Pega Underwriting for Life Insurance

Transcription

1 Pega Underwriting for Life Insurance USER GUIDE 7.4

2 2018 Pegasystems Inc., Cambridge, MA All rights reserved. Trademarks For Pegasystems Inc. trademarks and registered trademarks, all rights reserved. All other trademarks or service marks are property of their respective holders. For information about the third-party software that is delivered with the product, refer to the third-party license file on your installation media that is specific to your release. Notices This publication describes and/or represents products and services of Pegasystems Inc. It may contain trade secrets and proprietary information that are protected by various federal, state, and international laws, and distributed under licenses restricting their use, copying, modification, distribution, or transmittal in any form without prior written authorization of Pegasystems Inc. This publication is current as of the date of publication only. Changes to the publication may be made from time to time at the discretion of Pegasystems Inc. This publication remains the property of Pegasystems Inc. and must be returned to it upon request. This publication does not imply any commitment to offer or deliver the products or services described herein. This publication may include references to Pegasystems Inc. product features that have not been licensed by you or your company. If you have questions about whether a particular capability is included in your installation, please consult your Pegasystems Inc. services consultant. Although Pegasystems Inc. strives for accuracy in its publications, any publication may contain inaccuracies or typographical errors, as well as technical inaccuracies. Pegasystems Inc. shall not be liable for technical or editorial errors or omissions contained herein. Pegasystems Inc. may make improvements and/or changes to the publication at any time without notice. Any references in this publication to non-pegasystems websites are provided for convenience only and do not serve as an endorsement of these websites. The materials at these websites are not part of the material for Pegasystems products, and use of those websites is at your own risk. Information concerning non-pegasystems products was obtained from the suppliers of those products, their publications, or other publicly available sources. Address questions about non-pegasystems products to the suppliers of those products. This publication may contain examples used in daily business operations that include the names of people, companies, products, and other third-party publications. Such examples are fictitious and any similarity to the names or other data used by an actual business enterprise or individual is coincidental. This information is the property of: Pegasystems Inc. One Rogers Street Cambridge, MA USA Phone: (617) Fax: (617) Pega Underwriting for Life Insurance Document: User Guide Software Version: 7.4 Updated: April 2018

3 CONTENTS About this document... i Intended audience... i Guide organization... i Reference documents... ii Overview... 1 Benefits of Pega Underwriting for Insurance... 2 Getting started... 3 Understanding Pega Underwriting for Insurance terminology... 3 Portals... 4 New Business Case Manager portal... 4 Sample data... 5 Sample agency... 5 Sample agent... 5 Logins... 6 Pega Foundation for Insurance... 6 Managing a customer account (MCA)... 6 Agency/Agent Management (AAM) Landing page Searching for an agent and agency Creating an agent and agency Global addressing Implications at run time Underwriting rules Manage change Automated routing rules Submission intake Intake stages and steps overview Application Submission Requirement... 35

4 Stage 1: Initiate Initial information Stage 2: Capture application information Enter application information Intake complete Review application completeness Edit application data In good order Share list Mark finished Stage 3: Wrap up CheckSubmissions step Stage 4: Complete Resolve application Alternate stages Withdraw DNQApplication Submission risks analysis Submission case stages and steps Stage 1: Assess risk Generate requirements Routing to ILA Underwriter Stage 2: Issue Alternate stages Decline underwriting Agent follow-up Proposal rejected Architecture Application layers Application rules Rulesets Work classes Classes and work types Data classes overview Prefixes... 78

5 Work groups and work queues Operators, access groups, and portals System administrator accounts Access groups Access roles Portals Using case management Work parties Pega Underwriting for Life Insurance specific Pega app data model Database tables Data classes: Reference information Interface classes... 87

6 About this document The Pega Underwriting for Life Insurance is a development and implementation accelerator for individual life insurance providers (or business processors and third party administrators) that want to deploy a rules-based system with which their individual life insurance sales and underwriting users can interact to complete their work. The application is a core scaffold from which individual life insurance carriers, business processors, and third party administrators can reuse preconfigured rules to construct the processes and flows that meet customer-specific needs and market requirements, enabling carriers to leverage and develop competitive advantages. The application capacity addresses Intake (submission for one or two insureds), Sales (manages the carrier s response to the application), and Underwriter (requirements and risk determination) interactions. The application can integrate with back-end supporting systems such as requirements providers and policy administration systems, and with document management systems to support the processing of work done throughout the organization that is needed to respond to an application for Individual life insurance. The application contains rules that define different ways of performing the same function, allowing individual life insurance carriers, business process outsourcers, or third party administrators to benefit from the flexibility that Pega provides, and deploy the system to meet the requirements of new business case management and underwriting. Intended audience This guide is intended for all Pega Underwriting for Life Insurance users, including Insurance professionals specializing in Individual Life Insurance Sales and Underwriting, as well as the Business Analyst. This guide is intended for business users and therefore gives a conceptual overview of the application s basic concepts and the configured use cases. Guide organization This guide contains the following sections. Chapter 1: Pega Underwriting for Life Insurance overview Chapter 2: Getting started Chapter 3: Submission intake Chapter 4: Submission risks analysis Chapter 5: Architecture Provides a business overview of the application Describes how to navigate the user interface, basic user functions, portal layouts, and preconfigured rules Describes how new business case managers can capture application details and generate a quick risk assignment for small face amounts Describes how to complete and submit the Intake of an Individual Life Application Outlines the architecture of the application Pega Underwriting for Life Insurance User Guide i

7 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt. Reference documents In addition to this document, other relevant Pega Underwriting for Insurance documentation includes: Pega Underwriting for Insurance 7.4 Installation Guide Describes how to install Pega Underwriting for Insurance in your environment. Pega Underwriting for Life Insurance 7.4 Implementation Guide Describes how to implement Pega Underwriting for Life Insurance in your environment. These guides are available from the Pega Underwriting for Life Insurance product page. Pega Underwriting for Life Insurance User Guide ii

8 Overview Insurance carriers, whether they are large multinational publicly traded corporations or mutual companies, offer many different life insurance products to individual customers. These products include term life and accidental death benefit products. Pega Underwriting for Life Insurance is designed to provide a platform for new business case managers and underwriters to process and manage applications for individual life insurance. The ability to manage many complex steps that affect many different internal and external systems is crucial to this process. Some of the processes must be performed sequentially, while others can happen in parallel. The insurance customer, agent, new business case manager, and underwriter must always be able to see the progress of the case, and keep various parties representing both the customer and carrier management informed on the progress. The application provides the following capabilities: To receive and create one or more new individual life applicants Support for location based questions to address the requirements of different locales Efficient application data entry design including navigating freely between screens Identification of incomplete required data and determination of applicant s in good order status Communication with customer, agent, and other carrier staff about submitted cases The Pega Underwriting for Life Insurance application helps carriers achieve: Faster Time to Value - Pre-built application, targeting core data and processes in high ROI-yielding areas, offering flexibility for easy customization and adaptability for the future Improve Solution Quality - Reuse a broad portfolio of industry standards and best practices so that changes are implemented in one place and can affect many Reduction in Project Cost - Allowing Pega application to rest on top of existing systems means no costly rip and replace of existing environment behavior Other systems are railroad lines, requiring the current legacy systems to be replaced and forcing a large amount of data conversion, drastically restricting adaptability for new products, new regulations, and new pipelines in the future. The application approach of working alongside existing systems complements their benefits and allows the business the flexibility to expand, either within the legacy systems or by introducing new systems that easily integrate with the Pega Underwriting for Life Insurance application. Pega Underwriting for Life Insurance User Guide 1

9 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Benefits of Pega Underwriting for Insurance The Pega Underwriting for Insurance application helps reduce underwriting costs and improve underwriting efficiency through a process-driven approach that helps resolve submissions quickly. The business problems found in the typical insurance carrier environment often include: Inadequate visibility on channel production - Submissions come in from many different sources and many different agencies. Carriers cannot determine which sources and agencies bring in the most profitable risks. Underwriting capacity consumed by low margin, low value risks - Underwriters are not focused on the right risks or the right things for submissions. Inconsistent handling protocols - The processing rules are not documented properly, taking up time that could be better spent on other things. Limited ability to proactively address pipeline management - Carrier resources are stretched very thin performing manual tasks and do not have the time to devote to working more closely with agents and discuss the types of risks for which they have an appetite. The Pega Underwriting for Insurance application helps carriers address these issues: Source and Channel tracking Cases can be reviewed based on the method of submission and allow for the creation of tracing reports to identify agencies bringing in the best business. Automated Assignment Rules Only those cases that require manual intervention are assigned, allowing standard cases to be processed automatically, and for underwriters to only review those cases that need attention. Processing Rules Cases are handled with the same procedures according to carrier specific processing rules, allowing for manual intervention where necessary, and underwriting rules being applied consistently across the enterprise. Agent Interaction New Business Case Managers can directly exchange information regarding a submission within a case and remain in contact to improve communication and data integrity. Pega Underwriting for Life Insurance User Guide 2

10 2 Getting started This chapter introduces the Pega Underwriting for Life Insurance desktop and describes the navigation basics. Topics in this chapter are: Understanding Pega Underwriting for Insurance terminology Portals Understanding Icons and controls Sample data User logins Pre-configured rules (Underwriting and Business Rules) Assignments Understanding Pega Underwriting for Insurance terminology To begin working with Pega Underwriting for Insurance, it is useful to become familiar with the following application terminology: Application A form providing the insurer with certain information necessary to underwrite a given risk. Case (work item or service request) A unit of work in Pega Underwriting for Insurance. The application assigns identifiers such as APP-1354, SUB-1687 and so on, which are Pega Case IDs. These are configured in the application rule. Insured The applicant to which an insurance policy relates. Requirement In order to qualify for certain levels of coverage in certain risk classes, an applicant is required to meet certain eligibility by providing information to support the application such as blood tests, financial statements, or stress test. Service level Time interval to complete a request. Pega Underwriting for Insurance assigns a service level to each unit of work within the system. A service level defines one or two intervals known as goals and deadlines. The intervals indicate the expected or targeted turnaround time for the assignment or the expected amount of time to resolve the case. Submission A proposal for insurance presented to an underwriter. Work queue A centralized, shared pool of cases from which users can select work. Cases available to a user depend on the user's role. When cases are created, the application routes them to named work queues to wait for further processing and automatically retrieves them when users request work. Pega Underwriting for Life Insurance User Guide 3

11 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Worklist A list of case items assigned to a user. Pega Underwriting for Insurance routes work from work queues to users who are most qualified to process that work. Users can also pull new case items directly to their worklist. Portals Pega Underwriting for Life Insurance has two pre-configured portals available to users: New Business Case Manager Underwriter The sample users, provided with the application, use the appropriate portal and location for their purpose by default. When logged in as the Pega Underwriting for Life Insurance Administrator, you can access all portals. The sample regions are the United States and United Kingdom (UK). New Business Case Manager portal Log in to Pega Underwriting for Insurance as ILASysAdmin with the password install to view the New Business Case Manager portal. The New Business Case Manager portal contains the following tabs: Dashboard Contains information pertaining to employees within the manager s workgroup along with various metrics. Also contains Pega Pulse. My Worklist Contains the work objects assigned to the user along with the Urgency and Deadline for a Case to work upon. Calendar Contains SLAs depicted on a calendar. Reports Contains various Reports both Pega-provided and custom. Customer Management Enables quick search of Contact information of both Individual and Business Customers. Click the My worklist tab to see the open cases assigned to you under My Work section. Pega Underwriting for Life Insurance User Guide 4

12 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt This functionality has been implemented by overriding the Pega 7 Platform report definition written for retrieving all cases. You can modify filter conditions per the requirement. For more technical information, see the Pega Underwriting for Insurance 7.4 Implementation Guide. The + Create button lists the starting flow defined in the application rule. Click +Create > Application to launch a new application process. Starting flows should be modified by a system administrator. For more information on configuring new work types, see the Pega Underwriting for Insurance 7.4 Implementation Guide. The following access groups in Pega Underwriting for Insurance are configured to use the New Business Case Manager portal by default, which means that any user associated with these access groups, when logged in, are taken to the New Business Case Manager portal automatically. PegaInsureILAVerify:Manager PegaInsureILAVerify_UK:Manager Sample data Pega Underwriting for Insurance provides sample data such as contacts, business units, and policies that you can use to test different types of submissions. This data is loaded during the install into the sample database tables. Details are provided in the following tables: Sample agency Name Address Phone number A1 Insurance Agency 101 Main St. Cambridge, MA Sample agent Name Address ID Ashley Jones Carl Johnson 101 Main St. Cambridge, MA Main St. Cambridge, MA ajones@a1insurance.com cjohnson@a1insurance.com Pega Underwriting for Life Insurance User Guide 5

13 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Logins The application is installed with a sample set of users, access groups, and portals. The password is set to install. These allow you to access the Designer portal to view and configure the underlying processes and rules or launch business processes from a variety of user roles including managers and users. Select the Designer Studio > Org & Security> Organization > Operators landing page option to display a list of users. Select the Designer Studio > Org & Security > Groups & Roles landing page options to display a list of access groups and access roles. This table lists Pega-provided operators and access groups, and their associated portal rules: Pega Foundation for Insurance Operator ID Access group Default portal ILASysAdmin PegaInsureILA:Administrators Developer ILAVerificationSysAdmin PegaInsureILAVerify:Administrators Developer Dana Basil PegaInsureILAVerify:Manager New Business Case Manager Dana Basil UK PegaInsureILAVerify_UK:Manager New Business Case Manager Meryl Pepper PegaInsureILAVerfy:Underwriter Underwriter Meryl Pepper UK PegaInsureILAVerfify_UK:Underwriter Underwriter Managing a customer account (MCA) The customer account management process provides a comprehensive view of the customer and includes the capabilities to create a new customer (either individual or business), open an existing customer and view the details, or update the existing customer details. All the details such as customer profile with personal information, previous claims details, lists of policies linked to the customer, and customer activities can be captured and viewed in a single unified view. Navigating to the MCA screen of a customer Open the Case Manager portal and click on the Customer Management tab. Enter a value in the Last Name field, and then click Search. A list of matching customer records is displayed as shown in the screen shot below. Click on the Last Name or First Name link of a customer in the list. Doing so displays the MCA of that customer for further actions. Pega Underwriting for Life Insurance User Guide 6

14 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt See the sample MCA screen later in this section for sample customer Natalie Song. In the Case Manager portal, shown below, click the Customer Management tab. Searching for a customer Enter song in the Last Name field, and then click Search as shown in the following screen shot. The MCA screen appears when you click the last name or first name link in the result list. Below is the MCA screen for sample customer Natalie Song: Pega Underwriting for Life Insurance User Guide 7

15 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt You can see several tabs: Customer Profile, Policy List, Claims, and Audit. As you can see in the figure above, the customer profile screen displays the personal information of the customer. The Policy List screen displays all the policies for this customer. If the customer has any claims against his name, they are displayed under the Claims tab. The Audit tab displays the history and case-narrative details as shown in the following screen shot. Pega Underwriting for Life Insurance User Guide 8

16 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt There are some other useful options that you can access from the Actions menu as shown in the following screen shot. You can perform several actions from the Actions menu of the MCA work object related to managing the customer s account, such as: updating customer profile, adding attachments, and so on. You can create a Policy Loan Request or Start life submission using the Other actions menu in Actions area. Actions menu items Updating the customer profile From the Actions menu of the above MCA, select Update customer profile. This displays a screen to update the details of this customer. Below is the Update customer frofile screen for a sample customer, Natalie K. Song. Pega Underwriting for Life Insurance User Guide 9

17 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt On this screen, you can change or update the details of the customer and click Submit. This updates the customer details in the database. When you access this customer again, the updated details are displayed on the MCA. Click Submit and view the changes updated. Similarly, you can update the business customer profile as well. Pega Underwriting for Life Insurance User Guide 10

18 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Adding attachments Attachments serve an important purpose by enabling you to attach customer documents or proofs in the MCA itself. The attached documents can be identity proofs, address proofs, license documents of the customer and so on. Click Actions > Add attachments. A screen opens so that you can upload the documents. For example, upload a file for this customer. There is a 2MB limit to drag and drop files, but there is no limit on file size when browsing for the file. Click Choose file and then select the document from the system. Click Submit. Pega Underwriting for Life Insurance User Guide 11

19 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt You can search for a business user by selecting the Business radio button on the Customer search screen shown earlier. The following is the Customer search screen where you can search for a business customer. The following is the MCA screen of the GENEnterprises business customer: Pega Underwriting for Life Insurance User Guide 12

20 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Creating a new customer On the Customer search screen, when a search (explained in the preceding paragraphs) yields no results, then you can create a new customer by clicking Create new. The following figure shows the Create new button on the Customer search screen. Click Create new to launch the Create New Customer screen to collect details about the new individual customer or business customer. Pega Underwriting for Life Insurance User Guide 13

21 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The following is the Create New Business Unit screen used to collect information for a new business customer. Pega Underwriting for Life Insurance User Guide 14

22 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Complete all the details and then click Create. This creates a new customer information record. When searching for this customer, the Customer search screen displays this newly created customer s name. Then, if you click on the customer name link, the MCA screen is displayed. The following example shows the new customer creation process and how to search for the customer in the Customer search screen. Create a contact named Tom King. Pega Underwriting for Life Insurance User Guide 15

23 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Click Create new. This launches a screen to collect the customer details. Click Create in this screen after completing the details. Now search for this customer on the Customer search screen. Pega Underwriting for Life Insurance User Guide 16

24 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Click on the last name or first name link in the search result. This opens the MCA screen of Tom King. Agency/Agent Management (AAM) Landing page This is a tool in the application that is implemented as a landing page because it is anticipated that customers will have their own external Agency Management system with which Pega Underwriting for Insurance will integrate to use this data. Similar to MCA, there is a process in Pega Underwriting for Insurance to manage agencies and agents. Using this process, agents or agencies are searched, created, linked with each other and updated. AAM is available as a landing page in the Pega Underwriting for Insurance application. Select Design Studio > Framework Management >Tools > Agent/Agency Management to access AAM. This is unlike MCA, which is managed from the Case Manager portal. Pega Underwriting for Life Insurance User Guide 17

25 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt This is the landing page screen. From this screen, you can search for an agency and agent, and you can create an agency or agent. Pega Underwriting for Life Insurance User Guide 18

26 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Searching for an agent and agency Agent search The following figure shows the Agent search screen. Enter a value of a in the First name field. When you click on the Last name or First name links in the search results, a screen appears on which you can update agent personal information and the linked agency. You can also update the details of the LOBs that this agent is licensed to sell. The following figure shows the Update Agent Information window. Pega Underwriting for Life Insurance User Guide 19

27 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Click Update to update the details of this agent in the database. Agency search Search by Agency Name or Carrier Code when searching for an agency. The following is the Agency search screen when you search for an Agency Name by entering the string "a". Pega Underwriting for Life Insurance User Guide 20

28 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt All the agencies that match the search criteria are displayed in the search results. When you expand an Agency Name, all the agents linked to this agency are shown. Pega Underwriting for Life Insurance User Guide 21

29 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The following is the expanded Agency screen with agents linked to it: You can also update an agent by double-clicking on the agent in the list shown above. This means that you can update agent data two ways: from the agent search or from the agency search as explained above. The following is the Update Agent Information screen that opens when you click on an agent from the agency search results (shown in the previous figure). Pega Underwriting for Life Insurance User Guide 22

30 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt When you click the Agency Name link in the search results, a screen opens from which you can update agency data. The following is the Update Agency Information screen. Pega Underwriting for Life Insurance User Guide 23

31 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Creating an agent and agency Creating an agent On the Agent/Agency Management screen shown below, click Create Agent to create a new agent. When you click Create Agent, the Collect Agent Information screen opens. The Agent Intake screen collects agent details and then saves them in the database when you click Create. Agent details include personal information, the agency, and license information. Pega Underwriting for Life Insurance User Guide 24

32 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Creating an agency From the AAM screen, click Create Agency to open a screen where you collect the agency details: When you complete all the details, click Create. This creates an agency record in the database. Note: While creating an agent, ensure that ID of this agent is the same as the Operator ID and ID on this agent s operator ID record. (The assumption is that this agent has the required permissions to launch a submission process). This ensures that the Agent details are prepopulated on the Agent Intake stage screen in the policy submission process. Pega Underwriting for Insurance is packaged with two agent operator IDs: ajones@a1insurance.com and cjohnson@a1insurance.com. Global addressing The Pega Underwriting for Insurance application supports a generalized address structure that lets you support addresses from many countries by using a generic format. It can also be specialized for a specific country if needed. The application uses the class PegaIns-Data- Address- to represent any form of address used throughout the different flows. For address data capture and display, the PegaIns-Data-Address-AddressEntry section is used throughout the application. This section consists of multiple layouts that have visibility conditions on them. These visibility conditions are based on a dynamic layout properties Visibility Condition (when rule). In the AddressEntry section, the layout shown below is displayed when the Dynamic layout property Visibility Condition (when ruleimpcountry has the value of IsUnitedStates, meaning that the layout uses a US-specific address format. Pega Underwriting for Life Insurance User Guide 25

33 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The layout shown below is displayed for a generic implementation and is not countryspecific. By distributing address elements across multiple lines, the ordering of postal codes, regions and towns can be managed without implying any specific address structure. It also helps to manage variations in name and street address by providing a single input field for each element of an address. Implications at run time From the New Business Case Manager portal, start a, Application. The Insured screen looks like the one shown below with the Visibility Condition when rule IsUnitedStates. Pega Underwriting for Life Insurance User Guide 26

34 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Open the Dynamic layout properties Visibility Condition (when rule) and change to IsGeneric, and then save the change. Return to the New Business Case Manager portal and start an Application. Notice that the screen now displays the generic section. The entire application will now display the generic section for address collection and display. The following are the properties used to represent these fields: PegaIns-Data-Address- AddressLine1 PegaIns-Data-Address- AddressLine2 Piif-PostalAddress City PegaIns-Data-Address- State (Represents State, Province, Region, County etc.) PegaIns-Data-Address- ZipCode (Represents Zip Code or Postal Code) Pega Underwriting for Life Insurance User Guide 27

35 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Piif-PostalAddress Country Note: Because the same section is used throughout the application for the capture or display of addresses, any validations related to these address fields need to be handled within the particular flow action or section where it is used. No default validations are provided out-of-the-box with the application. Underwriting rules Manage change Underwriting (UW) is the process of assessing the risk of an individual or organization applying for insurance cover with an insurance company. Underwriting rules are business rules defined in the underwriting process to classify or rate, auto approve or reject, and route to appropriate underwriters for manual decision or rating. These rules can be based on several factors such as line of business, age, face amount, health style, medical history, financial history, driving record, loss history, and industry. Multiple rules can be defined and executed to come up with a consolidated result and decision or rating. Underwriting has been configured as an independent stage in each of the submission processes with the expectation that each customer modifies it to meet their unique needs. The Manage Change screen accessed from the left menu of the Underwriter portal, is where Underwriting managers can quickly and easily adjust previously created automated Underwriting rules to modify how those rules are applied. Pega Underwriting for Life Insurance User Guide 28

36 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt We have created some sample Underwriting rules for submissions that will modify the submission by applying endorsement forms, adding surcharges, including Terms & Conditions and other updates to the submission to make it a more acceptable risk. These Underwriting rules are the parameters for automated rules that are fired based on the bounds that are modified by the user here. Automated routing rules There are sample routing rules that are included in Pega Underwriting for Life Insurance for application handling related to specific applicant parameters. Applications submitted for insureds that are not a US citizen or card holder, are automatically set to DNQ (Do Not Quote) and are resolved. Applications that are submitted for insureds that either do not create any Requirement cases; applications that do not require any additional investigation such as blood tests, nor any Risk factor with a system generated Risk Class of Refer to Underwriter (RTU). The system automatically sets the risk class Preferred Plus and is processed straight through without requiring any Submission cases and Underwriting review. Pega Underwriting for Life Insurance User Guide 29

37 3 Submission intake The Pega Underwriting for Life Insurance application enables the carrier to collect application data from the applicant(s) more conveniently by grouping all of the related questions for each applicant. The Application (APP-) is the top level case type, and it will contain one or more submission (SUB-) subcases which in turn may contain one or more requirement (REQ-) subcases. The figures in this chapter show the nested case structure and demonstrate the end-to-end process for the intake subcase. Intake stages and steps overview After logging in as an Intake user, launch the New Business Case Manager Operator portal, and then click +Create > Application. A new APP- work object is generated with a status of New. Pega Underwriting for Life Insurance has been designed to reuse stages and steps throughout the process where applicable, so that the stages for each process are similar. Pega Underwriting for Life Insurance User Guide 32

38 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt The following figures show the stages and steps for each of the related case flows. Application Pega Underwriting for Life Insurance User Guide 33

39 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Submission Pega Underwriting for Life Insurance User Guide 34

40 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Requirement Stage 1: Initiate The initial stage in the Application process is the Initiate stage. The purpose of this stage is to collect Agency information and identify the applicant(s). The first screen in the flow is Initial information. Enter the Agency details, number of Applicant(s) and the Applicant s names. Pega Underwriting for Life Insurance uses common Pega Underwriting for Insurance functionality to select the agent or producer that is asking for the individual life plan proposal on behalf of the applicants. The Agent Intake stage lets you associate an agent with the submission. When you select the agency from the Agency Name drop-down list, the list of agents is filtered to display only agents or producers that are associated with the Agency and have an appointment with the carrier as confirmed by checking the Received agent agreement signature check box. For information on the creation and management of Agent data, see the Agency/Agent Management (AAM) topic in Chapter 2 of this user guide. With the applicant information, select the number of applicants; 1 or 2. Enter the required First name and Last name and optional Title and Middle name. The first party entered will be the Primary insured associated with the Application case. Pega Underwriting for Life Insurance User Guide 35

41 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Initial information Complete the required fields and Click Submit. Stage 2: Capture application information The next stage is the Capture application information screens which capture timespecific information about the applicant(s). The status of the application is Open- Application It is only relevant for this specific individual life plan request for those customers. In other words, if the same customer applies a year later, a new customer profile will be created for the applicant. Examples of time-specific information include the effective date of the individual life plan, or medical information. Pega Underwriting for Life Insurance User Guide 36

42 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Enter application information This application has two applicants and questions are grouped by category; Personal, Coverage, Medical, Authorization and Payment with applicants separated vertically. As application data may not be initially entered in the same order as the application screens the New Business Case Manager may navigate freely between screens by selecting the Next and Back buttons or the application screen tree navigation tool at the top. When the New Business Case Manager selects a different screen a green check mark is added to the previous screen to denote it has been viewed. Pega Underwriting for Life Insurance User Guide 37

43 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt When a beneficiary is added, additional questions are displayed. Pega Underwriting for Life Insurance User Guide 38

44 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Intake complete When the application intake is complete, click Finish on the Payment screen. After all the Application data required to create the submission for each applicant is entered, either in Enter Application Information or Review application completeness step, the system will automatically create the Submission case(s). The Application case status will update to Open-Application-Submission. Review application completeness When the Finish button is selected in the Payment screen on the Enter Application Information step, the Application case advances to the next step Review application completeness. The Application case remains assigned to the New Business Case Manager with the Review application completeness assignment. The system will determine if there are any incomplete fields required to generate a submission and issue a policy. Information about these incomplete fields will display in the Missing data section on the Review application completeness screen. Pega Underwriting for Life Insurance User Guide 39

45 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt In the example above there are two applicants; Tony M. Lawson and Sarah J. Lawson in the Application case. The incomplete fields for each applicant are identified with the application tab and sub-tab or section e.g. Personal: Insured. The fields are further identified by their short name label, e.g., Social Security number, Zip Code. The application data in the Missing data section matches the Review sections below where the New Business Case Manager may see entire application tabs and sub-tabs by selecting edit. Pega Underwriting for Life Insurance User Guide 40

46 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Edit application data Prior to creation of the submission(s) all fields on the Application are editable. To edit a specific Application screen or section with an incomplete field required to create a submission or issue the policy The New Business Case Manager may select the applicable Edit button from the Missing data section. Pega Underwriting for Life Insurance User Guide 41

47 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Or the New Business Case Manager may select the Edit button from the applicable application grouping in the Review section. Here the New Business Case Manager can edit both the Declaration section and the Medical records section of the Authorization tab. As the New Business Case Manager Pega Underwriting for Life Insurance User Guide 42

48 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt reviews and edits the application both the Missing data and review sections will refresh to display the changes. When the all the fields required to generate the submission(s) are complete the Submission (SUB-) case(s) will be automatically generated and Application status will advance to Open-Application-Submission. The Application fields required to generate the submission will then become read-only. In good order Within the Summary section in the application, the system will display the In good order status of the applicant based on the completeness of the fields required to create the submission and issue the policy. In the example above, both applicants have incomplete fields required to issue the policy, so they have the Not in good order icon. The fields required to create the submission are complete as displayed in the Summary with the applicant name and their SUB- identifier and status. When all the required fields are complete, the In good order icon is displayed and the Application complete icon is displayed in the Applicant s Missing data section. When all of the fields required to create the submission and issue the policy are complete i.e., all applicants are In good order, the Finish button will be enabled in the Review Application completeness section. Pega Underwriting for Life Insurance User Guide 43

49 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Share list While there are incomplete required fields displayed in the Missing data the New Business Case Manager may generate a list of all the incomplete fields with their tab and section labels to help the agent identify and return the required data. The system will display the Share list button and upon the selection the New Business Case Manager may choose to Export the list to Excel or PDF. Mark finished When all of the fields required to create the submission and issue the policy are complete, i.e., all applicants are In good order, the Finish button will be enabled in the Review Application completeness section. Pega Underwriting for Life Insurance User Guide 44

50 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt When a submission is rejected by either the underwriter or customer; Resolved- UWRejected or Resolved-CustomerRejected the Applicant is automatically set to In good order status and the application is complete for that applicant. Upon selection of Finish, the New Business Case Manager will see the Your action has been completed banner. Stage 3: Wrap up CheckSubmissions step Submission cases advances to the Wrap up stage with the CheckSubmissions step where the system determines if there are any child submission cases in Pending-Underwriting or Pending-Response status. If true, the Application will wait in Pending-Submission status until the applicable submission case(s) have passed those stages. Pega Underwriting for Life Insurance User Guide 45

51 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt If there are no submission cases in one of those status, the application case will automatically advance to Stage 4. The user may also advance the application case to the next stage by clicking Submit on the Waiting for all submissions to be underwritten assignment. Stage 4: Complete Resolve application When the application has advanced past the Wrap up stage the system will determine if all child submissions are in one of the following statuses; Resolved-Completed (policy issued), Resolved-UWRejected, Resolved-CustomerRejected. If one submission is still open e.g. Pending-Underwriting the Application case will wait until that submission is resolved. After all the child submissions are resolved the Application will automatically be Resolved- Complete. Pega Underwriting for Life Insurance User Guide 46

52 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt Alternate stages Withdraw At any point in the process the New Business Case Manager can decline coverage by selecting the Withdraw application option from the Other Actions menu. Upon selection, the system will display a confirmation screen. Upon clicking Submit, the Application case status is Resolved-Withdrawn. The system will automatically withdraw all child cases, including Submission and Requirement cases. Pega Underwriting for Life Insurance User Guide 47

53 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt DNQApplication The US Individual Life Application is configured to automatically Disqualify an application if any of the applicants is not a US citizen nor a permanent card holder. These questions are displayed on the Insured screen in the Application. When the answer to both questions is No, the system displays the ConfirmNonUSCitizen field value warning message: Term life insurance product is only for US citizens or permanent card holders. Clicking Next will resolve the application as does not qualify. Pega Underwriting for Life Insurance User Guide 48

54 TITLE of INTERNAL DOCUMENT Arial Bold 12 pt When the New Business Case Manager subsequently selects Next, the application is automatically Resolved-DNQ with the explanation for the DNQ displayed in the case s green banner. The not qualified is sent to the agent and attached to the Application and the reason is documented in the Application Audit > History. Pega Underwriting for Life Insurance User Guide 49

55 4 Submission risks analysis After all the required Application data to generate the submission for each insured is complete, the system will automatically create the affiliated Submission (SUB-) and Requirement (REQ-) sub-cases and route the Submission case to an underwriter based on availability. The underwriter will have access to all the application information for the applicant. If there are multiple applicants for the parent Application (APP-) case, each child submission case will be assigned to the same underwriter. The Application case will remain assigned to the NB Case Manager. When requirements cases are generated, the submission case goes to underwriter Review where the underwriter will compare system determined risk factors and requirement case data as business rules are executed. Based on all the information, the Underwriter will then determine the governing Underwritten risk class. When the underwritten risk class does not match the risk type submitted as part of the illustration (paper copy) then the NB Case Manager will need to follow-up with the agent to present the coverage proposal. If the underwritten risk class does match the submitted risk type, follow-up is not required. Submission case stages and steps After logging in as an underwriting user, launch the Underwriting portal and open the My worklist tool. A typical submission has the following stages and steps: Assess risk Generate requirements Routing to underwriter Risk determination Policy issuance Stage 1: Assess risk The Submission subcase is created for each applicant from the parent Application case. Within this stage the Underwriter has access to application and requirement information and tables used for risk class generation based on scoring rules. The Underwriter then determines the underwritten risk class and any additional substandard rating and extra premium charges. Generate requirements After the Submission (SUB-) case is created the next step is Create Requirements in which application data is systematically compared with the Age face table to determine which requirement are systematically generated for each applicant. The sample age face table uses the applicant s face value and age to determine which requirements are systematically generated. Pega Underwriting for Life Insurance User Guide 50

56 The system generated Requirement cases are assigned to the underwriter for processing. If no Requirement cases are systematically generated the Submission case is designated for straight through processing defined below. Routing to ILA Underwriter In the next step, Routing to ILA Underwriter, the underwriter is assigned to the Submission case based on availability. The submission status is Pending-Underwriting. Within this step, the Underwriter performs their analysis; reviewing application data, requirement processing and risk factor scoring for the Routing to ILAUnderwriter assignment. Application data review In the Review submission screen, the underwriter is able to review the application data for the applicant similarly to the review screens for the New Business Case Manager however, the data is in read-only mode. When the Submission case is created, fields on the Application case identified as "required to create the submission case" become non-editable. The New Business Case Manager may Pega Underwriting for Life Insurance User Guide 51

57 update the remaining editable fields after the submission case is created. Any updates to those remaining fields will not be updated in the application sections in the submission review screens. Requirements processing Pega Underwriting for Life Insurance has the following Requirement cases that represent specific medical, lifestyle, financial report types, which must be completed and reviewed by the underwriter prior to determining the appropriate Risk Class. The application consists of the following sample requirement cases: (REQ-); APS Attending Physicians Statement EKG Electrocardiogram FBP Full Blood Profile IR Inspection Report MED Full Medical Exam MIB Medical Information Board call MSU Microscopic Urinalysis PM Paramed Exam Rx Prescription check Pega Underwriting for Life Insurance User Guide 52

58 Schedule appointment The first step for the MED, PM, IR, EKG requirement cases will have the status of New and an assignment to the underwriter to Schedule appointment. Upon selection of the assignment Schedule action the system will display the Schedule appointment action section containing fields to schedule an appointment. Receive and analyze results Upon Submit, the next step is Receive and Analyze results and the case status will change to Pending-External with an assignment Receive results. The underwriter will be able to select the date the results were received, any result data fields and add Notes to the case. Pega Underwriting for Life Insurance User Guide 53

59 Pending-External is the default status for the Rx, MSU, MIB, FBP & APS Requirement (REQ- ) cases. The system will enter the Provider information in the Provider section. Also for these cases there will be no Scheduled on or Appointment date fields in the Provider section. The PM requirement case contains required fields may be manually entered from a Paramed report or may be integrated with an external Paramed system. The Rx requirement case Mark as received screen does not contain specific required data fields but rather the common Received date and optional Notes fields. Determine risk When the user submits, the Status will change to Pending- Analysis and copy the fields from the Mark as received screen to the Results section in read-only mode. The system will update the underwriter assignment to Determine risk. The system will also set the Reviewed by value to the user who manually selected Mark as received. Pega Underwriting for Life Insurance User Guide 54

60 Based on the results matching the applicant data and the requirement results the user is able to determine whether the requirement indicates a risk factor. In Pending-Analysis when the user selects the Determine risk action in the Risk Determination section the system will display the Risk determination action area containing fields to determine if the results match the applicant and if the requirement indicates a risk. The underwriter is also able to enter Description text which is required if the underwriter has determined the results indicate a risk factor. Upon submit from Pending-Analysis, the system will show the fields in Read-only mode with Resolved-Complete status. The risk determination value of Risk, No Risk, or No Match will be highlighted on the Resolved-Complete case. Pega Underwriting for Life Insurance User Guide 55

61 At any time prior to Resolved-Complete, the Underwriter may withdraw the Requirement by selecting Withdraw case from the Other actions menu of the Requirement case. The system will update the sortable and filterable Requirements summary table on the Submission case with status and risk values ('--' for pending, 'Risk' or 'No' and status 'Done' when complete.) Pega Underwriting for Life Insurance User Guide 56

62 The default order of the Requirements will be determined by the requirements priority value (descending).the system will highlight a list of overdue requirements in the Submission requirements section above the table of requirements. If there are no system generated requirements then 'No system generated requirements were generated' message displays in first row of the table. The underwriter is able to open the case by selecting the requirement case name hyperlink. The underwriter is able to order additional requirement cases by selecting the Order requirement drop down. Upon selection, the system will present a list of all requirements for the underwriter to select (including previously selected requirements). The underwriter may select one requirement at a time. When complete, the new requirement case is added to the table. Pega Underwriting for Life Insurance User Guide 57

63 In this screenshot, the EKG requirement was manually ordered. Generated risks factor scoring Like the requirements table, the Generated risk factor table contains risk evaluation that compares application and requirement data, to system tables and scoring rules configured by the carrier. Upon submission creation the system generates a default set of risk factors (Cholesterol and Blood pressure are created if a PM or MED requirement case is systematically or manually ordered). Initially Application data is compared to the Build chart BMI table which calculates the build chart points rating class. In the screen shot Pega Underwriting for Life Insurance User Guide 58

64 below the Application BMI 34.5 results in a score of 500 which is then compared to the Risk class chart and represents a return of RTU (Refer to Underwriter). The negative score and class is highlighted in red in this scenario. The Personal history value is calculated using the Personal history table. The Family history is compared to the Family history table. The Cholesterol and Blood pressure values taken from the PM or MED requirement case are compared with their respective tables and the scores for all the above are compared to the risk class chart to set the system risk class. Build chart, Cholesterol, and Blood pressure values will be updated when the latest PM or MED requirement case is resolved and case is a match for the applicant. Build chart, Cholesterol, and Blood pressure values will be updated when the latest PM or MED requirement case is resolved and the case is a match for the applicant. Here is an example of the PM showing a reduction in weight causing the BMI to be calculated at 31.0 and fall within the Standard Plus Rating class. Pega Underwriting for Life Insurance User Guide 59

65 The Underwriter is able to apply adjustments to the system generated risk factor points by selecting the Edit button. The Edit generated risks action area is then displayed containing all the risk factors and two fields Debit/Credit and Reason (which is required if a Debit/Credit is added. Within The underwriter Debit/Credit the underwriter can enter positive or negative integers from -140 to When the underwriter is finished applying the adjustments and clicks Submit, the system will refresh and display both the system generated and Underwriter points, and underwriter class along with the reason for any adjusted risk factor. The underwriter may also see updated Underwriter risk class values within the Edit generated risks screen by selecting Calculate risk class. Upon submit, the Risk factor table on the Review submission screen updates to include the underwriter adjustments. The underwriter may drill down for adjusted risk factor to see the details more clearly. The scores for Underwriter risk and Generated risk are the Pega Underwriting for Life Insurance User Guide 60

66 average score for all the risk factors and that value is then compared to the risk class chart to determine the system risk factor class. Risk determination When all the Requirements cases are resolved, the insured status changes from Not good order to In good order and the Complete review button is enabled to allow the underwriter to document their underwritten risk class. Upon clicking Complete review, the Determine risk action area is displayed. Pega Underwriting for Life Insurance User Guide 61

67 Below, the underwriter can see the Applied for Risk Class field value (read-only) from the Illustrated As field on the Personal screen in the Application Case. The underwriter selects the required underwriter risk class value (Preferred Plus, Preferred, Standard Plus, or Standard). Pega Underwriting for Life Insurance User Guide 62

68 If the underwriter has selected a value of Standard Plus or Standard then an additional option of 'Substandard Rating' will display in which the underwriter may select an optional substandard rating premium surcharge. The dropdown includes the letter type and percentage values e.g. 'E - 125%' or 'U - Uninsurable'. The underwriter may also enter a value in the Include flat extra which represents a surcharge on the premium rate for the term of the policy (Permanent) or for a subset of years on the policy (Temporary). Upon submit, the underwriting user sees the Your action has been completed. message. There are no longer any Open Assignments for the underwriter to complete. When the Underwritten class matches the Illustrated as class the submission advances to Pending- Issuance. When the Underwritten class differs from the Illustrated Class, or there is a substandard rating or flat extra surcharge on the submission, the submission case advances to the Agent Follow Up alternate stage, for the NB Case Manager to contact the Agent. Pega Underwriting for Life Insurance User Guide 63

69 Stage 2: Issue Upon submit the Submission sub-case (SUB-) status is set to Pending-Issuance, because the parent Application (APP-) case cannot progress until after all of the Submission cases have been rated, and the Application case has been marked as Finished. In the policy issuance process the system will first check to see that there are no other related submission cases that have not advanced past Pending-Underwriting or Pending- Response. If the first condition is false, the Pending-Issuance submission will wait until the related submission case has reached Pending-Issuance or in a Resolved-Underwriter Pega Underwriting for Life Insurance User Guide 64

70 Rejected or Resolved-Customer Rejected status. The system will then check to see that the application has been marked Finished. If all of the conditions are true the Submission (SUB- ) case status will be Resolved-Completed and the parent Application (APP-) case status will be Resolved-Completed. The system will automatically issue the policy, displaying the policy details on the submission case and send a confirmation to the application Agent with the policy details. Pega Underwriting for Life Insurance User Guide 65

71 When the Underwritten class matches the Illustrated as class, and the Submission is not waiting for a related submission case, and the Application has been marked Finished the submission will proceed directly to Resolved-Competed and the policy will be automatically issued. Alternate stages Decline underwriting The Underwriter can access the Decline submission from the Actions menu at any time except if the submission case status is Resolved-. The system will display the Decline Submission screen which includes a drop down menu of Decline Reasons. There is also a text area for the underwriter to document why the case is being denied. This can be included in an automated to the Agent upon conclusion. Upon submit the submission case status changes to Pending-Underwriter Rejected. An assignment for the New Business Case Manager is created Decline submission on the Submission (SUB-) case. Pega Underwriting for Life Insurance User Guide 66

72 When the New Business Case Manager opens the assignment, the Document agent response section displays with the Reason and Note entered by the Underwriter. When the New Business Case Manager checks off that the Agent has been notified and submits, the submission case is Resolved-Underwriter Rejected, and all of the Requirement (REQ-) cases are set to Resolved-Withdrawn. The declination reason is stored in the Submission (SUB-) case Notes under the Underwriting category. Pega Underwriting for Life Insurance User Guide 67

73 Agent follow-up When the Underwriter has determined the risk class and it differs from the Illustrated as class, or includes a Substandard rating or a Flat extra premium surcharge, the New Business Case Manager must contact the agent to discuss how the applicant wishes to proceed. An assignment for the New Business Case Manager is created Document agent response on the Submission (SUB-) case. The submission case status becomes Pending- Response. When the New Business Case Manager opens the Assignment the Document agent response section displays on the Submission (SUB-) case. Here, the New Business Case Manager can see the Underwritten class and the Illustrated as class as well as any Pega Underwriting for Life Insurance User Guide 68

74 substandard rating value or flat extra premium surcharge. The New Business Case Manager will present this information to the Agent and document the response. The Case Manager can mark the submission as Accept, Reject, or Renegotiate. Proposal accepted Selecting Accept and submitting will initiate the policy issuance path. Upon submittal of the acceptance response, the case will proceed to the issuance process. Pega Underwriting for Life Insurance User Guide 69

75 Proposal renegotiated Selecting Renegotiate and submitting will require the New Business Case Manager to document the reason for the Renegotiation. Upon submittal of the Renegotiate response the submission case status is updated to Pending-Underwriting status. The Reason for the renegotiate is stored in the Submission (SUB-) case Notes section under the Proposal negotiate category and the submission is assigned to the Underwriter. Pega Underwriting for Life Insurance User Guide 70

76 Proposal rejected Selecting Reject will require the New Business Case Manager to also document the rejection reason. Submitting a Rejection will initiate the Proposal Rejected Alternate stage. When the New Business Case Manager documents the Reject response and submits, the Submission (SUB-) case status will change to Resolved-Customer Rejected. The rejection reason and Agent/Broker message will be stored in the submission Notes section under the Proposal reject category. Pega Underwriting for Life Insurance User Guide 71

77 Pega Underwriting for Life Insurance User Guide 72

78 5 Architecture Application layers The Pega Underwriting for Life Insurance application has two different flavors: For the US For the UK Both the applications include a verification layer to allow for installation verification, demonstration, and testing. The verification layer application name is PegaInsuranceILAVerify: and its description is Pega Underwriting for Life Insurance Verification. This layer is not intended to be used for extension, but for customer verification and demonstration purposes only. Customers would extend on the base application PegaInsuranceILA: 07.40, which has the description Pega Underwriting for Life Insurance. The same applies to the multinational application PegaInsuranceILAVerify_UK: 07.40, a layer built for customer verification that is built on PegaInsuranceILA_UK: Use PegaInsuranceILA_UK: to extend on the application. Application rules Application rules define an ordered set of rulesets and versions that together identify the parts of an application layer. In addition, application rules relate an application's objectives, use cases, requirements, and actors to cases that are created as part of Pega 7 Direct Capture of Objectives capabilities. You can view a list of the application rules and their rulesets that form the application from Designer Studio by clicking Designer Studio > Application > Structure > Rule Set Stack. The Ruleset Stack tab displays the high level ruleset stack for each application rule defined in the application. Expand an application to list its rulesets. To see the ruleset stack for any of the supporting application layers, click the Expand icon (+) next to the application to expand and display the list. PegaInsuranceILAVerify:07.40 is built on PegaInsuranceILA:07.40, which is built on PegaInsuranceNBB:07.40, PegaInsurance:07.40, and PegaInsurancePrerequisites:07.40 applications, which represent the Core Pega Underwriting for Insurance layer and Pega Foundation for Insurance layer, respectively. Both of those layers are built on PegaRULES PegaInsureILAVerify_UK:07.40 is built on PegaInsuranceILA_UK:07.40, which is built on the PegaInsuranceNBB:07.40, PegaInsurance:07.40 and PegaInsurancePrerequisites:07.40 applications, which represent the Core Pega Underwriting for Insurance layer and Pega Foundation for Insurance layer, respectively. Both of those layers are built on PegaRULES Pega Underwriting for Life Insurance User Guide 73

79 The following screenshot shows the PegaInsureILAVerify:07.40 application rule: The following screenshot shows the application ruleset stack: The screenshot above shows the standard application stack for all the standard operators packaged as part of Pega Underwriting for Life Insurance Verification application. Rulesets The PegaInsureILAVerify:07.40 application consists of rulesets named PegaInsureILAVerify and PBISampleData that hold all Pega Underwriting for Life Insurance Verification-specific Pega Underwriting for Life Insurance User Guide 74

80 rules and Life Insurance sample products, respectively. It also has PegaInsureILADelegation, which has the decision tables delegated for underwriters. The PegaInsureILA:07.40 application consists of rulesets named ILABase, PegaInsureILA and PegaInsureILAAppGuide rulesets that hold all US-specific rules, all Pega Underwriting for Life Insurance-specific rules, and all Pega Underwriting for Life Insurance Application Guide rules, respectively. The PegaInsureILA_UK:07.40 application consists of rulesets named ILAUK, PegaInsureILA and PegaInsureAppGuide rulesets that hold all UK-specific rules, all Pega Underwriting for Life Insurance-specific rules and all Pega Underwriting for Life Insurance Application Guide rules, respectively. The PegaInsurance application consists of the following rulesets: PegaInsure-Int Integration related rules. PegaIns-Product The supporting products from Product Builder. PegaInsure The core Pega Foundation for Insurance rules. Piif Classes and rules that support the IAA data model. IIFUI Ruleset consisting of UI-specific rules for the UI Kit adoption. PegaApp Basic data models related to contacts, business units, and so on. The PegaInsurancePrerequisites application consists of the following rulesets: UI-Kit UI rules provided as part of UI Kit 7:11. PegaSP Product Configurator application rules that can be used to define an Insurance Policy. As of this release, we are packaging this only for backward compatibility. Currently no Pega Underwriting for Insurance flows refer to products created using PCF. Work classes Work classes support the behavior and appearance of the work items created and processed in the application. Every work class in Pega Underwriting for Life Insurance maps to a table named IIF_WORK in the PegaData database. The work class group for Pega Underwriting for Life Insurance is PegaIns-PAB-ILA-Work. The application and submission classes, have a direct inheritance to PegaIns-PAB-Work- Submission. The requirement class uses its class group as the direct parent. Classes and work types The Pega Underwriting for Life Insurance application has a single work class group, the PegaIns-PAB-ILA-Work class. All the three work types - Requirement, Submission and Pega Underwriting for Life Insurance User Guide 75

81 Application work type in Pega Underwriting for Life Insurance are created as child classes within this class group. The Pega Underwriting for Life Insurance work types are as follows: Work class Work type Class group PegaIns-PAB-ILA-Work-Application Application PegaIns-PAB-ILA-Work PegaIns-PAB-ILA-Work-Submission Submission PegaIns-PAB-ILA-Work PegaIns-PAB-ILA-Work-Requirement Requirement PegaIns-PAB-ILA-Work Data classes overview Data classes support capture and data storage for the processing of submission cases. To display the data class structure, select the class from the explorer panel, right-click, and select Inheritance. You can add data classes to the PegaInsuranceILA application rule in the Cases and Data tab. Data types defined here appear in the Data Explorer. This tab also provides a single view of all the data classes defined and used for the current application and built-on application. The following screenshot shows the Data class structure. Pega Underwriting for Life Insurance User Guide 76

82 The following table lists the key data classes: Data class Description Directly inherits from PegaIns-Data-Application-Life Contains data pertaining to the Pega Underwriting for Life Insurance application. PegaIns-Data- Application PegaIns-Data-Application-Life- Term PegaIns-Data-InsurancePolicy PegaIns-Data-Customer PegaIns-Data-Quote Contains data pertaining to the Term Product line. Represents a general insurance policy. It is specialized by its LOB specific subclasses. Contains data pertaining to the Applicant. Pertains data pertaining to the quotes associated to the Application. PegaIns-Data- Application-Life Piif-InsurancePolicy Piif-Customer PegaIns-Data- Pega Underwriting for Life Insurance User Guide 77

83 Data class Description Directly inherits from PegaIns-Data-ILAMissingData Contains data pertaining to the data PegaIns-Dataelements of the application that require user inputs. PegaIns-Data-ILAValidateFields Contains data pertaining to the data PegaIns-Dataelements of the application that require user inputs. PegaIns-Data-Requirement Contains data pertaining to the data PegaIns-Dataelements of the requirement case created for an underwriter to process Pega Underwriting for Life Insurance submission cases. PegaIns-Data-Requirement- Med Contains data pertaining to the data elements of the requirement case related to medical information. PegaIns-Data- Prefixes The application creates an Application cover object and associated submission-covered work objects. Each object has a unique ID that is computed by combining a system-assigned number with a prefix defined in the Cases and Data tab of the PegaInsuranceNBB application rule. The following table lists the prefixes for the work objects and their associated work class: Work object Description Applies to class APP- Application case created to PegaIns-PAB-ILA-Work-Application collect information related to applicants applying for the insurance policy SUB- Submission work object PegaIns-PAB-ILA-Work-Submission prefix for all submissions, created for each applicant filled in as part of the application REQ- Requirement work object prefix for requirement case created for processing submission cases PegaIns-PAB-ILA-Work-Requirement Work object prefixes are defined in the Cases and Data tab of the PegaInsuranceILA application rule. You can copy the prefixes to your application rule and then change them to meet your requirements. Pega Underwriting for Life Insurance User Guide 78

84 The following figure shows the Cases and Data tab of the application rule where the work object prefixes are defined. A prefix entered here overrides a prefix specified in the pydefault data transform. Leave the value blank here to use the data transform setting. Work groups and work queues Users are given access to particular work queues for processing work. The work group of the user determines which work queues they can access. Click Designer Studio > Org & Security > Tools > Work Groups to display a list of work groups and their associated work queues. The application uses workgroups to route the submission cases to underwriters. It has UnderwriterILA for US-based application and UnderwriterILAUK for UK-based applications. Click Designer Studio > Org & Security > Tools > Work Queues to display a list of work queues and their associated work groups. The application uses NewApplicationRequest to store application requests created by s. Operators, access groups, and portals System administrator accounts Use the following administrator ID to access and work with the application rules and processes: UserID: ILAVerificationSysAdmin Password: install This operator uses both US and UK access groups namely PegaInsureILAVerify:Administrators and PegaInsureILAVerify_UK:Administrators, which is linked to the application PegaInsuranceILAVerify and PegaInsuranceILAVerify_UK, respectively. Pega Underwriting for Life Insurance User Guide 79

85 UserID: ILASysAdmin Password: install This operator uses the access group named PegaInsureILA:Administrators, which is linked to the application PegaInsuranceILA (for all US-based applications). UserID: ILA_UKSysAdmin Password: install This operator uses the access group named PegaInsureILA_UK:Administrators, which is linked to the application PegaInsuranceILA_UK (for all UK-based applications). Access groups The following table lists the access groups shipped with the Pega Underwriting for Life Insurance application: Access group name PegaInsureILAVerify:Administrators PegaInsureILAVerify_UK:Administrators PegaInsureILAVerify:Manager PegaInsureILAVerify_UK:Manager PegaInsureILAVerify:Underwriter PegaInsureILAVerify_UK:Underwriter Purpose Life Insurance System Administrators (US application) Life Insurance System Administrators (UK application) Life Insurance New Business Case Managers (US application) Life Insurance New Business Case Managers (UK application) Life Insurance Underwriters (US application) Life Insurance Underwriters (UK application) Access roles The following table lists the access groups provided with the Pega Underwriting for Life Insurance application: Access role name PegaInsuranceILA:AppCreate PegaInsure:WorkMgr5 PegaInsure:DataMgr4 Purpose Role required to create application case Role assigned to Underwriters for updating the decision tables delegated to them Role required to perform read and write operation on sample data objects shipped as part of Pega Foundation for Insurance Pega Underwriting for Life Insurance User Guide 80

86 Portals Pega Underwriting for Life Insurance provides two portals customized for Life Insurance user groups: New Business Case Manager Underwriter Using case management The Pega Underwriting for Life Insurance application is configured using the Pega 7 Case Management features to define how work is processed. This set of capabilities enables you to: Construct covering relationships and build new case types using a tree structure. Add a new case type, which automatically creates class and case type rules, as well as standard starting flows for the new case type. Reuse existing case and work types. Manage various aspects of work processing, including: Service levels Attachments categories and automatic attachments Automatic and conditional instantiation of covered items a. Mapping roles to object access for your various case and work types Case Management features are accessed by selecting the Cases tab on the left side of the Designer Studio. Configuration Tip: For complete information about using case management features and functions, see the articles in the Case Management section of the PDN. Work parties Work party rules define which participants (roles) can be associated with a work object. Each work object can contain many roles in addition to the required originator role. Some roles may participate with multiple occurrences. This rule also controls how and whether users can add parties using the user forms. The preconfigured processes support the following work parties (for Application cases): Agent Agency Insured Person Pega Underwriting for Life Insurance User Guide 81

87 Underwriter NB Case Manager (New Business) Owner Originator The preconfigured processes support the following work parties (for Submission cases): Applicant Underwriter NB Case Manager Originator The preconfigured processes support the following work parties (for Requirement cases): Underwriter Originator For example, work parties are defined in the pycasemanagementdefault work parties rule for application case as shown in the following figure: These work parties can be modified or additional parties can be defined as per the sitespecific implementation requirements. The submission and requirement case use the Default workparties rule defined in PegaIns- PAB-ILA-Work. Pega Underwriting for Life Insurance User Guide 82