Health cover, connected to the care network
RIFT runs individual and group health, subsystems and personal-accident business on the same configurable core as the rest of your portfolio, with the provider, clinic and convention network connected natively. Prior authorisation, cashless and free-choice claims, medical audit and the Portuguese regulatory regime are all configured, not coded.
RIFT for Health
Individual and group health and their adjacent lines run on one product-definition framework, adapted through configuration, not customisation.
Where RIFT is different for health
The care ecosystem, the claims lifecycle and the Portuguese regime are part of the core, not a bolt-on integration.
Provider and convention networks
Manage providers and conventioned partners in the core, with agreed price tables per act, a provider portal for validation and electronic billing, and AdvanceCare, MediHealth and APS-SegurNet connectors.
Prior authorisation and waiting periods
Automatic authorisation below configurable thresholds and manual review for hospitalisation, surgery and advanced diagnostics, with waiting periods validated before any act is approved.
Cashless and free-choice claims
FNOL by app, portal or call centre, cashless payment direct to the network provider, and free-choice reimbursement to the policyholder, with payment by diagnosis-related groups (DRG) supported.
Medical audit and fraud prevention
Authorised-versus-billed validation, medical invoice audit, duplicate-act control per episode and over-billing pattern detection protect the loss ratio.
Coverage rules, co-payments and limits
Annual and lifetime limits per coverage and person, configurable co-payments and deductibles, and exclusions such as pre-existing conditions, all calculated automatically.
Group health and subsystems
Workforce management with entries, exits and dependents, professional segments and categories, and ADSE, SAMS and PT subsystem conventions on the same framework.
Loss-ratio rating and renewals
Annual group rating on real loss experience, individual and group stop-loss, age-band premium calculation and mid-term adjustment for new members.
Digital journeys and telemedicine
Self-service company and policyholder portals, a digital insured card validated at the provider, appointment booking in the network, integrated telemedicine and pharmacy-network connectivity.
Portuguese regime and reporting
Built for Lei 46/2014, GDPR Article 9 health-data handling, SNS and INEM integration, ASF health statistics and network-adequacy reporting, and IFRS 17 (LRC).
Proof it holds up
What health insurers get from the first release.
- Cashless at the network and free-choice reimbursement, settled in one claims core
- Automatic and manual prior authorisation, with waiting periods validated before approval
- Medical invoice audit, duplicate-act control and over-billing detection to protect the loss ratio
- Group health and subsystems, with ADSE, SAMS and PT conventions and loss-ratio rating
- Established connectors for AdvanceCare, MediHealth and APS-SegurNet, plus SNS, INEM and pharmacy networks
- Built for the Portuguese regime: Lei 46/2014, GDPR Article 9, ASF health statistics and IFRS 17 (LRC)
Explore other segments
One platform, tuned to each book of business.
Life
Risk, protection and capitalisation on one framework, with actuarial provisioning built in.
ExploreNon-Life
Motor, property and liability priced, underwritten and settled on a single configurable core.
ExplorePensions
Pension funds from defined benefit to PEPP, run on one core: contributions, benefits, the AT fiscal chain and ASF reporting.
Explore
Ready to transform your insurance operations?
Let us walk you through a tailored demo of RIFT, built for the full spectrum of insurance, from product definition to claims settlement.
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