syllabus ic38 corporate agents (composite) (life, health and general) section i common section chapter 1: introduction to insurance: life insurance – ...
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SYLLABUS
IC38 CORPORATE AGENTS (COMPOSITE) (LIFE, HEALTH AND GENERAL)
SECTION I COMMON SECTION CHAPTER 1: INTRODUCTION TO INSURANCE: Life insurance – History and evolution - History of insurance - Insurance through the ages - Modern concepts of insurance - History of insurance in India - Life insurance industry - How insurance works - Risk management techniques - Risk avoidance - Risk retention Risk reduction and control - Risk financing - Insurance vs Assurance - Insurance as a tool for managing risk - Considerations before opting for Insurance - Role of insurance in society - Insurance and Social Security. CHAPTER 2: CUSTOMER SERVICE: General concepts - Why Customer Service Quality of service - Customer service and insurance - Insurance agent’s role in providing great customer service - The Point of Sale - Best advice - The proposal stage - Acceptance stage - The claim stage - Grievance redressal - Integrated Grievance Management System (IGMS) - The Consumer Protection Act, 1986 - The Insurance Ombudsman - Communication process - Non-verbal communication Ethical behavior. CHAPTER 3: GRIEVANCE REDRESSAL MECHANISM: Consumer courts, Ombudsman - Integrated Grievance Management System (IGMS) - The Consumer Protection Act, 1986 - The Insurance Ombudsman. CHAPTER 4: REGULATORY ASPECTS OF CORPORATE AGENCY: Insurance contracts – Legal aspects and special features – Definitions – Scope and applicability of these Regulations - Consideration of application - Renewal of registration - Procedure where a registration is not granted - Effect of refusal to grant registration - Conditions of grant of registration to Corporate Agent Payment of fees and the consequences of failure to pay fees - Remuneration Conflict of interest - Disclosures to the Authority - Arrangements with insurers for distribution of products - Servicing of policyholders - Sale of Insurance by telemarketing mode and distance marketing activities of a corporate agent - Code of conduct for Corporate Agents - Maintenance of Records - Maintenance of books of account, records, etc - Code of Conduct. CHAPTER 5: LEGAL PRINCIPLES OF AN INSURANCE CONTRACT: Insurance contracts – Legal aspects and special features - Legal aspects of an insurance contract - Elements of a valid contract - Insurance contracts – Special features Uberrima Fides or Utmost Good Faith - Measures implemented to reduce the
risk - Breach of Utmost Good Faith - Insurable interest - Gambling and insurance - Proximate Cause - Contract of Adhesion – Indemnity – Subrogation.
SECTION 2 LIFE SECTION CHAPTER 6: WHAT LIFE INSURANCE INVOLVES: Life insurance business – Components, human life value, mutuality - The Asset – Human Life Value(HLV) The Risk - Level premiums - The Principle of Risk Pooling – Mutuality - The Life Insurance Contract. CHAPTER 7: FINANCIAL PLANNING: Financial planning and the individual life cycle – Definition - Types of Goals - Individual’s life cycle - Individual needs Financial products - Risk profile and investments - Role of financial planning Financial planning - When is the right time to start financial planning - Financial planning – Types - Cash planning - Insurance planning - Investment planning Investment parameters - Retirement planning. CHAPTER 8: LIFE INSURANCE PRODUCT I: Overview of life insurance products - What is a product - Purpose of life insurance products and needs covered Riders in Life Insurance Products - Traditional life insurance products - Term insurance plans - Variants of Term Assurance - Whole life insurance - Endowment assurance - Dividend method of profit participation. CHAPTER 9: LIFE INSURANCE PRODUCT II: Overview of non-traditional life insurance products - Limitations of traditional products - The shifts - The appeal – Needs met - Non-traditional life insurance products – Types. CHAPTER 10: APPLICATION OF LIFE INSURANCE: Married Women’s Property Act - Beneficiaries under MWP Act & its features - Key man Insurance – Insurable Losses - Mortgage Redemption Insurance (MRI). CHAPTER 11: PRICING AND VALUATION OF LIFE INSURANCE: Insurance pricing – Basic elements – Premium – Rebates - Determining the premium Components of Premium - Mortality and Interest - Guiding Principles for determining Amount of Loading - Expenses and reserves - Determination of Surplus and bonus - Ways of Valuing Assets - Allocating the surplus - Bonus Types of reversionary bonuses. CHAPTER 12: DOCUMENTATION – PROPOSAL STAGE: Life insurance – Proposal stage documentation – Prospectus - Proposal form – Different Reports Anti-Money Laundering (AML) - Know Your Customer (KYC) - Free-look period.
CHAPTER 13: DOCUMENTATION – POLICY CONDITION - I: Policy stage documentation - First Premium Receipt - Policy Document - Policy Document Standard Provisions - Specific Policy Provisions. CHAPTER 14: DOCUMENTATION – POLICY CONDITION – II: Policy conditions and privileges - Grace period - Policy revival measures - Non-forfeiture provisions Special policy provisions and endorsements - Provisions related to nomination – Assignment - Types of Assignment - Conditions for valid assignment - Nomination Vs. Assignment - Duplicate Policy – Alteration. CHAPTER 15: UNDERWRITING: Underwriting purpose - Equity among risks Risk classification - Selection process - Fraud monitoring and role of agent as primary underwriter - Methods of underwriting - Non-medical underwriting Conditions for non-medical underwriting - Rating factors in underwriting - Sources of Occupational Hazards - Medical underwriting - Medical Factors that influence an Underwriter’s Decision. CHAPTER 16: PAYMENTS UNDER A LIFE INSURANCE POLICY: Types of claims and claims procedure - Concept of claims - Risk event and claim - Ascertaining whether a claim event has occurred - Survival Benefit Payments - Surrender of Policy - Rider Benefit - Death Claim - Forms to be submitted for Death Claim Claim Procedure for Life Insurance Policy - Role of an agent
SECTION 3 HEALTH INSURANCE CHAPTER 17: INTRODUCTION TO HEALTH INSURANCE: What is health care – Definition of Health Determinants of Health – Levels of Healthcare – Levels of health care – Types of health care – Factors affecting the health systems in India – Evaluation of health insurance in India – Employees State Insurance Scheme Central Government health scheme – Commercial health insurance - Health Insurance Market – Infrastructure Public health sector - Private sector providers – Pharmaceutical industry – Insurance Providers – Intermediaries – Insurance selling activities – Insurance Servicing activities – financial product distribution – Other important organizations which form part of the health insurance market. CHAPTER 18: INSURANCE DOCUMENTATION: Proposal forms – Standard form of Declaration – Nature of questions in a proposal form - Elements of Proposal – Medical Questionnaire – Role of intermediary - Duty of an intermediary towards prospect (client) – Acceptance of the Proposal –(Underwriting) – Note on underwriting and processing of proposals – Premium receipts – Definition – Payment of premium in advance - Method of payment of premium – Policy Document - Conditions and warranties – Endorsements - Specimen Endorsements – Interpretation of policies – Renewal Notice – Anti –Money laundering and know your customer guidelines. CHAPTER 19: HEALTH INSURANCE PRODUCTS: Classification of health insurance product – Introduction – Definition – Features of health policies – Broad
classification of health insurance products – IRDA guidelines on standardization in health insurance – Hospitalization indemnity product – Top up covers or high deductible insurance plans – Senior citizen policy – fixed benefit covers – hospital cash – critical illness – hospital daily cash policy – critical illness policy – long term care insurance – combi-products – Package policies – Micro insurance and health insurance for poor sections – Rashtriya Swasthya Bima Yojana - Pradhan Mantri Suraksha Bima Yojana - Pradhan Mantri Jan-Dhan Yojana – Personal accident and disability cover- overseas travel insurance – Group health cover – Special products – Key terns in health policies. CHAPTER 20: HEALTH INSURANCE UNDERWRITING: What is Underwriting – Definition –need - Underwriting basic concepts – File and use guidelines – Other health insurance regulations of IRDAI – Basic Principles of Insurance and tools for underwriting -Underwriting process – Group health insurance – Underwriting of overseas travel insurance - Underwriting of personal accident insurance. CHAPTER 21: HEALTH INSURANCE CLAIMS: Claims management in insurance – stakeholders in claim process – Role of claims management in insurance company - Management of health insurance claims – Challenges in health insurance – claims process in health insurance - Documentation of health insurance claims – Claims reserving – Role of third party administrators – Claims management –personal accident – overseas travel insurance
SECTION 4 GENERAL SECTION CHAPTER 22: PRINCIPLES OF INSURANCE: Elements of Insurance: – Definition – Exposure to risk - Degree of risk exposure - Basis of risk classification- Hazard - Types of hazards – Mathematical principle of insurance (Risk pooling) - Conditions for insuring a risk – The Insurance Contract – Insurance Contract legal aspects – Special Features –Indemnity – Uberrima Fides or Utmost Good Faith – Insurable interest – Proximate cause CHAPTER 23: DOCUMENTATION: Proposal forms – Roe of Role of intermediary Duty of an intermediary towards prospect – Acceptance of the proposal – Premium receipt – Cover notes-Certificate of Insurance – Policy Document – Warranties – Endorsements – Interpretation of policies – Renewal notice CHAPTER 24: THEORY AND PRACTICE OF PREMIUM RATING: – Underwriting basics – Definition – Rate making basics – Rating factors – Hazard – Moral Hazard – Physical hazard – Addressing physical hazards - Short Period scales – Minimum Premium - Sum Insured – Deciding the sum insured CHAPTER 25: PERSONAL AND RETAIL INSURANCE: HOUSEHOLDER’S INSURANCE: - Retail Insurance Products - Sum Insured and Premium Shopkeeper’s Insurance - Sum Insured and Premium - Motor Insurance – Its coverages - ‘Third-Party Insurance’ - Exclusions - Sum Insured and Premium.
CHAPTER 26: COMMERCIAL INSURANCE: PROPERTY / FIRE INSURANCE: Variants of fire policy - Market Value or Reinstatement Value Policies - Declaration Policy - Floater Policies - Business Interruption Insurance – Coverages - Burglary Insurance - Risks covered under burglary insurance - Cash cover - Money Insurance - Coverage of Money Insurance - Important exclusions - Fidelity Guarantee Insurance - Bankers Indemnity Insurance - Jewelers’ Block Policy Engineering Insurance - Types of engineering insurance policies - Marine Insurance - Marine Cargo Insurance - Different types of marine policies - Liability Policies - Statutory liability – Types of Liability Policies. CHAPTER 27: CLAIMS PROCEDURE: Claims Settlement process – Importance of settling claims - -limitations or notice of loss – Investigation and assessment – Surveyors and loss assessors – Claim forms – Loss assessment and claim settlement - Important Aspects in an insurance claims – categories of claim – Discharge vouchers – Post settlement action – Selvage – Recoveries – Disputes related to claims – Other disputes resolution mechanisms.
