TCS BaNCS for Health and Personal
Accident Insurance
In today’s competitive market, insurers want to be seen as innovative, efficient and technology savvy. The
need to automate, be agile and connect to new or extended ecosystems to create exponential value for
the end customer is prime in a Business 4.0TM world
Insurers understand the need to leverage digital technologies, blockchain, Artificial Intelligence (AI) and
analytics to provide a rich experience and stay tuned to evolving customer needs by offering contextual
solutions at the right time and right place. Added to this, they are faced with the challenge of responding
rapidly and efficiently to regulatory changes and developing innovative solutions to suit market needs,
while also maintaining the desired underwriting quality. The advent and quick rise of insurtechs also
demands that carriers be able to offer solutions that can integrate with partner offerings seamlessly.
How can your insurance company simplify the healthcare journey and provide your customers with a
rich, seamless experience for both policy issuance and servicing?
How can you keep up with changing customer demands, launch solutions around multiple channels
and manage the consistent growth that the industry is witnessing today?
How can you leverage wearable-driven lifestyle data ingestion, insights, and real-time decision making
to predict losses?
TCS BaNCS Health Insurance – Digital, Benefits
Proven, Scalable, Configurable TCS BaNCS Health and Personal Accident Insurance Products
enables organizations to enhance administrative efficiency and
The Health solution from TCS BaNCS for Insurance, powered by APIs support faster growth by enhancing end user experience, with
and delivered on the cloud, is a complete solution suite, supporting a modules such as:
range of products, including customer management, product
definition, plan and network management, policy administration, A core business administration feature that provides flexibility
claims management, claims adjudication, insurance accounting and and configurability required to launch new products/ plans
reinsurance, among others. The solution's easy-to-use, web-based across all health insurance business lines like accident
interface supports global organizations with multiple languages and protection, medical insurance, disability and critical illness
currencies. Through its parameter-driven, component based
For individual and group customers, including small, medium
architecture, the solution allows flexible configuration and
and large organizations.
customization to meet specific business needs.
Self-servicing for ease of member enrolment, including claim
Recognized and ranked consistently as a leader and market star
assistance process
performer by industry experts worldwide, the solution has been
installed at more than seven customers across different geographies. Product and Plan Management
The solution offers various flavors of Health and Personal Accident
Insurance (Individual and Group Health and Personal Accident, Plan management
Voluntary Benefits, etc.), with enterprise and consumer apps made Single window-based product configurator
available through the cloud and on premise, helping organizations Product and plan versioning
become more agile and intelligent. TCS BaNCS enables you to offer
Product cloning facility
products and services to your customers throughout their lifecycle,
and journey with your company, based on their anticipated Supported by underlying business rules engine
requirements, and over the devices of their choice. Limits handling capability at product, plan, cover and medical
services level
TCS BaNCS’ strong digital core ensures enhanced business and
technical agility and efficiency by providing analytical insights for Medical entity/coding compatible e.g., supports ICD, CPT, DRG,
intelligent decision-making, alongside the amalgamation of IoT and AI medical package maintenance
within business processes. Co-payment/co-insurance and deductible definitions
It is an integrated solution comprising innovative and adaptive digital Exclusions/ clauses/ waiting period/ excess handling
apps and a high performing processing engine supporting a suite of a
wide range of products and services covering product configuration, CRM enabling Partner Management
service provider management, new business and policy servicing, Works as an operational CRM and provides a single view of the
pre-authorization, claims management with built-in configurable customer, intermediary management and other insurance
workflow, and is deployed with an assured 24 x 7 x 365 availability. business stakeholders
It caters to a wide gamut of products, sales channels, and lifecycle
360-degree customer portfolio view
functionalities, enabling firms to rapidly create and configure new
products across markets to increase profitability, scalability and Agent portfolio transfer capability
develop a competitive edge through automated claim adjudication Integrated complaint management functionality
and fraud control. Channel-specific premium, commission, incentives and taxes
Back Office Users/ Customer/Advisors/Agents or BaNCS assurance, Payrool User
Call Center Users Back-Office, Call Center Users, Executives Service Providers/Suppliers Applications Community
BaNCS Applications UI BaNCS Digital Suite of Apps Enterprise Channel Applications B2B Applications Channel UI
Channel
BaNCS Channel API Manager Integration
BaNCS Middleware Process &
Service
BaNCS API Repository & Gateway with Documentation Integration
BaNCS Core Application Enterprise Applications
Enterprise Business Management Components
Product
Call Center
Rules
GL, AR, AP
New
MIS/DWH
Rating Quote RI Mgmt
Mobile
Portal
Mgmt Business Engine
CRM
ECM
Ready Enterprise
Policy Fraud Mgmt Collection & Supplier Claims Accounting Adapters Information
Admin Payment Mgmt Mgmt for Systems
Enterprise
Infrastructure Compontents Applications
Enterprise Messaging
Doc XML Ref & Ops Application Application
Generation Reporting Security Audit Enterprise Security / Access Management
Provider and Network Management Processing of medical services/ benefits and medical packages
Service provider and clinician network maintenance Auto-adjudication process for authorizations/claims
Provider/ clinician associations to a network Claim rejection or cancellation handling
Price list/ fee guides management for medical services and Eligibility, limit checks and applicable tariff calculation for
packages services/ packages
Facility of price list maintenance Manual and automatic denial handling at claim and services
level
Versioning control facility for tariff changes
Waiting Period/ co-payment/ co-insurance handling in claims
Maintenance of tariffs - linked to duration, room type and other
processing
dimensions.
Reserve handling capability for authorizations/claims
Underwriting and Policy Management
Automatic and manual payment creation and approval
Product recommendations based on customer profiling Role-based authority for claims approval
Quote comparison facility for multiple plans Automated communication alerts - emails and SMS
Category management and plan selection Requirement and query handling with automated reminders
Multiple billing and payer handling Automated document generation
Premium calculation for individual & group policies Fraud handling based on varied business scenarios
Quick Quote creation and conversion to proposal processing eClaim management
Approval/ referral process support, including business Downloading of specific claims data for reconciliations
validation
Workflow Management: TCS BaNCS offers out-of-the-box
Single and detailed view of premium break-up and layering
integrated workflows that enable operation management
Standardized, flexi and customized plan offerings efficiently with real-time hot spots to facilitate informed and
Member upload against multiple categories with plan quicker decision-making. The workflow consists of a core and work
inheritance item processing engine and MI reports. This solution offers
Member and policy sub-status handling absolute independence to the administrator to manage and
maintain operations with minimal to no reliance on IT.
Member history view
Intercompany transfer and insurance portability support
Waiting period adjustment with impact on policy excess The TCS BaNCS Advantage
Policy and workflow audit trail maintenance and view Reduced time to market in launching new products
Health questionnaire maintenance for underwriting Multi-line,-channel, entity and multicurrency support through
Communication charter with requirement chasing functionality easy adoption of business processes, ratings; data masking
Generation of health specific documents needs for multi-channel deployment, ensuring transaction
visibility
Policy Servicing
Enhanced efficiency through automation of standardized and
Financial and non-financial endorsements simplified processes
Merging of multiple endorsements Architectural superiority with layered componentized J2EE
Out-of-sequence endorsements architecture and Open APIs, enabling easy partner integration
and compliance reporting through standardized integration
Policy cancellation and prorated adjustments layers
Policy suspension and reinstatement By empowering your organization to embrace risks, leverage
Renewal processing -- automatic/manual new and extended ecosystems, and create exponential value
Endorsement history view --- which are key elements of the TCS Business 4.0TM framework ---
we are able to foster growth and transformation, equipping
Authorization & Claims Management financial institutions with a clear and differentiated advantage.
End-to end claims processing from notification till settlement
Creation of claims without policy - FNOL feature
About TCS Financial Solutions
TCS Financial Solutions is a strategic business unit of Tata Consultancy Services. Dedicated to
providing business solutions to financial institutions globally, TCS Financial Solutions has
compiled a comprehensive product portfolio under the brand name of TCS BaNCS. The TCS
BaNCS universal financial solution is designed to help financial services institutions enhance
end customer experience, enabling them to embrace open and innovative technologies that
embody true digital customer engagement. Deployed at more than 450 installations
worldwide, it is the largest collection of components, enterprise and consumer apps for the
financial industry made available through the cloud, helping firms become more agile and
intelligent by leveraging the power of new and extended ecosystems.
To know more about TCS BaNCS, please visit: https://www.tcs.com/bancs
or write to us at tcs.bancs@tcs.com
About Tata Consultancy Services Ltd (TCS)
Tata Consultancy Services is an IT services, consulting and business solutions organization that
delivers real results to global business, ensuring a level of certainty no other can match.
TCS ers a consulting-led, integrated portfolio of IT and IT-enabled infrastructure, engineering
and assurance services. This is delivered through its unique Global Network Delivery ModelTM,
recognized as the benchmark of excellence in software development. A part of the Tata Group,
India’s largest industrial conglomerate, TCS has a global footprint and is listed on the National
Stock Exchange and Bombay Stock Exchange in India.
For more information, visit us at www.tcs.com
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