Group Subsgroup Member Class Plan Product Heirarchy

Healthcare insurance Group Plan Class heirarchy in Healthcare (for Business Analysts)

I always get may email from my visitors asking me to explain the hierarchy about different elements in health insurance products.  Usually Business Analysts in any company will have to have an excellent knowledge about Products, Plans, Class, Groups, Sub groups etc.. Because that is what they deal with in their role in any healthcare insurance domain.

Group:

Group is the top most element. Group usually indicates a client for Insurance company. Lets say ABC Electronics is a client of XYZ insurance company, so developers will define the ABC client as a Group. If ABC electronics have different branches in various cities then for ease of maintenance, sub groups are maintained under the main group. Under each sub group Members are created. Members are usually employees of ABC electronics in various states(branches).

These members will be assigned to a Insurance Product (HMO, PPO etc..) in the Insurance company. Usually members will chose or ABC company will allow them to chose as per their designation.

Product and Plan are technically same but some company use different ids for product and plan but their purpose is same. Plan name is mostly used for business purpose.

Each product has to be assigned to a Class. Class explains about which class the employees belong to so he can only chose certain products which are assigned to that class.

So, member is the lowest in the hierarchy (Group-Subgroup- Member).

Product is a separate parallel entity.. as all insurance companies will provider different products/plans to attract subscribers to take their insurance plan.

I hope I have explained upto your expectations, if you have any questions please respond in comments.

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