POS Description Medical

Introduction

Two COMPASS versions are available:

The Head Office Version has been designed for use in the head office or in branch offices. The assessment is based on the information included in a standard application form.

The Point-of-Sale-Version has been designed for use by an agent during a direct conversation with a client, over the counter in a Bank, on the Internet or in a telesales environment. Here the application form is completed using a dynamic dialog tailored to benefit, sum assured, age, duration and answers to the questions. In addition to the standard application form questions the client may be asked to provide additional information required for the assessment depending on disclosure. The system will prompt for more detailed information which will be recorded to complete the application process. In this way, the additional queries generated by a simple proposal form can be avoided whenever possible. In most cases the client can be informed of the underwriting decision on the spot.

This document contains specialities of the Point-of-Sale Version, the inquiry modules for disorders and activities to introduce it to the agent.

For general information about COMPASS and its features please refer to the product description and the user’s guides of COMPASS.

Dynamic inquiries for pursuits, foreign travelling and financial risk are included in separate documents.

Special Point-of-Sale Features

The Point-of-Sale Version of COMPASS (POS) is based on the Head Office version, i.e. all checks of this version are included. Furthermore the POS version requests all the information which an experienced underwriter in selected areas can obtain from the life assured. Recording takes place dynamically, depending on the input in question. Underwriting can then take place on the basis of this information. If no information relating to previous insurance and association registry notices are available to COMPASS, the assessment is carried out provisionally. The result can be displayed to the agent. The underwriting and display of the result can of course be carried out independently of recording at the head office.

Dynamic recording can take place for the following risk areas:

Pursuits
Foreign Travel
Medical
Financial

The structure and number of the usual application questions can be determined for each individual company so that each company can produce its own particular application. The risk-specific dynamic inquiries can be modified according to the companies need by the company itself or Gen Re or can be taken as given. New inquiries may be added.

The additional recorded information involves questionnaires or more precise stating of terms. More precise stating of terms is frequently used in the medical inquiries. This is to prevent medical attendance reports being requested as a result of imprecise terms.

Previous policies in portfolio and association registry information can be checked directly in the POS version, if the information is available. Otherwise the result is provisional.

Assessment can be separated from recording. If only recording is carried out the results would be the print-out of the application form for signature with all details of the life assured.

Evaluation of questionnaires is processed up to financial and medical and COMPASS competence limits. All limits are defined company specific with the maintenance program. It is also possible that the questionnaire evaluation results in a referral to an underwriter. COMPASS includes dynamic inquiries for all common questionnaires.

Design of User Interface

The COMPASS data-entry component or a data-entry component of the company will record the risk data. COMPASS comes with mandatory fields for all risk data, i.e. values have to be entered to avoid incomplete proposals.
If the applicant does not wish to provide details of a particular disorder the dialogue can be terminated. Cancellation is also possible within inquiries on a disorder. The dialog is continued with the next screen. If cancellation has taken place the cancel reaction specified in the POS inquiry module database is triggered (request document, refer). The applicant can send the written information to the company. It is irrelevant who selects cancellation, the agent or the client.
The information gathered up to the point of cancellation is stored.

No dynamic inquiry is triggered if medical limits are exceeded based on technical data, e.g. request ME because of large sum insured. This stop of dynamic inquiry can be controlled with the CSP stop at medical document which includes the relevant document.

Please note the following features of the dynamic inquiry:

Menu items are in alphabetical order.
Screen by screen return is possible conserving the previous details if input has previously been saved.
When changing details within a dynamic inquiry, the replies no longer required are discarded.
Replies to dynamic inquiries can be modified by navigating to the screen as long as no assessment has been made.
Questions of the standard proposal can be used within dynamic inquiries. They are only prompted if they have not previously been answered in the standard screen sequence.
Menus can be defaulted with already entered values, e.g. complications for a disorder. If one of the listed complications has been entered before as a disorder it is already selected when displaying the menu. Consequently menu selections are added to the disorder list, if a menu is defined in this way.
Before assessing the risk data the client can look at the data already entered and make changes (including deletions). The CSP delete possible controls whether data can be modified or deleted when the underwriting has already taken place. If the value is ‘no’, modifications or deletions are not possible after an assessment has taken place, but additional entries are allowed. If a term comes from a dynamic inquiry, e.g. as a result of a precision of an unspecific term, it cannot be deleted or changed anyway. If no limitations shall be valid for modification and deletion after an assessment, the CSP should be set accordingly.
Once recorded, terms are also kept, i.e. even if the questions for which the details were given were not prompted after changing the applied-for benefit, the details are used for the assessment.

Help information can be stored for every question with tool tips. The delivery of Gen Re only includes some selected tool tips because they are very company specific. Tool tips can be defined with the maintenance program.

Maintenance program

A dynamic inquiry is triggered by the module defined in the single risk via the maintenance program, e.g. module ‘Asthma unspecific’ for term ‘asthma attack’. This entry is independent on the benefit. The inquiry module is based on a decision tree which is defined in the POS inquiry module database in the maintenance program. This decision tree includes inquiries and/or decisions for all benefits. This means that dynamic inquiries can be used for all benefits applied for or only for single ones. The dynamic inquiry is then only performed when the relevant benefit is applied for. Otherwise the decision is taken directly from the tree without any further questions. Consequently if there is an entry in the field ‘POS Module’ of the database the assessment comes from the decision tree and no longer from the assessment database.

Furthermore it is possible to start dynamic inquiries depending on risk-related questions or screens of the proposal form. The definition of this trigger will be available in the maintenance program at a later point in time.

Inquiry modules are defined with the POS Editor of the maintenance program. This editor defined the complete dynamic inquiry, including all assessments. Also the cancel reaction is defined here for each module. The use of the POS editor is described in the user guide maintenance program.

Inquiry modules are pre-defined by Gen Re. If a company prefers to have other inquiries or new inquiry modules or other assessments there are two alternative company individual decision trees:

The company modifies the POS inquiry module database themselves. In this case Gen Re cannot guarantee that the modules work correctly and cannot offer any support regarding the trees. Updates will only be provided on paper.
The company commissions Gen Re to change the inquiry modules on a consultancy fee base. The company will provide the modified/new trees on paper; Gen Re will check them on plausibility and consistency, enter the modifications and test. Gen Re can guarantee that the modules work correctly and offer support. Updates will only be provided on paper or can again be commissioned by Gen Re.

Please note that it is not an easy task to design and implement new inquiry modules as several aspects have to be considered. A training course is offered by Gen Re for design and implementation of inquiry modules.

COMPASS limits

COMPASS includes several competence limits for the head office version which are the same for the Point-of-Sale version (please see COMPASS knowledge description for details). These limits are benefit specific and can be defined by the company.

Sum insured
IF the sum insured/annual benefit exceeds are defined limit, the application is referred with the comment ‘COMPASS limit exceeded’.
Premium amount
If the annual premium exceeds a defined limit, the application is referred with the comment ’COMPASS premium exceeded'.
Total loading
If the determined total loading exceeds a defined limit, the application is referred with the comment ‘loading to high’.
Extra mortality
If the determined extra mortality exceeds a defined limit, the application is referred with the comment ‘extra mortality to high’.
Medical loading
If the determined medical loading exceeds a defined limit, the applications is referred with the comment ‘loading to high’.
Number ratings
If the determined number of ratings (loadings, exclusion clauses) exceeds a defined limit, the application is referred with the comment ’too many ratings’.
Number loadings
If the determined number of loadings exceeds a defined limit, the application is referred with the comment ‘too many loadings’.
Medical limits
Medical limits can be defined by the company. COMPASS cannot make any final decision beyond these limits, because the examination has to be evaluated. The medical limit database can also include limits for requesting GPRs depending on sum and age.

Assessment result

If the proposal is assessed, the result can be displayed. The display can be done with the screens of Gen Re. The complete result is displayed.

Processing of the result by the company

Alternatively the result can be processed directly by the company, e.g. it can be displayed with company specific programs. The process can be done as follows:

Result	Action
Standard, borderline standard	Print-out of application for signature
ADBept with loading	Print-out of application for signature
Offer	Rating can be confirmed, print-out of application with rating
Substandard	Print-out of application for signature, refer to the underwriter with all information

Result

Action

Standard, borderline standard

Print-out of application for signature

ADBept with loading

Print-out of application for signature

Offer

Rating can be confirmed, print-out of application with rating

Substandard

Print-out of application for signature, refer to the underwriter with all information

Print-out of application means that all questions the life assured has already answered in the dialogue are included, i.e. including all dynamic inquiries. A possible questionnaire is then directly integrated into the application.

Provisional Result

In the POS system, in addition to the existing head office version, there is also a provisional result, e.g. if the portfolio data is not available at the point-of-sale. The output is marked “provisional” then. The portfolio data can be made available to the POS in various ways:

Agent takes clients details with him, it must be ensured that the details are up to date. If the client changes the agent the details are missing.
Agent has direct access to head office data.
Agent uses COMPASS placed on the head office server, data access is done via server
Agent uses COMPASS on the internet, data access is controlled via the internet/company connection

Association registry data are often not made available on the PC. Companies connected to the association registry can usually only indicate a provisional result if assessment is carried out without a mainframe connection. However, if the applicant has answered all the questions truthfully, the application is accepted in the standard manner.

Print-out of proposal

For print-out of the proposal the Gen Re generates an XML-file, which is formatted to HTML via XSLT. Via XSLT the print-out can be modified company-specific. The print-out includes all risk data (from standard proposal and dynamic inquiries). The print-out follows the screen sequence.

Integration aspects

Integration of the Point-of-Sale Version can be done in two ways:

Gen Re Screens for data-entry (Windows user interface or Browser user interface), which can be modified according to the companies need (Dialog Mode).
Company specific implementation of the screens. The logic of the dynamic inquiries is included in COMPASS, the company visualises the relevant questions and answers (ScreenBuilder-Mode). COMPASS transfers the requested data via CCP interface and the company screens display it for the user. This communication is repeated until all needed data is complete.

Both versions are also available for the head office version. Therefore this document contains no technical aspects.

Aspects of introducing the Point-of-Sale Version to agents

The COMPASS Point-of-Sale Version means major changes for the sales force, for which the agents must be prepared accordingly. The agent should be clearly shown the advantages of using the Point-of-Sale Version of COMPASS:

No additional effort and costs are incurred by the agent, as the application has to be completed anyway, now on screen instead of manually.
With the dynamic application structure the scope of the application can be considerably reduced for a number of applications.
Additional inquiries in the case of imprecise terms, request of additional evidence, which is frequently required by the head office, are greatly reduced. Delays to the processing of applications due to imprecise application details can therefore largely be avoided.
With the dynamic inquiry of questionnaire information a large number of comprehensive manual questionnaires and some general practitioner reports become superfluous. The client is asked questions specifically relating to his situation. Delays in the processing of applications due to requesting further documents, either from the client or the doctor, are clearly reduced.
The Point-of-Sale System makes the client a direct offer if a substandard risk is involved. The client can accept this offer immediately by signing the application, i.e. the policy can be issued much more quickly.
The agent can tell the client a provisional result immediately, thereby achieving a considerable Marketing effect, and in future he may even be able to print out the policy.
Direct enquiries in the Point-of-Sale System eliminate the applications which are not returned by clients, as filling in the various forms is too inconvenient for the client. For the agent this means that his Marketing efforts will be more successful if has come as far as making an application.
Direct dynamic inquiries in the Point-of-Sale System save the agent’s time he would have to spend for later inquiries. The agent gains valuable time which he can use for other clients.
For the agent it is best to calculate in local currency the profit he can make from using the Point-of-Sale System assuming that:
- time-consuming subsequent inquiries are eliminated
- applications are completed which have not been completed previously as a result of later client inquiries
- fast policy-issue is often necessary and will take on a high priority as competition increases

Comments regarding legal aspects

Print-Out of Application
All information which has been recorded must be printed out and presented to the client for signing. If the client is offered menu selections, the entire menu must be printed out in order to confirm that certain details have been requested but not given. If necessary the company can have the menu selections separately signed by the client on the application print-out.

Storing the Risk Data
Should the client decides not to accept the result, the data must be erased for data-protection reasons. The company may not use the data further, i.e. not even transfer it to head office. The company itself is responsible for deleting. Alternatively the client can be asked before recording risk data whether the data can be stored. Risk data recording can then be made dependent on the answer. With a positive answer recording and storage takes place and the data is passed on to head office in every case. In the event of a negative answer no risk data recording should be carried out, but the application form should be completed. If risk data recording is carried out anyway, the data must be subsequently erased, whereby misuse of the POS (“trying out”) is facilitated.

Security Concept

This security concept has the following tasks:

making misuse of data on the agent systems more difficult and to prevent this as far as possible
not to allow the client to be made "better than he is", i.e. it should not be possible for applications which cannot be accepted as “standard” to be changed in a way that the result is “standard”

The client’s personal data must be treated in accordance with the federal data protection law. In particular this means the data has to be deleted if the client/applicant has not given his permission to pass on the data.

In order to achieve the above aim, four areas are defined in which security measures as proposed:

Hardware measures in the agents’ PC
Measures in the agents’ software
Organisation measures
COMPASS Point-of-Sale version measures

Hardware measures in the agent systems

Boot protection
Additional hardware (Boot-EPROM) can prevent the agent system being booted up (started) with a foreign diskette. Uncontrolled random access to the data carriers (hard disk) can therefore be avoided.
Password for computers
For each agent system a password can be determined so that the system can only be used after entering the correct password.
Encoded hard disk
The data carriers of the agent systems should, even when removed from the agent system, not reveal their information. This can be achieved by means of additional hardware in the agent systems (e.g. DOS-Select). The hard disk is therefore encoded and can only be used in conjunction with the additional hardware.

These measures are becoming increasingly important with great mobility of the agent systems.

Measures in the agents’ software

The following measures must be implemented by the companies within the agents’ software

Password protection
A password can be determined for the entire software for the agent systems or parts thereof. This prevents unauthorised access.
Preventing/making more difficult the copying of applications
If applications in the fact finding software are automatically copied, there is a risk that in the event of non-standard results, a completely new application can be made in which changed client data could be assessed again. It should be checked whether the actions in the fact finding software may be logged in order to highlight noticeable features (e.g. an information file with serial number, name, date of birth, result and benefit).
No access to operating system level/user interface
When using a graphical user interface the graphical user interface should be encapsulated in such a way that only the fact finding software appears. This can partly be achieved by setting the fact finding software or the POS as a “shell”.

Organisation measures

Step by step introduction of the POS
When introducing the POS, all applications should be referred to underwriting assessment in the initial phase.
Monitoring new/suspicious agents
Even after the introduction of the POS, applications by new/suspicious agents should be referred for underwriting for a certain period of time (possibly 3 months).
No data storage on the agent systems
Risk-related (possibly also technical) client data should not be stored on the agent systems, but should be deleted after transfer to the data files at the companies’ head offices.
File-interface only contains one set
The input/output interfaces should only contain the currently processed record (application). Before the preparation of the client data, the technical data are transferred into the input data and after assessment the data in the output are deleted.
Conceal files/encapsulate consultation software
The POS files can be concealed on the agent systems with operating-system commands, so that when accessing the operating level it is not shown which modules are being called up. This can be combined with renaming modules (and for the duration of processing reverse renaming) of the consultation software and the POS.
Random checks of changes
At regular intervals, random checks should be made, and applications for which underwriting has been carried out, compared with the applications/contracts at the head offices.

COMPASS Point-of-Sale version measures

Assess only once.
Changes to client data can be made any number of times, but terms cannot be deleted or modified after the assessment depending on the CSP delete possible. The POS recognises if an application has been assessed or not; after an assessment modification or deletion of data is not permitted when the CSP has the value ‘no’

Disorders

Remarks for module definition

Currently there are decision trees for several disorder areas included in the POS COMPASS version. For some areas there exist one inquiry module to be triggered for unspecific disorder terms belonging to that area and one inquiry module to be triggered for the more specific terms.

When designing a dynamic inquiry the benefit has to be taken into account, because a POS module is always valid for all benefits. This may lead to high-level benefit nodes, e.g. if details are only needed for disability. A complete replacement of a paper questionnaire may also result in several modules caused by the different benefit assessments. You will find for example several benefit related modules for joints. Our aim is to replace as much paper questionnaires as possible to avoid a second client contact for gathering more information.

The dynamic inquiries will assess as much as possible on base of the provided details, including extra mortalities, loadings, exclusions and declines. Whenever the decision is GPR or GPR plus ME within a disorder inquiry module, the attending doctor is captured automatically. The several disorder inquiry modules are described in the following chapters.

If possible the requested information is assessed directly by COMPASS. If an assessment is not possible, the application is referred to the underwriter who can use the information for his assessment. Typically the inquiries contain elements from the specific questionnaires. However they are individually designed and therefore mostly considerably shorter.

The special situation of client conversation was taken into account during the design of the inquiry modules on the base of the principle ‘as much as necessary but as little as possible’. Particularly in the field of disorders, a balance between the necessary questions and the ability of the client to provide details regarding his disorder has been struck.

Abdomen disorders

AbdomenDisorders DataCollection

For Life, Disability, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Gynaecological complaints) Entry points: tube atresia, etc.

This is a data collection module. All details are recorded and referred.

Screen 1

If yes, module change to Cancer
If no, screen 2

Screen 2

If no, screen 3
If yes, screen 4

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

If once, screen 6
If continuously, screen 7
If repeatedly, screen 8

Screen 6

Go to screen 9

Screen 7

Go to screen 9

Screen 8

Go to screen 9

Screen 9

Go to screen 10

Screen 10

(Multiple Selection, Multiple Follow Up)

If other treatment, screen 11
If medication, screen 12
If surgery, screen 13
If planned surgery, screen 14
If radioactive or chemical therapy, screen 15
If no treatment, screen 16

Screen 11

Go to screen 16

Screen 12

Go to screen 16

Screen 13

Go to screen 16

Screen 14

Go to screen 16

Screen 15

Go to screen 16

Screen 16

If yes, go to screen 17
If no, refer

Screen 17

AbdomenDisorders 6 months

For Life, Disability, H&S, CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Gynaecological complaints)

Entry points: Curretage, removal of the ovary, etc.

Screen 1

If malign = yes, module change to Cancer
If malign = no, go to screen 2

Screen 2

If symptoms= no,
- Life, CI, LTC: STD
- Disability, H&S: Go to screen 3
If symptoms = yes, refer and go to screen 4

Screen 3

If last symptoms ≥ 6 months ago, STD
If last symptoms < 6 months ago, go to screen 5 and refer

Screen 4

Go to screen 5

Screen 5

If once, go to screen 6
If continuously, go to screen 7
If repeatedly, go to screen 8

Screen 6

Go to screen 9

Screen 7

Go to screen 9

Screen 8

Go to screen 9

Screen 9

Go to screen 10

Screen 10

(Multiple Selection, Multiple Follow Up)

If other treatment, screen 11
If medication, screen 12
If surgery, screen 13
If planned surgery, screen 14
If radioactive or chemical therapy, screen 14
If no treatment, screen 16

Screen 11

Go to screen 16

Screen 12

Go to screen 16

Screen 13

Go to screen 16

Screen 14

Go to screen 16

Screen 15

Go to screen 16

Screen 16

If yes, go to screen 17
If no, refer

Screen 17

AbdomenDisorders Disabilityown 6 months

For Disability own, H&S
Life, Disability any, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Gynaecological complaints) Entry points: Ovaritis, etc.

Screen 1

If malign = yes, module change to Cancer
If malign = no, go to screen 2

Screen 2

If symptoms= no,
- Life, CI, LTC: STD
- Disability, H&S: Go to screen 3

If symptoms = yes, refer and go to screen 4

Screen 3

If last symptoms ≥ 6 months ago, STD
If last symptoms < 6 months ago, go to screen 5 and refer

Screen 4

Go to screen 5

From screen 5 onwards, the screens are identical to those ones of the module AbdomenDisorders 6 months.

AbdomenDisorders 12 months

For Life, Disability, H&S, CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Gynaecological complaints)

Entry points: Enlarged uterus, etc.

Screen 1

If malign = yes, module change to Cancer
If malign = no, go to screen 2

Screen 2

If symptoms= no,
- Life, CI, LTC: STD
- Disability, H&S: Go to screen 3
If symptoms = yes, refer and go to screen 4

Screen 3

If last symptoms ≥ 12 months ago, STD
If last symptoms < 12 months ago, go to screen 5 and refer

Screen 4

Go to screen 5

From screen 5 onwards, the screens are identical to those ones of the module AbdomenDisorders 6 months

Orchidectomy

For Life, Disability, H&S
CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Gynaecological complaints)

Entry points: Operation on the testicle, Orchidectomy, etc.

Screen 1

If symptoms= yes, go to screen 3
If symptoms = no, go to screen 2

Screen 2

If last symptoms ≥ 12 months ago, STD
If last symptoms < 12 months ago, go to screen 5 and refer

Screen 3

Go to screen 5

Screen 5,… are equivalent to the questions of module AbdomenDisorders 6 months. It is always referred.

Cervical Smears (short version)

For all benefits.

Cancel reaction: Medical questionnaire (Gynaecological complaints)

Entry points: abnormal findings in specimens from female genital organs: abnormal cytological findings (SG), abnormal findings in specimens from female genital organs (MG), CIN I, CIN II, cervical dysplasia, etc

Screen 1

(Single Choice)

If Yes then STD for all benefits
If No or Not Known then GPR for all benefits.
If waiting for repeat then Refer for all benefits

Accidental injuries

Injury non-specific

For all benefits, except ADB: STD

Cancel reaction: Medical questionnaire (General)

Entry points: Car accident, etc.

Screen 1

The term is looked up in the disorder-DB.

If it is the first specification, the term is assessed according to the disorder db. If it is the second specification already, a module change to Other disorder is done. Result is refer.

Accidental Injury 6 months

For Life, CI, LTC, Disability, H&S
ADB: STD

Cancel reaction: accident questionnaire

Entry points: eye injury, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Screen 3

If < 6 months ago, refer and module change to Accidental Injury Data Collection
If ≥ 6 months ago, STD

Accidental Injury Disability 1 month LifeCILTC consequences

For Life, CI, LTC, Disability, H&S
ADB: STD

Cancel reaction: accident questionnaire

Entry points: injury of the ulna nerve, etc.

Disability

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer, and module change to Accidental Injury DataCollection

Screen 3

If < 1 months ago, refer and module change to Accidental Injury DataCollection
If ≥ 1 months ago, STD

Life, CI, LTC

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, STD

Screen 2

Always refer, and module change to Accidental Injury DataCollection

Accidental Injury DisabilityLTC 12 months

For LTC, Disability
Life, CI, ADB: STD

Cancel reaction: accident questionnaire

Entry points: femur fracture, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer and module change to Accidental Injury DataCollection

Screen 3

If < 12 months ago, refer and module change to Accidental Injury DataCollection
If ≥ 12 months ago, STD

Accidental Injury DisabilityCI LTC 12 months Life consequences

For Disability, H&S, LTC, Life, CI
ADB: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Injury of the oval, injury of the back of your neck, etc.

Life

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, STD

Screen 2

Always refer and module change to Accidental Injury DataCollection

Disability, H&S, CI, LTC

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer and module change to Accidental Injury DataCollection

Screen 3

If < 12 months ago, refer and module change to Accidental Injury DataCollection
If ≥ 12 months ago, STD

Accidental Injury DataCollection

For Life, CI, LTC, Disability, H&S
ADB: STD

Cancel reaction: accident questionnaire

Entry points: injury of the artery, etc.

This is a data collection module for all benefits. All details are recorded and referred to underwriting.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Go to screen 4

Screen 3

Go to screen 4

Screen 4

If treatment by physician = yes, go to screen 5
If treatment by physician = no, go to screen 6

Screen 5

Go to screen 6

Screen 6

If surgery = yes, go to screen 7
If surgery= no, go to screen 8

Screen 7

Go to screen 8

Screen 8

If planned surgery = yes, go to screen 9
If planned surgery = no, go to screen10

Screen 9

Go to screen 10

Screen 10

If unable to work = yes, go to screen 11
If unable to work = no, refer

Screen 11

Go to screen 12

Screen 12

If occupation change = yes, go to screen 15

Screen 13

Accidental Injury DataCollection only Disability

For Disability, H&S
ADB, Life, CI, LTC: STD

Cancel reaction: accident questionnaire

Entry points: open fracture, fracture of the arm, etc.

This is a data collection module. For Disability and H&S all details are recorded and referred. The screens are equivalent to the module Accidental Injury Data Collection.

Accidental Injury DataCollection Disability LTC consequences

For Disability, H&S, LTC
ADB, Life, CI: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: abdominal trauma, etc.

LTC

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, STD

Screen 2

Always refer, and module change to Accidental Injury Data Collection, screen 4

Disability, H&S

Module change to Accidental Injury Data Collection

Accidental Injury Disability own Occupation 3 months

For Disability own, H&S
ADB, Life, CI, LTC, Disability any: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Injury of the ellbow, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no
- If occupation not related to organ category, STD
- If occupation related to organ category, go to screen 3

Screen 2

refer

Screen 3

If < 3 months ago, refer
If ≥ 3 months ago, STD

Accidental Injury Disability own Occupation 6 months

For Disability own, H&S
ADB, Life, CI, LTC, Disability any: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: leg sprained, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no
- If occupation not related to organ category, STD
- If occupation related to organ category, go to screen 3

Screen 2

refer

Screen 3

If < 6 months ago, refer
If ≥ 6 months ago, STD

Accidental Injury Disability own Occupation or 12 months

For Disability own, H&S
ADB, Life, CI, LTC, Disability any: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: bruised leg, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Screen 3

If occupation not related to organ category and ≥ 12 months ago, STD
If occupation related organ category or < 12 months ago, module change to Accidental Injury Data Collection4

Accidental Injury DisabilityLTC 6 months

For Disability, H&S, LTC
ADB, Life, CI: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Breastbone fracture, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Screen 3

If < 6 months ago, refer and module change to Accidental Injury Data Collection
If ≥ 6 months ago, STD

AccidentalInjuryDisability 4weeks duration 6 months LTC consequences

For Disability, H&S, LTC
ADB, Life, CI: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: bruised back, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no,
- LTC: STD
- Disability, H&S: go to screen 3

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Screen 3

If ≥ 6 months ago and duration ≤ 4 weeks, STD
If < 6 months ago or duration > 4 weeks, module change to Accidental Injury Data Collection, screen 4

AccidentalInjuryDisability 4weeks duration 3 months LTC consequences

For Disability, H&S, LTC
ADB, Life, CI: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: bruised back, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no,
- LTC: STD
- Disability, H&S: go to screen 3

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Screen 3

If ≥ 3 months ago and duration ≤ 4 weeks, STD
If < 3 months ago or duration > 4 weeks, module change to Accidental Injury Data Collection

Electric shock Lightning

For Disability, H&S, LTC, Life, CI
ADB: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Lightening, electric shock, etc.

Life

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Screen 3

If < 6 months ago, refer and module change to Accidental Injury Data Collection
If ≥ 6 months ago, STD

CI, Disability, LTC, H&S

Module change to Accidental Injury Data Collection

Poisoning

For Disability, H&S, LTC, Life, CI
ADB: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Fish poisoning, etc.

Screen 1

If sequelaes yes, go to screen 2
If sequelaes = no, STD

Screen 2

Always refer, and module change to Accidental Injury Data Collection

BurnCorrosionFrostbite

For Disability, H&S, LTC, Life, CI
ADB: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Injuries due to burns, etc

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, STD

Screen 2

Always refer, and module change to Accidental Injury Data Collection

Arm/Hand - Loss of finger

For disability own, LTC
Life, CI, ADB, Disability any: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: loss of finger

Screen 1

If congenital, STD
If accident
- Disability own; H&S: Exclusion clause finger
- LTC: 10% loading
If disorder, go to screen 2

Screen 2

refer

Knee/Foot - Loss of foot

For all benefits except ADB: STD
Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: both feet lost

Screen 1

If yes, module change to Traumatic amputation
If no, go to screen 2

Screen 2

refer

Knee/Foot - Loss of toe

For disability own, LTC
Life, CI, ADB, Disability any: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: loss of toe, servered toe, toe lost, toe amputated, etc.

Screen 1

If congenital, STD
If accident
- Disability own; H&S: Exclusion clause toe
- LTC: 10% loading
If disorder, go to screen 2

Screen 2

refer

Traumatic Amputation

For Life, CI, LTC
Disability own, H&S: Exclusion Clause Amputation of lower/upper extremities
Disability any: 50% loading
ADB: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Loss of thumb, etc (simple amputations)

Life, CI

Screen 1

If symptoms = yes, go to, screen 2
If symptoms = no, STD

Screen 2

refer

LTC

Module change to Accidental Injury DataCollection

Traumatic deafness

For Life, CI, LTC, H&S
Disability: Exclusion Clause Deafness
ADB: STD

Cancel reaction: Medical questionnaire (accidental injuries)

Entry points: Traumatic deafness, etc.

Screen 1

If symptoms = yes, go to, screen 2
If symptoms = no, STD

Screen 2

refer

Allergies

Allergy (non-specific)

For all benefits except ADB: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: allergic shock, etc.

Screen 1

The term is looked up in the disorder-DB.

If it is the first specification, the term is assessed according to the disorder db. If the term is not found, it will be referred.
If it is the second specification already, a module change to Other disorder is done. Result is refer.

AllergyUnspecificDisability

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: allergy, allergic reaction, etc

Screen 1

The term is looked up in the disorder-DB.

If it is the first specification, the term is assessed according to the disorder db.
If it is the second specification already, a module change to Other disorder is done. Result is refer.

AllergyType

For Disability
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: allergy to animal hair, house dust allergy, allergy to strawberry, etc.

Screen 1

If gastrointestinal symptoms = yes, module change to FoodAllergy
If gastrointestinal symptoms = no, go to screen 2

Screen 2

If skin reaction = no and respiratory complaints = no, STD
If skin reaction =yes and respiratory complaints = yes, module change to SkinAllergy, module change to RespiratoryAllergy
If skin reaction = yes and respiratory complaints = no, module change to SkinAllergy
If skin reaction = no and respiratory complaints = yes, module change to RespiratoryAllergy

SkinAllergy

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: skin allergy, etc.

Screen 1

(Multiple Selection, Single Follow Up)

If other,
- If asthmatic complaints indicated in the application form, go to screen 2
- If no asthmatic complaints, go to screen 4
If allergic contact dermatitis, module change to Allergic contact dermatitis
- If nettle rash or urticaria, module change to Urticaria
- If light dermatosis or light reaction of the skin, module change to Allergy to light
If neurodermatitis or atopic dermatitis or atopic eczema, module change to Neurodermitis
- If nettle rash or urticaria, module change to Urticaria
- If light dermatosis or light reaction of the skin, module change to Allergy to light
If urticarial or nettle rash, module change to Urticaria
- If drug exanthema, module change to Drug allergy
- If light dermatosis or light reaction of the skin, module change to Allergy to light
If drug exanthema, module change to Drug allergy
- If light dermatosis or light reaction of the skin, module change to Allergy to light
If light dermatosis or light reaction of the skin, module change to Allergy to light

If asthmatic complaints have been indicated in the application form

Screen 2

refer
If medical treatment, go to screen 3

Screen 3

If no asthmatic complaints indicated

Screen 4

If yes, go to screen 5
If no, go to screen 2

Screen 5

If no medication, go to screen 2
If any medication, go to screen 6

Screen 6

If seasonal or if needed, go to screen 7
If ongoing therapy, go to to screen 2

Screen 7

Go to screen 2

Neurodermatitis

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: neurodermatitis, inflammatory skin disease, etc.

Hint:
The assessment differs between occupations related to neurodermatitis and others. The organ category is used to recognize these occupations. This – general- approach can result in an exclusion clause for an occupation for which it is not definitely needed. If you want to avoid this, the relevant occupation titles can be included in the rule explicitly or refer all assessment which might result in an exclusion clause to the underwriter.

If mental complaints are indicated, refer and record details. Mental complaints are derived from an application form question which is answered yes (COMPANY specific modification is required!!!) or from disorder terms and their relevant organ category.

For Disability any

Screen 1

If last symptoms ≥ 5 years ago and age ≤ 23,: STD
If last symptoms < 5 years ago or age > 23, go to screen 2

Screen 2

If > 4 areas or spread to other body parts, loading 50%
If ≤ 4 areas and no spread to other body parts
- If areas smaller than 2 cm = yes: STD
- If areas smaller than 2 cm = no: loading 25%

If Disability own

If asthmatic complaints are indicated in the application Exclusion clause respiratory and skin (combination clause)
If no asthmatic complaints are indicated, go to screen 3

Screen 3

If respiratory allergies = yes, Exclusion clause respiratory and skin (combination clause)
If respiratory allergies = no, go to screen 4

Screen 4

If last symptoms ≥ 5 years ago and age ≤ 23
- occupation related to allergy: loading 25%
- other occupations: STD
If last symptoms < 5 years ago or age > 23
- occupations related to allergy: exclusion clause allergic skin diseases
- other occupations: go to screen 5

Screen 5

If > 4 areas or spread to other body parts, loading 50%
If ≤ 4 areas and no spread to other body parts
- If areas smaller than 2 cm = yes: STD
- If areas smaller than 2 cm = no: loading 25%

AllergicContactDermatitis

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: contact dermatitis, allergy to nickel, allergy to synthetic material, etc.

If Disability any
- If occupation related to allergy: loading 50%
- If other occupation: STD
If Disability own, H&S
- If asthmatic complaints indicated in the application form Exclusion clause respiratory and skin
- (combination clause)
- If no asthmatic complaints, go to screen 1

Screen 1

If yes, Exclusion clause respiratory and skin (combination clause)
If no:
- If occupation related to allergy, exclusion Clause skin
- If other occupation, go to screen 2

Screen 2

If yes, go to screen 3
If no, exclusion clause allergic skin disease and hint ‚to be checked in 2 years’

Screen 3

If last symptoms < 2 years ago: Exclusion clause allergic skin disease and hint ‚to be checked in 2 years’
If last symptoms ≥ 2 years ago: STD

Urticaria

For all benefits, except ADB: standard

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: Urticaria, etc.

Screen 1

(Multiple selection, single follow up)

If vasculitis, request GPR
If allergic shock, anaphylactic shock, Angioedema or mucous membrane swelling, module change to Angioedema
If other symptoms,
- Life, CI, LTC standard
- Disability, H&S: go to screen 2

Screen 2

If only once
- If duration ≥ 6 weeks
  - If last symptoms ≤ 3 years ago
    
    H&S: exclusion clause Urticaria
    
    Disability 25% loading
  - If last symptoms >3 years ago: STD
- If duration < 6 weeks
  - If last symptoms ≤ 3 months: defer 3 months
  - If last symptoms > 3 months: STD
If more than once
- If last symptoms ≤ 3 years ago
  - H&S: exclusion clause
  - Disability: 25% loading
- If last symptoms > 3 years ago: STD

Angioedema

For all benefits, except ADB: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: Quinckes disease, etc.

1 Details

If more than once, refer
If only once
- If last symptoms ≥ 12 months ago: STD
- If last symptoms < 12 months ago, go to screen 2

2 Details

If symptoms = no, refer
If symptoms = yes, go to screen 3

3 Details

refer

Allergy to light

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: allergy to light, polymorphic eruptions to light, light-sensitive reaction, etc

For Disability any

Screen 1

If only once
- If duration ≥ 6 weeks
  - If last symptoms ≤ 5 years ago: 50% loading
  - If last symptoms > 5 years ago: STD
- If duration < 6 weeks
  - If last symptoms ≤ 3 months ago: 25% loading
  - If last symptoms > 3 months ago: STDl
If more than once
- If last symptoms ≤ 5 years ago: 50% loading
- If last symptoms > 5 years ago: STD

For Disability own, H&S

If asthmatic complaints indicated in the application form, Exclusion clause respiratory and skin (combination clause)
If no asthmatic complaints, go to screen 2

Screen 2

If yes, Exclusion clause respiratory and skin
If no, go to screen 3

Screen 3

If only once
- If duration ≥ 6 weeks
  - If last symptoms ≤ 5 years ago: Exclusion clause allergic skin diseases
  - If last symptoms > 5 years ago: STD
- If duration < 6 weeks
  - If last symptoms ≤ 3 months ago: 25% loading
  - If last symptoms > 3 months ago: STDl
If more than once
- If last symptoms ≤ 5 years ago: Exclusion clause allergic skin diseases
- If last symptoms > 5 years ago: STD

Respiratory tract allergy

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: from other modules

Screen 1

(Multiple Selection, Single Follow Up)

If other, screen 2 and refer
If Shortness of breath, module change to Respiratory DataCollection
If Asthma or asthmatic bronchitis, module change to Asthma
If allergic rhinitis, hay fever, pollinosis, allergic conjunctivitis or seasonal cold, module change to Hay fever

Screen 2

If yes, exclusion clause allergic respiratory and skin diseases (combi clause)
If no, go to screen 3

Screen 3

refer
If medication, go to screen 4

Screen 4

If seasonal or if needed, go to screen 7

Screen 5

Hay fever

For Disability own, H&S
Life, ADB, CI, LTC, Disability any: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: hay fever, allergic conjunctivitis, etc

Hint:
The assessment differs between occupations related to hay fever and others. The organ category is used to recognize these occupations. This – general- approach can result in an exclusion clause for an occupation for which it is not definitely needed. If you want to avoid this, the relevant occupation titles can be included in the rule explicitly or refer all assessments which might result in an exclusion clause to the underwriter.

If asthmatic complaints indicated in the application form, the assessment is done according to asthma because this is the more severe disorder. No further questions are asked for hay fever.

If no asthmatic complaints, go to screen 1

Screen 1

If yes, exclusion clause allergic respiratory and skin diseases (combi clause)
If no, go to screen 2

Screen 2

If medication = asthma spray or tablets without corticoid, module change to Asthma
If medication = corticoid tablets, refer with ‘medication untypical for hay fever’ and go to screen 3.
If medication = anti allergic tablets, nasal spray or no medication
- If occupation is not related to hay fever: STD
- If occupation is related to hay fever:
  - If anti allergic tablets or nasal spray: Exclusion clause allergic respiratory diseases
  - If no medication: go to screen 6

Screen 3

If seasonal or if needed, go to screen 4
If ongoing therapy, go to screen 5

Screen 4

Go to screen 5

Screen 5

refer

Screen 6

If immunotherapy = yes, go to screen 7
If immunotherapy = no, Exclusion clause allergic respiratory diseases

Screen 7

If no symptoms and therapy end > 3 years ago, 50% loading
If symptoms or therapy end ≤ 3 years ago, Exclusion clause allergic respiratory diseases

Insecticide allergy

For Disability, H&S
Life, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: bee sting, etc.

Screen 1

If immunotherapy = yes, go to screen 2
If immunotherapy = no
- Disability own, H&S: Exclusion clause insecticide allergy
- Disability any: 50% loading

Screen 2

If end < 12 months ago
- Disability own, H&S: Exclusion clause insecticide allergy for occupations related to, allergies , else 25% loading
- Disability any: 25% loading
If end ≥ 12 months ago
- Disability any: STD
- Disability own, H&S: Exclusion clause insecticide allergy for occupations related to, allergies1, else STD

Medication allergy

For Disability own
Life, Disability any, ADB, CI, LTC: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: drug allergy, etc.

Screen 1

If no, go to screen 2
If yes, go to screen 3

Screen 3

refer

Screen 2

If symptoms occurred 1-3 times:
- If last symptoms > 6 weeks ago, STD
- If last symptoms ≤ 6 weeks ago, 25% loading
If symptoms occurred > 3 times: refer

Food allergy

For all benefits except ADB: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: from other modules

If no mental complaints, go to screen 1

1 Complications

If complications = yes, module change to Angioedema
If complications =no,
- If Life, CI, LTC: standard
- If Disability, H&S
  - If asthmatic complaints indicated in the application form, go to screen 2
  - If no asthmatic complaints, go to screen 3

2 Details

If yes
- Diability own, H&S: Exclusion clause allergic respiratory and skin diseases (combi clause)
- Disability any: module change to Skin allergy
If no, standard (only Asthma assessment)

3 Details

If no skin allergy and no asthmatic complaints, standard
If skin allergy and asthmatic complaints,
- Diability own, H&S: Exclusion clause allergic respiratory and skin diseases (combi clause)
- Disability any: module change to Asthma and Skin allergy
If skin allergy = yes and asthmatic complaints = no, module change to Skin allergy
If skin allergy = no and asthmatic complaints = yes, module change to Asthma

Allergic diarrhoea

For all benefits except ADB: STD

Cancel Reaction: Medical Questionnaire (Allergy)

Entry points: allergic diarrhoea, allergic gastroenteritis, etc.

Disability
Module change to Gastrointestinal DataCollection

Life, CI, LTC

Screen 1

If consequences = yes, go to screen 2
If consequences = no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If minimum time elapsed ≥ 12 months ago and duration ≤ 6 weeks, STD
If minimum time elapsed < 12 months ago or duration > 6 weeks, Module change to Gastrointestinal DataCollection

Ear disorders

Ear DataCollection

For Life, Disability, H&S, LTC, CI
ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Vertigo, etc.

This is a data collection module for all benefits except ADB. The data is recorded and referred to underwriting.

Screen 1

If once, go to screen 2
If repeatedly, go to screen 3
If continuously, go to screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

Go to screen 6

Screen 6

If symptoms = yes, screen 7
If symptoms = no, screen 8

Screen 7

Go to screen 9

Screen 8

Go to screen 9

Screen 9

Go to screen 17

Screen 10

If surgery, go to screen 11
If surgery planned, go to screen 12
If other treatment, Screen 13
If medication, to to screen 14
If hearing device, go to screen 15
If no treatment, go to screen 16
If Tinnitus-Masker, go to screen 19
If Intravenous therapy, go to screen 20

Screen 11

Screen 12

Screen 13

Screen 14

Screen 15

Screen 16

Screen 17

If yes, go to screen 18
If no, go to screen 10

Screen 18

Go to screen 10

Screen 19

Screen 20

Ear DataCollection Disability

For Disability, H&S
Life, LTC, CI, ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Hearing loss, etc.

This is a data collection module for Disability and H&S. The data is recorded and referred to underwriting. The questions are equivalent to the module Ear DataCollection.

Ear inflammation

For Disability, H&S
Life, LTC, CI, ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Otitis media, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to Ear DataCollection

Screen 3

If symptoms ≥ 6 months ago, STD
If symptoms < 6 months ago, module change to Ear DataCollection

Otitis Externa

For Life, Disability, H&S, CI
LTC, ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Otitis Externa, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to Ear DataCollection

Screen 3

If symptoms ≥ 6 months ago and duration < 6 weeks, STD
If symptoms < 6 months ago or duration ≥ 6 weeks, module change to Ear DataCollection

Tinnitus

For Life, Disability, H&S, CI, LTC, ADB

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Tinnitus, etc.

Screen 1

If free of symptoms = yes
- Disability, H&S, go to screen 2
- Life, LTC, CI, ADB: standard
If free of symptoms = no, go to screen 3

Screen 2

If symptoms ≥ 6 months ago, standard
If symptoms < 6 months ago,
- Disability own, H&S: Exclusion clause Tinnitus
- Disability any: 50% loading

Screen 3

If cause known = yes, go to screen 4
If cause known = no
- Disability own, H&S: Exclusion clause Tinnitus
- Disability any: 50% loading
- Life, LTC, CI, ADB: standard

Screen 4

refer

Tympanic membrane DisabilityownOccupationf

For Disability own
Disability any, H&S, Life, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Myringitis, tympano sclerosis, etc.

If occupation related to ears, module change to Ear DataCollection. If other ocupation, STD

Deafness

For LTC, CI, Life, Disability, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Deafness, etc.

Disability, H&S

Screen 1

Exclusion clause Deafness

Life, CI, LTC

This is a data collection module for Life, CI and LTC. The data is recorded and referred to underwriting. The questions are equivalent to the module Ear DataCollection.

ImpairedHearing DataCollection

For Disability, H&S
CI, Life, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Deafness to high tones, etc.

Screen 1

Always refer

Meniere’s disease

For Disability, LTC, ADB
H&S: Exclusion clause defective hearing, vertigo, tinnitus
Life, CI: standard

Cancel reaction: Medical questionnaire (Ear disorders)

Entry points: Meniere’s disease, Meniere’s symptom complex, etc.

1 Attacks

If > 2 attacks
- Disability: Decline
- LTC: 10% loading
- ADB: 25% loading
If < = 2 attacks, go to screen 2

2 last attack

If last attack < = 1 year ago
- Disability: defer 12 months
- LTC: 10% loading
- ADB 25% loading
If last attack > 1 year ago and < = 3 years ago
- Disability Exclusion clause defective hearing, vertigo, tinnitus
- LTC: standard
- ADB 25% loading
If last attack > 3 years ago
- Disability: Exclusion clause defective hearing, vertigo, tinnitus*
- LTC: standard
- ADB 25% loading*

*The assessment can depend on the occupation. Electronically this cannot be determined, we have therefor taken the worst assessment.

Endocrine system disorders

Diabetes (unspecific)

For all benefits, except ADB: STD
Life assured below age 16: refer

Cancel reaction: General Practitioner Report

Entry points: diabetes, etc.

Screen 1

Single Choice

If “Diabetes Insipidus” then module change to GeneralDataCollection
If gestational diabetes/diabetes in pregnancy module change to Gestational diabetes
If Diabetes mellitus or insulin dependent diabetes or non insulin dependent diabetes module change to Diabetes

Diabetes

For Life. LTC

ADB: STD
CI, IP2/52, IP4/52: Decline
IP13/52: GPR
Life assured below age 16, refer

Cancel reaction: General Practitioner Report

Entry points: Diabetes mellitus, etc.

Initial smoking assessment (not for IP):
The smoking habits are taken into account within the diabetes module. Therefore the system will automatically come up with the corresponding questions if they have not been asked in the dialog taken place so far.

Screen 0 (suppressed if already asked)

If yes, add +25% extra mortality for Life, +25% loading for LTC.
Always go to screen 1

Screen 1

If < 6 months ago or > 120 months ago, then request GPR
If ≥ 6 months ago and ≤ 120 months ago, go to screen 2

Screen 2

If HbA1C-Wert > 8.0 or HbA1C-Wert < 5.0 or > 12 months ago, then GPR
If value or point in time is unknown then GPR
Else screen 3

Screen 3

If Yes then Screen 4
If No then GPR

Screen 4

Multiple Choice, Single Follow up

If no complications then go to screen 5
If any other or unknown then GPR

Overweight:

If overweight em > 50%, refer, else, add loading as usual

Screen 5

If unknown or other then GPR.
If diet or tablets (diabetes type 2) then
- Life
  - age 16 – 29: +200% extra mortality
  - age 30 – 39: +125% extra mortality
  - age 40 – 49: +75% extra mortality
  - age 50 – 59: +50% extra mortality
  - ages above 59 : +25% extra mortality
- LTC
  - age 16 – 29: decline
  - age 30 – 39: +40% loading
  - age 40 – 59: +20% loading
  - ages above 59: +10% loading
If insulin (diabetes type 1) then
- Life
  - age 16 – 29: +200% extra mortality
  - age 30 – 39: +125% extra mortality
  - age 40 – 59: +75% extra mortality
  - age 60 or above: +50% extra mortality
- LTC
  - age 16 – 29: decline
  - age 30 – 39: +50% loading
  - age 40 or above: 20% loading

Diabetes (Gestational/Pregnancy)

For all benefits except ADB: STD

Life assured below age 16, refer

Cancel reaction: General Practitioner Report

Entry points: diabetes in pregnancy, gestational diabetes.

Screen 1

If yes, go to screen 2
If no, STD

Screen 2

If time of diagnosis < 12 months ago, module change to Diabetes
If time of diagnosis ≥ 12 months ago, STD

Hyperlipidaemia

For all benefits except ADB.: STD

Cancel reaction: General questionnaire - disorders

Entry points: Cholesterol, Hyperlipidaemia, etc.

Screen 1

Always refer

On request this module can be extended to calculate ratings based on the values.

Thyroid disease Filter

For all benefits except ADB: STD

Cancel reaction: Medical questionnaire (thyroid)

Entry points: thyroidectomy, etc

Screen 1

If ≤ 6 months ago, module change to ThyroidDisease DataCollection
If > 6 months ago, screen 2

Screen 2

(Single Selection)

If unknown, module change to ThyroidDisease DataCollection
If malign, module change to Cancer
If benign or no surgery, screen 3

Screen 3

(Multiple selection, single follow up)

If shortness of breath or hoarseness, module change to ThyroidDisease DataCollection
If “other” complaints, screen 5
If “no symptoms” or “gain in weight”, screen 4

Screen 4

(Multiple selection, single follow up)

If iodine, thyroid hormone replacement or none, STD for all benefits
If other, screen 6

Screen 5

(Multiple selection, single follow up)

Always refer.
If other, screen 6

Screen 6

refer

Thyroid disease DataCollection LifeSTD

For Disability, LTC, H&S, CI
Life, ADB: STD

Cancel reaction: Medical questionnaire (Thyroid disorders)

Entry points: struma operation

Screen 1

If ≤ 6 months ago, module change to ThyroidDisease DataCollection
If > 6 months ago, go to screen 2

Screen 2

If unknown, module change to ThyroidDisease DataCollection
If malign, module change to Cancer
If benign or no surgery, screen 3

Screen 3

(Multiple selection, single follow up)

If shortness of breath or hoarseness, module change to ThyroidDisease DataCollection
If “other” complaints, screen 5
If “no symptoms” or “gain in weight”, screen 4

Screen 4

(Multiple selection, single follow up)

If iodine, thyroid hormone replacement or none, STD for all benefits
If other, screen 6

Screen 5

(Multiple selection, single follow up)

Always refer.
If other, screen 6

Screen 6

refer

ThyroidDisease DataCollection

For all benefits except ADB: STD

Cancel reaction: Medical questionnaire (Thyroid)

Entry points: chronic thyroiditis, etc.

This is a data collection module. All details are recorded and referred.

Screen 1

Go to screen 2

Screen 2

If benign or no surgery or unknown, screen 3
If malign, module change to Cancer

Screen 3

(Multiple selection, single follow up)

If other, screen 4
always screen 5

Screen 4

Go to screen 5

Screen 5

(Multiple selection, single follow up)

If other medication, screen 6
If Iodine, Thyroid hormone replacement or none, refer

Screen 6

refer

Anaemia (general)

For all benefits.

Cancel reaction: Medical questionnaire (Anaemia)

Entry points: anaemia

Screen 1

(Multiple choice, Single follow up)

If “other diagnosis” module change to Other disorder
If any other than “iron deficiency” then GPR for all benefits
If iron deficiency anaemia then module change to Anaemia for all benefits

Anaemia

For Life, CI, Disability, H&S, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Anaemia)

Entry points: iron deficiency, ferritin test, hypochromic anaemia, iron supply, etc.

Screen 1 Status

If still present = yes, screen 2
If still present = no, standard

Screen 2 Treatment

(Multiple choice, Single follow up)

If other, go to screen 3
If blood transfusion
- Life: 150% em
- LTC: GPR
- H&S: 25% loading
- CI: defer
- Disability own/any: decline
If none or iron supplement
- If consequences > 0, screen 3
- If no consequences, standard

Screen 3 Cause

(Multiple choice, Single follow up)

If suspected cancer, GPR
If other, go to screen 4
If stomach resection, module change to Gastrointestinal DataCollection
If chronic inflammation, module change to General specification for unspecific disorder
If gastritis, module change to Dyspepsia/gastritis
If gastric ulcer/stomach ulcer, module change to Stomach ulcer
If chronic bowel disease, module change to Gastrointestinal 12 months
If renal disease, module change to Chronic Nephritis
If pregnancy, diet, menstruation, STD
If unknown, refer

Screen 4

refer

Eye disorders

EyeDataCollection

For Life, CI Disability, H&S, LTC
ADB: STD

Cancel reaction: Medical questionnaire eyes

Entry points: Diplopia, ocular palsy, etc.

This is a data collection module, all details are recorded and referred to underwriting.

Screen 1

once, go to screen 2
If repeatedly, go to screen 3
If continuously, go to screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

If other treatment, go to screen 6
If surgery or laser, go to screen 7
If surgery planned, go to screen 8
If medication, go to screen 9
If no treatment or contact lenses or glasses, go to screen 10

Screen 6

Go to screen 10

Screen 7

Screen 10

Screen 8

Screen 10

Screen 9

Screen 10

Screen 10

If yes, Screen 11
If no, Screen 12

Screen 11

Screen 12

Screen 12

If yes, Screen 13
If no, Screen 14

Screen 13

Screen 15

Screen 14

Screen 15

Screen 15

Eye DataCollection LifeLTC STD

For CI, Disability, H&S
Life, LTC, ADB: STD

Cancel reaction: Medical questionnaire eyes

Entry points: Amblyopia, sight deterioration, etc.

This is a data collection module for CI, Disability and H&S. All details are recorded and referred to underwriting. The questions are according to questions in the module EyeDataCollection.

EyeSurgery

For Disability, H&S
Life, CI, ADB, LTC: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Cataract surgery, etc.

Screen 1

If surgery or laser planned, defer post surgery for all benefits.
If complications, go to screen 2
If no complications and no planned surgery:
- Dioptres right or left < -8 or > +8, Exclusion clause eye disorders
- Dioptres right and left ≥ -8 and ≤ +8 and correction with surgery or laser, go to screen 3
- Dioptres right and left ≥ -8 and ≤ +8 and correction with glasses or contact lenses: STD
- If diopters unknown, refer with ‘check missing diopters’

Screen 2

refer with ‘disorder to be checked’

Screen 3

If previous dioptres right and left ≥ -8 and ≤ +8 and surgery >6 months ago, STD
If previous dioptres right and left ≥ -8 und ≤ +8 and surgery ≤ 6 months ago, defer 6 months
If previous dioptres right or left < -8 or >+8, Exclusion clause eye disorders
If diopters unknown, refer with ‘check missing diopters’

Shortsightedness

For Disability and H&S only.
Life, CI, ADB, LTC: STD

Cancel reaction: General Questionnaire

Entry points: Short-sightedness, myopia, etc.

Screen 1

Eye surgery = yes, go to screen 2
Vision normal = no, Exclusion clause for eye disorder
Eye surgery = no and vision normal= yes, STD

Screen 2

If Diopters right and left eye > 8 or < -8, Exclusion clause for eye disorder
If Diopters right and left eye ≤ 8 and > -8, STD
If Diopters unknown, refer.

Gall bladder

Gall Bladder (non specific)

For all benefits except ADB: STD.

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: cholestasis, etc

Screen 1

(Single choice)

If cancer of the bile ducts or cancer of the gall bladder: module change to Cancer
If no diagnosis/unknown or hepatitis: GPR
If other, module change to Other disorder
If cholecystitis or inflammation of the gallbladder: module change to Gall bladder specific, screen 2
If gall stones or cholelithiasis, STD.

Gall Bladder Specific

For all benefits except ADB: STD.

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: cholecystitis, etc

Screen 1

Multiple choice, Single follow up

If acute biliary colic: defer
If cholangitis, hepatitis, other or unknown diagnosis or perforation of the gallbladder, GPR
If none included in this list, go to screen 2
If cancer of the gall bladder or cancer of the bile ducts, module change to Cancer
If other disorder of the bile ducts,…, module change to Other disorder

Screen 2

If surgery planned, defer
If no surgery planned
- If had surgery, module change to gall bladder surgery
- If not had surgery, go to screen 3

Screen 3

If complications = yes: go to screen 4
If complications = no
- If ≤ 1 episode: STD
- If > 1 episode
  - Life 50% extra mortality
  - CI, Disability own/any 50% loading
  - LTC STD

Screen 4

refer

Gall Bladder Surgery

For all benefits, except ABD: STD.

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Cholecystectomy, etc.

Screen 1

If symptoms since surgery took place = Yes, then go to screen 2
If symptoms since surgery took place = no, then STD

Screen 2

refer

Gall DataCollection

For Life, Disability, H&S, LTC, CI
ADB: STD

Cancel reaction: Medical questionnaire (gall bladder, liver)

Entry points: Gall bladder stenosis, etc.

This is a data collection module only. All details are recorded for all benefits except ADB and referred.

Screen 1

If once, screen 2
If continuously, screen 3
If repeatedly, screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

(Multiple choice, Multiple follow up)

If other treatment, go to screen 6
If medication, go to screen 7
If surgery, go to screen 8
If planned surgery, go to screen 9
If lithotripsy, go to screen 10
If no treatment, go to screen 11

Screen 6

Go to screen 11

Screen 7

Go to screen 11

Screen 8

Go to screen 11

Screen 9

Go to screen 11

Screen 10

Go to screen 11

Screen 11

If blood test = yes, go to screen 12
If blood test = no, go to screen 13

Screen 12

Go to screen 13

Screen 13

If no, screen 14
If yes, screen 15

Screen 14

Go to screen 16

Screen 15

Go to screen 16

Screen 16

yes, go to screen 17

Screen 17

Gall DataCollection 12 months

For Life, Disability, LTC, CI, H&S
ADB: STD

Cancel reaction: Medical questionnaire (gall bladder, liver)

Entry points: Postcholecystectomy syndrome, etc.

Screen 1

If yes, module change to Gall DataCollection
If no, go to screen 2

Screen 2

If last symptoms ≥ 12 months ago, STD
If last symptoms < 12 months ago, module change to Gall DataCollection

Gall DataCollection Disability Decl

For Life, LTC, CI
Disability, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire (gall bladder, liver)

Entry points: Alcoholic hepatitis, hepatic fibrosis, etc.

This is a data collection module for Life, CI and LTC. All details are recorded and referred to underwriting. The questions are according to questions in the module Gall DataCollection.

Gall DataCollection DisabilityCI Decl

For Life, LTC
Disability, H&S, CI: Decline
ADB: STD

Cancel reaction: Medical questionnaire (gall bladder, liver)

Entry points: Polycystic liver, etc.

This is a data collection module for Life and LTC. All details are recorded and referred to underwriting. The questions are according to questions in the module Gall DataCollection.

Gall DataCollection DisabilityCILTC Decl

For Life
Disability, H&S, CI, LTC: Decline
ADB: STD

Cancel reaction: Medical questionnaire (gall bladder, liver)

Entry points: Portocaval encephalopathy,etc.

This is a data collection module for Life. All details are recorded and referred to underwriting. The questions are according to questions in the module Gall DataCollection.

General modules

Coloscopy

For all benefits.

Cancel reaction: General Questionnaire - disorders

Entry points: colonoscopy

Screen 1

If no further treatment and preventive examination, STD
If further treatment or not preventive examination
- If further treatment, go to screen 4
- If other reason, go to screen 2
- If disorder/complaints, go to screen 3

Screen 2

refer

Screen 3

The term is looked up in the disorder-DB.

If it is the first specification, the term is assessed according to the disorder db.
If it is the second specification already, a module change to Other disorder is done. Result is refer.
If the term is not known, standard details are recorded.

Screen 4

refer

Degree of disability data collection

For all benefits

Cancel Reaction: general disorder questionnaire

Entry points: degree of handicap, etc.

Screen 1

refer

Examination

For all benefits, except ADB: STD

Cancel reaction: General questionnaire - disorders

Entry points: Medical examination, ECG, etc.

Screen 1

If other result, go to screen 2
If any other result, go to screen 3

Screen 2

Go to screen 3

Screen 3

If further medical treatment = yes, go to screen 4
If further medical treatment = no, refer

Screen 4

refer

General examinations

For all benefits.

Cancel reaction: General questionnaire - disorders

Entry points: Bronchial lavage, stomach pumped out, etc.

Screen 1

The term is looked up in the disorder-DB.

If it is the first specification, the term is assessed according to the disorder db.
If the term is not known, standard details are recorded.
If it is the second specification already, a module change to Other disorder is done. Result is refer.

General specification for unspecific disorder

For all benefits

Cancel Reaction: General questionnaire - disorders

Entry points: invalid, pensioner, unknown, etc.

The term is looked up in the disorder-DB.

If it is the first specification, the term is assessed according to the disorder db.
If the term is not known, standard details are recorded.
If it is the second specification already, a module change to Other disorder is done. Result is refer.

General DataCollection

For all benefits, except ADB: STD

Cancel Reaction: general disorder questionnaire

Entry points: medical advise, diabetes insipidus, etc.

This is a data collection module. All details are recorded for all benefits except ADB and referred.

Screen 1

If once, screen 2
If continuously, screen 3
If repeatedly, screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

(Multiple Selection, Multiple Follow Up)

If other treatment, screen 6
If medication, screen 7
If surgery, screen 8
If planned surgery, screen 9
If no treatment, screen 10

Screen 6

Go to screen 10

Screen 7

Go to screen 10

Screen 8

Go to screen 10

Screen 9

Go to screen 10

Screen 10

If yes, go to screen 11
If no, go to screen 12

Screen 11

Go to screen 12

Screen 12

If yes, screen 13
If no, screen 14

Screen 13

Go to screen 14

Screen 14

If yes, go to screen 15
If no, go to screen 16

Screen 15

Go to screen 16

Screen 16

If no, screen 17
If yes, screen 18

Screen 17

Go to screen 19

Screen 18

Go to screen 19

Screen 19

General DataCollection LifeLTC 6 months CI STD

For Life, LTC
Disability, H&S: module change to GeneralDataCollection
CI, ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Histoplasmosis, etc.

Screen 1

If symptoms = yes, go to screen 4
If symptoms = no, go to screen 2

Screen 2

If last symptoms ≥ 6 months ago, go to screen 3
If last symptoms < 6 months ago, defer for 6 months

Screen 3

If yes, refer
If no, STD

Screen 4

refer

General DataCollection Disability own

For Disability own, H&S
Life, CI, Disability any, LTC, ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Dermatophytosis, fungal infection of the hands, etc.

This is a data collection module for Disability own and H&S. All details are recorded and referred to underwriting All questions are according to questions in the module GeneralDataCollection.

General DataCollection Disability

For Disability, H&S
Life, CI, LTC, ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Cleft palate, foot deformities, etc.

This is a data collection module for Disability and H&S. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection.

General DataCollection DisabilityLTC

For Disability, H&S, LTC
Life, CI, ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Freiburg’s infraction, bone contortion, etc.

This is a data collection module for Disability, LTC and H&S. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection.

General DataCollection DisabilityownDecline

For Life, CI, Disability any, LTC
Disability own, H&S: Decline
ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Calcinosis, Behcet’s disease, etc.

This is a data collection module for Disability any, LTC,Life and CI. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection.

General DataCollection DisabilityDecline

For Life, CI, LTC
Disability, H&S: Decline
ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Ascites, spastic paralysis, etc.

This is a data collection module for LTC, Life and CI. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection

General DataCollection DisabilityLTCDecl

For Life, CI, ADB
Disability, H&S, LTC: Decline

Cancel reaction: General Questionnaire - disorders

Entry points: Paget’s diseaset, etc.

This is a data collection module for ADB, Life and CI. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection

General DataCollection DisabilityLTCCIDecline

For Life
Disability, H&S, LTC, CI: Decline
ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Hemiparesis, tetraplegia, etc.

This is a data collection module for Life. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection

General DataCollection inclADB DisabilityLTCCIDecl

For Life, ADB
Disability, H&S, LTC, CI: Decline

Cancel reaction: General Questionnaire - disorders

Entry points: Erb‘s paralysis, Takayasu’s arteritis, etc.

This is a data collection module for Life and ADB. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection.

General DataCollection DisabilityADBDecl

For Life, CI, LTC
Disability, H&S, ADB: Decline

Cancel reaction: General Questionnaire - disorders

Entry points: Amyloidosis, narcoleptic attacks, etc.

This is a data collection module for Life, CI and LTC. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection.

General DataCollection DisabilityCIDecl

For Life, LTC
Disability, H&S, CI, ADB: Decline

Cancel reaction: General Questionnaire - disorders

Entry points: Hypersensitivity angiitis, Wilson’s disease, etc.

This is a data collection module for Life and LTC. All details are recorded and referred to underwriting. The questions are according to questions in the module GeneralDataCollection.

Herpes Simplex

For Life, Disability, H&S
CI, LTC, ADB: STD

Cancel reaction: General Questionnaire - disorders

Entry points: Herpes simplex, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to GeneralDataCollection

Screen 3

If duration ≤ 3 weeks and minimum time elapsed ≥ 3 months ago, STD.
If duration > 3 weeks or minimum time elapsed < 3 months ago, module change to GeneralDataCollection

Other disorder

For all benefits

Cancel reaction: General questionnaire - disorders

Entry points: from other modules

This is a data collection module. All details are recorded and referred.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Go to screen 4

Screen 3

Go to screen 4

Screen 4

If medical treatment, go to screen 5

Screen 5

Request doctor address

For all benefits if the CSP “Request doctor address” is true. Currently the English COMPASS marketversion does not ask the doctor’s address.

In use:
Quest treating doctor and Quest doctor in hospital and Quest doctor for special treatment

These screens appear additionally in the modules that ask for an attending doctor (also in the hospital) or for a special treatment.

Sense of smell loss

Valid for Disability own, H&S
Life, CI, Disability any, LTC, ADB: STD

Cancel reaction: accident questionnaire

Entry points: sense of smell loss, etc.

If organ category stressed by occupation, module change to Accidental Injury DataCollection only Disability

If other occupation, STD

Gout

For all benefits, except ADB: STD

Cancel reaction: Medical questionnaire Gout

Entry points: Gout, etc.

Screen 1 Complications

If complications = yes
- Life, H&S, LTC, request GPR
- Disability own/any, CI, decline
If complications = no, screen 2

Screen 2 Details

If ≥ 3 attacks per year
- If persistent pain or tophi
  - Life: 150% em
  - CI: loading 100%
  - Disability own/any, LTC: decline
  - H&S: GPR request
- If persistent pain = no and tophi = no
  - If last attack ≤ 1 year
    
    Life: 50% em
    
    CI: loading 50%
    
    Disability own/any: loading 100%
    
    H&S: loading 30%
    
    LTC: standard
  - If last attack > 1 year ≤ 2 years
    
    Life: 50% em
    
    Disability own/any: loading 75%
    
    H&S: loading 25%
    
    CI, LTC: standard
  - If last attack > 2 years ≤ 5 years
    
    Life, CI, LTC: standard
    
    Disability own/any: loading 50%
    
    H&S: loading 10%
  - If last attack > 5 years, standard
If ≤ 2 attacks per year
- If unable to work ≤ 1 week and symptom-free between attacks = yes and several joints = no and joints damaged = no
  - If last attack ≤ 1 year
    
    Life, CI, LTC: standard
    
    Disability own/any: loading 25%
    
    H&S: loading 15%
  - If last attack > 1 year, standard
- If unable to work > 1 week or symptom-free between attacks = no or several joints = yes or joints damaged = yes
  - If persistent pain or tophi
    
    Life: 150% em
    
    CI: loading 100%
    
    Disability own/any, LTC: decline
    
    H&S: GPR request
  - If persistent pain = no and tophi = no
    
    If last attack ≤ 1 year
    
    Life: 50% em
    
    CI: loading 50%
    
    Disability own/any: loading 100%
    
    H&S: loading 30%
    
    LTC: standard
    
    If last attack > 1 year ≤ 2 years
    
    Life: 50% em
    
    Disability own/any: loading 75%
    
    H&S: loading 25%
    
    CI, LTC: standard
    
    If last attack > 2 years ≤ 5 years
    
    Life, CI, LTC: standard
    
    Disability own/any: loading 50%
    
    H&S: loading 10%
    
    If last attack > 5 years, standard

Hyperuricaemia

For Life, Disability, H&S, LTC, CI
ADB: standard

Cancel reaction: Medical questionnaire (Gout)

Entry points: Uric acid increased, hyperuricaemia, uric acid level increased, uric acid values increased, purine metabolic disturbance

Screen 1 Details

If gout attacks = yes or consequences = yes, module change to Gout If gout attacks = no and consequences = no
- LTC: 10% loading
- Life, Disability, CI, H&S: standard

Thyreoiditis

For all benefits

Cancel reaction: Medical questionnaire (thyroid)

Entry points: Thyreoiditis, inflammation of the thyroid, Hashimoto’s struma, Hashimoto’s syndrome, autoimmune thyroiditis

Screen 1 Details

If existent = yes, defer 3 months
If existent = no, go to screen 2

Screen 2 Symptoms

If symptoms = yes,
- Life, LTC, ADB, H&S: go to screen 3
- Disability, CI: decline
If symptoms = no, standard

Screen 3 Details

refer

Heart/Circulatory disorders

Arterial occlusion disorder

For Life, ADB, CI, LTC, H&S
Disability: Decline

Cancel reaction: Medical questionnaire Piles/haemorrhoids

Entry points: Arterial occlusion disorder, etc.

This is a data collection module for Life, CI, H&S, ADB and LTC. All details are recorded and referred to underwriting.

Screen 1

If once, screen 2
If continuously, screen 3
If repeatedly, screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

(Multiple Selection, Multiple Follow Up)

If other treatment, screen 6
If medication, screen 7
If surgery, screen 8
If planned surgery, screen 9
If no treatment, screen 10

Screen 6

Go to screen 10

Screen 7

Go to screen 10

Screen 8

Go to screen 10

Screen 9

Go to screen 10

Screen 10

If yes, go to screen 11
If no, go to screen 12

Screen 11

Go to screen 12

Screen 12

If yes, screen 13
If no, screen 14

Screen 13

Go to screen 14

Screen 14

If yes, go to screen 15
If no, go to screen 16

Screen 15

Go to screen 16

Screen 16

If no, screen 17
If yes, screen 18

Screen 17

Go to screen 19

Screen 18

Go to screen 19

Screen 19

Circulatory problems

For all benefits except ADB: STD.

Cancel reaction: General questionnaire disorders

Entry points: Circulatory problems, etc.

Screen 1

(Multiple Selection, Multiple Follow Up)

If heart surgery
- Life, LTC, H&S: request GPR
- Disability, CI: Decline
If vascular disease, heart complaints, heart disorder, heart rhythm disturbances or artificial heart valve, request GPR
If blood count changes or poor circulation, module change to General DataCollection.
If high blood pressure, module change to Hypertension.
If low blood pressure, STD.
If other circulatory disease, go to screen 2

Screen 2

Assessment according to the disorder database.

Hypertension

For all benefits, except ADB: STD

Cancel reaction: Medical questionnaire (High Blood Pressure)

Entry points: hypertension, etc.

Screen 1

If blood pressure values not available, request last 3 values at 10 minute intervals.

Life
If any disorder, GPR
If overweight extra mortality> 50%, GPR
Extra mortality is calculated with the Gen Re blood pressure table based on average, age
If extra mortality from hypertension > 50%, GPR

TPD, WOP, CI
If ECG abnormalities, cerebrovascular or cardiovascular disease or hyperlipidaemia, decline
If diabetes, peripheral vascular disease of the legs and pelvis, renal disease, arteriosclerosis, retinopathy or others, GPR
If overweight extra mortality> 50%, GPR Loading is calculated with the Gen Re blood pressure table based on average, age

IP
If cerebrovascular or cardiovascular disease or renal disease or diabetes or ECG changes or arteriosclerosis or peripheral vascular disease or hyperlipidaemia or retinopathy, decline
If others, GPR
If overweight extra mortality> 50%, GPR
Loading is calculated with the Gen Re blood pressure table based on average, age and waiting period.

H&S
If any disorders, decline
If overweight rating > 25%, decline
Loading is calculated with the Gen Re blood pressure table based on average, age

LTC
If cerebrovascular or cardiovascular disease or renal disease or diabetes or retinopathy or arteriosclerosis, decline
If ECG changes, peripheral vascular disease or others, GPR Loading is calculated with the Gen Re blood pressure table based on average, age
If LTC loading > 25%and hyperlipidaemia, decline
If LTC loading ≤ 25% and hyperlipidaemia, GPR

Varicose veins

For Life, Disability, H&S, CI
ADB: STD

Cancel reaction: Medical questionnaire (Piles/haemorrhoids)

Entry points: varicosis, etc.

Screen 1

(Multiple Selection, single follow up)

If abdomen or oesophagus: GPR
If elsewhere, go to screen 2
If rectal area, go to module Hemorrhoids
If upper leg or lower leg, go to screen 3

Screen 2

Refer with ‘disorder to be checked’

Screen 3

(Multiple Choice, Single follow up)

If other, screen 4
If eczema, ulcer, open leg, thrombosis
- Life: extra mortality 25%
- Disability own, H&S: Exclusion Clause varicose veins of the legs
- CI: loading 25%
- Disability any: loading 50%
- LTC: loading 20%
If other skin impairment or phlebitis
- Life, CI STD
- Disability own: loading 50%
If manual work: Exclusion Clause varicose veins of the legs
- Disability any: loading 25%
- LTC: STD, if manual work loading 10%
- H&S: Exclusion Clause varicose veins of the legs
If none or swelling or oedema, STD

Screen 4

Refer with ‘disorder to be checked‘

Superficial thrombophlebitis

For Life, Disability, LTC, H&S
CI, ADB: standard

Cancel reaction: Medical questionnaire (Piles/haemorrhoids)

Entry points: superficial thrombophlebitis, superficial venous thrombosis

1 Details

If only once and complications = no, go to screen 3
If frequency > 1 or complications = yes
- Life: 50% extra mortality
- Disability own: Exclusion clause varicose veins*
- Disability any: 25% loading
- H&S: GPR
- LTC: 10% loading

*The assessment can depend on the occupation (standing or sitting occupation). Electronically it is not possible to derive this from the occupation title, therefor for Disability own the worst assessment has been taken.

3 Cause

If yes, module change to varicose veins
If no, standard

Phlebothrombosis

For all benefits except ADB: standard

Cancel reaction: Medical questionnaire (Piles/haemorrhoids)

Entry points: deep thrombophlebitis, deep vein thrombosis, phlebothrombosis, DVT

1 Cause

(Multiple Selection, Single Follow Up)

If other cause, go to screen 2
If unknown or cardiovascular disease or infectious disease, refer
If immobilisation, accident, surgery, go to screen 3

2 other cause

refer

3 Frequency

If only once, go to screen 4
If frequency > 1, go to screen 5

4 Details

If complications and complaints = no, STD
If complications = yes or complaints = yes
- Life: 25% em
- Disability own: Exclusion clause varicose veins
- Disability any, CI: 25% loading
- LTC: 10% loading
- H&S: GPR

5 Complications

If complications = yes
- Life: 50% em
- CI: 50% loading
- Disability own/any, LTC, H&S, go to screen 6
If complications = no, go to screen 8

6 Complications

If complaints = no, refer
If complaints = yes, go to screen 7

7 Details

refer

8 Details

If yes
- Life: 50% em
- CI: 50% loading
- Disability own/any, LTC, H&S, go to screen 7
If no, go to screen 9

9 Details

If last symptoms < = 3 years
- Life: 50% extra mortality
- Disability own: Exclusion clause varicose veins*
- Disability any: 25% loading
- LTC: standard
- CI: 50 % loading
- H&S:
  - If last symptoms < = 1 year ago, defer 1 year
  - If last symptoms > 1 year ago, 15% loading
If last symptoms > 3 years ago
- Disability own: Exclusion clause varicose veins*
- Life, Disability any, CI: standard
- LTC, H&S: standard

Kidney, Urinary Tract and Bladder disease

KidneyDisorder DataCollection

For Life, Disability, LTC, H&S
ADB, CI: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Kidney infection, etc.

Screen 1

If once, go to screen 2
If repeatedly, go to screen 3
If continuously, go to screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

If “other treatment”, go to screen 6
If „medication“, go to screen 7
If Lithotripsy, go to screen 8
If Surgery, go to screen 9
If planned surgery, go to screen 10
If no treatment, go to screen 11

Screen 6

Go to screen 11

Screen 7

Go to screen 11

Screen 8

Go to screen 11

Screen 9

Go to screen 11

Screen 10

Go to screen 11

Screen 11

If urinary investigation, screen 12
If no, screen 13

Screen 12

Go to screen 13

Screen 13

If blood investigation, screen 14
If no, screen 15

Screen 14

Go to screen 15

Screen 15

If symptoms = yes, go to screen 16
If symptoms = no, go to screen 17

Screen 16

Go to screen 18

Screen 17

Go to screen 18

Screen 18

If unable to work, go to screen 19
If no, refer

Screen 19

KidneyDisorder DataCollection Disability LifeCILTC 12 months

For Life, CI, LTC, Disability, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: urinary fistula not used

Disability, H&S

All details are recorded for Disability and H&S and referred. The questions are equivalent to the module Kidney disorder data collection

Life, CI, LTC

Screen 1

If symptoms = yes, refer and go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to KidneyDisorder DataCollection

Screen 3

If no complaints since ≥ 12 months, STD
If no complaints since < 12 months, module change to KidneyDisorder DataCollection

KidneyDisorder DataCollection Disabilityown

For Disability own, H&S
Life, ,ADB, LTC, CI, Disability any: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Prolapse of the urethra, etc.

This is a data collection module for Disability own and H&S only. The data is recorded and referred to underwriting. The questions are equivalent to the module KidneyDisorder DataCollection.

KidneyDisorder DataCollection CI Decline

For Life, Disability, H&S, LTC
CI: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Dialysis, etc.

This is a data collection module for all benefits except ADB and CI. The data is recorded and referred to underwriting. The questions are equivalent to the module KidneyDisorder DataCollection.

Kidney failure

For Life,
Disability, H&S, LTC, CI: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Kidney failure, etc.

This is a data collection module for Life. The data is recorded and referred to underwriting. The questions are equivalent to the module KidneyDisorder DataCollection.

Nephrosis

For Life, LTC
Disability, H&S, CI: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Nephrosis, etc.

This is a data collection module for Life and LTC. The data is recorded and referred to underwriting. The questions are equivalent to the module KidneyDisorder DataCollection.

Kidney cyst

For Life
Disability, CI, LTC, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: chronic nephritis, etc.

This is a data collection module for Life. The data is recorded and referred to underwriting. The questions are equivalent to the module KidneyDisorder DataCollection.

Kidney Stone

For Life, Disability, CI, H&S
LTC, ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: kidney stone, etc.

Screen 1

If symptoms, colics or haematuria = yes
- If stones still present = no: GPR
- If stones still present = yes: refer
If symptoms, colics or haematuria = no
- If stones still present = no: screen 2
- If stones still present = yes
  - If one sided: STD
  - If both sided: GPR

Screen 2

If surgery = no: STD
If surgery = yes, screen 3

Screen 3

If both sided = yes or > 2 surgeries
- If last surgery ≤ 1 year ago
  - Life: 50% extra mortality
  - Disability: defer until 1 year
  - CI: 50% loading
- If last surgery > 1 year ago and ≤ 2 years ago
  - Life: 25% extra mortality
  - Disability, H&S: 100% loading
  - CI: 25% loading
- If last surgery > 2 years ago and ≤ 3 years ago
  - Life: STD
  - Disability, H&S: 50% loading
  - CI: STD
- If last surgery > 3 years ago: STD
If one sided or ≤ 2 surgeries
- If last surgery ≤ 1 year ago
  - Life: STD
  - Disability any: STD
  - Disability own, H&S: 50% loading
  - CI: STD
- If last surgery > 1 year ago: STD

Kidney stone surgery

For Life, Disability, H&S, CI
LTC, ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Kidney stone OP, Kidney stone remove, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

- Screen 2

Module change to KidneyDisorder DataCollection.

Screen 3

If both sided = yes or > 2 surgeries
- If last surgery ≤ 1 year ago
  - Life: 50% extra mortality
  - Disability, H&S: defer until 1 year
  - CI: 50% loading
- If last surgery > 1 year ago and ≤ 2 years ago
  - Life: 25% extra mortality
  - Disability, H&S: 100% loading
  - CI: 25% loading
- If last surgery > 2 years ago and ≤ 3 years ago
  - Life: STD
  - Disability, H&S: 50% loading
  - CI: STD
- If last surgery > 3 years ago: STD
If one sided and ≤ 2 surgeries
- If last surgery ≤ 1 year ago
  - Life: STD
  - Disability any: STD
  - Disability own, H&S: 50% loading
  - CI: STD
- If last surgery > 1 year ago: STD

Chronic Nephritis

For Life, LTC, CI
Disability, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: chronic nephritis, etc.

This is a data collection module. All details are recorded for Life, CI and LTC and referred. The questions are equivalent to the module KidneyDisorder DataCollection.

Inflammation of the bladder

For Disability own, H&S
Life, CI, Disability any, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Genito-urinary disorders)

Entry points: Bladder infection, etc.

Screen 1

If symptoms = no and ≤ 2 times: STD
If symptoms = yes or > 2 times: 50% loading

Urinary tract DataCollection

For Life, CI, Disability, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: from other modules, etc.

This is a data collection module for all benefits, except ADB. The data is recorded and referred to underwriting.

Screen 1

If once, go to screen 2
If repeatedly, go to screen 3
If continuously, go to screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

(Multiple Selection, Multiple Follow Up)

If surgery, go to screen 6
If surgery planned, go to screen 7
If medication, go to screen 8
If other treatment, go to screen 9
If no treatment, go to screen 10

Screen 6

Go to screen 10

Screen 7

Go to screen 10

Screen 8

Go to screen 10

Screen 9

Go to screen 10

Screen 10

If blood test = yes, go to screen 11
If blood test = no, go to screen 12

Screen 11

Go to screen 12

Screen 12

If urinalysis = yes, go to screen 13
If urinalysis = no, go to screen 14

Screen 13

Go to Screen 14

Screen 14

If symptoms = yes, go to screen 15
If symptoms = no, go to screen 16

Screen 15

Go to screen 17

Screen 16

Go to screen 17

Screen 17

If yes, go to screen 18
If no, refer

Screen 19

refer

Incontinence

For Life, CI, Disability, H&S, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Incontinence, etc.

Screen 1 Cause

If other causes, unknown or prostate hypertrophy, screen 2
If pelvic floor weakness, bladder or uterus prolapse
- Life, CI: standard
- Disability own/an, H&S: Exclusion clause
- LTC: 20% loading

Screen 2

If once, go to screen 3
If repeatedly, go to screen 4
If continuously, go to screen 5

Screen 3

Go to screen 6

Screen 4

Go to screen 6

Screen 5

Go to screen 6

Screen 6

(Multiple Selection, Multiple Follow Up)

If surgery, go to screen 7
If surgery planned, go to screen 8
If medication, go to screen 9
If other treatment, go to screen 10
If no treatment, go to screen 11

Screen 7

Go to screen 11

Screen 8

Go to screen 11

Screen 9

Go to screen 11

Screen 10

Go to screen 11

Screen 11

If blood test = yes, go to screen 12
If blood test = no, go to screen 13

Screen 12

Go to screen 13

Screen 13

If urinalysis = yes, go to screen 14
If urinalysis = no, refer

Screen 14

refer

Urinary bladder disorder

For Life, CI, Disability, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Bladder fistula, rupture of the bladder, etc.

Disability, H&S, LTC

The data is recorded and referred to underwriting. The questions are equivalent to the module UrinaryTractDataCollection.

Life, CI

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to UrinaryTractDataCollection.

Screen 3

If symptoms ≥ 12 months ago, STD
If symptoms < 12 months ago, module change to UrinaryTractDataCollection

Urethra operation

For Life, Disability, H&S
CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Urethra operation, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to UrinaryTractDataCollection.

Screen 3

If last symptoms ≥ 24 months ago, STD
If last symptoms < 24 months ago, module change to UrinaryTractDataCollection

Urethral stricture

For Life, Disability, H&S CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Urethral stricture, bladder disease, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to UrinaryTractDataCollection.

Screen 3

If symptoms ≥ 12 months ago, STD
If symptoms < 12 months ago, module change to UrinaryTractDataCollection

Malformation of the testicles

For Disability, H&S
Life, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Genito Urinary disorders)

Entry points: Malformation of the testicles, etc.

This is a data collection module for Disability and H&S. The data is recorded and referred to underwriting.

Screen 1

(Multiple Selection, Multiple Follow Up)

If surgery, go to screen 2
If surgery planned, go to screen 3
If other treatment, go to screen 4
If medication, go to screen 5
If no treatment, go to screen 6

Screen 2

Go to screen 6

Screen 3

Go to screen 6

Screen 4

Go to screen 6

Screen 5

Go to screen 6

Screen 6

If blood test= yes, go to screen 7
If blood test = no, go to screen 8

Screen 7

Go to screen 8

Screen 8

If urin analysis, go to screen 9
If no urin analysis, go to screen 10

Screen 9

Go to Screen 10

Screen 10

If symptoms = yes, go to screen 11
If symptoms = no, go to screen 12

Screen 11

Go to screen 13

Screen 12

Go to screen 13

Screen 13

If yes, go to screen 14
If no, refer

Screen 14

Mental disorders

Anxiety/Depression (non specific)

For all benefits.

Cancel reaction: Medical questionnaire (Anxiety/Depression)

Entry Points: depressed mood, etc.

Screen 1

Both selection menus: Multiple choice, Single follow up

If specification = other, module change to Other disorder
If specification = bipolar depression, endogenous depression or manic depression or schizophrenia or personality disorder or symptoms = delusions or hallucinations, then GPR
If specification = depression, reactive depression, neurosis or stress and symptoms = other or no symptoms then module change to anxiety/depression

Anxiety/Depression

For all benefits.

Cancel reaction: Medical questionnaire (Anxiety/Depression)

Entry Points: depression, etc.

Screen 1

If suicide = Yes then screen 2
If suicide = no
- If single episode
  - If last episode ≤ 1 year ago
    
    Life, ADB: GPR
    
    IP, TPD, WOP, CI, H&S: decline
    
    LTC: 25% loading
  - If last episode > 1 year ago and ≤ 2 years ago
    
    Life: 50% extra mortality
    
    CI: 50% loading
    
    IP, TPD, WOP: Exclusion clause
    
    H&S: decline
    
    LTC, ADB: STD
  - If last episode > 2 year ago and ≤ 3 years ago
    
    Life: 25% extra mortality
    
    CI: 25% loading
    
    IP, TPD, WOP: Exclusion clause
    
    H&S: decline
    
    LTC, ADB: STD
  - If last episode > 3 years ago
    
    Life, CI, ADB, LTC: STD
    
    IP, TPD, WOP: Exclusion clause
    
    H&S: 75% loading
- If more than one episode
- H&S: decline
- Other benefits:
  - If last episode ≤ 1 year ago
    
    Life, ADB, CI: GPR
    
    IP, TPD, WOP: decline
    
    LTC: 75%
  - If last episode > 1 year ago and ≤ 3years ago
    
    Life: 75% extra mortality
    
    CI: 75% loading
    
    IP, TPD, WOP: decline
    
    LTC: 50%
    
    ADB: STD
  - If last episode > 3 year ago and ≤ 5 years ago
    
    Life: 50% extra mortality
    
    CI: 50% loading
    
    IP, TPD, WOP: decline
    
    LTC: 50%
    
    ADB: STD
  - If last episode > 5 years ago
    
    Life: 25% extra mortality
    
    CI: 25% loading
    
    IP, TPD, WOP: GPR
    
    LTC: 25%
    
    ADB: STD

Screen 2

If suicide attempt only once and > 10 years ago: as above
Else decline all benefits

Mental DataCollection

For all benefits

Cancel reaction: Medical Questionnaire Mental Illness

Entry points: acute stress, etc.

This is a data collection module. All details are recorded and referred to underwriting.

Screen 1

Always go to screen 2

Screen 2

If medication, go to screen 3
If psychological therapy, go to screen 4
If other therapy, go to screen 5
If none, go to screen 6

Screen 3

Go to screen 6

Screen 4

Go to screen 6

Screen 5

Go to screen 6

Screen 6

If inpatient = yes, go to screen 7
If inpatient = no, go to screen 8

Screen 7

Go to screen 8

Screen 8

If unable to work = yes, go to screen 9

Screen 9

Mental DataCollection DisabilityLTCADB decline

For Life, CI
Disability,H&S, LTC, ADB: Decline

Cancel reaction: Medical Questionnaire Mental Illness

Entry points: Schizophrenia, etc.

This is a data collection module for Life and CI. All details are recorded and referred to underwriting. The questions are according to questions in the module Mental DataCollection

Mental DataCollection Disabilityown

For Disability own, H&S:
Life, CI, Disability any, LTC, ADB: STD

Cancel reaction: Medical Questionnaire Mental Illness

Entry points: Stuttering, Lack of concentration, etc.

This is a data collection module for Disability own and H&S. All details are recorded and referred to underwriting. The questions are according to questions in the module Mental DataCollection

Stress Syndrome

For all benefits

Cancel reaction: Medical questionnaire (Mental diseases)

Entry points: Reaction to stress, stress syndrome

Screen 1

If continuously or repeatedly or complaints = yes
- Disability, H&S: decline
- Life, CI, LTC, ADB: go to screen 2 and refer
If only once and complaints = no
- last symptoms ⇐ 6 months ago
  - ADB: STD
  - Life: 50% extra mortality
  - CI: 50% loading
  - Disability, H&S, LTC: defer 6 months
- last symptoms > 6 months ago and ⇐ 2 years
  - ADB: STD
  - Life: 25% extra mortality
  - CI: 25% loading
  - Disability own: Exclusion clause Mental disorders
  - Disability, any, H&S: 50% loading
  - LTC: 10% loading
- last symptoms > 2 years ago: standard

Screen 2

Always go to screen 3

Screen 3

If medication, go to screen 4
If psychological therapy, go to screen 5
If other therapy, go to screen 6
If none, go to screen 7

Screen 4

Go to screen 7

Screen 5

Go to screen 7

Screen 6

Go to screen 7

Screen 7

If inpatient = yes, go to screen 8
If inpatient = no, go to screen 9

Screen 8

Go to screen 9

Screen 9

If unable to work = yes, go to screen 10
If unable to work = no, refer

Screen 10

*refer

School stress

For Disability, H&S
Life, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire (Mental diseases)

Entry points: School stress, examination stress

Screen 1

If last symptoms > 2 years ago and only once and complaints=no and duration ≤ 12 weeks, then STD
otherwise go to screen 2 and refer

Screen 2

Always go to screen 3

Screen 3

If medication, go to screen 4
If psychological therapy, go to screen 5
If other therapy, go to screen 6

Screen 4

Go to screen 7

Screen 5

Go to screen 7

Screen 6

Go to screen 7

Screen 7

If inpatient = yes, go to screen 8
If inpatient = no, go to screen 9

Screen 8

Go to screen 9

Screen 9

If unable to work = yes, go to screen 10
If unable to work = no, refer

Screen 10

Liver

Hepatitis (Specification)

For Life, CI, Disability, H&S, LTC
ADB: STD

Cancel reaction: General questionnaire – disorders

Entry points: active hepatitis; acute hepatitis; Autoimmune hepatitis (SG); concomitant hepatitis; diffuse hepatitis; hepatitis; hepatitis following blood transfusion; infectious hepatitis; infectious icterus; infectious jaundice; Inflammatory liver disease, unspecified (SG); non-infectious hepatitis; Nonspecific reactive hepatitis (SG); Other inflammatory liver diseases (MG)

Screen 1 frequency

If once, go to screen 3
If repeatedly, go to screen 4
If continuously, go to screen 5

Screen 3 details

Go to screen 6

Screen 4 details

Go to screen 6

Screen 5 details

Go to screen 6

Screen 6 doctor control

Go to screen 7

Screen 7 treatment

If surgery, go to screen 8
If surgery planned, go to screen 8
If medication, go to screen 9
If other treatment, go to screen 10
If Lithotipsy, go to screen 11

Screen 8 Surgery or surgery planned

Go to screen 12

Screen 9 Medication

Go to screen 12

Screen 10 other treatment

Go to screen 12

Screen 11 Lithotipsy

Go to screen 12

Screen 12 blood test

If blood test = yes, go to screen 13
If blood test = no, go to screen 14

Screen 13 result blood test

Go to screen 14

Screen 14

If symptoms = yes, go to screen 15
symptoms = no, go to screen 16

Screen 15 symptoms

Go to screen 17

Screen 16 no symptoms

Go to screen 17

Screen 17 time off

If preriods off work = yes, go to screen 18
If periods off work = no – end

Screen 18

Hepatitis A & E

For Life, CI, Disability, H&S, LTC
ADB: STD

Cancel reaction: General questionnaire – disorders

Entry points: Acute hepatitis A (MG), Acute hepatitis E (SG); hepatitis A; Hepatitis A without hepatic coma (SG); hepatitis E; virus hepatitis type A

Screen 1 Status

If consequence = yes or Liver values = high or unkown -→ decline
If consequence = no and Liver values = standard -→ standard
If consequence = no and Liver values = high -→ decline

Nervous system

Epilepsy

For all benefits

Cancel reaction: Medical questionnaire Epilepsy

Entry points: spasmodic torticollis, cataplexy, twilight state, grand mal

Screen 1

If status epilepticus = yes, decline
If status epilepticus = no, go to screen 2

Screen 2

If brain surgery = yes, GPR
If brain surgery = no, go to screen 3

Screen 3

(Multiple selection, single follow up)

If any selection except congenital epilepsy or none, GPR
If congenital epilepsy or none, go to screen 4

Screen 4

If CT/MRI = yes, go to screen 5
If CT/MRI = no, go to screen 6

Screen 5

image::image-2021-11-18-17-22-54-967.png[

Go to screen 6

Screen 6

Always go to screen 7

Screen 7

If suffering from consciousness = no, refer
If suffering from consciousness = yes, go to screen 8,

Screen 8

If yes, go to screen 9
If no, refer

Screen 9

refer

EpilepsyDecision

For all benefits

Cancel reaction: Medical questionnaire Epilepsy

Entry points: focal epilepsy, psychomotor agitation, psychomotor attacks, temporal lobe epilepsy, absentia, akinetic attacks, infantile spasm, attacks, cerebral convulsions, cerebro-organic attacks, convulsive disorder, epilepsy, epileptic attacks, epileptic fits, state of absentia, attack, convulsions, seizure, fits, partial seizure, tonic clonic seizure, Jacksonian attack, Jacksonian fit, Jackson’s epilepsy.

Screen 1

If status epilepticus = yes, decline
If status epilepticus = no, go to screen 2

Screen 2

If brain surgery = yes, GPR
If brain surgery = no, go to screen 3

Screen 3

(Multiple selection, single follow up)

If any selection except congenital epilepsy or none, GPR
If congenital epilepsy or none, go to screen 4

Screen 4

If CT/MRI = yes, go to screen 5
If CT/MRI = no, go to screen 9

Screen 5

If unknown, GPR
If abnormal, GPR
If normal, go to screen 6

Screen 6

If suffering from consciousness = yes, go to screen 7
If consciousness = no
- If last attack >= 3 years ago
  - Life, CI, LTC: standard
  - Disability own: refer ‚disorder to be checked because of occupation‘
  - Disability any: 50% loading
  - ADB: 25% loading
  - H&S: 15% loading
- If last attack < 3 years ago
  - Disability: decline
  - ABD: 50% loading
  - Life, CI, LTC, H&S
- If attacks/year < = 3
  - LTC: standard
  - Life: 50% extra mortality
  - CI: 25% loading
  - H&S: 30% loading
- If attacks/year > 3
  - LTC: 20% loading
  - Life: 100% extra mortality
  - CI: 50% loading
  - H&S: Exclusion clause

Screen 7

If yes, go to screen 8
I no, refer

Screen 8

Refer

Screen 9

If status first diagnosis < 2 years : defer24 month
If status first diagnosis >= 2 years : go to screen 6

Headaches General

For all benefits

Cancel reaction: Medical questionnaire (headache)

Entry points: Continuous headache, neckache and headache, etc.

Screen 1 Primary disease

If no, go to screen 2
If yes, screen 3 and refer

Screen 2 Details

(Multipe selection / Single follow up)

If Cluster or Horton’s headache
- Life, CI, ADB, LTC: GPR
- Disability own/any, H&S: decline
If medication overuse headache, GPR
If migraine, module change to Headaches Migraine
If tension headache, psychogenic headache or none/unknown, module change to Headaches Tension headache

Screen 3 Details primary disease

refer

Headaches Migraine

For Disability own/any, H&S
Life, CI, ADB, LTC: standard

Cancel reaction: Medical questionnaire (headache)

Entry points: Migraine, cervical migraine, etc.

Screen 1 Frequency

If < 4 days per month or few days per year
- Disability own/any: standard
- H&S: 15% loading
If 4 - 14 days per month
- Disability own/any: 50% loading
- H&S: 25% loading
If ≥ 15 days per month
- Disability own/any: decline
- H&S: defer

Headaches Tension headache

For all Disability own/any, H&S Life, CI, ADB, LTC: standard

Cancel reaction: Medical questionnaire (headache)

Entry points: Tension headache, common headaches, etc.

Screen 1 Frequency

If < 15 days per month or few days per year
- Disability own/any: standard
- H&S: 15% loading
If ≥ 15 days per month
- Disability own/any: decline
- H&S: defer

Pregnancy depression

For Life, CI, LTC, Disability, H&S ADB: STD

Cancel reaction: Medical questionnaire (mental diseases)

Entry points: depression during pregnancy

Screen 1

If yes, go to screen 2
If no, go to screen 3

Screen 2

If time of diagnosis < 12 months ago, defer
If time of diagnosis ≥ 12 months ago, module change to Mental disorder DataCollection

Screen 3

If last symptoms <12 months ago or treatment = yes, refer
If last symptoms ≥ 12 months ago and treatment = no, Standard

Pregnancy complications

For Life, CI, LTC, Disability, H&S
ADB: STD

Cancel reaction: General questionnaire - disorders

Entry points: Pregnancy complications, etc.

Screen 1

If yes, go to screen 2
If no, STD

Screen 2

If time of diagnosis < 12 months ago, go to screen 3
If time of diagnosis ≥ 12 months ago, STD

Screen 3

refer

Locomotor system – modules

Spine

Spinal cervical pain

Only for Disability own/any, CI, LTC
Life, ADB: STD
H&S: Exclusion clause spine

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Cervicalgia, cervical syndrome, etc.

Screen 1

If yes
- Disability own/any, CI: Exclusion clause spine
- LTC: GPR
If no
- Disability own/any, LTC, screen 2
- CI: standard

Screen 2

If symptoms = yes, screen 3
If symptoms = no, standard

Screen 3

If frequency > 4
- Disability own/any: Exclusion clause spine
- LTC: 20% loading
If frequency 2-4
- If ≤ 12 months ago
  - Disability own/any: Exclusion clause spine
  - LTC: 10% loading
- If > 12 months ≤ 36 months ago, screen 4
If frequency ≤ 2
- If ≤ 12 months ago
  - Disability own: Exclusion clause spine
  - Disability any: 50% loading
  - LTC: 10% loading
- If > 12 months ≤ 36 months ago
  - Disability own: 25% loading
  - Disability any, LTC: standard

Screen 4

If age at diagnosis ≤ 30 years
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: 10% loading
If age at diagnosis > 30 years
- Disability own: 25% loading
- Disability any: standard
- LTC: 10% loading

Back

Only for Disability own/any, CI, LTC
Life, ADB: STD
H&S: Exclusion clause spine

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Lumbago, lumbar spine syndrome, lumboischialgia, etc.

Screen 1

If yes
- Disability own/any, CI: Exclusion clause spine
- LTC: GPR
If no
- Disability own/any, LTC screen 2
- CI: standard

Screen 2

If symptoms = yes, screen 3
If symptoms = no, standard

Screen 3

If frequency > 4
- Disability own/any: Exclusion clause spine
- LTC: 20% loading
If frequency 2-4
- If ≤ 12 months ago
  - Disability own/any: Exclusion clause spine
  - LTC: 10% loading
- If > 12 months ≤ 36 months ago, screen 4
If frequency ≤ 2
- If ≤ 12 months ago
  - Disability own: Exclusion clause spine
  - Disability any: 50% loading
  - LTC: 10% loading
- If > 12 months ≤ 36 months ago
  - Disability own: 25% loading
  - Disability any, LTC: standard

Screen 4

If age at diagnosis ≤ 30 years
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: 10% loading
If age at diagnosis > 30 years
- Disability own: 25% loading
- Disability any: standard
- LTC: 10% loading

Osteochondrosis

Only for Disability own/any, CI, LTC
Life, ADB: STD
H&S: Exclusion clause spine

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Scheuermann’s disease, juvenile kyphosis, osteochondritis, etc.

Screen 1

If yes
- Disability own/any, CI: Exclusion clause spine
- LTC: GPR
If no
- Disability own/any, LTC, screen 2
- CI: standard

Screen 2

If symptoms = yes, screen 3
If symptoms = no
- Disability own: 25% loading
- Disability any, LTC: standard

Screen 3

If frequency > 4
- Disability own: Exclusion clause spine
- Disability any: 50% loading
- LTC: 30% loading
If frequency 3-4
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: 20% loading
If frequency ≤ 2
- If ≤ 12 months ago
  - Disability own: Exclusion clause spine
  - Disability any: 50% loading
  - LTC: 30% loading
- If > 12 months ≤ 36 months ago
  - Disability own: 25% loading
  - Disability any: standard
  - LTC: 10% loading

Scoliosis

Only for Disability own/any, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Scoliosis, kyphosis, hunchback, etc

Screen 1

If yes
- Disability own/any, H&S, CI: Exclusion clause spine
- LTC: GPR
- Life: standard
If no, screen 2

Screen 2

If breathing problems
- Life: 75% em
- CI: 75% loading
- Disability own/any, LTC, H&S: decline
If no breathing problems
- Life, CI: standard
- H&S: Exclusion clause
- Disability own/any, LTC
  - If symptoms = no
    
    Disability own: 25% loading
    
    Disability any, LTC: standard
  - If symptoms = yes, screen 3

Screen 3

If frequency > 4
- Disability own: Exclusion clause spine
- Disability any: 50% loading
- LTC: 30% loading
If frequency 3-4
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: 20% loading
If frequency ≤ 2
- Disability own: 25% loading
- Disability any: standard
- LTC: 10% loading

Ankylosing spondylitis

Life, Disability own/any, H&S, LTC, CI ADB: STD.

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Bechterew’s disease, ankylosing spondylitis

Screen 1

(Multiple selection, single follow up)

If joints or organs
- Life: 150% em
- CI: 150 % loading
- Disability own/any, LTC, H&S: decline
If uveitis
- Life: 100% em
- CI: 100 % loading
- Disability own/any, LTC: decline
- H&S: 30% loading
If none
- Life: 50% em
- CI: 50% loading
- Disability own/any, LTC, H&S, screen 2

Screen 2

If pain = yes or paralysis = yes, decline
If pain = no and paralysis = no, screen 3

Screen 3

If ≤ 3 years
- Disability own/any, LTC: defer 3 years
- H&S: Exclusion clause spine
If > 3 years
- Disability own, H&S: Exclusion clause Spine
- Disability any: 100% loading
- LTC: 30% loading

Spondyloarthrosis

Only for Disability own/any, CI, LTC
Life, ADB: STD
H&S: Exclusion clause spine

Cancel reaction: Medical questionnaire (back trouble)

Entry points: thoracic spondylosis, cervical spine wear, etc.

Screen 1

If yes
- Disability own/any, CI: Exclusion clause spine
- LTC: GPR
If no
- CI: standard
- Disability own/any, LTC, screen 2

Screen 2

If lack of mobility or age < = 30 years
- Disability own: Exclusion clause spine
- Disability any: 50% loading
- LTC: 10% loading
If no lack of mobility and age > 30 years
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: standard

Spinal injury

For Disability own/any and LTC
Life, CI, ADB: STD
H&S: Exclusion clause spine

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Vertebral column fracture, fractured vertebra, etc.

Screen 1

If not able to work or injury < = 6 months, defer 6 months
If fully able to work and injury > 6 months
- If symptoms = yes
  - Disability own/any: Exclusion clause spine
  - LTC: GPR
- If symptoms = no
  - Disability own: If injury < = 36 months excl., otherwise standard
  - Disability any: If injury < = 36 months 50% loading., otherwise standard
  - LTC : If injury < = 36 months 10% loading., otherwise standard

Spondylolisthesis

Only for Disability own/any, CI, LTC
Life, ADB: STD
H&S: Exclusion clause spine

Cancel reaction: Medical questionnaire (back trouble)

Entry points: Spondylitis, Spondylolisthesis, Sacroiliitism etc.

Screen 1

If yes
- Disability own/any, CI: Exclusion clause spine
- LTC: GPR
If no
- Disability own/any, LTC, screen 2
- CI: standard

Screen 2

If symptoms = yes, screen 3
If symptoms = no, standard

Screen 3

If frequency > 4
- Disability own: Exclusion clause spine
- Disability any: 50% loading
- LTC: 20% loading
If frequency ≤ 2
- If ≤ 12 months ago
  - Disability own: Exclusion clause spine
  - Disability any: 50% loading
  - LTC:standard
- If > 12 months ≤ 36 months ago, standard
If frequency 3-4, screen 4

Screen 4

If age at diagnosis ≤ 30 years
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: 10% loading
If age at diagnosis > 30 years
- Disability own: 25% loading
- Disability any, LTC: standard

Hip

Hip joint dysplasia

For Disability, H&S, LTC
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: hip joint dysplasia, etc.

Screen 1

If symptoms = yes or at work in full capacity = no
- Disability own: Exclusion clause hip joint
- H&S: Exclusion clause hip joint
- Disability any: 50% loading
- LTC: 30% loading
If symptoms = no and at work in full capacity = yes, screen 2

Screen 2

If ≤ 24 months
- Disability own: Exclusion clause hip joint, hint ‘reexamination in 2 years possible’
- H&S: Exclusion clause hip joint
- Disability any: 50% loading
- LTC: 30% loading
If > 24 months
- If manual work
  - Disability own, H&S: Exclusion clause hip joint
  - Disability any: 25% loading
  - LTC: 10% loading
- If non-manual work
  - Disability own/any:25% loading
  - H&S: standard
  - LTC: 10% loading

Hip replacement

For Disability any and LTC
Life, CI, ADB: standard
Disability own, H&S: Exclusion clause for hip joint endoprosthesis

Cancel reaction: Medical questionnaire (Joints)

Entry points: Total hip replacement, THR

1 Details

If complaints = yes
- Disability any: 50% loading
- LTC: 30% loading
If complaints = no
- Disability any: 25% loading
- LTC: 10% loading

Hip arthrosis

For Disability any and LTC Life, CI, ADB: standard Disability own, H&S: Exclusion clause for hip joint

Cancel reaction: Medical questionnaire (Joints)

Entry points: Coxarthrosis, hip joint arthrosis, joint degeneration

1 Details

If complaints = yes
- Disability any: 75% loading
- LTC: 30% loading
If complaints = no, screen 2 - 04

Screen 2

If age < = 30 years
- Disability any: 75% loading
- LTC: 30% loading
If age > 30 years and < = 59 years
- Disability any: 50% loading
- LTC: 20% loading
If age > 59 years
- Disability any: 25% loading
- LTC: 10% loading

Leg length discrepancy

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: Leg length difference, etc.

Screen 1

If paralysis, neuritis, sensory loss = yes, GPR
If paralysis, neuritis, sensory loss = no, screen 2

Screen 2

If ≤ 1 cm, standard
If > 1 cm ≤ 2, screen 3
If > 2 cm
- Disability own, H&S: Exclusion clause leg length difference
- Disability any: 75% loading
- LTC: 30% loading

Screen 3

(Multiple selection, Single Follow Up)

If other complaints, screen 4
If complaints > 1
- Disability own, H&S: Exclusion clause leg length difference
- Disability any: 75% loading
- LTC: 30% loading
If hip complaints:
- Disability own, H&S: Exclusion clause hip
- Disability any: 50% loading
- LTC: 30% loading
If back complaints:
- Disability own, H&S: Exclusion clause spine
- Disability any: 50% loading
- LTC: 20% loading
If knee complaints
- Disability own, H&S: Exclusion clause knee
- Disability any: 50% loading
- LTC: 20% loading
If no complaints
- Disability own: 25%
- Disability any, LTC, H&S: standard

Screen 4

refer ‘disorder to be checked’

Coxa vara

For Disability own/any, LTC
Life, CI, ADB, H&S: standard

Cancel reaction: Medical questionnaire joints

Entry points: Coxa valga, Coxa vara

Screen 1

If surgery and no limitations: normal
If no surgery or limitations
CoxaVara02 (surgery=no), CoxaVara03(limitations=yes), CoxaVara04(both)
- If manual
  - Disability own: Exclusion clause coxa vara
  - Disability any: If both sides 75% loading, else 50% loading
  - LTC:If both sides 30% loading, else 20% loading
- If no manual work
  - Disability own: If both sides 75% loading, else 50% loading
  - Disability any: If both sides 75% loading, else 50% loading
  - LTC: If both sides 30% loading, else 20% loading

Hip joint fractures

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: Hip bone fracture, acetabulum fracture, etc.

Screen 1

If limitations = yes or work in full capacity = no
- Disability own, H&S: Exclusion clause hip joint and upper leg
- Disability any: 50% loading
- LTC: 30% loading
If limitations = no and work in full capacity = yes, screen 2

Screen 2

If free of symptoms < = 12 months
- Disability own, H&S: Exclusion clause hip joint and upper leg, ‘reexam. in 2 years’
- Disability any: 50% loading
- LTC: 20% loading
If free of symptoms > 12 months - < = 24 months
- If manual work
  - Disability own : Exclusion clause hip joint and upper leg, ‘reexam. in 1’ H&S: Exclusion clause hip joint and upper leg
  - Disability any: standard
  - LTC: 20% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading
If free of symptoms > 24 months
- If manual work
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
  - H&S: Exclusion clause hip joint and upper leg
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Pelvis fractures

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints Entry points: Pelvic fracture, pelvic margin fracture, pelvic fracture

Screen 1

If limitations = yes or work in full capacity = no
- Disability own, H&S: Exclusion clause pelvis
- Disability any: 50% loading
- LTC: 30% loading
If limitations = no and work in full capacity = yes, screen 2

Screen 2

If free of symptoms < = 12 months
- Disability own: Exclusion clause pelvis, ‘reexamination. in 2 years possible’
- H&S: Exclusion clause pelvis
- Disability any: 50% loading
- LTC: 20% loading
If free of symptoms > 12 months - < = 24 months
- If manual work
  - Disability own: Exclusion clause pelvis, ‘reexam. in 1 year possible’
  - H&S: Exclusion clause pelvis
  - Disability any: standard
  - LTC: 20% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading
If free of symptoms > 24 months
- If manual work
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
  - H&S: Exclusion pelvis
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Femur fractures

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: Fracture of shaft of femur, femur fracture, etc.

Screen 1

If unknown, GPR
If close to the hip, MC hip joint fractures
If close to the knee or middle part, screen 2

Screen 2

If limitations = yes or work in full capacity = no
- Disability own, H&S:
- If close to knee: Exclusion clause of knee joint
- If middle part: Exclusion of upper leg
- Disability any: 50% loading
- LTC: 30% loading *If limitations = no and work in full capacity = yes, screen 3 -10

Screen 2

If free of symptoms < = 24 months
- Disability own, H&S
  - If close to knee: Exclusion clause of knee joint
  - If middle part: Exclusion of upper leg
- Disability any: standard
- LTC: 20% loading
If free of symptoms > 24 months
- If manual work
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
  - H&S:
    
    If close to knee: Exclusion clause of knee joint
    
    If middle part: Exclusion of upper leg
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Slipped capital femoral epiphysis

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: slipped femoral epiphysis

Screen 1

If limitations = yes or work in full capacity = no
- Disability own, H&S: Exclusion clause hip joint and upper leg
- Disability any: 50% loading
- LTC: 30% loading
If limitations = no and work in full capacity = yes, screen 2

Screen 2

If free of symptoms < = 24 months
- Disability own: Exclusion clause hip joint and upper leg, ‘reexam. in 2 years’
- Disability any: 50% loading
- LTC: 30% loading
- H&S: Exclusion clause hip joint and upper leg
If free of symptoms > 24 months
- If manual work
  - Disability own: Exclusion clause hip joint and upper leg
  - Disability any: 25% loading
  - LTC: 10% loading
  - H&S: Exclusion clause hip joint and upper leg
- If no manual work
  - Disability own/any: 25% loading
  - H&S: standard
  - LTC: 10% loading

Intra-articular loose body

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: loose body in hip

Screen 1

If surgery = no
- Disability own, H&S: Exclusion intra-articular loose body hip
- Disability any: 50% loading
- LTC: 20% loading
If surgery = yes, screen, 2

Screen 2

If limitations = yes
- Disability own, H&S: Exclusion intra-articular loose body hip
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 3

Screen 3

If ≤ 12 months
- Disability own, H&S: Exclusion intra-articular loose body hip
- Disability any: 50% loading
- LTC: 20% loading
If > 12 months
- If manual work
  - Disability own : Exclusion intra-articular loose body hip
  - Disability any, H&S: standard
  - LTC: 10% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Knee/leg/foot

Ruptured ankle joint

For Disability, H&S * Life, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: ankle joint distortion, ankle displacement, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause ankle joint
- Disability any: 25% loading
If no, screen 2

Screen 2

If free of symptoms since ≤ 3 months
- Disability own, H&S: Exclusion clause ankle joint
- Disability any: 25% loading
If free of symptoms since > 3 months
- If manual work
  - Disability own, H&S: Exclusion clause ankle joint
  - Disability any: standard
- If no manual work, standard

Ankle joint fracture

For Disability, H&S
Life, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: ankle fracture, ankle bone fracture, etc.

Screen 1

If symptoms = yes or work at full capacity = no
- Disability own, H&S: Exclusion clause ankle joint
- Disability any: 25% loading
If symptoms = no and work at full capacity = yes, screen 2

Screen 2

If free of symptoms since ≤ 6 months
- Disability own, H&S: Exclusion clause ankle joint
- Disability any: 25% loading
If free of symptoms since > 6 - ≤ 36 months
- If manual work
  - Disability own, H&S: Exclusion clause ankle joint
  - Disability any: standard
- If no manual work, standard
If > 36 months, standard

Knee Specification

For Disability own/any, LTC, H&S
Life, ADB, CI: STD.

Cancel reaction: Medical questionnaire joints

Entry points: chondromalacia of the patella, knee joint effusion, etc.

Screen 1

(Single selection)

If not included in this list, module change to Other disorder
If meniscus symptoms, module change to Meniscus rupture
If knee ligament rupture, module change to Knee ligament injury
If twisted knee, module change to Knee pain
If patella fracture, module change to Patella fracture
If cartilage damage, module change to Knee arthrosis
If unknown, GPR

Knee ligament injury (ex Knee ligament rupture)

For Disability own/any, LTC, H&S
Life, ADB, CI: STD.

Cancel reaction: Medical questionnaire (Accident)

Entry points: rupture of the knee joint ligament, etc

Screen 1

(Multiple selection, Single follow up)

If meniscus or unknown
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If limitations = yes
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If no limitations, screen 2

Screen 2

If ≤ 24 months
- Disability own, H&S: Exclusion clause knee joint, hint ‘reexamination in 2 years’
- Disability any: 25% loading
- LTC: 10% loading
If > 24 months
- If cruciate ligament
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
  - H&S: Exclusion clause knee joint
- If collateral ligament, standard

Knee pain (ex-luxation)

For Disability, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: chondropathy of the patella, kneecap injury

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If no, screen 2

Screen 2

If free of symptoms since ≤ 24 months
- If manual work
  - H&S: Exclusion clause knee joint
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
- If no manual work
  - Disability own : 25%
  - Disability any: standard
  - LTC: 10% loading
  - H&S: Exclusion clause knee joint
If free of symptoms since > 24 months, standard

Patella fracture

For Disability, LTC and H&S.
Life, ADB, CI: STD

Cancel reaction: Medical questionnaire joints

Entry points: Patella fracture, etc.

Screen 1

If limitations = yes
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 2

Screen 2

If ≤ 2 years
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 25% loading
- LTC: 10% loading
If > 2 years
- If manual work
  - Disability own, H&S: Exclusion clause knee joint
  - Disability any: standard
  - LTC: 10% loading
- If no manual work
  - Disability own/any, H&S: standard
  - LTC: 10% loading

Patella luxation

For Disability, LTC and H&S.
Life, ADB, CI: STD

Cancel reaction: Medical questionnaire joints

Entry points: patella luxation, dislocation of the knee, etc

Screen 1

If limitations = yes
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 2

Screen 2

If > 24 months, standard
If ≤ 24 months, screen 3

Screen 3

If single occurrence
- If manual work
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
  - H&S: Exclusion clause knee joint
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading
If multiple occurrence
- If manual work
  - Disability own, H&S: Exclusion clause knee joint
  - Disability any: 25% loading
  - LTC: 20% loading
  - H&S: Exclusion clause knee joint
- If no manual work
  - Disability own: 50% loading
  - Disability any: 25% loading
  - LTC: 20% loading
  - H&S: Exclusion clause knee joint

Knee bursitis

For Disability, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: knee mucous lingua removed, bursitis of knee

Screen 1

If symptoms = yes
- Disability own/any, H&S: Exclusion clause knee joint
- LTC: 20% loading
If no, screen 2

Screen 2

If free of symptoms since ≤ 24 months
- If manual work
  - H&S: Exclusion clause knee joint
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
- If no manual work
  - Disability own, H&S: standard
  - Disability any: standard
  - LTC: 10% loading
If free of symptoms since > 24 months, standard

Meniscus rupture

For Disability, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: knee mucous lingua removed, bursitis of knee

Screen 1

If symptoms = yes or ligament injury
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50& loading
- LTC: 20% loading
If symptoms = no and ligament injury = no, screen 2

Screen 2

If free of symptoms since ≤ 24 months
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 25% loading
- LTC: 10% loading
If free of symptoms since > 24 months
- If manual work
  - H&S: Exclusion clause knee joint
  - Disability own: 50% loading
  - Disability any: standard
  - LTC: 10% loading
- If no manual work
  - Disability own/any: standard
  - LTC: 10% loading
  - H&S: standard

Knee arthrosis

For Disability, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire (joints)

Entry points: Gonarthrosis, knee joint arthrosis, etc.

Screen 1

If limitations = no and deformation = no
- If age at diagnosis ≤ 30 years
  - Disability any: 50% loading
  - Disability own, H&S: Exclusion clause Gonarthrosis
  - LTC: 20% loading
- If age at diagnosis > 30 years and < 60 years
  - Disability any: 25% loading
  - LTC: 20% loading
  - Disability own: 25% loading, if manual work Exclusion Gonarthrosis
  - H&S: standard, if manual work Exclusion Gonarthrosis
- If age at diagnosis > 60 years
  - Disability any: 25% loading
  - LTC: 10% loading
  - Disability own: 25% loading, if manual work Exclusion Gonarthrosis
  - H&S: standard, if manual work Exclusion Gonarthrosis
If limitations = yes or deformation = yes
- Disability any: 50% loading
- Disability own, H&S: Exclusion clause Gonarthrosis
- LTC: 30% loading

Cruciate ligament injury

For Disability own/any, LTC, H&S
Life, ADB, CI: STD.

Cancel reaction: Medical questionnaire (Arthritis)

Entry points: rupture of the cruciate ligament, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If symptoms = no, screen 2

Screen 2

If ≤ 24 months
- Disability own, H&S: Exclusion clause knee joint, hint ‘reexamination in 2 years’
- Disability any: 25% loading
- LTC: 10% loading
If > 24 months
- Disability own: 50% loading
- Disability any: standard
- LTC: 10% loading
- H&S: Exclusion clause knee joint

Collateral ligament injury

For Disability own/any, LTC, H&S
Life, ADB, CI: STD.

Cancel reaction: Medical questionnaire (Arthritis)

Entry points: outer ligament injury, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause knee joint
- Disability any: 50% loading
- LTC: 20% loading
If symptoms = no, screen

Screen 2

If ≤ 24 months
- Disability own, H&S: Exclusion clause knee joint, hint ‘reexamination in 2 years’
- Disability any: 25% loading
- LTC: 10% loading
If > 24 months, standard

Intra-articular loose body knee

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: loose body in the knee, loose body in knee joint

Screen 1

If surgery = no
- Disability own, H&S: Exclusion intra-articular loose body knee
- Disability any: 50% loading
- LTC: 20% loading
If surgery = yes, screen, 2

Screen 2

If limitations = yes
- Disability own, H&S: Exclusion intra-articular loose body knee
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 3

Screen 3

If ≤ 12 months
- Disability own, H&S: Exclusion intra-articular loose body knee
- Disability any: 50% loading
- LTC: 20% loading
If > 12 months
- If manual work
  - Disability own : Exclusion intra-articular loose body knee
  - Disability any, H&S: standard
  - LTC: 10% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Intra-articular loose body ankle joint

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: loose body in ankle joint

Screen 1

If surgery = no
- Disability own, H&S: Exclusion intra-articular loose body ankle joint
- Disability any: 50% loading
- LTC: 20% loading
If surgery = yes, screen, 2

Screen 2

If limitations = yes
- Disability own, H&S: Exclusion intra-articular loose body ankle joint
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 3

Screen 3

If ≤ 12 months
- Disability own, H&S: Exclusion intra-articular loose body ankle joint
- Disability any: 50% loading
- LTC: 20% loading
If > 12 months
- If manual work
  - Disability own : Exclusion intra-articular loose body ankle joint
  - Disability any, H&S: standard
  - LTC: 10% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Shoulder

Shoulder complaints

For Disability, H&S, LTC
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: shoulder complaints, shoulder problems, etc.

Disability, H&S

Screen 1

If restriction = yes
- If age at diagnoses ≤ 30 years
  - Disability own/H&S: Exclusion clause shoulder joint
  - Disability any: 50% loading
- If age at diagnosis > 30 years
  - H&S: Exclusion clause shoulder joint
  - Disability own: 50% loading
  - Disability any: standard
If restriction = no, then go to screen 2

Screen 2

If free of symptoms since ≤ 12 months
- Disability own/H&S: Exclusion clause shoulder joint
- Disability any: standard
If free of symptoms > 12 months - ≤ 36 months
- If manual work
  - Disability own/H&S: Exclusion clause shoulder joint
  - Disability any: standard
- If no manual work
  - If age at diagnoses ≤ 30 years
    
    H&S: Exclusion clause shoulder joint
    
    Disability own: 25% loading
    
    Disability any: standard
  - If age at diagnosis > 30 years, standard ShoulderComp06
If free of symptoms > 36 months
- If manual work
  - Disability own: Exclusion clause shoulder joint
  - Disability any, H&S: standard
- If no manual work, standard

LTC

Screen 1

If yes, 20% loading
If no, screen 2

Screen 2

If free of symptoms since ≤ 12 months, 20% loading
If free of symptoms since > 12 months, 10% loading

Shoulder injury

For Disability, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire accidents

Entry points: bruised shoulder, broken shoulder, etc.

Screen 1

If symptoms = yes
- Disability any, H&S: Exclusion clause shoulder joint
- Disability own: 50% loading
- LTC: 20% loading
If no, go to screen 2

Screen 2

If free of symptoms since ≤ 24 months
- Disability own/H&S: Exclusion clause shoulder joint
- Disability any: 50% loading
- LTC: 20% loading
If free of symptoms > 24 months - ≤ 36 months
- If manual work
  - Disability own/H&S: Exclusion clause shoulder joint
  - Disability any: standard
  - LTC: 10% loading
- If no manual work
  - LTC: 10% loading
  - Disability own: 25% loading
  - Disability any, H&S: standard
If free of symptoms > 36 months
- If manual work
  - Disability own: Exclusion clause shoulder joint
  - Disability any, H&S: standard
  - LTC: 10% loading
- If no manual work
  - LTC: 10% loading
  - Disability own/any, H&S: standard

Shoulder contusion

For Disability, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire accidents

Entry points: bruising of the shoulder, bruising of the shoulder-blade, etc.

Screen 1

If symptoms = yes
- Disability any, H&S: Exclusion clause shoulder joint
- Disability own: 50% loading
- LTC: 20% loading
If symptoms = no, go to screen 2

Screen 2

If free of symptoms since ≤ 6 months
- Disability own/H&S: Exclusion clause shoulder joint
- Disability any: 50% loading
- LTC: 20% loading
If free of symptoms > 6 months, standard

Shoulder arthrosis

For Disability and H&S
Life, CI, ADB: STD
LTC: 20% loading

Cancel reaction: Medical questionnaire joints

Entry points: Omarthrosis, shoulder joint arthrosis, clavicle arthrosis, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause shoulder joint
- Disability any: 50% loading
If restriction = no, then go to screen 2

Screen 2

If age at diagnoses ≤ 30 years
- Disability own, H&S: Exclusion clause shoulder joint
- Disability any: 50% loading
If age at diagnosis > 30 years
- If manual work
  - Disability own, H&S: Exclusion clause shoulder joint
  - Disability any: 25% loading
- If no manual work
  - Disability own/any: 25% loading
  - H&S: standard

Shoulder luxation

For Disability, H&S, LTC
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire accident

Entry points: Shoulder joint luxation, etc.

Screen 1

If congenital, screen 2
If accident/injury or deterioration, module change to Shoulder injury

Screen 2

If restrictions = yes
- Disability own, H&S: Exclusion clause shoulder joint
- Disability any: 50% loading
- LTC: 20% loading
If restrictions = no
- If manual work
  - Disability own: 50% loading
  - Disability any: standard
  - H&S: Exclusion clause shoulder joint
  - LTC: 10% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - H&S: standard
  - LTC: 10% loading

Intra-articular loose body shoulder

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: loose body in shoulder

Screen 1

If surgery = no
- Disability own, H&S: Exclusion intra-articular loose body shoulder
- Disability any: 50% loading
- LTC: 20% loading
If surgery = yes, screen, 2

Screen 2

If limitations = yes
- Disability own, H&S: Exclusion intra-articular loose body shoulder
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 3

Screen 3

If ≤ 12 months
- Disability own, H&S: Exclusion intra-articular loose body shoulder
- Disability any: 50% loading
- LTC: 20% loading
If > 12 months
- If manual work
  - Disability own : Exclusion intra-articular loose body shoulder
  - Disability any, H&S: standard
  - LTC: 10% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Arm/hand

Carpal tunnel syndrome

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel Reaction: Medical questionnaire joints

Entry points: carpal tunnel syndrome, CTS, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion hand/arm
- Disability any: 50% loading
- LTC: 10% loading
If symptoms = no, screen 2

Screen 2

If no surgery
- If free of symptoms since ≤ 12 months
  - Disability own, H&S: Exclusion, hint ‘re-examination after surgery possible’
  - Disability any: 50% loading
  - LTC: 10 % loading
- If free of symptoms since > 12 months
  - Disability own/any: 25% loading
  - LTC, H&S: standard
If surgery
- If free of symptoms since ≤ 6 months
  - Disability own, H&S: Exclusion, hint ‘re-examination after 6 months possible’
  - Disability any: 50% loading
  - LTC: 10 % loading
- If free of symptoms since > 6 months, standard

Surgery for carpal tunnel syndrome

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel Reaction: Medical questionnaire joints

Entry points: operated carpal-tunnel syndrome

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion hand/arm
- Disability any: 50% loading
- LTC: 10% loading
If symptoms = no, screen 2

Screen 2

If free of symptoms since ≤ 6 months
- Disability own, H&S: Exclusion, hint ‘re-examination after 6 months possible’
- Disability any: 50% loading
- LTC: 10 % loading
If free of symptoms since > 6 months, standard

Finger injury

For Disability own, LTC, H&S
Life, CI, Disability any, ADB: STD

Cancel reaction: Medical questionnaire accident

Entry points: finger extremity fracture, etc.

Screen 1

If restrictions = yes or at work in full capacity = no
- Disability own, H&S: Exclusion clause for affected fingers
- LTC: 10% loading
If restrictions = no and at work in full capacity = yes, screen 2

Screen 2

If free of symptoms since ≤ 12 months
- Disability own, H&S: Exclusion clause for affected fingers, hint ‘reexamination 1 year’
- LTC: 10 % loading
If free of symptoms since > 12 months, standard

Hand/arm injury

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire accident

Entry points: arm broken, injury of the arm, etc.

Screen 1

If restrictions = yes or at work in full capacity = no
- Disability own, H&S: Exclusion clause of the hand / arm
- Disability any: 50% loading
- LTC: 20% loading
If restrictions = no and at work in full capacity = yes, screen 2

Screen 2

If free of symptoms since ≤ 6 months
- Disability own, H&S: Exclusion clause of the hand / arm, hint ‘reexamination 3 years’
- Disability any: 50% loading
- LTC: 20% loading
If free of symptoms since > 6 months and ⇐ 36 months
- Disability own, H&S: Exclusion clause of the hand / arm, hint ‘reexamination 3 years’
- Disability any: 25% loading
- LTC: 10% loading
If free of symptoms since > 36 months, standard

Tennis elbow

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: tennis elbow, tennis arm, etc.

Screen 1

If multiple occurrence (> 1)
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 20% loading
If single occurrence, screen 2

Screen 2

If symptoms = yes
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 10% loading
If symptoms = no, screen 3

Screen 3

If free of symptoms since ≤ 6 months
- Disability own, H&S: Exclusion, hint ‘re-examination after 6 months possible’
- Disability any: 50% loading
- LTC: 10% loading
If free of symptoms since > 6 months, standard

Tendonitis

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: tendinitis, etc.

Screen 1

If multiple occurrence (> 1)
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 20% loading
If single occurrence, screen 2

Screen 2

If symptoms = yes
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 10% loading
If symptoms = no, screen 3

Screen 3

If free of symptoms since ≤ 6 months
- Disability own, H&S: Exclusion, hint ‘re-examination after 6 months possible’
- Disability any: 50% loading
- LTC: 10% loading
If free of symptoms since > 6 months, standard

Arm arthrosis

For Disability own/any, LTC and H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: arm arthrosis, hand arthrosis, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 20% loading
If symptoms = no, then go to screen 2

Screen 2

If age at diagnoses ≤ 30 years
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 20% loading
If age at diagnosis > 30 years and < 60 years
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 25% loading
- LTC: 20% loading
If age at diagnoses > 60 years
- Disability own: 50% loading
- Disability any: 25% loading
- LTC: 10% loading
- H&S: Exclusion clause arm/hand

Finger arthrosis

For Disability own/any, LTC and H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: thumb arthrosis, finger arthrosis, etc.

Screen 1

If symptoms = yes
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 20% loading
If symptoms = no, then go to screen 2

Screen 2

If age at diagnoses ≤ 30 years
- Disability own, H&S: Exclusion clause arm/hand
- Disability any: 50% loading
- LTC: 20% loading
If age at diagnosis > 30 years, screen 3

Screen 3

If age at diagnosis > 30 years and < 60 years
- If >1 finger affected
  - Disability own, H&S: Exclusion clause arm/hand
  - Disability any: 25% loading
  - LTC: 20% loading
- If 1 finger affected
  - Disability own/any: 25% loading
  - LTC: 10% loading
  - H&S: standard
If age at diagnoses > 60 years
- If >1 finger affectedH&S: Exclusion clause arm/hand
  - Disability own/any: 25% loading
  - LTC: 10% loading
- If 1 finger affected, standard

Intra-articular loose body elbow

For Disability own/any, LTC, H&S
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: loose body in elbow

Screen 1

If surgery = no
- Disability own, H&S: Exclusion intra-articular loose body elbow
- Disability any: 50% loading
- LTC: 20% loading
If surgery = yes, screen 2

Screen 2

If limitations = yes
- Disability own, H&S: Exclusion intra-articular loose body elbow
- Disability any: 50% loading
- LTC: 20% loading
If limitations = no, screen 3

Screen 3

If ≤ 12 months
- Disability own, H&S: Exclusion intra-articular loose body elbow
- Disability any: 50% loading
- LTC: 20% loading
If > 12 months
- If manual work
  - Disability own : Exclusion intra-articular loose body elbow
  - Disability any, H&S: standard
  - LTC: 10% loading
- If no manual work
  - Disability own: 25% loading
  - Disability any, H&S: standard
  - LTC: 10% loading

Joints

Clicked joint

For Disability, H&S
Life, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: Clicked joint, etc.

Screen 1

If restriction in movement = no, refer
If restriction in movement = yes, go to screen 2

Screen 2

always refer

Intra-articular loose body (unspecific)

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: loose body in joint, etc.

Screen 1

Term completion and search in disorder-DB. If term in DB, reaction after new term.
If term is not in DB, term can be retained and the request will be forwarded with ‘disorder not found’.

Ganglion

For Disability own, H&S
Life, Disability any, CI, LTC, ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: Ganglion, etc.

Screen 1

If complications = yes
- Disability own, H&S: Exclusion clause ganglion
- Disability any: 25% loading
- LTC: 10% loading
If complications = no, go to screen 2

Screen 2

If last symptoms ≤ 12 months
- H&S: Exclusion clause ganglion
- Disability own/any: 25% loading
- LTC: 10% loading
If last symptoms > 12 months, standard

Ruptured joint ligaments (unspecific)

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: rupture of the ligaments, simple dislocation, joint strain, etc.

Screen 1

Term completion and search in disorder-DB. If term in DB, reaction after new term.
If term is not in DB, term can be retained and the request will be forwarded with ‘disorder not found’.

Capsule rupture

For Disability, H&S
Life, LTC, ADB, CI: STD

Cancel reaction: Medical questionnaire joints

Entry points: rupture of the capsule, etc.

Screen 1

(Single Selection)

If free of symptoms = no, screen 3 and refer
If free of symptoms = yes, screen 2

Screen 2

If ≥ 3 months ago, STD
If < 3 months ago
- Disability own, H&S: refer
- Disability any: If area ≠ shoulder or knee, then STD, otherwise refer

Screen 3

Bursitis

For Disability own/any, LTC, H&S
Life, ADB, CI: STD

Cancel reaction: Medical questionnaire joints

Entry points: Bursitis, etc.

Screen 1

(Single Selection)

If knee joint, module change to Knee bursitis
If shoulder joint, module change to Shoulder complaints
If other joint(s), screen 2

Screen 2

If single occurrence, screen 3
If multiple occurrence
- Disability own, H&S: Exclusion clause relevant joint
- Disability any: 50% loading
- LTC: 20% loading

Screen 3

If restrictions = yes
- Disability own, H&S: Exclusion clause relevant joint
- Disability any: 50% loading
- LTC: 20% loading
If restrictions = no, screen 4

Screen 4

If ≤ 6 months
- Disability own, H&S: Exclusion clause relevant joint
- Disability any: 50% loading
- LTC: 20% loading
If > 6 months
- LTC: 10% loading
- Disability own/any, H&S: standard

Arthritis

For all benefits
ADB: standard

Cancel reaction: Medical questionnaire (Arthritis)

Entry Points: arthritis, chronic arthritis, etc.

If rheumatoid arthritis (M06), ankylosing spondylitis (M45), psoriasis (L40), (M10), SLE (M32), or reactive arthritis (M02) are indicated on the claim, arthritis is not assessed. Otherwise, screen 1

Screen 1

(Multiple Selection, Single Follow Up)

If SLE, module change to General DataCollection DisabilityLTCCIDecl
If rheumatoid arthritis, module change to Rheumatoid arthritis
If ankylosing spondylitis, module change to Ankylosing spondylitis
If psoriasis
- Life: 50% extra mortality
- CI: 50% loading
- LTC: GPR
- Disability own/any, H&S: decline
If reactive arthritis, screen 7
If gout, module change to Gout
If none of these
- If Life, CI: standard
- If Disability own/any, LTC, H&S, screen 2

Screen 2

If > 1 joint
- Disability own/any, H&S: decline
- LTC: 30 %loading
If = 1 joint, screen 3

Screen 3

(Single Selection)

If other joint, screen 4
Always screen 5

Screen 4

Screen 5

If restrictions = yes
- Disability own, H&S:
  - Finger/elbow joint or wrist: Exclusion clause arthritis arm/hand
  - Hip joint: Exclusion clause Arthritis hip joint
  - Ankle joint / toe joint: Exclusion clause arthritis anklejoints
  - Knee joint: Exclusion clause arthritis kneejoint
  - Shoulder joint: Exclusion clause arthritis shoulder joint
  - Other joint: refer ‘disorder to be checked’
- Disability any: 75% loading
- LTC: 30% loading
If restrictions = no, screen 6

Screen 6

If < = 12 months
- Disability own, H&S:
  - Finger/elbow joint or wrist: Exclusion clause arthritis arm/hand
  - Hip joint: Exclusion clause Arthritis hip joint
  - Ankle joint / toe joint: Exclusion clause arthritis anklejoints
  - Knee joint: Exclusion clause arthritis kneejoint
  - Shoulder joint: Exclusion clause arthritis shoulder joint
  - Other joint: refer ‘disorder to be checked’
- Disability any: 75% loading
- LTC: 30% loading
If 12 - ≤ 36 months
- Disability own/any: 50% loading
- H&S: 25% loading
- LTC: 20% loading
If > 36 months
- Disability own/any, H&S: standard
- LTC: 10% loading

Screen 7

If more than once = yes and duration > 6 months
- Life: 75% extra mortality
- CI: 75% loading
- LTC: 30% loading
- Disability own: 100% loading
- Disability any: 75% loading
- H&S: decline
If more than one = no and duration ⇐ 6 months, GPR

Rheumatoid arthritis

For Life, CI
H&S: Exclusion clause relevant joint
Disability own/any, LTC: decline
ADB: standard

Cancel reaction: Medical questionnaire (Arthritis)

Entry Points: rheumatic arthritis, polymyalgia rheumatica, etc.

Screen 1

If other diseases = yes, screen 2
If other diseases = no
- If age ≤ 39
  - Life: 75% extra mortality
  - CI: 125% loading
- If age > 39 and ≤ 49
  - Life: 50% extra mortality
  - CI: 100% loading
- If age > 49 and ≤ 59
  - Life: 50% extra mortality
  - CI: 75% loading
- If age > 59 and ≤ 74
  - Life: 50% extra mortality
  - CI: 50% loading
- If age > 74
  - Life: 25% extra mortality
  - CI: 25% loading

Screen 2

refer ‘disorder to be checked’

Neuralgia

For Disability, Life, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: Neuralgia, etc.

Screen 1

If yes, defer
If no, go to screen 2

Screen 2

If last symptoms ≥ 24 months ago, go to screen3
If last symptoms < 24 months ago, defer

Screen 3

If yes, go to screen 4
If no, STD

Screen 4

refer

Osteomyelitis

For Disability, Life, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: Osteomyelitis, inflammation of the periosteum, etc.

Screen 1

If yes, defer
If no, go to screen 2

Screen 2

If single occurrence
- If symptoms = yes
  - Life: 50% extra mortality
  - CI: 50% loading
  - Disability own/any, LTC, H&S: defer
- If symptoms = no, screen 3
If multiple occurrence
- If symptoms = yes
  - Life: 100% extra mortality
  - CI: 100% loading
  - Disability own/any, LTC, H&S: defer
- If symptoms = no, screen 3

Screen 3

If single occurrence
- If ≤ 12 months
  - Life: 50% extra mortality
  - CI: 50% loading
  - Disability own/any, LTC, H&S: defer 12 months
- If > 12 months
  - Life, CI, Disability any, H&S: standard
  - Disability own: 25% loading
  - LTC: 10% loading
If multiple occurrence
- If ≤ 12 months
  - Life: 100% extra mortality
  - CI: 100% loading
  - Disability own/any, LTC, H&S: defer, ‘reexam. 24 months’
- If > 12 months - ≤ 24 months
  - Life: 75% extra mortality
  - CI: 75% loading
  - Disability own/any, LTC, H&S: defer, ‘reexam. 12 months’
- If > 24 months - ≤ 36 months
  - Life: 50% extra mortality
  - CI, Disability any: 50% loading
  - Disability own 75% loading
  - LTC: 20% loading
  - H&S: 15% loading
- If > 36 months
  - Life, CI, H&S: standard
  - Disability any: 25% loading
  - Disability own 50% loading
  - LTC: 10% loading

Ulcerous arthritis

For Disability, Life, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire joints

Entry points: joint abscess, etc.

Screen 1

If yes, defer
If no, go to screen 2

Screen 2

If yes,
- Life, CI: STD
- Disability, H&S, LTC, go to screen 3
If no, STD

Screen 3

refer

Osteoporosis

For Life, CI, Disability own/any, LTC
ADB: standard
H&S: Exclusion clause

Cancel reaction: General questionnaire disorders

Entry points: Osteoporosis

1 Details

(Multiple Selection, Single Follow Up)

If other cause or unknown, module change to General DataCollection
If oestrogen deficiency, go to screen 2

2 Spontaneous fracture

If spontaneous fracture = yes
- Life, CI, Disability any/own, screen 3
- LTC: decline
If spontaneous fracture = no
- Life, CI: standard
- Disability own/any: 50% loading
- LTC: 40% loading

Screen 3

If involvement = yes
- Disability own/any, decline
- Life, CI, screen 4
If involvement = no
- Disability own/any, screen 5
- Life, CI, standard

Screen 4

If last fracture ≤ 6 months, defer 6 months
If last fracture > 6 months - ≤ 24 months
- Life: 50% extra mortality
- CI: 50% loading
If last fracture > 24 months, standard

Screen 5

If cured = no, defer
If cured = yes
- If manual work, Exclusion clause for osteopenia/osteoporosis
- If no manual work, 50% loading

Joint replacement (unspecific)

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: endoprothesis, arthroplasty, etc.

Screen 1

Term completion and search in disorder-DB. If term in DB, reaction after new term. If term is not in DB, term can be retained and the request will be forwarded with ‘disorder not found’.

General joints (unspecific)

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: swelling of the joint, epiphysitis, etc.

Screen 1

Term completion and search in disorder-DB. If term in DB, reaction after new term. If term is not in DB, term can be retained and the request will be forwarded with ‘disorder not found’.

Osteochondrosis (unspecific)

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: osteochondrosis

Screen 1

Term completion and search in disorder-DB. If term in DB, reaction after new term. If term is not in DB, term can be retained and the request will be forwarded with ‘disorder not found’.

General operations

For Disability own/any, LTC, H&S
Life, CI, ADB: standard

Cancel reaction: Medical questionnaire joints

Entry points: hip operation, removal of wire, etc.

Screen 1

Term completion and search in disorder-DB. If term in DB, reaction after new term. If term is not in DB, term can be retained and the request will be forwarded with ‘disorder not found’.

Respiratory disorders

Asthma unspecific

For all benefits, except ADB.

Cancel reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: asthma, etc.

Screen 1

Single choice

If not known or continuous asthmatic spasm then module change to RespiratoryDataCollection
If “other” then module change to Other disorder
If cardiac asthma,
- Life: GPR
- other benefits: decline
If occupation related asthma, status asthmaticus, allergic asthma, asthma due to infection or exercise related asthma then module change to asthma

Asthma

For all benefits, except ADB: STD.

Cancel reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: allergic asthma, etc.

Screen 1

Single choice

Smoking is asked only if it has not been asked beforehand.
If last attack ≥ 2 years ago, standard
If last attack < 2 years, go to screen 2

Screen 2

If inhaler less than once a week (occasionally) and not hospitalised
- Life, CI, H&S, Disability any: standard
- LTC: 10% loading
- Disability own: If stressed occupation Exclusion clause Asthma else standard
If inhaler once a week or more (permanent) and not hospitalised
- Life: 75% extra mortality
- CI, H&S: 75% loading
- LTC: 30% loading
- Disability own/sim: If stressed occupation Exclusion clause Asthma else 75% loading
- Disability any: 50% loading
If treated with tablets or hospitalised
- Life: 150% extra mortality
- Disability own/any, CI, H&S, LTC: decline
If smoker, additionally:
- Life: 25% extra mortality
- CI, Disability any: 25% loading
- LTC: 10% loading
- H&S: 10% loading
- Disability own/sim: If stressed occupation Exclusion clause Asthma else 25% loading

Bronchitis

For all benefits, except ADB: STD

Cancel Reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: Bronchitis, etc.

Screen 1

If ≤ 3 times or last symptoms > 12 months ago STD
If > 3 times or symptoms < = 12 months ago, module change to Respiratory DataCollection

Respiratory DataCollection

For all benefits, except ADB: STD

Cancel reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: pulmonary tuberculosis, bronchopneumonia, etc.

This is a data collection module for all benefits except ADB. The data is recorded and referred to underwriting.

Screen 1

If once, go to screen 2
If repeatedly, go to screen 3
If continuously, go to screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

If yes, go to screen 6
If no, go to screen 7

Screen 6

Go to screen 7

Screen 7

Go to screen 8

Screen 8

(Multiple Selection, Multiple Follow Up)

If other treatment, go to screen 9
If surgery, go to screen 10
If surgery planned, go to screen 11
If medication, go to screen 12
If oxygen therapy, go to screen 13
If none, go to screen 14

Screen 9

Go to screen 14

Screen 10

Go to screen 14

Screen 11

Go to screen 14

Screen 12

Go to screen 14

Screen 13

Go to screen 14

Screen 14

If yes, go to screen 15
If no go to screen 16

Screen 15

Go to screen 16

Screen 16

If yes, go to screen 17
If no, go to screen 18

Screen 17

Go to screen 19

Screen 18

Go to screen 19

Screen 19

If yes, go to screen 20
If no, refer

Screen 20

Respiratory DataCollection DisabilityownCILTCDecline

For Life, Disability any.
ADB: STD
Disability own, CI, LTC, H&S: decline

Cancel Reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: asbestosis, etc.

This is a data collection module for Life and Disability any. The details are recorded and referred to underwriting. The questions correspond to the questions of module Respiratory DataCollection.

Lung fibrosis

For Life, CI
Disability, LTC: decline
ADB: STD

Cancel Reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: Lung fibrosis, etc.

This is a data collection module. The details are recorded for Life and CI and referred to underwriting

Screen 1

Go to screen 2

Screen 2

(Multiple Selection, Multiple Follow Up)

If other treatment, go to screen 4
If medication, go to screen 5
If oxygen therapy/ Nebuliser, go to screen 6
If none, go to screen 7

Screen 4

Go to screen 7

Screen 5

Go to screen 7

Screen 6

Go to screen 7

Screen 7

If yes, to to screen 8
If no, go to screen 9

Screen 8

Go to screen 9

Screen 9

If yes, go to screen 10
If no, go to screen 11

Screen 10

Go to screen 12

Screen 11

Go to screen 12

Screen 12

If yes, go to screen 13
If no, refer

Screen 13

Cleft nose

For Disability, H&S
Life, LTC, CI, ADB: STD

Cancel reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: Cleft nose, missing nose, etc.

Screen 1

If deformations = yes, go to screen 2
If deformation =no, go to screen 3

Screen 2

Go to screen 3

Screen 3

refer

Vocal cord inflammation

For all benefits, except ADB: STD

Cancel reaction: Medical questionnaire (Asthma/Bronchitis)

Entry points: vocal cord inflammation

Screen 1

If yes, defer
If no, go to screen 2

Screen 2

If yes, STD
If no, go to screen 3

Screen 3

refer

Skin disorders

Lupus-Erythematosus skin

For Life, CI, Disability any, LTC
Disability own, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire skin

Entry points: diskoider Erythematodes, u.a.

This is a data collection module for Life, CI, Disability any and LTC. All details are recorded and referred to underwriting.

Screen 1

(Multiple Follow Up, Multiple Selection)

If other cause, go to screen 2
If any cause, go to screen 3

Screen 2

Screen 3

Screen 3

If symptoms = yes, go to screen 4
If symptoms = no, go to screen 5

Screen 4

Go to screen 6

Screen 5

Go to screen 6

Screen 6

Go to screen 7

Screen 7

If surgery, to screen 9
If ointment/gause, go to screen 10
If other treatment, go to screen 11
If medication, go to screen 12
If no treatment, go to screen 13

Screen 9

Go to screen 13

Screen 10

Go to screen 13

Screen 11

Go to screen 13

Screen 12

Go to screen 13

Screen 13

If yes, go to screen 14
If no, go to screen 15

Screen 14

Go to screen 15

Screen 15

If yes, go to screen 16
If no, refer

Screen 16

refer

Removal of mole

For Life, Disability, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Skin)

Entry points: Mole, etc.

Screen 1

If amount ≥ 5 moles or malign or unknown, go to screen 2
If amount < 5 moles and benign, STD

Screen 2

If further treatment, go to screen 3
If malign or completely cured = no or time since diagnosis ≤ 5 years ago or amount ≥ 5, refer
If unknown or benign and completely cured =yes and time since diagnosis > 5 years ago, STD

Screen 3

refer

Psoriasis

For Life, CI, Disability, H&S, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Skin)

Entry points: Psoriasis, etc.

Screen 1

Only single selections

If different parts of the body, go to screen 2 (only for data entry).

The evaluation that follows is done in all situations:

Life

If joint symptoms = yes, then +50% extra mortality
If joint symptoms = no
- If different parts of the body or chronic, 25% extra mortality
- If only face or hands and once or recurrent, STD

If joint symptoms = yes, then +50% loading
If joint symptoms = no
- If different parts of the body or chronic, 25% loading
- If only face or hands and once or recurrent, STD

Disability own

If joint symptoms: decline
If only face or hands and once or recurrent
- If occupation related to psoriasis: Exclusion clause Psoriasis
- If occupation not related to psoriasis: STD
If different parts of the body or chronic: GPR

Disability any

If joint symptoms: decline
If only face or hands and once or recurrent: STD
If different parts of the body or chronic: 75% loading

LTC

If joint symptoms = yes, GPR, otherwise STD

H&S

If joint symptoms: refer
If only face or hands and once or recurrent: STD
If different parts of the body or chronic: Exclusion clause

Relevant occupations: Hairdressers, beauticians and related workers (514), Medical doctors (221), Nursing and midwifery professionals (222), Traditional and complementary medicine professionals (223), Dentists (2261), Domestic, hotel and office cleaners and helpers (911), Building and related trades workers, excluding electricians (71), Metal, machinery and related trades workers (72), Manufacturing labourers not elsewhere classified (9329), Refuse workers (961)

Screen 2

Skin problems

For Life, Disability, H&S, LTC
CI, ADB: STD

Cancel reaction: Medical questionnaire skin

Entry points: Skin affection, etc.

Life

Screen 1

If yes, go to screen 2
If no, go to screen 3

Screen 2

Go to screen 4

Screen 3

If duration < 6 weeks and last symptoms ≥ 6 months ago, STD
If duration > 6 weeks or last symptoms < 6 months ago, refer and go to screen 4

Screen 4

If at other areas, go to screen 5
If over the complete body or on the face or hands, go to screen 6

Screen 5

Go to screen 6

Screen 6

If once, go to screen 7
If repetitive, go to screen 8
If complete year, go to screen 9

Screen 7

Go to screen 10

Screen 8

Go to screen 10

Screen 9

Go to screen 10

Screen 10

(Multiple Follow Up, Multiple Selection)

If other cause, go to screen 11
If any cause, go to screen 12

Screen 11

Screen 12

Screen 12

Go to screen 14

Screen 14

(Multiple Selection, Multiple follow Up)

If surgery, go to screen 15
If ointment/gause, go to screen 16
If other treatment, go to screen 17
If medication, go to screen 18
If no treatment, go to screen 19

Screen 15

Go to screen 19

Screen 16

Go to screen 19

Screen 17

Go to screen 19

Screen 18

Go to screen 19

Screen 19

If yes, go to screen 20
If no, go to screen 21

Screen 20

Go to screen 21

Screen 21

If yes, go to screen 22
If no, refer

Screen 22

refer

Disability, H&S, LTC

Data collection according the questions for Life and refer (no assessment!).

Skin ulcer

For Life
CI, Disability, H&S, LTC: module change to Skin DataCollection
ADB: STD

Cancel reaction: medical questionnaire (skin)

Entry points: Skin ulcer, etc.

Screen 1

If malign, module change to Cancer
If benign, STD
If not known, module change to Skin DataCollection

Skin DataCollection

For Life, Disability, H&S, LTC, CI
ADB: STD

Cancel reaction: Medical questionnaire (skin)

Entry points: Actinomycosis of the skin, etc.

This is a data collection module only. All details are recorded for all benefits except ADB and referred.

Screen 1

If at other areas, go to screen 2
If over the complete body or on the face or hands, go to screen 3

Screen 2

Go to screen 3

Screen 3

If once, go to screen 4
If repetitive, go to screen 5
If complete year, go to screen 6

Screen 4

Go to screen 7

Screen 5

Go to screen 7

Screen 6

Go to screen 7

Screen 7

(Multiple Follow Up, Multiple Selection)

If other cause, go to screen 8
If any cause, go to screen 9

Screen 8

Go to screen 9

Screen 9

If other symptoms = yes, go to screen 10
If other symptoms = no, go to screen 11

Screen 10

Go to screen 12

Screen 11

Go to screen 12

Screen 12

Go to screen 13

Screen 13

(Multiple Selection, Multiple follow Up)

If surgery, go to screen 14
If ointment/gause, go to screen 15
If other treatment, go to screen 16
If medication, go to screen 17
If no treatment, go to screen 18

Screen 14

Go to screen 18

Screen 15

Go to screen 18

Screen 16

Go to screen 18

Screen 17

Go to screen 18

Screen 18

If yes, go to screen 19
If no, go to screen 20

Screen 19

Go to screen 20

Screen 20

If yes, go to screen 21

Screen 21

Skin DataCollection Disability

For Disability any
LTC, CI, ADB: STD
Disability own, H&S: Exclusion clause Skin disorders

Cancel reaction: Medical questionnaire skin

Entry points: Cutaneous scab, hypertrichosis, etc.

This is a data collection module for Disability any. All details are recorded and referred to underwriting. The questions are according to questions in the module Skin DataCollection.

Skin DataCollection DisabilityLTC

For Disability, H&S, LTC
Life, CI, ADB: STD

Cancel reaction: Medical questionnaire skin

Entry points: Skin degeneration, etc.

This is a data collection module for Disability, H&S and LTC. All details are recorded and referred to underwriting. The questions are according to questions in the module Skin DataCollection.

Skin DataCollection DisabilityDecl

For Life, CI, LTC
Disability, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire skin

Entry points: Urticaria pigmentosa, etc.

This is a data collection module for Life, CI and LTC. All details are recorded and referred to underwriting. The questions are according to questions in the module Skin DataCollection.

Stomach/Bowel disorders

Stomach Complaints

For all benefits.

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry Points: stomach complaints, etc.

Screen 1

(Multiple choice, single follow up)

If colon cancer or stomach cancer, then module change to Cancer
If colon surgery, stomach rupture, then module change to Gastrointestinal DataCollection
If not known/no diagnosis given, then module change to Gastrointestinal DataCollection
If other, then module change to Gastrointestinal DataCollection
If irritable bowel/IBS, then module change to IrritableBowel
If hiatus hernia, gastric ulcer, duodenal ulcer, then module change to Stomach ulcer
If dyspepsia, gastritis, gastroenteritis, then module change to Dyspepsia/gastritis
If gall surgery, then module change to gall bladder surgery

Dyspepsia/Gastritis

Life, Disability, H&S, CI
AD, LTC: STD.

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry Points: Acute erosive gastritis, allergic gastritis, etc.

Screen 1

If currently suffering from condition
- ≤ 3 times and less than 2 weeks
  - Life: STD
  - CI: STD
  - IPo/s 2/52: Decline
  - IPo/s ≥4/52: 50% loading
  - TPD own/sim, WOP own/sim: +50% loading
  - IPany/ADL, TPD any/ADL, WOP any/ADL: STD
  - H&S: STD
- ≤ 5 times and less than 2 weeks
  - Life: 50% extra mortality
  - CI: 50 % loading
  - IPo/s 2/52: Decline
  - IPo/s 4/52: 100% loading
  - TPD own/sim, WOP own/sim: 50% loading
  - IPo/s 13/52: 75% loading
  - IPany/ADL, TPD any/ADL, WOP any/ADL: 50% loading
  - H&S: 25% loading
- > 5 times or more than 2 weeks: module change to Gastrointestinal DataCollection
If in the past
- ≤ 3 times and less than 2weeks:
  - IP o/s 2/52: Decline
  - other benefits: STD
- ≤ 5 times and less than 2 weeks:
  - Life: 50% extra mortality
  - Disability any/ADL: STD
  - CI: 50% loading
  - IPo/s 2/52: Decline
  - TPD own/sim, WOP own/sim: 25% loading
  - IPo/s 4/52: 75% loading
  - IPo/s 13/52: 50% loading
  - H&S: 25% loading
- > 5 times or more than 2 weeks: module change to Gastrointestinal DataCollection

Stomach Ulcer

For all benefits except ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry Points: stomach ulcer, etc.

Screen 1

If unknown, GPR for all benefits
If malignant, module change to Cancer
If fully recovered = no, module change to Gastrointestinal DataCollection
If fully recovered = yes and benign, go to screen 2

Screen 2

If surgery, evaluation as ‘no surgery’ plus go to screen 3
If no surgery
- LTC: standard
- Life, CI, Disability, H&S
  - Fist diagnosis > 5 years ago
    
    last treatment ≤ 12 months
    
    Life: 50% extra mortality
    
    CI: 50% loading
    
    Disability, H&S: defer 12 months
    
    last treatment > 12 months and ≤ 3 years
    
    Life: 25% extra mortality
    
    CI: 25% loading
    
    Disability own: 75% loading
    
    Disability any: 50% loading
    
    H&S: 50% loading and exclusion clause Gastric ulcer
    
    last treatment > 3 years
    
    Life, CI, Disability any: STD
    
    Disability own: 50% loading
    
    H&S: 20% loading
  - First diagnosis < = 5 years ago
    
    last treatment ≤ 12 months
    
    Life: 25% extra mortality
    
    CI, Disability any: 25% loading
    
    Disability own: 50% loading
    
    H&S: 40% loading and exclusion clause Gastric ulcer
    
    last treatment > 1 year
    
    Life, CI, Disability: STD
    
    H&S: 10% loading

Screen 3

If complications = no
- Life: add 50% extra mortality
- CI: add 50% loading
- Disability own: add 75% loading
- Disability any: add 25% loading
- LTC: standard
- H&S: add 20% loading
If complications = yes
- Life: add 75% extra mortality
- CI: add 75% loading
- Disability, LTC, H&S: GPR for all benefits

Gastrointestinal DataCollection

For Life, Disability, CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: gastrectomy, etc.

This is a data collection module for all modules. All details are recorded and referred.

Screen 1

Single selection

If Once, screen 2
If recurrently, screen 3
If permanently, screen 4

Screen 2

Go to screen 5

Screen 3

Go to screen 5

Screen 4

Go to screen 5

Screen 5

Go to screen 6

Screen 6

If “other treatment”, screen 7
If „medication“, screen 8
If Surgery, screen 9
If planned surgery, screen 10
If no treatment, screen 11

Screen 7

Go to screen 11

Screen 8

Go to screen 11

Screen 9

Go to screen 11

Screen 10

Go to screen 11

Screen 11

If sequelae = yes, go to screen 12
If sequelae = no, go to screen 13

Screen 12

Go to screen 14

Screen 13

Go to screen 14

Screen 14

If unable to work, go to screen 16
If no, refer

Screen 16

Gastrointestinal 12months

For Life, Disability, CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: colitis, enteritis, etc.

Screen 1

If symptoms = yes, refer and go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If last symptoms > = 12 months, STD
If last symptoms < 12 months, module change to Gastrointestinal DataCollection

Gastrointestinal 12months LTC STD

For Disability, Life, CI
LTC, ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: disorder of the peritoneum, gastric diverticulum, etc.

Screen 1

If symptoms = yes, refer and go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If last symptoms > = 12 months, STD
If last symptoms < 12 months, module change to Gastrointestinal DataCollection

StomachSurgery

For Disability, Life, CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Resection of the colon, etc.

Screen 1

If followed up = yes or unknown diagnosis
- LTC: Decline
- Life, CI, Disability, H&S, go to screen 2
If malign (not benign), module change to Cancer
If benign = yes and followed up = no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If last symptoms < 12 months ago,
- LTC: Decline
- Life, CI, Disability, defer 12 months *If last symptoms > = 12 months ago, module change to Gastrointestinal DataCollection

Stomach perforation

For Disability, LTC, Life, CI, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Stomach perforation, Gastric perforation u.a.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

Life, CI, LTC
- If no complaints < 18 months ago, module change to Gastrointestinal DataCollection
- If no complaints ≥ 18 months ago, STD
Disability, H&S
- If no complaints < 36 months ago, module change to Gastrointestinal DataCollection
- If no complaints ≥ 36 months ago, STD

Diverticulum of the intestine

For Disability, LTC, Life, CI, H&S
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Diverticulum of the intestine, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms = no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If no complaints < 6 months ago, module change to Gastrointestinal DataCollection
If no complaints ≥ 6 months ago, STD

Irritable bowel

For Life, Disability, CI, LTC
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: irritable bowel, etc.

Screen 1

If symptoms = yes, refer and go to screen 2
If symptoms = no,
- Life, CI, LTC: go to screen 4
- Disability, H&S: go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If last symptoms ≥ 12 months ago and duration ≤ 6 weeks, STD
If last symptoms < 12 months ago or duration > 6 weeks, module change to Gastrointestinal DataCollection

Screen 4

If duration > 6 weeks, module change to Gastrointestinal data collection
If duration ≤ 6 weeks, STD

Intestinal ulcer

For Life, CI, LTC
Disability, H&S: Module change to Gastrointestinal DataCollection
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Intestinal ulcer, etc.

Screen 1

If not known, GPR
If malign, module change to Cancer
If followed up = yes, go to screen 2
If followed up = no and benign, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If no complaints < 12 months ago, Module change to Gastrointestinal DataCollection
If no complaints ≥ 12 months ago, STD

Intestinal infarction

For Life, CI, LTC
Disability, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Intestinal infarction, etc.

Life, CI, LTC:Module change to Gastrointestinal DataCollection

Ileus Bowel Obstruction

For Life,
Disability, H&S, CI, LTC: Module change to Gastrointestinal DataCollection
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Ileus, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms =no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If no complaints < 36 months ago, Module change to Gastrointestinal DataCollection
If no complaints ≥ 36 months ago, STD

Oesophagitis

For Life,
Disability, CI, H&S, LTC: Module change to Gastrointestinal DataCollection
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Oesophagitis, etc.

Screen 1

If symptoms = yes, go to screen 2
If symptoms =no, go to screen 3

Screen 2

Module change to Gastrointestinal DataCollection

Screen 3

If no complaints < 6 months ago, module change to Gastrointestinal DataCollection
If no complaints ≥ 6 months ago, STD

Oesophageal varices

For Life, CI, LTC
Disability, H&S: Decline
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Oesophageal varices, etc.

Life, CI, LTC: Module change to Gastrointestinal DataCollection

Oesophageal ulcer

For all benefits
ADB: STD

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Oesophageal ulcer, etc.

Screen 1

If malign, module change to Cancer
If not known or followed up = yes, module change to Gastrointestinal DataCollection
If followed up = no and benign, go to screen 2

Screen 2

If no complaints < 12 months ago, defer 12 months
If no complaints ≥ 12 months ago
- CI: Exclusion clause tumours of the stomach and oesophagus
- Life, Disability, H&S, LTC: go to screen 3

Screen 3

If age at diagnosis < 40
- Life: 150% extra mortality
- Disability, H&S: Decline
- LTC: 40% loading
If age at diagnosis ≥ 40 and ≤ 49
- Life: 100% extra mortality
- Disability, H&S: 100% loading
- LTC: 40% loading
If age at diagnosis ≥ 50 und ≤ 59
- Life: 75% extra mortality
- Disability, H&S: 75% loading
- LTC: 30% loading
If age at diagnosis ≥ 60
- Life: 50% extra mortality
- Disability, H&S: 50% loading
- LTC: 20% loading

Hemorrhoids

For Disability own and LTC
Life, CI, Disability any, ADB: STD
H&S Exclusion clause

Cancel reaction: Medical questionnaire (Stomach/Bowel complaints)

Entry points: Haemorrhoids, varices of the anus, piles, etc.

Screen 1

If recurred
- Disability own: Exclusion clause disorder of the rectum and anus
- LTC: 10% loading
If symptoms = yes and recurred = no, screen 2
If symptoms = no and recurred = no, STD

Screen 2

If external = yes
- Disability own: Exclusion clause disorder of the rectum and anus
- LTC: 10% loading
If external = no, STD

Tumours

Benign Tumours unspecific

For Life, Disability, CI, H&S, LTC
ADB: STD

Cancel reaction: Medical Questionnaire (Growths, Cysths, Lumps and Tumours) Entry points: cyst, etc.

Screen 1

If unknown or > 3 tumours: screen 4
If non benign then module change to Cancer
If benign and ≤ 3 tumours: screen 2

Screen 2

If yes: GPR for all benefits
If no: screen 3

Screen 3

If yes: GPR for all benefits
If no: STD

Screen 4

If further treatment, refer and go to screen 5
If benign or not completely cured or time since diagnosis ≤ 5 years, refer
If unknown and completely cured and time since diagnosis > 5 years, STD

Screen 5

Benign Tumours specific without amount

For Life, Disability, CI, H&S, LTC
ADB: STD

Cancel reaction: Medical Questionnaire (Growths, Cysts, Lumps and Tumours)

Entry points: breast amputation , etc.

Screen 1

If non benign then module change to Cancer
If benign and no follow up: STD
If unknown: screen 2
If follow up: GPR

Screen 2

If further treatment, go to screen 3
If benign/unknown or not completely cured or time since diagnosis ≤ 5 years, refer
If unknown and completely cured and time since diagnosis > 5 years, STD

Screen 3

refer

Benign Tumours specific

For Life, Disability, CI, LTC, H&S
ADB: STD

Cancel reaction: Medical Questionnaire (Growths, Cysths, Lumps and Tumours)

Entry points: removal of polyps, removal of breast node, etc.

Screen 1

If unknown or > 3 tumours, go to screen 2
If non benign, module change to Cancer
If benign and ≤ 3 tumours and no follow up treatment: STD
If follow up, request GPR

Screen 2

If further treatment, go to screen 3
If benign/unknown or not completely cured or time since diagnosis ≤ 5 years, refer
If unknown and completely cured and time since diagnosis > 5 years, STD

Screen 3

refer

Cancer

For all benefits

Cancel reaction: Medical questionnaire (Growths, Cysts, Lumps and Tumours)

Entry points: all tumours, breast cancer, etc.

Screen 1

(Multiple Selection, Multiple Follow Up)

If other treatment, screen 2
If minimum time elapsed > 10 years and no sequelae and only once
- Surgery
- STD
- Chemo or x-rays
- Life: 50% extra mortality
- Disability own: 50% loading
- ADB, CI, Disability any, LTC: STD
otherwise refer

Screen 2

refer

Ulcer

For all benefits

Cancel reaction: General questionnaire - disorders

Entry points: ulcer

Screen 1

Multiple Selection, multiple follow up

If bowel ulcer, module change to Intestinal ulcer
If duodenal ulcer or stomach ulcer, module change to stomach ulcer
If gall bladder ulcer, module change to Gall DataCollection
If lower leg ulcer, module change to General DataCollection
If malignant tumour, module change to Cancer
If skin ulcer, module change to Skin ulcer
If urinary bladder ulcer, module change to KidneyDisorder DataCollection
If vocal cord ulcer, module change to Benign tumours specific without amount If “other ulcer”, screen 2

Screen 2

Search of the term in the disorder database, and assess accordingly.

Basaloma

For all benefits except ADB: standard

Cancel reaction: Medical questionnaire (Growths, Cysts, Lumps and Tumours)

Entry points: Basaloma, basal cell carcinoma

1 Occurrence

If recurred = yes, request GPR
If recurred = no, go to screen 2

2 Removal

If completely removed = yes, go to screen 3
If completely removed = no, request GPR

3 Therapy

If further therapy = yes, request GPR
If further therapy = no,
- Life, CI, Disability, LTC: standard
- H&S: go to screen 4

4 Last treatment

If last treatment < 1 year ago, defer 1 year
If last treatment>= 1 year, standard