SAS - Smart Assemble System (Re-engineering of AIT Core Health Insurance System) — Software Requirements Specification (SRS)
Table of Contents
- 1 Document Information
- 2 Project Overview
- 3 User Requirements
- 4 Detailed Feature Requirements
- 5 Technical Requirements
- 6 External Dependencies
- 7 Release Planning
- 8 Risks Assumptions
- 9 Market Specific Considerations
- 10 Sign Off
- 11 Additional Context
1 Document Information
| Field | Value |
|---|---|
| Project Name | SAS - Smart Assemble System (Re-engineering of AIT Core Health Insurance System) |
| Version | 1.0 |
| Date | 2025-08-01 |
| Project Manager | TBD |
| Tech Lead | TBD |
| Qa Lead | TBD |
| Platforms | ['Web', 'Mobile (iOS/Android)', 'Desktop'] |
| Document Status | Final Draft |
| Client | Assemble Insurance Tanzania Limited |
| Document Code | AIT-082025 |
2 Project Overview
2.1 What Are We Building
2.1.1 System Function
SAS (Smart Assemble System) is a comprehensive health insurance management platform designed to handle end-to-end insurance operations including sales, underwriting, membership management, claims processing, provider network management, customer relationship management, wellness programs, and financial integration. The system replaces the legacy AIT core system with a modern, scalable, web-based centralized platform.
2.1.2 Users
- Internal Staff: Admins, Underwriters, Claims Processors, Finance Officers, Customer Service Representatives, Wellness Agents, IT & Audit Personnel
- External Members: Individual and Corporate Insurance Members
- Healthcare Providers: Hospitals, Clinics, Doctors, Pharmacies
- Sales Intermediaries: Sales Agents, Brokers, Sales Executives
- Management: Executives, Business Development Managers, Regional/Country Sales Managers
2.1.3 Problem Solved
Legacy system limitations in processing health insurance operations efficiently. Need for automated workflows, real-time processing, multi-channel access, integrated financial systems, and comprehensive reporting capabilities. Current manual processes causing delays in claims processing, policy issuance, and member services.
2.1.4 Key Success Metric
Reduction in claims processing time from days to hours, 95% system uptime, automated policy issuance within 24 hours, real-time member verification, and seamless integration with external systems (Sage ERP, Active Directory, Hospital Systems, Payment Gateways)
2.2 Scope
2.2.1 In Scope
- Web-based centralized medical insurance system
- Self-service member portal and mobile application
- Sales module/portal/mobile application for multi-level sales management
- Provider module/portal for healthcare facilities
- Admin portal for internal staff operations
- Business Intelligence dashboard with real-time analytics
- Complete membership lifecycle management (enrollment, renewal, termination, reinstatement)
- Underwriting and product configuration system
- Claims processing and case management (verification, adjudication, payment)
- Provider network management and accreditation
- Financial management (invoicing, receipting, premium collection, commission calculation)
- Customer service and retention tools (ticketing, CRM, chatbot)
- Wellness program management
- Re-insurance management (treaty configuration, bordereaux)
- Integration with Active Directory, Sage ERP, Hospital Systems, Banks, SMS/Email gateways
- Multi-currency support and exchange rate management
- Comprehensive reporting and audit trail
- Role-based access control with maker-checker workflows
- Document management and card printing
- API for third-party integrations
- Technical training and documentation delivery
2.2.2 Out Of Scope
- General insurance products (motor, property, etc.)
- Direct integration with government regulatory systems (to be handled separately)
- Third-party actuarial software integration
- Blockchain-based claims processing
- International claims processing outside Tanzania and Kenya markets
3 User Requirements
3.1 Authentication User Management
| Feature Code | I Want To | So That I Can | Priority | Notes |
|---|---|---|---|---|
| FT-AUTH-INTERNAL-LOGIN | Log in and out securely with role-based access as an internal user (employee or executive of Assemble) | Access my dashboard and perform role-specific functions based on my user type | Must | Integration with Active Directory (AD) for user retrieval and management. Support for SSO. |
| FT-AUTH-EXTERNAL-LOGIN | Log in and out securely with role-based access as an external beneficiary, member, or partner of Assemble | Access my dashboard and perform role-specific functions based on my user type | Must | Database authentication with email/password. Support for members, providers, agents/brokers. |
| UR-3101 | Create User Groups/Profiles each with a set of user roles | Manage permissions and access control systematically | Must | Role-based access control (RBAC) implementation |
| UR-3102 | Configure security policy on password complexity | Ensure strong authentication security across the platform | Must | Configurable password rules: length, complexity, expiry, history |
| UR-3103 | Implement a Maker-Checker mechanism for all critical transactions | Ensure proper authorization and reduce fraud risk | Must | Dual control for sensitive operations like claims approval, policy changes, financial transactions |
| UR-3104 | Log all user activity in the system | Track user actions for audit, compliance, and security purposes | Must | Comprehensive audit trail including timestamps, user IDs, IP addresses, actions performed |
| UR-3105 | Extract a user audit trail report | Review user activities and investigate security incidents | Must | Filterable by user, date range, action type, module |
| UR-3106 | Integrate the core system with Active Directory (AD) for user management | Centrally manage internal user accounts and authentication | Must | LDAP integration for SSO. Provide reports showing active/inactive users with historical data extraction (as at XX date). |
3.2 Core Business Features
| Feature Code | I Want To | So That I Can | Priority | Notes |
|---|---|---|---|---|
| FT-SALES-001 | Manage the complete sales lifecycle from lead to policy issuance | Track sales performance, manage commissions, and grow the business | Must | Includes lead management, quotations, applications, policy issuance, commission calculation, and sales reporting |
| FT-MEMBERSHIP-001 | Manage complete member lifecycle including enrollment, renewal, changes, and termination | Maintain accurate member records and provide seamless service | Must | Supports individual, family, and corporate enrollments with bulk operations |
| FT-UNDERWRITING-001 | Configure insurance products with flexible benefit structures and pricing | Offer competitive products that meet diverse customer needs | Must | Support for full insurance, full fund, and hybrid products with individual and family benefits |
| FT-CLAIMS-001 | Process claims efficiently from submission to payment | Ensure timely settlement and member satisfaction | Must | Includes verification, adjudication, approval workflows, payment processing, and reconciliation |
| FT-PROVIDER-001 | Manage provider network including accreditation, contracts, and payments | Maintain quality network and control costs | Must | Provider registration, credentialing, contract management, price lists, and provider grouping |
| FT-FINANCE-001 | Manage financial operations including invoicing, receipting, and integration with ERP | Ensure accurate financial records and reconciliation | Must | Seamless integration with Sage ERP for AR/AP, premium collection, and commission payments |
| FT-CRM-001 | Provide excellent customer service and retention capabilities | Improve customer satisfaction and reduce churn | Should | Ticketing system, online portals, chatbot, feedback management, and retention workflows |
| FT-WELLNESS-001 | Offer and manage wellness programs for members | Promote preventive care and member engagement | Should | Program management, booking system for wellness services, tracking, and reporting |
| FT-REPORTING-001 | Access comprehensive reports and real-time dashboards | Make data-driven decisions and monitor business performance | Must | Real-time dashboards for all operations with export capabilities and scheduled reports |
| FT-REINSURANCE-001 | Manage reinsurance treaties and generate bordereaux reports | Manage risk transfer and comply with reinsurance agreements | Should | Treaty configuration, premium bordereaux, claims bordereaux |
3.3 Additional Features
| Feature Code | I Want To | So That I Can | Priority | Notes |
|---|---|---|---|---|
| UR-2901 | Provide a test environment for changes and user training | Test new features and train users without affecting production | Must | Separate test/staging environment mirroring production |
| UR-3201 | Implement serial controls on claim forms and registration numbers | Prevent fraud and ensure unique identification | Must | Auto-generated sequential numbers with no gaps |
| UR-3301 | Generate exception reports on data extremes, amendments, deletions, and reversals | Detect anomalies and potential fraud | Must | Automated alerts for suspicious activities |
| UR-3401 | Provide an API for interfacing with provider systems and other AIT systems | Enable seamless data exchange and integration | Must | RESTful API with authentication and documentation |
| UR-3402 | Integrate all system operations reports to Teammate system | Consolidate reporting across AIT systems | Should | Example: Production Report integration |
| UR-3403 | Access real-time dashboards for all operations | Monitor business performance instantly | Must | Live metrics, KPIs, and visual analytics |
| UR-3404 | Receive full technical training for the AIT technical team | Support end-users effectively | Must | Comprehensive training program for IT staff |
| UR-3409 | Access comprehensive user training manuals and guidelines | Learn how to use the system effectively | Must | User-friendly documentation for all user types |
| UR-3410 | Receive technical documentation covering architecture, integrations, and source code | Maintain and extend the system | Must | System architecture, deployment specs, API docs, and source code documentation |
| UR-3411 | Configure global multi-currency settings with exchange rates | Support operations in multiple currencies | Must | Support for USD, TZS, KES with configurable exchange rates |
4 Detailed Feature Requirements
4.1 Ft Auth Internal Login
4.1.1 Priority
Must Have
4.1.2 User Story
As an internal staff member, I want to log in using my Active Directory credentials so that I can access the admin portal and perform my job functions securely.
4.1.3 Preconditions
User must have an Active Directory account with appropriate permissions
4.1.4 Postconditions
User is authenticated and redirected to their role-specific dashboard
4.1.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| AUTH-INTERNAL-TC-001 | Verify successful login with valid AD credentials | High |
| AUTH-INTERNAL-TC-002 | Verify login fails with invalid credentials | High |
| AUTH-INTERNAL-TC-003 | Verify SSO functionality across admin and BI portals | High |
| AUTH-INTERNAL-TC-004 | Verify session timeout after configured inactivity period | Medium |
| AUTH-INTERNAL-TC-005 | Verify logout functionality and session cleanup | High |
4.2 Ft Auth External Login
4.2.1 Priority
Must Have
4.2.2 User Story
As an external user (member, provider, or agent), I want to log in using my email and password so that I can access my portal and manage my account.
4.2.3 Preconditions
User must have a registered account in the system
4.2.4 Postconditions
User is authenticated and redirected to their portal dashboard
4.2.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| AUTH-EXTERNAL-TC-001 | Verify successful login with valid credentials for member portal | High |
| AUTH-EXTERNAL-TC-002 | Verify successful login with valid credentials for provider portal | High |
| AUTH-EXTERNAL-TC-003 | Verify successful login with valid credentials for agent portal | High |
| AUTH-EXTERNAL-TC-004 | Verify password reset functionality via email | High |
| AUTH-EXTERNAL-TC-005 | Verify account lockout after multiple failed attempts | High |
| AUTH-EXTERNAL-TC-006 | Verify phone number verification during registration | Medium |
4.3 Ft Sales 001
4.3.1 Priority
Must Have
4.3.2 User Story
As a sales agent, I want to manage leads, create quotations, and track sales performance so that I can meet my targets and earn commissions.
4.3.3 Preconditions
Sales agent account with appropriate permissions
4.3.4 Postconditions
Sales activities are tracked, commissions calculated, and policies issued
4.3.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| SALES-TC-001 | Verify lead creation and assignment to sales agent | High |
| SALES-TC-002 | Verify quotation generation with accurate premium calculation | High |
| SALES-TC-003 | Verify sales target setting and tracking per agent | Medium |
| SALES-TC-004 | Verify commission calculation based on configured rates | High |
| SALES-TC-005 | Verify sales performance reports by agent, product, channel | High |
| SALES-TC-006 | Verify member list upload by sales agent or client | Medium |
| SALES-TC-007 | Verify sales hierarchy configuration (Country > Region > Branch > Unit > Agent) | High |
4.4 Ft Membership 001
4.4.1 Priority
Must Have
4.4.2 User Story
As an underwriting officer, I want to enroll members, manage their policies, and handle renewals so that members have continuous coverage.
4.4.3 Preconditions
Valid policy and product configuration in the system
4.4.4 Postconditions
Members are enrolled, cards issued, and policy documents generated
4.4.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| MEMBERSHIP-TC-001 | Verify individual member enrollment with all required fields | High |
| MEMBERSHIP-TC-002 | Verify family-based enrollment with multiple members | High |
| MEMBERSHIP-TC-003 | Verify bulk member upload via Excel with validation | High |
| MEMBERSHIP-TC-004 | Verify member photo upload and display | Medium |
| MEMBERSHIP-TC-005 | Verify automatic policy renewal with notifications | High |
| MEMBERSHIP-TC-006 | Verify member addition mid-policy with prorated premium | High |
| MEMBERSHIP-TC-007 | Verify member termination with refund calculation | High |
| MEMBERSHIP-TC-008 | Verify member reinstatement after termination | Medium |
| MEMBERSHIP-TC-009 | Verify card printing and dispatch tracking | High |
| MEMBERSHIP-TC-010 | Verify policy document generation with member list | High |
| MEMBERSHIP-TC-011 | Verify TIN number capture and visibility in plan schedule | Medium |
| MEMBERSHIP-TC-012 | Verify duplicate detection during enrollment | High |
| MEMBERSHIP-TC-013 | Verify family grouping by ID number during bulk upload | Medium |
4.5 Ft Underwriting 001
4.5.1 Priority
Must Have
4.5.2 User Story
As an underwriting manager, I want to configure insurance products with flexible benefits and pricing so that I can offer competitive products to the market.
4.5.3 Preconditions
System configured with benefit types and pricing parameters
4.5.4 Postconditions
Products are available for quotation and sales
4.5.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| UNDERWRITING-TC-001 | Verify creation of full insurance product | High |
| UNDERWRITING-TC-002 | Verify creation of full fund product | High |
| UNDERWRITING-TC-003 | Verify creation of hybrid product (benefit-wise insured/fund) | High |
| UNDERWRITING-TC-004 | Verify parent-child benefit structure setup | Medium |
| UNDERWRITING-TC-005 | Verify Buffer/Excess of Loss cover configuration | High |
| UNDERWRITING-TC-006 | Verify SBP (Special Benefit Pool) configuration | High |
| UNDERWRITING-TC-007 | Verify indemnity configuration and management | High |
| UNDERWRITING-TC-008 | Verify product cloning functionality | Medium |
| UNDERWRITING-TC-009 | Verify benefit editing with authorization | High |
| UNDERWRITING-TC-010 | Verify waiting period configuration (entry date and policy level) | High |
| UNDERWRITING-TC-011 | Verify exclusions and waiting period setup per client | High |
| UNDERWRITING-TC-012 | Verify multi-currency premium configuration | High |
| UNDERWRITING-TC-013 | Verify loading/discount isolation across policy terms | Medium |
4.6 Ft Claims 001
4.6.1 Priority
Must Have
4.6.2 User Story
As a claims processor, I want to efficiently process claims from submission to payment so that members receive timely reimbursement for covered services.
4.6.3 Preconditions
Valid member with active policy and approved provider
4.6.4 Postconditions
Claim is adjudicated, approved/rejected, and payment processed if applicable
4.6.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| CLAIMS-TC-001 | Verify member verification using fingerprint scanning | High |
| CLAIMS-TC-002 | Verify member verification using facial recognition | Medium |
| CLAIMS-TC-003 | Verify member verification using OTP | Medium |
| CLAIMS-TC-004 | Verify offline verification during connectivity outage | High |
| CLAIMS-TC-005 | Verify pre-authorization request submission and approval | High |
| CLAIMS-TC-006 | Verify claim registration with provider invoice | High |
| CLAIMS-TC-007 | Verify claim classification (Inpatient/Outpatient) | High |
| CLAIMS-TC-008 | Verify auto-processing against policy clause conditions | High |
| CLAIMS-TC-009 | Verify claim rejection with coded reasons | High |
| CLAIMS-TC-010 | Verify claim reprocessing through Indemnity | Medium |
| CLAIMS-TC-011 | Verify claim reprocessing through Excess of Loss | Medium |
| CLAIMS-TC-012 | Verify claim reprocessing through Ex-gratia | Medium |
| CLAIMS-TC-013 | Verify claim reversal with appropriate controls | High |
| CLAIMS-TC-014 | Verify SMS notification to member on claim utilization | Medium |
| CLAIMS-TC-015 | Verify claims transmittal report generation | High |
| CLAIMS-TC-016 | Verify waiting period enforcement during verification | High |
| CLAIMS-TC-017 | Verify processing of claims for terminated members (within grace period) | Medium |
| CLAIMS-TC-018 | Verify exclusion of benefits not eligible to certain members (e.g., maternity to males) | High |
4.7 Ft Provider 001
4.7.1 Priority
Must Have
4.7.2 User Story
As a provider network manager, I want to manage provider relationships, contracts, and price lists so that I can maintain a quality network and control costs.
4.7.3 Preconditions
Provider registration form and documentation
4.7.4 Postconditions
Provider is accredited, contracted, and can submit claims
4.7.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| PROVIDER-TC-001 | Verify provider accreditation process | High |
| PROVIDER-TC-002 | Verify provider information editing with audit trail | Medium |
| PROVIDER-TC-003 | Verify provider suspension/termination with effective date | High |
| PROVIDER-TC-004 | Verify contract upload and management | High |
| PROVIDER-TC-005 | Verify alert on contract expiry (90 days) | Medium |
| PROVIDER-TC-006 | Verify price list upload with effective date tracking | High |
| PROVIDER-TC-007 | Verify mapping of provider items to internal tariff | High |
| PROVIDER-TC-008 | Verify item deactivation on price list | Medium |
| PROVIDER-TC-009 | Verify provider group creation and management | High |
| PROVIDER-TC-010 | Verify linking client to specific provider groups | High |
| PROVIDER-TC-011 | Verify capitation arrangement configuration | High |
| PROVIDER-TC-012 | Verify provider statement generation | High |
4.8 Ft Finance 001
4.8.1 Priority
Must Have
4.8.2 User Story
As a finance officer, I want to manage invoicing, receipting, and reconciliation so that financial records are accurate and up-to-date.
4.8.3 Preconditions
Sage ERP integration configured and operational
4.8.4 Postconditions
Financial transactions are recorded in both SAS and Sage ERP
4.8.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| FINANCE-TC-001 | Verify deposit invoice generation after quotation | High |
| FINANCE-TC-002 | Verify tax invoice generation after member enrollment | High |
| FINANCE-TC-003 | Verify invoice includes member listing and premium breakdown | High |
| FINANCE-TC-004 | Verify VAT and tax rate configuration | High |
| FINANCE-TC-005 | Verify premium categorization (Fund, Wellness, Medical) | Medium |
| FINANCE-TC-006 | Verify commission rate configuration per client | High |
| FINANCE-TC-007 | Verify exchange rate integration from Sage | High |
| FINANCE-TC-008 | Verify invoice cancellation/reversal with controls | High |
| FINANCE-TC-009 | Verify prorated premium on member additions | High |
| FINANCE-TC-010 | Verify prorated refund on member deletions | High |
| FINANCE-TC-011 | Verify credit note application during invoice generation | High |
| FINANCE-TC-012 | Verify receipt of single/multiple invoices in one transaction | High |
| FINANCE-TC-013 | Verify receipt cancellation/reversal | High |
| FINANCE-TC-014 | Verify premium register report (summary and detailed) | High |
| FINANCE-TC-015 | Verify commission window based on DBN flows | Medium |
| FINANCE-TC-016 | Verify integration with Sage for AR (invoices/receipts) | High |
| FINANCE-TC-017 | Verify integration with Sage for AP (claims/commissions) | High |
| FINANCE-TC-018 | Verify UPR and DAC report generation | High |
4.9 Ft Crm 001
4.9.1 Priority
Should Have
4.9.2 User Story
As a customer service representative, I want to manage customer inquiries, feedback, and retention activities so that I can improve customer satisfaction.
4.9.3 Preconditions
CRM module configured with ticket types and workflows
4.9.4 Postconditions
Customer issues are tracked, resolved, and satisfaction measured
4.9.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| CRM-TC-001 | Verify ticket creation from multiple channels | High |
| CRM-TC-002 | Verify ticket assignment and escalation | High |
| CRM-TC-003 | Verify live claim ratio notifications on CRO dashboard | Medium |
| CRM-TC-004 | Verify HR portal for corporate clients | High |
| CRM-TC-005 | Verify HR can upload renewal lists and forms | High |
| CRM-TC-006 | Verify CRO can view company and HR information | Medium |
| CRM-TC-007 | Verify online membership application with phone verification | High |
| CRM-TC-008 | Verify individual renewal workflow without email to underwriters | Medium |
| CRM-TC-009 | Verify automatic renewal after payment confirmation | High |
| CRM-TC-010 | Verify CRO can view clients by status (lost, renewed, delayed, new) | Medium |
| CRM-TC-011 | Verify live provider report on CRO dashboard | Medium |
| CRM-TC-012 | Verify single online portal for feedback and queries | High |
| CRM-TC-013 | Verify automatic renewal letter generation | Medium |
| CRM-TC-014 | Verify chatbot integration with WhatsApp | Should |
| CRM-TC-015 | Verify activity tracking for corporate CROs | Medium |
4.10 Ft Wellness 001
4.10.1 Priority
Should Have
4.10.2 User Story
As a wellness agent, I want to manage wellness programs and client consultations so that I can promote preventive care and member engagement.
4.10.3 Preconditions
Wellness module configured with programs and providers
4.10.4 Postconditions
Wellness activities are tracked and members are engaged
4.10.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| WELLNESS-TC-001 | Verify client wellness information recording | Medium |
| WELLNESS-TC-002 | Verify query/case management from start to finish | High |
| WELLNESS-TC-003 | Verify real-time case status tracking | Medium |
| WELLNESS-TC-004 | Verify addition of new query types by authorized users | Medium |
| WELLNESS-TC-005 | Verify reminder system for follow-up sessions | Medium |
| WELLNESS-TC-006 | Verify wellness report filtering | Medium |
| WELLNESS-TC-007 | Verify wellness package payment tracking | Medium |
| WELLNESS-TC-008 | Verify live wellness program bookings (e.g., psychologist) | High |
| WELLNESS-TC-009 | Verify client can view and book available time slots | High |
| WELLNESS-TC-010 | Verify booking confirmation via SMS/WhatsApp | Medium |
| WELLNESS-TC-011 | Verify client can change session time or provider | Medium |
| WELLNESS-TC-012 | Verify gym module attendance tracking | Should |
| WELLNESS-TC-013 | Verify online wellness quotation and booking | Medium |
4.11 Ft Reporting 001
4.11.1 Priority
Must Have
4.11.2 User Story
As a manager, I want to access comprehensive reports and dashboards so that I can monitor performance and make informed decisions.
4.11.3 Preconditions
Data available in the system for reporting
4.11.4 Postconditions
Reports are generated accurately and available for export
4.11.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| REPORTING-TC-001 | Verify real-time dashboard for all operations | High |
| REPORTING-TC-002 | Verify sales performance reports by agent, product, channel | High |
| REPORTING-TC-003 | Verify production per user report | Medium |
| REPORTING-TC-004 | Verify member list reports by various filters | High |
| REPORTING-TC-005 | Verify underwriting status report | High |
| REPORTING-TC-006 | Verify claims register and transmittal reports | High |
| REPORTING-TC-007 | Verify member/family utilization reports | High |
| REPORTING-TC-008 | Verify corporate utilization reports with claim ratios | High |
| REPORTING-TC-009 | Verify provider distribution and statement reports | High |
| REPORTING-TC-010 | Verify exception reports for data extremes | Medium |
| REPORTING-TC-011 | Verify SBP/Buffer/Indemnity/Ex-gratia reports | Medium |
| REPORTING-TC-012 | Verify exceeded benefits analytical reports | High |
| REPORTING-TC-013 | Verify claim experience reports by age band, region, product | High |
| REPORTING-TC-014 | Verify report export to PDF, Excel, Word formats | High |
| REPORTING-TC-015 | Verify scheduled report generation and distribution | Medium |
4.12 Ft Reinsurance 001
4.12.1 Priority
Should Have
4.12.2 User Story
As an underwriting manager, I want to manage reinsurance treaties and generate bordereaux so that I can manage risk transfer efficiently.
4.12.3 Preconditions
Reinsurance treaties configured in the system
4.12.4 Postconditions
Bordereaux reports generated and risk transfer tracked
4.12.5 Test Cases
| Id | Description | Weight |
|---|---|---|
| REINSURANCE-TC-001 | Verify treaty configuration setup | High |
| REINSURANCE-TC-002 | Verify premium bordereaux generation | High |
| REINSURANCE-TC-003 | Verify claims bordereaux generation | High |
| REINSURANCE-TC-004 | Verify bordereaux export formats | Medium |
5 Technical Requirements
5.1 Performance Standards
| Requirement | Target | How To Test |
|---|---|---|
| Inter-module communication response time | ≤ 3 seconds | Load testing with Apache JMeter simulating concurrent requests across modules. Measure response time from API call to response received. |
| System uptime | 99.5% availability (excluding planned maintenance) | Monitor uptime using system monitoring tools (Prometheus/Grafana) over a 30-day period. Calculate uptime percentage. |
| Concurrent users support | Support minimum 500 concurrent users without performance degradation | Stress testing with 500+ simulated concurrent users performing typical operations. Monitor response times and system resources. |
| Database query performance | 95% of queries execute in < 1 second | Enable slow query logging in PostgreSQL. Analyze query performance using EXPLAIN ANALYZE. Optimize queries exceeding threshold. |
| Report generation time | Standard reports generate in < 30 seconds | Measure time from report request to delivery for each report type with production-like data volumes. |
| Claim processing time | Auto-adjudication completes in < 10 seconds per claim | Measure time from claim submission to adjudication result. Test with various claim types and complexity levels. |
| Member verification response | < 2 seconds for real-time verification | Measure response time from verification request to eligibility result at provider portal. |
| File upload processing | Bulk member upload (1000 records) completes in < 5 minutes | Upload test files with 1000, 2000, 5000 member records. Measure processing time including validation. |
5.2 Platform Requirements
| Platform | Minimum Version | Target Version | Notes |
|---|---|---|---|
| Web Browser | Chrome 90+, Firefox 88+, Safari 14+, Edge 90+ | Latest stable versions | All portal modules require modern browser capabilities with WebSocket support for real-time features. JavaScript must be enabled. |
| Mobile Devices | iOS 13+, Android 9.0+ | iOS 15+, Android 12+ | Flutter mobile app requires minimum screen size 5 inches, camera for document scanning, and biometric sensors for authentication. |
| Server Infrastructure | Ubuntu 20.04 LTS or RHEL 8+ | Ubuntu 22.04 LTS | On-premise deployment using Docker Swarm for orchestration. Minimum 32GB RAM, 8 CPU cores for production cluster. |
| Database | PostgreSQL 13+ | PostgreSQL 15+ | Master-replica cluster configuration with minimum 3 nodes. SSD storage required for optimal performance. |
| Cache & Queue | Redis 6.2+ | Redis 7.0+ | Used for caching and Celery task queue. Minimum 8GB RAM allocation. |
5.3 Security Privacy
| Requirement | Must Have | Implementation |
|---|---|---|
| Data encryption at rest | True | PostgreSQL database encryption with AES-256. Sensitive fields (biometric data, medical records) encrypted at application level using Django's encryption libraries. |
| Data encryption in transit | True | TLS 1.2+ for all communications. Wildcard SSL certificate (*.sas.assemble.com) managed by Traefik. HTTPS enforced via HSTS headers. |
| Role-based access control (RBAC) | True | Django's permission system with custom user groups and roles. Granular permissions at module and operation level. |
| Multi-factor authentication (MFA) | False | Optional MFA using OTP for high-privilege accounts (admins, finance officers). SMS or authenticator app based. |
| Audit trail logging | True | All user actions logged with timestamp, user ID, IP address, and action details. Logs stored for minimum 7 years for compliance. |
| Session management | True | Secure session cookies with HttpOnly and Secure flags. Configurable timeout (default 30 minutes inactivity). Session revocation on logout. |
| Password security | True | Configurable password complexity rules. Minimum 8 characters with uppercase, lowercase, number, special character. Password hashing using PBKDF2-SHA256. Password history to prevent reuse. |
| API authentication | True | JWT tokens for API access. Token expiry and refresh mechanism. API key authentication for system integrations. |
| Data backup | True | Daily automated database backups with 30-day retention. Weekly full backups with 1-year retention. Encrypted backup storage. |
| GDPR/Data protection compliance | True | Data minimization principles. Consent management for data processing. Right to erasure (soft delete) functionality. Data access request handling. |
| Penetration testing | True | Annual third-party penetration testing. Quarterly internal security audits. Vulnerability scanning with automated tools. |
| Disaster recovery plan | True | RTO (Recovery Time Objective) of 4 hours. RPO (Recovery Point Objective) of 1 hour. Documented DR procedures with quarterly drills. |
5.4 Scalability Requirements
| Requirement | Target | Implementation |
|---|---|---|
| Horizontal scaling of Django instances | Scale from 3 to 10+ instances based on load | Docker Swarm with auto-scaling policies based on CPU/memory utilization |
| Database read scaling | Support 3+ read replicas for reporting and analytics | PostgreSQL streaming replication with connection pooling (PgBouncer) |
| Celery worker scaling | Independent scaling of worker pools by task type | Separate worker pools for claims, reports, and general tasks with auto-scaling |
| Cache layer | Redis cluster with minimum 16GB memory | Cache frequently accessed data (member info, product config) with TTL strategy |
5.5 Integration Requirements
| Requirement | Protocol | Purpose | Must Have |
|---|---|---|---|
| Active Directory integration | LDAP/LDAPS | Internal user authentication and management | True |
| Sage ERP integration | REST API / ODBC | Financial transactions synchronization (AR/AP, invoices, receipts, payments) | True |
| Hospital Management Systems | REST API | Claims submission, member verification, pre-authorization | True |
| Payment gateway integration | REST API | Online premium payments, mobile money integration | True |
| SMS gateway integration | REST API / SMPP | Member notifications, OTP delivery, alerts | True |
| Email service integration | SMTP / API | Email notifications, document delivery, reports | True |
| Teammate system integration | REST API | Production reports and operational data sharing | False |
6 External Dependencies
6.1 Third Party Services
| Service | What It Does | Criticality | Backup Plan |
|---|---|---|---|
| Active Directory (Microsoft AD) | Centralized authentication and user management for internal staff | High | Local database authentication fallback for internal users in case of AD unavailability |
| Sage ERP System | Financial management, accounting, invoicing, and payment tracking | High | Queue financial transactions in SAS for later synchronization. Manual reconciliation procedures documented. |
| SMS Gateway Provider | Send SMS notifications for member alerts, OTP, claim updates, renewal reminders | Medium | Secondary SMS provider configured. Email notifications as fallback for non-OTP messages. |
| Email Service Provider | Send email notifications, policy documents, reports, and communications | Medium | Secondary SMTP server configured. Document delivery through portal as alternative. |
| Payment Gateway (Banks/Mobile Money) | Process premium payments online via credit cards, bank transfers, mobile money | High | Manual payment recording option. Multiple payment gateway integrations for redundancy. Offline payment channels (bank deposits). |
| Hospital Management Systems | Electronic claims submission, member verification, pre-authorization requests | Medium | Manual claims submission through provider portal. Offline verification using exported member lists. |
| SSL Certificate Authority (Let's Encrypt) | Provide SSL/TLS certificates for secure communications | High | Commercial CA as backup. Cert-manager for automatic renewal and failover. |
| Teammate System (AIT) | Receive operational reports and production data from SAS | Low | Reports stored in SAS and exported manually if integration fails. |
6.2 Device Requirements
| Feature | Required | Optional | Notes |
|---|---|---|---|
| Internet Connectivity | True | False | Minimum 2 Mbps bandwidth per concurrent user. Offline mode supported for member verification with sync capability. |
| Biometric Scanner (Fingerprint) | False | True | Required at service points for member verification. USB fingerprint scanners compatible with web browser APIs. |
| Webcam/Camera | False | True | Required for facial recognition member verification. Mobile devices use built-in cameras. |
| Card Printer | True | False | PVC card printer for member ID card printing. Integrated with card management module. |
| Document Scanner | False | True | For scanning claim documents and supporting documentation. Mobile app can use camera as scanner. |
| Barcode/QR Code Scanner | False | True | For scanning member cards at service points. Mobile devices use camera. |
7 Release Planning
7.1 Development Phases
| Phase | Features Included | Timeline | Success Criteria |
|---|---|---|---|
| Phase 1 - Foundation & Core Modules | ['FT-AUTH-INTERNAL-LOGIN', 'FT-AUTH-EXTERNAL-LOGIN', 'UR-3101 - User Groups/Profiles', 'UR-3102 - Password Policy Configuration', 'UR-3103 - Maker-Checker Mechanism', 'UR-3104 - User Activity Logging', 'UR-3105 - Audit Trail Reports', 'UR-3106 - Active Directory Integration', 'UR-3405 - Web-based Centralized Platform', 'UR-3411 - Multi-currency Configuration', 'UR-2901 - Test Environment Setup'] | 3 months | Authentication and authorization system operational. Admin portal accessible. User management functional. Audit trail tracking all activities. |
| Phase 2 - Product & Membership Management | ['FT-UNDERWRITING-001', 'FT-MEMBERSHIP-001', 'UR-0301 to UR-0317 - Product Configuration', 'UR-1201 to UR-1702 - Member Enrollment & Management', 'UR-1801 to UR-1819 - Card Printing & Reports', 'UR-2803 to UR-2817 - Enhanced Enrollment Features'] | 4 months | Product configuration complete. Member enrollment operational (individual, family, corporate). Bulk enrollment working. Card printing functional. Policy documents generated. |
| Phase 3 - Sales & Agent Management | ['FT-SALES-001', 'UR-0101 to UR-0210 - Sales Management', 'SE-001 to SE-022 - Sales Portal Features', 'UR-3407 - Sales Module/Portal/Mobile App', 'UR-0601 to UR-0616 - Quotation & Invoicing'] | 3 months | Sales agent hierarchy configured. Lead management operational. Quotation generation working. Commission calculation automated. Agent portal accessible. |
| Phase 4 - Finance & Billing | ['FT-FINANCE-001', 'UR-0601 to UR-0616 - Invoice & Receipt Management', 'UR-0701 to UR-1107 - Premium Management', 'UR-4001 to UR-4006 - Sage Integration'] | 3 months | Invoicing operational. Receipt management functional. Sage ERP integration complete. Premium collection tracking. Commission payment processing. |
| Phase 5 - Claims Processing | ['FT-CLAIMS-001', 'UR-2301 to UR-2739 - Claims Management', 'Advanced verification methods (fingerprint, facial recognition, OTP)'] | 4 months | Member verification functional (all methods). Claims submission operational. Auto-adjudication working. Pre-authorization process functional. Claims payment processing. Provider portal for claims submission. |
| Phase 6 - Provider Network Management | ['FT-PROVIDER-001', 'UR-1901 to UR-2211 - Provider Management', 'UR-3408 - Provider Portal'] | 2 months | Provider registration operational. Contract management functional. Price list management working. Provider groups configured. Provider portal accessible. Capitation arrangements functional. |
| Phase 7 - Customer Service & Wellness | ['FT-CRM-001', 'FT-WELLNESS-001', 'CC-001 to CC-003 - Call Center Features', 'RT-001 to RT-013 - Retention Features', 'CW-001 to CW-022 - Wellness Features', 'UR-3406 - Self-service Member Portal'] | 3 months | Member portal operational. Customer service ticketing functional. Wellness program management working. Chatbot integrated. Retention tools operational. |
| Phase 8 - Reporting & Analytics | ['FT-REPORTING-001', 'UR-3403 - Real-time Dashboards', 'UR-3402 - Teammate Integration', 'All department-specific reports'] | 2 months | BI dashboard operational. All standard reports available. Real-time metrics functional. Report scheduling working. Export capabilities operational. |
| Phase 9 - Re-insurance & Advanced Features | ['FT-REINSURANCE-001', 'UR-2801 to UR-2802 - Re-insurance Management', 'UR-3201 - Serial Controls', 'UR-3301 - Exception Reports', 'UR-3401 - API for Integrations'] | 2 months | Re-insurance treaty management functional. Bordereaux generation working. API documentation complete. External integrations operational. |
| Phase 10 - Training, Testing & Go-Live | ['UR-3404 - Technical Training', 'UR-3409 - User Training Materials', 'UR-3410 - Technical Documentation', 'System-wide UAT', 'Performance testing', 'Security audit', 'Data migration', 'Go-live preparation'] | 2 months | All training completed. UAT passed. Performance benchmarks met. Security audit cleared. Production data migrated. System live and stable. |
7.2 Release Checklist
- All phase features implemented and tested
- UAT sign-off from all departments
- Performance testing passed (concurrent users, response times)
- Security audit completed and vulnerabilities addressed
- Penetration testing passed
- Data migration completed and verified
- Integration testing with external systems passed
- Backup and disaster recovery procedures tested
- User training completed for all user types
- Technical training completed for IT team
- Documentation delivered (user manuals, technical docs, API docs)
- Production environment configured and tested
- Monitoring and alerting configured
- Support processes and procedures documented
- Go-live communication plan executed
- Rollback plan documented and tested
- Production data reconciliation procedures in place
- Performance baselines established
- Support team ready (L1, L2, L3)
- Business continuity plan approved
8 Risks Assumptions
8.1 Risks
| Risk | Probability | Impact | Mitigation |
|---|---|---|---|
| Integration complexity with Sage ERP may cause delays | High | High | Early engagement with Sage team. Dedicated integration testing phase. Mock services for parallel development. Detailed API documentation and testing. |
| Hospital systems integration may have varying standards | High | Medium | Standardized API with adapters for different hospital systems. Fallback to manual processes. Provider portal as alternative submission channel. |
| Active Directory integration may have network/connectivity issues | Medium | High | Local authentication fallback. Caching of user credentials. Comprehensive error handling and monitoring. |
| Data migration from legacy system may be complex | High | High | Dedicated migration team. Data cleansing phase. Multiple migration dry-runs. Parallel run period. Comprehensive reconciliation procedures. |
| User adoption challenges due to change from legacy system | Medium | Medium | Comprehensive training program. Change management strategy. Super-user champions. Phased rollout by department. Extended support during transition. |
| Performance issues under high concurrent load | Medium | High | Performance testing early and often. Horizontal scaling capability. Caching strategy. Database optimization. Load balancing configuration. |
| Security vulnerabilities in biometric data handling | Low | High | Encryption at rest and in transit. Security audit and penetration testing. Compliance with data protection regulations. Regular security updates. |
| Third-party service downtime (SMS, payment gateways) | Medium | Medium | Multiple provider redundancy. Queuing mechanisms for retry. Offline capabilities where possible. Manual fallback procedures. |
| Scope creep extending timeline | High | High | Strict change control process. Requirements freeze per phase. Prioritization of must-have vs should-have. Regular stakeholder reviews. |
| Infrastructure capacity insufficient for growth | Low | Medium | Scalable architecture design. Horizontal scaling capability. Regular capacity planning. Cloud migration path if needed. |
8.2 Assumptions
- Client has on-premise infrastructure with adequate capacity (32GB RAM, 8 CPU cores minimum)
- Active Directory is operational and accessible from application servers
- Sage ERP has documented API for integration
- Network connectivity is stable between all integrated systems
- Client IT team available for coordination and support during development
- Legacy system data can be extracted in structured format for migration
- Users have access to modern web browsers (Chrome 90+, Firefox 88+, Safari 14+)
- Biometric devices (fingerprint scanners) are compatible with web browser APIs
- SMS and email gateway providers are pre-selected by client
- Payment gateway integrations are coordinated by client with banking partners
- Hospital management systems have technical teams for integration coordination
- TIRA compliance requirements are documented and stable
- Client will provide test data and support for UAT
- Training can be conducted on-site or remotely as needed
- Production deployment will be on-premise using Docker Swarm
- Client has SSL certificate or will use Let's Encrypt
- Backup infrastructure is available for disaster recovery
- Client has defined SLAs for system availability and performance
9 Market Specific Considerations
9.1 Primary Market
- Tanzania
- Kenya
9.2 Target Demographics
- Individual retail customers seeking health insurance coverage
- Small and Medium Enterprises (SMEs) with 5-100 employees
- Large corporates with 100+ employees requiring group health insurance
- Sales agents and brokers distributing insurance products
- Healthcare providers (hospitals, clinics, pharmacies) in urban and semi-urban areas
9.3 Local Considerations
| Consideration | Details |
|---|---|
| Regulatory Compliance | System must comply with TIRA (Tanzania Insurance Regulatory Authority) requirements for health insurance operations, reporting, and data management. |
| Multi-currency Support | Support for TZS (Tanzanian Shilling), KES (Kenyan Shilling), and USD for cross-border operations and premium payments. |
| Mobile Money Integration | Integration with M-Pesa (Kenya) and M-Pesa/Tigo Pesa/Airtel Money (Tanzania) for premium payments given high mobile money adoption. |
| Language Support | Primary language English. Optional Swahili localization for member-facing portals to improve accessibility. |
| Network Connectivity | Offline mode support for member verification due to intermittent internet connectivity in some service areas. Sync capability when online. |
| Provider Network Distribution | Provider network concentrated in urban areas (Dar es Salaam, Nairobi, Mombasa, Arusha). System should support regional provider grouping and referral management. |
| Tax Regulations | VAT and other insurance taxes must be configurable per country. Integration with local tax authorities if required. |
| Identity Verification | Support for local ID systems (NIDA in Tanzania, National ID in Kenya) for member registration and verification. |
9.4 Payment Preferences
| Preference | Value |
|---|---|
| Mobile Money | 60% |
| Bank Transfer | 25% |
| Cash Bank Deposit | 10% |
| Credit Card | 5% |
9.5 Competition
| Competitor | Strengths | Differentiation |
|---|---|---|
| Jubilee Health Insurance | Established brand, wide network, mobile app | SAS offers better digital experience, faster claims processing, wellness programs, multi-channel access |
| AAR Healthcare | Integrated healthcare services, own clinics | SAS provides flexible product configuration, better agent tools, comprehensive reporting |
| Britam Health Insurance | Strong financial backing, comprehensive products | SAS offers superior user experience, real-time processing, chatbot support, self-service capabilities |
| Resolution Health East Africa | Technology-focused, innovative products | SAS provides better provider network management, financial integration with Sage, extensive customization |
10 Sign Off
10.1 Approval
| Role | Name | Signature | Date |
|---|---|---|---|
10.2 Document History
| Version | Date | Changes Made | Changed By |
|---|---|---|---|
| 0.1 | 2025-08-01 | Initial draft created from client requirements document AIT-082025 | Technical Team |
| 1.0 | 2025-10-17 | Comprehensive SRS populated with all requirements from client document and system design. Ready for stakeholder review. | Development Team |
11 Additional Context
11.1 Success Metrics
11.1.1 Operational Efficiency
11.1.1.1 Metric
Claims processing time reduction
11.1.1.2 Baseline
5-7 days (current legacy system)
11.1.1.3 Target
< 24 hours for standard claims, < 1 hour for auto-adjudicated claims
11.1.1.4 Measurement
Track average time from claim submission to approval/payment
11.1.2 User Adoption
11.1.2.1 Metric
Member portal registration and usage
11.1.2.2 Target
60% of members registered within 6 months, 40% monthly active users
11.1.2.3 Measurement
Track portal registrations, login frequency, feature usage
11.1.3 Provider Satisfaction
11.1.3.1 Metric
Provider portal usage and claim submission
11.1.3.2 Target
70% of claims submitted electronically within 12 months
11.1.3.3 Measurement
Track electronic vs manual claim submissions, provider feedback surveys
11.1.4 System Performance
11.1.4.1 Metric
System uptime and response time
11.1.4.2 Target
99.5% uptime, < 3 seconds average response time
11.1.4.3 Measurement
Monitor with Prometheus/Grafana, monthly uptime reports
11.1.5 Financial Accuracy
11.1.5.1 Metric
Reconciliation accuracy with Sage ERP
11.1.5.2 Target
99.9% accuracy, zero material discrepancies
11.1.5.3 Measurement
Monthly reconciliation reports, audit findings
11.1.6 Sales Productivity
11.1.6.1 Metric
Time from quotation to policy issuance
11.1.6.2 Baseline
7-10 days (current)
11.1.6.3 Target
< 24 hours for standard policies
11.1.6.4 Measurement
Track timestamps in sales workflow
11.1.7 Customer Satisfaction
11.1.7.1 Metric
Net Promoter Score (NPS)
11.1.7.2 Target
NPS > 50
11.1.7.3 Measurement
Quarterly customer satisfaction surveys
11.1.8 Cost Reduction
11.1.8.1 Metric
Operational cost per policy
11.1.8.2 Target
20% reduction within 12 months
11.1.8.3 Measurement
Compare operational costs before and after system implementation
11.2 System Architecture
11.2.1 Approach
Modular Monolith with Django
11.2.2 Deployment
On-premise using Docker Swarm
11.2.3 Database
PostgreSQL cluster with master-replica configuration
11.2.4 Frontend
React 19 for all portals (admin, member, provider, agent, BI)
11.2.5 Mobile
Flutter for iOS and Android apps
11.2.6 Async Processing
Celery workers with Redis as broker
11.2.7 Ai Ml Service
FastAPI service for fraud detection, chatbot, churn prediction
11.2.8 Load Balancing
Traefik with subdomain-based routing
11.2.9 Caching
Redis for application cache and session storage
11.2.10 File Storage
Local file system with backup to external storage
11.2.11 Monitoring
Prometheus and Grafana for metrics and alerting
11.3 Portal Subdomains
11.3.1 Admin
admin.sas.assemble.com - Internal staff portal with AD SSO
11.3.2 Member
member.sas.assemble.com - Member self-service portal
11.3.3 Provider
provider.sas.assemble.com - Healthcare provider portal
11.3.4 Agent
agent.sas.assemble.com - Sales agent and broker portal
11.3.5 Bi
bi.sas.assemble.com - Business intelligence dashboard with AD SSO
11.3.6 Api
api.sas.assemble.com - REST API endpoints
11.4 Key Modules
11.4.1 Authentication
User auth, roles, permissions, AD integration
11.4.2 Membership
Member enrollment, profiles, biometric data, policy management
11.4.3 Sales
Lead management, policy sales, quotations, commission calculation
11.4.4 Underwriting
Risk assessment, pricing, product configuration
11.4.5 Claims
Claims submission, adjudication, payment processing
11.4.6 Finance
Billing, payments, reconciliation, Sage integration
11.4.7 Pnm
Provider network management, accreditation, contracts
11.4.8 Customer Service
Support tickets, inquiries, complaints, retention
11.4.9 Wellness
Wellness programs, health content, bookings
11.4.10 Reporting
Report generation, analytics, dashboards
11.4.11 Crm
Customer engagement, agents, chatbot, campaigns
11.4.12 Reinsurance
Treaty configuration, bordereaux generation
11.4.13 Core
Shared utilities, base models, audit logs, notifications