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Lami Embedded Insurance Boundary

This page defines how Lami fits into Afiax Enterprise as an embedded-insurance partner integration.

Lami sits on the embedded-insurance rail around Afiax FHIR, Afiax Pay, and Afiax Billing. It does not replace the clinical core, the payments rail, or the country-pack reimbursement layer.

Partner role​

Lami provides the partner-facing embedded-insurance capability in the Afiax Enterprise model.

In this role, the integration covers:

  • insurance product distribution
  • quote and purchase journeys
  • policy lifecycle connectivity
  • partner-facing embedded-insurance activation inside care and payment journeys
  • insurance event results that later influence payment or finance workflows

Current implementation state​

Implemented in this repo today:

  • the boundary documentation
  • the clinical and reimbursement context that an embedded-insurance flow would need
  • the payment and finance split that determines where Lami can attach

Not implemented in this repo:

  • partner transport and authentication
  • product catalog integration
  • quote and purchase flows
  • policy lifecycle synchronization

This is deliberate. Lami is an adjacent integration service concern, not Afiax FHIR core code.

Core rule​

Afiax FHIR remains the clinical and coverage-context source of truth.

Afiax Pay remains the payments and wallet rail.

Afiax Billing remains the ERP and enterprise finance surface.

Lami remains the embedded-insurance partner integration.

What Afiax FHIR provides to the Lami rail​

Afiax FHIR provides:

  • verified patient and organization context
  • encounter-linked service context where needed
  • coverage and payer-linked identifiers
  • billable-event context that drives insurance-related offers or settlement
  • canonical workflow evidence when insurance outcomes affect care or reimbursement

What Afiax Pay provides to the Lami rail​

Afiax Pay provides:

  • premium collection
  • co-pay and wallet movement
  • subsidy and refund handling
  • payment authorization and settlement support

What Afiax Billing provides to the Lami rail​

Afiax Billing provides:

  • finance-side accounting
  • receivable and settlement views
  • downstream reconciliation when partner insurance outcomes affect enterprise finance

What Lami provides to Afiax Enterprise​

Lami provides the partner integration layer for embedded-insurance workflows.

That includes:

  • insurance product and quote connectivity
  • policy activation and status connectivity
  • partner-facing embedded-insurance lifecycle orchestration
  • insurance event results that feed payment and finance workflows

Runtime sequence​

The intended sequence is:

  1. Afiax FHIR provides the canonical care, patient, and coverage context
  2. Lami provides partner-product and policy workflow
  3. Afiax Pay executes payment or premium movement where needed
  4. Afiax Billing records finance-side settlement when required
  5. normalized outcomes that affect care or reimbursement write back into Afiax FHIR

This keeps partner-product execution outside the clinical core while preserving end-to-end visibility.

What stays outside the Lami boundary​

Lami does not become:

  • the clinical record
  • the national reimbursement system
  • the enterprise finance ledger
  • the wallet and payment ledger

Those remain in Afiax FHIR, the country pack, Afiax Billing, and Afiax Pay.

Kenya interpretation​

In Kenya, Lami sits alongside the Kenya pack rather than inside it.

That means:

  • the Kenya pack handles SHA reimbursement workflows
  • Lami handles embedded-insurance partner workflows
  • Afiax Pay handles payment and premium movements
  • Afiax Billing handles finance-side accounting and reconciliation

This preserves the difference between national health-financing integration and partner-distributed insurance.

Integration placement​

The Lami integration fits best as a partner integration service outside this repo.

This repo should own only:

  • canonical data requirements
  • event contracts
  • normalized status expectations
  • rules for where partner insurance outcomes write back into Afiax FHIR

The partner-specific transport, authentication, product configuration, and marketplace logic remain outside this repo.

Operational result​

This boundary offers:

  • embedded insurance without polluting the canonical clinical model
  • clear separation between partner insurance and national reimbursement
  • reusable partner integration across countries