GLTC_elearning_V1.1.pptx

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© 2007, Cognizant Technology Solutions. Confidential
GROUP
LONG TERM CARE APPLICATION

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Introduction to CARE
 GLTC CARE Application is designed to handle all the administrative functionalities of the
Group Long Term Care business of John Hancock apart from Claims.
 CARE is a homegrown system developed on IBM-Mainframe technologies driven by DB2
Tables. The front end work station of CARE is developed in Power Builder.
 Some of the important features of the system can be highlighted as :
• Plan design, client set up and enrollment for coverage is handled through work
station.
• CARE system is enabled with features like Coverage Change, Increases/Decreases,
Inflation Elections, Automatic benefit Increase (ABI), Termination, Suspense
processing, Coverage conversion processing.
• The system also administers billing and payment and stores history of cash flow
• The system is also equipped to process missing information, underwriting, plan
changes/design (as per the specifications from a client) and work item processing.
• A manual process is used for verification of agent licensing information as there is
no interaction with LARS.
• It generates output for corporate accounting system and various reports and
letters
• CARE has no Rating System ; hence rates are uploaded in database during new
client set up.

Processes in CARE
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Process Description
Client Set up : JH BA team identifies client's requirements from the Questionnaire and
Application filled up by client. They determines unique client number and policy number
and set up plan and billing details in the database.
Eligibility : Eligibility file contains the information(e.g.-name, age, DOB,EE-ID) of all the
members of a client. Client sends eligibility file to JH
Billing : Billing is the process of calculating premiums and dues in the system and send
the billing files to clients/payor(s) depending on the billing methods - Direct Billing,
Payroll/Pension Billing and ABW (Automatic Bank Withdrawal)
Payment : Payment is the process of collecting premiums from client / insured/ payor
through the payment methods - Direct Payments, Payroll/Pension Deduction, ABW
Coverage Changes : Through out the life cycle of the coverage the insured can opt for
increase/decrease/termination etc in his/her coverage.
App Entry : Requests for enrollment can come through enrollment files or on Paper
application form or application kit provided by the John Hancock. These forms are stamped
with receiving date and sent for App Entry process. During this process application for a
member is entered manually into the system.

Client Set Up
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 Client Requirements are identified by filling up the JH Questionnaire and
Client Application.
 JH BA team designs plan and its components for client and also determines
unique client number and policy number

Eligibility
System
reformats
the file
Error
Found
JH BA Team
Yes
Talks to
Client
Client
Sends
Eligibility File
 TCLIENT_MBR_HIST
 TTIME_RELEASE
 TPERSON_ADDRESS
Ongoing Eligibility
Tables updated
 TCLIENT_MEMBER
 TPERSON
 TPERSON_ADDRESS
No
Initial Eligibility
Tables updated
System loads
file into
database
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Process Flow

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App Entry /Enrollment
No
 TWORK_ITEM
JH Customer
representative team
collects information
to resolve issues
Create
Work Item
No
JH Underwriters
work on the
application
 TCOVERAGE_LAYER
 TCOVLAYR_STAT_HIST
 TCOVLAYR_PREM_HIST
Tables updated
Coverage
Denied
System Checks
for
Application
Completeness
Tables populated
with Applicant Data
 TAPPLICANT_INSURED  TCOVERAGE_LAYER
 TCOVLAYR_STAT_HIST
 TCOVLAYR_PREM_HIST
Tables populated with
Coverage Details
Data Entry Into System
JH BA Team
Guaranteed
Issue
Coverage
Approved
 TCOVERAGE_SUMMARY
 TCOVSUMM-HISTORY
 TCOVSUMM_STAT_HIST
 TCERTIFICATE
Tables populated with
Approved Coverage Details
Yes
 TENROLL_PER_CLASS
 TCLIENT_PLCY_CLASS
Process Flow

Billing
Billing is the process of calculating premiums and dues in the system and send the
billing files to clients/payor(s) depending on the billing method
Available Billing methods are
 Direct Billing
Payors are billed each month for all the insured's’ (under the Payor) premium
and bills are directly sent to Payors.
 Payroll/Pension Billing
The client’s Payors system loads this deduction information into their payroll
or pension system. John Hancock sends the files weekly, biweekly, monthly or
even annually, based on the payroll cycle of the client.
 ABW (Automatic Bank Withdrawal)
A billing method for insured(s) to pay their GLTC bills by automatically
deducting their monthly premium from their savings or checking account
directly
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Payroll/Pension Direct

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JH BA Team
TBILLING_SCHEDULE TTIME_RELEASE
For each
insured
process
Billing
 TPAYOR_INSRD_HIST
 TCERTIFICATE
 TBILL_MESSAGE
 TPOLICY
 TFIN_INSTITUTION
TPAYOR_INSRD_HIST
Get all payors for a client those
are on DIR/ABW method
Active insureds
from
TCOVSUMM_STA
T_HIST
Yes
No
Error
File
Calculated New Bill Amount
Read last Bill Amount;
Retro & Past Due Balance
Amount
 TINSURED_BILL_HIST
 TINSURED_FIN_HIST
 TBILL_MESSAGE
Insert Bill History row
Process Bill Message
Update Retro & Past Due Balance Amounts
in coverage summary table with zero
Payroll/Pensio
n Billing
Direct Billing
ABW Billing
Billing
Process Flow

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Payroll/Pension
DIRECT
ABW
Payment
Payment is the process of collecting premiums from client / insured/ payor
Available payment methods are
 Payroll/Pension Deduction
Client deducts payments on payroll / pension billing locations based on
billing frequency and sends payment files to JH
 Direct Payments
The insured makes payment to JH via Lockbox , which is a bank/vendor
that processes the individual check / wires from each insured
 Automatic Bank Withdrawal (ABW)
The payor authorizes John Hancock to automatically withdraw the
monthly premium from payor’s bank account for each billing period.

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Payment
No
 Load the tape amount
in TBILL_LOC_REMIT
table
 Process overnight
Batch cycle to check
Tape Amt=Check
Amt?
Payment File
Client
Payment
details
through paper
Payment
through check
/ wire
Reformat
Processing
Entry using
Batch Payment
Screen
Entry using Bill
loc payment
screen
 Enter actual payment
deducted in
TTIME_RELEASE table
 Load check amount
in TBILL_LOC_CHECK
table
Yes
 Payor
Exists?
Recon
Analyst Team
Yes
No
 Apply payment to
CARE database
 Suspense
Processing
Process Flow

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Future purchase option
Offered to each client for
every 3 years and is optional
Automatic Benefit Increase
Occurs when insured’s daily
maximum benefit increases (5%
compounded) automatically each
year on policy anniversary date
Coverage increase
Request will be Processed after
undergoing the complete
underwriting process
Non Forfeiture
Termination
Entire coverage or most recent
coverage layer will be terminated
Reinstatement
Insurance coverage is renewed
after a lapse due to non payment
of premium for a certain period of
time
Death
Non Payment
On Request
LMB Ends
RLM (Reduced Lifetime
Maximum)
Benefit Bank is used if insured
cannot afford to pay premiums
anymore still they will have some
sort of coverage and they will not
lose everything they have paid
RLM is calculated on each piece
of coverage
Reduced paid up benefit is not
offered anymore
Coverage Changes

Correspondence
 Rate Quote Letter : It is sent by John Hancock along with the coverage application
form to all the eligible members. This rate quote chart highlights the changes in the
premium amount & DMB values with the variation in the age of the person.
 Approval Letter: It will be triggered once the coverage is approved.
 Missing info Letter: It will be triggered if any information is missed in the application.
 Decline Letter: It will be triggered if the coverage is declined.
 Termination Letter: It will be triggered if the coverage gets terminated due to Non
Payment of premium or Death.
 Other types of letters:
 Reinstatement Letter
 Letters for Ineligible Member
 FOCUS is used only for approval letters to older clients.
 All other letters and correspondence for new clients are generated using EZLetter .
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TTIME_RELEASE
Valid
Time_Release_
Fn_Cd
N
Y
Entry found in
Correspondence
N
Y
Hold code in
Tcorrespondence is
‘H’ and Release fn cd
in Ttime_Release is
‘PRLS’
N
Release
criteria
matches
 Approval
letter
Y N
Approval Letter generation
TCORRESPONDENCE
Update Ttime_Release
table
Do not release
letter
Y
Process Flow

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MI,NA,TERM Letter generation
TTIME_RELEASE TCORRESPONDENCE
Release type code =
‘L’ and Release fn cd
= Letter type cd
 MI
 Letter
 NA
 Letter
 TERM
 Letter
Process Flow
Check the letter type
code and generate
letters

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THANK YOU

GLTC_elearning_V1.1.pptx

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