chunk stringlengths 2.15k 5.19k | source_file stringclasses 11
values | chapter stringlengths 2 6 ⌀ | section stringlengths 2 88 ⌀ | chunk_id stringlengths 22 54 | metadata dict |
|---|---|---|---|---|---|
has been submitted but before communication of the risk acceptance by thecompany.4. I/ We declare and consent to the company seeking medical information from anydoctor or from a hospital who at any time has attended on the life to be insured/
proposer or from any past or present employer concerning anything which affec... | IC 38 -IA- Eng-Health.md | null | Nature of questions in a proposal form | IC 38 -IA- Eng-Health_006 | {
"file_size": 4590,
"chunk_index": 6,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Example 3",
"Prospectus",
"Previous and Present insurance",
"Acceptance of the proposal (underwriting)",
"Nature of questions in a proposal form"
]
} |
Details of the subject matter
Type of cover required
Details of the physical features both positive and negative
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 me... | IC 38 -IA- Eng-Health.md | D-19 | C. | IC 38 -IA- Eng-Health_007 | {
"file_size": 4590,
"chunk_index": 7,
"chunk_tokens": 1008,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Conditions and Warranties",
"Prospectus",
"EXAMPLES:",
"Policy Document",
"Conditions:"
]
} |
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 Ombudsman
t)... | IC 38 -IA- Eng-Health.md | t14 | E. | IC 38 -IA- Eng-Health_008 | {
"file_size": 4590,
"chunk_index": 8,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Conditions and Warranties",
"Warranties:",
"Answers to Test Yourself",
"Answer 2",
"EXAMPLES:"
]
} |
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.**Test Yourself 2**If certain terms and conditions of the policy need to be modified at the time of issuance,
it is done by setting out the amendments through __________.I... | IC 38 -IA- Eng-Health.md | H-03 | Test Yourself 2 | IC 38 -IA- Eng-Health_009 | {
"file_size": 4590,
"chunk_index": 9,
"chunk_tokens": 1006,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Preserving the savings of an individual",
"Answer 2",
"Introduction to health insurance products",
"Mass policies"
]
} |
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 offer long... | IC 38 -IA- Eng-Health.md | s10 | Regulations for Health Insurance | IC 38 -IA- Eng-Health_010 | {
"file_size": 4590,
"chunk_index": 10,
"chunk_tokens": 1001,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Hospitalization indemnity",
"Regulations for Health Insurance",
"Example"
]
} |
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 ... | IC 38 -IA- Eng-Health.md | s10 | C. | IC 38 -IA- Eng-Health_011 | {
"file_size": 4590,
"chunk_index": 11,
"chunk_tokens": 1004,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Day Care Procedures",
"Hospitalization indemnity",
"Example",
"Inpatient hospitalization expenses",
"Post hospitalization expenses"
]
} |
regular medical tests, dental and pharmacy costs.20**4.** **Pre and post hospitalization expenses****i.** **Pre hospitalization expenses**Hospitalization could be either emergency hospitalization or planned. If a
patient goes in for a planned surgery, there would be expenses incurred by him
prior to the hospitalization... | IC 38 -IA- Eng-Health.md | null | Pre and post hospitalization expenses | IC 38 -IA- Eng-Health_012 | {
"file_size": 4590,
"chunk_index": 12,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"COVERAGE OPTIONS AVAILABLE",
"Example",
"Individual coverage:",
"Domiciliary Hospitalization",
"Post hospitalization expenses"
]
} |
dependent insured’s under a single policy with a separate sum insured chosen
for each insured person. In such covers, each person insured under the policy
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... | IC 38 -IA- Eng-Health.md | f22 | Family floater: | IC 38 -IA- Eng-Health_013 | {
"file_size": 4590,
"chunk_index": 13,
"chunk_tokens": 1000,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"What is a pre-existing disease?",
"Co-payment (popularly called Co-pay)",
"Example",
"Sub limits and Disease specific capping",
"Deductible/ Excess"
]
} |
insurance policy that provides that the policyholder/ insured will bear a specified
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 d... | IC 38 -IA- Eng-Health.md | null | Deductible/ Excess | IC 38 -IA- Eng-Health_014 | {
"file_size": 4590,
"chunk_index": 14,
"chunk_tokens": 973,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Maternity cover:",
"Coverage for Day care procedure",
"Deductible/ Excess",
"Cost of pre policy check up",
"Add on covers"
]
} |
of the insurers. Some of them are:24 **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 version productsfor certain ailments which are life threatening and... | IC 38 -IA- Eng-Health.md | d25 | Maternity cover: | IC 38 -IA- Eng-Health_015 | {
"file_size": 4590,
"chunk_index": 15,
"chunk_tokens": 1008,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Top-up covers or high deductible insurance plans",
"Hospital cash:",
"Standard Health Product",
"Recovery benefit:",
"Reinstatement of sum insured:"
]
} |
in the market and customers were not able 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 ... | IC 38 -IA- Eng-Health.md | null | Individual Plan | IC 38 -IA- Eng-Health_016 | {
"file_size": 4590,
"chunk_index": 16,
"chunk_tokens": 1019,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Top-up covers or high deductible insurance plans",
"Senior Citizen Policy",
"Example",
"Family Floater Plan",
"Individual Plan"
]
} |
sub limit whichever is higher. In some policies they follow the typical indemnity
plans such as expenses falling within specified period of 30/ 60 days or 60/ 90 days.IRDAI has mandated that all health insurers and TPAs shall establish a separate
channel to address the health insurance related claims and grievances of ... | IC 38 -IA- Eng-Health.md | null | F. | IC 38 -IA- Eng-Health_017 | {
"file_size": 4590,
"chunk_index": 17,
"chunk_tokens": 1007,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Per day amount limit",
"CRITICAL ILLNESS POLICY",
"HOSPITAL DAILY CASH POLICY",
"Standalone cover or add-on cover",
"Supplementary cover"
]
} |
treatment as well as for living expenses post treatment. Onset of critical illness
threatens the financial security of a person. A basic health insurance policy may not
be sufficient to cover all medical costs in such cases.Critical illness policy has a provision to pay a lump sum amount on diagnosis of
certain named c... | IC 38 -IA- Eng-Health.md | d-19 | Disease Specific Products | IC 38 -IA- Eng-Health_018 | {
"file_size": 4590,
"chunk_index": 18,
"chunk_tokens": 1008,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Corona Kavach",
"Disease Specific Products"
]
} |
admissible.)a. Room, Boarding, Nursing Expenses as provided by the Hospital / NursingHome.
b. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees
c. Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances,ventilator charges, medicines and drugs, costs towards diagnostics,
diagno... | IC 38 -IA- Eng-Health.md | m14 | Standard Vector Borne Disease Health Policy: | IC 38 -IA- Eng-Health_019 | {
"file_size": 4590,
"chunk_index": 19,
"chunk_tokens": 999,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Hospitalization Benefit:",
"Diagnosis Cover:",
"Travel Insurance:",
"Health plus Life Combo Products",
"Combo-products"
]
} |
insurance but also accidental death/ disability benefits along with Medical expenses
due to illness/ accident and the coverages like Loss of or delay in arrival of checked
in baggage, Loss of passport and documents, Third party liability for property/
personal damages, Cancellation of trips and even Hijack cover tradit... | IC 38 -IA- Eng-Health.md | null | H. | IC 38 -IA- Eng-Health_020 | {
"file_size": 4590,
"chunk_index": 20,
"chunk_tokens": 937,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Scope of coverage:",
"Rashtriya Swasthya Bima Yojana",
"Pradhan Mantri Jan Arogya Yojana",
"Enrolment Modality/ Period",
"Premium"
]
} |
savings bank account on the prescribed forms will be required to be given by 31 [st]
May of every year,Joining subsequently on payment of full annual premium may be possible on
specified terms. Individuals who exit the scheme at any point may re-join the
scheme in future years through the above modality.Benefits under ... | IC 38 -IA- Eng-Health.md | r2 | Premium | IC 38 -IA- Eng-Health_021 | {
"file_size": 4590,
"chunk_index": 21,
"chunk_tokens": 994,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Personal Accident and Disability cover",
"Scope of cover",
"Exclusions:",
"Sum insured",
"Permanent partial disability (PPD):"
]
} |
at the time of claim. Thus, if a person has more than one policy with different
insurers, claims would be paid under all the policies.**4.** **Scope of cover**These policies are often extended to cover medical expenses, i.e. reimbursement
of hospitalization/ medical costs incurred following the accident.**5.** **Value ... | IC 38 -IA- Eng-Health.md | a35 | Scope of cover | IC 38 -IA- Eng-Health_022 | {
"file_size": 4590,
"chunk_index": 22,
"chunk_tokens": 1016,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Scope of cover",
"Exclusions:",
"Overseas Travel insurance",
"Need for the policy:",
"Group Health cover"
]
} |
can be paid in Indian rupees except in the case of the employment plan where
premium has to be paid in dollars. The plans are usually of two types: World-wide excluding USA/ Canada35 World-wide including USA/ CanadaSome products provide cover for a group of countries. Examples are travel to Asian
countries only, Euro... | IC 38 -IA- Eng-Health.md | a35 | Corporate Frequent Flyer plans | IC 38 -IA- Eng-Health_023 | {
"file_size": 4590,
"chunk_index": 23,
"chunk_tokens": 1017,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Non-employer employee groups",
"CORPORATE BUFFER OR FLOATER COVER",
"Disease covers",
"Child cover",
"Tailor-made cover"
]
} |
family member. In such situations, if the buffer cover is opted for it brings relief,
whereby the excess expenses over and above the family sum insured are met from
this buffer amount.Amounts are drawn from the buffer, once a family’s sum insured is exhausted.
However this utilization is usually restricted to major ill... | IC 38 -IA- Eng-Health.md | d-19 | O. | IC 38 -IA- Eng-Health_024 | {
"file_size": 4590,
"chunk_index": 24,
"chunk_tokens": 942,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Hospital",
"Network Provider",
"Disease covers",
"Test Yourself 1",
"Special Products"
]
} |
independent organizations for managing health insurance claims. These agencies
are known as the TPAs. In India, a TPA is engaged by an insurer for provision of
health services which includes among other things:i. Providing an identity card to the policyholder which is proof of his insurancepolicy and can be used for ad... | IC 38 -IA- Eng-Health.md | s38 | Hospital | IC 38 -IA- Eng-Health_025 | {
"file_size": 4590,
"chunk_index": 25,
"chunk_tokens": 994,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Medical practitioner",
"Reasonable and necessary expenses",
"Hospital",
"Notice of claim",
"Cumulative bonus"
]
} |
Moreover, if a claim is made in any particular year, the cumulative bonus accrued
can only be reduced at the same rate at which it is accrued.**Example**A person takes a policy for Rs. 3 lacs at a premium of Rs. 5,000. In the second year,
in case of no claims in the first year, he gets a sum insured of Rs. 3.15 lacs (5... | IC 38 -IA- Eng-Health.md | H-04 | Example | IC 38 -IA- Eng-Health_026 | {
"file_size": 4590,
"chunk_index": 26,
"chunk_tokens": 1007,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Room rent restrictions",
"Example",
"Chapter Introduction"
]
} |
insurance. Underwriting is a very important aspect of any type of insurance and
plays a vital role in issuance of an insurance policy. In this chapter, you will get an
understanding about basic principles, tools, methods and process of underwriting.
It will also provide you the knowledge about group health insurance un... | IC 38 -IA- Eng-Health.md | n42 | Learning Outcomes | IC 38 -IA- Eng-Health_027 | {
"file_size": 4590,
"chunk_index": 27,
"chunk_tokens": 1015,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"What is underwriting?",
"Example",
"Factors which affect chance of illness",
"Learning Outcomes",
"Look at this Scenario"
]
} |
sickness usually comes much before death and could be frequent. Hence, it is quite
logical that the underwriting norms and guidelines are much tighter for health
coverage than death coverage.**3.** **Underwriting – Risk Assessment**In health insurance, there is a higher focus on medical or health findings than
financia... | IC 38 -IA- Eng-Health.md | null | Underwriting – Risk Assessment | IC 38 -IA- Eng-Health_028 | {
"file_size": 4590,
"chunk_index": 28,
"chunk_tokens": 1004,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Purposes of Underwriting",
"Understanding Moral Hazard in Health Insurance",
"Gender:",
"Test Yourself 1",
"Example"
]
} |
insurance just to collect a claim.**Test Yourself 1**Underwriting is the process of ___________.
I. Marketing insurance products
II. Collecting premiums from customers
III. Risk assessment and risk pricing
IV. Selling various insurance products**B.** **Underwriting – Basic concepts****1.** **Purposes of Underwriting**
... | IC 38 -IA- Eng-Health.md | o46 | Test Yourself 1 | IC 38 -IA- Eng-Health_029 | {
"file_size": 4590,
"chunk_index": 29,
"chunk_tokens": 1011,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Equity among risks",
"Purposes of Underwriting",
"Substandard risks",
"Moral Hazard report",
"Test Yourself 1"
]
} |
by an agent or company representative to decide whether an applicant is suitable
for granting insurance coverage. The agent plays this critical role of **primary**
**underwriting** . He is in the best position to know whether prospective client is
insurable.Some insurance companies require the agents to provide a state... | IC 38 -IA- Eng-Health.md | e48 | Moral Hazard report | IC 38 -IA- Eng-Health_030 | {
"file_size": 4590,
"chunk_index": 30,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Moral Hazard report",
"Other Health Insurance regulations of IRDAI",
"Role of the Underwriting department",
"Fraud monitoring role of Agent",
"Migration of Health I... |
decided by the new insurance company. Procedurally, the request for porting should
be made by the insured to the old insurer at least 45 days before the renewal,
specifying the company to which the policy has to be ported. The policy has to be
renewed without a break (there is a 30 day grace period if porting is under ... | IC 38 -IA- Eng-Health.md | e48 | E. | IC 38 -IA- Eng-Health_031 | {
"file_size": 4590,
"chunk_index": 31,
"chunk_tokens": 985,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Basic principles relevant to underwriting",
"Financial documents",
"Reports of sales personnel",
"Example",
"Migration of Health Insurance"
]
} |
Knowing the financial status of the proposer is particularly relevant for benefit
products and to reduce the moral hazard. However, normally the financial
documents are only asked for in cases of:a) Personal accident covers or
b) High sum assured coverage or
c) When the stated income and occupation as compared to the c... | IC 38 -IA- Eng-Health.md | d50 | Medical reports | IC 38 -IA- Eng-Health_032 | {
"file_size": 4590,
"chunk_index": 32,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Reports of sales personnel",
"Non-medical underwriting",
"Example",
"Test Yourself 3",
"Numerical rating method"
]
} |
The process is speedy but the premiums may be relatively higher.**3.** **Numerical rating method**This is a process adopted in underwriting, wherein numerical or percentage
assessments are made on each component of the risk.
Factors like age, sex, race, occupation, residence, environment, build, habits,
family and pers... | IC 38 -IA- Eng-Health.md | null | Numerical rating method | IC 38 -IA- Eng-Health_033 | {
"file_size": 4590,
"chunk_index": 33,
"chunk_tokens": 1004,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Underwriting other than employer- employee groups",
"Use of general or standard exclusions",
"Test Yourself 4",
"Health Insurance at Group Level",
"Example"
]
} |
i) Preference of the group holder for administration of the group insurance bya third party administrator (of his choice or one selected by the insurer) or
by the insurer itself
j) Past claims experience of the proposed group**Example**A group of members working in mines or factories is at higher health risk than a
gro... | IC 38 -IA- Eng-Health.md | null | Example | IC 38 -IA- Eng-Health_034 | {
"file_size": 4590,
"chunk_index": 34,
"chunk_tokens": 998,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Rating",
"Underwriting other than employer- employee groups",
"Risk group II",
"Group discount criteria",
"Example"
]
} |
The minimum and maximum age for being covered and renewed varies from
company to company.**Family Package Cover**The Personal accident policy also has a family package cover wherein Children and
Non-earning spouse are covered for to death and permanent disablement (total or
partial) only.**Premium Discount in Group Pol... | IC 38 -IA- Eng-Health.md | H-05 | Family Package Cover | IC 38 -IA- Eng-Health_035 | {
"file_size": 4590,
"chunk_index": 35,
"chunk_tokens": 1009,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"Stakeholders in claim process",
"Exclusion of death cover",
"Group discount criteria",
"Answer 5",
"Premium"
]
} |
to that promise. The occurrence of an insured event leading to a claim under the
policy is the true test of that promise. How well an insurer performs is evaluated by
how well it keeps its claims promises. One of the key rating factors in insurance is
the claims paying ability of the insurance company.**1.** **Stakehol... | IC 38 -IA- Eng-Health.md | null | Stakeholders in claim process | IC 38 -IA- Eng-Health_036 | {
"file_size": 4590,
"chunk_index": 36,
"chunk_tokens": 979,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"Stakeholders in claim process",
"Reserving:",
"Claim process broadly comprises following steps",
"Owners",
"Diagram 1:"
]
} |
business.
The general process and supporting documents for a claim under fixed benefit
product or critical illness or daily cash product etc. would be quite similar, except
for the fact that such products may not come with cashless facility.In both cases of indemnity as well as reimbursement type of claim, the basic st... | IC 38 -IA- Eng-Health.md | null | Diagram 2: | IC 38 -IA- Eng-Health_037 | {
"file_size": 4590,
"chunk_index": 37,
"chunk_tokens": 993,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Denial of claims",
"Arriving at the final claim payable:",
"Claim process broadly comprises following steps",
"Diagram 2:",
"Example"
]
} |
involved.Earlier every TPA/ insurer had its own list of non-payable items, now the same
has been standardized under IRDAI Health Insurance Standardization Guidelines.**c)** **Payment of claim**Once the payable claim amount is arrived at, payment is done to the customer
or the hospital as the case may be. The payment ma... | IC 38 -IA- Eng-Health.md | l2 | Payment of claim | IC 38 -IA- Eng-Health_038 | {
"file_size": 4590,
"chunk_index": 38,
"chunk_tokens": 970,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Step 2",
"Denial of claims",
"Step 3",
"Payment of claim",
"Step 1"
]
} |
|**Step 2**| The hospital compiles the necessary information such as:<br>i. Diagnosis of illness<br>ii. Treatment,<br>iii. Name of treating doctor,<br>iv. Number of days of proposed hospitalization and<br>v. The estimated cost<br> This is presented in a format, called the cashless authorization form.<br>|
|**Step 3**... | IC 38 -IA- Eng-Health.md | t64 | Step 2 | IC 38 -IA- Eng-Health_039 | {
"file_size": 4590,
"chunk_index": 39,
"chunk_tokens": 1010,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"Step 2",
"Death",
"Discharge summary",
"Step 6",
"Documentation in Health Insurance Claims"
]
} |
policy and could prejudice the approval of the subsequent request.**C.** **Documentation in Health Insurance Claims**This section explains the need for and content of each of the documents required
to be submitted by the customers:**1.** **Discharge summary**Discharge summary can be termed as the most important documen... | IC 38 -IA- Eng-Health.md | t64 | C. | IC 38 -IA- Eng-Health_040 | {
"file_size": 4590,
"chunk_index": 40,
"chunk_tokens": 1001,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Death",
"Discharge summary",
"Documentation in Health Insurance Claims",
"Investigation reports",
"Claim form"
]
} |
case of insurers not using TPAs, the services are performed by in-house team.**1.** **Post sale service of health insurance**a) Once the proposal (and the premium) is accepted, the coverage commences.
b) If a TPA is to be used for servicing the policy, the insurer passes on theinformation about the customer and the pol... | IC 38 -IA- Eng-Health.md | d66 | Post sale service of health insurance | IC 38 -IA- Eng-Health_041 | {
"file_size": 4590,
"chunk_index": 41,
"chunk_tokens": 988,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Customer relationship and contact management",
"Test Yourself 4",
"Example",
"Post sale service of health insurance",
"Claims Investigation"
]
} |
verification (passport/ PAN card/ Voter's ID/ Driving license) for address
verification (Telephone bill/ Bank account statement, Electricity bill/ Ration
card).
f) Legal heir certificate containing affidavit and indemnity bond both dulysigned by all legal heirs and notarized
g) Permanent disability certificate from a c... | IC 38 -IA- Eng-Health.md | e68 | Test Yourself 4 | IC 38 -IA- Eng-Health_042 | {
"file_size": 4590,
"chunk_index": 42,
"chunk_tokens": 994,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Assistance companies – Role in overseas claims",
"Claims services essentially include:",
"Test Yourself 4",
"Hospitalization Procedures",
"Claims Management- Overse... |
travel insurance policy.v. Hospitals usually contact the assistance companies/ insurers on the callcentre numbers to check the validity of the policy and verify coverages.vi. Once the policy is accepted by the hospital the insured would undergotreatment in the hospital on a cashless basis.vii. Some basic information re... | IC 38 -IA- Eng-Health.md | t2 | Reimbursement of medical expenses and other non-medical claims: | IC 38 -IA- Eng-Health_043 | {
"file_size": 4590,
"chunk_index": 43,
"chunk_tokens": 809,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Answer 3",
"Test Yourself 5",
"Answer 1"
]
} |
## IC - 38 **INSURANCE AGENTS** **LIFE****ACKNOWLEDGEMENT****This course is based on revised syllabus prescribed by Insurance Regulatory and**
**Development Authority of India (IRDAI) and prepared by Insurance Institute of**
**India, Mumbai.****AUTHORS/ REVIEWERS (in Alphabetical order)**Dr. R. K. Duggal
Dr. Shashidhar... | IC 38 -IA-Eng-Life.md | C-46 | INSURANCE AGENTS | IC 38 -IA-Eng-Life_000 | {
"file_size": 4771,
"chunk_index": 0,
"chunk_tokens": 1000,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"The Asset – Human Life Value (HLV)",
"IC - 38",
"INSURANCE AGENTS",
"Chapter Introduction",
"LIFE"
]
} |
|L-05|Applications of Life Insurance|38|
|L-06|Pricing and Valuation in Life Insurance|43|
|L-07|Life Insurance Documentation|52|
|L-08|Life Insurance Underwriting|65|
|L-09|Life Insurance Claims <br>|78|iv## SECTION## LIFE INSURANCE1## CHAPTER L-01## WHAT LIFE INSURANCE INVOLVES**Chapter Introduction**We have seen som... | IC 38 -IA-Eng-Life.md | L-05 | Chapter Introduction | IC 38 -IA-Eng-Life_001 | {
"file_size": 4771,
"chunk_index": 1,
"chunk_tokens": 1009,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"The Asset – Human Life Value (HLV)",
"Interest",
"Diagram 1:",
"Example",
"Chapter Introduction"
]
} |
income. Thus one should grow suspicious if Mr. Rajan was to ask insurance of Rs. 2
crores, while earning only Rs. 1.2 lakhs a year. The actual amount of insurance
purchased would depend on factors like how much insurance one can afford and
would like to buy.**B.** **Risk and Life Insurance**As we have seen above, life ... | IC 38 -IA-Eng-Life.md | null | B. | IC 38 -IA-Eng-Life_002 | {
"file_size": 4771,
"chunk_index": 2,
"chunk_tokens": 1005,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Nature of life insurance risk",
"Level premiums",
"Diagram 1:",
"Example",
"Assurance:"
]
} |
claims of those dying at higher ages. The level premium is an average of both. The
excess premiums of earlier ages compensate for the deficit of premiums in later
ages. The level premium feature is illustrated below.**Diagram 2:** **Level Premium**Level premiums are required because life insurance contracts are long te... | IC 38 -IA-Eng-Life.md | t2 | Diagram 2: | IC 38 -IA-Eng-Life_003 | {
"file_size": 4771,
"chunk_index": 3,
"chunk_tokens": 982,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Diagram 2:",
"Test Yourself 1",
"Example",
"Chapter Introduction"
]
} |
expected net future earnings.c) The level premium is a premium fixed such that it does not increase with agebut remains constant throughout the contract period.d) Mutuality is one of the important ways to reduce risk in financial markets, theother being diversification.e) The element of guarantee in a life insurance co... | IC 38 -IA-Eng-Life.md | t2 | Key Terms | IC 38 -IA-Eng-Life_004 | {
"file_size": 4771,
"chunk_index": 4,
"chunk_tokens": 1017,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Financial planning and the individual life cycle",
"Empty Nester(age 55 to 65):",
"Key Terms",
"What is financial planning?",
"The Economic Life Cycle"
]
} |
concerned about the high cost of education to make the child qualified
to face the challenges of life.For instance, consider the amount that
needs to be set up to finance a medical course that runs for five years.In
many Indian homes, making provision for marriage and settlement of
girl children is a critical area of c... | IC 38 -IA-Eng-Life.md | e11 | Empty Nester(age 55 to 65): | IC 38 -IA-Eng-Life_005 | {
"file_size": 4771,
"chunk_index": 5,
"chunk_tokens": 1012,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Wealth accumulation",
"Individual needs",
"Empty Nester(age 55 to 65):",
"Parting with liquidity",
"Example"
]
} |
There are two types of such needs:**i.** **Specific transaction needs** : that are linked to specific life events whichrequire a commitment of resources. For instance making a provision for
higher education/ marriage of dependents; or purchase of a house or
consumer durables**ii.** **General transaction needs:** Amount... | IC 38 -IA-Eng-Life.md | e11 | Specific transaction needs | IC 38 -IA-Eng-Life_006 | {
"file_size": 4771,
"chunk_index": 6,
"chunk_tokens": 1008,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Wealth accumulation",
"Financial products",
"Contingency",
"Risk profile and investments",
"Risk Profile"
]
} |
needs along with his or her risk profile and income, to chart out a road map for
meeting various anticipated/ unforeseen needs through recommending appropriate
financial products.Elements of financial planning include: Investing - allocating assets based on one’s risk taking appetite, Risk management, Retirement pla... | IC 38 -IA-Eng-Life.md | c14 | Diagram 4: | IC 38 -IA-Eng-Life_007 | {
"file_size": 4771,
"chunk_index": 7,
"chunk_tokens": 1016,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Financial Planning Advisory Services",
"Multiple investment choices",
"Role of Financial planning",
"Elements of Financial Planning",
"Changing lifestyles"
]
} |
An unplanned, impulsive approach to financial planning is one of the prime causes
of financial distress of individuals.**Test Yourself 2**When is the best time to start financial planning?I. Post retirement
II. As soon as one gets his first salary
III. After marriage
IV. Only after one gets rich**C.** **Financial plann... | IC 38 -IA-Eng-Life.md | null | Test Yourself 2 | IC 38 -IA-Eng-Life_008 | {
"file_size": 4771,
"chunk_index": 8,
"chunk_tokens": 958,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Financial Planning Advisory Services",
"Health insurance",
"Investment planning",
"Returns",
"Time horizon"
]
} |
For instance, if an amount of Rs 1000 is invested today at 8% rate of interest,
at the end of five years, it would accumulate to Rs 1469 and at the end of
10 years it would more than double to reach Rs 2159. This expectation of
returns which helps to accumulate wealth is one of the prime motives of
investment. At the s... | IC 38 -IA-Eng-Life.md | null | Risk tolerance | IC 38 -IA-Eng-Life_009 | {
"file_size": 4771,
"chunk_index": 9,
"chunk_tokens": 920,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Time horizon",
"Estate planning",
"Tax planning",
"Risk tolerance",
"Retirement planning"
]
} |
or utilised according to one’s wishes after one is no more.**6.** **Tax planning**Tax planning is done to determine how to gain maximum tax benefit from existing
tax laws and also for planning of income, expenses and investments taking full
advantage of the tax breaks. As per the tax laws in India, life insurance premi... | IC 38 -IA-Eng-Life.md | s19 | Tax planning | IC 38 -IA-Eng-Life_010 | {
"file_size": 4771,
"chunk_index": 10,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Tangible",
"Answer 3",
"Intangible:"
]
} |
agent’s role is to understand and pitch on these features and benefits to make the
products of their companies unique and attractive compared to others.**Example**Colgate, Close up and Promise are all different brands of toothpastes. But the
features of each brand is different from the other.Products may be:**i.** **Ta... | IC 38 -IA-Eng-Life.md | p24 | Example | IC 38 -IA-Eng-Life_011 | {
"file_size": 4771,
"chunk_index": 11,
"chunk_tokens": 1002,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Riders in Life Insurance Products",
"Tangible",
"Test Yourself 1",
"Diagram 1:",
"Suitability Information"
]
} |
of the contract. Riders are commonly used to provide supplementary benefits like
increasing the amount of death benefit provided by a policy, say, because of
accidents. Life insurance companies offer a number of riders through which the
value of their offerings get enhanced Riders help to customise different
requiremen... | IC 38 -IA-Eng-Life.md | p24 | Test Yourself 1 | IC 38 -IA-Eng-Life_012 | {
"file_size": 4771,
"chunk_index": 12,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Convertibility",
"Test Yourself 1",
"Diagram 3:",
"Term insurance with return of premiums",
"Increasing term assurance"
]
} |
one to buy relatively large amounts of life insurance on a limited budget.**f)** **Variants**A number of variants of term assurance are possible.**Diagram 3:** **Variants of Term Assurance****i.** **Decreasing Term Assurance**
These plans typically consist of decreasing term insurance which provides an
amount of death ... | IC 38 -IA-Eng-Life.md | e26 | Variants | IC 38 -IA-Eng-Life_013 | {
"file_size": 4771,
"chunk_index": 13,
"chunk_tokens": 1007,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Whole life insurance",
"Variants",
"Variants:",
"Limitations of term plans:",
"Example"
]
} |
compulsory method of savings accumulation.People buy endowment plans as a sure method of providing against old age or for
meeting specific purposes like having a fund for (a) educational purposes, (b)
meeting children’s marriage expenses or(c) paying a mortgage (housing) loan.**Government usually offers tax benefits on... | IC 38 -IA-Eng-Life.md | a28 | Government usually offers tax benefits on the premiums paid, which make it | IC 38 -IA-Eng-Life_014 | {
"file_size": 4771,
"chunk_index": 14,
"chunk_tokens": 1000,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Non-participating products",
"Variants:",
"Example",
"Important",
"Money Back Policy"
]
} |
be disclosed at the time of taking the policy.**Important**Death benefits are subject to regulations of IRDAI issued from time to time. At
present, as per the new Regulation 9 of IRDAI (Non-linked) Products Regulation,
2019 pertaining to traditional products, the minimum death cover is as follows:For all non-linked ind... | IC 38 -IA-Eng-Life.md | null | Important | IC 38 -IA-Eng-Life_015 | {
"file_size": 4771,
"chunk_index": 15,
"chunk_tokens": 1002,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Pension Plans and Annuities",
"Saral Pension:",
"Important"
]
} |
annuity options.**Saral Pension:** To provide uniformity across Insurers, to reduce confusion in the
market about annuity schemes, and to make available a product that will broadly
meet the needs of an average customer, in January 2021, IRDAI mandated all Life
Insurers to introduce a standard, immediate annuity product... | IC 38 -IA-Eng-Life.md | o4353 | Saral Pension: | IC 38 -IA-Eng-Life_016 | {
"file_size": 4771,
"chunk_index": 16,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Yield:",
"Chapter Introduction",
"Surrender value:"
]
} |
products which have insurance as well as a savings element in them.People have been questioning the ability of traditional life insurance policies to
provide a rate of return comparable to other assets in the financial market. Issues
have also been raised about the way they are structured into a single package of
benef... | IC 38 -IA-Eng-Life.md | e2019 | Limitations of traditional products | IC 38 -IA-Eng-Life_017 | {
"file_size": 4771,
"chunk_index": 17,
"chunk_tokens": 1002,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Features of Non-Traditional Policies:",
"Yield:",
"Test Yourself 1",
"Universal Life and Variable Life",
"Diagram 1:"
]
} |
displacing traditional plans in many markets.Unit linked policies help to overcome the limitations of traditional products.
The premium paid by the policyholder gets divided into two major portionsthe first portion which is utilised for providing insurance cover, andthe second portion that gets invested into the fund o... | IC 38 -IA-Eng-Life.md | null | Diagram 1: | IC 38 -IA-Eng-Life_018 | {
"file_size": 4771,
"chunk_index": 18,
"chunk_tokens": 1009,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"Transparent structure",
"Diagram 1:",
"Unitising",
"Death Benefit",
"The Value of Units"
]
} |
the benefits, vis-à-vis the premiums paid, would be very low and even less than the
premiums paid in the early years of the contract.**iv.** **Death Benefit**Unlike in traditional policies, the amount of death benefit in ULIP policies is a
multiple of the premiums paid. In case of death during the term of the policy, t... | IC 38 -IA-Eng-Life.md | e2 | Death Benefit | IC 38 -IA-Eng-Life_019 | {
"file_size": 4771,
"chunk_index": 19,
"chunk_tokens": 1010,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Summary",
"Answers to Test Yourself",
"Answer 2",
"Diagram 1:",
"Death Benefit"
]
} |
becomes payable to the Official Trustee of the State in which the office at
which the insurance was effected is situated.39**Benefits**The Trust is set up under a deed that cannot be revoked or amended. It can contain
one or more insurance policies. It is important to appoint a trustee who would be
responsible for admi... | IC 38 -IA-Eng-Life.md | t40 | Benefits | IC 38 -IA-Eng-Life_020 | {
"file_size": 4771,
"chunk_index": 20,
"chunk_tokens": 1015,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Mortgage Redemption Insurance (MRI)",
"Test Yourself 1",
"What is MRI?",
"Chapter Introduction"
]
} |
IV. Evade eviction in case of default**Summary**Section 6 of the Married Women’s Property Act, 1874 provides for security of
benefits under a life insurance policy to the wife and children.The policy effected under MWP Act shall be beyond the control of court
attachments, creditors and even the life assured.Keyman insu... | IC 38 -IA-Eng-Life.md | L-06 | Summary | IC 38 -IA-Eng-Life_021 | {
"file_size": 4771,
"chunk_index": 21,
"chunk_tokens": 999,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Extra charges",
"Rebates",
"Diagram 1:",
"Insurance pricing – Basic elements"
]
} |
would hence encourage payment via yearly and half yearly modes by allowing a
rebate on these. They may also charge a little extra for monthly mode of
payments, to cover additional administrative expenses involved.**3.** **Extra charges**The tabular premium is charged for those individuals who are not subject to any
sig... | IC 38 -IA-Eng-Life.md | g45 | Extra charges | IC 38 -IA-Eng-Life_022 | {
"file_size": 4771,
"chunk_index": 22,
"chunk_tokens": 1005,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Extra charges",
"Net premium",
"Example",
"Lapses and contingencies",
"Expenses and reserves"
]
} |
derive Higher the mortality rate in the mortality table, higher the premiumswould be
Higher the interest rate assumed, lower the premium**Net premium**
The estimates of mortality and interest give the “Net Premium”**Gross premium**
Gross premium is the net premium plus an amount called loading. There are
three consi... | IC 38 -IA-Eng-Life.md | null | Net premium | IC 38 -IA-Eng-Life_023 | {
"file_size": 4771,
"chunk_index": 23,
"chunk_tokens": 977,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Surplus and bonus",
"Net premium",
"Test Yourself 1",
"Example",
"Lapses and contingencies"
]
} |
receive premiums in future for these policies.Liabilities are thus the present value of all payments that have to be made less the
present value of premiums expected to be received on these policies. The present
value is arrived at by applying a suitable rate of discount [the interest rate]
Surplus arises as a result o... | IC 38 -IA-Eng-Life.md | m2 | Example | IC 38 -IA-Eng-Life_024 | {
"file_size": 4771,
"chunk_index": 24,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Unit Linked Policies",
"Answers to Test Yourself",
"Compound Bonus",
"Simple Reversionary Bonus",
"Example"
]
} |
insured for purchasing an insurance policy.The process of setting the premium for life insurance policies involves
consideration of mortality, interests, expense management and reserves.Gross premium is the net premium plus an amount called loading.A lapse means that the policyholder discontinues payment of premiums. I... | IC 38 -IA-Eng-Life.md | m2 | Key Terms | IC 38 -IA-Eng-Life_025 | {
"file_size": 4771,
"chunk_index": 25,
"chunk_tokens": 1007,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Prospectus:",
"Proposal Form:",
"Chapter Introduction",
"Key Terms"
]
} |
facility of Nomination is available to the proposer, the Agent shall inform him/ her
of the provisions of Section 39 of the Act and encourage the proposer to avail the
facility.Aspects related to the personal financial planning of the life proposed including his/
her work span, projected income and expenses, as well as... | IC 38 -IA-Eng-Life.md | null | Age Proof: | IC 38 -IA-Eng-Life_026 | {
"file_size": 4771,
"chunk_index": 26,
"chunk_tokens": 991,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Moral Hazard report",
"Policy Schedule",
"B. Policy Stage Documentation",
"Example",
"Policy Document"
]
} |
receipts when it receives further premiums from the proposer. These receipts are
known as renewal premium receipts (RPR). The RPRs act as proof of payment in the
event of any disputes related to premium payment.**2.** **Policy Document**The policy document is the most important document associated with insurance. **It*... | IC 38 -IA-Eng-Life.md | null | Policy Document | IC 38 -IA-Eng-Life_027 | {
"file_size": 4771,
"chunk_index": 27,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Grace Period",
"Policy Schedule",
"Diagram 1:",
"Specific Policy Provisions",
"Example"
]
} |
otherwise have lapsed for non-payment of premium, to continue in force during the
grace period. Every life insurance contract undertakes to pay the death benefit on
the condition that the premiums have been paid up to date and the policy is in
force. The “Grace Period” clause grants the policyholder an additional perio... | IC 38 -IA-Eng-Life.md | e58 | Important | IC 38 -IA-Eng-Life_028 | {
"file_size": 4771,
"chunk_index": 28,
"chunk_tokens": 1012,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Non-forfeiture provisions",
"Payment of overdue premiums with interest:",
"Important",
"Satisfactory evidence of continued insurability:",
"Definition"
]
} |
surrender value), from lapsation, by keeping them alive to the extent of paid-up
sum assured even without payment of further premiums. This is because the
policyholder has a claim to the cash value accumulated under the policy.**a)** **Surrender values**Surrender value is the amount you stand to get when you decide to ... | IC 38 -IA-Eng-Life.md | e58 | Surrender values | IC 38 -IA-Eng-Life_029 | {
"file_size": 4771,
"chunk_index": 29,
"chunk_tokens": 1009,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Policy loans",
"Special policy provisions and endorsements",
"Example",
"Important",
"A nominee does not have any right"
]
} |
iv. Nomination can be done either **at the time the policy is bought or later** atany time before the maturity of the Policy.59v. Nomination may be incorporated in the text of the Policy itself or by anendorsement on the Policy. Nominations need be communicated to the
insurer and registered by the insurer in the record... | IC 38 -IA-Eng-Life.md | null | Important | IC 38 -IA-Eng-Life_030 | {
"file_size": 4771,
"chunk_index": 30,
"chunk_tokens": 857,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Types of Assignment",
"Provisions related to nomination",
"Important",
"Diagram 3:",
"A nominee does not have any right"
]
} |
The person who transfers the rights is called **assignor** and the person to whom
property is transferred is called **assignee** . On assignment, the ownership of the
policy changes and hence nomination is cancelled, except when assignment is
made to the insurance company for a policy loan.There are two types of assign... | IC 38 -IA-Eng-Life.md | f62 | Diagram 3: | IC 38 -IA-Eng-Life_031 | {
"file_size": 4771,
"chunk_index": 31,
"chunk_tokens": 1009,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"Commonly extended privileges to policyholders",
"Types of Assignment",
"Conditions for valid assignment",
"Important",
"Diagram 3:"
]
} |
no objection from anyone else.b) **Alteration**Policyholders may seek to effect alterations in policy terms and conditions.
There is provision to make such changes subject to consent of both the insurer
and assured. Normally alterations may not be permitted during the first year of62the policy, except for change in the... | IC 38 -IA-Eng-Life.md | f62 | Alteration | IC 38 -IA-Eng-Life_032 | {
"file_size": 4771,
"chunk_index": 32,
"chunk_tokens": 1003,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Chapter Introduction",
"Key Terms",
"Answer 1"
]
} |
death.The assignment of a life insurance policy implies the act of transferring the
rights right, title and interest in the policy (as property) from one person to
another. The person who transfers the rights is called assignor and the person
to whom property is transferred is called assignee.Alteration is subject to c... | IC 38 -IA-Eng-Life.md | e13 | Key Terms | IC 38 -IA-Eng-Life_033 | {
"file_size": 4771,
"chunk_index": 33,
"chunk_tokens": 986,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Key Terms",
"Field or Primary level",
"Equity among risks",
"Substandard lives",
"Chapter Introduction"
]
} |
These are the ones whose anticipated mortality is higher than the average or
standard lives, but are still considered to be insurable. They may be accepted
for insurance with higher (or extra) premiums or subjected to certain
restrictions.**iv.** **Declined lives**
These are the ones whose impairments and anticipated e... | IC 38 -IA-Eng-Life.md | null | Declined lives | IC 38 -IA-Eng-Life_034 | {
"file_size": 4771,
"chunk_index": 34,
"chunk_tokens": 1007,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Example: Consider the case of an insured who",
"Underwriting at the Department level",
"Methods of Underwriting",
"Methods of underwriting",
"Acceptance with a lien ... |
regard to a life proposed for underwriting.**a)** **Acceptance at ordinary rates (OR)** is the most common decision. This ratingindicates that the risk is accepted at the same rate of premium as would
apply to an ordinary or standard life.68**Diagram 3:** **Underwriting decisions****b)** **Acceptance with an extra:** T... | IC 38 -IA-Eng-Life.md | null | Acceptance at ordinary rates (OR) | IC 38 -IA-Eng-Life_035 | {
"file_size": 4771,
"chunk_index": 35,
"chunk_tokens": 1004,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Example: Consider the case of an insured who",
"Acceptance with a restrictive clause:",
"Minors",
"Acceptance with a lien on the sum assured:",
"Test Yourself 1"
... |
companies often divide their underwriting into categories accordingly. Factors like
income, occupation, lifestyle and habits, which contribute to moral hazard, are
assessed as part of **financial underwriting**, while medical aspects of health fall
under **medical underwriting** .**a)** **Female insurance**Women genera... | IC 38 -IA-Eng-Life.md | null | Female insurance | IC 38 -IA-Eng-Life_036 | {
"file_size": 4771,
"chunk_index": 36,
"chunk_tokens": 997,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Examples",
"Minors",
"Occupation",
"Accidental hazards",
"Example"
]
} |
These tests may reveal deeper insights about the health of the proposed life
than the answers given in the proposal or an ordinary medical examination 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 elsew... | IC 38 -IA-Eng-Life.md | null | Examples | IC 38 -IA-Eng-Life_037 | {
"file_size": 4771,
"chunk_index": 37,
"chunk_tokens": 1015,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Examples",
"Moral hazard",
"Health hazards",
"Occupation",
"Accidental hazards"
]
} |
accidents, violence, family abuse, depression 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.73**Test Yoursel... | IC 38 -IA-Eng-Life.md | null | Substance abuse | IC 38 -IA-Eng-Life_038 | {
"file_size": 4771,
"chunk_index": 38,
"chunk_tokens": 1007,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Substance abuse",
"Backdating:",
"Getting a lower premium based on age:",
"Average longevity of the family",
"Blood pressure"
]
} |
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 better returns if you had bought it
in April 2013. You and your insurance company agree to... | IC 38 -IA-Eng-Life.md | L-09 | Backdating: | IC 38 -IA-Eng-Life_039 | {
"file_size": 4771,
"chunk_index": 39,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Set the timing of payment:",
"To coincide with special dates:",
"Answers to Test Yourself",
"Answer 2",
"Backdating:"
]
} |
3. Non-medical underwriting
4. Rating factor
5. 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.77## CHAPTER L-09## LIFE INSURANCE CLAIMS**Chapter Introduction**This chapter explain... | IC 38 -IA-Eng-Life.md | L-09 | Answers to Test Yourself | IC 38 -IA-Eng-Life_040 | {
"file_size": 4771,
"chunk_index": 40,
"chunk_tokens": 1009,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Survival claim",
"Answer 3",
"Diagram 1:"
]
} |
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 ... | IC 38 -IA-Eng-Life.md | s81 | Surrender value payments | IC 38 -IA-Eng-Life_041 | {
"file_size": 4771,
"chunk_index": 41,
"chunk_tokens": 987,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Maturity Claim",
"Participating Plan:",
"Rider Benefit",
"III.",
"Annuities:"
]
} |
**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... | IC 38 -IA-Eng-Life.md | s81 | Unit Linked Insurance Plan (ULIP): | IC 38 -IA-Eng-Life_042 | {
"file_size": 4771,
"chunk_index": 42,
"chunk_tokens": 1005,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Repudiation of death claim",
"Section 45",
"Section 45: Indisputability Clause",
"Unit Linked Insurance Plan (ULIP):",
"Important"
]
} |
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... | IC 38 -IA-Eng-Life.md | null | Role of an agent | IC 38 -IA-Eng-Life_043 | {
"file_size": 4771,
"chunk_index": 43,
"chunk_tokens": 672,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Test Yourself 1",
"Answer 1",
"Role of an agent",
"Summary"
]
} |
## IC - 38 **INSURANCE AGENTS** **SECTION-GENERAL****ACKNOWLEDGEMENT****This course is based on revised syllabus prescribed by Insurance Regulatory and**
**Development Authority of India (IRDAI) and prepared by Insurance Institute of**
**India, Mumbai.****AUTHORS/ REVIEWERS (in Alphabetical order)**Dr. R. K. Duggal
Dr.... | IC 38 -IA-Eng-Non-Life.md | C-46 | INSURANCE AGENTS | IC 38 -IA-Eng-Non-Life_000 | {
"file_size": 4549,
"chunk_index": 0,
"chunk_tokens": 1004,
"has_examples": false,
"has_tables": true,
"key_concepts": [
"SECTION-GENERAL",
"IC - 38",
"INSURANCE AGENTS",
"Proposal forms",
"ANNEXURES"
]
} |
|**SECTION **|**ANNEXURES**|**ANNEXURES**|
|A-1|Annexures – Specimen Proposal forms and Claims Forms for filling up<br>|68|iv## SECTION **GENERAL INSURANCE**1## CHAPTER G-01## GENERAL INSURANCE DOCUMENTATION**Chapter Introduction**As discussed in Chapter 7, the Proposal form contains information which are useful for
th... | IC 38 -IA-Eng-Non-Life.md | A-1 | SECTION | IC 38 -IA-Eng-Non-Life_001 | {
"file_size": 4549,
"chunk_index": 1,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": true,
"key_concepts": [
"Proposal forms",
"Sum insured",
"Elements of a proposal",
"ANNEXURES",
"Example"
]
} |
profession, occupation or business are of importance as they could have a
material bearing on the risk.**iv.** **Details and identity of the subject matter of insurance**The proposer is required to clearly state the subject matter that is proposed forinsurance.**Example**The proposer is required to state if it is:**i.*... | IC 38 -IA-Eng-Non-Life.md | t-1938 | Details and identity of the subject matter of insurance | IC 38 -IA-Eng-Non-Life_002 | {
"file_size": 4549,
"chunk_index": 2,
"chunk_tokens": 1011,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Premium Receipt",
"Declaration by insured",
"Test Yourself 1",
"Sum insured",
"Example"
]
} |
company has to process the proposal within 15 days’ time. The agent is expected to
keep track of these timelines, follow up internally and communicate with the
prospect/ insured as and when required by way of customer service. This entire
process of scrutinizing the proposal and deciding about acceptance is known as
un... | IC 38 -IA-Eng-Non-Life.md | t-1938 | Test Yourself 1 | IC 38 -IA-Eng-Non-Life_003 | {
"file_size": 4549,
"chunk_index": 3,
"chunk_tokens": 994,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"A cover note would incorporate the following:",
"Pending",
"Premium Receipt",
"Description of the risk covered",
"Test Yourself 1"
]
} |
of the steamer, number of packages, or exact value etc. are not known. Even in
respect of exports, a cover note may be issued e.g. a certain quantity of cargo
meant for shipment is sent by the exporter to the docks. It may happen that, owing
to difficulty of securing adequate shipping space, shipment of the cargo by th... | IC 38 -IA-Eng-Non-Life.md | n7 | Clauses: | IC 38 -IA-Eng-Non-Life_004 | {
"file_size": 4549,
"chunk_index": 4,
"chunk_tokens": 835,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Certificate of Insurance – Motor Insurance",
"Note:",
"Important",
"Clauses:",
"Conditions:"
]
} |
d) Date of expiry of insurance
e) Persons or classes of persons entitled to drive
f) Limitations as to use
g) Additional risks, if anyThe Motor Cover Note incorporates a certificate to the effect that it is issued in
accordance with the provisions of Chapters X and XI of the Motor Vehicles Act, 1988.**Important**The va... | IC 38 -IA-Eng-Non-Life.md | e9 | Important | IC 38 -IA-Eng-Non-Life_005 | {
"file_size": 4549,
"chunk_index": 5,
"chunk_tokens": 998,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Certificate of Insurance – Motor Insurance",
"Test Yourself 1",
"Note:",
"CERTIFICATE OF INSURANCE",
"Important"
]
} |
e) Sums insured;
f) Perils covered and exclusions ;
g) Any excess/ deductible applicable;
h) Premium payable and where the premium is provisional subject toadjustment, the basis of adjustment of premium ;
i) Policy terms, conditions and warranties;
j) Action to be taken by the insured upon occurrence of a contingency l... | IC 38 -IA-Eng-Non-Life.md | null | Test Yourself 1 | IC 38 -IA-Eng-Non-Life_006 | {
"file_size": 4549,
"chunk_index": 6,
"chunk_tokens": 1004,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Marine Cargo Insurance, a warranty",
"Warranties",
"Burglary Insurance",
"Test Yourself 1",
"Endorsements"
]
} |
continue to be the same only if the warranties attached to the policy are
complied with.**Test Yourself 2**Which of the following statements is correct with regards to a warranty?I. A warranty is a condition which is never stated in the policy
II. A warranty forms part of a policy document
III. A warranty is always com... | IC 38 -IA-Eng-Non-Life.md | null | Test Yourself 2 | IC 38 -IA-Eng-Non-Life_007 | {
"file_size": 4549,
"chunk_index": 7,
"chunk_tokens": 1006,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Meaning of wordings",
"Construction of policies",
"Specimen",
"Endorsements",
"Interpretation of policies"
]
} |
d) Clauses in italics over-ride the ordinary printed wording where they areinconsistent.13e) Clauses printed or typed in the margin of the policy are to be given moreimportance than the wording within the body of the policy.
f) Clauses attached or pasted to the policy override both marginal clauses andthe clauses in th... | IC 38 -IA-Eng-Non-Life.md | e14 | Important | IC 38 -IA-Eng-Non-Life_008 | {
"file_size": 4549,
"chunk_index": 8,
"chunk_tokens": 962,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"On the other hand,",
"The",
"Meaning of wordings",
"Construction of policies",
"Renewal Notice"
]
} |
IV. As per regulations there is no legal obligation on insurers to send a renewalnotice to insured before the expiry of the policy**Summary**a) The first stage of documentation is essentially the proposal forms through whichthe insured informs about himself/ herself
b) The duty of disclosure of material information ari... | IC 38 -IA-Eng-Non-Life.md | G-02 | Summary | IC 38 -IA-Eng-Non-Life_009 | {
"file_size": 4549,
"chunk_index": 9,
"chunk_tokens": 954,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Answers to Test Yourself",
"Answer 2",
"Answer 3",
"Physical Hazards",
"Nature of flooring:"
]
} |
2. Appreciate Underwriting as a function
3. Methods used by underwriters to reduce the risk
4. Understand how the Sum Insured is fixed.17**A.** **Physical Hazards**A thorough knowledge of various hazards to which property and persons are exposed
is most essential for underwriting.Physical hazard can be ascertained from... | IC 38 -IA-Eng-Non-Life.md | null | A. | IC 38 -IA-Eng-Non-Life_010 | {
"file_size": 4549,
"chunk_index": 10,
"chunk_tokens": 1016,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Personal accident",
"The age of the person:",
"The type of vehicle:",
"Nature of flooring:",
"Situation:"
]
} |
may decide to charge an extra premium before acceptance of the same. By loading
the premium the higher probability of claims or occurrence of large claims is taken
into consideration.**Example**Normal rate of premium is charged for cargo shipped by liners or other vessels,
which comply with the prescribed standards. Ho... | IC 38 -IA-Eng-Non-Life.md | null | Example | IC 38 -IA-Eng-Non-Life_011 | {
"file_size": 4549,
"chunk_index": 11,
"chunk_tokens": 1013,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Personal accident",
"Discounts",
"Moral hazard",
"Imposition of warranties",
"Fire:"
]
} |
to the maximum bonus that can be availed. It is allowed by way of deduction on the
total premium at renewal only, depending upon the incurred claim ratio for the
entire group or to Motor vehicle Own damage policy holders for claim free years.**No claim bonus is a powerful strategy to improve underwriting experience and... | IC 38 -IA-Eng-Non-Life.md | null | No claim bonus is a powerful strategy to improve underwriting experience and | IC 38 -IA-Eng-Non-Life_012 | {
"file_size": 4549,
"chunk_index": 12,
"chunk_tokens": 1002,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Carelessness",
"Sub-limits:",
"Information",
"Moral hazard",
"Need for short period scales"
]
} |
refund is made keeping the premium on short period scale for the period Insurer
was in risk.22**Minimum premium**It is the practice to charge minimum premium under each policy so that
administrative expenses of issuing the policy are covered.**Test Yourself 1**What is expected of an agent when she detects a moral hazar... | IC 38 -IA-Eng-Non-Life.md | d23 | Minimum premium | IC 38 -IA-Eng-Non-Life_013 | {
"file_size": 4549,
"chunk_index": 13,
"chunk_tokens": 957,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Fire insurance:",
"Marine cargo insurance:",
"Test Yourself 1",
"Motor insurance",
"Minimum premium"
]
} |
the market to replace the damaged raw material, after the loss.**e)** **Marine cargo insurance:** It is an agreed valued policy and the sum insured is asper the agreement between insurer and insured at the time of contract. Normally
it would consist of the sum of cost of the commodity plus Insurance + freight i.e.
CIF ... | IC 38 -IA-Eng-Non-Life.md | e24 | Marine cargo insurance: | IC 38 -IA-Eng-Non-Life_014 | {
"file_size": 4549,
"chunk_index": 14,
"chunk_tokens": 1015,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Summary",
"Answers to Test Yourself",
"Answer 2",
"Retail Insurance Products",
"Marine cargo insurance:"
]
} |
that deal with personal lines of insurance as the buyers also are essentially from the
same consumer segment.**B.** **'All Risks' and ‘Named Perils’ Insurance Policy**Non-life insurance policies can be broadly classified into two categories: Named peril policies
All risk policiesi. "All risks" typically means that a... | IC 38 -IA-Eng-Non-Life.md | null | B. | IC 38 -IA-Eng-Non-Life_015 | {
"file_size": 4549,
"chunk_index": 15,
"chunk_tokens": 1005,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Machinery Breakdown:",
"Personal Accident",
"Shopkeeper’s Insurance",
"Baggage",
"What does shopkeeper’s insurance cover?"
]
} |
**v.** **Baggage** : Compensates for loss of baggage while on travel for official purposes
**vi.** **Fixed Plate Glass and Sanitary Fittings covers accidental loss of damage to:** Fixed plate glass
Sanitary fittings
Neon Sign/ Glow Sign/ Hoarding
**vii.** **Personal Accident**
**viii.** **Infidelity/ Dishonesty of... | IC 38 -IA-Eng-Non-Life.md | null | Baggage | IC 38 -IA-Eng-Non-Life_016 | {
"file_size": 4549,
"chunk_index": 16,
"chunk_tokens": 983,
"has_examples": false,
"has_tables": false,
"key_concepts": [
"Personal Accident",
"Baggage",
"Householder’s Insurance",
"Legal Liability:",
"Sum Insured and Premium"
]
} |
declared by a policyholder is less than what ought to have been declared for the
property in question, the policyholder’s claim will not be settled proportionately
but upto the Sum Insured that is declared.29**F.** **Sum Insured and Premium**Industrial units or offices will maintain books of accounts showing therein va... | IC 38 -IA-Eng-Non-Life.md | null | F. | IC 38 -IA-Eng-Non-Life_017 | {
"file_size": 4549,
"chunk_index": 17,
"chunk_tokens": 999,
"has_examples": true,
"has_tables": false,
"key_concepts": [
"Test Yourself 1",
"Housebreaking",
"Burglary",
"Motor Insurance",
"Theft"
]
} |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.