Introduction

This article explains the incomplete application process in instances where an application form (ie. Electronic or Paper) is received however the relevant information related to Transfer of Cover, Specific Health Questions, Intermediary Fee Agreements and the Policy Holders email address is not provided. 

Summary of instances of 'Incomplete' applications

In the Membership & Underwriting division our focus is to provide an accurate underwriting function on new business & endorsements, however we have come across new business application forms being submitted without certain information. In general no application can/will be processed without all the required standard information or supporting documentation. Adherence to this will assist with ensuring that policies are activated within turn-around-time and without errors. 

From time to time we are supplied with applications which do not contain the following standard information or supporting documentation (not limited to the below):

From time to time we are supplied with applications which do not contain the following standard information or supporting documentation (not limited to the below):

1. Transfer of Cover applications:

   1. A recent (not older than 30 days) copy of the Master policy Schedule from the previous provider which indicates the current option &  original inception date; or
   2. A recent (not older than 30 days) copy of the Cancellation Certificate from the previous provider which indicates the current option &  original inception date. 

2. Specific Health Questions:

   1. All (Questions 1 (one) - 5 (five) medical questions must be answered
   2. All medical questions that are answered YES must include :

1. The   disorder/condition where applicable;
2. Confirmation of disorder/condition if a list of medication is provided;
3. Confirmation of which beneficiary the questions are related to.

3. Intermediary Fee Agreement not listing the actual services rendered:

   1. A duly signed intermediary fee agreement that lists services that are over & above intermediary services in order for the fee to be included upon activation of the policy.

4. Family Size Rules:

   1. Families with more than 2 Adult dependants, documented proof is required to evidence eligible dependents being covered on the Medical Scheme. This includes child dependants that meet the definition of full-time students, who are principal members of their own medical scheme option.
   2. Documented proof of full-time studies is required to verify dependants over the age of 21(twenty-one).

5. Email address (mandatory):

   1. A valid email address that will be recorded on the policy in order to ensure that communication is sent out. This can include:

1. Clients email address; or
2. Their appointed intermediary office email address.

How we will apply the process:

In the event that the  standard information or supporting documentation is not provided for points 1 – 5 above, the following has been implemented as part of our standard processes:

Transfer of Cover Applications and Specific Health Questions that are incomplete:

1. Upon receipt of the application form, the underwriter will email the required information that will be assist with activating the policy;
2. Where the requested information has not been provided within 3 (three) working days, the policy will be activated and the below underwriting terms will be imposed:

3. Waiting periods Name

   Full Description that should appear in Risk Level Underwriting in cases where transfer of cover documents are not provided or where conditions are not fully declared on Specific Health Questions

   Standard Underwriting

   A 3 (Three) Month General Waiting Period Applicable to all insured person/s including: 10 (ten) month waiting period on pre-existing conditions, related surgery, treatment and complications thereof 10 (ten) month waiting period for pregnancy and confinement 12 (twelve) month waiting period on all pre-existing cancer-related treatments  (General policy terms, conditions, policy specific waiting periods & exclusions will apply) Note: The broker concession will be applied as and where applicable

4. Upon activation of the policy an email will be sent to the broker/sender advising them that the policy has been activated with standard waiting periods.

Please provide us with the ‘requested outstanding information’ within 30 days in order to amend the underwriting terms and apply the relevant transfer of cover underwriting.

Intermediary Fee Agreement not listing services being rendered that are over and above intermediary services:

1. Upon receipt of the application form, the administrator/underwriter will send an email requesting the completed fee agreement or services that are over and above intermediary services;
2. Where the requested information has not been provided within 3 (three) working days, the policy will be activated without the additional intermediary fee.
3. Upon activation of the policy an email will be sent to the broker/sender advising them that the policy has been activated without the fee.

Please ensure that the updated signed intermediary fee agreement or elaboration of the list of services is provided as we may not add the fee retrospectively.

Family Size Rules:

1. Sirago will continue to verify  the family size upon receipt of the application form, on both electronic and paper applications forms received prior to activation of the policy.
2. We reserve the right to call upon a certificate of membership (COM) or proof of enrollment prior to activation of the policy.

Applications without Email Address:

1. Upon receipt of the application form, the underwriter will send an email requesting the policy holder’s email address or brokers email address that can be used on record.
2. As our system dictates that an email is mandatory, in the instance where the requested information has not been provided within 24 hours, the policy will be activated. 
3. If the broker does not give us an email address for the policy holder, we will add the brokers office email address (ie. The brokers email address for underwriting communication). Should the policy schedule be posted to the policy holder, the broker must indicate this as well.
4. Upon activation of the policy an email will be sent to the broker/sender advising them that the policy has been activated with the alternative email address.

Please provide us with the requested email address within 30 days in order to amend the policy holder's contact information