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the damage was due to the ‘normal wear and tear’ of the car and the airconditioning system, which was an excluded peril in the insurance policy. Mr Ajay approached the Court and after examining the survey report which said that the car was 12 years old and neither the car nor the air-conditioning had been serviced/ rep...
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Scenario 2:
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insurer and insured agree on the value of the property to be insured, at the38beginning of the insurance contract. In the event of total loss, the insurer agrees to pay the agreed amount of the policy. This type of policy is known as “ **Agreed Value Policy** ”.**b)** **Underinsurance:** Consider a situation now where ...
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Agreed Value Policy
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compensation paid by the airline, say, Rs 15 lakhs.**F.** **Contribution:**Like Subrogation, ‘Contribution’ also follows from the Principle of Indemnity. Hence, it is also called a ‘corollary’ of Indemnity. Contribution is a principle that arises in general insurance contracts. It tells us how the liability is to be me...
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F.
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provide financial protection against certain specified risks for a price or consideration known as the premium. The contractual agreement takes the form of an insurance policy.**2.** **Legal aspects of an insurance contract**This section looks at some features of an insurance contract and considers thelegal principles ...
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Legal aspects of an insurance contract
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the premium in advance. In other words, insurance protection cannot be sold oncredit basis in India.Section 64 VB of the Insurance Act 1938 states, “No risk to be assumed unless premium is received in advance”. No insurer shall assume any risk unless and until the premium is received in advance or is guaranteed to be p...
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Solicitation
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policy of the company and the product offered. All continuity benefits are maintained if the policy is renewed within the grace period. However Claims, if any, during the break period will not be considered. As per IRDAI Regulations, the grace period is 15 days in case of Monthly mode of Premium collection and 30 days ...
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Motor Policies
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disclosed as part of the terms and conditions of the insurance contract and referred to as Short period scales.**Important****i.** **Coercion** - Involves pressure applied through criminal means.**ii.** **Undue influence** – using one’s position to dominate the will of anotherperson, to obtain an undue advantage over t...
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Important
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premium the insurer would require to accept the risk and whether any extra conditions are to be imposed on the risk - all these are part of **underwriting** .It is also important to know what rate is to be charged and how the rates aremade.**Definition**Underwriting is the process of determining whether a risk offered ...
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Definition
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and that the prices are decided on a scientific basis.**2.** The insurer should plan for the possibility of withdrawal of the products in thefuture and the options that would be available to the policyholder on such withdrawal of the product.**3.** The withdrawn product shall not be offered to the prospective customers...
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C.
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fire are more than stone structures; hence, a higher premium is required to insurethe wooden structure.The same concept applies to Life and Health Insurance also. An individual suffering from high blood pressure or diabetes has higher chances of suffering aheart attack.**Test Yourself 1**Identify the two factors that a...
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Test Yourself 1
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similar type and quality.**Test Yourself 2**What is pure premium?I. Premium sufficiently big enough to pay for losses only II. Premium applicable to marginal members of the society III. Premium after loading for administrative costs IV. Premium derived from the most recent loss experience period**2.** **Deductible**‘De...
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Test Yourself 2
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the premises. In Life Insurance the usual practice is to apply loading for adverse health,habits, heredity or occupational factors.**Key Terms**- Deductibles- Franchise**Answers to Test Yourself****Answer 1** - The correct option is I.**Answer 2** - The correct option is I.59## CHAPTER C-06## CLAIMS PROCESSING**Chapte...
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Key Terms
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as “Act of God” perils. These perils may result in losses to many policies of insurer in the affected region. Surveyors are appointed for assessment of certain categories of non-life insurance claims.In such major and catastrophic losses, the surveyor is asked to proceed to the loss site immediately for an early assess...
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On account payment
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respective laws applicable. Thus, insurers can recover the loss from shipping companies, railways, road carriers, airlines, port trust authorities etc.**Example**In the case of non-delivery of consignment, the carriers are responsible for the loss. Similarly, the port trust is liable for goods which are safely landed b...
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Example
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refuse to pay the claim on the ground that the policy is void because it was obtained through fraudulent non-disclosure of material facts (breach of the legal duty of ‘utmost good faith’), the issue has to be resolved through litigation.**D.** **Other dispute resolution mechanisms**As per IRDAI regulations, all policie...
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D.
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terms of such prospectusWhether the plan is participative or non-participativeThe allowable Add-on covers (also called Riders in Life insurance) on the productand their benefits are also stated.Other important information which a Prospectus includes:1. Any differences in covers and premium. E.g. for different age group...
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Test Yourself 1
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as name, father’s name, address and other identifying inputs. To determine the true identity of their customers, documents like address proof, PAN card, photographs etc. are collected with the proposal.In respect of Life and Health insurances, details of the proposers’ family members (including parents) indicating thei...
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Declaration in the Proposal Form
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II. Amount expected to be claimed III. Duty to Disclose material facts IV. Confidentiality of details given**Some examples of such notes are:**‘Non-disclosure of facts material to the assessment of the risk, providing misleading information, fraud or non-co-operation by the insured will nullify the cover under the poli...
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Some examples of such notes are:
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individuals, corporates, partnership firms, trusts and foundationsiii. Income proof documents and financial status, esp. in case of high-valuetransactionsiv. Purpose of insurance contract73**a)** **Age Proof – for Personal Lines**While dealing with person related insurances like Life, Health, Personal Accident, etc. In...
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Age Proof – for Personal Lines
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afford to treat them indifferently. The role of customer service and relationships is important in the service sector and more so for insurance.Every enterprise has a goal to delight its customers. This can be explained by examining how buying insurance differs from buying a car.A car can be seen, touched, test driven ...
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Quality of service
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builds goodwill and brand value, which helps in expanding the business.**Test Yourself 1**What is meant by customer lifetime value?I. Sum of costs incurred while servicing the customer over his lifetime78II. Rank given to customer based on business generated III. Sum of economic benefits that can be achieved by buildin...
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Test Yourself 1
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them and be known by them.All the people one knows and approaches may not be proper candidates for insurance or they may not be interested in buying. It is thus necessary to **qualify** them so that one targets only those who are likely to buy insurance. The prospecting process becomes successful only when an agent is ...
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Invite for an Interview:
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He/ she also **needs to be a risk assessor, underwriter, risk management** **counsellor, designer of customised solutions and a relationship builder** (who thrives on building trust and long-term relationships), all rolled into one.**2.** **The Proposal stage**The agent has to support the customer in filling out the pr...
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The Proposal stage
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name of such proposer/ policyholder.83**6.** **Service after issuance of Policy Document and Receipt for Premium**Once the premium is paid by the customer, the insurer is bound to issue a receipt. A receipt is also to be issued even in case the premium is paid inadvance.The agent may approach the insured and enquire wh...
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Service after issuance of Policy Document and Receipt for Premium
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**work and outside. Communication skills are the most important of these soft** **skills.****1.** **Process of communication**What is communication?All communications require a sender, who sends a message, and a person who received that message. The process is complete once the receiver has understood the message of th...
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Process of communication
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talk, walk, sit and stand, all says something about us, and what is happeninginside us.87It is often said that people listen to only a small percentage of what is actually said. What we don’t say may speak a lot more about us in a louder way. Obviously, one needs to be very careful about one’s body language.**a)** **Co...
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Confidence
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benefits of some of our health plans. Could you help us by asking us your doubts?”89**Paraphrasing the speaker’s exact words** – “So, you are saying that ‘our health plans are not attractive enough’ – Have I understood you correctly?”**Test Yourself 4**Which among the following is not an element of active listening?I. ...
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Paraphrasing the speaker’s exact words
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**Answer 5** - The correct option is III.92## CHAPTER C-09## GRIEVANCE REDRESSAL MECHANISM**Chapter Introduction**Insurance industry is essentially a service industry where customer expectations are constantly rising. There is dissatisfaction with the standard of services. Despite continuous product innovation and sign...
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Answer 5
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The complaint registration process involves two steps – (i) Registering oneself by entering one’s policy details and (ii) Registering one’s complaints and viewing the status of the complaints. Complaints are then forwarded to the respective insurance companies and IRDAI facilitates disposal of Grievances.IGMS tracks co...
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C.
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service and compensation, if any claimed exceeds Rs. 1 crore but does not exceed Rs.10 crores.  It also has appellate and supervisory jurisdiction to entertain appeals fromthe District Commission.  Other powers and authority are similar to those of the District Commission.**iii.** **National Consumer Disputes Redress...
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National Consumer Disputes Redressal Commission
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any of the following: i. To **return** to the complainant the **price** (or premium in case of insurance)and/ or charges paid by the complainant ii. To award such amount as **compensation** to the consumers for any loss orinjury suffered by the consumer due to negligence of the opposite party iii. To remove the defects...
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Nature of complaints
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 the insurance company had rejected the complaint or  the complainant had not received any reply within one month afterreceipt of the complaint by the insurer. ii. The complainant is not satisfied with the reply given by the insurer iii. The complaint is made within one year from the date of rejection by theinsurance...
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Recommendations by the Ombudsman
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3. District Commission4. State Commission5. National Commission6. Insurance Ombudsman**Answers to Test Yourself****Answer 1** -The correct answer is I.100## CHAPTER C-10## REGULATORY ASPECTS FOR INSURANCE MARKETING **FIRM****Chapter Introduction**In this chapter, we discuss Regulatory aspects of Insurance marketing fir...
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Answers to Test Yourself
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These regulations shall covera. (i) Tie-ups with insurers:The Insurance Marketing Firms (IMF) shall engage Insurance Sales Persons (ISP) for the purpose of soliciting and procuring insurance products of maximum of two Life insurers, two General insurers and two Health insurers at any point of time, under intimation to ...
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REGISTRATION OF INSURANCE MARKETING FIRM
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Firm shall follow the following procedure:**a.** Submit an application to the Authority (Form A). **b.** Remit the non-refundable application fees of five thousand rupees alongwith the application for grant of a registration. **c.** Submit all the necessary documents as mentioned in detail in theapplication Form - A al...
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Consideration of application and eligibility criteria for Insurance Marketing
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_time to time._ b. The Applicant shall ensure that the net worth is maintained at all timesand Insurance Marketing Firm shall submit a certificate duly certified by a chartered accountant to this effect annually within three months from the close of the financial year. c. The aggregate holdings of equity shares or cont...
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Principal Officer of the Insurance Marketing Firm:
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requirements for training, examination and certification as mentioned below: **a.** The Principal Officer shall undergo Fifty Hours of Insurance Marketing Firmtraining from an institution recognised by the Authority, and should pass an examination, at the end of the period of training, conducted by the Examination Body...
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null
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**b.** FSE deployed in the Insurance Marketing Firm shall meet the necessarytraining, qualifications, experience and other requirements as may be specified by the other regulatory/ statutory authorities for the line of activity undertaken on an on-going basis in order to be fully in compliance with applicable law, regu...
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null
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State are allowed for registration/renewal. **3.** The Area selected by the Insurance Marketing Firm shall be clearlymentioned in the application Form A and renewal application Form AA while submitting the application to the Authority. Provided that if an applicant is opting for more than one district, then at least on...
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null
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**a.** Undertake to immediately notify the Authority in writing within 30 daysof: i) Any change in the status of registration with regard to scope ofactivities of the Insurance Marketing Firm issued by the Authority; ii) any change in the engagement with the insurers; iii) any addition or deletion of ISPs; iv) Any chan...
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Companies
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b. Furnishes wrong or false information; or conceals or fails to disclosematerial facts in the application submitted for obtaining a registration; c. Indulges in rebates or inducements in cash or kind to a client or any ofthe client's Directors or other employees or any person acting as an introducer; d. Fails to carry...
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null
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u. Act in a fiduciary capacity towards its clients and shall disclose allconflicts of interests as and when they arise; v. Follow recognized standards of professional conduct and discharge hisfunctions in the interest of the policyholders. Comply with provisions of the Act, as amended from time to time, IRDA Act, 1999,...
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Violation of Code of Conduct by the ISP
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It is known as **Human Life Value (HLV)** and is used worldwide.The HLV concept considers human life as a kind of property or asset that earns an income. It thus measures the value of human life based on an individual’s expected net future earnings. Net earnings means the income a person expects to earn each year in th...
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Human Life Value (HLV)
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|---|---| | Uncertainty: In general insurance<br>contracts, the concerned risk event is<br>uncertain. No one can be certain about<br>whether a house would catch fire or a<br>car meet an accident.| There is no such question Death is<br>certain once a person is born. What<br>is uncertain is the time of death.<br>Life i...
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Nature of life insurance risk
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Some do argue that it may be better to buy only Term Insurance from an insurance company and invest the balance premiums in instruments that yield higher returns.Let us consider the arguments for and against traditional cash value insurance contracts.**a)** **Advantages**i. Insurance has historically been proven as a *...
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Advantages
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various stages in life, during which he/ she is expected to play a series of roles These stages are illustrated in the diagram given below.**Diagram 2:** **The Economic Life Cycle**125**Life Stages and Priorities****a)** **Learner (till say age 20 -25)** :The stage when one is preparing for hisfuture byimproving his or...
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Diagram 2:
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particular role, a number of needs come up for which funds have to be provided.**Example**When a person gets married and starts a family of his own, he may need to have his own house. As children grow older, funds are needed for their higher education. As an individual goes well past middle age, the concern is for havi...
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Example
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need to have all three types of products. In a nutshell one may say there is:i. A need to save – For cash requirementsii. A need to insure – Against uncertaintiesiii. A need to invest – For wealth creation**6.** **Risk profile and investments**As an individual moves through various stages in the life cycle, from young ...
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Risk profile and investments
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while upgrading it over time.**iv.** **Inflation**Inflation is a rise in the general level of prices of goods and services in an economy over a period of time. This leads to a fall in the value of money. As a result, the purchasing power of money gets reduced. Inflation can play havoc post retirement. Financial plannin...
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Inflation
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type of policy is best suited.**i.** **Life insurance** may be decided by estimating the income and expenserequirements of the dependents in the event of premature death of the bread winner.**ii.** **Health insurance** requirements may be assessed in terms of thehospitalisation expenses that are likely to be incurred i...
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Life insurance
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meet his needs post retirement and deciding on various retirement options for meeting these needs. Retirement planning involves three phases**a)** **Accumulation:** Accumulation of funds is done through various kinds ofstrategies to set aside money for investment with this purpose.**b)** **Conservation:** Conservation ...
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Accumulation:
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**Answer 3** - The correct option is III.137## CHAPTER L-03## LIFE INSURANCE PRODUCTS: TRADITIONAL**Chapter Introduction**The chapter introduces you to the world of life insurance products. It begins by talking about products in general and then proceeds to discussing the need for life insurance products and the role t...
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Answer 3
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insurance policy to a client, an Agents should be able to justify the suitability of the product for the client’s needs.In other words, the Agent takes into account the particular prospect’s risk profile- age, income, family status, life stage, financial and family goals, investment objectives, insurance portfolio alre...
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Riders in Life Insurance Products
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insured suffers from a specified disability during the term of the contract, a disability benefit would be paid to the beneficiaries/ insured person. The benefits will continue till the death of the insured person.**Diagram 2:** **Disability****c)** **Term insurance as a rider**Protection under Term Life is usually pro...
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Diagram 2:
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account. He/ she can withdraw cash in the form of a policy loan from this cash value or even redeem it by surrendering the policy for its cash value.143In case of outstanding loans, the amount of loan and interest get deducted from the pay-out to the beneficiaries upon death.**A whole life policy is a good plan for the...
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A whole life policy is a good plan for the main earner of the family who wishes
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addition to a guaranteed sum assured, a share in the surpluses( bonuses) that are generated by the insurer. These are known as ‘With Profit’ plans.**6.** **Non-participating products**The Policy holders who buy non-linked without profit [non par] plans are paid a benefit that is fixed and guaranteed at the beginning of...
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Non-participating products
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designed to help protect one from the risk of outliving one’s income. Through annuitization, one’s contributions are converted into periodic payments that can last for life.Individuals can avail of pension benefits by purchasing pension plans from insurance companies. Pension plans can be **on accumulation or deferred*...
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Saral Pension:
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4. Money back policy 5. Par and non-par schemes 6. Reversionary bonus147**Answers to Test Yourself****Answer 1** -The correct option is III. **Answer 2** - The correct option is I.148## CHAPTER L-04## LIFE INSURANCE PRODUCTS: NON-TRADITIONAL**Chapter Introduction**The chapter introduces you to the world of non-traditio...
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Answers to Test Yourself
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became very popular. Its features are **flexible premiums, flexible face amount** **and death benefit amounts.** Unlike traditional policies, where fixed premiums have to be paid periodically to keep the contract in force, universal life policies allow the policyholder (within limits) to decide the amount of premiums h...
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Unit linked insurance
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policyholder’s account at the date when the claim payment is due to be made. A unit is created by dividing an investment fund into a number of equal parts.**ii.** **Transparent structure**The charges for insurance cover and expenses in ULIPs are clearly specified. Once these charges are deducted from the premium, the b...
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Transparent structure
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It has other applications as well. It can be applied to the creation of trusts with resultant insurance benefits; it can be applied for creating a policy covering key personnel of industries and also for redeeming mortgages. We shall briefly describe these various applications of life insurance.**Learning Outcomes**155...
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Learning Outcomes
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manager, or someone with specific skills or knowledge which is especially valuable to the company.**b)** **Insurable losses**The following are the losses for which key person insurance can provide compensation:157i. Losses related to the extended period when a key person is unable towork, to provide temporary personnel...
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Insurable losses
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most cases the same throughout the term and are expressed as an annual rate.**Example**If the premium for a twenty year endowment policy for a given age is Rs. 4,800, it means that Rs. 4,800 has to be paid each year for twenty years.However it is possible to have some policies in which the premiums are payable only in ...
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Example
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‘loading’] the other elements to the net premium we get the gross or office premium**a)** **Mortality and Interest**Mortality is the first element in premiums. It is the chance or likelihood that a person of a certain age would die during a given year. To find out the expected Mortality of a person, “Mortality Tables” ...
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Mortality and Interest
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**contingencies + Bonus loading****Test Yourself 1**What does a policy lapse mean?I. Policyholder completes premium payment for a policy II. Policyholder discontinues premium payment for a policy III. Policy attains maturity IV. Policy is withdrawn from the market**B.** **Surplus and bonus****1.** **Determination of su...
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Test Yourself 1
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already attached bonuses. It is thus a bonus on a bonus. A way to express it may be as @ 8% of basic sum assured plus attached bonus.**iii.** **Terminal Bonus**As the name suggests, this bonus attaches to the contract only at the time of its termination [by death or maturity]. It is applicable only for the claims arisi...
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Terminal Bonus
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The prospectus should also provide:(a) a description of the contingency or contingencies to be covered by insurance; (b) the class or classes of lives or property eligible for insurance under theterms of such prospectus. In Life insurance, the prospectus should also mention about the Riders (also called Add-on covers i...
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Proposal Form:
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of purchasing a life insurance policy and such a change would increase the chance of a loss. This is one factor that Life insurance underwriters take into account seriously when assessing the risk.Life insurance companies seek to guard against the possibility of individuals seeking to make a profit from the purchase of...
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Example
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insurance contractiv. The signature of the authorised signatory and policy stampv. The address of the local Insurance Ombudsman.**b)** **Standard Provisions**The second component of the policy document is made up of standard policy provisions, such as relating to proof of age, premium payment grace period etc. which ar...
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Standard Provisions
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insurability of the insured. Not only must her health be satisfactory but other factors such as financial income and morals must not have deteriorated substantially.**iii.** **Payment of overdue premiums with interest:** The policy owner isrequired to make payment of all overdue premiums with interest from due date of ...
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Payment of overdue premiums with interest:
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amount if the policy had been surrendered. In that case the insurance would have been terminated.Insurers charge interest on policy loans, which are payable semi-annually or annually. Although loan and interest are repayable periodically, If the loan has not been repaid, the insurer deducts the amount of outstanding (u...
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Example
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to them jointly, or to the survivor or survivors. Nominations made after the commencement of the policy have to be intimated to the insurers to be effective.177Section 39(11) of the Insurance Act says that where a policyholder dies after the maturity of the policy but the proceeds and benefit of his policy has not been...
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Diagram 2:
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doubt the alleged loss. Satisfactory proof may need to be produced that the policy has been lost and not dealt with in any manner. Generally the claim may be settled on the claimant furnishing an indemnity bond with or without surety.If payment is shortly due and the amount to be paid is high, the office may also insis...
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Alteration
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force a policy that has either been terminated because of non-payment of premiums or has been continued under one of the non-forfeiture provisions.A policy loan is different from an ordinary commercial loan in two respects, firstly the policy owner is not legally obligated to repay the loan and the insurer need not per...
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Key Terms
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These consist of those whose anticipated mortality corresponds to the standard lives represented by the mortality table.**ii.** **Preferred risks** These are the ones whose anticipated mortality is significantly lower than standard lives and hence could be charged a lower premium.**iii.** **Substandard lives** These ar...
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Preferred risks
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with regard to a life proposed for underwriting.**a)** **Acceptance at ordinary rates (OR)** is the most common decision. Thisrating indicates that the risk is accepted at the same rate of premium as would apply to an ordinary or standard life.**Diagram 3:** **Underwriting decisions****b)** **Acceptance with an extra:*...
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Acceptance at ordinary rates (OR)
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are assessed as part of **financial underwriting**, while medical aspects of health fall under **medical underwriting** .**a)** **Female insurance**Women generally have greater longevity than men. However they may face some problems with respect to moral hazard. This is because many women in Indian society are victims ...
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Female insurance
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can provide.**Examples** When a proposal is submitted at a branch located far away from the place of residence of the proposed insuredA medical examination is done elsewhere even when a qualified medical examiner is available near one’s place of residence.A third case is when a proposal is made on the life of another w...
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Examples
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and suicides.**Substance abuse** : Substance abuse refers to the use of various kinds of substances like drugs or narcotics, sedatives and other similar stimulants. Some of these are even illegal and their use indicates criminal disposition and moral hazard.**Test Yourself 2**Which of the following is an example of mor...
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Substance abuse
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balance among various salts in the urinary system. It can indicate any malfunctioning of the system.**d)** **Backdating:**Backdating means changing the start date of the policy to an earlier one. For example, you bought a Life insurance policy on 1st June, 2013 but later you think that the policy would have generated b...
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Backdating:
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2. Standard life 3. Non-medical underwriting 4. Rating factor1955. Medical underwriting 6. Anti-selection**Answers to Test Yourself****Answer 1** - The correct option is III.**Answer 2** - The correct option is II.**Answer 3** - The correct option is II.196## CHAPTER L-09## LIFE INSURANCE CLAIMS**Chapter Introduction**...
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Answers to Test Yourself
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contract itself. For instance, the date of maturity and the dates when the instalments of survival benefits may be paid under a money back policy are clearly laid out at the time of preparing the contract.**iii.** **Surrender value payments** are different from other claim payments.Here, unlike other claims, the event ...
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Surrender value payments
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**iii.** **Unit Linked Insurance Plan (ULIP):** In case of ULIPs, the insurer pays thefund value as the maturity claim.**iv.** **Money-back Plan:** In case of money-back policy, the insurer pays thematurity claim minus the survival benefits already paid during the term of the policy.The insurance contact terminates aft...
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Unit Linked Insurance Plan (ULIP):
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repudiated giving all the relevant reasons, within 30 days from the date of receipt of all relevant papers and required clarifications. However, if the insurer needs the claim to be investigated, it shall initiate and complete the investigation at the earliest, in any case not later than 90 days from the date of receip...
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Role of an agent
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b) Explain the concept of healthcare and the types and levels of healthcare. c) Appreciate the factors affecting healthcare in India and the progress madesince independence. d) Discuss the evolution of health insurance in India. e) Know the health insurance market in India.206**A.** **Understanding Healthcare**The word...
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A.
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or a district or a state will be based upon the various healthcare factors called indicators of that area such as: Size of population  Death rate  Sickness rate  Disability rate  Social and mental health of the people  General nutritional status of the people  Environmental factors such as if it is a mining area...
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C.
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which runs its own hospitals and dispensaries and also contracts public/ private providers wherever its own facilities are inadequate.**2.** **Central Government Health Scheme**The ESIS was soon followed by the Central Government Health Scheme (CGHS), which was introduced in 1954 for the central government employees in...
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Central Government Health Scheme
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allowed to transact all types of Health Insurances, while Life Insurance Companies are also permitted to transact certain types of Health Insurances.**2.** **Intermediaries:**A number of people and organizations providing services as part of the insurance industry also form part of the health insurance market. Insuranc...
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Intermediaries:
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policy:1. The proposal form incorporates a prospectus which gives details of the cover,such as coverage, exclusions, provisions etc. The prospectus forms part of the proposal form and the proposer has to sign it as having noted its contents. 2. The proposal form collects information relating to the name, address,occupa...
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Medical Questionnaire
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insured/ proposer or from any past or present employer concerning anything which affects the physical or mental health of the life to be assured/ proposer and seeking information from any insurance company to which an application for insurance on the life to be assured/ proposer has been made for the purpose of underwr...
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Nature of questions in a proposal form
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 Previous history of insurance and claim experienceIn the case of a health insurance proposal, the insurer may also refer the prospective customer e.g. above 45 years of age to a doctor and/ or for medical check-up. Based on the information available in the proposal and, where medical check-up has been advised, based ...
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C.
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of the insurer in the circumstances p) Any special conditions q) Provision for cancellation of the policy on grounds of misrepresentation,fraud, non-disclosure of material facts or non-cooperation of the insured r) The details of the Add-on covers, if any s) Details of Grievance Redressal mechanism and address of Ombud...
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E.
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d) Extension of insurance to cover additional perils/ extension of policy period e) Change in risk, e.g. change of destinations in the case of an overseas travelpolicy f) Cancellation of insurance g) Change in name or address etc.220**Test Yourself 2**If certain terms and conditions of the policy need to be modified at...
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Test Yourself 2
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of the population.The benefit structures, pricing, underwriting and marketing for each segment are quite distinct.**Regulations for Health Insurance** : Some important changes have been brought in Health Regulations, 2016 regarding Health Products, some of which have been given below:1. Life Insurance Companies can off...
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Regulations for Health Insurance
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8. standard File and Use format for getting IRDAI for new policies 9. Standardisation of exclusions10. Exclusions not allowed**C.** **Hospitalization indemnity** **product**Hospitalization indemnity products protect individuals from the expenditure they may need to incur in the event of hospitalisation. In most of the ...
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C.
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patient goes in for a planned surgery, there would be expenses incurred by him prior to the hospitalization. Such expenses are known as Pre hospitalisation expenses**Definition**It means medical expenses incurred during a predefined number of days preceding the hospitalization of the Insured Person, provided that these...
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Definition
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can claim up to the maximum amount of his sum insured during the currency of the policy. Premium will be charged for each individual insured according to his age and sum insured chosen and any other rating factor.**ii.** **Family floater:** In the variant known as a family floater policy, the familyconsisting of spouse...
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Family floater:
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percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured. Co-payment is the concept of the insured bearing a portion of each and every claim under a health policy. These could be compulsory or voluntary depending on the product. Co-payment brings in a certain discipline among the insured...
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Deductible/ Excess
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of the insurers. Some of them are: **Maternity cover:** Maternity was not offered earlier under retail policies but isnow offered by most insurers, with varying waiting periods.  **Critical illness cover:** Available as an option under the high end versionproducts for certain ailments which are life threatening and e...
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Maternity cover:
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to compare them, causing confusion.]The following two types of plans are available under Arogya Sanjeevani Insurance Policy:- **Individual Plan** : A single policyholder will be the beneficiary of ArogyaSanjeevani policy.**Family Floater Plan** : Multiple family members of the policyholder canbecome the beneficiaries o...
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Individual Plan
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