ANALYSIS (Part two) TEAM MEETING 8th MAY, 2017

We noted last week that a lot of claims are being repudiated. Our focus for this week will be on reasons why a lot of claims are repudiated.

REASONS FOR REPUDIATION PRODUCT ANALYSIS LADYCARE FIPP TOTAL CONTINGENCY NOT COVERED 31 2 33 FRAUD 1 NON DISCLOSURE 5 10 BENEFIT WAITING PERIOD NOT DONE 3 POLICY LAPSED AT DEATH UNISSUED POLICY   CLAIM BEFORE ACCEPTANCE DATE AGE ABOVE COVERABLE LIMIT POLICY NOT INCEPTED EXCLUSION OTHER 43 15 58

CONTINGENCY NOT COVERED On LAYCARE a lot of claims are filled for contingencies that are not covered by the product. Some of which are: UTERINE FIBROID ABDOMINAL PAIN BREECH BIRTH SEVERE MALARIA hos NO TRACE OF MALIGNANCY PREMATURE RAPTURE OF MEMBRANE CAESAREAN SECTION (CS) HERNIA SUGERY LEG INJURY NULLIPAROUS PROLAPSED INTERVERTEBRAL DISC UTERINE CONTRACTION TUMOUR WAS REMOVED ANGINA PECTORIS AND PELVIC INFLAMMATORY DISEASE BREAST LUMP FIBROID

COVERABLE CONTINGENCIES On LAYCARE we cover the following based on Enterprise Life’s definitions: CRITICAL ILLNESS (100% BENEFIT) BREAST CANCER OVARIAN CANCER UTERINE CANCER CANCER OF VULVA & VAGINA CERVICAL CANCER CANCER OF THE FALLOPIAN TUBES SYSTEMATIC LUPUS NEPHRITIS CRITICAL ILLNESS (50% BENEFIT) HEART ATTACK STROKE CORONARY ARTERY BY-PASS SURGERY LOSS OF SPEECH BLINDNESS AND MAJOR BURNS SOLID CANCER PARALYSIS MAJOR ORGAN TRANSPLANT

COVERABLE CONTINGENCIES; LAYCARE HOSPITALIZATION BENEFIT covers: BREAST CANCER OVARIAN CANCER CERVICAL CANCER UTERINE CANCER CANCER OF THE VULVA & VAGINA CANCER OF THE FALLOPIAN TUBES RHEUMATOID ARTHRITIS OSTEOPOROSIS URINARY INCONTINENCE REQUIRING SURGICAL REPAIR MATERNITY COMPLICATIONS covers: ECTOPIC PREGNANCY MISCARRIAGE DUE TO ACCIDENT PRE-ECLAMPSIA DISSEMINATED INTRAVASCULAR COAULATION FEMALE RELATED ILNESS covers: RHEUMATOID ARTHRITIS OSTEOPOROSIS URINARY INCONTINENCE REQUIRING SURGICAL REPAIR

COVERABLE CONTINGENCIES; EFIPP We cover the following based on Enterprise Life’s definitions: STROKE HEART ATTACK CORONARY ARTERY DISEASE REQQUIRING SURERY HEART VALVE REPLACEMENT SURGERY OF THE AORTA VALVOTOMY CORONARY ANGIOPLASTY AND STENTING SOLID CANCER PARALYSIS MAJOR ORGAN TRANSPLANT MAJOR BURNS

NON-DISCLOSURE Non-disclosure of preexisting conditions of Policy Holders is also one of the reasons why claims are repudiated. Some of the pre existing conditions that are confronted by the Claims Department are: LET YOUR CLIENTS DISCLOSE PRE-EXISTING CONDITIONS FOR THEIR OWN BENEFIT AND YOUR BENEFIT. Known SICKLE CELL ISCHEMIC STROKE IMMUNOSUPPRESSION HYPERTENSIVE BREAST CANCER

LET YOUR CLIENTS DISCLOSE PRE-EXISTING CONDITIONS FOR THEIR OWN BENEFIT AND YOUR BENEFIT. ALSO MAKE IT YOUR BUSINESS TO LET YOUR CLIENTS KNOW THE COVERABLE CONTIENCIES AND MOST OF ALL THE NON-COVERABLE ONES