Policy wording
I'm going on a skiing trip if I'm caught in an avalanche will I be covered for search and rescue
No search and rescue is NOT covered under general exlcusions
Why can’t customers use alternative treatments?
We are ok with customers finding alternative treatments or any treatment that suits them, but the pre-existing condition must be diagnosed by a medical professional first.
Give 5 examples of when you would screen all & exclude all at the POS
1.Diagnosed & awaiting tests/ investigations
2. Unresolved infection
3. Dialysis
4. Radiotherapy
5. Chemotherapy
Which referral tab would you follow when medical declines on a geo/ cruise upgrade
Upgrades to geo/cruise and answer yes to the first question: "Have you had a change in health?"
Can a customer amend their medical on Mystaysure?
Yes, they can add and amend conditions
I'm going scuba diving but I do not hold any qualifications - Am I covered?
If you do not hold a diving qualification we will only cover you to dive to a maximum depth of 18 meters when accompanied by and under the direction of qualified diving instructor as part of an accredited course
Why would you screen a suspected condition if a customer doesn't know if they had it?
This sometimes happens in the medical world -people can be told they had a suspected Stroke or suspected Heart Attack. The only time we would be screening the condition is if it appears on their medical record. if it doesn’t then we wouldn’t have to screen it.
Give me 3 examples of when we cannot cover customer at POS?
1. Terminal illness
2. Doesn't fit eligibility criteria
3. Medical declines on the HUB
When pre-exisiting medical is excluded on the policy and the customer wants to include them =, what is the correct process?
Re-screen previous medical and include any new conditions and run through a referral then charge the premium if applicable
Are amendments made through Mystaysure free of charge?
No customer will still have to pay the AP but will avoid having to pay AF
Adopted, fostered and step-children are not classed by Staysure as family
False- they are classed as family by Staysure definition
A customer has called to declare that they have recently suffered with Covid-19. What is the correct process we must follow?
Tell them we can’t cover anything related to their most recently contracted Covid but may look to cover any newly contracted cases on a claim by claim basis – pop a note on the system.
What must you check when the customer declares a preventative medication for a condition? What are the 3 exceptions?
1. Have you ever had the condition before?
2. HBP, Cholesterol, Diabetes
Explain in your own word: If the insured still wishes to travel and can find alternative cover with a different company that fully covers ALL of their pre-existing conditions, then they can still submit a cancellation claim for the cost of the new single trip policy that they buy elsewhere up to the cancellation cost of the holiday.
You must advise them that the policy excess still applies if they choose to go down this route.
Customer can purchase a ST policy with another company (not within Staysure ecosystem) that covers all of their pre-existing conditions up to the cancellation cost of the holiday minus any excess. And then they submit a cancellation to have the cost of the ST policy purchased elsewhere reimbursed
How many contact ID's can be linked with MyStaysure ID?
Only 1 contact ID can be linked with MyStaysure ID
Which insurance principle implies that everyone entering the contract must be honest and provide correct information
Upmost good faith
What must you do if a customer declares they have a rash on their arm and are still awaiting tests?
Follow the undiagnosed condition process
Is there a timeframe on NTR
There is no timescale, even if the customer declares a NTR from 55 years we would still have to check the NTR questions
You following the "awaiting scans, tests, results" referral and you come across this question: "Is the scan, tests or results related to a condition on the accepted procedure list? (If unsure, answer no)" - in your own word explain what is the meaning? Would you ask this question to your customer?
Effectively it is there to capture if a test is in relation to any of the conditions that are listed in the accepted listed such as cataracts etc - if unsure select no. The agent doesn’t have to ask the customer as the customer won’t know
How does auto account creation work?
As soon as the policy is purchased a link is sent to the customer to set up an account if they haven't already
Which insurance principle implies that every customer must be taking reasonable care of their belongings in order to have a valid claim (e.g. not leave them unattended)
Loss minimization
Give 3 scenarios when I can remove a condition off the policy?
1. When it no longer fits the 2 year criteria and the 2 year criteria has been checked and all answers are no.
2. Mis-diagnosed for this ensure that the mis-diagnosed condition no longer shows on their medical records.
3. If stated to by referral outcome.
1.How many accepted surgeries will our underwriter cover? What would happen if a customer declares multiple accepted surgeries? Will the UW cover a non-accepted surgery?
2. What would you screen it as?
1. Our Underwriter can only allow cover for one procedure from the list. If procedure is not on the list, or multiple procedures are selected; then the existing rule where all pre-existing medical conditions are excluded from cover MUST be applied.
2. Mark it as awaiting surgery "other"
If medical is already excluded from the customer’s policy and they call us to add on a new condition for which they are awaiting tests, what is the correct process we must follow?
Add on the new condition and continue to leave everything excluded until the test results come back
What would you do if multiple contact ID's need to be linked to MyStaysure profile
Link contact ID with contact ID using the exception manager