Insurance Basics : 1 Insurance Basics
Definition of Insurance : 2 Definition of Insurance Insurance is the pooling of fortuitous losses by transfer of such risks to insurers, who agree to indemnify insureds for such losses. Pooling? Spreading losses incurred by the few over the entire group Fortuitous losses--?Insurance pays for losses that are unforeseen,
unexpected, and occur as a result of chance Indemnification--?The insured is restored to his or her approximate
financial position prior to the occurrence of the loss
Insurer & Insured : 3 Insurer & Insured Insurance company, which assumes risk is referred as Insurer.
Person taking the insurance cover is referred as Insured
Insurance is a contract : 4 Insurance is a contract Indemnity Contract
All general insurance contracts including motor, mediclaim, property, marine etc Benefit Contract
All life insurance contracts, Disability benefit, Critical Illness policies. Insurance policy is not a contract
Insurance policy is an evidence of contract
Types of Insurance Companies : 5 Types of Insurance Companies Life Insurance Company
General Insurance Company
Reinsurance Company
4. Captive Insurance Company
Life Insurance Company : 6 Life Insurance Company These companies provide
a. Insurance on life of a person
b. Disability insurance covers
c. Annuity products
d. Superannuation products
e. Investment products
f. Medical benefit product
General Insurance Company : 7 General Insurance Company These companies provide
Insurance covers other than life insurance
No saving component products
Indemnity policies like
1. Fire Insurance
2. Motor Insurance
3. Mediclaim
d. Benefit Policy like
1. Accident Benefit Policy
2. Hospital Cash
3. Critical Illness
Reinsurance Company : 8 6-8 Reinsurance Company Reinsurance is an arrangement by which the primary insurer that initially writes the insurance transfers to another insurer part or all of the assumed risk
The primary insurer is the ceding company
The insurer that accepts the insurance from the ceding company is the reinsurer
GIC is the national re insurer in India
Captive Insurer : 9 Captive Insurer A captive insurer is an insurer owned by a parent firm for the purpose of insuring the parent firm’s loss exposures
A single-parent captive is owned by only one parent
An association or group captive is an insurer owned by several parents
Captives are formed for several reasons, including:
Costs may be lower than purchasing commercial insurance
A captive insurer has easier access to a reinsurer
A captive insurer can become a source of profit
Slide 10 : 10 Life Insurance is a long term contract
General Insurance are short term contract
Premium & Promise to perform : 11 Premium & Promise to perform Insured pays a premium to transfer the risk to insurance company
In return Insurance company promise to make good any loss suffered by insured during the policy period.
Mortality Rate & Table : 12 6-12 Mortality Rate & Table Mortality Rate is basically death per 1000 people .
Mortality Table is prepared for death per 1000 people for different age group and separately for male & female lives. Age 25 – Rs 1.45 per Rs. 1000 SA
Age 26 – Rs 1.50 per Rs. 1000 SA
Age 27 – Rs 1.55 per Rs. 1000 SA
Age 28 – Rs 1.65 per Rs. 1000 SA
Morbidity Rate & Table : 13 6-13 Morbidity Rate & Table Morbidity Rate is basically critical illness per 1000 people .
Morbidity Table is prepared for critical illness per 1000 people for different age group and separately for male & female lives. Age 25 – Rs 2.45 per Rs. 1000 SA
Age 26 – Rs 2.70 per Rs. 1000 SA
Age 27 – Rs 3.00 per Rs. 1000 SA
Age 28 – Rs 3.35 per Rs. 1000 SA
Level Premium : 14 Level Premium The uniform premium that an insured is required to pay through out the term of the policy is called level premium. Age 25 – Rs 1.45 per Rs. 1000 SA
Age 26 – Rs 1.50 per Rs. 1000 SA
Age 27 – Rs 1.55 per Rs. 1000 SA
Age 28 – Rs 1.65 per Rs. 1000 SA
These premiums are averaged based on PV
Pure and Speculative Risk : 15 Pure and Speculative Risk A pure risk is one in which there are only the possibilities of loss or no loss (Fire, Earthquake, Collision)
A speculative risk is one in which both profit or loss are possible (gambling) Insurance deals with Pure risk only
Insurable Interest : 16 Insurable Interest Can you take an insurance policy on your neighbour’s car ? No, because in case of damage to neighbour’s car,
you will not be put in a financial loss
Insurable Interest : 17 Insurable Interest In life insurance, insurable interest must exist at the
time of inception In General Insurance, insurable interest must exist at the
Time of loss
Peril : 18 Peril Peril is defined as the cause of the loss
Fire
Collision
Earthquakes
Tornadoes
Hurricanes
Theft, burglary
In an auto accident, the collision is the peril In Insurance
Loss is covered
Only if it occurs
Because of insured
PERIL
Hazard & Type of Hazards : 19 Hazard & Type of Hazards A HAZARD is a condition that increases the chance of loss
Physical hazards are physical conditions that increase the chance of loss (icy roads, defective wiring)
Moral hazard is dishonesty or character defects in an individual, that increase the chance of loss (faking accidents, inflating claim amounts)
Occupational hazard arise out of one’s job. Eg- A worker working in a mine.
Incontestable clause : 20 Incontestable clause U/s 45 of the Insurance Act 1938,The incontestable clause states that the insurer cannot contest the policy on the ground of incorrect or false statements in the proposal forms after it has been in force two years during the insured’s lifetime
Incontestable clause : 21 Incontestable clause The insurer can contest a claim after the incontestable period if it finds any material fact like:
The beneficiary takes out the life insurance policy with the intent of murdering the insured
The applicant has someone else take a medical examination
An insurable interest does not exist at the inception of the policy
Suicide Clause : 22 Suicide Clause The suicide clause states that if the insured commits suicide within ONE year after the policy is issued, the face amount of insurance will not be paid;
There can only be a refund of the premium paid
Presumption of Death : 23 Presumption of Death When a person leaves his usual place of residence and is neither heard or known to be living for a term of 7 years, the person is presumed to be dead.
Grace Period Provisions : 24 Grace Period Provisions A life insurance policy contains a grace period during which the policyholder is allowed to pay an overdue premium
Prevents the policy from lapsing by giving the policyowner additional time to pay
15 DAYS FOR MONTHLY PREMIUN PAYING TERM.
30 DAYS FOR OTHER PREMIUN PAYING TERM.
Nonforfeiture Options : 25 Nonforfeiture Options The payment to a withdrawing policyowner is known as a nonforfeiture value or cash surrender value
A policyowner has a right to the policy’s accumulated cash value;
Reinstatement Provisions : 26 Reinstatement Provisions The reinstatement provision permits the owner to reinstate a lapsed policy
To reinstate, the following requirements must be met:
Evidence of insurability is required
All overdue premiums plus interest are paid
Any policy loans are repaid or reinstated
ASSIGNMENT : 27 ASSIGNMENT A life insurance policy is freely assignable to another party. Assignment can be
Absolute assignment,
Collateral assignment,
Only certain rights are transferred to the creditor
Purpose is to protect the insurer from paying the policy proceeds twice
NOMINATION : 28 NOMINATION Nomination is a simple way to ensure easy payment of policy moneys in the case of a death claim. Section 39
of the
Insurance Act 1938 A nomination can be
changed any number
of times A
nomination can be made
at the inception or after
the policy is issued.
Advance payment of premium : 29 Advance payment of premium Sec 64VB of the Insurance Act says, that premium must be paid in advance for assuming risk
Bonus or Dividend : 30 Bonus or Dividend Bonus come from three main sources:
The difference between expected and actual mortality experience
Excess earnings
The difference between expected and actual operating expenses
Bonus or Dividend : 31 Bonus or Dividend If a policy pays Bonus it is called a with bonus or a participating policy
If a policy does not pay Bonus it is called a without bonus or a Non-participating policy
Bonus or Dividend : 32 Bonus or Dividend Simple reversionary bonus
The bonus declared is simply added to the SA. No bonus is calculated on already accrued past bonuses
Compound reversionary bonus
The bonus declared is added to the SA. Bonus is also calculated & payable on already accrued past bonuses
Married Woman’s Property Act : 33 Married Woman’s Property Act If an insurance policy is purchased by an individual on his own life and is meant for the benefit of his wife and/or children and this is duly expressed on the face of it,
Then under section 6 of the Married women’s property Act 1874, it will be deemed to be a trust for the benefit of his wife, his wife and children or any of them according to the interest expressed
Endorsements : 34 Endorsements In property and liability insurance, an endorsement is a written provision that adds to, deletes from, or modifies the provisions in the original contract
e.g., an earthquake endorsement to a homeowners policy
Riders : 35 Riders Riders are defined as a special policy
provisions or group of provisions that may
be added to a policy to expand or limit the
benefits otherwise payable.
Riders can be classified in two categories
Policy Riders
Benefit Riders
Claims : 36 6-36 Claims A claim is the demand that the insurer should redeem the promise made in the contract. Claims can be
Maturity Claim
Survival Benefit Claim
Death Claim
Loss Claim
Misrepresentation : 37 6-37 Misrepresentation A misrepresentation is a written or oral statement that is false.
Example: A person writing in a proposal form that he had availed 30 days casual leave last year, whereas he had availed 30 days medical leave.
Concealment : 38 6-38 Concealment Concealment is the failure to disclose known facts.
Example: A person not writing in a proposal form that he had availed 30 days medical leave during the last year.
Conditions : 39 6-39 Conditions Conditions are provisions in the policy that qualify or place limitations on the insurer’s promise to perform
If policy conditions are not met, insurer can refuse to pay the claim
Waiver : 40 Waiver Waiver is defined as the voluntary relinquishment of a known legal right
Estoppel : 41 Estoppel Estoppel occurs when a representation of fact made by one person to another person is reasonably relied on by that person to such an extent that it would be inequitable to allow the first person to deny the truth of the representation
Estoppel Example : 42 Estoppel Example Estoppel Example
consider the case of a debtor and a creditor. The creditor might unofficially inform the debtor that the debt has been forgiven. Even if the original contract was not terminated, the creditor may be estopped from collecting the debt if he changes his mind later. It would be unfair to allow the creditor to change his mind in light of the unofficial agreement he made with the debtor beforehand.
In the same way, a landlord might inform a tenant that rent has been reduced, for example, if there was construction or a lapse in utility services. If the tenant relies on this advice, the landlord could be estopped from collecting the full rent.
Deductibles : 43 Deductibles A deductible is a provision by which a specified amount is subtracted from the total loss payment that otherwise would be payable
Deductibles : 44 Deductibles The purpose of a deductible is to:
Eliminate small claims that are expensive to handle and process
Reduce premiums paid by the insured
Reduce moral and morale hazard
Example : - In Car insurance there is a deductible of Rs 500 for every claim.
Excess & Franchise : 45 Excess & Franchise These are a type of deductibles, which forms part of a general insurance policy in most cases.
Excess: In an insurance policy, the excess is the portion of any claim that is not covered by the insurance provider. if a reported claim is below the limit of excess, it is not payable,
Franchise : if a reported claim is below the limit of franchise, it is not payable, but if the claim is more than the excess amount , the insured gets the full claim amount without any deduction.
Excess & Franchise : 46 Excess & Franchise Option I Option II
Claim Amount 4000.00 10000.00
Excess under Policy 5000.00 5000.00
Claim Payable NIL 5000.00
Claim Amount 4000.00 10000.00
Franchise under Policy 5000.00 5000.00
Claim Payable NIL 10000.00
Underwriting : 47 6-47 Underwriting Underwriting refers to the process of selecting, classifying, and pricing applicants for insurance.
The objective is to produce a profitable book of business.
Rate making : 48 6-48 Rate making Rate making refers to the pricing of insurance
Total premiums charged must be adequate for paying all claims and expenses during the policy period
Rates and premiums are determined by an actuary, using the company’s past loss experience and industry statistics
Pure Premium & Gross Premium : 49 6-49 Pure Premium & Gross Premium Pure Premium is net loss experience by the company . It does not include administrative expenses, marketing expenses, profit and other contingencies.
Gross Premium is the final premium chargeable to the insured. It includes pure premium, administrative expenses, marketing expenses, profit and other contingencies.
Pure Premium : 50 6-50 Pure Premium Let us consider the following facts
Cost of a Car is : Rs. 2,00,000
Past Loss Experience : 5 Cars are stolen or completely
damaged out of 100 cars every
year on an average based on
last 5 year data.
Hence there will be a liability of Rs. 200000 X 5 Cars
= Rs. 10,00,000 in a year
Thus the premium needed is Rs 10,00,000 from 100 cars
Premium per car Rs. 10,00,000 / 100 = Rs. 10,000
Gross Premium : 51 6-51 Gross Premium Gross Premium = Pure Premium + Expenses
In above example Pure premium was Rs 10000. If the expenses are 30% of the gross premium, then the pure premium as calculated above will need to be loaded for these expenses.
Hence the Gross premium will be =
Pure Premium / ( 1- expense %)
= 10000 / ( 1-0.30)
= 10000/.70
= 14285.71
IRDA : 52 IRDA Insurance regulatory development authority
is the main regulator of insurance business in India.
Established by an act in 1999
Agent : 53 Agent An agent is someone who legally represents the principal and has the authority to act on the principal's behalf
One agent can represent only one life + one non life insurance company
Needs to pass IRDA Exam conducted by III.
Practical training of 50hrs is required
Broker : 54 Broker A broker is someone who legally represents the insured, and:
solicits applications and attempts to place coverage with an appropriate insurer
is paid a commission from the insurers where the business is placed
does not have the authority to bind the insurer
Ombudsman : 55 Ombudsman An ombudsman is defined as a person appointed to investigate grievances of insured.
Claims upto Rs 20 lacs can be heard by an Ombudsman