The document discusses the meaning and importance of insurance. It provides definitions of insurance from various sources that emphasize insurance as a means of distributing risk among a group of individuals. It also outlines some key benefits of life insurance, such as providing security and savings. The document then discusses characteristics of insurance contracts and factors that affect life and health insurance consumption, including health, age, and other medical factors.
The document discusses the meaning and importance of insurance. It provides definitions of insurance from various sources that emphasize insurance as a means of distributing risk among a group of individuals. It also outlines some key benefits of life insurance, such as providing security and savings. The document then discusses characteristics of insurance contracts and factors that affect life and health insurance consumption, including health, age, and other medical factors.
The document discusses the meaning and importance of insurance. It provides definitions of insurance from various sources that emphasize insurance as a means of distributing risk among a group of individuals. It also outlines some key benefits of life insurance, such as providing security and savings. The document then discusses characteristics of insurance contracts and factors that affect life and health insurance consumption, including health, age, and other medical factors.
Insurance is a cooperative form of distributing a certain risk over a
group of persons who are exposed to it - Ghosh and Agarwal.
Insurance is a contract in which a sum of money is paid to the assured as consideration of insurers incurring the risk of paying a large sum upon a given contingency. - Justice Tindall.
Insurance may be described as a social device whereby a large group of individuals, through a system of equitable contributions, may reduce or eliminate certain measurable risks of economic loss common to all members of the group Encyclopedia Britannica.
Insurance has been defined as a plan by which large numbers of people associated themselves, to the shoulders of all, risks attach to individuals
IMPORTANCE OF LIFE INSURANCE 1.Insurance provides security against loss of a given contingency. 2. A sense of security removes tension and fears. It stimulates more and better work. 3.The insurance provides adequate amount to the dependents at the early death of the property owner to pay off the unpaid loan. 4.The insurance assists the family and provides adequate amount at the time of need. 5. Systematic saving is possible because regular premiums are required to be compulsory paid. 6.Life Insurance is a best media of saving. In India, the Insurance policies carry a special exemption from income tax and excise duty. 7.All the needs of the individual such as family needs, old age needs, re-adjustment needs, special needs are helped by insurance for meeting requirements and necessary needs.
CHARACTERISTICS OF INSURANCE Nature of Insurance Sharing of Risks Co-operative Device Valuation of Risk Payment made on contingency Amount of Payment Large Number of Insured Persons Insurance is not Gambling Insurance is not charity Characteristics of Insurance It is a contract for compensating losses Premium is charged for Insurance contract. The payment of Insured as per terms of agreement in the event of loss. It is a contract of good faith It is a contract for mutual benefit It is an instrument of distributing the loss of few among many. The occurrence of the loss must be accidental Insurance must be considered with public policy
MEANING OF VALID CONTRACT A contract may be defined as an agreement between two or more parties to do or to abstain from doing an act, and which is intended to create a legally binding relationship. This could be summarized as an agreement designed to have legal consequences.
INSURANCE CONTRACT Like any other contract the contract of insurance must fulfill all the essential elements of contracts as laid down in the law of contract of Indian Companies Act, 1872. Insurance is a contract between two parties whereby one party called insurer undertakes, in exchange for a fixed amount of money on the happening of a certain event. At the same time the Insurance Contract must fulfill certain other elements relating exclusively to insurance which are known as Fundamental Principles The special contract of Life insurance involves the following principles:
1. Insurable interest 2. Utmost good faith 3. Material Facts
1. INSURABLE INTEREST
A person has an "insurable interest" in something when loss or damage to it would cause that person to suffer a financial loss or certain other kinds of losses. UTMOST GOOD FAITH Insurance contracts are based upon mutual trust and confidence between the insurer and the insured. Utmost good faith in insurance means that each party to a proposed contract is legally obliged to reveal to the other party all information which would influence the others decision to enter the contract, whether such information is requested or not MATERIAL FACTS Every circumstance is material which would influence the judgment of a prudent insurer in fixing the premium or determining whether he will take the risk There has been some criticism of the use of the term prudent underwriter and there has been a tendency to substitute reasonable underwriter in applying the rule. In some quarters it has been suggested that the view of the reasonable insured rather than a reasonable underwriter should be the test of whether a fact is material or not The test will be a view of a prudent or reasonable underwriter.
FACTORS AFFECTING LIFE & HEALTH CONSUMPTION A life insurance policy is an agreement between you and your insurance company. An agreement cannot take place without the consent of both the parties involved in the contract. You will be charged premiums based on how you are rated on several pre-determined factors - "Health" being one of the major factors the health of the applicant attracts special attention. Medical examinations are carried out to learn more about your medical profile Learn how health and life insurance are related and why the words "Better Health, Lower Rates" are so meaningful Your age is also a factor in the cost of life insurance. If you want to attract lower insurance premiums then you might consider insuring yourself at a younger age.
INSURANCE DOCUMENTS AND CONDITIONS The life insurance contract is a long-term one, lasting 30 or 40 years. Transactions may be few and far between. If the premiums are paid without any default and no changes are made in address, nominations, etc., the policy file may not be opened till the claim arises. In the absence of proper documentation, it may not be possible to know the dues and the rights or even the identities of the persons concerned.
PROPOSAL FORMS AND OTHER RELATED DOCUMENTS The first and the foremost document in the insurance file is the proposal or application for insurance. The proposal form in which the application for insurance are made, is printed by the insurer and made available through agents. Some companies make the proposal form available through the Internet. The person proposing for insurance, called the proposer, is required to give details about himself (name, date of birth, address, and occupation), name and particulars of the person to be insured, the amount of insurance, the plan and term preferred, mode of premium, nominee, etc. The proposal form is normally given to the insurer along with (i) the personal statement of health and habits of the person to be insured, filled up by the proposer and (ii) the confidential report of the agent. If medical examination is required, the personal statement is given to the medical examiner, which sends it the insurer along with his report of the medical examination.
PROSPECTUS
In life insurance, the prospectus gives complete details about the set up of the company, the plans of insurance they make available and other general terms and conditions. The prospectus of the life insurance company is not bound by the regulations of the SEBI. It is quite simpler in content and in the purpose. In terms of the IRDA Regulations, the prospectus should state details of the various insurance plans on offer, the benefit and other terms and conditions, whether the policy is participating or not participating, the riders available along with that policy and the scope of the riders. A prospectus is not necessarily a single book containing all details of all the plans under offer. Some insurers print separate pages for each plan describing the benefits and obligations and also a summary of the terms and conditions of the particular policy. MEDICAL EXAMINATION The individual proposed to be insured, is normally subject to medical examination to determine the state of health and the terms of insurance if agreed upon. The rigor of the medical examination increases along with that of the age increase of the person to be insured and the proposed SA. Increasing rigor means more specialized tests like radiology, sonography, ECG, stress test, lipid profile, etc AGE PROOF The risk of death is higher as age increases. The likelihood that a person aged 70 will die in the next year is more than that of a person aged 20 years dying within one year. Age of the proposer, therefore, plays a vital role in assessing the risk of death and therefore the amount of premium to be charged. Age is considered along with other features like health, habits, etc., by the underwriter.
SPECIAL REPORTS Besides the proposal form, personal statement, agents report, medical examiners report and age- proof, special medical reports may also be called for, if the following conditions are applicable: The SA is very high, say Rs. 15 Lakhs or more The age at entry is very high, say, 60 years or more The proposer wants insurance cover under a high- risk plan The normal medical examination discloses some adverse feature
POLICY DOCUMENTS The policy document is the main evidence of the insurance contract. It contains the subject matter and the terms and conditions of the contract. It sets forth the rights, the duties and obligations of the insurance company and of the policyholder. All insurance policies are most likely to follow the similar format, because the format and the wordings have been developed over the years. The wordings may sound to be too legalistic. Some insurers therefore, issue a small supplement along with the policy to explain in simple language the main contents of the policy. NEED AND FORMAT The policy document is required to be signed and also stamped as per the Stamp Act. Otherwise, it cannot be enforced in a court of law. In the case of PLI, the policy is exempt from stamp duty. Most of the standard terms and conditions are printed on the document. Special clauses, relevant to a particular contract, are attached to the policy document and form part of the contract.
It is usual to divide the policy document into the following divisions: Preamble Alteration Duplicate policy Schedule Attestation and Conditions and Privileges
POLICY PREAMBLE A typical policy document begins with a paragraph, which states in the following substance:
That the insurer had received a proposal with a personal statement and the first installment of premium That the insurer had agreed to grant the insurance cover (promise to pay the sums specified on the occurrence of the events specified) on the terms stipulated later in the policy document That it is understood and agreed that the basis of the grant of the insurance cover is the statements made in the proposal and personal statements signed by the proposer That the grant of the insurance cover is subject to the proposed paying the premiums stated in the policy document on the due dates
SCHEDULE The Preamble is followed by the Schedule of the policy. The Schedule contains particulars and details as under, which mention the specific details relating to the insurance contract, of which the policy document is the evidence.
Policy Number Name, address of the proposer and of the life assured Date of proposal Date of birth and age of the life assured Date of commencement of insurance Plan and Term Sum Assured Mode of payment of premium viz. yearly, half-yearly, quarterly or monthly and due dates Installment premium Date of last payment of premium Name of the nominee Date of maturity Conditions and privileges not applicable Additional or special conditions
ATTESTATION Attestation is the signature on the behalf of insurer. It will appear at the end of the first page of the policy. Some insurers prepare a supplementary contract in respect of the additional benefits provided through the riders. In such case, the supplementary contract will be attested separately CONDITIONS AND PRIVILEGES The provisions of the contract which are stated in the first page of the policy, if strictly interpreted, would make the contract very rigid and hard on the policy holder. For example, premiums are payable when they fall due and failure to pay premiums on or before the due date, would involve complete forfeiture of the assurance. The policy conditions provide the following, which reduce the apparent severity of the contract. Days of grace Revival of lapsed policies Non-forfeiture regulations Paid up provisions Surrender value Loans Claim concessions All the privileges are discussed in detail in the following chapters.
ALTERATIONS
The policy document embodies the terms of the contract. These terms continue to operate throughout the currency of the policy unless it is modified by mutual consent of the parties to the contract, viz the policyholder may desire alterations in the terms of the contract to suit changed circumstances The types of alterations for which requests are normally made are as follows: Alteration in plan or term Reduction in SA Change in mode of payment of premium Alteration in name Change of the nominee Removal of an extra premium. Splitting up of policy into two or more policies Alteration from without profit to with profit plan or vice versa Grant of accident benefit Settlement option of payment of SA by installments Grant of premium waiver benefit Correction in policies (generally soon after commencement)
DUPLICATE POLICY During the long duration of the policy term, people may shift residences and rearrange personal belongings. It is possible that after some years, the policy document is not found, having been misplaced or lost. Sometimes the document may also get damaged due to moisture or termites. The loss or damage does not absolve the insurer of his liability to pay the policy moneys, when the claim arises. The claim, in such cases, may be paid to the claimant even without the policy document. But the policyholder might want the document for making an assignment or for pledging it against a loan. After all, a policy document represents property.
GROUP INSURANCE
INTRODUCTION Group Insurance is a plan of insurance that provides cover to a large number of individuals under a single policy called the master policy. The individuals covered under the master policy are not parties to the contract The contract will be between the insurer and the body that represents the group of individuals covered This body may be the employer, who is interested in obtaining benefits for his employees through insurance The body may be association of individuals through whom the collective interests of the individuals are safeguarded, like a trade or professional association
GROUP INSURANCE IN INDIA In India the development of group insurance has taken place since that of the early 1960s. Before which the group insurance business was very little. Originally, group insurance was restricted to employer-employee groups only. Since then the scheme has been extended to cover different groups, provided they are identifiable by homogeneous common attributes like profession, membership of a cooperative society, etc. The number of persons covered by group insurance policies is increasing at a faster rate than the individuals policies. New insurers find that they can reach larger numbers of people easier through group insurance.
NATURE OF GROUP INSURANCE In group insurance scheme, live covers in granted to a number of persons under one contract while individual insurance is between an individual and the corporation. It is single contract covering many lives in a group which is considered as a whole. Group Selection: Under a certain limit called Free Cover Limit life cover is granted without medical examination. Group Selection is aimed at obtaining a group of individual lives which contain reasonable average cross-section of risk from which practicable rates of morality could be expected. The group must have sufficient large individuals at different risks. GROUP INDURANCE VS INDIVIDUAL INSURANCE GROUP INDURANCE INDIVIDUAL INSURANCE 1) In the case of group insurance, the contract is with the employer or with the group / association. A single master policy is issued covering all the members. The individuals covered under the master policy are not parties to the contract. They are only the beneficiaries. The amount and terms of insurance are negotiated by the employer or group, and apply on a uniform basis to all members In the case of individual insurance, the contract is between the insurer and the individual policyholder. The individual decides whether he should be insured, for how much and under what plan. The individual pays the premium and has the right to seek termination or alteration of the contract CONTI.. 2) The premium has to be paid by the employer or group to the insurer The premium has to be paid by the individual to the insurer 3) Group insurance is provided only to groups, which have been formed for reasons other than obtaining the insurance coverage. Entry into and exits from the groups will have to be for reasons unrelated to the insurance cover. Employees join or leave an organization for reasons unrelated to the insurance cover provided by the organization Individual insurance is provided only to individual , which have been formed for reasons other than obtaining the insurance coverage. Entry into and exits from the individual will have to be for reasons unrelated to the insurance cover 4) The master policy will stipulate the extent of insurance cover available to each member. The member will not have a choice about the extent of this cover. That would have been fixed on the basis of some objective criterion, like the earnings, the seniority The individual policy will stipulate the extent of insurance cover available to individual . CONTI.. 5) The premium is received in one lump sum from the group covering the entire group. The costs of administration would naturally be low. Therefore, the premium charged in group policies tends to be lower than in the case of individual policies The premium is received from individual high compare with group insurance. The cost of administration would naturally be high. 6) The premiums charged on a group policy vary from year to year. This is because of the new entrants into the scheme as well as exits due to retirement, death, etc. The premiums will also be changed according to the mortality experience of the group. The premiums charges on a individual policy fixed. TYPES OF GROUP INSURANCE Initially the LIC had offered three major Group Term Insurance Schemes, to employers covering employee benefits. 1. The Group Insurance Scheme (Term) 2. Group Gratuity Scheme 3. Group Superannuation Scheme or Group Pension Scheme THE GROUP INSURANCE SCHEME (TERM)
THE GROUP TERM INSURANCE SCHEME IS A TERM INSURANCE SCHEME RENEWABLE EVERY YEAR. THIS IS THE SIMPLEST AND CHEAPEST OF THE SCHEMES. A FIXED SUM IS PAID ON THE DEATH OF A MEMBER COVERED UNDER THE SCHEME. THIS SCHEME IS FOUND USEFUL BY EMPLOYERS, TO HELP EMPLOYEES WHO DIE YOUNG, WITHOUT HAVING ACCUMULATED ENOUGH SAVINGS
GROUP GRATUITY SCHEME
The trustees may not have as much expertise in the investment of funds as the insurer may have The insurer, with its massive portfolios, is in a better position to secure maximum benefit from the market, in terms of protection from fluctuations as well as better spread, than an individual trust with its relatively small portfolio can do The benefit of the group term insurance, given by an insurer will ensure that families of employees dying early get the same gratuity as if the employee had completed the full term of service. The insurer has actuarial skills to evaluate the adequacy of the fund from time to time.
SOCIAL SECURITY SCHEMES In India, group term insurance cover is made available to poorer sections of society like landless agricultural laborers, handloom workers, rickshaw pullers, village artisans, etc. with the help of social security fund. In case of death of any member a prescribed sum, say, Rs. 5000 is paid to the dependants. This amount is doubled if the death is by accident. The premium is financed either wholly or partly, by the Central Government. Other weaker sections of society like co-operative milk producers, tailors, barbers, masons, carpenters etc. are also covered by Group Social Security Schemes.
ANNUITIES Annuity may be defined as the payment of amounts periodically during the life time of the annuitant in consideration of the payment of an agreed sum to insurance company CLASSIFICATION OF ANNUITIES A. By Commencement of Income:
Immediate Annuity. Annuity Due. Deferred Annuity.
B. By Number of Lives Covered:
Single Life Annuity. Multiple Life Annuity.
C. By Mode of Payment of Premium:
Level Premium Annuities. Single Premium Annuities.