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  • Prime Senior Underwriting Direct Reject Scenario

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    amir
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    This document provides guidelines on accepting or rejecting applicants for a senior health insurance plan based on their medical conditions. Conditions are categorized and described as either acceptable if meeting criteria, a direct reject, or requiring mandatory documents for underwriting review if in the acceptable range. Some conditions that would result in direct rejection include unoperated heart disease, paralysis with neurodeficit, and Parkinson's disease. Conditions requiring further documentation include cancer with staging details, epilepsy with recent reports, and heart diseases with surgical reports and follow up details. Disability certificates are needed if the disability is over 40%.

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    Prime Senior

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    This document provides guidelines on accepting or rejecting applicants for a senior health insurance plan based on their medical conditions. Conditions are categorized and described as either acceptable if meeting criteria, a direct reject, or requiring mandatory documents for underwriting review if in the acceptable range. Some conditions that would result in direct rejection include unoperated heart disease, paralysis with neurodeficit, and Parkinson's disease. Conditions requiring further documentation include cancer with staging details, epilepsy with recent reports, and heart diseases with surgical reports and follow up details. Disability certificates are needed if the disability is over 40%.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    18 views1 page

    Prime Senior Underwriting Direct Reject Scenario

    Uploaded by

    amir
    This document provides guidelines on accepting or rejecting applicants for a senior health insurance plan based on their medical conditions. Conditions are categorized and described as either acceptable if meeting criteria, a direct reject, or requiring mandatory documents for underwriting review if in the acceptable range. Some conditions that would result in direct rejection include unoperated heart disease, paralysis with neurodeficit, and Parkinson's disease. Conditions requiring further documentation include cancer with staging details, epilepsy with recent reports, and heart diseases with surgical reports and follow up details. Disability certificates are needed if the disability is over 40%.

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    © All Rights Reserved
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    of 1

    ManipalCigna Prime Senior Important Reject /Accept Information

    Acceptable for Evaluation (If meeting Direct REJEECT Scenario Mandatory Documents Required for UW decision if falling in Acceptable
    Category of Illness
    this ONLY ) Please Don’t LOGIN the case Range
    1. Cancer staging.
    No treatment/ symptoms for minimum last
    2. Treatment details - Medical and/or Surgical.
    3 years
    i.Cancer or Tumour or Lump Grade 3 & Above is direct Reject 3. Certificate of treatment completion along with discharge summary.
    Only Grade 1 and 2 are acceptable for 4. Recent follow up Consultation papers with investigation reports
    evaluation basis complete document.
    Recent follow up Consultation papers with investigation reports latest ECG and
    ii. Epilepsy No episode in last 2 year
    CT report

    ANGIOPLASTY or CABG WITH Hypertension + Diabetes


    1. Discharge Summary with Angiography & Angioplasty/CABG Report
    Surgical intervention done minimum 2 2. Recent follow up papers from cardiologist mentioning B.P records and ECG
    iii. Heart Diseases(Angioplasty/CABG) CORONARY ARTERY DISEASE -TRIPLE VESSEL
    years back and maximum 7 years back .Recent investigations reports including 2D Echo ,HbA1c and other blood
    DISEASE
    reports suggested by cardologist
    Un-Operated HEART DISEASE - REJECT
    iv. Physical
    impairment/infirmity/deformity or any
    Disability shall be less than 40% Above 40% disability is REJECT Disability certificate showing the % of disability
    condition that may affect mobility/
    sight/hearing/speech
    SLE (Systemic Lupus Erythematosus)
    Sjogren's Syndrome
    v. Auto-Immune Diseases
    Ankylosing Spondylytis
    Rheumatoid Arthritis
    Inflammatory Bowel Disease
    CLD (Chronic Liver Disease)
    Vi. Gastro Intestinal Conditions
    Hepatitis B & Hepatitis C
    Pancreatitis
    Parkinsons disease Direct Reject
    Paralysis with Neurodeficit
    Mysthenia Gravis
    Vii. Cerbro Vascular Conditions
    Neuro Muscular Disorders
    Cerebral palsy
    Alzeimer's
    Chronic Kidney Disease (CKD)
    Viii. Genito Urinary Conditionns Nephropathy/Nephritic Syndrome/Nephrotic Syndrome/Glomerulonephritis
    Single Kidney/Polycystic Kidney/Contracted Kidney

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