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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... | Final IC 38 -IMF_Composite -English.md | k37 | Scenario 2: | Final IC 38 -IMF_Composite -English_019 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | e38 | Agreed Value Policy | Final IC 38 -IMF_Composite -English_020 | {
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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... | Final IC 38 -IMF_Composite -English.md | t40 | F. | Final IC 38 -IMF_Composite -English_021 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | null | Legal aspects of an insurance contract | Final IC 38 -IMF_Composite -English_022 | {
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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... | Final IC 38 -IMF_Composite -English.md | e47 | Solicitation | Final IC 38 -IMF_Composite -English_023 | {
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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
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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... | Final IC 38 -IMF_Composite -English.md | e2 | Important | Final IC 38 -IMF_Composite -English_025 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | o54 | Definition | Final IC 38 -IMF_Composite -English_026 | {
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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... | Final IC 38 -IMF_Composite -English.md | f56 | C. | Final IC 38 -IMF_Composite -English_027 | {
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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... | Final IC 38 -IMF_Composite -English.md | f56 | Test Yourself 1 | Final IC 38 -IMF_Composite -English_028 | {
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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... | Final IC 38 -IMF_Composite -English.md | n58 | Test Yourself 2 | Final IC 38 -IMF_Composite -English_029 | {
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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... | Final IC 38 -IMF_Composite -English.md | C-06 | Key Terms | Final IC 38 -IMF_Composite -English_030 | {
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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... | Final IC 38 -IMF_Composite -English.md | o62 | On account payment | Final IC 38 -IMF_Composite -English_031 | {
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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... | Final IC 38 -IMF_Composite -English.md | s64 | Example | Final IC 38 -IMF_Composite -English_032 | {
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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... | Final IC 38 -IMF_Composite -English.md | t66 | D. | Final IC 38 -IMF_Composite -English_033 | {
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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... | Final IC 38 -IMF_Composite -English.md | s5 | Test Yourself 1 | Final IC 38 -IMF_Composite -English_034 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Declaration in the Proposal Form | Final IC 38 -IMF_Composite -English_035 | {
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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
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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,
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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
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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
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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.
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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... | Final IC 38 -IMF_Composite -English.md | null | The Proposal stage | Final IC 38 -IMF_Composite -English_041 | {
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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... | Final IC 38 -IMF_Composite -English.md | e85 | Service after issuance of Policy Document and Receipt for Premium | Final IC 38 -IMF_Composite -English_042 | {
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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... | Final IC 38 -IMF_Composite -English.md | e86 | Process of communication | Final IC 38 -IMF_Composite -English_043 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Confidence | Final IC 38 -IMF_Composite -English_044 | {
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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. ... | Final IC 38 -IMF_Composite -English.md | g91 | Paraphrasing the speaker’s exact words | Final IC 38 -IMF_Composite -English_045 | {
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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
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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
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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.
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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... | Final IC 38 -IMF_Composite -English.md | null | Nature of complaints | Final IC 38 -IMF_Composite -English_049 | {
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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... | Final IC 38 -IMF_Composite -English.md | n4 | Recommendations by the Ombudsman | Final IC 38 -IMF_Composite -English_050 | {
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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... | Final IC 38 -IMF_Composite -English.md | n4 | Answers to Test Yourself | Final IC 38 -IMF_Composite -English_051 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | null | REGISTRATION OF INSURANCE MARKETING FIRM | Final IC 38 -IMF_Composite -English_052 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Consideration of application and eligibility criteria for Insurance Marketing | Final IC 38 -IMF_Composite -English_053 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Principal Officer of the Insurance Marketing Firm: | Final IC 38 -IMF_Composite -English_054 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | null | Final IC 38 -IMF_Composite -English_055 | {
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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... | Final IC 38 -IMF_Composite -English.md | e109 | null | Final IC 38 -IMF_Composite -English_056 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | null | Final IC 38 -IMF_Composite -English_057 | {
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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... | Final IC 38 -IMF_Composite -English.md | e112 | Companies | Final IC 38 -IMF_Composite -English_058 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | null | Final IC 38 -IMF_Composite -English_059 | {
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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
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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... | Final IC 38 -IMF_Composite -English.md | null | Human Life Value (HLV) | Final IC 38 -IMF_Composite -English_061 | {
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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... | Final IC 38 -IMF_Composite -English.md | y121 | Nature of life insurance risk | Final IC 38 -IMF_Composite -English_062 | {
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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 *... | Final IC 38 -IMF_Composite -English.md | y121 | Advantages | Final IC 38 -IMF_Composite -English_063 | {
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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... | Final IC 38 -IMF_Composite -English.md | r126 | Diagram 2: | Final IC 38 -IMF_Composite -English_064 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Example | Final IC 38 -IMF_Composite -English_065 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | s129 | Risk profile and investments | Final IC 38 -IMF_Composite -English_066 | {
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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... | Final IC 38 -IMF_Composite -English.md | s132 | Inflation | Final IC 38 -IMF_Composite -English_067 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Life insurance | Final IC 38 -IMF_Composite -English_068 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | m135 | Accumulation: | Final IC 38 -IMF_Composite -English_069 | {
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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... | Final IC 38 -IMF_Composite -English.md | L-03 | Answer 3 | Final IC 38 -IMF_Composite -English_070 | {
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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... | Final IC 38 -IMF_Composite -English.md | p140 | Riders in Life Insurance Products | Final IC 38 -IMF_Composite -English_071 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Diagram 2: | Final IC 38 -IMF_Composite -English_072 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | A whole life policy is a good plan for the main earner of the family who wishes | Final IC 38 -IMF_Composite -English_073 | {
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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... | Final IC 38 -IMF_Composite -English.md | n145 | Non-participating products | Final IC 38 -IMF_Composite -English_074 | {
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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*... | Final IC 38 -IMF_Composite -English.md | o4353 | Saral Pension: | Final IC 38 -IMF_Composite -English_075 | {
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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... | Final IC 38 -IMF_Composite -English.md | s147 | Answers to Test Yourself | Final IC 38 -IMF_Composite -English_076 | {
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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... | Final IC 38 -IMF_Composite -English.md | e2019 | Unit linked insurance | Final IC 38 -IMF_Composite -English_077 | {
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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... | Final IC 38 -IMF_Composite -English.md | e2 | Transparent structure | Final IC 38 -IMF_Composite -English_078 | {
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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... | Final IC 38 -IMF_Composite -English.md | y156 | Learning Outcomes | Final IC 38 -IMF_Composite -English_079 | {
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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... | Final IC 38 -IMF_Composite -English.md | L-06 | Insurable losses | Final IC 38 -IMF_Composite -English_080 | {
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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
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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” ... | Final IC 38 -IMF_Composite -English.md | s165 | Mortality and Interest | Final IC 38 -IMF_Composite -English_082 | {
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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
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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... | Final IC 38 -IMF_Composite -English.md | m2 | Terminal Bonus | Final IC 38 -IMF_Composite -English_084 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Proposal Form: | Final IC 38 -IMF_Composite -English_085 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Example | Final IC 38 -IMF_Composite -English_086 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Standard Provisions | Final IC 38 -IMF_Composite -English_087 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | null | Payment of overdue premiums with interest: | Final IC 38 -IMF_Composite -English_088 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Example | Final IC 38 -IMF_Composite -English_089 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Diagram 2: | Final IC 38 -IMF_Composite -English_090 | {
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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
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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,
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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... | Final IC 38 -IMF_Composite -English.md | null | Preferred risks | Final IC 38 -IMF_Composite -English_093 | {
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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:*... | Final IC 38 -IMF_Composite -English.md | s188 | Acceptance at ordinary rates (OR) | Final IC 38 -IMF_Composite -English_094 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | e189 | Female insurance | Final IC 38 -IMF_Composite -English_095 | {
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"Accidental hazards",
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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... | Final IC 38 -IMF_Composite -English.md | d190 | Examples | Final IC 38 -IMF_Composite -English_096 | {
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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... | Final IC 38 -IMF_Composite -English.md | c193 | Substance abuse | Final IC 38 -IMF_Composite -English_097 | {
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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... | Final IC 38 -IMF_Composite -English.md | r1955 | Backdating: | Final IC 38 -IMF_Composite -English_098 | {
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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**... | Final IC 38 -IMF_Composite -English.md | r1955 | Answers to Test Yourself | Final IC 38 -IMF_Composite -English_099 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | null | Surrender value payments | Final IC 38 -IMF_Composite -English_100 | {
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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... | Final IC 38 -IMF_Composite -English.md | k202 | Unit Linked Insurance Plan (ULIP): | Final IC 38 -IMF_Composite -English_101 | {
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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... | Final IC 38 -IMF_Composite -English.md | k202 | Role of an agent | Final IC 38 -IMF_Composite -English_102 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | A. | Final IC 38 -IMF_Composite -English_103 | {
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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... | Final IC 38 -IMF_Composite -English.md | y209 | C. | Final IC 38 -IMF_Composite -English_104 | {
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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... | Final IC 38 -IMF_Composite -English.md | e211 | Central Government Health Scheme | Final IC 38 -IMF_Composite -English_105 | {
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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... | Final IC 38 -IMF_Composite -English.md | e211 | Intermediaries: | Final IC 38 -IMF_Composite -English_106 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Medical Questionnaire | Final IC 38 -IMF_Composite -English_107 | {
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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... | Final IC 38 -IMF_Composite -English.md | d217 | Nature of questions in a proposal form | Final IC 38 -IMF_Composite -English_108 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | D-19 | C. | Final IC 38 -IMF_Composite -English_109 | {
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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... | Final IC 38 -IMF_Composite -English.md | H-03 | E. | Final IC 38 -IMF_Composite -English_110 | {
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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... | Final IC 38 -IMF_Composite -English.md | H-03 | Test Yourself 2 | Final IC 38 -IMF_Composite -English_111 | {
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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... | Final IC 38 -IMF_Composite -English.md | s10 | Regulations for Health Insurance | Final IC 38 -IMF_Composite -English_112 | {
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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 ... | Final IC 38 -IMF_Composite -English.md | s10 | C. | Final IC 38 -IMF_Composite -English_113 | {
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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... | Final IC 38 -IMF_Composite -English.md | e228 | Definition | Final IC 38 -IMF_Composite -English_114 | {
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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... | Final IC 38 -IMF_Composite -English.md | e228 | Family floater: | Final IC 38 -IMF_Composite -English_115 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Deductible/ Excess | Final IC 38 -IMF_Composite -English_116 | {
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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... | Final IC 38 -IMF_Composite -English.md | d19 | Maternity cover: | Final IC 38 -IMF_Composite -English_117 | {
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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... | Final IC 38 -IMF_Composite -English.md | null | Individual Plan | Final IC 38 -IMF_Composite -English_118 | {
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