Exclusion Card Deck
Every exclusion rule as a trading card with its net cost to the fund.
The job
Shows which exclusions and rejection rules cost more in callbacks, overturned decisions and regulatory risk than they save in claims, so the product committee can reword or retire them and see the effect.
The moment
Each exclusion rule in the insurer's policies is a trading card showing its net cost to the fund. The product committee plays the card for pre-existing conditions.
It shows 4,100 contacts with members, 68% of them angry, and 31% mentioning a decision overturned on appeal. Net, the rule costs $2.3 million a year.
The CFO, who expected to defend the rule, says out loud that it costs more than it saves.
The rule is retired for one plan. Next quarter the card is stamped retired, with 2,300 fewer complaints, inside the range set in advance.
What it does
- Mark a rule for reword or retirement
- Notify product and legal
- Send the committee pack
- Record a retired card's verdict
- Show a card's evidence
What you see
Collectible trading cards with rarity, verbatim flavour text, a net-cost line, a trade table and a retired pile
What it moves
The net cost of each rule in dollars (claims saved minus callbacks, overturned decisions and regulatory risk), and the complaints and overturned decisions avoided after a rule is reworded or retired.
Built for
- Product & digital
- Compliance, complaints & legal
- CX leaders & VoC
- Finance
