Toward an end-to-end process for handling mental health insurance claims

We sampled about four thousand claims for that number. In terms of underwriting, where members are obviously making active decisions to access funds prior to increasing their amount of insurance relative to what’s provided automatically, we’re seeing a range of factors that are effecting members accessibility to that cover. Some of the funds that we serve, we’ve seen quite significant dropout rates of up to 26 per cent. That in itself is a statistic that’s of concern, given that the dropout rates range across the funds from around 11 per cent to 26 per cent. In many respects it highlights member disengagement with the process, because they’ve actively gone out there and said ‘yes, we want more insurance cover’.

But then as they’ve actually gone through the process, they’ve come to the conclusion it’s either too hard, too complicated, too many requirements, they just don’t want to go ahead with it so they effectively cancel the application…Now I know there have been some initiatives to try to address that with respect to increasing the amounts of cover available through short forms, long forms, personal statements and the like. But they effectively will address the cleanskin underwriting. The issue is those members that have to go through the health process – blood tests, medical examinations and the like. John Paul: You make the comment that you’re worried about the fact that there’s 26 per cent that don’t proceed. I just wonder whether you’ve got, underneath that statistic, some indication of whether these people have sought to get underwriting because they’ve developed cancer or they’ve got some other reason for seeking that cover.

They‘ve then got the form and they‘ve realized that, okay, I‘m not going to be able to go through that process because I‘m going to identify this problem, and therefore they don‘t proceed. So have you done anything on that? Nick Galanakis: That’s a very good question. The analysis hasn’t gone into that sort of depth as of yet. I guess the CURE initiative will be looking at a high level, an outline of why we’re actually undertaking it and from there we’ll start focusing on exactly what it is the funds are trying to get out of the information, and what we’re seeing out there. So the short answer to your question is no. That will be something we’ll want to look at. Damian Hill: There’s quite a diversity among funds in your percentage of cases declined there. Can you attribute that to any different underwriting standards, like 100 per cent ‘accept the client’ versus perhaps being accepted with exclusions or loadings? Nick Galanakis: Definitely. That’s actually spot on.

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Why super needs a ‘zero-defect mindset’  for operational risk

From cyber-attacks and credential-stuffing scams to fragile third-party ecosystems, the super system is facing a reckoning about how resilient it really is. As the implausible becomes inevitable, funds must sharpen their focus on operational risk.

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