CHAPTER 1: INTRODUCTION TO INSURANCE: Life insurance – History and evolution – History of insurance – Insurance through the ages – Modern concepts of insurance – History of insurance in India – Life insurance industry – How insurance works – Risk management techniques – Risk avoidance – Risk retention – Risk reduction and control – Risk financing – Insurance vs Assurance – Insurance as a tool for managing risk – Considerations before opting for Insurance – Role of insurance in society – Insurance and Social Security.
CHAPTER 2: CUSTOMER SERVICE: General concepts – Why Customer Service – Quality of service – Customer service and insurance – Insurance agent’s role in providing great customer service – The Point of Sale – Best advice – The proposal stage – Acceptance stage – The claim stage – Grievance redressal – Integrated Grievance Management System (IGMS) – The Consumer Protection Act, 1986 – The Insurance Ombudsman – Communication process – Non-verbal communication – Ethical behavior.
CHAPTER 3: GRIEVANCE REDRESSAL MECHANISM: Consumer courts, Ombudsman – Integrated Grievance Management System (IGMS) – The Consumer Protection Act, 1986 – The Insurance Ombudsman.
CHAPTER 4: REGULATORY ASPECTS OF INSURANCE AGENT: Definitions- Appointment of Insurance Agent by the Insurer- Appointment of Composite Insurance Agent by the insurer- Insurance Agency Examination- Disqualification to act as an Insurance Agent- Code of Conduct- Suspension of Appointment of an Agent- Procedure for Cancellation of Agency- Effect of suspension/cancellation of Agency appointment- Procedure to be followed in respect of resignation/surrender of appointment by an insurance agent- General conditions for appointment of Agents by the insurer
CHAPTER 5: LEGAL PRINCIPLES OF AN INSURANCE CONTRACT: Insurance contracts – Legal aspects and special features – Legal aspects of an insurance contract – Elements of a valid contract – Insurance contracts – Special features – Uberrima Fides or Utmost Good Faith – Measures implemented to reduce the risk – Breach of Utmost Good Faith – Insurable interest – Gambling and insurance – Proximate Cause – Contract of Adhesion – Indemnity – Subrogation. SECTION 2
CHAPTER 6: WHAT LIFE INSURANCE INVOLVES: Life insurance business – Components, human life value, mutuality – The Asset – Human Life Value(HLV) – The Risk – Level premiums – The Principle of Risk Pooling – Mutuality – The Life Insurance Contract.
CHAPTER 7: FINANCIAL PLANNING: Financial planning and the individual life cycle – Definition – Types of Goals – Individual’s life cycle – Individual needs – Financial products – Risk profile and investments – Role of financial planning – Financial planning – When is the right time to start financial planning – Financial planning – Types – Cash planning – Insurance planning – Investment planning – Investment parameters – Retirement planning.
CHAPTER 8: LIFE INSURANCE PRODUCT I: Overview of life insurance products – What is a product – Purpose of life insurance products and needs covered – Riders in Life Insurance Products – Traditional life insurance products – Term insurance plans – Variants of Term Assurance – Whole life insurance – Endowment assurance – Dividend method of profit participation.
CHAPTER 9: LIFE INSURANCE PRODUCT II: Overview of non-traditional life insurance products – Limitations of traditional products – The shifts – The appeal – Needs met – Non-traditional life insurance products – Types.
CHAPTER 10: APPLICATION OF LIFE INSURANCE: Married Women’s Property Act – Beneficiaries under MWP Act & its features – Key man Insurance – Insurable Losses – Mortgage Redemption Insurance (MRI).
CHAPTER 11: PRICING AND VALUATION OF LIFE INSURANCE: Insurance pricing – Basic elements – Premium – Rebates – Determining the premium – Components of Premium – Mortality and Interest – Guiding Principles for determining Amount of Loading – Expenses and reserves – Determination of Surplus and bonus – Ways of Valuing Assets – Allocating the surplus – Bonus – Types of reversionary bonuses.
CHAPTER 12: DOCUMENTATION – PROPOSAL STAGE: Life insurance – Proposal stage documentation – Prospectus – Proposal form – Different Reports – Anti-Money Laundering (AML) – Know Your Customer (KYC) – Free-look period.
CHAPTER 13: DOCUMENTATION – POLICY CONDITION – I: Policy stage documentation – First Premium Receipt – Policy Document – Policy Document – Standard Provisions – Specific Policy Provisions.
CHAPTER 14: DOCUMENTATION – POLICY CONDITION – II: Policy conditions and privileges – Grace period – Policy revival measures – Non-forfeiture provisions – Special policy provisions and endorsements – Provisions related to nomination – Assignment – Types of Assignment – Conditions for valid assignment – Nomination Vs. Assignment – Duplicate Policy – Alteration.
CHAPTER 15: UNDERWRITING: Underwriting purpose – Equity among risks – Risk classification – Selection process – Fraud monitoring and role of agent as primary underwriter – Methods of underwriting – Non-medical underwriting – Conditions for non-medical underwriting – Rating factors in underwriting – Sources of Occupational Hazards – Medical underwriting – Medical Factors that influence an Underwriter’s Decision.
CHAPTER 16: PAYMENTS UNDER A LIFE INSURANCE POLICY: Types of claims and claims procedure – Concept of claims – Risk event and claim – Ascertaining whether a claim event has occurred – Survival Benefit Payments – Surrender of Policy – Rider Benefit – Death Claim – Forms to be submitted for Death Claim – Claim Procedure for Life Insurance Policy – Role of an agent.
CHAPTER 17: INTRODUCTION TO HEALTH INSURANCE: What is health care – Definition of Health Determinants of Health – Levels of Healthcare – Levels of health care – Types of health care – Factors affecting the health systems in India – Evaluation of health insurance in India – Employees State Insurance Scheme – Central Government health scheme – Commercial health insurance – Health Insurance Market – Infrastructure Public health sector – Private sector providers – Pharmaceutical industry – Insurance Providers – Intermediaries – Insurance selling activities – Insurance Servicing activities – financial product distribution – Other important organizations which form part of the health insurance market .
CHAPTER 18: INSURANCE DOCUMENTATION: Proposal forms – Standard form of Declaration – Nature of questions in a proposal form – Elements of Proposal – Medical Questionnaire – Role of intermediary – Duty of an intermediary towards prospect (client) – Acceptance of the Proposal –(Underwriting) – Note on underwriting and processing of proposals – Premium receipts – Definition – Payment of premium in advance – Method of payment of premium – Policy Document – Conditions and warranties – Endorsements – Specimen Endorsements – Interpretation of policies – Renewal Notice – Anti –Money laundering and know your customer guidelines
CHAPTER 19: HEALTH INSURANCE PRODUCTS: Classification of health insurance product – Introduction – Definition – Features of health policies – Broad classification of health insurance products – IRDA guidelines on standardization in health insurance – Hospitalization indemnity product – Top up covers or high deductible insurance plans – Senior citizen policy – fixed benefit covers – hospital cash – critical illness – hospital daily cash policy – critical illness policy – long term care insurance – combi-products – Package policies – Micro insurance and health insurance for poor sections – Rashtriya Swasthya Bima Yojana – Pradhan Mantri Suraksha Bima Yojana – Pradhan Mantri Jan-Dhan Yojana – Personal accident and disability cover- overseas travel insurance – Group health cover – Special products – Key terns in health policies.
CHAPTER 20: HEALTH INSURANCE UNDERWRITING: What is Underwriting – Definition –need – Underwriting basic concepts – File and use guidelines – Other health insurance regulations of IRDAI – Basic Principles of Insurance and tools for underwriting -Underwriting process – Group health insurance – Underwriting of overseas travel insurance – Underwriting of personal accident insurance.
CHAPTER 21: HEALTH INSURANCE CLAIMS: Claims management in insurance – stakeholders in claim process – Role of claims management in insurance company – Management of health insurance claims – Challenges in health insurance – claims process in health insurance – Documentation of health insurance claims – Claims reserving – Role of third party administrators – Claims management –personal accident – overseas travel insurance.