Policy Cancellation

Case Description

Customers may reach out to cancel an individual health policy or inquire about an involuntary cancellation of their previously purchased policy. This SOP outlines the steps to handle such requests.

Note: please collect the below details before proceeding with any cancellations:

1. New policy copy or visa cancellation

2. Iban details in the below format

3. Bank Account Name                  

4. Name of Bank              

5. Branch                         

6. Bank Address

7. Account Number    

8. IBAN                      

9. Currency

10. Swift code

Resolution Steps

1. Capture Policy Details:

   • Ask the customer to provide the Policy Number.

   • If the policy number is unavailable, request the Customer Phone Number or Sponsor EID.

2. Access Admin Portal:

   • Navigate to Admin Portal > Reports > Purchased Policies.

   • Search for the policy using the provided details (Policy Number, Phone Number, or Sponsor EID).

   • If no details are available, search by Date and narrow down the options using Name or Nationality.

3. Create a CRM Case:

   • Log the case in the CRM system and update the case notes with the following information:

     • Policy Number

     • Policy Issuance Date

     • Policy Start Date

     • Cancellation Reason

     • Policy Holder IBAN Account Number

     • Supporting Documents (e.g., Visa Cancellation, Another Insurance Active Policy)

4. Assign the Case:

   • Assign the case to the Team Lead (TL).

5. TL Action:

   • The TL will email the details to ahourani@shory.com from the cxopsleaders@shory.com mailbox.

   • Email Subject Format:
     [Policy Number] - [CRM Case Number] - Individual Health Policy Cancellation

Types of Cancellation

1. Voluntary Cancellation

• Reasons:

  • Visa Cancellation

  • Purchase of Insurance Elsewhere

2. Involuntary Cancellation

• Reason:

  • Fake Declaration

Conditions for Cancellation

For DHA (Dubai Policies) & DOH (All Other Policies):

• Grace Period: 30 days.

• Proof: Must be shared with the current insurer.

Premium Refund:

• For DHA:

  • Refund is calculated on a monthly basis.

  • If the request is mid-month, refunding starts from the next month.

  • Note: Patient Support Program (Basmah Fees) is not refunded.

• For DOH:

  • Refund is based on the short-period table (if cancellation is confirmed by the Insurance Company).

Important Information:

• If the client has a bad loss ratio (had claims), the insurer will not reimburse the premium.

• If no claims were made, the client is reimbursed as per the premium refund policy.

• Policy Changes:

  • Changes to the policy (e.g., upgrades, downgrades, or modifying policy details) are not allowed through Shory.

Information to Capture

• Policy Holder IBAN Account

• Visa Cancellation Form (if applicable)

• New Health Insurance Policy (if applicable)

Coverage Restrictions

• Parents: Coverage is not offered for parents, even if they are sponsored by their children.

• Eligible Dependents: Coverage is limited to spouses and children only.

Policy Additions

• Late Additions: Not allowed. Dependents cannot be added to an existing policy at a later stage.

Abu Dhabi Residents (Shafafiya API)

• Shafafiya API: Used for Abu Dhabi residents (similar to ADP for motor insurance).

• Restrictions:

  • Outstanding Fines: Policies cannot be purchased if there are fines on the customer’s file. Advise them to clear the fines and try again.

  • No Shafafiya File: Occurs if the individual is new to the UAE or has recently changed their emirate of residence. This is considered a dead-end.

  • Active Current Policy: By law, an individual cannot hold two active health insurance policies simultaneously.

General Verbiage

• “I understand your request to cancel the policy. Let me verify the details and guide you through the process.”

• “Please ensure all required documents are ready to expedite the cancellation process.”

Conclusion

This SOP ensures a structured approach to handling policy cancellation requests. It provides clear steps to verify policy details, document the case, and guide customers through the cancellation process while adhering to regulatory requirements.