Pre-requisite steps:

1. Set up Benefits module.
2. Set up employee dependents.

Roles

HR Administrator

Role: Responsible for setting up and managing the Health Plan module within the HRplus system. They define claim types and their limits, add and maintain healthcare provider information, process employee health plan claims, run reports, and manage refunds for settled claims.

Employee

Role: Submits health plan claims for themselves and their dependents through the Employee Self-Serve module. They provide necessary documentation to support these claims and ensure compliance with the health plan requirements.

Dependent

Role: An individual covered under the employee's health plan. Claims are submitted on their behalf by the employee, and they rely on the employee to manage their healthcare benefits.

Health Care Provider

Role: Delivers medical services to employees and their dependents. They may submit claims directly to the insurance company or provide documentation to the employee for claim submission.

Insurance Company

Role: Processes health plan claims submitted by employees or healthcare providers, determines eligibility and coverage for the claimed services, and issues refunds for approved claims.