> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Insurance Management
> A complete guide to the Insurance Management module - who uses it, how the end-to-end lifecycle works, and how to monitor daily operations through the workspace, number cards, charts, and notifications.
Insurance Management is a purpose-built module that handles the full lifecycle of insurance - from the first enquiry through to claim settlement. It is used by insurance teams, HR departments, and accounts staff to manage policies, collect premiums, and process claims in one connected system.
***
## What This Module Does
Every insurance operation - selling a policy, collecting monthly premiums, handling a claim - involves multiple people and steps. Without a shared system, teams end up chasing each other on email, missing payment deadlines, and losing track of where each case stands.
Insurance Management solves this by putting the entire lifecycle in one place:
* A customer or employee applies for insurance coverage
* The team reviews and approves the application
* The system creates the policy and generates a complete payment schedule automatically
* Invoices are raised each month without manual work
* When a claim is made, the team reviews it and the system creates the payment and closes the billing cycle
Every step is connected. Every team sees the same information. Nothing falls through the cracks.
***
## Who Uses This Module
| Role | What They Do Day-to-Day |
| ---------------------------------- | ------------------------------------------------------------------------------------------------- |
| **Customer Service Team** | Handles new applications - creates proposals, starts the policy review process, uploads documents |
| **Insurance Billing Specialist** | Verifies applicant identity (KYC), manages premium schedules, processes claims and invoices |
| **Insurance Manager** | Approves or rejects proposals and policies, reviews claims, oversees the full operation |
| **HR Team (HR User / HR Manager)** | Handles employee insurance requests - approving family add-ons and managing deductions |
| **Accounts Team** | Processes invoices and payment entries for premium collection and claim payouts |
| **Employees** | Submit requests to add family members to their health insurance coverage; view their own policy |
***
## End-to-End Lifecycle
The insurance process follows a fixed sequence. Each step depends on the one before it.
The Customer Service team records the applicant's details and submits a Policy Proposal for review.
The Insurance Manager reviews and approves the proposal.
The Customer Service team creates the Insurance Policy. The Billing Specialist verifies documents through KYC, and the Insurance Manager gives final approval.
The moment the policy is approved, the system generates the complete instalment schedule for the policy term.
The system raises a Sales Invoice for each instalment as it falls due.
The accounts team records payment against each invoice.
If the policyholder experiences a covered event, the Billing Specialist raises an Insurance Claim.
The Insurance Manager approves the claim, and the system immediately creates a Payment Entry for the payout.
Once the claim is marked as paid, the system closes all remaining instalments and the premium schedule ends.
Nothing in this chain is skipped. A policy cannot exist without an approved proposal. A premium schedule cannot exist without an approved policy. A claim cannot be settled without an active schedule.
***
## Feature Overview
The module contains these features, organised by their role in the lifecycle:
**Setup (configured once by your administrator)**
| Feature | Purpose |
| --------------------------- | ----------------------------------------------------------------------------------------------------- |
| **Insurance Category** | Groups similar types of insurance together (e.g. Health, Life, Accident) |
| **Insurance Product** | The specific plan being offered - defines coverage amount, premium rates, term, and eligibility rules |
| **Insurance Document Type** | The types of documents applicants must submit (e.g. ID Proof, Medical Certificate) |
| **Claim Type** | Categories of claims the insurer accepts (e.g. Medical, Accidental, Life) |
| **Insurance Premium Slab** | Age-based premium rate tables attached to a product |
**Day-to-Day Operations**
| Feature | Purpose | Who Uses It |
| ---------------------------------------- | ------------------------------------------------------------------------- | ------------------------------------------------------- |
| **Policy Proposal** | Captures a new insurance application before the policy is formally issued | Customer Service, Insurance Manager |
| **Insurance Policy** | The live insurance contract - the central record everything else links to | Customer Service, Billing Specialist, Insurance Manager |
| **Insurance Premium Schedule** | The complete table of monthly payment instalments for a policy | Billing Specialist, Accounts |
| **Insurance Claim** | Records an incident and manages the claim review and settlement | Billing Specialist, Insurance Manager, Accounts |
| **Insurance Member Request** | Allows employees to add family members to their health insurance | Employee, HR User, HR Manager |
| **Employee Health Insurance Management** | Tracks an employee's group health insurance details | HR Manager |
**Supporting Records (created automatically or linked)**
| Feature | Purpose |
| ---------------------------------- | ------------------------------------------------------ |
| **Insurance Policy Member** | Lists each person covered under a policy |
| **Nominee Beneficiary** | Records who receives the benefit in the event of death |
| **Insurance application Document** | Stores uploaded files and identity documents |
| **Insurance dependent details** | Family member details added through a member request |
***
## Your Workspace
When you open the **Insurance Management** workspace, everything you need is organised into three sections.
### Top Section - Number Cards
Eight live counters update automatically throughout the day, giving you an instant status check without opening a single record.
### Middle Section - Visual Workflow Pipeline
Three visual pipelines show you the stages every record passes through:
**Insurance Process**
```mermaid theme={null}
%%{init: {'theme':'base','themeVariables':{'fontFamily':'DM Sans','primaryColor':'#e7fdf6','primaryBorderColor':'#14f1b1','primaryTextColor':'#0f172a','lineColor':'#14f1b1'}}}%%
flowchart LR
IP[Insurance Product] --> PP[Policy Proposal] --> POL[Insurance Policy] --> PS[Premium Schedule] --> SI[Sales Invoice]
```
**Insurance Claim Process**
```mermaid theme={null}
%%{init: {'theme':'base','themeVariables':{'fontFamily':'DM Sans','primaryColor':'#e7fdf6','primaryBorderColor':'#14f1b1','primaryTextColor':'#0f172a','lineColor':'#14f1b1'}}}%%
flowchart LR
IC[Insurance Claim] --> JE[Journal Entry] --> PE[Payment Entry]
```
**Employee Insurance**
```mermaid theme={null}
%%{init: {'theme':'base','themeVariables':{'fontFamily':'DM Sans','primaryColor':'#e7fdf6','primaryBorderColor':'#14f1b1','primaryTextColor':'#0f172a','lineColor':'#14f1b1'}}}%%
flowchart LR
POL[Insurance Policy] --> MR[Insurance Member Request] --> SS[Salary Slip]
```
### Lower Section - Charts
Two charts give you a visual picture of your insurance portfolio and product mix.
### Bottom Section - Quick Access Cards
Three card groups give you one-click access to every form you use regularly.
| Card Group | Contains |
| ------------------------ | --------------------------------------------------------------------------------------------------------------------------------------------------- |
| **Insurance Management** | Insurance Category, Insurance Product, Policy Proposal, Insurance Policy, Insurance Premium Schedule, Sales Invoice, Payment Entry, Insurance Claim |
| **HR Masters** | Employee, Salary Component, Salary Slip, Insurance Member Request |
| **Masters** | Item, Customer, Supplier, Insurance Document Type |
***
## Number Cards - Monitoring Daily Operations
The eight number cards on the workspace are your primary monitoring tool. Check them at the start of each day to understand what needs attention.
| Card | What It Shows | Who Should Act | What To Do |
| ---------------------------- | --------------------------------------------------------------- | ----------------------------- | ------------------------------------------------------------------------------------------------------ |
| **Approved Policies** | Total policies that have completed all approvals and are active | Insurance Manager | Confirm all approved policies have a premium schedule. If any don't, alert your administrator. |
| **Approved Proposals** | Total proposals approved and ready to become policies | Customer Service Team | Convert each approved proposal into a policy. Don't leave them sitting approved without follow-up. |
| **Policies in KYC Pending** | How many policies are waiting for identity verification | Insurance Billing Specialist | Open each pending policy and complete the KYC review. A high number here means applicants are waiting. |
| **Rejected Policies** | Total policies that were declined | Insurance Manager | Review rejections periodically to identify patterns - are the same documents always missing? |
| **Rejected Proposals** | Total proposals that were declined | Insurance Manager | Check whether applicants were informed and whether corrected applications were resubmitted. |
| **Paid Instalments** | Count of premium invoices that have been paid | Billing Specialist / Accounts | Use as a collection health indicator. Compare to total invoiced to understand payment rate. |
| **Approved Member Requests** | Employee family add-on requests that were approved | HR Team | Confirm the salary deduction has been applied correctly for each approved request. |
| **Rejected Member Requests** | Employee family add-on requests that were declined | HR Team | Ensure the employee was informed of the reason and knows how to reapply if circumstances change. |
Click any number card to open the filtered list of records behind that number. This takes you directly to the relevant records without needing to search.
***
## Dashboard Charts - Monitoring Your Portfolio
Two charts on the workspace give you a visual overview of the insurance portfolio.
### Insurance Sum Assured by Company
**Chart type:** Donut
**What it shows:** The total coverage amount (sum assured) distributed across each insurance company you work with.
**When to use this:** Check this when you want to understand how your coverage commitments are spread across providers. A single provider holding most of the coverage indicates concentration risk. Use it during portfolio reviews or when considering adding a new provider.
**Who uses it:** Insurance Manager, senior team members reviewing provider relationships.
### Insurance Product Policy Term (Policy Proposals by Product)
**Chart type:** Bar
**What it shows:** The volume of proposals grouped by insurance product - which plans are being applied for most frequently.
**When to use this:** Use this to spot which products are most in demand and which are rarely chosen. A product with very low uptake may need repricing or better communication. A product with very high uptake may need more staffing to handle the applications.
**Who uses it:** Insurance Manager, Customer Service Team leads.
***
## Notifications & Alerts
The system sends two automated email notifications related to insurance. Both go directly to the policyholder without any manual action from the team.
### New Policy Created - Email to Policyholder
**When it fires:** The moment a new Insurance Policy is approved and submitted.
**Who receives it:** The policyholder (the customer or employee the policy was issued to).
**What the email contains:**
* Applicant name and contact details
* Insurance company and product name
* Proposal date, policy start date, and policy status
* Coverage amount (sum assured)
* Premium payment mode, premium amount, and total premium
* Policy duration
* Registered address
**What you need to do:** Nothing - this email goes out automatically. If a policyholder says they did not receive the confirmation email, check that their email address on the policy is correct. If it is correct, contact your administrator to check the email delivery logs.
### Premium Payment Reminder - Email to Customer
**When it fires:** When a Premium Schedule instalment's due date is today.
**Who receives it:** The customer linked to the premium schedule.
**What the email contains:**
* Policy number
* Premium amount due
* Due date
**What you need to do:** If a customer says they did not receive a payment reminder, check that today's date matches the instalment's due date and that the customer's email is correctly linked to the premium schedule.
The payment reminder only fires if the due date on the instalment matches today's date exactly. If the instalment date was missed (e.g. the system was down), the reminder will not be re-sent automatically. You may need to follow up with the customer manually.
***
## Complete Workflow - Start to Finish
Here is the full journey a typical insurance case follows, from the first customer enquiry to final settlement.
**Day 1 - Application**
A customer or employee approaches the insurance team wanting coverage. The **Customer Service team** opens a new **Policy Proposal**, records the applicant's details, selects the insurance product and coverage amount, and uploads the required documents. They submit the proposal to the Insurance Manager for review.
**Day 1 or 2 - Proposal Approval**
The **Insurance Manager** reviews the proposal on the workspace. The *Approved Proposals* number card shows how many are waiting. The Manager clicks Approve (or Reject). If approved, the proposal status changes to Approved. The Customer Service team is now ready to create the policy.
**Day 2 - Policy Creation and KYC**
The **Customer Service team** converts the approved proposal into an **Insurance Policy** and clicks *Initiate* to start the review process. The policy moves to *Initiated* status. The Customer Service team then sends the documents for identity verification by clicking *Review* - the policy moves to *KYC Pending*. The *Policies in KYC Pending* number card on the workspace now increases.
**Day 2 or 3 - KYC Verification**
The **Insurance Billing Specialist** opens the policy, reviews all documents and identity details, and clicks *Complete KYC*. The policy moves to *Approved* status.
**Immediately after KYC - Automatic Setup**
The moment the policy is approved and submitted, the system does three things automatically:
1. Creates the full **Insurance Premium Schedule** with a row for every monthly instalment over the entire policy term
2. Sends the **Policy Confirmation email** to the policyholder
3. Raises the first instalment's **Sales Invoice** and marks that instalment as *Invoiced*
**Every Month - Premium Collection**
The **Accounts team** processes the monthly Sales Invoice and records payment. Each instalment in the schedule moves from *Invoiced* to *Paid*.
**If a Claim is Needed - Claim Filing**
When an incident occurs, the **Insurance Billing Specialist** opens a new **Insurance Claim**, links it to the policy and schedule, records the incident date, describes what happened, enters the claimed amount, and uploads the supporting documents. The claim is submitted.
**Claim Review**
The **Insurance Manager** reviews the claim, sets the approved payout amount, and updates the claim status to *Approved*.
**Automatic Payment Entry**
The moment the claim is approved and saved, the system automatically creates a draft **Payment Entry** addressed to the insurance company for the approved amount. The Accounts team processes and finalises this payment.
**Final Settlement**
Once the insurance company pays out and the payment is confirmed, the team updates the claim status to *Paid*. At that moment:
* All remaining unpaid instalments in the premium schedule are automatically closed
* The premium schedule status changes to *Closed*
* No further invoices are raised
* The insurance lifecycle for this policy is complete
***
## Daily Tasks by Role
**Customer Service Team - Morning Checklist**
* Check *Approved Proposals* card - convert any approved proposals into policies
* Check open Policy Proposal list - follow up on proposals still in Draft
* Initiate KYC on any newly created policies
**Insurance Billing Specialist - Morning Checklist**
* Check *Policies in KYC Pending* card - open each pending policy and complete verification
* Review open Claims - check for any newly submitted claims that need review
* Check premium schedule instalments - monitor for overdue items
**Insurance Manager - Morning Checklist**
* Review new Policy Proposals awaiting approval
* Review any Claims in Approved status awaiting payout
* Check *Rejected Policies* and *Rejected Proposals* cards for patterns
* Review the *Insurance Sum Assured by Company* chart periodically for portfolio balance
**HR Team - As Needed**
* Review *Insurance Member Request Approved* and *Rejected* cards
* For approved requests, confirm salary deductions have been applied
* For rejected requests, inform the employee with reasons
**Accounts Team - Daily**
* Process open Sales Invoices for premium instalments
* Process Payment Entry records created after claim approval
***
## What Each Page Covers
| Page | What You Will Learn |
| ---------------------------------------------------------- | ----------------------------------------------------------- |
| [Policy Proposal](./policy-proposal) | How to create and submit an insurance application |
| [Insurance Policy](./insurance-policy) | How to issue a policy, complete KYC, and get final approval |
| [Insurance Premium Schedule](./insurance-premium-schedule) | How to read and manage the payment schedule for a policy |
| [Insurance Claim](./insurance-claim) | How to file, approve, and settle a claim |