Work with Quotes and Group Contracts
Learning Objectives
After completing this unit, you’ll be able to:
- Identify the objects in the group insurance data model.
- Describe the relationship between group, quote, contract, and policy objects.
- Explain how the group insurance data model supports a typical business process.
Group Insurance Overview
Anna has a Cumulus medical insurance plan through her employer, Cloud Kicks. Cumulus Insurance is the insurance carrier, and Anna is a group member and policyholder. Cloud Kicks doesn’t just offer insurance to Anna, they offer medical insurance to her group of coworkers as well.
The Group Insurance data model allows Cumulus to manage group insurance by tracking data for groups, quotes, contracts, and plans. Let’s work through the data model Justus Pardo implemented for the new quoting and policy administration system.
Cloud Kicks’s Group Information
At Cloud Kicks, Anna works with all sorts of employees. She coordinates with her manager on project deadlines, assists the new part-time intern with onboarding, and even participates in company-wide meetings with Cloud Kicks executives. All of these employees are part of the group. Cloud Kicks offers each group member different health insurance plans according to their group class. It’s important for Cumulus to have the latest group information to provide Cloud Kicks with an accurate quote.
Here is a model of some of Cloud Kicks group data.
Let’s work through some basic group insurance data model objects and relationships.
| Object |
Description |
|---|---|
|
Account |
The Account object is a Salesforce standard object. Multiple Account types are available for businesses and consumers. Account objects have a parent-child relationship. Cloud Kicks has a Group Account (1). Anna has a client account and a contact record. Fields from these records merge to form a Person Account (2). |
|
Group Census |
The Group Census object (3) contains overall details that are useful for the quote that Cumulus prepares for Cloud Kicks. Cumulus uses group census data such as the number of members, dependents, and spouses to determine health plan prices. An account can have multiple group census records. |
|
Group Census Member |
Each Group Census record (3) has multiple Group Census Members (4). Each member record contains specific information relevant to the member. In our example, each Cloud Kicks employee is also a Group Census Member. Anna’s record contains her date of birth, address, and relationship to the employee, herself. All covered dependents also have a Group Census Member. This includes Anna’s husband, Nigel, who is connected to Anna’s Person Account. |
|
Group Class |
Group Class records (5) are classification groups of employees. Multiple variables determine the classes. Cloud Kicks has several employee classes, including part-time individual contributor, full-time individual contributor, managerial, and executive classes. As a data scientist, Anna is a full-time individual contributor. Group Class has a parent-child relationship, like the Account object. This allows a vertical organization of Group Classes. For example, an executive could be a member of a full-time Group Class and an executive Group Class. |
|
Group Class Contribution |
Group Class Contribution data (6) specifies the contribution amount the employer and employee make for the group class towards the premium. For full-time individual contributors, like Anna, the eligible employee (EE) contribution is 70% of the premium. Cloud Kicks, the employer (ER), contributes 30% of the premium. |
The Cumulus Insurance Quote
Great! We organized the Cloud Kicks group census data. Now that Cumulus knows more about their group, let’s get a personalized quote underway.
Here’s a model of quote data at Cloud Kicks. Unlike the other diagrams, we break it down into records to show the function of the joining entity, Quote Line Item Group Class.
This table describes how the insurance data model organizes the group quote information.
| Object |
Description |
|---|---|
|
Quote Line Item |
Quote Line Items (1) are health plans offered to the group that are associated with the quote. The line items can be vision, medical, or dental plan options. In our example, Cumulus includes quotes for a standard health plan and a premium health plan. |
|
Quote |
Quote Line Item records (1) make up a Quote (2) of proposed prices for products and services. |
|
Group Class |
The Group Class object (3) is the root object for the group insurance quote for Cloud Kicks. Each Group Class can connect to multiple Quote Line Item Group Classes. |
|
Quote Line Item Group Class |
Quote Line Item Group Class (4) is a joining entity, which links the appropriate line items to each group class. Every Quote Line Item can have a different Group Class. During the enrollment period, knowing which line items are available to each group class sure comes in handy. |
The Cloud Kicks Contract
Cumulus and Cloud Kicks work out the details of the group insurance quote. Once the quote is agreed, they transition into the contract phase. Here’s how the model looks with Cloud Kicks contract data.
This table describes how the insurance data model organizes Cloud Kicks group information in the contract phase.
| Object |
Description |
|---|---|
|
Group Account |
The Cloud Kicks Group Account (1) is an Account object. |
|
Group Class |
Each Cloud Kicks Group Class (2) can connect to multiple Contract Group Plans similarly to Quote Line Item Group Classes. |
|
Quote Line Item |
The Quote Line Item (3) products and plans offered to the group in the quote hold a one-to-one relationship with Contract Group Plan records. |
|
Contract Group Plan |
Quote line item records (3) translate into Contract Group Plan records (4) once the contract is in place. Contract Group Plan records have a parent-child relationship and can nest with themselves. |
|
Contract |
The Contract object (5) is a standard Salesforce object. Each account can have many contracts, and each contract can have multiple Contract Group Plans. |
|
Insurance Contract |
The Insurance Contract object (6) is an extension of the standard Contract object. The Insurance Contract gives Cumulus Insurance additional contract fields. With this object, Cumulus can capture insurance-specific attribute data like the Cloud Kicks enrollment start date and agency information. Cloud Kicks works with a Cumulus distribution agency, MaxProtect, to negotiate pricing. |
Time to Enroll
After the contract is signed, it’s time to enroll Cloud Kicks employees and their dependents. Using bulk upload, a benefits admin uploads group census data with their member plan selections to create the insurance policies. Woo hoo! Now Cumulus covers Anna and her colleagues.
Here is Cloud Kicks policy data structure.
| Object |
Description |
|---|---|
|
Contract Group Plan |
Quote line item records translate into Contract Group Plan records (1) once under contract. Contract has a parent-child relationship and can nest in itself. Many Group Census Member Plans stem from a single Contract Group Plan. One product, Cumulus Health Insurance, has many Contract Group Plans. All of the Contract Group Plan records make up only one contract between Cumulus and Cloud Kicks. |
|
Group Census Member Plan |
The Group Census Member Plan (2) is the insurance plan for each group member. It has a many-to-one relationship with the Contract Group Plan and the Group Census Member (3). Each member can have multiple plans. |
|
Product |
Product (4) represents the insurance product Cumulus sells. |
|
Insurance Policy |
After enrollment, the Contract Group Plan forms the basis of the Group Insurance Policies (5). This completes the process from quote to enrollment. |
Thank goodness. Now the insurance data model reflects Anna, her family, and the whole Cloud Kicks group, who have superior coverage from Cumulus. Next, let’s help producers and agencies work together and organize their data.