Working with Policies

This chapter provides overviews of insured items and discusses how to:

• Work with policies.

• Change policies.

Understanding the Policy Data Model in PeopleSoft Policy and Claims Presentment

A policy is an insurance contract that states what is being insured, by whom, and for how much. It contains data that both the policyholder and the insurance company need to understand what the policyholder is insured for, the insured item, what coverages apply, for how long the insurance is effective, and how much the policyholder agrees to pay in premiums. In PeopleSoft Enterprise Policy and Claims Presentment, an insurance policy is a type of financial account.

A financial account represents a holding by the customer of a product that an insurance company provides. The financial account presents information from various legacy systems in a consistent interface. The financial account maps to the product, inheriting the terms and conditions from the product that the customer purchased.

The legacy administration systems create the financial account record and its sub-records. These accounts are not created in the PeopleSoft Enterprise CRM system. The Product Sales functionality queues up a transaction to the legacy system, which starts the process of creating a new account header record and its sub-records; the legacy system performs the actual creation of these records, and a message comes back from the legacy system to create the data structure in the PeopleSoft Enterprise CRM system.

Each financial account record represents one policy. If a business contact has two policies, there will be one financial account instance in the database for each. You can attach coverage at several levels in the data model. Coverage can be at either the policy or the covered asset level.

Use the Financial Account pages to view general account information, insurance account details, and policy information. Use the View Policy pages to view covered assets, including coverages, deductibles, limits, and options.

Understanding Insured Items

This section provides an overview of insured items and discusses:

• Covered assets in property and casualty (P&C).

• Policy changes.

Insured items, or covered assets, are related to a policy as the specific thing insured against loss. Policies may be written for many insured items, or for only one. For example, usually, a life policy has one insured item for a person's life while a household policy insures many items. Some companies write a car insurance policy that includes many vehicles, while other companies create a one-to-one policy to insured items. For group policies, there are many insured items.

Insured items can be a person, a place, or a thing. You must collect specific information regarding the item that is to be insured. This data includes the specific attributes that make up the item to avoid confusion regarding what or who is insured, and so you can price the policy accurately. Based on the type of insured item, you may need different types of information.

Each insurance policy has at least one covered asset. In property and casualty (P&C) lines of business, these assets are the items that the policy insures. In life or health policies, the covered asset is the insured person or persons. Covered assets can be of different types, and each can have different attributes. For example, when a car is insured, you must capture the vehicle identification number (VIN), whereas when a person is insured, you must capture the social security number. You can view a given policy's details, such as insured items for P&C, coverage, dollar limits, deductibles, options, and exclusions. The data elements that appear depend on the policy type.

Covered Assets in P&C

For P&C, insured items are assets. These assets may include a car, a boat, a home, a wine collection, and so on. Assets have a value, and the purpose of insuring them is to protect the use or enjoyment of the asset. Covered assets are insured against loss by the policy.

Generally, P&C covered assets or insured items include:

• Personal vehicles, including cars, minivans, pickup trucks, and sport utility vehicles.

• Commercial vehicles, including trucks, commercial vans, tractors, and combines.

• Boats, including sail, motor, and yachts.

• Commercial boats, including fishing boats.

• Mobile homes.

• Personal real estate, including single-family dwellings such as apartments, condominiums, townhouses, houses, duplexes, triplexes, and four-unit or fewer apartments where the owner also lives.

• Commercial real estate, including major apartment buildings, office buildings, commercial stores, shopping centers, and undeveloped, raw land.

• Personal property, including art work, jewelry, furs, computers, and wine collections.

• Commercial property, including equipment, machinery, and aircraft.

Insured items share some common characteristics. Each item:

• Is either owned or leased for use and is associated in some way to a business contact as owner, primary user, or lessor.

• Is related to insurance policies (a type of financial contract).

• Has a dollar value.

• Has a location or primary location.

  For example, a boat is moored at an address, a car is garaged at an address, a house has an address, an apartment building has an address, equipment is located in a primary location (an address or maybe a site), and personal property is either at one's home or in a safe deposit box, both of which would have an address or location.

• Has attributes that are necessary to describe the item for authentication.

  For example, the VIN, make, model, type, and year uniquely describe a car. A home's particular location, address, or housing tract number in the county records uniquely authenticates a house (title insurance information). The name of the producer, vineyard, or estate name; country of origin; and the year of vintage authenticate a bottle of wine.

• Can have additional attributes to provide more detail to the description.

  For example, attributes that may be related to risk, help the insurance company determine ratings or assess risk.

Policy Changes

An insurance policyholder may request a change to the policy. The PeopleSoft Enterprise CRM system captures all of the modification information and transmits it to the legacy system. Modifications to the policy may or may not require a quote, depending on the requested change. For example, changing the beneficiary on a life insurance policy does not require a quote because it does not impact the premium; however, a change in coverage on an automobile policy does require a quote because the premium may change. If a quote is required because of the requested change, the system returns the quote that the legacy system generates. If the user chooses to continue with the new quote, a message is sent to legacy system requesting the modification. The actual modification takes place in the legacy system.

Modification options are product-specific. The owner of an auto insurance policy may want to add a driver to the policy; however, this is not an option for a life insurance policy. Each modification is set up as an action type, and the actions are linked to the product itself. When you link the action to the product, that modification option becomes available to the policyholder. Set up the allowable actions in the Action component (for example, adding a driver is a valid action that can be linked to auto insurance product).

This diagram illustrates the process flow for policy changes:

Policy change process flow

Working with Policies

This section discusses how to:

• Establish insurance asset types.

• View insurance financial accounts.

• View relationships.

• View terms and conditions.

• View address history.

• View policies.

• View asset details.

• View billing history.

• View payment history.

Pages Used to Work with Policies

Establishing Insurance Asset Types

Access the Asset Type page.

Type	Short description for asset type. These are the types of assets associated with insurance policies.
Description	Long description for asset category.

Viewing Insurance Financial Accounts

Access the Financial Account page.

Account Type	Displays the type of account. Values are Checking, Savings, Credit, Insurance, and Investment.
Registration Type	Displays the account registration type. Under personal accounts, the values are Individual, Joint with rights of survivorship, Tenants in common, Community property, Named beneficiary, Custodial account for minor, and Trust. Under business accounts, the values are Corporation, Partnership, and LLC.
Registration Name	Displays the name that the insurer gave to the account while registering it.
Asset Type	Displays the type of assets linked with the account.
Status	Displays the policy's status.
Begin Date and End Date	Display the policy's beginning and end dates.
Last Statement Date	Displays the issue date of the last statement.
Tax Ident. Number Type (tax identification number type)	Displays the taxpayer identification type. Values are SSN and Federal Employer ID.
Tax ID	The customer's tax identification number entered in the Consumer component.
Policy Type	Displays the specific insurance-policy type.
Policy Status	Displays the policy's current status. Values are Issued and available for change, Not in force, Has been rated, Quoted and awaiting review, Submission has been quoted but not bound, Non renew, and Cancel.
Insured Name	Displays the insured's name. The customer may not be the insured but a beneficiary or a contact of the insured.
Premium Amount	Displays the premium for the policy.
Carrier Name	Displays the policy carrier's name.
Product Code	Displays a company-unique code that indicates the policy's product classification.
LOB Code (line of business code)	Displays a code that identifies the line of business classification. This element uses the line of business code list.
Policy Name	Displays the name that the insurer gave to the policy.
Policy Version	Displays a number or other identifier with which the company identifies this version of the policy.
State	Displays the state in which the policy was issued.
Payment Terms	Displays the time frame such as monthly, semiannual, or annual for the premium payment.
Payor Name	Displays the name of the person or entity who is paying for the policy.
NAIC Code	Displays an industry code that uniquely identifies an organization that is chartered under state or provincial laws to act as an insurer.
LOB Subcode (line of business subcode)	Displays the line of business subcode, if applicable.
Current Term Amount	Displays the total gross amount including premiums, plus taxes, fees, discounts, surcharges, and so on for the current term. When a policy is issued for its normal full term, this value is the full term amount at inception.
Contract Term Duration	Displays the contract's duration in units.
Contract Term Effective Date	Displays the period for the contract, policy, binder, and so on.
Contract Term Expiry Date	Displays the period for the contract, policy, binder, and so on.
Bill Account Number	Displays the account number that is used for billing purposes. The billing entity assigns this billing number.
Billing Method Code	Displays a code that identifies whether the policy is to be billed directly (by company) or through an agency.
Group ID	Displays the identifier for the group or association for a policy that is written as part of group or association business.
Customer Servicing Code	Displays a code that identifies who services customer calls for the associated policy.
Signed Date	Displays the date when the application form was signed.
Original Inception Date	Displays the date when this insurer first issued a policy to the insured.
Language Code	Displays a code that indicates the language in which the policy is written.
Mailing Responsibility Code	Displays a code that identifies the organization that is responsible for mailing the policy and any related materials to the insured.
Payor Code	Displays a code that identifies the entity who is paying for the policy.
Rate Effective Date	Displays the rate's effective date.
Signed by Code	Displays a code that identifies or certifies that the signature-required application or endorsement has been signed and that the agent has the signed document.
Other Insurance Company Code	Displays a code that indicates if the insured is known to have other insurance policies with the insurer on this policy, and if additional information is available.
Renewal Payor Code	Displays a code that identifies the person or entity who is paying for the policy renewal.
Renewal Billing Method Code	Displays a code that indicates whether the renewed policy is to be billed directly (by company) or through an agency.
Renewal Term Duration	Displays the renewal policy's term.
Renewal Term Expiration Date	Displays the date that coverage under the renewal policy ends.
Renewal Term Effective Date	Displays the date that coverage under the renewal policy begins.
Total Number of Losses	Displays the total number of losses that occurred for the past number of years as you specify in the Number of Years Loss Info field. This field applies to P&C.
Total Paid Loss Amount	Displays the total amount paid for the losses that are incurred during the period that you define in the Number of Years Loss Info field. This field applies to P&C.
Number of Years Loss Info	Displays the number of years of loss information that the insurer requires. This field applies to P&C.

Note. System administrators can use Insurance Translate Values to define valid prompt values for various fields in the application. The navigation is Set Up CRM > Product Related > Financial Services > Insurance Translate Values. This enables administrators to add, remove, or change values without logging into PeopleSoft Application Designer. This applies to both Financial Account and Policy pages (Agent-facing and Self-Service). The component name is RBI_XLAT_VALUE_INS.

Viewing Relationships

Access the Financial Account - Relationships page.

The Relationships page displays the relationship between —financial account and other business objects.

Viewing the Terms and Conditions

Access the Financial Account - Terms and Conditions page.

The system displays the terms and conditions associated with the financial account.

Viewing the Address History

Access the Address History page.

The system displays the address that is associated with the financial account.

Viewing Policies

Access the View Policy page.

The system displays details about coverage of policy assets or insured items. The policy creation EIP populates the fields.

The system displays the details of deductibles, limits, and options for each policy asset in the Deductibles/Limits/Options group box.

Note. System administrators can use Insurance Translate Values to define valid prompt values for various fields in the application. The navigation is Set Up CRM > Product Related > Financial Services > Insurance Translate Values. This enables administrators to add, remove, or change values without logging into PeopleSoft Application Designer. This applies to both Financial Account and Policy pages (Agent-facing and Self-Service). The component name is RBI_XLAT_VALUE_INS.

Viewing Asset Details

Access the Asset Type Details page.

Property Name	This is the description of the type of property. Every insured asset has some properties.
Value of Property	Property values of the associated insured asset.

Viewing Billing History

Access the Billing History page.

From Date and To Date	Enter the date range for the billing history information.
Get Billing History	Click to retrieve the billing history.
Bill ID	Displays the bill ID from the legacy system.
Bill Status	Displays the bill status from the legacy system.

Viewing Payment History

Access the Payment History page.

Start Date and End Date	Enter the date range for the payment history.
Get Payment History	Click to generate the payment history.
Payment ID	Displays the company ID that is used for the payment.
Payment Status	Displays the payment status.
Payment Method	Displays the payment method.

Changing Policies

Policy owners can modify their policies. Policy changes can be made by the customer service representative through the 360-Degree View or by the policy owner as a self-service transaction.

This section discusses how to:

• Set up actions.

• Change policies.

• Run policy change scripts.

Pages Used to Change Policies

Setting Up Actions

Access the Action page.

Action Code	Displays the action code that you entered on the search page.
Action Name	Enter the name of the action or change.
Action Type	Select an action type.
Re-Quote	Select whether the action requires a re-quote for a changed premium.
Action Reference	This does not apply to insurance.
Application Method	Select the application method to be associated with the change. Values are Application Form, Configurator and Branch Script.
Script Name	The script associated with the change when the application method value of Branch Script is selected.
Form Name	The form associated with the change when the application method value of Application Form is selected.
Description	The configurator model associated with the change when the application method value of Configurator is selected.

Changing Policies

Access the Change Policy page.

Policy Number	Select the policy number to be changed. The system displays only those policies that the customer owns.
Modification Type	Select the change request for the policy. Modification types are the action types that are attached to the policy.
Go	Click to launch the associated branch script, PeopleSoft Enterprise Advanced Configurator link, or application form.

Running the Change Policy Script

Access the Execute Script page.

The Execute Script page displays the application form, PeopleSoft Enterprise Advanced Configurator link, or branch script that is associated with the policy change. This example shows a sample model, but any change model may be used.

See PeopleSoft Enterprise CRM Advanced Configurator 8.9 PeopleBook.

See Running Scripts.