Insureds.

• Provides for Group and/or Cert Billing (COBRA and Associations).
• Supports Monthly, Quarterly, Semi-Annual, Annual Cycles.
• Tracks Retroactivity - future and past effective dates.  
• Statements should show retro and change activity by Coverage.
• Supports Rate Calculation based on Age Reduction.
• Interfaces to Reynolds and Reynolds for mass printing.  
• Detailed Billing History at Group and Insured Level.  
• Has Bill and Reprint function.

Payment/Posting

• Posts to Group Coverage level; needed at certificate level.
• Imports Lock-Box Files.
• Automatic Posting or ability to send to Suspense.
• Daily Balancing Reports.
• Calculates Refunds at Group and Insured Level.

Commissions

• BSI pays out all premiums BSI collect.
• BSI pays the Carrier, BSI and Brokers.
• BSI has the ability to Split Commissions between multiple Brokers. 
• Track Licensing to Carrier/State level. Tracks held commissions.
• Commission Statement - agents can roll to agency.
• Shows Premium YTD / Calendar YTD with Full Group List.
• Imports and processes Non-Administered Business.
• Carrier Reports

Brokers and Agents

• Associations - Brokers are associated with multiple Agencies and Agencies can be affiliated with other organizations (i.e. Smith Agency has 5 agents). Smith Agency belongs to LFA. BSI needs the ability to track and report on these different associations.
• Licensing - BSI needs to track license information by Broker, by Carrier by State. This should allow for a status of Pending, Active or Terminated.
• The system needs to have the ability to hold/track commissions until the broker has completed the licensing information.
• Once the broker is licensed, the system must pay all held commissions.
• The Commission statement must reflect the difference between licensed and released commissions.
• The system must allow for a change in licensing status from Active to Terminated, not pay any additional commissions but still show YTD figures on the Commission statement.

Calculating Premium

• All premium collected is paid out through the commission process. BSI pays the Carrier, Brokers, Marketing and Administration. Commissions are set up per group per coverage.
• Brokers will split cases and share commissions. BSI need the ability to calculate premium based on the total premium paid but pay only a percentage of the commission scale (i.e broker receives 25% of the 5% commission scale). The calculation must be on the total premium paid for the YTD Coverage Policy Year due to sliding scales.
• BSI has the ability to pay flat and sliding scales based on 1^st year and renewal premium. Commission scales need to have an effective date. If a producer is assigned a particular scale and the Carrier changes the percentage, BSI only need to create a new effective date for that scale 
• BSI has the ability to pay commissions at the enrollee level within a group. Commission is based on each enrollee’s effective date.
• Maintain History of Premium paid. Retroactive changes are made to prior payments.

Commission Statements

• Brokers associated with an agency must be able to receive their own statement while the premium is paid directly to the agency.

Carrier Reports

• BSI has many Carrier Export Reports. Blue Cross Blue Shield requires a specific report, while all other Carriers receive a standard report.

Letters

• Late/Lapse process. Letters and days specific to Carriers.
• Student Letters

Report Categories

• New Business, Term, Replacement
• Enrollment Reports
• Balancing Reports
• Billed/Non-Billed
• Paid/Non-Paid
• 100% Commission Report - to validate 100% pay out