Premium Billing This system creates monthly bills for insurance Yes 34 GB & Insurance benefits, accepts and tracks receivables for 87 Files (Tables) Accounting premium payments, calculates claim 102 million records reimbursements and vendor payments, and interfaces with the State general ledger accounting system. System has approximately thirty (30) years of transactional data. Insurance/UNIX Application The Insurance/UNIX application is the primary source for enrollment, eligibility and premium business transactions. This application was initially developed in the late 1990’s. It leverages an ADABAS database, which is the primary source of business functionality for the system. Insurance/UNIX data and business logic is accessed interactively from two other PEBA insurance division web-based applications, EBS and MyBenefits. The EBS system is used by employers to assist employees with enrollment in various PEBA insurance products. The MyBenefits web application provides self-service functionality for subscribers. One of the key interfaces of this application is the daily and monthly enrollment extract files that are used to support the internal PEBA Premium Billing & Insurance Accounting system. Each night, all subscriber, coverages, and premium data is extracted from the UNIX ADABAS files, converted, and reloaded into separate MySQL data tables that are required for the Premium Billing & Insurance Accounting system. The Insurance/UNIX application also generates daily files of enrollment changes that are provided to third party claims administrators (TPA). Insurance/UNIX Key Functions The Enrollment/ UNIX application performs the following key functions: No. Key Functions 1 Allows users to key enrollment changes from paper forms for members. 2 Updates member coverage to reflect web-based enrollment requests. 3 Creates files of enrollment changes for TPAs. 4 Generates and monthly enrollment files used by the internal Premium Billing & Insurance Accounting system. 5 Stores historical member coverage and changes. 6 Stores coverage and calculates premiums. 7 Uses the FILE2TIFF system to generate and store correspondence.
Premium Billing & Insurance Accounting This system creates monthly bills for insurance benefits, accepts and tracks receivables for premium payments, calculates claim reimbursements and vendor payments, and interfaces with the State general ledger accounting system. System has approximately thirty (30) years of transactional data. Yes 34 GB 87 Files (Tables) 102 million records Insurance/UNIX Application The Insurance/UNIX application is the primary source for enrollment, eligibility and premium business transactions. This application was initially developed in the late 1990’s. It leverages an ADABAS database, which is the primary source of business functionality for the system. Insurance/UNIX data and business logic is accessed interactively from two other PEBA insurance division web-based applications, EBS and MyBenefits. The EBS system is used by employers to assist employees with enrollment in various PEBA insurance products. The MyBenefits web application provides self-service functionality for subscribers. One of the key interfaces of this application is the daily and monthly enrollment extract files that are used to support the internal PEBA Premium Billing & Insurance Accounting system. Each night, all subscriber, coverages, and premium data is extracted from the UNIX ADABAS files, converted, and reloaded into separate MySQL data tables that are required for the Premium Billing & Insurance Accounting system. The Insurance/UNIX application also generates daily files of enrollment changes that are provided to third party claims administrators (TPA). Insurance/UNIX Key Functions The Enrollment/ UNIX application performs the following key functions: No. Key Functions 1 Allows users to key enrollment changes from paper forms for members. 2 Updates member coverage to reflect web-based enrollment requests. 3 Creates files of enrollment changes for TPAs. 4 Generates and monthly enrollment files used by the internal Premium Billing & Insurance Accounting system. 5 Stores historical member coverage and changes. 6 Stores coverage and calculates premiums. 7 Uses the FILE2TIFF system to generate and store correspondence.
2018%20New%20Benefits%20Administration%20System%20Request%20for%20Qualifications%20-%20PEBA0202018RFQ.docx