- Initiate the BJU3AZ Underwriting batch run to check that the risk benefit cover for all members of a product does not exceed the evidence of health (EOH) limit. This should be performed periodically, e.g. once a month.
Note:
This batch run will include the salary increases that come through for any members during the latest monthly member update cycle.
- Check the risk schedule. This report displays all of those members whose annual salary exceeds the EOH limit for the product.
- For all cases where a member's cover exceeds the EOH limit:
- inform the member that medical evidence of health must be submitted to the underwriter
- liaise with the underwriter for decisions to finalize existing cases.
- Update the Evidence of Health Report Details screen with details received from the underwriter
- Recalculate the risk benefit premiums for all members for whom a decision has been received from the underwriter, using the Salaries and Contributions screen on the web, where applicable.
Note:
When the BJU3AZ Underwriting batch job runs and the Members’ insured cover or salary is checked to the Evidence of Health (EOH) Limit and a Membership Risk Cover record has been created, the system will insert a Service Request on My Work with the following details:
- Process Name of UNDERWRITING
- Activity Name of INITIATE
- Start Date equal to the Effective Date on the Membership Risk Cover record
- Product Code
- Membership Reference Number.
For more information refer to
My Work
Process SR
Underwriting
Disability Claim Assessment
Pre-benefit Screening
The following reports are available for selection:
|
Report |
Purpose |
|
Pre-Benefit Screening Status |
To monitor pre-benefit screening in process |
|
Members Pre- Screened |
To invoice the product for pre-benefit screenings processed |
|
Pre-Screened Documents Received |
To monitor the receipt of pre-screening documents received and for the payment to the laboratory for blood tests performed by them |
|
Pre-Screening Reminder Sent |
Displays Memberships with a Service Requests with a Process of PRE-BENEFIT SCREENING and for which the Activity Name is currently FOLLOW UP MEDICAL FORM i.e. the Activity Status is not COMPLETED. |
|
Changes in Member's Pre-Benefit Screening Status |
Displays the Current and previous in respect of the following:
- Underwriter Decision - Cover Amount - Medical Exclusion - Restriction Period End Date |
|
Restriction Periods Expired |
To identify members whose restriction period expires so that their records can be updated if required |
|
Pre-Screening Restrictions |
To advise the trustees of the fund for which members cover restrictions have been imposed |
For more information refer to
Reports
Underwriting
The EOH limit (also known as the free cover limit), is the maximum salary / cover up to which a member may enjoy the resultant risk cover without having to provide evidence of health.
Note:
An EOH limit amount could be defined either in terms of salary or in terms of cover.
Example:
The risk benefit cover is equal to 3 times annual salary and the EOH limit is R100000 salary. A member’s current annual salary has been increased to R120000. The member currently exceeds the EOH limit by R20000.
This member’s annual salary will be held at R100 000 for purposes of determining risk benefit cover. The member’s risk benefit cover will be 3 x 100000 = R300000, until such time as evidence of good health has been submitted, and accepted by the underwriter.
If the underwriter accepts the evidence of health, then the member’s risk benefit cover benefit will be 3 x 120000 = R360000.
To view the EOH limit that is set for a product, select a risk benefit product from the BAGA Benefit Product List screen.
From the BAGA Benefit Product List screen, highlight the required risk benefit product, then select Evidence of Health from the sub-menu on the left.
The BAFK Benefit Risk Product EOH Limit List screen will be displayed. The risk product EOH amount will be shown.
Highlight the risk product EOH amount and click DISPLAY. The BAFK Benefit Risk Product EOH Limit Maintain screen will be displayed.
Note:
In some cases, the risk product may be defined as "Free of EOH", which means that the risk product does not have an EOH limit.
On the Benefit Risk Product EOH Limit Maintain screen, the EOH LIMIT INDICATOR radio buttons indicate whether the risk benefit cover amount displayed is Annual Salary or Cover.
The system provides a facility to manage the EOH for the members of a product. This facility is a batch run, which can be initiated at any time, and checks the EOH limit for a selected member.
To initiate this batch run, log in to the system from the Logon page.
Click infrastructure.
The Welcome screen will be displayed.
From the main menu on top, select Batch. A sub-menu will be displayed on the left.
Select Batch Jobs from the sub-menu on the left. The Batch Job Submission screen will be displayed.
Locate the following batch job called from the list:
|
BATCHJOB21 |
Load data for Underwriting changes |
JU3AZ_UNDWRT\Bju3azo0.bat |
To initiate the batch job, click Submit in the Action column.
When a change in membership data is recorded that results in a change in members’ risk benefit cover amounts, the EOH limits are checked for the relevant risk products.
Log in to the system from the Logon page.
Click products.
The Welcome screen will be displayed.
From the main menu on top, click List. The JU1BK List screen will be displayed.
Highlight a product from the list and select Underwriting from the sub-menu on the left.
The JU3BM Risk Schedule List screen will be displayed. All members whose annual salary exceeds the EOH limit for the product will be shown.
Highlight a member from the list and select Membership Risk Cover from the sub-menu on the left.
The JU3BL Membership Risk Cover list screen will be displayed.
Highlight a risk cover for the member and click OPEN. The JU3BL Membership Risk Cover screen will be displayed.
This screen allows you to manage the EOH for each member’s risk benefit cover. You are able to document decisions made by the underwriter for each member.
Descriptions of the input fields in the Risk Cover section of this screen appear below.
|
Risk Cover |
|
|
Underwriter Decision |
Select the appropriate value from the drop-down box.
The following options are available: ACCEPTED The underwriter has accepted the member’s application for cover in excess of the EOH limit. The member’s risk benefit cover can increase in excess of the EOH limit. ACCEPT RESTRICT The underwriter has accepted the member’s application for cover in excess of the EOH limit but with restrictions. The member’s risk benefit cover can increase in excess of the EOH limit. DECLINED The underwriter has declined the member’s application for cover in excess of the EOH limit. The member’s risk benefit cover will remain at the EOH limit. PENDING The member’s application for cover in excess of the EOH limit is pending because either the member has not yet submitted evidence of health to the underwriter or the underwriter is still assessing the information. The member’s risk benefit cover will remain at the EOH limit. RESTRICTED Restrictions have been applied on the member’s cover. (Also refer to the Restriction Reason field below). |
|
Effective Date |
The date on which the member details on this screen become effective. |
|
Cover Amount |
The current amount of risk benefit cover that a member is entitled to. |
|
Potential Cover |
The amount of risk cover that a member will be entitled to if EOH is accepted by the underwriter. |
|
Next Limit |
The value above which evidence of health will be required. Note: If a value has been captured for SALARY INCREASE %, no value can be captured here. |
|
Salary |
The member's risk salary. |
|
Premium Loading Percentage |
The additional percentage of premium that the member must pay for the amount of risk benefit cover in excess of the EOH limit.
Note: A member’s EOH may be accepted by an underwriter, but deemed to be such that there is still sufficient risk present to warrant the imposition of a health loading. The loading may be either a percentage or a flat amount, but not both. If a value is entered in the percentage field, then the amount field will be disabled, and vice versa. |
|
Premium Loading Amount |
The additional flat amount of premium that the member must pay for the amount of risk benefit cover in excess of the EOH limit.
Note: A member’s EOH may be accepted by an underwriter, but deemed to be such that there is still sufficient risk present to warrant the imposition of a health loading. The loading may be either a percentage or a flat amount, but not both. If a value is entered in the amount field, then the percentage field will be disabled, and vice versa. |
|
Run Date |
The date that the batch job ran. |
|
End Date |
The date on which the member details on this screen are no longer in force. |
|
Restriction End Date |
The date on which restrictions imposed on the member’s cover will end. |
|
Salary Increase % |
The percentage increase in salary above which evidence of health will be required. Note: If a value has been captured for NEXT LIMIT, no value can be captured here. |
|
Auth. Userid |
The User ID of the person who authorised the Membership Risk Cover. |
|
Auth Timestamp |
The timestamp for the authorised Membership Risk Cover. |
|
Restriction Reason |
The specific reason for a restriction placed on a member’s cover. Select the appropriate value from the drop-down list. |
|
LOAD DOCUMENT |
Select Load Document to upload a document (e.g. Medical Questionnaire, Medical Examination or Pathology Report, etc.).
Refer to Load Document below. |
|
VIEW DOCUMENT |
Select View Document to display the documents linked to the JU3BL Membership Risk Cover record. Only users with the necessary access linked to the UNDERWRITING Document Category will have access to view the documents. If no documentation has been received or further documents are required, the Communicate button must be selected.
Refer to View Document below. |
|
ADDITIONAL ASSESSMENT |
Select Additional Assessment to display and select from a list of medical conditions for which the member must be assessed.
Refer to Additional Assessment below. |
|
COMMUNICATE |
Select Communicate for the relevant template to be selected for correspondence to be forwarded to the Product. The system will flow to a Document Select screen and list the Document Templates with a PDF Process of PRESCREENING or UNDERWRITING from where the relevant templates can be selected.
Refer to Communicate below. |
|
ADDITIONAL NOTES
|
Select Additional Notes to add any free form text notes regarding the member’s evidence of health. Note: In order to save a new note, the underwriting record must be updated. Thereafter, the note can be updated or maintained. Refer to Additional Notes below. |
Click OK. The JU3BL Membership Risk Cover List screen will be re-displayed. The value selected in the UNDERWRITER DECISION field will be displayed, e.g. ACCEPTED.
This functionality allows you to upload a document (e.g. Medical Questionnaire, Medical Examination or Pathology Report, etc.).
Note:
This functionality can be accessed using either of the following methods:
On the Membership Risk Cover List screen, select Load Document from the sub-menu on the left.
On the JU3BL Membership Risk Cover screen, click LOAD DOCUMENT.
Once Load Document has been selected, the Document Upload screen will be displayed.
Click 
alongside Document Type, then select the required type of document to be uploaded (e.g. Medical Questionnaire, Medical Examination or Pathology Report, etc.) from the drop-down list.
Capture any free form text about the document being uploaded in the Comment field.
Use BROWSE to find the document to be uploaded, then click SUBMIT. A message will confirm that the file has been successfully uploaded.
This functionality allows you to display the documents linked to the JU3BL Membership Risk Cover record. This allows you to review Underwriter feedback.
Only users with the necessary access linked to the UNDERWRITING Document Category will have access to view the documents.
If no documentation has been received or further documents are required, the Communicate button must be selected.
Note:
This functionality can be accessed using either of the following methods:
On the Membership Risk Cover List screen, select View Document from the sub-menu on the left.
On the JU3BL Membership Risk Cover screen, click VIEW DOCUMENT.
The Documents Uploaded screen will be displayed.
This screen displays any documents already uploaded.
Click alongside Document Categories, then select the required document category to be viewed (e.g. Disability management etc.) from the drop-down list.
The Document Categories field value selected will determine which Document Types are displayed for selection.
Click alongside Document Type, then select the required type of document to be viewed (e.g. Medical Questionnaire, Medical Examination or Pathology Report, etc.) from the drop-down list. A list of documents previously uploaded will be displayed for the File Document selected.
The Document Type field values displayed for selection are determined by the Document Category selected in the Document Categories field.
Note:
The system will only display the document categories and document types relevant to the particular menu and to which the user has access.
Click the hyperlinked document name to view the document.
To capture Storage Information for the document, click at the end of the line.
The Storage Information screen will be displayed.
This screen allows for the capture of the Company, Region and Box Number for the selected document.
Capture information as follows:
|
Company |
Select a Company from the drop-down list. |
|
Region |
Select a Region from the drop-down list. |
|
Box Number |
The Box Number where the document is stored
This field is alphanumeric. |
Click SAVE.
The Documents Uploaded screen will display the data captured in the Company, Region and Box Number fields.
For more information, refer to
Infrastructure
System Entities
File Storage Company
This functionality allows you to specify the medical conditions for which additional assessment is required.
Select ADDITIONAL ASSESSMENT on the JU3BL Membership Risk Cover screen.
The JU3TE Additional Assessment List screen will be displayed.
Click MEDICAL CONDITIONS to display a list of medical conditions to select from.
The JU3TE Additional Assessment screen will be displayed.
Click on one or more items in the Medical Condition column and click OK.
Note:
You may select more than one medical condition at the same time. To deselect a medical condition, click on the item a second time.
The JU3TE Additional Assessment List screen will be displayed with the selection (s) made.
This functionality allows you to communicate with a Client by selecting a specific Letter Template for disability Claim Assessment, Pre-screening or Underwriting.
Note:
This functionality can be accessed using either of the following methods:
On the Membership Risk Cover List screen, select Member Communication from the sub-menu on the left.
On the JU3BL Membership Risk Cover screen, click COMMUNICATE.
Select COMMUNICATE on the JU3BL Membership Risk Cover screen.
The JU3BN Membership Risk Cover Communication screen will be displayed.
Select one of the following values from the Process Type drop-down list:
- DIS ASSESSMENT
- PRE SCREENING
- UNDERWRITING
Click the LIST button alongside PDF Template to select a Template.
The JU3BN Letter Template List screen will display a list of Letter Templates available for selection.
Select a Letter Template and click SELECT.
The selection will be displayed on the JU3BN Letter Template List screen.
To preview the PDF document that is produced using the selected PDF Template, click PREVIEW PDF DOCUMENT
The letter will be displayed in PDF format.
Example:
Click CLOSE to return to the JU3BL Membership Risk Cover screen.
To capture a text note regarding the member’s evidence of health, click ADDITIONAL NOTES.
Note:
In order to save a new note, the underwriting record must be updated. Thereafter, the note can be updated or maintained.
The JV0AA Maintain Notation screen will be displayed.
To add a new note, click NEW.
The JV0AA Maintain Notation screen will be displayed.
Capture data as follows:
|
Header |
A short description of the note. |
|
Date |
The date on which the note is captured. |
|
Follow-up Date |
The date on which the note must be followed up with the member or Client. |
|
Type |
The type of note that is being captured. Select a value from the drop-down list. Examples: Medical Questionnaire, Pathology Report or Personal Declaration. |
|
Response Date |
The date on which a response was received from the member or Client.
This date will also be displayed on the JU3EV Member Correspondence screen |
|
Purpose |
The general purpose of the note. Select a value from the drop-down list. Examples: Inbound, Information, Internal or Outbound. Note: The note will not be displayed on the Report to the Employer if a value of Internal is selected. |
|
Source |
The source of the note. Select a value from the drop-down list. Examples: Medical Report, Bulk Load, External, Letter, Phone Call etc. |
|
Status |
The status of the note. Select a value from the drop-down list. Values are currently:
Completed, Outstanding, Pending or Referred to Back Office |
|
Text input area |
Provide the relevant free-form text. |
Click OK.
The JV0AA Maintain Notation screen will be re-displayed. The short description will appear as the HEADER.
Viewing existing notes
To view existing notes, highlight the required note, then click OPEN. The JV0AA Notation Details screen will be displayed.
Deleting notes
To delete notes, highlight the required note, then click DELETE. The JV0AA Maintain Notation screen will be displayed.
Click OK. A confirmation message will be displayed.
Are you sure you wish to delete this occurrence?
Click YES.
The JV0AA Maintain Notation screen will be re-displayed.
This functionality allows you to to view a history of the Service Request linked to the Membership Risk Cover record.
On the Membership Risk Cover List screen, select a Membership Risk Cover then select Process Flow from the sub-menu on the left.
The Process Flow screen will be displayed.
The Process Flow screen displays the Activity Names per Service Request.
- A status of OPEN is displayed if the status of the Activity Name is not equal to COMPLETED.
- A status of COMPLETED is displayed if the status of the Activity Name is equal to COMPLETED.
If CLOSE is selected, the Process Status of the Activity Name of the Service Request will be set to COMPLETED.
If OPEN is selected for an Activity Name, the Activity Name of the Service Request will be updated to the Activity Name selected.
Click HISTORY to view a history of each OPEN and COMPLETED Process Status for an Activity Name.
Click BACK to return to the Process Flow screen.
Click SUBMIT once the necessary selection has been made.
Changes that have been made to a member’s risk cover may affect the risk premium being charged. To recalculate the correct risk benefit premiums for a member, go to the Salaries and Contributions screen on the web (under the Data Capture option for the current open cycle).
Select the member whose premium must be recalculated, and click RECALCULATE.
The system will automatically recalculate the risk premium, taking into account the underwriter’s current decision as well as any premium loading percentage or amount.