Pce Ceilli

PRE-CONTRACT EXAMINATION
(PCE) TUTORIAL
保险代理员约前考试复习
ALLIANZ ACADEMY
FEBRUARY 2021
Highly Confidential
© Copyright Allianz SE
COURSE • Understand key contents of PCE.
理解考试的重点内容
OBJECTIVE • Increase passing rate!
增加及格率
课程目标 • Reminder on things to bring:
需要携带的物品
A. Identity Card
身份证
B. Exam Permit
准考证
PCE Tutorial | Allianz Academy

© Copyright Allianz SE 19-Feb-21 2
PCEIA (AC)
COURSE Part A: (Chap 1-6) –50 questions
OBJECTIVE Part B: (Chap 7-10)
Part C: (Chap 11-16) –50 questions
课程目标 PCIL
Part A: (Chap 1-6) –40 questions
Part B: (Chap 7-10)
Part C: (Chap 11-16) –30 questions
Part D: (CEILLI) –30 questions
Passing rate: 50%

CONTENT
05
RISK & INSURANCE LAW OF AGENCY
TOPICS
01 风险与保险代理法则
BASIC PRINCIPLES OF MEDICAL & HEALTH
02 INSURANCE
保险基本原则 06 INSURANCE
医药与保健保险
LEGISLATION & CONSUMER LEGAL ASPECTS OF LIFE
03 PROTECTION
法规与消费人保障 11 INSURANCE
寿险的法律层面
12
THE INSURANCE CONTRACT LIFE INSURANCE PRODUCTS
04 保险契约寿险产品

CONTENT LIFE INSURANCE PREMIUM
TOPICS
13 RATING
寿险的保费定价
LIFE INSURANCE
UNDERWRITING &
14 DOCUMENTS
寿险的核保与文件
LIFE INSURANCE CLAIMS
15 寿险的索赔
CODE OF PRACTICE FOR
16 LIFE INSURANCE AGENTS

寿险代理员的行为准则

THE BASICS OF INSURANCE
保险基本知识
A
RISK & INSURANCE
第1章风险与保险

01
1.1 MEANING OF RISK 风险的定义
Hazard, danger, chance of loss / injury

风险是指危害、危险、发生损失或伤害的机率
A person, thing, or factor likely to cause loss / danger.
可能造成损失的人物、事件或因素
PCE |Tutorial
Learning & Development
| Allianz Academy Department
1.1 MEANING OF RISK 风险的定义
Probability of loss Exposure to danger

损失的可能性 Subject matter of 暴露于危险
insurance
保险主旨
| Learning
PCE Tutorial & Development
1.2 TYPES OF RISK 风险的分类
PCE
PCE|Tutorial
Learning & Development
| Allianz AcademyDepartment
1.2 TYPES OF RISK 风险的分类

1.3 PERIL, HAZARD, AND LOSS 损失因素、危险因素和损失
PERIL Legal Hazard 法律
损失因素
Cause of a loss Moral Hazard 道德
造成损失的导因
Physical Hazard 实体
HAZARD
危险因素 LOSS
Condition which 损失
increases chance of Reduction or disappearance
a loss of economic value
增加损失机会的情况经济价值的减少或消失

1.4 RISK MANAGEMENT 风险管理
3 Steps of Risk Management: 风险管理过程涉及三个基本步骤
IDENTIFY ANALYSE CONTROL

鉴定分析控制

1.5 RISK HANDLING METHODS 风险处理法
Prevent 预防
Retain 保留
Avoid 避开
Control 控制
Transfer 转移
1.6 INSURANCE VS. TAKAFUL 保险与回教保险

1.6 INSURANCE VS. TAKAFUL 保险与回教保险
TAKAFUL
• An alternative form of insurance
保险的另一个选择
• Takaful means “to protect / guarantee”
回教保险的意思是保护或保证
• Based on Shariah principles
根据伊斯兰回教法
• Shariah principles of mutual assistance & Islamic principles (Mudharabah

– profit & loss sharing; Tabarru – Donations)

1.7 FUNCTIONS OF INSURANCE 保险的功能
1. Risk Transfer Mechanism 风险转移
• For protection, insured pays premium to insurance company, and transfers
risk of loss to insurer.
受保人支付一笔保费予保险公司以换取保障，并将损失与损伤的风险转移至保
险公司.
• Uninsured 未投保
 Not insured. 没有投保
• Underinsured 投保不足
 Sum assured purchased is insufficient to cover loss. 保险金额购买不足以
支付损失

2. Calculation of Equitable Premiums 合理保费
Premium contributed by each insured has to be equal to the risk brought to the
pool.
投保人应缴付的保费将根据他带给该基金的风险程度而定
3. Creation of Common Pool 共同基金

Class of portfolio (eg., fire pool)
保险公司通常以业务类别区基金，比如火患基金

结合保费
投保者
保费索赔
开销及其他支出
利润

1.8 BENEFITS OF INSURANCE 保险的益处
• Peace of Mind / Security 安枕无忧
• Compelled Savings (retirement / old age) 强迫储蓄
• Financial Protection 财务保障
• Cost Stabilization 稳定成本
• Loss Control 损失控制
• Social Benefits 社会效益
• Creation of Employment 创造就业机会
• Capital for Investment 投资资本

1.9 NATURE OF INSURABLE RISKS 可受保风险
Inevitable events
不可避免的事件
Uninsurable
risks
Deliberate acts with
fraudulent intention Gradual damages
蓄意的行为，并存在渐进式损坏
欺诈意图

What Are Insurable Risks? 什么是可受保的风险？
• Fortuitous (random) / Accidental 偶发性
• Financial Value 存有经济价值
• Pure Risk & Particular Risk 纯风险和特殊风险
• Insurable Interest 保险利益
• Public Policy 公共政策
• Homogeneous Exposures 大量同质风险

Similar
Characteristics
同质或相似风险
Random Independent
Occurrences Loss
of Loss Exposures
随机发生的损失 Individual Loss 独立的损失风险
Exposure 个人损失
风险

Law of Large Number 大数字定律
1.10 LIFE & GENERAL INSURANCE 寿险与普通保险
Life Insurance 人寿保险
• Covers human life. 保障人命
- Compels savings for retirement & old age.
强迫个人为退休及年老生活而储蓄
- Premature death / illnesses / disabilities.
过早死亡/顽疾/伤残
General Insurance 普通保险
• Covers all non-life risks. 保障所有寿险以外的风险
- Eg., motor property, marine insurance
如车辆、财产和海上保险

1.11 THE INSURANCE MARKET 保险市场
Consists of 包含:
Inter- Buyers
Sellers
mediaries中
卖方买方
间人

1.12 INSURANCE INDUSTRY PERFORMANCE 保险业的表
现
• 2012 Penetration Rate 2012年保险穿透率 : 54%
• 2016 Penetration Rate 2016年保险穿透率 : 55%
• Malaysian life insurance industry grew (2012) 寿险业增长: 3.6%
• Malaysian life insurance industry grew (2016) 寿险业增长: 16.2%
• New business total premium: 新生意的保费总额 :
2011 2012 2016

RM7.92 billion RM8.20 billion RM9.75 billion

SELF ASSESSMENT
1. What is insurance? 什么是保险？

a) It is a risk transfer mechanism 是风险转移
b) It prevents policyholders from risk 帮持保人远离风险
c) To make profit from the insured loss 从受保人的损失赚取利益
d) Involves risk management to reduce the probability of loss
风险管理为了减少损失的可能性
Answer : A

SELF ASSESSMENT
2. Which of the following is the condition which increases chance of a loss?

以下哪个情况会增加损失发生的机率？
a) Peril 损失因素
b) Hazard 危险因素
c) Loss 损失
d) Risk 风险
Answer : B

SELF ASSESSMENT
3. Which of the following are the characteristics of insurable interest?
以下哪个是保险利益的特性
i. Insurable interest 保险利益
ii. Homogeneous exposures 大量同质风险
iii. Pure risk 纯风险
iv. Particular risk 特定风险
v. Fortuitous 偶发性
a) i & ii Answer : D
b) i, iii & iv
c) iii, iv & v
d) All of the above

SELF ASSESSMENT
4. Which of the following is the least effective approach to handling risks? 以下哪项
是处理风险的最无效方法？
a) Avoiding the risk 避开风险
b) Transferring the risk 转移风险
c) Retaining the risk 保留风险
d) Ignoring the risk 忽视风险
Answer : D

SELF ASSESSMENT
5. What does Mudharabah in Takaful mean? 在回教保险里的Mudharabah是什么意
思？
a) Interest 利息
b) Profit and loss sharing 损益分享
c) Donation 捐助
d) Mutual assistance 互助
Answer : B

BASIC PRINCIPLES OF INSURANCE
第2章保险基本原则

02
2.1 BASIC PRINCIPLES OF INSURANCE 保险六大基本原则
Utmost Good
Insurable Interest Indemnity
Faith
保险利益填补损失
至高真诚
Subrogation Contribution Proximate Cause

代位求偿分摊直接原因
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2.2 UTMOST GOOD FAITH 至高真诚
Uberrima Fides 秉持至高真诚
• The duty to deal honestly & openly with each other.
诚实及开诚布公对待彼此的责任
Caveat Emptor (let the buyer beware)

买者自负（买家当心）
In commercial contracts, there is no need for parties to disclose information not
requested, as each party is expected to make best bargain.
在商业合同，当事人没有必要披露没有被请求的信息, 因为每一方都有望促成最便
宜的交易。
Proposal Form 要保书
• Include specific questions to elicit information
包含特定问题为了收集相关资料
• Expressly request insurance applicant to disclose any other relevant exceptional
circumstances.
明确要求保险要保人透露任何相关的特殊状况

Disclosure Requirements during: 透露要求

Disclosure Requirements during: 透露要求

Breach of Good Faith 违反至高真诚原则
Misrepresentation Non-Disclosure
误述不透露
Innocent Innocent
无恶意性无恶意性
Fraudulent
Fraudulent
欺诈性 (ie.concealment) 隐匿

Consequences of Breach 违反至高真诚原则的后果

Financial Services Act 2013 (FSA) Schedule 9
2013年金融服务法令（FSA）附表9
• Consumer Insurance Contracts 消费者保险契约
- Entered by an individual 个人订立的保单
- If proposer fails to answer proposal form completely & insurer did not pursue
further, insurer is deemed to have waived requirement for disclosure, and
cannot subsequently reject claim on grounds of non-disclosure
如果要保人对要保书或承保人提出的问题给予不完整或不相关的答案，而事后承
保人没有进一步追究，承保人将被视为已放弃要求要保人履行该透露责任

• Non-consumer Insurance Contracts 非消费者保险契约
- Related to individual’s trade, business, or profession.
与个人从事的行业、生意及专业有关的合约
- Proposer have duty to disclose all relevant material facts even when specific
questions are not asked in proposal form.
要保人必须透露所有相关重要事实，即使要保书内不含或无提出的特定问题

•Non-consumer Insurance Contracts 非消费者保险契约
− However disclosure is not required in matters that:
尽管如此，在该透露责任下无须透露：
1. Reduces risk to insurer 使承保人风险降低的事实
2. Common knowledge 一般常识；
3. Insurer already know / should know
承保人知道的事实或者进行业务时应该知道的事实；或
4. Insurer already waived requirement for disclosure
承保人放弃要求透露的事实

2.3 INSURABLE INTEREST 保险利益
• The legal right to insure, arising from a legitimate financial interest which the
insured has in the subject matter of insurance.
保险利益是指投保人对其保险主旨中的合法财务利益投保的合法权利。合法财务
利益是指受法律认可的财务利益。
• To prevent moral hazard.
为了防止道德危险因素

In life insurance, a person has insurable interest in:
在寿险，一个人对以下几项拥有保险利益：
- Own life (to an unlimited extent)
对本身的生命（无限的保险利益）
- His/her spouse, child, or ward
他的配偶、子女或未成年的被监护人
- His/her employee
他/她的雇员
- A person whom he/she is wholly/partially dependent on for
maintenance/education (at time of insurance)
保单开始生效时，完全或部分依靠他生活或受教育的人士

When must it exist? 何时需有保险利益存在?
At Inception At Claim
申请投保时面临损失时
Life Insurance 人寿保险 
General Insurance 普通保险  
Marine Insurance 海上保险 

Subject Matter of Insurance 保险的主旨
Subject Matter of Insurance Contract

• Financial interest of the insured in the subject matter of insurance
一

Assignment 转让
• Transfer of rights & liabilities from one person to another.
转让是将权利和责任转移给另一个人
• Assignor
转让者
• Assignee
被转让者
• Prior consent of insurer is needed for assignment to be valid.
承保人的事先同意是使转让生效的必需条件

2.4 INDEMNITY 填补损失
• Insurer is required to restore the insured to the same financial position
immediately before the loss
填补损失原则要求承保人恢复投保人的原本经济状况（在损失发生之前所享有的
状况）
• The insured (after being indemnified) shall NOT receive more compensation
than before the loss.
投保人在获得赔偿后，情况不会比损失前更好

• Example
worth
ALLIANZ RM250,000
Insurance
Building
ABC
UP TO
RM250,000

• General insurance are contracts of indemnity, because subject matter of
insurance is measurable in terms of monetary/replacement value.
普通保险是填补损失的契约，这是因为其保险主旨可用金钱或替换值来衡量

2.5 SUBROGATION 代位求偿
• Allows insurer to take over insured’s legal rights to recover from a negligent 3rd
party responsible for loss.
代位求偿提供权力予承保人，在赔偿投保人后接下投保人的法律权利，向导致有
关损失的第三者要求赔偿。
• To prevent the insured to recover loss from more avenues.
确保投保人不能从多种途径中索取比损失更多的赔偿金
• Supports principle of indemnity, reduces insurers’ cost of claims, penalize
wrongdoer.
支持填补损失原则，降低承保人的索赔成本和惩戒犯错者

Example:
ALLIANZ
Insurance

© Copyright Allianz SE 19-Feb-21 CAR A CAR B 53
Under contract
根据合同
Subrogation rights Common law

may exist at 普通法
代位求偿可能存在于
Salvage
打捞

2.6 CONTRIBUTION 分摊
• Supports principle of indemnity.
分摊也是一种填补损失
• Allows insurer to call upon other insurers liable for the same loss to contribute
proportionately to the cost of indemnity payment.
当一宗损失有两份或以上的保单来承担时，负责赔偿的承保人可基于分摊原则，
要求其他对同样损失具有法律责任的承保人按比例分摊有关赔偿金
• Obliged to claim against all the insurers
有权根所有保险公司索赔

• Conditions: 列条：
- In force at time of loss
发生损失时
- Cover common interest
保障同样的利益
- Cover a common peril
保障同样的风险
- Same subject matter
保障的相同主旨
- Legally enforceable
具有法律效力

Example:
ABC
Building Insurance
Insurance
Co. A Co. B
paid paid
50% 50%
of loss of loss

2.7 PROXIMATE CAUSE 直接原因
• The dominant / main / original cause of loss.
近因原则适用于鉴定损失的主要或有效原因
- Example:
Heart Attack Car Accident Drown
Proximate Cause?
Heart Attack
Death

Successive Causes 并存原因
• 2 or more perils operate one after another (ie., direct chain of events)
有两个或以上的风险可能并存(即同时)
- If original cause is insured peril = liability
如果主要的原因是被保的风险，承保人有责任
- If original cause is excluded peril = NO liability
如果主要的原因是被排除在外的风险，承保人完全不承担任何责任

Example: Mr. A bought insurance that covers car accidents & death
Heart Attack Car Accident Drown
Proximate Cause? 直接原因
Insured Peril? 受保风险

Uninsured Peril? 不受保风险
Claimable? 可索赔？ Death
Accident 意外
© Copyright Allianz SE 19-Feb-21 Death 死亡 61
Concurrent Causes 后续原因
- 2 or more perils operate simultaneously to bring about loss.
当一连串原因一个接一个发生，而造成事故和损失

SELF ASSESSMENT
1. In life insurance, insurable interest must exist 寿险必须有保险利益在

a) At time of inception 买保险时
b) At time of loss 损失时
c) At time of inception & time of loss 买保险时和损失时
d) During the currency of the policy 保单运行时
Answer : A

SELF ASSESSMENT
2. In the concept of contribution, if an individual bought more than 1 policy and met
into an accident, he/she will be payable through?
在分摊的概念，一个人买超过一份保单发生了意外，他/她会得到赔偿通过？
a) Ratios divided by companies 公司分别的百分比
b) Only from 1 company 只从一间公司
c) Once the payment has been made by 1 company, the rest of the companies
will pay the balance 如果一间公司给了，其他公司会给余额
d) Policy owner makes the decision to choose which company to pay
持保人选择从哪一间公司索赔
Answer : A

SELF ASSESSMENT
3. Why is indemnity a principle in insurance contract? 为什么填补损失是保单的原则？
a) Allows the insurer to commence a recovery action before it pays a claim
允许保险公司在给出索赔前有一个恢复动作
b) Allows the insurer to take over the insured’s legal rights to recover from a negligent
third party responsible for the loss
允许保险公司接管受保人的法定权利从疏忽的第三方索赔
c) Requires insurer to restore the insured to the same financial position
要求保险公司恢复受保人到原本的经济位置
d) Ensure that the insured receive more than the loss 确保受保人得到比损失更多
Answer : C
SELF ASSESSMENT
4. The proximate cause of a loss is always ______. 造成损失的最直接原因总是_____
a) The dominant cause. 主要原因
b) The cause nearest the loss in time. 最接近时间损失的原因
c) The cause nearest the loss in distance.最接近距离损失的原因
d) An insured peril. 受保风险
Answer : A
SELF ASSESSMENT
5. Which one of the following statements is TRUE about existence of insurable
interest? 关于保险利益的存在，以下哪一项陈述是正确的？
a) For life insurance, insurable interest need to exist at the beginning and during the
time of los. 对于人寿保险，保险利益必须在投保开始和损失期间存在。
b) For marine insurance, insurable interest only need to exist at the beginning of
submission. 对于海上保险，保险利益只需要在投保开始时就存在。
c) For general insurance, insurable interest need to exist at the beginning or during
time of loss. 对于普通保险，保险利益只需要在投保开始或损失期间时存在。
d) For a husband to buy life insurance on his wife‘s life, insurable interest only need
to exist at the beginning. 要让丈夫购买妻子一生的人寿保险，保险利益只需要在开始
时就存在
Answer : D
SELF ASSESSMENT
6. Mr Ahmad had fully claimed from his own insurer, however, he also requested the
third party (the one who caused the loss) to reimburse his loss. Mr Ahmad has
breached the principle of _____. Mr Ahmad 已向自己的保险公司提出全额索赔，但他
还要求第三方（造成损失的一方）偿还损失。 Mr Ahmad违反了_____原则。
a) Subrogation 代位求偿
b) Contribution 分摊
c) Indemnity 填补损失
d) Assignment 转让
Answer : A
LEGISLATION &
CONSUMER PROTECTION
第3章法规与消费人保障

03
3.1 INSURANCE LEGISLATION 保险法规
Historical Development & Changes in Equity
历史发展和权益变动 Minimum paid-up capital / surplus of assets over
liabilities prescribed by the Act 实收资本/盈余资
产超过负债的最低法律规定
Insurance Act 1963 Local / foreign direct insurers & local pro RM100 mil.
1963年保险法令管制 general reinsurers
Local pro life reinsurers RM50 mil
Insurance Act 1996 Foreign pro life & general insurance RM20 mil
Insurance brokers RM500k
1996年保险法令 Adjusters RM150k
Insurance (Amendment) Act 2005

2005年保险法令（更动）
Financial Services Act

(FSA) 2013
© Copyright Allianz SE 19-Feb-21
2013年金融服务法令 70
Banking & Financial
Islamic Financial Services Act

Institutions Act 1989 (BAFIA)
Financial Services Act*

1989年银行与金融机构法令
Islamic Banking Act 1983
(FSA) 2013
(IFSA) 2013
Exchange Control Act 1953 (IBA)
(ECA) 1953年外汇管制法令 1983年伊斯兰银行法令
Insurance Act 1996

Takaful Act 1984
1996年保险法令
1984年回教保险法令
Payment Systems Act 2003

(PSA) 2003年支付系统法令

• Primary objectives of FSA & IFSA:
 Clarity & transparency in BNM administration
国家银行在管理方面体现更大的清晰度和透明度
 Clear focus on Shariah compliance & governance
符合伊斯兰教教义与治理
 Regulate financial holding companies & non-regulated entities
规范金融控股公司及非受规管实体的条款
 Strengthen business conduct & consumer protection requirements to
promote consumer confidence
加强商业行为和消费人保护的要求，促进消费人的信心

Role of Central Bank of Malaysia (BNM)
马来西亚中央银行（马来西亚国家银行）的角色
• Key regulatory objectives of BNM in insurance sector:
国家银行对保险业的主要监管目标：
1. Foster fair, responsible, professional business conduct of financial institutions
促进公正、负责和专业的金融机构商业行为
2. Strive to protect rights & interests of financial consumers
致力于保护金融消费者的权利与利益
3. Promote monetary & financial stability conducive to sustainable economy
growth
促进货币与金融稳定以利于经济的可持续增长

Role of Central Bank of Malaysia (BNM)
马来西亚中央银行（马来西亚国家银行）的角色
4. Monitor solvency & market conduct to enhance professional standards &
consumer confidence
密切监督偿债能力和市场行为以提高保险业的专业水平和消费者信心
- Risk-Based Capital (RBC) Framework
风险为基础的资本架构
- Capital Adequacy Ratio (CAR)
保险公司之资本充足率

3.2 COMPANIES ACT 1965 1965年公司法令
Objective 宗旨：
• Regulates the formation, registration, incorporation, management, and
dissolution of companies in Malaysia.
管制马来西亚所有的公司之组成、注册、成立、管理与解散
• Governed by Companies commission of Malaysia (CCM) / Suruhanjaya Syarikat
Malaysia (SSM)
由马来西亚公司监管委员会（CCM)/（SSM）管理

3.2 COMPANIES ACT 1965 1965年公司法令
2 Types of Companies
公司可分为两种
COMPANY LIMITED BY UNLIMITED COMPANY

SHARES 股份有限公司无限公司
Private
Public Company
Company (“Sdn.
(“Bhd.”) 公众公司
Bhd.”) 私人公司
3.3 MALAYSIA DEPOSIT INSURANCE CORPORATION ACT 2011
2011年马来西亚存款保险机构法令
Perbadanan Insurance Deposit Malaysia (PIDM)
马来西亚存款保险机构
• A statutory body to administer national deposit insurance system
负责管理国家存款保险制度的法定机构
• PIDM membership is compulsory
强制注册成为PIDM成员

3.3 MALAYSIA DEPOSIT INSURANCE CORPORATION ACT 2011
2011年马来西亚存款保险机构法令
Perbadanan Insurance Deposit Malaysia (PIDM)
马来西亚存款保险机构
• Objective 宗旨：
- To protect depositors
保护投保人
- PIDM provides safety net to
一旦成员机构不幸倒闭
- Depositors = <RM250k
存户= <RM250,000
- Takaful certificate & insurance policy owners = < RM500k
回教保险凭证和保险持保人= <RM500,000
3.4 FINANCIAL CONSUMER LITERACY & EDUCATION
金融消费者的知识与教育
Consumer Education Programme (CEP)/“Insurance Info”
保险与回教保险消费者教育计划（CEP）“保险资讯”
• Joint effort between BNM and Insurance & Takaful industry
马来西亚国家银行和保险与回教保险业联办
• To enhance financial literacy & awareness
提高公众的金融知识和醒觉

3.4 FINANCIAL CONSUMER LITERACY & EDUCATION
金融消费者的知识与教育
Consumer Education Programme (CEP)/“Insurance Info”
保险与回教保险消费者教育计划（CEP）“保险资讯”
• Key Objectives: 主要宗旨
- Make well-informed decisions
做出明智的决定
- Select products that best meet their needs
挑选最能符合需求的保险产品
- Understand their rights & responsibilities
了解本身作为消费者的权利与责任

3.5 FINANCIAL CONSUMER COMPLAINTS & DISPUTES
金融消费者的投诉与纠纷
Steps to make a complaint?
Complainant State
lodge written Sort details in
essential sensible order
complaint to information
company 安排资料
提供资料
书写投诉信
Allow respond 2-4WW Company must 2WD

time for provide written Submit to
complainant acknowledgement complaint unit &
等待回复公司提供书函 keep original
documents
6 Mths
提呈给投诉服务部
门,保存原档案
No Response: Unsatisfied:
“No Further Action”
Forward complaint to FMB / BNM
无反应
不满意.上达去国家银行 81
Financial Mediation Bureau (FMB) 金融仲裁局
• Independent body that helps settle disputes
为独立机构，宗旨是协助解决金融消费者与其成员，即金融服务供应商之间的纠纷
• FMB members: 成员包括
- Licensed banking institutions in Malaysia 在马来西亚的持牌银行机构
- Licensed insurance companies & Takaful operators
持牌保险公司和回教保险经营者
- List of issuers of credit cards, charge cards, e-money, and remittance service
providers
名单中的信用卡、赊账卡、电子货币的发卡商以及汇款服务供应商

Complaints must be submitted within 6 months from the date of the

© Copyright Allianz SE 19-Feb-21 final decision 投诉必须在最终决定以后的六个月内提交 83
• Other types of complaints not handled by FMB
不处理的投诉种类
- Claims that exceed the limits
索赔额超出规定限额
- Pricing of insurance products / underwriting issues
保险产品的定价及核保问题
- Cases referred to court/ arbitration
已经或正提交至法院或仲裁庭
- Fraud cases 欺诈个案

BNMLINK
• Facilitate effective response in matters related to the financial sector
为马来西亚国家银行与广大群众之间的重要联系点之一
• Provides consumer financial education
为消费者提供金融教育

BNMLINK
•Types of complaints not handled by BNM: 不处理的投诉种类
1. Complaints referred to and/or decided by FMB
已提交至FMB的投诉
2. Cases referred to solicitors
FMB已作出裁决的投诉
3. Cases by institutions not under BNM’s supervision
涉及不受国家银行监督的机构之个案
4. Complaints made by agents against their principals
代理员对其主方的投诉或雇主
5. Matters not related to insurance / Takaful
其它与保险或回教保险无关的事项
3.6 PERSONAL DATA PROTECTION ACT 2010
2010年个人资料保护法令
• Regulates the processing of personal data in commercial transaction
负责监管商业交易中的个人资料的处理过程
• What is personal data? 个人资料

- Any personal info
商业交易中的任何个人资料
- Sensitive personal data
敏感性个人资料
- Expressions of opinion about a subject
个人的对某些观点的看法

3.6 PERSONAL DATA PROTECTION ACT 2010
2010年个人资料保护法令
• Purpose of PDPA: 目的
- Protect personal data from being misused
保护属于公众的个人资料，以免在商业交易中被滥用
- Protect sensitive data from being misused
保护敏感资料免受滥用
- Facilitate international trade
促进国际贸易
- Protect consumer rights
保护消费者权利

3.7 ANTI-MONEY LAUNDERING & ANTI-TERRORISM
FINANCING ACT 2001 (AMLATFA)
What is money laundering? 洗黑钱活动
• Illegal proceeds legalized through banking system to conceal money trail.
通过能避开审计追踪和匿名交易，使非法基金与其来源分离并融入正常经济体系
• Money laundering activities include:
1. Placement 处置
2. Layering 分层化
3. Integration 整合

Measures to prevent money laundering & financing of terrorism:
防止洗黑钱和恐怖主义融资活动
1. Record-keeping 保存记录
2. Suspicious Transaction Reporting (STR) 可疑交易报告
3. Financial Intelligence Unit
其职能为与国内及国外执法机构合作的金融情报单位
4. Investigation into money laundering activities 调查洗黑钱活动

Measures to prevent money laundering & financing of terrorism:
防止洗黑钱和恐怖主义融资活动
5. Freeze, seize, and forfeit terrorist property and property
执法机构冻结、扣押和充公恐怖分子的财产，以及涉及或来自洗黑钱和恐怖融资
犯罪行为的财产，并起诉洗黑钱者
6. Prohibition of falsification, concealment, and destruction of documents
禁止伪造、藏匿和销毁文件

3.8 COMPETITION ACT 2010 2010年竞争法令
• Restricting anti-competitive practices

遏制马来西亚的反竞争行为建立一个法律框架
• Applies to any commercial activity within/outside Malaysia
适用于任何在马来西亚境内和境外进行的商业活动（除了能源、通讯与多媒体领
域的活动）
• 2 main types of prohibition, against …
竞争法令实施两大禁令，即反对
- Anti-competitive agreements 反竞争协议
- Abuse of dominant position 滥用“主导地位”的企业

3.8 COMPETITION ACT 2010 2010年竞争法令
Malaysian Competition Commission (MyCC)
马来西亚竞争委员会
• To protect competitive process for the benefit of businesses, consumers, and
economy
保护竞争过程，以使商业、消费者和经济受益其中

SELF ASSESSMENT
1. Which is the objective of Perbadanan Insurans Deposit Malaysia (PIDM)?

哪个是马来西亚存款保险机构的宗旨？
a) Help settle disputes between financial consumers & financial service providers
who are its members 帮忙解决金融顾客和金融服务员之间的问题
b) Administer the national deposit insurance system aimed at protecting
depositors in commercial & Islamic banks
管理国家存款保险系统为了保护商业和伊斯兰银行的存户
c) Regulate the processing of personal data in a commercial transaction
管理个人资料在商业交易的流动
d) Keep a close watch on solvency & market conduct to enhance professional
standards 管理市场偿付能力和运行为了专业标准

Answer : B 94
SELF ASSESSMENT
2. Financial Services Act 2013 replaced which of the Acts below?

金融服务法令2013代替了以下哪个法令？
a) Takaful Act 1984 回教保险法令1984
b) Islamic Banking Act 1983 伊斯兰银行法令1983
c) Companies Act 1965 公司法令1965
d) Insurance Act 1996 保险法令1996
Answer : D

SELF ASSESSMENT
3. What is the role of risk-based capital? 风险资本架构的角色是什么？
a) Determine the Capital Adequacy Ratio (CAR) 确定资本充足率
b) Protect the rights & interest of financial consumers 保护金融客户的权利和利益
c) Promote financial stability in the economy 提倡经济的稳定
d) Strengthened business conduct & consumer protection requirements
让生意进行得更严谨和顾客保护需求
Answer : A

SELF ASSESSMENT
4. Which of below is NOT a complaint or dispute resolution mechanism for
financial consumers? 以下哪项不是解决金融消费者的投诉或争议的机构？
a) Financial Mediation Bureau (FMB) 金融仲裁局
b) Complaints Unit of an insurance company 保险公司的投诉单位
c) Malaysia Competition Commission (MyCC) 马来西亚竞争委员会
d) BNMLINK
Answer : C

THE INSURANCE CONTRACT
第4章保险契约

04
4.1 THE LAW OF CONTRACT 契约法律
• A contract is a legally binding agreement

契约是具有法律约束力的协议
• Recognized and enforced by the courts
具有法律约束力的承保协议

4.2 FORMATION OF INSURANCE CONTRACT 契约的订立
5 essential factors to form a valid contract:
订立一份有效的契约须具备的5大要素:-
1. Offer and Acceptance 献议与承受

2. Intention to Create a Legal Relationship
具有建立法律关系的意愿
3. Consideration 报酬
4. Capacity to Contract 立约能力
5. Legal Form 合法形式

a) Offer and Acceptance 献议与承受
• Can be made to one person, a group; either orally, in writing, or by conduct.
献议可通过书面、口头或行动来表达,来向一个人、一群人或全体公众提出献议
OFFER
Insurer
Insured ACCEPTANCE

a) Offer and Acceptance 献议与承受
• Counter offer 反献议
Exclusion or loading
COUNTER OFFER
Insurer Insured
ACCEPTANCE

b) Intention to Create Legal Relationship
具有建立法律关系的意愿
• Not considered a contract if parties have no intention for arrangements to be
legally binding
即使双方已达成了一项协议，但是若他们并没有意愿让该协议具有法律约束力，
则不会产生任何契约

c) Consideration 报酬
• Some right, interest, profit, or benefit to one party;
一方承受一些权利、利益、利润或益处
• Some forbearance, detriment, loss or responsibility given, suffered or
undertaken by the other
而另一方被给予、蒙受或承担一些负担、损害、损失或责任
Pay Premium
Insurer
Insured
Sum Assured & Benefit
• “Cash-before-cover”
保护前现金
d) Legal Form 合法形式
• Written documentation required by law.
法律规定的契约必须以书面形式.
e) Contractual Capacity 立约能力

• Depends on whether parties have full legal capacity to contract
契约的有效性取决于双方是否具有立约的法定能力

• Minors:
- Below age 16: Not competent
未满16岁：没有资格签订合同
- Aged 10-16: WITH written consent of parent / guardian
年龄介于10至16岁的未成年者，需父母或监护人的书面同意

4.3 VOID, VOIDABLE, AND UNENFORCEABLE CONTRACTS
无效、可使无效及不能实施的契约
Void Contract 无效的契约
• No binding effect
对任何一方均不具法律约束力
• Deemed void due to:
保险契约可能因下列原本被视为无效：
- No insurable interest 不具保险利益
- No “consensus ad idem” 没有“达成协议”
- Fraudulent misrepresentation / concealment 存在欺诈性误述或隐瞒
- Non-fulfillment of policy condition 无法完成保单条款

Void Contract 无效的契约
- Others: 其他
 Changes in law 更改法律
 Lack of contractual capacity 缺乏立约能力
 Violates fundamental principle and declared null by courts
违反基本原则，并由法院宣布无效

Voidable Contract 可使无效的契约
• A valid contract, but one/both party have the right to void it
它具有约束力，但是其中一方（或可能双方）有权将之搁置
• Voidable if: 契约可使无效，诸如：
- Misrepresentation, drunkenness, duress, or insanity
误述、醉酒、被迫或精神失常等
- Misrepresentation of material fact = terminated from date of breach
误述重大的事实而导致将从违约之日起终止。

Unenforceable Contract 不能实施的契约
• Valid but cannot be enforced in a court if one party refuses to keep the
agreement
如果其中一方拒绝协议，契约虽有效但是不能实施
• If parties do not perform the agreement, the court will not compel them
如果当事人不履行协议，法院不会强迫他们
• Such as defense to a claim
如防御索赔

4.4 PARTS OF AN INSURANCE POLICY 保险保单的组成部分

SELF ASSESSMENT
1. Which are the five essential factors for the formation of a valid contract? 以下哪
个是有效契约的五大要素？
i. Offer & acceptance 献议与承受
ii. Capacity to contract 立约能力
iii. Legal form 合法形式
iv. Consideration 报酬
v. Intention to create legal relationship 具有建立法律关系的意愿
a) i & ii
b) ii & iii
c) i, ii, iii & iv
d) All of the above Answer : D
SELF ASSESSMENT
2. What is a voidable contract? 什么是可使无效契约？

a) A breach of contract by one or both parties 一方或双方违约
b) A fundamental mistake rendering the contract void 基本的错误导致契约失效
c) A contract which is binding but either party has the right to set it aside
一份邦定契约任何一方有权弃权
d) One party’s legal incapacity to enter a contract 一方没有法定契约能力
Answer : C

SELF ASSESSMENT
3. What is the operative clause of an insurance policy? 什么是保单的实施条款？
a) The clause that described what the insured must do in the event of a claim
条款描述受保人在索赔时需要做的
b) The clause that describes or refers to the cover provided by the insurers
条款描述或显示保险公司提供的保障
c) The clause that describes the risks excluded from the policy cover
条款描述保单里不被受保的风险
d) The operating clause that refers to the proposer, the parties & the premium
实施条款显示投保人，有关各方和保费
Answer : B
SELF ASSESSMENT
4. Which of the following best describes an unenforceable contract? 以下哪项最能
描述不能实施的契约？
a) Legally binding even if one party refuses to keep to the agreement 即使一方拒
绝遵守协议也具有法律约束力
b) A valid contract but cannot be enforced in a court 有效契约，但不能在法院执行
c) A valid contract which is not illegal 有效的合法契约
d) A legal contract which is not binding 不具有约束力的法律契约
Answer : B
SELF ASSESSMENT
5. Which of the following does NOT form an integral part of an insurance policy?
以下哪项不构成保险单的组成部分？
i. Schedule 附表
ii. Proposal Form 提案表格
iii. Operative Clause 实施条款
iv. Attestation 证明
v. Exclusions and Conditions 除外条款和条规
a) i, ii, iii & iv
b) ii only
c) ii and iv
d) ii, iv and v Answer : B
LAW OF AGENCY
第5章代理法则

05
5.1 LAW OF AGENCY 代理法则
• Agent is a person who: 代理员
- Has the authority / power to act on behalf of another person (principal)
代表另一人行事，被代表的一方被称为“主方”
- Brings about a contract between principal and a 3rd person (financial consumer)
代理员的任务是促进主方和第三方缔结契约。该第三方在保险业被称为“金融消
费者”。

• Insurance agent is a person who:保险代理是：
- Solicits/obtains a proposal for insurance on behalf of an insurer
代表保险公司征求/收集保险提案
- Offers/assumes to act on behalf of an insurer in negotiating a policy
假设代表保险公司洽谈保单
- Does any act on behalf of an insurer in relation to issuance, renewal or
continuance of a policy
代表保险公司作执行任何关于发行，更新或继续一份保单

The relationship between principal & agent may come in 3 ways
主方与代理员之间的关系可透过下列三大方式建立:
a) Agency by Agreement 协议（委托）代理
b) Agency by Necessity 客观需要的代理
c) Agency by Ratification 追认的代理

5.2 DUTIES OF INSURANCE AGENT TO PRINCIPAL
保险代理员对主方的责任
• Obey principal’s instructions 服从主方的指示
• Exercise proper care & skill 运用适当的技能和谨慎
• Perform duties personally 亲自执行职务
• Act in good faith towards principal 对主方秉持诚信原则
• Account for monies received on behalf of principal 负起代表主方收取保费的责任
DUTY

5.2 DUTIES OF INSURANCE AGENT TO PRINCIPAL
保险代理员对主方的责任
If agent fails duties, principal may:
当代理员无法履行其职责时,主方可:
• Sue agent for damages from contract breach / illegal acts
起诉代理员赔偿违约损失
• Serious cases – dismiss agent without notice / compensation

若是严重违约行为，可在无给予通知或赔偿的情况下解雇该代理员
DUTY

5.3 DUTIES OF PRINCIPAL TO INSURANCE AGENT
主方对保险代理员的责任
• Pay agreed remuneration (ie., commission)
支付协定的报酬
• Indemnify agent 补偿代理员
- Reimbursement for agency duties
代理员在执行其代理职务时开销可获得补偿
DUTY

5.4 AUTHORITY OF AGENTS 代理员的职权
• Agents have been
Express Actual Authority
given right/power to
act on behalf of • Expressed instructions
principal. (oral / writing).
Actual Authority *
Authority
Apparent / Implied Actual Authority

Ostensible Authority*
• Authority to do anything which
• Agents have NO real authority is necessary to carry out
to do an act. expressed instructions.
• It only appears in eyes of 3rd • “Usual / customary authority”
party that they have such
authority.
* Principal is bound by BOTH authorities!

© Copyright Allianz SE 19-Feb-21 * Knowledge of insurance agent = knowledge of insurer. 124
5.4 AUTHORITY OF AGENTS 代理员的职权
• 代理员已被明示或
默许实际的权力代
明示的实际权力
表主方行事的权利 • 通过口头或书面授予明示的
或权力实际权力
实际权力
职权
明显权力* 默许的实际权力
• 进行明示指示时偶然或必须进
• 代理员根本没有真正的权力
行任何行为的权力
进行有关行为
• 也称为一般权力（或惯例权力）
• 在第三者看来，他们却具有
该权力
* 主方须对代理员进行其实际和明显权利的行为负责
© Copyright Allianz SE 19-Feb-21 *因此，该代理员的知识即被视为是承保人的知识 125
5.6 TERMINATION OF AGENCY 代理的终止
Principal-agent relationship may be terminated by:
主方与代理员的关系可因下列的实施而终止：
• Notice of revocation 主方给予代理员撤销通知 (principal  agent)
• Notice of renunciation 代理员给予主方放弃通知 (agent  principal)
• Completion of transaction 完成所授权的交易

• Expiration of period stipulated in contract 期限届满
• Mutual agreement 双方同意
• Death, lunacy, bankruptcy (of principal/agent)
主方或代理员逝世、精神错乱或破产
• Operation of any law which renders contract illegal
依据任何法律，代理员的契约为不合法
5.7 LIST OF PROHIBITED BUSINESS CONDUCTS
禁止进行的商业行为一览表
1. Engaging in misleading, deceptive conducts
涉及误导或欺骗性行为或陈述
2. Inducing/attempt to induce consumer to act /not act by:
通过下列方式诱使或企图诱使金融消费者：
• Making statement, forecast, or comparison that is misleading /false
作出误导、虚假或欺骗性陈述、说明、承诺、预测或比较
• Dishonestly concealing, omitting, or providing material facts ambiguously
以模棱两可的方式不诚实地隐瞒、忽略或提供重要事实

3. Exerting pressure, threatening, harassment, or physical coercion in relation to
the provision of any fsp to consumer
对金融消费者施加不当的压力、影响或使用或威胁、使用骚扰、胁迫或武力
4. Demanding payments from consumer for unsolicited fsp
要求金融消费者缴付尚未磋商的金融服务或产品之款项
5. Exerting undue pressure / coercing consumer to acquire any fsp as a condition
to acquire another fsp
胁迫金融消费者购买任何金融产品或服务作为得到其它金融服务或产品的条件

6. Colluding with any other person to fix / control fsp features to the detriment of
consumer
与任何其他人串通、操纵或控制任何金融产品或服务的条款或特点，以致有损任
何金融服务或产品，除非是已获银行批准的任何税率或保费率或保单条款。

SELF ASSESSMENT
1. What are the duties of an insurance agent to the principle?
保险代理员对主方的责任是什么？
i. Obey principle’s instructions 遵从主方的指示
ii. To exercise proper care & skill 运用适当的技能和谨慎
iii. To collect monies from policy owner & place into agency’s account
向持保人收取钱然后放进代理的帐号
iv. To act in good faith towards principles 对主方秉持诚信原则
v. To perform duties personally 亲自执行职务
a) i & ii Answer : C
b) i, iii & v
c) i, ii, iv & v
d) All of the above
SELF ASSESSMENT
2. Which of the following is not one of the three main ways through which the
relationship between principal & agent may come about?
以下哪项不是确定主方和代理员之间的关系的3个方法？
a) Consent 同意
b) Authority 协议
c) Ratification 追认
d) Necessity 客观需要
Answer : A

SELF ASSESSMENT
3. Apparent/ostensible authority can arise in cases below, except:
明显权利只会在以下情况发生，除了：
a) Agent perform acts which are usually performed by persons in the agent’s
position 代理员执行平时代理员的职责
b) Unknown to the third party, the authority of the agent has been terminated
被开除的代理员执行了，第三方却不知道该代理员被开除了
c) Apparent agent has never been appointed at all 没有这方面的代理员
d) Principle has restricted the authority of a validly appointed agent 主方限制在职
的代理员的权限
Answer : A

SELF ASSESSMENT
4. How is the relationship between an insurer and an agent created? 保险公司与代
理员之间的关系是如何建立的？
i. By agreement or consent 通过协议或同意
ii. By ratification 通过追认
iii. By necessity通过客观需要
iv. By statute 通过该法规
a) i, ii & iii
b) i & ii
c) ii & iii
d) All of the above Answer : A

SELF ASSESSMENT
5. Under which circumstances can agency be terminated? 在什么情况下可以终止代理？
i. By the completion of the transaction where the authority was given for that transaction only 在
完成仅授权予的交易时
ii. By expiration of the period stipulated in the contract of agency 通过代理合同规定的期限届满
iii. By mutual agreement 经双方同意
iv. By death, lunacy or bankruptcy of the principal or the agent 主方或代理员逝世、精神错乱或破
v. By operation of any law which renders the contract of an agent illegal 依据任何法律，代理员的
契约为不合法
a) i, ii & iii
b) ii, iv & v
c) ii, iii & iv
d) All of the above
Answer : D
MEDICAL & HEALTH INSURANCE
第6章医药与保健保险

06
6.1 INTRODUCTION 简介
Medical and Health Insurance (MHI) 医药与保健保险
• An insurance policy on disease, sickness, or medical expense that provides
specified benefits against risks of becoming totally / partially incapacitated as a
result of sickness / disability
一个提供顽疾，疾病，或者医疗费用的保险，提供保障于完全/部分丧失劳动能力
的疾病/残疾的风险收益

6.2 TYPES OF MHI PRODUCTS 产品的种类
1. Medical Expense / Hospital and Surgical Insurance (HSI)
医药费用或住院与手术保险(HSI)医药与保健保险
- Provides reimbursement of medical expenses for illness, sickness, disease, or
injury 提供赔偿予保单持有人因疾病或受伤而必需接受医疗时所承担的医药费用
2. Critical Illness (CI) 严重疾病或危疾保险

- Provides lump sum payment of the sum insured upon diagnosis of any of (36)
dread diseases specified in policy
严重疾病保单将在受保人确诊患上保单规定的36种危疾其中之一时一次性给付
投保额。

• Can also be extended to cover other benefits with extra premium:
通过支付额外保费，即可增加其它保障利益，如:-
- Overseas cover 海外保障
- Accidental death benefit 意外死亡利益
- Outpatient day care surgery and consultation 门诊日间手术与咨询
- Daily cash allowance at government hospitals 政府医院每日现金津贴
- Outpatient cancer treatment or kidney dialysis 门诊癌症治疗或洗肾
- Organ transplant 器官移植
- Insured child’s daily guardian allowance 受保儿童每日家属看护津贴

3. Disability Income Insurance 残废收入保险
- Give insured an income stream to replace occupational income loss due to
disability or sickness
旨在取代发生致残意外或疾病时的职业收入损失
4. Hospital Income Insurance 住院收入保险

- Pay a pre-agreed amount of allowance for hospitalization on a
daily/weekly/monthly basis (subject to annual limit)
一旦受保人因疾病或受伤而必需住院治疗，住院收入保险保单将每日、每周或
每月给付津贴（并以年度限额为限）

6.3 EMERGENCE OF MANAGED CARE ORGANIZATIONS (MCO)
管理式保健组织的出现
• Role of MCO: 责职
- Specializes in the management & administration of healthcare systems
专业于医疗保健系统的管理与行政工作
• MCO’s are required to register with Ministry of Health
必须向马来西亚卫生部注册
• MCO’s do not have authority to approve / settle claims
没有权力批准/理赔

6.4 REGULATIONS APPLICABLE TO MHI
医药与保健保险的适用条例

6.4 REGULATIONS APPLICABLE TO MHI
医药与保健保险的适用条例
No person shall invite any person to make an offer or proposal to enter into a
contract of insurance without disclosing:
没有任何人可以邀请另一个人投保如果没有告知他们以下：
• The name of the licensed insurer
持牌承保人的名称
• His relationship with the insurer
与持牌承保人的关系
• The premium charged by the licensed insurer
持牌承保人收取的保费

6.5 UNDERWRITING POLICIES & PROCEDURES
核保政策与程序
1. Risk Evaluation
sufficient information
YES in proposal form? NO
2. Further Investigations
/ Documentations
3. Risk Classification
Standard Sub- Decline

Standard
© Copyright Allianz SE 19-Feb-21 4. Modification to Policy Benefits & Coverage 143
1. Risk Evaluation and Selection 风险评估与遴选
- Scrutinize applicants’ information through proposal form
详细审阅申请者所提供的资料
2. Further Medical Investigations and/or Documentation
进一步医学调查和/或证明文件
- Request further evidence of medical condition / history (if required)
需做进一步医学调查和/或证明文件的情况（如被要求）

3. Risk Classification 风险分类

4. Modification to Policy Benefits & Coverage 修改保单利益与保障范围
i.Exclusion endorsement 排除于保障范围之外
ii.Extra - Premium / Loading 付额外保费或附加保费
iii.Benefit Limitations 受益限制

6.6 GROUP MHI 集体医药与保健保险
• Mainly catered for employers as healthcare benefits for employees’
remuneration package 主要是为了迎合雇主为员工提供的保健利益
- No individual risk evaluation or selection
无进行个人风险评估或遴选
- Contributory & Non-contributory Insurance
分担型或非分担型保险
- If group policy owner has no insurable interest, insurer is liable to the person
insured.
如果持保人没有保险利益，承保人会赔偿给受保人。

6.6 GROUP MHI 集体医药与保健保险

6.7 COST CONTAINMENT MEASURES 成本控制措施
• To limit claim costs and prevent claim leakage
遏制不断上涨的索赔成本和防止索赔漏洞
• Examples of limitations applied to core benefits of HSI policy:
适用于住院与手术保险保单核心利益的限制之例子
- Inner limits 内限
- Schedule of surgical procedures 外科手术收费表
- Maximum period of compensation 最高赔偿期限
- Time frame 时限

6.7 COST CONTAINMENT MEASURES 成本控制措施
• Deductible 免赔额
- A fixed amount the policyholder must first pay, regardless of total cost of
eligible benefit
保单持有人必须先给付固定金额，无论合格利益总费用是多少
• Cost-sharing Provisions 共同分担条款

- Share percentage of cost incurred on every claim (cannot be more than 20%
of cost!)
适用的情况下施加分担条款.应仅限于不超过每项索赔的20%

6.8 RENEWAL OF MHI 医药与保健保险的更新
For existing renewable MHI policies: 对于现有可更新的医药健康保单
Policies may be renewed with Insurer shall notify decisions &

modified terms conditions reason to modify terms / decline
renewal / defer renewal at least 30
保单可以以修改条款更新
days before policy anniversary date.
承保人必须在保单周年日之前至少
Policies may not be renewed / 30天通知保单持有人其修改条款的
renewal is deferred 决定，以及有关修改/其拒绝或递
保单可能不可以更新/更新被递延更新的决定的原因
延

6.8 RENEWAL OF MHI 医药与保健保险的更新
• For continuity of coverage, insurer shall not :
- Unilaterally terminate MHI policy
单方面终止医药与保健保单
- Refuse to renew cover for a risk that policy owner has made a claim for
- 持保人拒绝在索赔后更新风险的保障
- Refuse to renew a policy that is guaranteed renewable
拒绝更新保证可更新的保单

6.9 AUTOMATIC TERMINATION OF POLICY 保单自动终止
MHI policy is automatically terminated in the following situations:
医药与保健保险保单将在发生下列情况时宣告自动终止：
1. On the death of insured 当受保人身故
2. Annual / Lifetime limit stipulated are exhausted
保单条款规定的年度限额或终身限额已用完
3. On the policy anniversary date following insured’s maximum eligibility age
在受保人达致最高合格年龄的保单周年日

6.10 PERSONAL INCOME TAX EXEMPTION 个人所得税免税额
RM3,000 for purchase of

MHI & education policies.
购买医药与保健保险保单
和教育保单可获得
RM3,000的税务减免

SELF ASSESSMENT
1. Upon diagnosis of one of the 36 critical illnesses, critical illness insurance will
provide _________ of the sum assured. 当确诊其中一个36种疾病，严重疾病保险
会提供——————的保额。
a) 50% of the sum assured 一半的保额
b) Lump sum cash payment 一次性给付现金
c) Lump sum cash payment with 20% cost of insurance
一次性给付现金和20%保险费用
d) 80% of the sum assured with 20% cost of insurance 80%的保额和20%的保险
费用
Answer : B
SELF ASSESSMENT
2. In group policy, insurance claims of insured is payable to?
集体保单的受保人索赔给谁？
a) Employer 雇主
b) Employee 员工
c) Employer & employee 雇主和员工
d) Company fund 公司资金
Answer : B

SELF ASSESSMENT
3. Which of the following events does NOT automatically terminate a medical and
health? 下列哪一项情况不会导致医药与保健保险保单自动被终止？
a) Exhaustion of the annual limit or lifetime limit stipulated in the policy 保单条款规
定的年度限额或终身限额已用完
b) The anniversary date following the insured’s maximum eligibility age 投保人达
致最高合格年龄的保单周年日
c) Breach of a policy condition 违反保单条款
d) The death of an insured person 投保人身故
Answer : C

SELF ASSESSMENT
4. What benefits are payable under a hospital income insurance policy? 住院收入
保险保单应给付什么利益？
a) Income stream to replace a portion of the pre-disability income if insured is not
able to work due to illness 当投保人因疾病无法工作，给付收入以取代伤残之前收
入的一部分
b) Fixed allowance on regular intervals due to hospitalisation caused by illness or
injury 定期给付固定津贴予因疾病或受伤住院
c) Reimbursement of medical expenses due to hospitalisation caused by illness
or injury 赔偿医药费用予因疾病或受伤住院
d) Lump sum payment of sum insured upon diagnosis of any of the 36 dread
diseases 在确诊患上36种危疾的其中之一时一次过给付投保额

Answer : B
SELF ASSESSMENT
5. Which of the following is NOT an option with the renewal of a medical and
health insurance policy?下列哪一项不是更新医药与保健保险保单的选项？
a) Notify the insured that renewal is on a level premium 通知投保人是以均衡保费
更新保单
b) Notify the insured that renewal is with an increased premium 通知投保人是在增
加保费的条件下更新
c) Notify the insured 30 days before the policy anniversary that policy is not
renewed 在保单周年前30天通知投保人其保单未更新
d) Refuse to renew a policy that is guaranteed renewable 拒绝更新受保证可更新
的保单
Answer : D
SELF ASSESSMENT
6. What are the various methods used by insurers to contain medical claims cost
and inflated claims? 哪些是承保人可使用的各种方法，以抑制医药索赔成本和索赔
的增加？
i. Inner limits 内限
ii. Schedule of surgical procedures 外科手术收费表
iii. Maximum period of compensation 最高赔偿额
iv. Time frame 时限
v. Deductible or Cost – Sharing option 免赔额或成本分担选项
a) i, & ii
b) ii, iii & iv
c) i, ii, iii & iv
d) All of the above Answer : D
LIFE INSURANCE
第三部分：寿险
C
LEGAL ASPECTS OF LIFE INSURANCE
第11章寿险的法律层面

11
11.2 MISSTATEMENT OF AGE 年龄的误述
• A life insurer shall not avoid life policy / refuse claim only on grounds of
misstatement of age
承保人不可基于受保人误述年龄而使保单无效或拒绝赔偿
• Based on true age & stated age, they may change sum assured & bonuses
accordingly
保障期限是根据受保人的年龄计算（保障期限更改为实际年龄计算的期限，并更
改受保条件）

11.3 OBJECTION TO LIFE POLICY 拒绝寿险保单
Cooling-off Period / Free-Look Period 检阅期
Within 15 days after policy delivery,
policy owner may return policy to
insurer
Insurer refunds premium (less

medical examination expense)
Policy cancelled; insurer’s liability

ceases
11.3 拒绝寿险保单
检阅期
保单送达持保人的手中，15天内持
保人可以归还给保险公司
保险公司归还保费（减去体检费用）
保单取消；保险公司的债务停止

11.7 SURRENDER OF LIFE POLICY 解除寿险保单(退保)
• A regular premium policy acquires surrender value after premium has been paid
for 3 consecutive years
定期保费保单在保单持有人连续3年缴清保费的情况下具有退保价值

11.7 SURRENDER OF LIFE POLICY 解除寿险保单(退保)
• When surrendering policy, policyholders have disadvantage, because:
退保对保单持有人造成伤害，因为：
- Ceased protection cover & all associated benefits
所有与保单有关的利益，包括保险保障都宣告终止
- During initial years of policy, surrender value is ~30% of premiums paid
保单生效初期,退保价值为截止退保日期的已付保费之30%
- For investment-linked policies, most premium paid in initial years goes to
charges 投资联结保单损失更大，因为最初几年，大部分的保费用来支付各种
费用

11.8 NON-PAYMENT OF LIFE POLICY PREMIUMS
无缴付寿险保单
Non-Forfeiture Condition 不可没收条款
• Where a life policy provides surrender value, it shall NOT lapse / be forfeited due to
non-payment of premiums
具有退保价值的寿险保单，不可基于无缴付保费而宣告失效或被没收
• Policyholders have options to convert to: 投保者可选择转换成：
1. Paid-Up Policy 缴清保单
Sum Assured 保额
Age 年龄
11.8 NON-PAYMENT OF LIFE POLICY PREMIUMS
无缴付寿险保单
Non-Forfeiture Condition 不可没收条款
2. Extended Term Assurance 扩展定期保险
Sum Assured 保额
Age 年龄

11.12 NON-CONTESTABILITY PERIOD 寿险契约的不可抗辩期
• If policy has been in force for more than 2 years, insurer will not be able to
contest policy’s validity even if there was misrepresentation/ non-disclosure.
寿险契约在受保人生命中生效超过两(2)年后，承保人不能基于文件中存有误述或
不实或错误的陈述，而使该契约无效
UNLESS!除非
• Insurer can proof that the misrepresentation/ non-disclosure were of material

fact with fraudulent intent.
承保人可以证明该陈述是保单持有人或受保人欺诈性作出或遗漏的重要事件或隐
瞒的重要事实

SELF ASSESSMENT
1. In a regular premium policy, how many years do the policyholders have to pay
continuously to acquire surrender value? 在定期保费保单，持保人需持续给保费多
少年才可以有弃保价值？
a) 2
b) 3
c) 1
d) 0
Answer : B

SELF ASSESSMENT
2. The insurer will not be able to contest the validity (non-contestability) of the
policy if life insurance policy has been in force for: 保险公司不可以抗辩保单如果保
单已经实行了：
a) A period of more than 2 years 超过两年
b) A period of less than 2 years 少过两年
c) A period of 1 year 一年
d) None of the above 以上皆不是
Answer : A

SELF ASSESSMENT
3. When insurer reduce the premium & refund overpayments due to misstatement
of age, this means:
当保险公司因为误述年龄而减少保费然后退还多缴的保费说明：
a) Misstate age greater than the original age 误述年龄大过原本年龄
b) Misstate age lower than original age 误述年龄小过原本年龄
c) Misstate age same as original age 误述年龄和原本年龄一样
d) Misstate age was not informed to insurer 误述年龄没有通知保险公司
Answer : A

SELF ASSESSMENT
4. What remedy is available for a policy owner who is not agreeable to the policy terms
after taking delivery of the policy? 下列哪一项是保单持有人在收到保单后不同意保单条款
的解决方案？
a) Return the policy to the insurer within 30 days and request cancellation of the policy 30
天内退还保单予承保人，并要求取消该保单
b) Return the policy to the insurer within the grace period and demand cancellation 在宽
限期内退还保单予承保人，并要求取消该保单
c) Return the policy within the 15 days and refund any expenses incurred by the insurer
for issuing the policy 在15天内退还保单以及承保人缮发保单的任何费用予承保人
d) Return the policy to the insurer within 15 days and expect a full refund minus
expenses incurred for medical examination 15天内退还保单，并可获得全额退还，惟须
扣除体检费用
Answer : D
SELF ASSESSMENT
5. When an agent invites any person or individual to make an offer or proposal to
enter into a contract of insurance, the agent should disclose:当代理员邀请任何人作
出要保献议以订立保险契约的时候，代理员必须透露：
i. The name of the licensed insurer. 持牌承保人的名称
ii. His relationship with the insurer. 其与承保人的关系
iii. The premium charged by the licensed insurer. 持牌承保人收取的保费
iv. The benefit of taking up the offer with him. 接受其献议可获得的利益
a) i, ii, iii & iv
b) i, ii & iii
c) ii & iv
d) i & ii
Answer : B
LIFE INSURANCE PRODUCTS
第12章寿险产品

12
Benefits of life insurance 寿险保单的好处
• Financial protection for dependents & cover family’s daily expenses

为家属提供财务保障和支付家庭的日常开销
• Maintain standard of living
维持他们的生活水平
• Pay off household debts
偿还任何的家庭债务
• Secure children’s education
保障孩子的教育
• Supplement retirement savings
补充退休储蓄

12.2 TYPES OF LIFE INSURANCE POLICIES 寿险保单种类
Endowment Whole Life

Insurance Assurance终身
储蓄
5 Types of
Life Insurance Term
Policies Assurance
5种人寿保险定期
Investment-
Linked Life
Insurance投资 Life-Annuity Plan
连接生命年金储蓄

12.2 TERM ASSURANCE 定期保险
• The earliest, simplest, purest form of fixed-term life insurance protection
最早期和最简单的寿险形式，固定期限以及暂时的定期保险
• Lowest premium 最低保费
• Sum Assured (SA) paid only on death
保额在死亡时付给
• No benefits payable if life assured survives the term
期满后没有满期利益
• No cash/surrender value
不含现金价值/退保价值

12.2 TERM ASSURANCE 定期保险
Unique features of term assurance 定期保险的特点

• Guaranteed Insurability 保证可投保
• Guaranteed Convertibility 保证可转换
• Decreasing Term Assurance 递减定期保险

12.2 WHOLE LIFE ASSURANCE 终身保险
• Purest & cheapest form of permanent life insurance protection
最纯正也是最便宜的永久性保障
• Policy in force as long as premiums are paid, even till old age
只要保费已缴付保单就继续保持生效，直至老年
• Sum assured is payable on death or upon the attainment of a certain age
保额会在达到一定的岁数后领取
Sum Assured 保额
Premium
保费
Continuous Payment 持续缴付
@ 100
12.2 WHOLE LIFE ASSURANCE 终身保险
Limited Payment Whole Life Assurance Policies 限期缴交保费终生人寿
- Premiums payable for a limited period / ceases upon attainment of a specified
age 保费只需缴交至某个年限/到达某个规定的岁数
- Higher premiums 更高的保费
- SA is payable on death 保额在死亡时付给
Sum Assured 保额
Premium Limited Payment

保费限期缴交保费
@ 100 182
12.2 ENDOWMENT INSURANCE 储蓄保单
• Guaranteed payment of sum assured upon maturity
保证在保单期限结束或满期日给与保额
• Premature death : sum assured paid to beneficiaries
保额将会在过早死亡中赔出
• Provides both protection & savings
同时提供保障和储蓄
• Special privileges like non-forfeiture and paid-up policy provisions
随着累积的现金价值，保单可享有如不可没收条款及缴清保单的特殊权限

12.2 INVESTMENT-LINKED INSURANCE 投资连接寿险
• Combines investment & protection
结合投资与保障
• Option of investing in equities (higher risk), bonds, or fixed income securities
(lower risk) or a combination of both
投保人给出投资股票（高风险），债券，或固定收入证券（低级风险）或两者的
组合的选项
• Policyholder may not know exactly the amount of returns earned on the
investments
投保人可能不知道到底赚取投资收益的金额


保费
投资部分保险部分
（配置）（无配置）
减去代理员佣金和
加上投资回酬
行政开销
减去保险费用、保单费
用和基金管理费用

12.2 LIFE ANNUITY PLAN 生命年金计划
• A retirement fund that provides ‘pension’ for the lifetime of the annuitant
生命年金是一项退休基金，为年金领取人提供终身“养老金”
• No payment of SA on death / disability / critical illness.
死亡，伤残和顽疾下，都不具有投保额
• Death during the annuity period : premium (or the balance of it) will be paid to
the beneficiary
如果在年金期间发生死亡，保费（或它的余额）将支付给年金者的受益人/配偶，
根据购买的年金类型

2 Types of Annuity: 年金计划可分为两大类
• Immediate Annuity 即刻年金
Purchase
Money
购买价
Age 年龄
$ $ $ $ $ $ $

• Deferred Annuity 延期年金
Purchase Deferred
Money 延期
购买价
Age 年龄
$ $ $ $ $

8% tax exemption on
investment income in
deferred annuity fund
从2013年开始生效，
马来西亚政府给予8%
免征所得税奖掖予寿
险承保人的延期年金
基金的投资收入

12.3 CRITICAL ILLNESS INSURANCE 严重疾病保险
• Lump sum cash payment if the policyholder is diagnosed with one of the critical
illnesses listed in the policy
当保单持有人被确诊患上保单所列的严重疾病之其中之一时，此保单将一次过给
付现金赔偿
• Policy is automatically terminated on payment of the sum assured
保单随后自然终止
• In Malaysia, CI is sold as an optional extra/ a stand-alone life/ health insurance
policy 在马来西亚，严重疾病保险是以附加选择或作为独立的寿险或保健保单的
方式出售

12.4 GROUP LIFE INSURANCE 集体保险保单
Group Life Underwriting Guidelines 集体保险核保指南
• Minimum 10 employees 最少的保障人数为10人
- Special consideration may be given for non-contributory schemes.
特别情况下也提供非捐献式计划
• Eligibility only for permanent employees aged16 – 60
只限年龄介于16岁至60岁之间的全职雇员
 New employees will be automatically added
新雇员将在受雇日期起自动加入
- Employees who resign/ retire/ terminated will be deleted
已辞职、退休或被停职的雇员则在终止日起被除名

12.5 SUPPLEMENTARY CONTRACTS 补充契约
Rider 附加保单
• Riders supplement basic life insurance policy with additional benefits on
payment of additional premium
增加保费以得到附加保单提供的额外利益
Waiver of Premium Provision 豁免保费条款

• Waives future premium payments in the event of TPD
在受保人遭受永久性完全残废时豁免缴付之后的保费

12.5 SUPPLEMENTARY CONTRACTS 补充契约
Personal Accident (PA) Rider 个人意外附加保单
- Provides payment of an additional benefit / sum insured in the event of death /
disability caused by an accident
在发生因意外造成的死亡或残废时给付额外利益或投保额
- ‘Accident’ = ‘bodily injury solely & directly caused by external, violent and visible
means’
“意外”是指“完全和直接因外来和激烈的事故所造成，和外表明显可见的人身
伤害”

12.6 PARTICIPATING & NON-PARTICIPATING CONTRACTS
分红及非分红契约
Enjoy Company
Surplus
Sum Assured
Sum Assured 享有公司的盈利
保额保额
Age
© Copyright Allianz SE 19-Feb-21 年龄 195
12.7 METHODS OF DISTRIBUTING SURPLUS 盈余的分配方式
• Simple Reversionary Bonus 单元储备红利
• Compound Reversionary Bonus 复元储备红利
• Cash Bonus 现金红利
• Maturity or Terminal Bonus 期满或期终红利
• Interim Bonus 期中红利
• Guaranteed Bonus 保证红利
(*for non-par policy非分红契约)

SELF ASSESSMENT
1. Which of the following about Life-Annuity Plan is correct?

以下哪项关于生命年金计划是对的？
a) Provide payment of the sum assured on death 在死亡是给于保额
b) It provides pension for the lifetime of the annuitant 给于年金领取人终生退休金
c) Can be purchased for the right to a series of periodic payments at intervals of 2
years under contract with a life insurer 可以从保险公司购买两年定期付款的权利
d) It covers retirement & critical illness as well 保障退休和严重疾病
Answer : B

SELF ASSESSMENT
2. Which of the following is NOT TRUE about term insurance?
以下哪项关于定期保险是错的？
a) The policy offers non-forfeiture option to the policyholder 保单有不可没收条款
b) The policy can be renewed without evidence of insurability
没有可受保证据保单也可以更新
c) The premium payable is cheaper compared to whole life policy
保费比终生保费便宜
d) The policy contains no cash value 保单没有现金价值
Answer : A

SELF ASSESSMENT
3. Which of the following is TRUE about the distribution of surplus?
以下哪项关于盈余的分配是对的？
a) Simple reversionary bonus 单元储备红利
b) Maturity bonus 期满或期终红利
c) Interim bonus 期中红利
d) All of the above 以上皆是
Answer : D

SELF ASSESSMENT
4. A whole life policy differs from a term policy in that 终身寿险保单和定期保单最
大的差异是
a) Premium on a whole life policy increases each year. 终身寿险保单的保费逐年
增加。
b) No premiums are required when the insured turns 65. 年届65岁后不必缴付保费
c) The rate on a whole life policy is always lower than that charged on a term
policy. 终身寿险保单的保费率通常比定期保单来得低
d) A whole life policy accumulates cash value, whereas a term policy does not. 终
身寿险保单具有累积现金价值，定期保单则没有。
Answer : D

SELF ASSESSMENT
5. Life insurance policyholders have a right to share in the divisible surplus of the
insurer’s life insurance fund only if 寿险保单持有人有权共享承保人的寿险基金的可
分配盈利，只有在
a) The company earns a specified amount of profits. 公司赚取特定数额的利润。
b) The policy is issued by a takaful company. 该保单是有回教保险公司签发。
c) The policy is from specific life insurance companies. 该保单上来自特定寿险公
司
d) They own a participating policy. 他们拥有分红型保单
Answer : D
SELF ASSESSMENT
6. An option to convert a term to permanent insurance without proof of insurability
but with premium adjustment 无需可保性证明，但是必须调整保费，以将定期保险
转换成永久性保险的选择称为
a) Guaranteed suitability option. 保证适合性选择。
b) Guaranteed insurability option. 保证可保性选择。
c) Guaranteed convertibility option. 保证可转换选择
d) Guaranteed permanent option. 保证永久性选择
Answer : C

LIFE INSURANCE PREMIUM RATING
第13章寿险的保费定价

13
• Life insurance companies are required to set aside ‘capital reserves’ to pay
policy benefits & honour contractual obligations
寿险契约是长期和永久性的，因此寿险公司必须预留"资本储备"，以便在缮发保
单后的许多年内支付保单利益和履行契约责任
• Actuaries are important for determining premium that commensurate with the
risk profiles and contingent events
精算师扮演举足轻重的角色，以制定与风险状况及突发事件相称的保费

13.2 COSTING THE RISK 风险成本计算
Factors taken into account when pricing premiums
计算保费的各种关键元素和风险因素:
• Mortality 死亡率
• Investment returns 投资回酬
• Effect of inflation on expenses 通膨对开支的影响
• Amount of corporate tax 企业纳税额
• Insurer’s ability to pay management expenses in the present
承保者当下管理风险与支出的能力
• Insurer’s ability to meet contractual obligations in the future
承保者在未来面对合同义务的能力

13.3 LEVEL PREMIUMS 均衡保费
• Premium remains constant throughout the duration of a life policy
"均衡保费"指在整个寿险保单期限内保费维持不变
Sum Assured
保额
Age
年龄
13.4 GROSS & NET PREMIUMS 总保费和净保费
• Net Premium = Pure Risk Premium + Interest
净保费 = 纯风险保费 + 利息
• Gross Premium = Net Premium + Management Expenses and Contingencies +

Profit
总保费 = 净保费 + 管理开销和应急费用 + 利润

13.5 LOADING FOR CONTINGENCIES 应急费用的额外保费
Where will consumers be charged loadings? 客户何时会被征额外保费？
1.Endowment policies 储蓄保单

- Provides sum assured upon maturity / pre-mature death, hence will be
charged extra premium to cover survival benefit 在保单期限结束时仍健在、在
期满日或早逝时给付投保额赔偿的储蓄保单将征收额外保费以保障生存利益
2.Yearly renewable contracts (optional) 每年可更新契约

- May charge higher premiums on renewal due to an adverse change to the
insured’s occupation or other contingencies
每年更新契约（视受保人和承保人的选择而定）将在更新保单时，基于受保人
的职业出现不利的改变或其它意外情况而征收更高的保费
13.5 LOADING FOR CONTINGENCIES 应急费用的额外保费
3.Participating policies 分红保单
- Will charge extra premiums for participating in company profits
分红保单有权享有可分配盈余，也因为共享公司盈利的特权而被征收额外保费
或附加保费
4.Periodic payment of premiums 按期缴付保费

- Charge premium loading to cover administration cost & for the premiums that
will not be collected after death.
被征收额外保费以支付行政费用以及身故日期之后无法收取的保费

13.6 GROUP INSURANCE PREMIUM 集体保险的保费
• Group insurance are ‘experience rated’ 集体保险属于“经验费率”
• Premiums are calculated using average mortality rate of group & adjusted for
past claims experience, acquisition cost, management expenses, and profit
margin
其保费是以该群人的平均死亡率计算，并根据过去的索赔经验、购置成本、管理
开销和利润率等调整。

13.7 PERSONAL INCOME TAX RELIEF 个人所得税减免
• RM 6,000 tax relief allowed for purchasing life insurance on the life of the
taxpayer or spouse, including contributions to Employees Provident Fund (EPF)
所有投保予纳税人或配偶生命的寿险保费可获得RM6,000的课税减免，包括缴纳
受批准基金，如公积金（EPF）
• RM 3,000 tax relief allowed for the purchase of education and MHI
投保教育及医药与保健保险另可获得RM3,000的课税减免

SELF ASSESSMENT
1. Which of the following is true about gross premium for participating policies?
以下哪项关于分红保单的总保费是对的？
a) Net premium plus loading for expenses plus loading for profits & contingencies
净保费加额外保费费用加额外保费盈利和紧急费用
b) Net premium plus loading for expenses 净保费加额外保费费用
c) Present value of benefit payable plus present value of expenses less present
value of future premium receivable 现有利益价值家现有开销减现有未来可收取保费
d) None of the above 以上皆不是
Answer : A

SELF ASSESSMENT
2. The premium payments are uniform throughout the duration of a life insurance
policy cease on death. The above statement refers to? 保费统一，在整个寿险保单
期限内保费维持不变。以上说明？
a) Level premium 均衡保费
b) Annual premium 年度保费
c) Instalment premium 分期交付保费
d) True premium 真的保费
Answer : A

SELF ASSESSMENT
3. Net premiums include 净保费包括
i. Pure risk premium 纯风险保费
ii. Interest 利息
iii. Management expenses 管理开销和应急费用
iv. Profit 利润
Answer : A
a) i & ii
b) ii & iv
c) iii & iv
d) All of the above

LIFE INSURANCE UNDERWRITING &
DOCUMENTS
第14章寿险的核保与文件

14
14.2 RISK SELECTION 风险选择
Underwriting 核保
• The process of risk assessment, evaluation and selection
风险评估、估算和选择过程
• Based on the identification of factors which contribute to ‘good’ or ‘bad’ risks
鉴定“好”或“坏”的风险因素
• 2 main types of underwriting
核保可分成两大类，分别是与准寿险保客的健康和财务状况有关

Medical Underwriting 医药核保
- Assess ‘physical hazard’ of risk proposed
医药核保关乎寿险要保风险的“实质危险因素”
• Considered factors include 其中包括:

- Age, height, weight, personal and family medical history, lifestyle, etc
年龄、身高、体重、个人及家族病史、生活习惯等

Financial Underwriting 财务核保
• Assess the ‘moral hazard’
财务核保旨在评估附于或固有的“道德危险因素”
• Considered factors include: 核保过程包括
- Existence of insurable interest 保险利益的存在
- Whether the amount of insurance applied for commensurate with the financial
standing / earning capacity of applicant
保险金额是否与申请者的财务状况或收入能力相符
- Whether the insured maintains multiple insurance policies with other insurers
检查投保人是否购买多项保单
- Whether any other insurer has turned down the application for insurance coverage,
and if so, why. 是否曾遭到拒绝其投保申请，如有，是什么原因
14.3 UNDERWRITING GUIDELINES 核保指南
Underwriting Guidelines 核保指南
- The criteria used by an insurance company to determine whether to insure an
applicant / what premium to charge
"核保指南"是保险公司用于决定是否承保一名申请者或应征收多少保费的准则.
- Guidelines set minimum standards for the acceptance of risks; while computer
programmes & actuarial data (including mortality rates) determine the premium
payable
此指南设定承保风险的最低标准；而电脑程序及精算数据（包括死亡率）则用
于制定应付的保费



Handling Adverse Risk 处理不利风险
• Adverse Selection / Anti-Selection 逆向选择 / 逆选择
- People with higher risks buy more insurance 风险越高者购买越多保险
- Insurers ask a range of questions and may request medical examination report
on high-risk individuals
为了应对逆向选择的影响，承保人可要求体检医生对高危人群提供一份独立报告
- Ensure premiums commensurate with risk
以使保费与风险相称

Some ways insurers handle adverse risks:
以下是承保人处理不利风险的一些方案：
- Charge extra premiums / loadings 征收额外保费或附加保费
- Reduced death benefits / sum assured
减少死亡利益或投保额，但维持标准的保费率
- Recommend alternative insurance plan
建议一项替代保险计划（如每年可更新型定期保险，而非终身寿险）
- Exclude a particular condition / impairment, or restrict participation in specific sports /
activities
排除特定条款或缺陷或限制从事特定种类的体育项目或活动
- Adjust bonuses in a participating policy
调整分红保单的红利（此方案鲜少被采用）

14.4 ASSUMPTION OF RISK 风险承担
• Insurers will assume risk immediately upon receiving 1st premium after the
issuance of letter of acceptance (LoA)
承保人将在发出承受书之后和收到首期保费时即刻开始承担风险
• Entitled to cooling off / free-look period
保单持有人享有“冷却”或“免阅”期
• Backdating of commencement date of insurance may be allowed for up to 6
months
某些情况下，保单的生效日可提前至6个月之久，以让要保人享有以更低年龄来计
算的更低保费

14.4 ASSUMPTION OF RISK 风险承担
• Extra premium charges/ loading imposed by the insurer will have to be informed
in writing (i.e., counter-offer)
增加保费书：若需增收额外保费或附加保费，承保人必须以书面通知
• If proposer agrees to the revised terms, he must give written consent by signing
and returning a copy of LoA in order to issue insurance policy.
如果要保人同意修改后的条款，他必须签署并交回承受书

14.5 ROLE OF THE INSURANCE AGENT IN THE UNDERWRITING
PROCESS 保险代理员在核保过程中扮演的角色
• Middlemen who assist underwriter in selecting good risks
保险代理员是帮助核保员做出良好风险评估的中间人
• Acts as point of contact with prospective clients
与准保客接触的桥梁
• Should inform customers of salient product features
告知准保客该产品的显著特点
• Guide prospective clients in providing full disclosure of material facts
引导准保客透露重要事实，以使保客和核保员能作出明智的决定

14.6 INSURANCE DOCUMENTS 保险文件
Medical Examiners
Proposal Form
Report
要保书
体检报告
Agent’s Report Policy Form

代理员报告保单

SELF ASSESSMENT
1. Which of the following is true? 以下哪项是对的？
i. Standard : Normal risk, acceptable by standard policy terms
标准：普通风险，可被接受并以标准保单条款
ii. Sub-standard : Higher than normal risk, acceptable with extra premiums
次标准：高过普通风险，可被接受以额外保费
iii. Below average : May not be accepted or may be deferred for a specific period
低于标准：可能不被接受或在特定期限内被延期
iv. Decline : Unacceptable risk will be rejected or declined
拒绝：不可接受风险会被拒绝
a) i, ii & iii
b) i, iii & iv Answer : D
c) ii, iii & iv
d) All of the above 228
SELF ASSESSMENT
2. Which are some of the ways insurers handle adverse risks?
以下哪个是保险公室防止不利的风险？
i. Exclude a particular condition or impairment 排除特定条款或缺陷
ii. Recommend an alternative insurance plan 建议一项替代保险计划
iii. Charge extra premiums or loading 征收额外保费或附加保费
iv. Reduce the death benefit or sum assured 减少死亡利益或投保额
a) i & ii
b) ii & iv
Answer : D
c) iii & iv
d) All of the above

LIFE INSURANCE CLAIMS
第15章寿险的索赔

15

1. 通知保
险公司或
代理员
2. 完整无
误地填写
规定的表
格
3. 提呈索
赔表格和
支持文件
索赔
过程
15.2 TYPES OF CLAIMS 索赔种类
• Death 死亡
• Maturity 期满
• Critical illness 严重疾病
• Permanent and Total Disability 完全永久性残废
• Other benefits under supplementary contracts / riders
补充契约或附加保单下的其它利益

15.3 DEATH CLAIMS 死亡索赔
• Other than claim form , insurer will require the following supporting documents:
除了索赔表格，承保者会要求索赔者提供支持有关索赔的重要文件：
- Original policy contract
保单契约正本
- Original/ certified true copy of death certificate
死亡证书（正本/核实副本）
- Original/ certified true copy of burial permit
埋葬许可证（正本/核实副本）
- Claimant’s IC 索赔人的身份证
- Proof of relationship 关系证明
- Proof of age 年龄证明

15.3 DEATH CLAIMS 死亡索赔
• For accidental death, documents include: 意外死亡所需的文件包括：
- Police report 警方报告
- Post Mortem Report 验尸报告
- Newspaper cutting, if any 剪报，如有
- Death certificate 死亡证书
• For missing person case: 失踪人士案件

- A statutory presumption of death has to be obtained from a court of competent
jurisdiction, 7 years after efforts to search for missing person is exhausted
必须在彻底搜寻7年不果后向具有司法管辖权的法院申请法定推定死亡证书

15.4 MATURITY CLAIMS 期满索赔
• Insurance company will inform policyholder of impending maturity claim &
request documentary evidence for proof of age, (ie., IC/ birth certificate) to
process the claim
保险公司将通知保单持有人其期满索赔日期即将来临，并要求提呈年龄证明文件
，如身份证或出生证，以处理索赔事宜
• Policyholder will receive claim payment after signing a discharge of liability
保单持有人将在签署解除责任书之后收到赔偿金

15.5 CRITICAL ILLNESS INSURANCE CLAIMS 严重疾病索赔
• Required to submit a medical report of the diagnosis by the attending physician

在投保人被确诊患时，保单持有人必须提呈一份由主治医生签发的确诊医药报告，
以供索赔处理

15.6 TOTAL & PERMANENT DISABILITY CLAIMS
完全永久性残废
The following documents are needed to process TPD claim:
以下是处理TPD索赔不可或缺的文件：
• TPD due to natural causes (ie., illnesses) 自然原因导致的完全永久性残废
- Duly completed TPD Claim Form 完整填写的TPD索赔表格
- TPD Medical Report 完全永久性残废的医药报告
- Original Policy Document 保单文件正本
- Other supporting test/laboratory report and investigation results
其它支持性检验/化验室报告和检查结果
• TPD due to accident 意外导致的完全永久性残废
- Above documents + copy of police report
因意外造成的完全永久性残废索赔，也必须提供一份警方报告副本
15.7 PERSONAL ACCIDENT CLAIM 个人意外索赔
• The principle of proximate cause applies to PA claims
近因原则通常用于个人意外索赔
• Documents needed to determine the cause of death by an accident:
需要呈交的文件
- Claim form 索赔表格
- Police report 警方报告
- Post-mortem report 验尸或法医报告

SELF ASSESSMENT
1. A life claim can arise under any of the following situations, except 寿险索赔会在
以下情况发生，除了
a) Death of insured 受保人死亡
b) Death of beneficiary 受益人死亡
c) Maturity of the life policy 寿险到期
d) Critical illness 严重疾病
Answer : B

SELF ASSESSMENT
2. A death claim must be paid within _____ days of receipt of notification of the
claim; otherwise, the law requires compound interest to be charged on the amount
payable. 死亡索赔要在索赔通知的————天内支付，法律规定须给于的数目累积
的回酬
a) 15 days
b) 30 days
c) 60 days
d) 90 days
Answer : C

SELF ASSESSMENT
3. In the case of a missing person, what is the time lapse before a statutory
presumption of death can be issued by a court? 当一个人失踪，需要多久法定死亡
证书才会被法院批准？
a) 1 year
b) 3 years
c) 5 years
d) 7 years
Answer : D

SELF ASSESSMENT
4. The following documents are required for a total and permanent disability claim
due to an accident, EXCEPT: 因意外造成的完全永久性残废索赔需要下列各种文件
，除了：
a) A duly completed claim form. 一份完整填妥的索赔表格
b) A certified copy of the police report. 一份警方报告核实副本
c) A medical certification by the attending doctor. 一份主治医生的医药证书
d) A certified copy of the attending doctor’s credentials. 一份主治医生的资格证书
核实副本
Answer : D

CODE OF PRACTICE FOR LIFE
INSURANCE AGENTS
第16章寿险代理员的行为准则

16
Insurance Agents
寿险代理员

16.2 CODE OF ETHICS 道德准则
• Insurance agents should practice the following: 保险代理员应履行下列守则：
- Avoid conflicts of interest 避免利益冲突
- Avoid misuse of position 避免滥权
- Prevent misuse of information 避免滥用资料
- Ensure completeness and accuracy of relevant records
确保相关记录的完整和正确性
- Ensure confidentiality of communication & transactions
确保通讯与交易保持机密性
- Ensure fair & equitable treatment of all policy owners
确保所有保单持有人获得公平与公正的待遇
- Conduct business with the utmost good faith & integrity
秉持至高真诚与诚信的态度执行业务
16.3 CODE OF PRACTICE 行为准则
• A guide for life insurance agents to conduct business with utmost good faith &
integrity 行为准则是确保寿险代理员秉持至高真诚与诚信原则执行业务的指南
• Every agent has to sign declaration of observance of Code of Practice, which
includes: 所有注册寿险代理员须签署一份遵守此行为准则声明书
- The manner in which agents should handle complaints from policyholders
代理员对保单持有人的投诉应采取的处理方式
- Requires agents to co-operate with insurer in establishing facts
要求他们与保险公司合作以查明事实真相
- Give proper advice of policyholders’ rights & avenues for redress with the
insurance company concerned
同时就保单持有人的权利以及与保险公司解决相关问题的措施，为保单持有人提
供适当的咨询

16.4 SELLING LIFE INSURANCE 寿险销售
Agents Should …代理员应该:
 Make prior appointment with prospective client
在造访前应与准保客预约，应安排在保客方便的时候进行
 Identify himself & insurance company
表明身份和所代表的保险公司
 Ensure that policy proposed suits client’s needs & resources
尽可能确保所提议的保单适合准保客的需要和能力范围
 Give advice only on insurance matters in which he is knowledgeable
根据自己的能力提供有关保险的建议，并在需要时寻求其他专家的咨询
 Treat all information of prospective policyholder in confidence and only for the sole
purpose of issuing an insurance policy
对准保客所提供的所有资料保密，并仅供缮发保单的用途

16.4 SELLING LIFE INSURANCE 寿险销售
Agents Should Not 代理员不应该…
 Inform prospective client of referrer’s name, unless have referrer’s consent to
disclose 通知准保客其姓名是他人所给的，除非代理员在准保客的要求下能透露该人
的姓名，而该人也同意
 Make / issue / cause any misrepresentation, induce non-disclosure/concealment of
material facts.
对任何保单的条规或利益，作出或发出误述、误导、不公平或偏见的比较
 Make misleading, unfair, or biased comparison or statements in any policy
做出误导性，不公，或有偏见的见解
 Fraudulently conceal a material fact, or use any unauthorized sales brochure or
sales illustration 诱使准保客在办理保险时作出不实的陈述或误述重要事实，或阻止
准保客在办理保险时透露重要事实，或诱使准保客隐瞒任何与要保书有关的重要事实
。
16.5 PROVIDING INSURANCE COVERAGE 提供保险保障
Agent’s role is to: 代理员所扮演的角色是
• Explain the main provisions of insurance contract by informing clients to policy

restrictions & exclusions applicable
解释保险契约的重要条款，提醒保客注意保单的限制和除外条款
• Obtain specialist advice from underwriters (if necessary)
并在有需要时咨询专家（核保员）解释保障范围、保单条规

16.6 DISCLOSURE REQUIREMENTS 透露要求
• When soliciting insurance business, the agent should disclose:
代理员在邀请他人作出要保献议以订立保险契约的时候，必须透露：
- Insurer name 持牌承保人的名称
- Relationship with insurer 与持牌承保人的关系
- Premium charged by insurer 持牌承保人收取的保费
• If a group insurance is arranged, agent should disclose to each insured:
在为与其没有保险利益的集体保单持有人准备集体保单的时候，代理员必须向每
一位投保人透露：
 All 3 above, and 以上三样，以及
 Conditions of group policy (including remuneration payable to him)
该集体保单的条款，包括他应得的报酬
16.7 ACCOUNTS & FINANCIAL ASPECTS 会计与财务方面
• If authorised to collect monies in accordance with terms of agency appointment,
agent shall: 若被授权收取保费，代理员应根据其代理委任书的条款：
- Keep proper account of all financial transactions
妥当保持所有与准保单持有人的财务来往账目
- Acknowledge receipt of all money received
确认收到及保持一份所有与保单相关款项的记录
- Remit any such monies so collected in strict conformity with his agency
appointment
严格遵守其代理委任书，将所收到的任何款项呈交公司

16.8 EXISTING POLICYHOLDERS 现有保单持有人
The Agent Shall 代理员应该:
- Abide by the principles set out in the Code

遵守行为准则所规定的相关守则
- Endeavour to maintain contact with all his policyholders
尽力与所有保单持有人维持良好联系，以保存现有生意
- Comply with the requirement for claims settlement
并在索赔人填写索赔表格时给予一切适当的协助和遵守索赔清算规定的要求

SELF ASSESSMENT
1. Which of the following statement is NOT TRUE about the duties of an insurance
agent? 以下哪项关于代理员的责任是不对的？
a) Avoid conflict of interest 避免利益冲突
b) Not to accept any secret profit 不接受任何秘密档案
c) Delegate his duties to his new recruit 指使新代理员执行他的责任
d) Comply with principle’s instruction & to notify him when compliance becomes
impossible 遵守主方的指示并通知主方当不能执行
Answer : C

SELF ASSESSMENT
2. What is considered as ethical for an agent to do? 对代理员来说什么是道德的？

a) Sharing policy owner’s salary & weight to other agents
和其他代理员分享持保人的薪水和重量
b) Sharing policy owner’s clinical information to insurer
和保险公司分享持保人的医疗资讯
c) Sharing policy owner’s details to other agents
和其他代理员分享持保人的资料
d) Avoid informing policy owners the provisions of the contract
避免告知持保人契约的内容
Answer : B

SELF ASSESSMENT
3. When selling insurance, what should the agent refrain from doing? 在进行保险
销售时，代理员不应该做什么？
a) Ensure unsolicited or unarranged calls are made at a time suitable to the client
确保无预约或预先安排的造访在保客方便的时候进行
b) Inform the client outright of his intention to discuss matters relating to insurance
告知保客其造访目的是为了商讨与其保险需要有关的事宜
c) Give specialist advice on insurance and all other matters in order to impress
his client 为保险及所有其它事项提供专业意见以便打动保客
d) Ensure that the policy proposed is suitable to the needs and resources of the
prospective policyholder 确保所提议的保单适合准保客的需要，并介于其能力范围
Answer : C
SELF ASSESSMENT
4. The insurance agent should NOT 保险代理员不应该：
a) Inform the prospective policyholder that his name was given by another person, unless he is
prepared to disclose that person’s name if requested to do so by the prospective policyholder and
has that person’s consent to do so. 通知准保客其姓名是他人所给的，除非代理员在准保客的要求
下能透露该人的姓名，而该人也同意如此。
b) Make, issue, or cause any written or oral statement misrepresenting or making misleading,
unfair or biased comparison regarding the terms conditions or benefits in any policy. 对任何保单的
条规或利益，作出或发出误述或误导或不公平或偏见的比较，不论是书面或口头上的陈述。
c) Prevent the prospective policyholder from stating material facts to the insurance company or
induce the person not to state them. 阻止准保客向保险公司透露重要事实或诱使他不透露有关重要
事实。
d) All of the above 以上皆是
Answer : D
SELF ASSESSMENT
5. What issues must be drawn to the client’s attention in trying to explain the main
provisions of the insurance contract? 在解释寿险主要条款时，代理员必须提醒保
客注意什么事项？
a) The basic cover provided by the policy 保单所提供的基本保障
b) The policy exclusions, extra charges imposed and purpose of such charges 保
单的除外条款，额外费用以及征收有关费用的目的
c) The cooling-off period when the insured can object to any provisions in the
policy 让受保人拒绝保单内任何条款的冷却期
d) The agent’s contact details if after sales service is required by the client 代理员
的联络号码，以方便保客需要售后服务时联络
Answer : B
END OF TUTORIAL
COMMON PITFALLS
When answering PCE questions, the following are common mistakes made by
participants:
在回答PCE考试问题时，以下是考生常犯的错误：
1. Does not understand what the question wants.
• Pay close attention to words/phrases like “Except”, “Which are false”, “NOT”
and etc.
• Questions may not always ask you for the right answers!
不了解问题要什么。需要加倍关注的字眼/短语如“除了”，“哪一个是错的”，
“不是”等
2. Choose a few right options from a list of options given (eg. Choose the right
answer) 从一系列选择中选出对的答案
A. I, II and III B. II and IV
THANK YOU
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