JRules for Policy Management

Comprehensive catalog of thousands of rules

Congratulations on securing a new enterprise group deal and signing the contract! Now it's time to onboard your insured clients and establish the unique rules requested by your enterprise customer to finalize the deal. JRules provides a comprehensive catalog of thousands of rules, allowing you to quickly align them with the contract items.

We understand that implementing new rules can be a challenge and often turns into lengthy IT projects, causing your pre-authorization and claims teams to manually manage operations. With JRules, you can implement new rules in just hours, not months, streamlining the process and saving valuable time.

Policy production is a critical aspect where even minor errors can result in significant budgetary losses. Selecting the right rules that comply with the contract is essential, especially when dealing with lengthy contracts containing numerous business rules. Our solution simplifies the selection process, making it accessible to employees at all levels.

Using our user-friendly, step-by-step process, you'll first choose which illnesses are covered, followed by waiting periods, limits, cover redirections, and pregnancy and maternity emergency admission rules.

Each policy is different, so is JRules!

We know you have hundreds of different enterprise customers and each one has different special clauses, changing your original policy templates.

We have screened over hundred thousand pages of insurance policies and created over 2500+ business rules to match your needs. The platform is fully customisable by your policy managers and product owners thanks to Decision Center.

Scope of Rules

  • Covered and Uncovered Diseases Groups for inpatient, outpatient and treatment
  • Network Management Rules
  • Policy Management Rules
  • Pricing/Service Procurement Rules
  • Deductibles and Cover Limit Rules
  • Covers Management
  • Pharmacy and Vaccination Rules
  • Waiting Period Management
  • Emergency Admission Rules
  • Maternity and Newborn Rules

Over 250 parameters are checked and controlled, including

  • ICD-10 Codes, Health Service Codes
  • Age, Gender
  • Waiting Periods
  • Doctor Specialty
  • Cover Limits and Cover Redirection
  • Surgery/Inpatient Rules
  • UW Exemptions
  • Patient History

Health Insurance Solutions

JSure Health Insurance Platform

JSure Health Insurance Platform

JPolicy Maker for Contract Management

JPolicy Maker for Contract Management

JMed Master

JMed Master
Data

JSure B2B

JSure
B2B

Smart UnderWriter

Smart UnderWriter

JPharmacy

JPharmacy

JPharma Catalog

JPharma Catalog

JPacks for Medical Image Transfer

JPacks for Medical Image Transfer

Market Acoustics - Next Best Action Suite

Market Acoustics - Next Best Actions Suite

Our vertical expertise sets us apart

We are ranked among the best providers in EMEA region

 

new1

Banking

Change your bank’s approach to develop more significant customer bonds and generate fresh business expansion prospects.

new2

Insurance

Drive your insurance company forward with our tailored solution packages for a wide variety of next generation insurance products.

new3

Public Services

Shift your service quality covering the demands and expectations of citizens with seamless online transactions.

new4

Energy

Unleashing your data by our innovative solutions helps you increase the validity of the supply-demand balance planning by accurate estimation.

JForce

Retail

In this hostile and demanding environment, we help you shift to profitability by optimizing your stocks and managing competition.

Monthly Newsletter

Sign Up to our monthly newsletter and keep an

eye on industry news and expert ideas.