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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.205**A.** **Understanding Healthcare**The word... | Final IC 38 - WA_Composite - English.md | null | A. | Final IC 38 - WA_Composite - English_102 | {
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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 - WA_Composite - English.md | y208 | C. | Final IC 38 - WA_Composite - English_103 | {
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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 - WA_Composite - English.md | e210 | Central Government Health Scheme | Final IC 38 - WA_Composite - English_104 | {
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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 - WA_Composite - English.md | e210 | Intermediaries: | Final IC 38 - WA_Composite - English_105 | {
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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 - WA_Composite - English.md | null | Medical Questionnaire | Final IC 38 - WA_Composite - English_106 | {
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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 - WA_Composite - English.md | d216 | Nature of questions in a proposal form | Final IC 38 - WA_Composite - English_107 | {
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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 - WA_Composite - English.md | D-19 | C. | Final IC 38 - WA_Composite - English_108 | {
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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 - WA_Composite - English.md | H-03 | E. | Final IC 38 - WA_Composite - English_109 | {
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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.219**Test Yourself 2**If certain terms and conditions of the policy need to be modified at... | Final IC 38 - WA_Composite - English.md | H-03 | Test Yourself 2 | Final IC 38 - WA_Composite - English_110 | {
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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 - WA_Composite - English.md | s10 | Regulations for Health Insurance | Final IC 38 - WA_Composite - English_111 | {
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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 - WA_Composite - English.md | s10 | C. | Final IC 38 - WA_Composite - English_112 | {
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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 - WA_Composite - English.md | e227 | Definition | Final IC 38 - WA_Composite - English_113 | {
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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 - WA_Composite - English.md | e227 | Family floater: | Final IC 38 - WA_Composite - English_114 | {
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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 - WA_Composite - English.md | null | Deductible/ Excess | Final IC 38 - WA_Composite - English_115 | {
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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 - WA_Composite - English.md | d19 | Maternity cover: | Final IC 38 - WA_Composite - English_116 | {
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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 - WA_Composite - English.md | null | Individual Plan | Final IC 38 - WA_Composite - English_117 | {
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Pre-post hospital expenses are either paid as a percentage of hospital claims or
a 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... | Final IC 38 - WA_Composite - English.md | null | F. | Final IC 38 - WA_Composite - English_118 | {
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have resulted in death. However surviving a major illness entails huge expense
for 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 illn... | Final IC 38 - WA_Composite - English.md | d-19 | Disease Specific Products | Final IC 38 - WA_Composite - English_119 | {
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June 2020:1. Hospitalization Expenses incurred for the treatment of Covid-19 on Positivediagnosis of Covid-19 in a government authorized diagnostic centre covering235the following: (Expenses on Hospitalization for a minimum period of 24 hours
are admissible.)a. Room, Boarding, Nursing Expenses as provided by the Hospit... | Final IC 38 - WA_Composite - English.md | d-19 | Standard Vector Borne Disease Health Policy: | Final IC 38 - WA_Composite - English_120 | {
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cover benefits with indemnity policies and even life insurance policies and
hospital daily cash benefits with indemnity policies.**Travel Insurance:**Travel insurance policy is also offered as a package policy covering not only health
insurance but also accidental death/ disability benefits along with Medical
expenses ... | Final IC 38 - WA_Composite - English.md | null | Travel Insurance: | Final IC 38 - WA_Composite - English_121 | {
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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 ... | Final IC 38 - WA_Composite - English.md | r2 | Premium | Final IC 38 - WA_Composite - English_122 | {
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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 ... | Final IC 38 - WA_Composite - English.md | f240 | Scope of cover | Final IC 38 - WA_Composite - English_123 | {
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where premium has to be paid in dollars. The plans are usually of two types: World-wide excluding USA/ Canada World-wide including USA/ Canada241Some products provide cover for a group of countries. Examples are travel to
Asian countries only, European countries only or travel to a particular country
only.**Corporate... | Final IC 38 - WA_Composite - English.md | a241 | Corporate Frequent Flyer plans | Final IC 38 - WA_Composite - English_124 | {
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of a 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 majo... | Final IC 38 - WA_Composite - English.md | d-19 | O. | Final IC 38 - WA_Composite - English_125 | {
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services of 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 hisinsurance policy and can be... | Final IC 38 - WA_Composite - English.md | s244 | Hospital | Final IC 38 - WA_Composite - English_126 | {
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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... | Final IC 38 - WA_Composite - English.md | H-04 | Example | Final IC 38 - WA_Composite - English_127 | {
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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... | Final IC 38 - WA_Composite - English.md | n248 | Learning Outcomes | Final IC 38 - WA_Composite - English_128 | {
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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
financial or income based underwriting. However, the latter ca... | Final IC 38 - WA_Composite - English.md | s251 | Underwriting – Risk Assessment | Final IC 38 - WA_Composite - English_129 | {
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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**
There are two main purposes for Underwriting.i. To prevent anti-selection, that is selection agai... | Final IC 38 - WA_Composite - English.md | s251 | B. | Final IC 38 - WA_Composite - English_130 | {
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gathering 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... | Final IC 38 - WA_Composite - English.md | s254 | Moral Hazard report | Final IC 38 - WA_Composite - English_131 | {
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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 is254unde... | Final IC 38 - WA_Composite - English.md | s254 | E. | Final IC 38 - WA_Composite - English_132 | {
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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... | Final IC 38 - WA_Composite - English.md | k257 | Medical reports | Final IC 38 - WA_Composite - English_133 | {
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class, build etc. 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, habit... | Final IC 38 - WA_Composite - English.md | t259 | Numerical rating method | Final IC 38 - WA_Composite - English_134 | {
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h) Difference in healthcare costs across regions in case of multiple locationsspread in different geographical locations
i) Preference of the group holder for administration of the group insuranceby a third party administrator (of his choice or one selected by the insurer)
or by the insurer itself
j) Past claims experi... | Final IC 38 - WA_Composite - English.md | null | Example | Final IC 38 - WA_Composite - English_135 | {
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respectively.**Age Limits**General age limits for the working population (employer employee) is 1870.However for students Minimum age could be 5 years too.
The minimum and maximum age for being covered and renewed varies from
company to company.261**Family Package Cover**The Personal accident policy also has a family p... | Final IC 38 - WA_Composite - English.md | H-05 | Age Limits | Final IC 38 - WA_Composite - English_136 | {
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e) Discuss personal accident claims
f) Understand the concept and role of TPAs264**A.** **Claims Management in Insurance**It is very well understood that insurance is a ‘ **promise’** and the policy is a
‘ **witness’** to that promise. The occurrence of an insured event leading to a claim
under the policy is the true t... | Final IC 38 - WA_Composite - English.md | s264 | A. | Final IC 38 - WA_Composite - English_137 | {
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(hospitalization) indemnity products which form the major part of health
insurance 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
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nature of the illness/ injury involved.Earlier every TPA/ insurer had its own list of non-payable items, now the same
has been standardized under IRDAI Health Insurance StandardizationGuidelines.**c)** **Payment of claim**Once the payable claim amount is arrived at, payment is done to the customer
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|---|---|
|**Step 3**|~~~~ The TPA studies the information provided in the_cashless authorization_<br>_form_ and takes a decision on whether the cashless authorization could<br>be provided and if so, for how much amount it should be authorized<br>and it is communicated to the hospital without delay.|
|**Step 4**| The... | Final IC 38 - WA_Composite - English.md | y271 | Step 3 | Final IC 38 - WA_Composite - English_140 | {
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about the condition of the patient and the line of treatment and helps the claim
processing person immensely to understand the illness/ injury and the line of
treatment. Where the patient unfortunately does not survive, the discharge
summary is termed **Death Summary** in many hospitals. The discharge summary is
always... | Final IC 38 - WA_Composite - English.md | g273 | Death Summary | Final IC 38 - WA_Composite - English_141 | {
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c) The TPA enrols the members (while the proposer is the person taking thepolicy, members are those covered under the policy) and may issue a
membership identification in the form of a card, either physical or
electronic.
d) The membership with the TPA is used for availing cashless facility as wellas processing of clai... | Final IC 38 - WA_Composite - English.md | null | Customer relationship and contact management | Final IC 38 - WA_Composite - English_142 | {
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h) Medical certificate from treating doctor mentioning the type of disabilityand disability period. Leave certificate from employer giving details of
exact leave period, duly signed and sealed by the employer.
The above list is only indicative, further documents (including photographs of scar
marks, site of accident et... | Final IC 38 - WA_Composite - English.md | l276 | Test Yourself 4 | Final IC 38 - WA_Composite - English_143 | {
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valid 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 informat... | Final IC 38 - WA_Composite - English.md | t2 | Reimbursement of medical expenses and other non-medical claims: | Final IC 38 - WA_Composite - English_144 | {
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consumer Commissions or even the legal authorities.j) Frauds occur mostly in hospitalization indemnity policies but Personalaccident policies also are used to make fraud claims.k) The TPA provides many important services to the insurer and getsremunerated in the form of fees.279## SECTION **GENERAL INSURANCE**280## CHA... | Final IC 38 - WA_Composite - English.md | G-01 | GENERAL INSURANCE | Final IC 38 - WA_Composite - English_145 | {
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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 proposedfor insurance.**Example**The proposer is required to state if it is:**i.*... | Final IC 38 - WA_Composite - English.md | f283 | Details and identity of the subject matter of insurance | Final IC 38 - WA_Composite - English_146 | {
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the 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 a... | Final IC 38 - WA_Composite - English.md | t-1938 | Test Yourself 1 | Final IC 38 - WA_Composite - English_147 | {
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name 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 ... | Final IC 38 - WA_Composite - English.md | y287 | Clauses: | Final IC 38 - WA_Composite - English_148 | {
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d) Date of expiry of insurance
e) Persons or classes of persons entitled to drive
f) Limitations as to use
g) Additional risks, if any287The 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... | Final IC 38 - WA_Composite - English.md | y287 | Important | Final IC 38 - WA_Composite - English_149 | {
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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... | Final IC 38 - WA_Composite - English.md | n289 | Test Yourself 2 | Final IC 38 - WA_Composite - English_150 | {
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complied with.**Test Yourself 3**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 communicated to the insured separately and cannot bepart of the policy docume... | Final IC 38 - WA_Composite - English.md | null | Test Yourself 3 | Final IC 38 - WA_Composite - English_151 | {
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f) Clauses attached or pasted to the policy override both marginal clausesand the clauses in the body of the policy.
g) Printed wording is over-ridden by typewritten wording or wordingimpressed by an inked rubber stamp.
h) Handwriting takes precedence over typed or impressed wording.
i) Finally, the ordinary rules of g... | Final IC 38 - WA_Composite - English.md | y294 | Important | Final IC 38 - WA_Composite - English_152 | {
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c) Insurance companies usually add a declaration at the end of the Proposal formto be signed by the insurer
d) Elements of a proposal form include:i. Proposer’s name in full
ii. Proposer’s address and contact details
iii. Proposer’s profession, occupation or business
iv. Details and identity of the subject matter of in... | Final IC 38 - WA_Composite - English.md | G-02 | Key Terms | Final IC 38 - WA_Composite - English_153 | {
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are some examples of physical hazard in various classes of insurance.**a)** **Fire****i.** **Construction:** Construction refers to the building materials used in wallsand roof. A concrete building is superior to a timber building.**ii.** **The height:** Greater the number of storey’s, the greater the hazard becauseof ... | Final IC 38 - WA_Composite - English.md | null | Fire | Final IC 38 - WA_Composite - English_154 | {
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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... | Final IC 38 - WA_Composite - English.md | null | Example | Final IC 38 - WA_Composite - English_155 | {
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limit 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 freeyears.**No claim bonus is a powerful strategy to improve underwriting experienc... | Final IC 38 - WA_Composite - English.md | null | No claim bonus is a powerful strategy to improve underwriting experience and | Final IC 38 - WA_Composite - English_156 | {
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In that case refund is made keeping the premium on short period scale for the
period Insurer was in risk.**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 ... | Final IC 38 - WA_Composite - English.md | o303 | Minimum premium | Final IC 38 - WA_Composite - English_157 | {
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in 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 isas per 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. C... | Final IC 38 - WA_Composite - English.md | y305 | Marine cargo insurance: | Final IC 38 - WA_Composite - English_158 | {
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channels 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 mea... | Final IC 38 - WA_Composite - English.md | s309 | B. | Final IC 38 - WA_Composite - English_159 | {
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A till (box/ drawer/ counter) at the business premises
**v.** **Baggage** : Compensates for loss of baggage while on travel for officialpurposes
**vi.** **Fixed Plate Glass and Sanitary Fittings covers accidental loss of damage****to:** Fixed plate glass
Sanitary fittings
Neon Sign/ Glow Sign/ Hoarding
**vii.** ... | Final IC 38 - WA_Composite - English.md | s309 | Baggage | Final IC 38 - WA_Composite - English_160 | {
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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.**F.** **Sum Insured and Premium**Industrial units or offices will maintain books of accounts showing therein valu... | Final IC 38 - WA_Composite - English.md | g312 | F. | Final IC 38 - WA_Composite - English_161 | {
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synonymous with ‘larceny’.**Test Yourself 2**Under the shopkeeper package policy, the insured may opt for an additional ‘Fixed
plate glass and sanitary fittings’ cover. This will cover accidental loss of damage to
which of the following?I. Fixed plate glass
II. Sanitary fittings
III. Neon signs
IV. All of the above**G.... | Final IC 38 - WA_Composite - English.md | g312 | Test Yourself 2 | Final IC 38 - WA_Composite - English_162 | {
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party. Third-party insurance is purchased by the insured (first party) from an
insurance company (second party) for protection against another party's claims
(third party) for liability arising out of the action of the insuredThird party insurance is called ‘Liability Insurance’ as well.**Two important types of covers ... | Final IC 38 - WA_Composite - English.md | s315 | Two important types of covers that are popular in the market are discussed | Final IC 38 - WA_Composite - English_163 | {
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from Regional Transport Authority
III. In the name of any family member of the vehicle owner, including the vehicleowner, subject to approval from the Regional Transport Authority
IV. If the vehicle will be driven by anyone other than the owner, then primarypolicy should be in the name of the vehicle owner and addition... | Final IC 38 - WA_Composite - English.md | s315 | Summary | Final IC 38 - WA_Composite - English_164 | {
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stocks and stock in process, including stocks at suppliers/ customer's premises,Stocks held in trust, if specifically declared, machinery temporarily removed from
the premises for repairs can be insured. Monetary relief is essential to rebuild
and renew the property damaged to bring back the business to its normal cour... | Final IC 38 - WA_Composite - English.md | n318 | What does the Standard Fire policy cover? | Final IC 38 - WA_Composite - English_165 | {
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industries, storage risks and so on. The policy underinsurance to the extent of31915% is waived. Bharat Sookshma Udyam Policies allow increase in Sum Insurer
during the policy tenure by endorsement.**ii.** **Bharat Laghu Udyam Suraksha(meant for enterprises where the total****value at risk is more than Rs. 5 Crore and ... | Final IC 38 - WA_Composite - English.md | f31915 | Bharat Laghu Udyam Suraksha(meant for enterprises where the total | Final IC 38 - WA_Composite - English_166 | {
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called fire floater policies as the sum insured ‘floats’ over multiple locations.**vi.** **Premium rating depends on:**a) The type of occupancy, whether industrial or otherwise.
b) All property located in an industrial complex will be charged one ratedepending on the product(s) made.
c) Facilities outside industrial co... | Final IC 38 - WA_Composite - English.md | e321 | Premium rating depends on: | Final IC 38 - WA_Composite - English_167 | {
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when the cash is secured in a safe, which is burglar proof and is of an approved
make and design. The common conditions applicable for granting cash cover are
given below:a) Cash lost from the safe following the use of the original key to open, it iscovered only where such key has been obtained by violence or threats o... | Final IC 38 - WA_Composite - English.md | y323 | First Loss Insurance | Final IC 38 - WA_Composite - English_168 | {
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amount in transit and adjust this premium at the time of expiry of the policy,
based on actual amount in transit during the policy period, as declared by the
insured.**b)** **Premises section:** This section covers loss of cash from one’s premises/locked safe due to burglary, housebreaking, hold up etc. Other features ... | Final IC 38 - WA_Composite - English.md | s324 | Premises section: | Final IC 38 - WA_Composite - English_169 | {
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Etc.) that are to be guaranteed for a specified amount and the name are
not mentioned.**e)** **Blanket policy:** This policy covers the entire staff without showing namesor positions. No enquiries about the employees are made by the insurers.
Such policies are only suitable for an employer with a large staff and the
or... | Final IC 38 - WA_Composite - English.md | s2 | Blanket policy: | Final IC 38 - WA_Composite - English_170 | {
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d) Number of branches.**Test Yourself 6**Which of the below can be covered under a bankers indemnity insurance policy?I. Money securities lost or damaged whilst within the premises due to fire
II. Forgery or alteration of cheques
III. Dishonesty of employees with reference to money
IV. All of the above**G.** **Jewelers... | Final IC 38 - WA_Composite - English.md | y328 | Test Yourself 6 | Final IC 38 - WA_Composite - English_171 | {
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electrical breakdown by any cause (subject to excepted risks) to the insured
property:a) While it is at work or at rest.
b) While being dismantled for cleaning or overhauling
c) During cleaning or overhauling operations and during reassemblythereafter.
d) When being shifted within the premise.329Premium is charged on t... | Final IC 38 - WA_Composite - English.md | t330 | Boiler and Pressure Plant Policy: | Final IC 38 - WA_Composite - English_172 | {
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storage on lease or hire for storage of perishable commodities. The cover is
against the risk of deterioration and contamination following breakdown of
the refrigeration plant and machinery and also due to rise in temperature and
sudden and unforeseen escape of refrigerants into the cold storage rooms.**6.** **Civil En... | Final IC 38 - WA_Composite - English.md | d331 | Civil Engineering Completed Risk: | Final IC 38 - WA_Composite - English_173 | {
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accidental damages during the project. It is suitable for the insured who is
deprived of the anticipated earning and for the financial institutions to the extent
of their interest in the project. It is issued as an extension to the MCE/ EAR/ CAR
Policy before the actual commencement of project.The policy also covers fi... | Final IC 38 - WA_Composite - English.md | d332 | Test Yourself 8 | Final IC 38 - WA_Composite - English_174 | {
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whilst in transit from one place to another. However, the insured is required to
always act with reasonable care in all circumstances within his control. The main
feature of this policy is that it's an Agreed Value Policy. The valuation is agreed
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period have to be declared by the insured to the insurer as agreed
between them on a fortnightly, monthly or quarterly basis.**iii.** **Open Cover**The open cover is a contract for a year giving the Insured continuous
protection to cover a large number of shipments/ despatches. The
premium on the consignments would be ... | Final IC 38 - WA_Composite - English.md | null | Open Cover | Final IC 38 - WA_Composite - English_176 | {
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compensation for the alleged wrong doing, it would raise a need for payment of
compensation or meeting expenses involved in defending the suits filed by the
claimants. In other words there is a financial loss arising from a liability to pay.
The existence of such a liability and the amount of compensation to be paid wo... | Final IC 38 - WA_Composite - English.md | l2 | Statutory liability | Final IC 38 - WA_Composite - English_177 | {
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arising out of the use and operation of lifts. It covers legal liabilities for:a) Death/ bodily injury of any person (excluding employees of the insured)b) Damage to property (excluding insured’s own or employee’s property)The premium rates depend upon the limit of indemnity, any one person, any one
accident and any on... | Final IC 38 - WA_Composite - English.md | s339 | Professional Liability | Final IC 38 - WA_Composite - English_178 | {
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policyholders on the happening of a loss event. Insurer fulfils this promise by
providing prompt, fair and equitable service in either paying the policyholder or
paying claims made against the insured by a third party.One of the non-life insurance companies had the inscription “Pay if you can;
repudiate if you must” in... | Final IC 38 - WA_Composite - English.md | null | Settling claims professionally is regarded the biggest advertisement for an | Final IC 38 - WA_Composite - English_179 | {
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investigation to determine the cause and extent of loss is done, by an officer ofthe insurers.**The investigation** of other claims is entrusted to independent licensed
professional surveyors who are specialists in loss assessment. The assessment of
loss by independent surveyors is based on the principle that since bot... | Final IC 38 - WA_Composite - English.md | e2 | The investigation | Final IC 38 - WA_Composite - English_180 | {
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Insurance Rules 1939 and specific regulations issued by IRDAI.Claims made outside the country in case of ‘Travel Policy’ or ‘Marine Open
Cover’ for exports, are assessed by the claims settling agents abroad named in
the policy. These agents may assess the loss and make payment, which is
reimbursed by the insurers along... | Final IC 38 - WA_Composite - English.md | f345 | Important | Final IC 38 - WA_Composite - English_181 | {
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comprehensive policy. Which among the following is most appropriate for Raj todo?I. Notify the insurer of the loss as soon as reasonably possibleII. Notify the insurer at the time of insurance renewalIII. Damage the car further so as to receive a bigger compensationIV. Ignore the damage346**Test Yourself 3**Which of th... | Final IC 38 - WA_Composite - English.md | e346 | ANNEXURESThese annexures are provided so that the students get a better idea of proposal | Final IC 38 - WA_Composite - English_182 | {
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## IC - 38 **INSURANCE MARKETING FIRM** **COMPOSITE****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
D... | Final IC 38 -IMF_Composite -English.md | C-46 | INSURANCE MARKETING FIRM | Final IC 38 -IMF_Composite -English_000 | {
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|C-06|Claims Processing|60|
|C-07|Documentation|67|
|C-08|Customer Service|76|
|C-09|Grievance Redressal Mechanism|93|
|C-10|Regulatory Aspects for Insurance Marketing Firm|101|
|**SECTION **|**LIFE INSURANCE **|**LIFE INSURANCE **|
|L-01|What Life Insurance Involves|118|
|L-02|Financial Planning|125|
|L-03|Life Insura... | Final IC 38 -IMF_Composite -English.md | C-06 | SECTION | Final IC 38 -IMF_Composite -English_001 | {
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|---|---|
|**Benevolent**<br>**Societies/**<br>**Friendly**<br>**Societies**|Greeks of 7th Cy. AD, used to pay in advance to take care of the<br>family of members who died and also the funeral expenses of the<br>member.<br>Similar practices were followed in England as well.|
|**Rhodes**|Traders of Rhodes who were sendi... | Final IC 38 -IMF_Composite -English.md | n1 | Benevolent | Final IC 38 -IMF_Composite -English_002 | {
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Insurance Regulatory and Development Authority of India (IRDAI) in April 2000
as a statutory regulatory body for the insurance industry.f) An amendment of the Insurance Act in 2021, has allowed Foreign investors, tohold up to 74% of the paid up equity capital in an Indian Insurance company.
Foreign insurers can now est... | Final IC 38 -IMF_Composite -English.md | null | Insurance industry today (As on 30 | Final IC 38 -IMF_Composite -English_003 | {
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persons have similar assets which are exposed to similar risks. Their assets
are also referred to as ‘risks’ in many contexts.d) This pool of funds is used to compensate the few who might suffer the lossescaused by a **peril** .e) This process of pooling funds and compensating the unfortunate few is carriedout through ... | Final IC 38 -IMF_Composite -English.md | null | Insurance reduces Risk Burden | Final IC 38 -IMF_Composite -English_004 | {
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who can be individuals or corporates. The benefits they pay to policyholders are
contractual obligations. Insurance contracts are meaningful only if the Insurers
are financially capable of taking over the risks and compensating for the losses,
if and when they occur. The structure arises from application of the mutuali... | Final IC 38 -IMF_Composite -English.md | null | Mutuality | Final IC 38 -IMF_Composite -English_005 | {
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spread of Malaria.**c)** **Changes made in dangerous or hazardous operations,** while usingmachinery and equipment or in the performance of other task - e.g. (i)
wearing helmets inside construction sites; (ii) wearing gloves and face
shields while handling chemicals.**d)** **Leading a healthy lifestyle** - helps in red... | Final IC 38 -IMF_Composite -English.md | n13 | Changes made in dangerous or hazardous operations, | Final IC 38 -IMF_Composite -English_006 | {
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the **severity** (amount of loss). This works in different ways – (a) If the amount of
loss is very high, and the probability of its occurrence is small, the cost of the
risk would be low as such instances may be very few. (b) Even if the amount of
loss is small, if the probability of its occurrence is very high, the c... | Final IC 38 -IMF_Composite -English.md | n13 | Diagram 6: | Final IC 38 -IMF_Composite -English_007 | {
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to the prospect to enable the prospect to decide on the best cover that would bein his or her interest”.If the proposal and other connected papers are not filled by the customer, a
certificate may be incorporated at the end of proposal form from the customer
that the contents of the form and documents have been fully e... | Final IC 38 -IMF_Composite -English.md | r16 | G. | Final IC 38 -IMF_Composite -English_008 | {
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India?I. PM Jan Arogya Yojana - Ayushmaan Bharat
II. PM Fasal Bima Yojana
III. PM Suraksha Bima Yojana
IV. All of the above**Summary**Insurance is risk transfer through risk pooling.Commercial insurance business as practiced today started at the Lloyd’sCoffee House in London.An insurance arrangement involves the follow... | Final IC 38 -IMF_Composite -English.md | d17 | Summary | Final IC 38 -IMF_Composite -English_009 | {
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scarcity and its ownership or possession by someone. **Insurance of assets**Insurance provides protection only against financial losses arising from
unexpected events and not natural wear and tear, of assets due to usage overtime.We must note that **insurance cannot protect an asset from loss or damage** . An
earthqua... | Final IC 38 -IMF_Composite -English.md | d22 | Insurance of assets | Final IC 38 -IMF_Composite -English_010 | {
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On this basis one may identify three types of risk events or situations: **Critical**Where losses are of such a magnitude; that may result in total loss or
bankruptcy. Losses can be critical when the accident results in significant and22severe impact, disability, damage to equipment and the environment, which
may be r... | Final IC 38 -IMF_Composite -English.md | d22 | Critical | Final IC 38 -IMF_Composite -English_011 | {
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under the policy, such claims are clearly fraudulent and could be justifiably
rejectedA classic instance of moral hazard is purchasing insurance for a factory and then
burning it down to collect the insurance amount or buying health insurance after
onset of a major ailment.24**c)** **Legal hazard** is more prevalent in... | Final IC 38 -IMF_Composite -English.md | null | Legal hazard | Final IC 38 -IMF_Composite -English_012 | {
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because of a principle known as the “Law of large numbers”. It states that
the larger the size of the pool of risks, the actual average of losses would be
closer to the estimated or expected average loss.**c)** **Insurance Companies to remain Solvent:**If the pools of risks and the premium pools created are not suffici... | Final IC 38 -IMF_Composite -English.md | y27 | Insurance Companies to remain Solvent: | Final IC 38 -IMF_Composite -English_013 | {
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b) Risk
c) Hazard
d) Risk pooling
e) Offer and acceptance
f) Lawful consideration**Answers to Test Yourself****Answer 1** - The correct option is II.28#### CHAPTER C-0 3## PRINCIPLES OF INSURANCE**Chapter Introduction**In this chapter, we discuss the principles, based on which the mechanism ofinsurance works.a) Utmost ... | Final IC 38 -IMF_Composite -English.md | C-0 | Answers to Test Yourself | Final IC 38 -IMF_Composite -English_014 | {
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of premium and the terms and conditions. The insured has an obligation to
fully and accurately disclose all facts that are material to an insurancecontract.Whether an undisclosed fact was material or not would depend on the
circumstances of the individual case and could be decided ultimately only in a
court of law. The... | Final IC 38 -IMF_Composite -English.md | null | Example | Final IC 38 -IMF_Composite -English_015 | {
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answers were incomplete.**b.** **Duty to Disclose:** In the case of insurance contracts, the duty to disclose ispresent throughout the entire period of negotiation until the proposal is
accepted and a Life Insurance policy is issued.Once the Life Insurance policy is accepted, there is no further need to disclose
any ma... | Final IC 38 -IMF_Composite -English.md | null | Duty to Disclose: | Final IC 38 -IMF_Composite -English_016 | {
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(c) the date of revival of the policy or (d) the date of the rider to the policy,whichever is later.33The insurer needs to communicate the reasons on which the policy is
questioned in writing to the insured or his/ her legal representatives, nominees
or assignees.The expression "fraud" means any act committed by the in... | Final IC 38 -IMF_Composite -English.md | y34 | B. | Final IC 38 -IMF_Composite -English_017 | {
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insurance, insurable interest should be present both at the time of taking the
policy and at the time of claim with some exceptions like marine policies inwhich case it must exist at the time of claim.35In case of fire and accident insurance, insurable interest should be present
both at the time of taking the policy an... | Final IC 38 -IMF_Composite -English.md | null | C. | Final IC 38 -IMF_Composite -English_018 | {
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