Insurance: products, policies, premiums, claims and reinsurance

#Purpose and scope

This chapter covers the Insurance module (the C# module installed per tenant). It is not the “insurance” Industry Pack, which is a separate JSON-only configuration bundle; the two are unrelated systems that happen to share a key. The module does however post to ledgers that the Insurance industry pack creates, so both are needed (see below).

#Before you start

1. Install the Insurance industry pack (Finance → Industry Packs). Postings use its ledgers (policyholder receivable, unearned premium, claims expense and reserve, and the reinsurance ledgers RI-CEDED-PREM, RI-PAYABLE and RI-RECOVERABLE). Without it BSuit says “Insurance ledgers not found — install the Insurance industry pack … first.”
2. Permissions (granted to INSURANCE-MANAGER): insurance.premium.bill, insurance.premium.collect, insurance.policy.cancel, insurance.policy.lapse, insurance.claim.review, insurance.claim.reserve, insurance.claim.pay, insurance.claim.reject, insurance.claim.close, insurance.reinsurance.cede and insurance.reinsurance.recover. A tenant can delegate a single finance action without handing out the role.
3. A cash or bank ledger for collections and claim payments.

#1. Products, rating factors and quotes

1. Create Products with a code, name, category, base rate per sum insured, and optional minimum and maximum sum insured.
2. Create Rating factors for a product: a factor key (for example risk_zone:high) and a multiplier. The risk-zone, age-band and similar adjustments compound.
3. Use Quote on a product with a sum insured and a list of factor keys. Annual premium is the sum insured times the base rate, multiplied by every matching factor, rounded to 2 decimals at the end. Keys that match no active factor are reported back instead of ignored.

#2. Policyholders and policies

1. Create Policyholders as Individual or Organization, with an optional national ID or registration number used to recognise the same party across policies.
2. Create a Policy for the policyholder: product, coverage start and end (end after start), sum insured, premium (positive) and premium frequency: single, monthly, quarterly, semi_annual or annual. It starts as a Draft with a POL- number.
3. Issue the policy. This activates it and builds the installment schedule: the premium is split evenly across the periods and the last installment absorbs the rounding remainder.

#3. Bill and collect premium

1. On the policy open its installments and Bill each one when due (needs insurance.premium.bill). Billing debits policyholder receivable and credits unearned premium. At this point the premium is a liability, not revenue.
2. Collect a premium receipt (needs insurance.premium.collect) from the policyholder into a cash or bank ledger. It is allocated oldest installment first and capped at the outstanding billed balance; an installment becomes Paid once fully covered.
3. A daily sweep recognises unearned premium as revenue pro-rata over the coverage period. Only billed premium is earned, and re-running never double-earns.

#4. Renew

1. Choose Renew on a policy whose term is running or finished. BSuit creates a new Draft policy for the next term with the same length, starting the day after the old term ends, keeping the policyholder and optionally re-rating from the product.
2. Issue the new policy as in step 2.

#5. Claims

1. Record a claim in Claims against a policy. The policy must be active (or expired), the incident date must fall inside the coverage window and not be in the future, the reported date cannot be before the incident, and the claimed amount must be positive and within the sum insured. A heuristic fraud-risk score is calculated automatically on creation to help triage; it does not decide anything.
2. Start the review (needs insurance.claim.review). Status moves from Reported to Under review.
3. Reserve (needs insurance.claim.reserve): enter a positive reserve not above the claimed amount or the sum insured. BSuit posts debit claims expense, credit claims reserve, and the claim becomes Approved.
4. Pay (needs insurance.claim.pay) from a cash or bank ledger. Each payment debits the reserve and credits the ledger you choose, is recorded as its own payment, and cannot exceed the remaining reserve. When the paid amount reaches the reserve the claim becomes Paid; until then it stays Approved, so part payments are possible.
5. Reject (needs insurance.claim.reject) a claim that has no reserve yet, or Close (needs insurance.claim.close) an approved, paid or rejected claim. Closing releases any unpaid reserve (debit claims reserve, credit claims expense).

#6. Reinsurance (quota share)

1. Open Reinsurance treaties and create a treaty for an active policy: reinsurer name (required) and cession ratio above 0 and at most 1 (for example 0.3 for 30%). The total ceded share on one policy cannot exceed 100%.
2. Cede premium (needs insurance.reinsurance.cede): debit reinsurance ceded premium, credit reinsurer payable, for the cession ratio times the policy premium. For a cancelled or lapsed policy only the retained (earned) premium counts, so a cancellation shrinks the cession.
3. Recover claims (needs insurance.reinsurance.recover): debit reinsurance recoverable, credit claims paid, for the cession ratio times the total claims paid on the policy.