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            Considerations for Policy and Underlying Structure

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            Considerations for Policy and Underlying Structure

            Insurance policies can represent highly complex real-world risk structures involving multiple insured entities, assets, and coverages. Agency Billing is designed to work with this inherent complexity by leveraging the flexibility of the FSC Insurance data model. Understanding how policy structures are modeled and how billing interacts with those structures is essential to ensure accurate and predictable billing outcomes.

            Required Editions

            Available in: Lightning Experience
            Available in: Professional, Enterprise, and Unlimited Editions where Insurance Brokerage is enabled

            Policy Structure

            Insurance policies can be modeled in a wide variety of structures depending on the line of business and the nature of the risk being insured. The FSC Insurance data model supports most standard and complex policy hierarchies commonly used in the insurance industry. Typical examples include:

            • A policy with one or more coverages, such as personal health insurance or aggregated group health insurance where individual members aren’t tracked.
            • A group health policy insuring multiple members, with each member having their own set of coverages.
            • A group health policy that includes both members and dependent members, each with their own coverages.
            • A commercial policy covering multiple assets, such as office buildings and warehouses, where each asset has its own coverages.
            • A commercial policy with a mix of general coverages that apply across all assets and specific coverages applied to individual assets, such as in a commercial auto policy.
            • Complex commercial policies that include general coverages alongside asset-level and member-level coverages.
            • Highly complex policies that include general coverages, asset-specific coverages, and members associated with those assets, each with their own coverages, such as a personal auto policy.
            • Variations where general coverages exist alongside member-level coverages, with assets associated to those members, such as in certain pet insurance models.

            • Overall, the insurance policy data model is flexible enough to represent nearly all common and advanced policy structures required for Agency Billing.

            Insurance Policy Surcharge to Model Taxes and Fees

            The Insurance Policy Surcharge object plays a critical role in Agency Billing and is used to model both taxes and fees. In the current Agency Billing design, surcharge records applied on terminal (leaf) level of the policy hierarchy, such as at coverage level are considered for billing.

            For example, if multiple surplus lines taxes apply to a specific cyber liability coverage, each tax is modeled as a separate surcharge record associated with that coverage. This approach ensures accurate calculation, transparency, and traceability of taxes and fees during billing and invoicing.

             
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