Knowledge Description

In our system the individual results have the following meaning:

Standard
An entirely normal risk.

Borderline standard
A slightly increased risk, which is accepted at standard terms in accordance with company policy (business decision - e.g. a loading or further requirements like a medical attendant’s report are being waived).

Accept with loading
An increased risk, for which loading or exclusion clauses are required. However, these are already captured in the proposal and reflected in the relevant premium (e.g. occupational group in IP). Therefore a policy can be issued and there is no need to make an offer.

Offer
As above, but the loading will result in the payment of an extra premium, or an exclusion clause has to be accepted by the client; consequently the client will be given an offer.

Risk data incomplete
Data relevant to the risk (e.g. occupation) is missing in the application. Therefore not all assessments can be completed.

Substandard
The application must be referred to an underwriter. The system may arrive at this result because

Decline
The risk should be declined. This result tells the underwriter that the application cannot be accepted in its present form. The underwriter should be able to evaluate alternative offers on the basis of the risk factors identified by the system. Therefore each application is evaluated in all areas, even where the reason for decline (e.g. HIV infection) can easily be identified. The underwriter thus obtains a concise overview of all risk-related aspects.

The assessment result can be displayed with COMPASS or with a company’s own screens. The output interface includes all information needed to display the assessment. The result displayed in COMPASS is structured in the following way:

For the COMPASS Point-of-Sale – the output has to be implemented by a company. Each company has to decide, which results shall be displayed.

Beneficiary Death
The completeness of the beneficiary is checked. If no beneficiary is indicated, the incomplete reaction for the relevant beneficiary is triggered as for any other incomplete data. If the beneficiary is indicated, it is checked within the AIDS risk (see AIDS risk). Furthermore a check is performed to see whether, in the event of death, a drawing entitlement is indicated for the insured himself. This is the case if the beneficiary is the policyholder, but the policyholder is also the assured person. In this case the application is referred with the comment ‘insured authorizes himself’. Term or whole life benefits are checked as to whether the death beneficiary is indicated. If it is missing COMPASS reacts according the incomplete reaction.

Special agreements
If the question for special agreements is answered ‚yes’ and no special agreements are indicated, a client request is initiated.

Agent check
COMPASS stores the following data on the agent/broker:

The following checks are processed for the agent:

Agent flag
The agent code is stored in a database with text, which then appears as a comment in the result 'check agent/broker, because'. No further processing is done with this code (e.g. special commission arrangement, new broker).

Agent is premium contributor
If the agent’s / broker’s name is the same as the premium payer’s name and the broker is not the policyholder, the application is referred with the comment 'broker and premium payer are identical'. The agent / broker data is made available to COMPASS via the interface database from the company’s own agent / broker database.

The agent’s nationality is checked within the check for the policyholder.

Relationship between PH and AP
If an AP exists that has specified ‘other’ as relationship to the PH, the application is referred with ‘check relationship between APs and PHs’. This reaction is only executed if the field relationship to PH is used in the input interface. It is executed only once for the application form. See also the chapter ‘special checks for PH’ for other regulations on the relationship between AP and PH.

Missing signatures
If the general question for signatures is answered with ‚no’, the signature is requested from the client.

Missing account holder signature
If the account holder is different as the AP and PH and the answer to the questions for signature of account holder is answered with ‚no’, the signature is requested from the client.

Missing agent signature
If the question for signature of the agent is answered ’no’, the application is referred with a hint on the missing signature.

Deletions
Deletions and amendments in the closing declaration or on the reverse of the application are significant. Applications with deletions are therefore referred with the comment 'deletion/amendment in the closing declaration, or similar.

Telephone Inquiry
If the question regarding telephone enquiry is answered "yes", the result contains the comment 'telephone enquiry - confirm in writing’.

This chapter includes policyholder related completeness checks. The checks are only done if the Policyholder (PH) is not an assured person (AP).

Investment income
If the question for investment income (y/n) is answered with ‚yes’ and/or no amount is given, COMPASS reacts according to the incompleteness reaction.

Occupation
If the sex of the policyholder is male or female and the occupation is not given, COMPASS reacts according to the incompleteness reaction.

Occupational status
If the sex of the policyholder is male or female and the occupational status is not given, COMPASS reacts according to the incompleteness reaction.

Branch of industry
If the sex of the policyholder is male or female and the branch of industry is not given, COMPASS reacts according to the incompleteness reaction.

Physical work
If the sex of the policyholder is male or female and the answer to the field physical work (y/n) is not given, COMPASS reacts according to the incompleteness reaction.

Annual income
If the sex of the policyholder is male or female and the amount of the annual income is not given, COMPASS reacts according to the incompleteness reaction.

The financial assessment for the policyholder is implemented within this risk. The documentation contains the description of these checks in the chapter Financial Assessment.

Signatures
The incompleteness check for the policyholder’s signature is processed, if it is needed:

A typical value for signature_age might be 18 years. The system will check the age on the day the application form was signed.

Minor Policyholders
In the financial limit database the benefit group ‘Life: Financial Check for PH’ is reserved for financial PH checks. The sum assured that is used for the test, is the sum of the sums of all benefits with event death. In the limit-database several entries can be made in different age ranges. So every company has the flexibility to decide up to which sums minor policyholders are acceptable. Possible explanation texts for referral are: 'policyholder is a minor’ or 'check sum assured for under-aged policyholder'. Additional documents can be requested. The rules required documents and required hints initiate the request.

The assessment of the nationality risk for the PH is based on the Country Database. The country database includes a code for any synonym term. The relation 'Region belongs to country' connects abbreviations, towns and regions of a country with the country. The assessment of e.g. single regions can be different.

Nationality cannot be captured
Where '?' is entered for nationality, the application is referred with the comment 'nationality cannot be entered'.

Nationality unknown
A check is made to see whether the database contains any entry at all for the specific nationality. If not, the application is referred with the comment 'policyholder’s nationality not found'. If the policyholder’s nationality is unknown, the incompleteness reaction is triggered if the PH is a natural person.

The PH will be assessed on the basis of his nationality and place of residence. The following assessments have been used within the nationality risk for compensation of the risk level:

Other assessments, e.g. a request of additional documents (work permission, etc), can be implemented.

Risk level may depend on the following conditions:

Residence
The residence check is done with the internal attribute residence ok for PH. For setting of the internal attribute the value of the country db attribute ’Residence’ is used and checked on adherence. The attribute ‘Residence’ has four values:

The relation ’Country belongs to country group’ determines the membership to a country group. The countries of this country group can be assessed analogue, but individual assessment is also possible.

For a referral the comment 'no matching residence' can be given.

Length of Residence
The length of residence can be checked in addition to the residency.

This risk can contain overall rules for document requirements for nationality. Currently it is empty.

For the following application fields it is checked, whether the answer is given and if details have been indicated. This assessment is only done, if the fields are part of the application form. If details are missing, the relevant question and a hint on the missing details is given in the result:

Hints to all questions
If a question is not used in a source type, the plausibility rule has to be deleted or the incomplete reactions have to be set to ‘ignore’ to avoid an incompleteness reaction. If questions are depending on conditions (to be defined in the user interface db), the conditions have to be repeated within this risk level. Possible conditions are only for IP, only for very high sums insured.

Hints to the medical questions
Answers to medical questions of the AP can be processed as needed according to plausibility and completeness. Processing is person-related, unless a reaction applies to one particular benefit/event. 50 questions (health question 1 to 50) are available for these medical questions. Plausibilities in regard of questions numbers, periods and organ categories can be included.

Examples:

Category 1
When the question is answered with 'yes' and no disorder is given in response to this question, the incompleteness reaction is triggered.
If the question is answered 'yes' and a disorder is stated, the assessment takes the disorder into account.

Category 2
If the question is answered with 'yes' and no disorder is given in response to the specified organ category, the application is referred with the comment 'no disorder given for organ system' or the result is incomplete.
If the question is answered with 'yes' and a relevant disorder is given, the assessment takes the disorder into account.

Category 3
If the question is answered with 'yes' and no disorder is given in response to this question, the incompleteness reaction is triggered.
If the question is answered with 'yes' and a disorder is given, the application is referred with the comment 'check disorder to following question'.

Category 4
If the question is answered with 'yes' in response to this question, the incompleteness reaction is triggered.
If the question is answered with 'yes' and a disorder is given, the assessment takes the disorder into account for Life, Accident, H&S and LTC. IP, CI and TPD applications will be referred in any case with the comment 'check disorder to following questions'.

Category 5
If the question is answered with 'yes' and no disorder or dioptres are given in response to this question, the incompleteness reaction is triggered.
If the question is answered with 'yes' and a disorder or dioptres are given, the assessment takes the disorder or visual impairment into account.

Assessment of pre-existing policy

For application detail and association registry entries it is checked if the policy is with one’s own company. The company is defined with CSP company.

Association registry

The details are taken from the interface data. A check is made to see whether there is any data available on the life to be assured. Independent on the event/benefit, only entries with result substandard are taken into account. It is checked by which company the entry given.

Association registry own company
If the pre-existing policy is with one’s own company, the application is referred with the comment 'pre-existing policy accepted as substandard risk'.

Association registry other companies
If the pre-existing policy is with another company the CSP association registry reaction GPR will determine whether the application is referred with the comment ‘check association registry’ (066) and additionally a GPR is requested.

Association registry company unknown
If the company cannot be found in the company database, the application is referred with the comment 'entry with unknown company'.

Own Portfolio details

The portfolio details are entered in the interface in cumulative form. For every event in the portfolio the following fields may be provided by the administrative system: sum assured to be considered for the financial assessment, sum assured to be considered for the medical assessment and acceptance result (worst acceptance result of all pre-existing policies). The sum of the field with the extension _f, for example sum_assured_f, is used in the financial assessment. The sum of the field with the extension _e, for example sum_assured_e, is used in the evaluation of examination limits.

Own portfolio policy substandard
If the acceptance result from pre-existing policies is ‘substandard’, the application is referred to the underwriter with the comment 'pre-existing policy with substandard result in portfolio’.

Own portfolio policy declined
If the acceptance result from pre-existing policies is ‘decline, the application is referred to the underwriter with the comment 'pre-existing policy declined in portfolio’.

Own portfolio policy incomplete
If the acceptance result from pre-existing policies is ‘incomplete’, the application is referred to the underwriter with the comment 'pre-existing policy incomplete in portfolio’.

Own portfolio policy claim
If the acceptance result from the pre-existing policies is ‘claim', the application is referred to the underwriter with the comment 'pre-existing policy with claim in portfolio’.

Own portfolio policy longstop
If the longstop limit is exceeded, recognized by the interface field longstop, the application is referred and the comment ‘check longstop limit’ is given. A longstop limit is an internal definition of pre-existing insurances.

Application details

Benefit related substandard previous insurances
Substandard, declined or deferred pre-existing policies, which are declared by the life to be assured in the application form (as an answer to the question related to every type of benefit), are referred to the underwriter with the comment 'client indicates pre-existing substandard policy'. Substandard previous insurances at the own company are processed in the same way.

General substandard previous insurances
Substandard, declined or deferred pre-existing policies, which are declared by the life to be assured in the application form (as an answer to the general field for substandard, declined or deferred pre-existing policies), are referred to the underwriter with the comment 'client indicates pre-existing substandard policy’.

Medical questions with special reactions
Questions included within this paragraph contain the described reactions. They can be used accordingly or the reaction can be modified via the maintenance program:

Incapable of working
Have you been ill for longer than two weeks?
If the question is answered with 'yes' and no disorder is given in response to this question and the AP is not a child, the application is referred with the comment 'no individual health indication'. If the question is answered with 'yes' and a disorder is given, the assessment takes the disorder into account. If the question is not answered, an 'incomplete' reaction is given unless the life assured is a child (age under 18), i.e. the age at proposal is less or equal to CSP signature age.

Healthy and able to work
Are you healthy/able to work?
If the answer is ‘no’ and no disorder is given in response to this question and the AP is not a child, the application is referred with the comment 'no individual health indication'
If the question is answered with 'no' and a disorder is given, the assessment takes the disorder into account. If the question is not answered, an 'incomplete' reaction is given unless the life assured is a child (age under 18), i.e. the age at proposal is less or equal to CSP signature age.

Reduction in earning capacity
Do you suffer from any reduction in your earning capacity?
Independent of the percentage of the reduction of earning capacity, the application is referred to the underwriter for final assessment. The hint ‘reduction on earning capacity’ is given. If the percentage of the reduction of earning capacity is missing, the incomplete reaction is triggered.

More disorders
Have you stated all disorders?
If the answer is ‘no’, the application is referred with the comment ‘not all disorders specified’.

Positive HIV test
Have you tested positive for HIV/AIDS?
If the answer is 'yes', the AIDS risk probability is set to 1.0 and the application is declined.

Suicide attempt
Have you ever attempted suicide?
If the answer is 'yes', the application is referred with the comment ‘suicide attempt’.

Hypertension
Do you suffer from high blood pressure?
If the answer is 'yes', the medical report blood pressure is requested. If the answer is missing, the incompleteness reaction is triggered.

Cholesterol
Do you suffer from hypercholesterolaemia?
If the answer is 'yes', the medical report for cholesterol is requested. If the answer is missing, the incompleteness reaction is triggered.

Suspicious signature
If the signature is suspicious, the application is always referred with the comment 'suspicious signature', because it may reveal signs of illness, alcohol or drug abuse etc.

The Aids combination risk consists of the evaluation of the lifestyle questions and the aids risk derived from all application data, based on a probability function.

Currently this risk level does not include any check. Possible checks are e.g. healthy person but younger than 60 and already a pensioner.

This chapter includes assessments considering the sum insured of same events, independent on the benefit.

Signatures
The incompleteness check for the assured person’s signature is processed, if it is needed:

A typical value for CSP signature age might be 18 years. COMPASS will check the age on the day the application form was signed.

Signature health declaration
The signature for the health declaration is needed, if the age at proposal is less or equals the value of CSP signature age. If the signature is not available it is requested from the client.

Minor assured persons
The benefit group related entries in the financial limit database can be used for age and sum insured related checks of minor assured persons. So every company has the flexibility to decide up to which sums minor assured persons are acceptable. Possible explanation texts for referral are: 'insured is a minor, acceptance guidelines not adhered to’.

Classification

The disorders are classified according to the ICD10 classification of the World Health Organisation (WHO). ICD 10 has been used selectively as the use of the full ICD10 would have made the database inefficient (more than 50,000 entries) and would have included many entries that will never occur in an application form. All ICD 10 chapters covering terms already used in the previous disorder database have been included in the new database. Of course each company can individually decide to have further terms added at any time. Some of the previous terms have been abbreviated or slightly changed to improve readability and unambiguity. No changes have been made to the structure or keys of the database. Additionally a surgery coding system called OPS310 has been added, so that the database now covers approximately 16,000 entries.

Synonyms are expressed by adding a separator (= dash) and a 3-digit consecutive number (starting with 001) to the key. 3-digit numbers, which are followed by 5-digit sub groups, cannot have synonyms.

Examples for synonyms:
X99.99-999
X99.9-999
X99-999

B35.9-001 | Appendicitis
B35.9-002 | acute appendicitis

Synonyms are expressed by adding a separator (= dash) and a 2-digit consecutive number to the key. X-digit numbers which are followed by x+1-digit sub groups cannot have synonyms.

Example for synonyms:
9-999.XX-99
9-999.X-99
9-999-99

5-445-01 | Bypass stomach
5-393.7-01 | Bypass lower leg

As each individual term has a separate key all terms can be assessed individually.

Basis for the disorder assessments

ICD10 is structured so that most of the assessments are homogenous at the Major Group (MG) level, and quite a lot of the major groups within a Super Group are also homogenous for assessments.

In making the modifications to the Disorder DB, consideration was given to current underwriting guidelines given in the Gen Re CLUE online manual. This gave valuable insights into the risk of a given disorder by benefit and in particular how this risk is evaluated in terms of the recommended underwriting decision.

This decision often requires further information not given in an application form but requiring a GPR or Pathology results which may not be available to the applicant. However, there are many instances where a condition may be accepted at Standard when a given time has elapsed since the complete resolution of a condition and/or the condition was within a specified duration. Also loadings and exclusions are possible.

Any assessment that was not obvious from CLUE was checked against Medical Literature and opinions from various other sources. These included Medical Journal archives and the use of the various Internet search tools.

The writer’s own experience, both as a Registered Medical Practitioner and previous position as Chief Underwriter for a major Direct Life company, was also used extensively in evaluating each assessment. An overriding consideration was to ensure that all assessments were valid and consistent, with as much homogeneity of assessments within subgroups as possible for ease of implementation and maintenance without compromising the validity of these assessments.

In the Disease-Database, questionnaires are required to collect information. Only for malignant and benign tumurs, diseases of the nervous system/psyche and heart diseases, instead of a questionnaire a report from the treating doctor is necessary.

Corresponding to the ICD10, the following chapters are included in the Disease-Database:

The chapter’s abbreviation, for example “H”, is always to be found in first position on the disease key.

The combination of disorders is assessed on the basis that the event specific relations disorder has combi-risk IP own/similar, IP any/ADL, TPD own/similar, TPD any/ADL, Life from the disorder database, which includes codes for those organ categories, which are important in the context of a special disorder. In the disorder database an organ category is defined for every disorder.

The values of the relation ‘disorder has combi-risk …’ are compared with the organ category of another disorder indicated in application. If the organ category of another disease is included in the values of the relation and the other way round, the comment 'check combination of disorder' is given and the disorders concerned are indicated. This comparison is made for each disorder. In this case the application is referred to the underwriter.

Example:
Disorder 1 has organ category 'A' and combi-risk 'EGH' Disorder 2 has organ category 'G' and combi-risk 'AFL' Disorder 2 has the organ category 'G' of the combi-risk of disorder 1. In addition disorder 1 has the organ category 'A' of the combi-risk of disorder 1. The proposal is referred.

Example: The applicant mentions ‘inflamed radicular ganglions’ and ‘gingivostomatitis’.

The result is the 'worst' result of all single impairments.

In general, the sequence for the following rules is given from the document; it can be determined with the priority value (highest value = highest priority) within the rule. Within the sequence all rules are processed.

Maximum number of disorders/drugs
If the result following the assessments of specific disorders is 'offer' or better, the number of disorders plus assessed drugs is compared with CSP maximum number of disorders. If the value of the CSP is exceeded, the proposal is referred with the comment 'too many disorders/drugs’.

Maximise extramortality/loadings percent
For disorders belonging to the same group (same code at the first 4 digits, e.g. J30.1 allergic rhinitis due to pollen and J30.1-003 allergy to grass pollen the extra mortality/loading is maximised. This value is considered for the following checks as one single extramortality/loading.

Add extramortality/add loadings percent
eExtramortalities/loadings of disorders belonging to different groups are added.

Maximise liens
Liens from several disorders are maximised.

Maximum number extramortality/Maximum number loadings percent/Maximum number liens
If the number of rated disorders exceeds the value of CSP maximum number of disorder/drug ratings, the application will be referred with the comment 'several ratings from disorder/drug'.

The assessment of height and weight is based on the units kilogram and centimetres. The input when recording the risk data can be made in either metric or imperial measurements. The system will compute from imperial to metric.

Depending on height, weight, age at assessment, race and sex of the life to be assured, the extra mortality is assessed according to the BMI assessment of the Gen Re Clue manual (BMI Calculator). If race is not known, the standard tables are used. In the Race-DB the possible races are included and when the attribute ‘lighter ethnic group’ is marked the build tables for the lighter ethnic groups are used (e.g. races Singapore, Chinese, Malay, Philippines, Indonesian, Tamille, Hong Kong-Chinese, Thailand, Myanmai and Vietnamese).

In COMPASS, the genders "female", "male" and "diverse" are used. The gender "diverse" is used in the default rules (e.g. overweight/underweight, hypertension) analogously to "female".

Alternatively build can be assessed based on the Body Mass Index (BMI). The event specific internal attribute extra mortality/loading from BMI can be used.

The calculator returns specific extra mortalities if specific reactions are requested:

If no specific rules as indicated above apply to the extra mortality/loading the result of the calculator is used as the rating for the different benefits.

Further general rules:

Underweight
If the life to be assured is a child (age < 18 years) and the BMI is <17 or the life to be assured is an adult and the BMI is < 23 and the calculated extra mortality is > 30 then the applications is referred. Otherwise the extra mortality is taken.

Unit for weight okay
If the calculated extra mortality is equal to or exceeds 300 %, the result is 'refer' and the comment 'unit for weight okay ?’ is given.

Event specific rules
Event specific rules for height/weight are listed below. Within the event specific rules the benefits can be differentiated. Please note that these are only examples and can be modified by each company. For each rule any other reaction and condition is possible. Appropriate result texts are included in the hint text db:

Disability own/similar and any/ADL
If loading > 100%, refer with ‘check overweight’.

CI
If loading > 150%, refer with ‘check overweight’.

This risk is only checked for the events IP and WOP.

Dioptres shortsighted
From the negative dioptres given in the proposal it is derived, whether the AP is that much shortsighted that it is relevant for the benefits mentioned above. If the dioptres exceed the value ‘-8’, the exclusion clause for 'disorders of eyes and complications' is offered.

Dioptres long sighted
From the positive dioptres given in the proposal it is derived, whether the AP is that much long sighted that it is relevant for the benefits mentioned above. If the dioptres exceed the value ‘+8’, the application is referred and the comment ‘check occupation because of long-sightedness’ is given.

Missing dioptres are requested from the client (reaction ’incomplete’).

The pregnancy check is done when the applicant indicates a disorder with special check ‘pregnancy’ in the disorder db relation ‘disorder has special check’ or when the applicant indicates a current ‘pregnancy’ or when a 'yes' is given to the question for current pregnancies.

The following conditions are usual for assessment:

Beside the general compensations the following pregnancy specific compensations are available:

The recommendations of Gen Re include standard assessment for pregnancies up to the benefit related limits.

Pregnancy complications
If the question ’complications during pregnancy’ is answered with ’yes’, the application is referred and the comment 'check pregnancy complications' is given.

For the assessment of smoking, the single values for cigarettes, cigars and pipes can be used, but also the overall quantity or only one single value. The assessment can depend on the benefit type Smoker/Non-Smoker/General.

The following factors are often used for the smoker assessment:

Beside the general compensations the following smoking specific compensations are available:

The recommendation of Gen Re include the following rules:

Non-Smoking limit cigarettes
If the answer to the questions ‘Do you smoke?’ is ‘yes’ and the benefit type is ‘non-smoker’ and the number of cigarettes (internal attribute number cigarettes now internal) exceeds ‘0’, then the application is declined with the additional comment ‘smoking and non-smoker rate’.

Non-Smoking limit cigars
If the answer to the questions ‘Do you smoke?’ is ‘yes’ and the benefit type is ‘non-smoker’ and the number of cigars (internal attribute number cigars now internal) exceeds ‘0’, then the application is declined with the additional comment ‘smoking and non-smoker rate’.

Non-Smoking limit pipes
If the answer to the questions ‘Do you smoke?’ is ‘yes’ and the benefit type is ‘non-smoker’ and the number of pipes (internal attribute number pipes now internal), exceeds ‘0’, then the application is declined with the additional comment ‘smoking and non-smoker rate’.

Non-Smoking limit total
If the answer to the questions ‘Do you smoke?’ is ‘yes’ and the benefit type is ‘non-smoker’ and the number of cigarettes/cigars/pipes exceeds ‘0’ (internal attribute number smoked now internal), then the application is declined with the additional comment ‘smoking and non-smoker rate’.

Non-Smoking confirmation
If the answer to the question ‘Smoker confirmation?’ is ‘no’ and the benefit type is ‘non-smoker’, then the application is referred with a hint on this field.

General benefit - current smoking

Smoking benefit - current smoking
For smoking benefits half of general benefit ratings are taken.

Elapsed time since stopped smoking (Non-Smoker benefit)
If the answer to the question ‘Have you ever smoked’ is 'yes' and benefit type is ‘non-smoker’ and the applicant is now a non-smoker and the time since cessation of smoking is exceeds 12 months (internal attribute smoking time elapsed) the reaction is ‘standard’.
If it is less or equal 12 months, the reaction is refer with the comment 'smoking in the past'.

Ever smoked and currently smoking (Non-Smoker benefit)
If the answer to the question ‘Have you ever smoked’ is 'yes' and the applicant is a smoker and the benefit type is ‘non-smoker’, the application is referred with the additional comment ‘smoking in the past’.

Intend smoking (Non-Smoker benefit)
If the answer to the question ‘Do you intend smoking?’ is 'yes' and a non-smoker benefits is applied for, refer to underwriter with the comment ‘intended smoking in non-smoker tariff’.

Smoker diseases
If, in addition to smoking, disorders with organ category ‘Smoking’ in the relation ‘Disorder has organ category’ is mentioned (and this disease doesn’t lead to a referral), the result is 'refer' and the application is referred with the comment 'check combination of smoking and disorders'. The assessment is done according to the process of combination of disorders.

Stop smoking on medical grounds
If the answer to the question ‘Stop smoking on medical grounds’ is ‘yes’, the application is referred with the comment ‘stop smoking on medical ground’.

The following criteria’s are used for the assessment of alcohol:

According to the assessment recommendation of the Gen Re Compass includes the following rules for all events:

Alcohol male limit
If 4-5 units are daily consumed, the extra mortality is 25%. The loading for CI is 25%, for Disability the loading is 50%, LTC is standard.
If 6-8 units are daily consumed, the extra mortality is 75%. The loading for CI is 75%. For Disability a report from the treating doctor and a liver test are requested. LTC gets declined.
If more than 8 units are daily consumed, a report from the treating doctor and a liver test are requested for Life. CI and Disability get declined as LTC.

Past
In case that, alcohol consumption is not given at the moment, but it has been beforehand, it is forwarded with ‘proof for alcohol consumption in the past’, as a hint.

Alcohol Female limit
The same as for males are defined but rule Alcohol Female limit is used.

Ever drunk rule
If the answer to the question ‘Has your alcohol consumption ever been higher?’ is 'yes' and currently there is no alcohol consumption, refer with the comment 'check alcohol consumption in the past’.

Stop drinking rule
If the answer to the question ‘Were you advised to stop drinking on medical grounds?’ if 'yes', the application is referred with the comment 'stop drinking on medical ground’.

Drinking and disorders
If, in addition to drinking, diseases with organ category ’Drinking’ are mentioned (and these diseases don’t lead to a referral), the application is referred with the comment ‘check combination of drinking and disorders’. The internal attribute AP has drinking disorders is used for this assessment.

According to the proposals two assessments are implemented:

Critical Illnesses of AP (CI decline rule)
If the answer to the question ‘Do you suffer or have you ever suffered from any of the following critical illnesses’ is 'yes', the application is declined.

Critical Illnesses in the family of the AP
The following criteria’s are used for the assessment of critical illnesses of family members of the AP:

COMPASS includes the assessment recommendation of Gen Re. The following rule is implemented:

CI number of episodes
If the number of deceased or ill family members exceeds or is equal to the value of 2 and the age of the deceased or ill family members is below 60 years, a GPR for the life assured is requested.

Furthermore family history can be evaluated on the level of the occurred disorders within the family history. These rules are very much company specific and therefore not delivered with COMPASS. Each company can decide on its own rules and define them within the Family History Risk. The following rule is given as an example how a rule for family history disorders can look like:

Rule: Any incidence of Polycystic kidneys, polyposis coli, Huntingtons Chorea, cystic fibrosis, muscular dystrophy requires a GPR for all benefits.

All listed disorders belong to family history class ‘inheritable diseases’. The family history classes are defined via the Family History Class DB. In the Disorder DB the listed disorders are attached via the relation ‘Disorder belongs to family history class’. The rule looks like as follows then.

If the result of family history is more than one loading, the application is referred with the comment 'too many loadings' (026), otherwise the medical consolidation takes place.

Considering the amount of job descriptions the assessment was specified on high hierarchy levels if possible. Beside group assessments, assessments of single occupations have been defined if necessary. The assessment was completely defined via occupational classes, based on the experience of Gen Re and public available information. Each company has to check the classification and assessments individually.

The assessment is done for every occupational hazard unless it is included in the occupation. For LTC the assessment is done in every situation because the occupation is not checked separately. In addition, this check is done for LTC, if the relation ‘occupation has occupational hazard’ in the occupation has an entry and generates indirectly an occupational hazard. For ADB no check is done.

Occupational hazards are assessed on the basis of the Occupational Hazard-DB.

Occupational hazards can be selected from a selection panel. All hazards mentioned have to be allocated to a particular category; if none of the categories is applicable, 'other' should be chosen. Should any database changes be made between entering and assessing an application, the occupational hazard may no longer be in the database. The non-existing key is translated into ‘other occupational hazards’ and assessed according to that entry.

The following assessments have been used within the occupational hazard risk for compensation of the risk level:

For each occupation a termination age limit for disability benefits (IP and WOP) can be specified for male and female applicants. This is done by selecting a termination-age category (called category in this chapter) in the benefit related attributes termination-age category male and termination-age category female.

For each category several entries in the termination age category database can exist (they have the same value in the attribute Termination Age-ID). At least one entry per category should exist. One entry describes a benefit payment period and an insurance period, and whether a loading is required for this constellation.

Currently only one entry per category is included, although more are possible. When several entries are created, this is mainly used to reflect the following idea: The normal allowable termination ages (insurance and benefit payment) need no loading (entry 3). When a higher termination age is applied for, this can be accepted with an additional loading. The loading is increased as the termination age is increased (e.g. 5-year step, 50% increment), up to a termination age, which is the highest acceptable termination age for the occupation (entry 1).

Example: Termination age category (Termination age 55 with options)

The termination age assessment is only performed, when the attribute termination age category male/female for the occupation has a non-blank entry.

The termination age that is used for the calculation is the sum of the age for assessment with the insurance period / benefit payment period. We will explain now, how the correct record for the calculated insurance period and benefit payment period is identified:

When the calculated insurance period is the same as the calculated benefit payment period, only those records from the relevant category are considered, that have an insurance period that equals the benefit payment period (only entry 1 in the example above).

Otherwise the remaining entries are checked. If no suitable record can be found, all records considered again.

Now the entry will be considered which has termination ages less or equal to the termination ages applied for and the loading is less or equal to the loading already applied for.

If a suitable record can be found, the result is ‘offer’ with the hints ‘termination age reduction for insurance period’ or/and ‘termination age reduction for benefit payment period’. The best matches will be offered.

If no record can be found which has a loading smaller or equal to the one applied for, the application is referred with the hint ‘check termination age’.

If no record can be found for the specified category, the occupation is referred with the hint ‘termination age category not found’.

Example 1:
An IP with termination age 70 for insurance and benefit payment period is applied for, the loading applied for is 25 %.

The specified termination age category has the following entries:

The applied for termination ages are the same, therefore only record 2, 3 and 4 are considered. Only for record 2 and 3 the loading applied for is not exceeded.

The termination age is exceeded for both records; it has to be reduced. The maximum possible termination age comes from record 3. The result is ‘offer’ with the hints ’termination age reduction for insurance period to 60’ and ‘termination age reduction for benefit payment period to 60’ with loading 25%.

Example 2:
An IP with termination age 50 for insurance and benefit payment period is applied for, the loading applied for is 25 %.

The specified termination age category has the following entries:

The applied for termination ages are the same, therefore record 2, 3 and 4 are considered. Only for record 2 and 3 the loading applied for is not exceeded.

If the termination age is okay for both entries, the record with the lowest termination ages is taken (record 2). The result is ‘standard’ with the hint ‘loading in premium too high’.

The occupation combination consists hierarchically of the database related assessment for the single occupations and the general occupation assessment. The results are consolidated as given below

No check is done for LTC.

Combination performed and second occupation for Life, Accident, CI, TPDany/ADL, H&S

Refer second occupation if not standard
If the occupation currently performed and the second occupation are different, both occupations are assessed. If one of the occupations is not standard, the application is referred with the comment 'check second occupation’.

Please refer to chapter Occupation general for rules for other benefits.

Combination performed occupation and occupation from occupational status

The result is the “worst“ result of all sub-risks.

Refer, if several clauses
If both occupations are assessed with exclusion clauses and the clauses are different, the application is referred with the hint ‚’check occupation’.

Refer, if several questionnaires
If both occupations are assessed with questionnaires and the questionnaires are different, the application is referred with the hint ‚’check occupation’.

Refer, if loading and exclusion clause
If both occupations are assessed with a loading and an exclusion clause, the application is referred with the hint ‘check occupation’.

Maximise loadings percent/maximise loadings per mille
The maximum loading is taken into account for further assessment.

Occupation general

The following assessments are processed for the performed occupation and the second occupation:

Occupation cannot be entered
Where '?' is entered for occupation, the application is referred with the comment 'occupation cannot be entered'.

Occupation unknown
A check is made to see whether the database contains any entry at all for the specific occupation. If not, the application is referred with the comment 'occupation not found'.

The following rules are evaluated additionally for IP and TPDown/similar benefits:

No fulltime employment
If the life to be assured has no full-time job or is unemployed, the application is declined with the comment 'no full-time job in last …​ months'. If the answers are not given, the reaction is ‘incomplete’.

Check times off work
If the life to be assured has been off work e.g., the application is referred with the comment ‘check times off work’. If the answer is not given, the reaction is ‘incomplete’.

Business miles/unusual use of machinery - 1
If the applicant indicates use of machinery or tools and the premium class of the life to be assured is a subset of ‘admin duties’ (class 1- please note: to be adapted to company specific classes) only, the application is referred with the comment 'unusual use of machinery'. If the use of machinery or tools is not known, the reaction is ‘incomplete’.

Business miles/unusual use of machinery - 2
If an applicant indicates an average business mileage exceeding 20,000 miles p.a. and is less or equal 100,000 miles p.a. and the premium class of the life to be assured is a subset of ‘admin duties’ (class 1) only, the application is referred and the comment 'occupation class change because of mileage' is given. If the average business miles exceed 100,000 miles p.a. the application is referred and the comment ‘business mileage exceeded’ is given. If the average business miles are not known, the reaction is ‘incomplete’.

Self employed rules - 1
If the life to be assured is self-employed and has been self-employed for less than 3 years, the occupational questionnaire will be requested. If the time is unknown, the reaction is ‘incomplete’

Self employed rules – 2
If the life to be assured is self-employed and the number of employees is below 2, the application is referred with the comment 'self-employed’. If the number of staff is unknown, the reaction is ‘incomplete’.

High amount of manual work
If the applicant indicates manual duties of more than 50% while his occupation does not imply manual duties to that extent (the occupational status is ‘employee’, ‘student’), the application is referred with the comment 'unusually high amount of manual work'.

Low amount of manual work
If the applicant indicates manual duties of less than 50% while his occupation would be expected (the occupational status is ‘housewife’, ‘worker’), the application is referred with the comment 'unusually low amount of manual work'.

Check working hours
If the applicant indicates working less than 17.50 hours per week, the application is referred with the comment ‘weekly working time less than expected’. If the working hours are unknown, the reaction is ‘incomplete’.

The following rules are evaluated if appropriate for IP:

Salary continuation
Any salary continuation stated by the applicant must not continue beyond the deferred period applied for. If it does and less than 100% of the previous salary is received, the comment ‘continuing income benefit memo required’ (422) is given. The result remains ‘standard’. If 100% or more of previous salary is received, the waiting period will be extended according to the next possible waiting period (4/13/26/52 weeks).

Deferred period
If the deferred period applied for is lower than specified in the assessment, the result is offer and the comment ‘increase waiting period to’ is given.

The following rules are evaluated if appropriate for IP, TPD and WOP:

All checks are benefit depending.

Occupation Class Shifts
If several different premium class changes apply for the currently performed occupation, the application will be referred with the comment ‘too many occupational class shifts’, e.g. premium class change because of mileage and duties.

Wrong Occupation class
If the derived premium class is different to the class of the proposal, the application will be referred with the comment ‘occupation class mismatch’. The check is done for the currently performed occupation.

Show Occupation class
The derived premium class for the currently performed occupation is passed to the output. The display of the class in the result is controlled by the benefit specific CSP show occupation class. The CSP can have the following values:

This CSP has no influence on the result of the assessment of the occupation database and the occupation class check. But if the class is not displayed in the result, the class related result ‘too many occupation class shifts’ and ‘wrong occupation class’ are also not displayed.

Combination performed and second occupation for IP, WOP, TPDown/similar

Refer second occupation
If the occupation currently performed and the second occupation are different, the application is referred with the comment 'check second occupation’.

Occupation according to database

Occupations are assessed on the basis of the Occupational DB. The assessment is processed for the occupation currently performed, for the second occupation and the occupation derived from the occupational status.

The following assessments have been used within the occupation database for compensation of the risk level:

Risk levels may depend on conditions. The following conditions are available, but not used in the Gen Re assessment:

Occupational status
It might be necessary to depend the assessment of an occupation on the occupational status. This can easily be achieved with including the relevant occupational status in the condition of the assessment. As an example the assessment for the following combinations can be taken:

Physical work
It might be necessary for the assessment of an occupation to depend on the physical work. This can easily be achieved by including the answer to physical work (y/n) in the assessment. ). Alternatively the internal attribute physical work internal can be used. It is derived in the following way:

If the information in not indicated in the proposal, the internal attribute is set to yes.

The terminal age is checked within the termination risk. The annual benefit is checked within the financial risk.

Add loadings percent/per mille
If the assessment for an occupation includes more than 1 rule and several loadings are given, e.g. a loading based on the class assessment and a loading based on the special job description, the loadings are added.

The result is the “worst“ result of all sub-risks.

Too many foreign travels
If the overall result is ’standard’ or ’borderline standard’, the number of trips to foreign countries is checked against COMPASS limits. The number of trips is compared to CSP maximum number of foreign travels. If the number of trips is too high, the result is ‘refer’ and the application is referred with the comment ’too many trips abroad’.

Too many rateable trips abroad
Where several loadings arise, the application will be referred with the comment ‘too many rateable trips abroad’.

Maximise loadings per mille / Maximise loadings per mille / Maximise liens
For consolidation of the loading the highest loading/lien is taken into account.

The result is the “worst“ result of all sub-risks.

Too many pursuits
If the final result is 'standard' or 'borderline standard', a check is made to establish whether the total number of pursuits does not exceed COMPASS limits. This is done by comparing the number of pursuits with the CSP maximum number of pursuits. If the number of pursuits is equal to or exceeds the value of the CSP, the result is 'refer' and the application is referred with the comment 'too many pursuits’.

Too many rateable pursuits
If there are rateable pursuits (e.g. with a loading) than the value of CSP maximum number of pursuit ratings is checked. If the number of rateable pursuits is equal to or exceeds the value of the CSP, the application is referred with the comment 'too many rateable pursuits'.

Adding loadings percent / Adding loadings per mille / Maximise liens
If there are several ratings from different pursuits and the result is not 'refer' yet, the overall rating is computed by adding all ratings. For liens the maximum is taken.

To assess the financial risk, COMPASS must know the life assured’s income (natural person, male or female). There are various ways to establish the life assured’s income:

Establish income
If policyholder and life assured are identical and apply for IP cover, income details may be in the application form. If the actual income is not available, a statistical average income will be established on the basis of occupation, occupational position, branch of industry, manual duties 'y'/'n'. A difference is made between the average income of blue-collar and white-collar workers. This difference can be individually changed by each company.

Those performing manual duties will be classified as blue-collar workers.

The occupational position and the classification blue- or white-collar worker is established as below:

For the occupational position 'unemployed', the following exceptions regarding the occupation are made:

The table below shows which income is used for assessment:

If the occupational position is unknown, the relevant category from the Occupation-DB is used. If both the occupation and occupational position are unknown, the statement about manual duties is used to determine the relevant category. If the occupational position is not clear from the application, e.g. if no distinction between blue-collar or white-collar work is made, the relevant field can be left empty; the system will then proceed on the basis of the occupational position from the Occupation-DB.

Apart from establishing the income, a further distinction can be made for male/female applicants (CSP income factor female). The income will then be multiplied by the relevant factor. E.g. CSP '1.00' means identical income for male and female lives.

The annual gross income is required to establish the annual benefit needed. A plausibility check between income stated and average income is made (refer to relevant comments on average income), if the CSP maximum deviation from average income has a value exceeding ’0’ (’0’ means no plausibility check):

Check 1. is made by means of a company-specific (CSP maximum deviation from average income). The income is regarded ok if it is greater than the average income multiplied by 1/CSP and less than the average multiplied by the CSP. In the database, the average income is the gross income. However, if a company asks for net income in the application form (known from the value of CSP net income in application, this can easily be converted by means of the CSP ratio gross/net income. If it is not within the tolerance range, the application is referred with the comment 'average income is exceeded'.

If the normal income is within the tolerance range and additional income is mentioned, a plausibility check for the additional income is made as well. If the total income is unusually high that means greater than CSP maximum deviation from average income, the application is referred with the comment 'income/additional income unusually high'. In all cases, the income stated will be used for further assessments.

Monthly income
Check 2. is made to establish whether the monthly income was stated. Processing for incomes below the average income is as follows:

The test as described in check 1 is executed with the income multiplied by 13. If it passes the test, the system’s comment is 'income was regarded as monthly income'.

Total income
The income used for the needs analysis is displayed in the result with the hint ’annual income for need analysis’, if the annual benefit has to be reduced. The income indicated in the proposals is used. If it was considered as monthly income, the calculated annual income is used. If the income is missing, the derived average income is used.

A premium check is made for the PH as the legal owner of the policy, regardless of whether he actually pays the premium (PH risk – financial risk). If there are two PHs, their salaries are added together.

Ongoing premium check

The relation between income and premium as well as the overall annual COMPASS limit are checked.

Premium COMPASS limit
If the annual premium exceeds COMPASS’s limit (CSP COMPASS limit for annual premiums), the application is referred with the comment 'premium exceeds COMPASS limit’.

Relation premium/income
The relation premium/income is checked in two steps. First at all only the premium currently applied for is checked. If this premium exceeds a special percentage of the income, premiums of previous insurances are taken into account for the check of the second limit.

Premium payments for existing cover can be taken from the interface field cumul premium PH. Each company can decide for itself whether or not to take into consideration premiums other than for life cover.

If the income is indicated in the application form and it is not zero, it is taken for the assessment. Otherwise the average income is taken into account.

The relation between annual premium and annual income is checked against a warning limit (CSP warning ratio premium/income). If the CSP is exceeded, the relation between total premium (i.e. for current and existing cover) and annual income is checked against a critical limit (CSP critical ratio premium/income). If this is exceeded, a financial risk is assumed and the application is referred with the comment 'check relation premium/income'.

If this check should not be executed the CSP warning ratio premium/income should set to 0.

If several APs apply for the insurance nevertheless only the PH income is taken into account.

Single premium check

Single premium COMPASS limit
For single premium policies only a company-specific limit is checked (CSP COMPASS limit for single premium); where required, the application is referred with the comment 'single premium above COMPASS limit'.

For all benefits (Life, IP own/similar, IP any/ADL, WOP own/similar, WOP any/ADL, ADB, LTC, DD) total sums can be checked to request documents or referrals to underwriter (AP risk – event sum check – financial limits). These limits are stored in the financial limit database. The sums/annual benefit of all currently applied for benefits with the same event are added, the bonus is taken into account too.

Also all known existing cover at the own company, i.e. taken from t he proposal and portfolio data, are taken into account (the CSP company is used for comparison), depending on the value of the benefit specific CSP own pre-existing covers included for financial limits.

The interface provides fields for all types of cover that could be relevant for the company. COMPASS does not directly access a company’s existing portfolio-DB. Existing cover is taken from the interface field sum_assured_f. The maximum pre-existing cover from both sources will be relevant. Furthermore all simultaneous applications that are marked 'a' (current in 'substandard' (y/n/a)) are accumulated. They are treated and assessed as separate applications.

If the CSP other pre-existing covers included for financial limits is 'yes', existing cover with other companies is also taken into consideration.

Various limits to be set by the individual company can be taken into consideration during financial assessment according to the entries included in the Financial Limit database, for example:

Where certain pieces of evidence are automatic financial requirements, the system will check whether the evidence is available. If it is not available, the system will suggest to obtain the special evidence. If it is available and not marked ‘existence sufficient’, the application is referred with a hint to the relevant document.

For referral the following hints are available:

Specialities Life

Life relation income sum
If the given income is not zero, then the following check is executed. The relation between sum assured and annual income is checked against the value of CSP financial life income sum. If the sum assured is greater than the income multiplied by the value of the CSP and greater than the loan (information from the interface field ‘borrowing’ for every life benefit), the comment ‘check sum assured compared with income’ is given and the application is referred. If this check should not be executed the CSP financial life income sum should set to 0.

Specialities Pension benefits
No previous cover is taken into consideration.

Specialities IP
For IP annual benefits including the bonus are taken into account, but only those benefits which are possible after the need assessment, i.e. possibly only the reduced annual benefit, if the CSP consolidate reduced is set to’ yes’.
The annual benefit can be related to the occupation class via the financial limits risk in the AP event sum risk.

Specialities Critical Illness

CI Relation income to sum
The calculated sum assured is checked against the amount (income_of_AP * CSP factor for CI sum assessment) plus the borrowing (information is taken from the interface field ‘borrowing’). If a certain limit is exceeded, the application is referred with the comment 'check sum assured compared with income'. Unless the income is mentioned in the application, the average income is used for calculation purposes.

CI occupational limit
The calculated sum assured is checked with the occupational limit from the occupation-DB-field maximum benefit sum. If the sum is exceeded, the application is referred with the comment ‘sum assured exceeds occupational limit’.

Specialities WOP
No financial checks are done for WOP.

Specialities TPD

TPD Relation income to sum
The calculated sum assured is checked against the amount (income_of_AP * CSP TPD limit income factor ) plus the borrowing (information is taken from the interface field ‘borrowing’). If a certain limit is exceeded, the application is referred with the comment 'check sum assured compared with income'. Unless the income is mentioned in the application, the average income is used for calculation purposes.

TPD occupational limit
The calculated sum assured is checked with the occupational limit from the occupation-DB-field maximum benefit sum. If the sum is exceeded, the application is referred with the comment ‘sum assured exceeds occupational limit’.

Specialities LTC

Need long term care
The LTC annual benefit is checked with the occupational limit from the occupation database field maximum benefit occupation. If the sum is exceeded, it is reduced and the comment ‘occupational fixed limit’ is given

The check for IP own/similar is done before IP any /ADL.

For the need assessment the AP’s income is needed. The following income is taken into account, depending on the availability:

Establish need

There are two ways to establish the applicant’s need:

The CSP IP need assessment will determine which method is carried out. If the CSP is 'y', the equation with the percentage of income is applied. If the CSP is ‘n’ only fixed limits are checked (occupation,..)

Percentage of income
COMPASS will distinguish between individual IP employed/self-employed (applied for by a life insured) and company IP (policyholder is the company, life assured is the employee). This is recognized by using the ‘relation of AP to PH’ or the ‘sex of policyholder’ field.

The IP need database includes records for income levels with related IP need percentages for company IP (executive), individual IP employee (employee) and individual IP self-employed (self employed). The state amount benefit will be taken into account once, also separated for the different IPs. The state amount benefit is stored in the IP needs general database.

The calculation is done as follows depending on the kind of policy:

As long as income up to > 0 the partial benefits are calculated as follows:
benefit =(min(income, income up to) – income from)* IP need percentage of this record

All partial benefits are added to the total possible IP benefit. The relevant state benefit is subtracted from the total.

The overall annual need according to income is now established.

Reduction by previous cover

Depending on the benefits applied for, the reduction by previous cover will take into account the total IP coverage, independent on the type cover. This is done according to the following procedure:

IP own/similar

The maximum IP o/s will be derived as a minimum from the calculation explained above, and from possible fixed limits which can be specified in the occupation and nationality database. If the fixed limits are different for IP own and IP own/similar the minimum is taken.

The following benefits from other sources will be deducted from the need established, to obtain the realistic need for IP o/s:

The derived amount will be deducted from the need established for IP o/s.

For determination of the final IP o/s need, the IP o/s applied for are taken into account ascending depending on the deferred period. Step by step the IP o/s are deducted from the derived established need.

If the need is shortened or reduced to 0 during the calculation, the IP o/s benefit applied for is referred. If other IP o/s with longer deferred periods are still available, these ones are also referred to (please see chapter ‘assessment of need’ for more details).

If all IP o/s applied for can be allowed without any shortening, the result for IP o/s is ‘standard’. If there is still ‘open’ cover after deducting all IP o/s benefits applied for, the sum will be shown in the result as not covered need, if during IP any/ADL calculation no need deduction is done (please see chapter ‘assessment of need’ for more details).

IP any/ADL

The maximum IP any/ADL will be derived as a minimum from the calculation explained above, and from possible fixed limits, which can be specified in the occupation and nationality database. If the fixed limits are different for IP any and IP ADL the minimum is taken.

The following benefits from other sources will be deducted from the need established, to obtain the realistic need IP any/ADL:

The derived amount will be deducted from the need established for IP any/ADL.

For determination of the final IP any/ADL need, the IP any/ADL applied for are taken into account ascending depending on the deferred period. Step by step the IP any/ADL are deducted from the derived established need.

If the need is shortened or reduced to 0 during the calculation, the IP any/ADL benefit applied for is referred. If other IP any/ADL with longer deferred periods are still available, these ones are also referred (please see chapter ‘assessment of need’ for more details).

If all IP any/ADL applied for can be allowed without any shortening, the result for IP any/ADL is ‘standard’. If there is still ‘open’ cover after deducting all IP any/ADL benefits applied for, the sum will be shown in the result as not covered need (please see chapter ‘assessment of need’ for more details).
If no uncovered need is available after calculation of IP any/ADL benefit, also no uncovered need will be shown in the result for IP o/s.

Assessment of need

The following checks are processed alternatively (please only use one alternative via the CSP setting process):

1) IP over insured
The overall annual need established is compared to the amount applied for (available from interface). If the need is exceeded by the value of CSP IP over insured percentage or more, the application is referred with the comment ‘benefit exceeds need'. If the application is referred with due to exceeding annuity, an additional hint depending on the reason is given ‘reduction of benefit to’ together with the maximum possible value. Depending on the cause other comments can be given :

A rounding factor (CSP rounding of reduced annual benefit to) can be taken into account when the annual benefit is reduced.

2) Annual benefit in tolerance range
A tolerance range can be taken into account depending on the CSP annual benefit in tolerance range. If the tolerance range is used the comment ‘annual benefit in tolerance range’ is given with the relevant value.

Waiver of premium/Deduction of annual benefit
Before the reduced annual benefit is finally determined (and later on displayed in the result), COMPASS checks whether the minimum annual benefit (CSP minimum benefit (annual benefit)) is still exceeded. If the minimum amount is not exceeded, the annual benefit is reduced to ‘0’.

Show additional need
If the amount applied for is below the need established, the agent can be notified with a comment 'amount applied for below need', if desired by the company (CSP show additional need). The comment will state the amount not covered so far. The bonus is not taken into account here.

Overall rules: