General Features
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A.
Health Insurance Platform Modules - 2026
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0
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Policies
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Claims
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Providers
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Telemedicine
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Wellness
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Payments
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Network
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Enrollment
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Eligibility
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Reports
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Compliance
B.
Platform Deliverables
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1
iOS Policyholder App
Native iOS application for members to manage policies and claims.
2
Android Policyholder App
Native Android application for mobile insurance management.
3
Policyholder Web Portal
Web-based interface for insurance policy management.
4
iOS Provider App
Native iOS application for healthcare providers and hospitals.
5
Android Provider App
Native Android application for provider claims submission.
6
Provider Web Dashboard
Comprehensive web dashboard for healthcare provider administration.
7
Main Website
Marketing website with insurance products and information.
8
Admin Management Panel
Complete insurance company administration and management.
9
Claims & Finance Panel
Claims processing, financial reporting, and commission management.
10
Administrator Dashboard
Complete platform monitoring and operational control dashboard.
11
Real-Time Eligibility Check
Instant policy eligibility verification system.
12
Compliance Management
Regulatory compliance, HIPAA, and insurance standards.
13
Telemedicine Integration
Built-in telemedicine and virtual consultations.
14
iOS Apps Submission
Deployment to iTunes App Store for policyholder and provider apps.
15
Android Apps Submission
Deployment to Google Play Store for complete insurance ecosystem.
16
1 Year Bug Support
Technical support for platform bugs and performance issues.
6 Months
1 Year
2 Years
17
Licensed Source Code
Full access to modifiable insurance platform source code.
Included
Included
18
Lifetime License
Permanent platform usage rights with no recurring fees.
2 Years
Lifetime
Lifetime
19
Free Annual Upgrade
2 years of feature updates and security enhancements.
2 Years
20
Text and Banner Changes
Custom text, banner, and branding modifications.
C.
Policy Management & Enrollment Features
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21
Digital Policy Issuance
Issue insurance policies digitally with e-signatures.
22
Multiple Plan Options
Individual, family, group, and corporate health plans.
23
Customizable Coverage
Customize coverage levels and add-ons.
24
Plan Comparison Tools
Compare different insurance plans side by side.
25
Online Enrollment
Complete online policy enrollment process.
26
Digital Insurance Cards
Generate and manage digital insurance cards.
27
Dependent Management
Add and manage dependents on policies.
28
Premium Calculator
Calculate insurance premiums based on coverage.
29
Policy Renewal Management
Automatic policy renewal reminders and processing.
30
Portfolio Management
Manage multiple insurance policies in one account.
31
Premium Payment Options
Monthly, quarterly, annual premium payment options.
32
Policy History
Complete policy history and changes log.
33
Premium Adjustment
Adjust premiums based on risk factors.
34
Risk Assessment Tools
Assess risk factors for premium calculation.
35
Policy Documents
Access all policy documents and certificates.
36
Video Enrollment Support
Video assistance for policy enrollment.
37
Coverage Analytics
Analyze coverage adequacy and gaps.
38
Wellness Program Integration
Integrate wellness programs with policies.
39
Porting Requests
Process insurance portability requests.
40
Premium Discounts
Offer discounts for healthy behaviors.
41
Waiting Period Management
Manage policy waiting periods and exclusions.
42
No-Claim Bonus Tracking
Track and apply no-claim bonuses.
43
Grace Period Management
Manage premium payment grace periods.
44
Advanced Plan Search
Search plans by coverage, premium, and features.
D.
Claims Management & Processing Features
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45
Digital Claims Submission
Submit insurance claims digitally with document upload.
46
Real-Time Claim Tracking
Track claim status in real-time from submission to payment.
47
Hospital Cashless Processing
Cashless hospitalization claim processing.
48
Document Upload & OCR
Upload claim documents with OCR processing.
49
Instant Claim Intimation
Instant claim intimation and acknowledgment.
50
Provider Direct Submission
Providers submit claims directly to insurer.
51
Claim Status Updates
Automatic status updates throughout claim lifecycle.
52
Claim History
Complete claim history and payment records.
53
Claim Notifications
Notifications for claim updates and requirements.
54
Claim Sharing
Share claim details with family members.
55
Settlement Tracking
Track claim settlement amounts and dates.
56
Claim Re-submission
Re-submit claims with additional information.
57
Co-pay Calculation
Calculate co-pay amounts automatically.
58
Deductible Tracking
Track deductible amounts and remaining coverage.
59
Fraud Detection
AI-powered fraud detection in claims.
60
Claim Notes
Add internal notes to claims for processing.
61
TPA Integration
Integrate with Third Party Administrators.
62
Pre-authorization Requests
Process pre-authorization for treatments.
63
Claim Reimbursement
Process reimbursement claims with receipts.
64
Claim Rejection Management
Manage and appeal rejected claims.
65
Mobile Claim Submission
Submit claims from mobile devices.
66
Bulk Claim Processing
Process multiple claims in batches.
67
Hospital Network Integration
Integrate with network hospitals for cashless.
68
Turnaround Time Tracking
Track claim processing turnaround times.
E.
Provider Network Management Features
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69
Provider Directory
Comprehensive directory of network providers.
70
Provider Search & Locator
Search providers by location and specialty.
71
Specialty Filtering
Filter providers by medical specialty.
72
Provider Ratings & Reviews
Rate and review network providers.
73
Real-Time Availability
Check provider availability in real-time.
74
Provider Onboarding
Digital onboarding for new network providers.
75
Provider Credentialing
Manage provider credentials and certifications.
76
Provider Performance
Track provider performance metrics.
77
Network Updates
Notify members of network changes.
78
Provider Sharing
Share provider information with others.
79
Contract Management
Manage provider contracts and agreements.
80
Fee Schedule Management
Manage provider fee schedules.
81
Network Adequacy Analysis
Analyze network coverage adequacy.
82
Provider Payment Processing
Process payments to network providers.
83
Quality Assurance
Monitor and ensure provider quality.
84
Provider Notes
Add internal notes about providers.
85
Appointment Booking
Book appointments with network providers.
86
Preferred Providers
Mark preferred providers for quick access.
87
Provider Portal
Provider portal for claims and information.
88
Network Optimization
Optimize provider network coverage.
89
Mobile Provider Search
Search providers from mobile devices.
90
Provider Communication
Communicate with network providers.
91
Network Analytics
Analyze network utilization and performance.
92
Emergency Provider Locator
Locate emergency providers quickly.
F.
Telemedicine & Virtual Care Features
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93
Virtual Consultations
HD video consultations with doctors.
94
Audio Consultations
Audio-only doctor consultations.
95
Chat Consultations
Text-based chat with healthcare providers.
96
Appointment Scheduling
Schedule virtual appointments.
97
Instant Consultation
Connect with available doctors instantly.
98
Specialist Access
Access to specialists via telemedicine.
99
Follow-up Appointments
Schedule follow-up virtual visits.
100
Consultation History
History of all virtual consultations.
101
Appointment Reminders
Reminders for upcoming virtual appointments.
102
Prescription Sharing
Share e-prescriptions digitally.
103
Telemedicine Coverage
Check telemedicine coverage in policy.
104
Health Record Integration
Integrate with electronic health records.
105
Virtual Visit Limits
Track virtual visit limits and usage.
106
Co-pay Calculation
Calculate co-pay for virtual visits.
107
HIPAA Compliance
Ensure HIPAA compliance for telemedicine.
108
Clinical Notes
Access clinical notes from virtual visits.
109
Group Therapy Sessions
Virtual group therapy and support sessions.
110
Mental Health Support
Access to mental health professionals.
111
E-Prescriptions
Digital prescriptions sent to pharmacies.
112
Consultation Recordings
Record consultations (with consent).
113
Mobile Telemedicine
Access telemedicine from mobile devices.
114
Urgent Care Virtual
Virtual urgent care consultations.
115
Remote Monitoring
Remote patient monitoring integration.
116
24/7 Access
Round-the-clock telemedicine access.
G.
Wellness & Preventive Care Features
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117
Health Risk Assessment
Digital health risk assessment tools.
118
Wellness Tracking
Track wellness metrics and goals.
119
Health Goal Setting
Set and track health improvement goals.
120
Nutrition Tracking
Track nutrition and dietary habits.
121
Activity Integration
Integrate with fitness trackers and apps.
122
Preventive Screenings
Schedule preventive health screenings.
123
Vaccination Reminders
Reminders for vaccinations and boosters.
124
Health History
Maintain personal health history.
125
Health Reminders
Reminders for health check-ups.
126
Health Reports
Generate health and wellness reports.
127
Wellness Rewards
Rewards for achieving wellness goals.
128
Health Challenges
Participate in health challenges.
129
Premium Discounts
Premium discounts for healthy behaviors.
130
Wellness Program Enrollment
Enroll in wellness programs.
131
Health Coaching
Access to health coaches.
132
Health Journal
Digital health journal and notes.
133
Preventive Care Calendar
Calendar for preventive care schedule.
134
Mental Wellness
Mental wellness and mindfulness tools.
135
Health Education
Access to health education resources.
136
Progress Tracking
Track wellness progress over time.
137
Mobile Wellness
Access wellness tools on mobile.
138
Family Wellness
Track wellness for entire family.
139
Health Device Integration
Connect health monitoring devices.
140
Sleep Tracking
Track and analyze sleep patterns.
H.
Payment & Billing Features
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141
Premium Payment Processing
Secure premium payment collection.
142
PayPal Integration
Premium payments via PayPal.
143
Bank Transfer Support
Direct bank transfer for premiums.
144
Auto-Pay Setup
Automatic premium payment setup.
145
Stripe Integration
Advanced payment processing via Stripe.
146
Digital Wallet Support
Accept payments via digital wallets.
147
Multi-Currency Support
Accept payments in multiple currencies.
1 Currency
10 Currencies
50 Currencies
148
Installment Plans
Premium installment payment options.
149
Secure Payment Gateway
PCI-DSS compliant payment processing.
150
PCI Compliance
Full payment card industry compliance.
151
Automated Receipts
Generate payment receipts automatically.
152
Payment Reconciliation
Reconcile payments with policies.
153
Payment Reminders
Reminders for premium due dates.
154
Late Fee Calculation
Calculate late fees for overdue premiums.
155
Refund Processing
Process premium refunds when applicable.
156
Payment Analytics
Analyze payment patterns and trends.
157
Payment Notifications
Notifications for successful payments.
158
3D Secure Authentication
Enhanced security for card payments.
159
Premium Financing
Premium financing options.
160
QR Code Payments
Pay premiums by scanning QR codes.
161
Corporate Billing
Corporate group premium billing.
162
Commission Payments
Pay commissions to agents and brokers.
163
Reward Point Payments
Pay premiums using reward points.
164
Gift Premium Payments
Gift premium payments to others.
