Tamilnadu Chief Minister's Comprehensive Health Insurance Scheme

Showing posts with label general health insurance in india. Show all posts
Showing posts with label general health insurance in india. Show all posts

Sunday, 18 January 2015

CONCEPT OF RISK

Concept of Risk
Ø In insurance, risk is applied to certain assets to certain assets that can be insured, such as a human life, a house, a car, etc.
Ø Here are some of the definitions of risk:
·        Risk is the chance of damage or loss.
·        Risk is doubt concerning the outcome of a situation.
·        Risk is something or someone considered to be a potential hazard
·        Risk to human life
·        Life insurance mainly deals with 2 risks – premature death and living too long
·        Life insurance companies offer additional benefits of riders along with life insurance plans to cover the risk of death of death or due to accident and illness


Friday, 16 January 2015

Benefits of a professional insurance market

v Need based Selling
Ø Ensures that customer gets what he is looking for rather than what the company wants to sell.
v Disclosure
Ø All the relevant information about the product needs to be disclosed to the customer.
v Benefits to customer of a professional insurance market:
Ø Higher confidence among policy holder Increase in insurance penetration.
Ø Social benefits.
Ø  Employment generation.
Ø Increase in profit for insurance company.




History of insurance

The history of insurance in India can be divided into there phases

    Ø The first phase (pre-liberalization)  was dominated by private and foreign insurance companies before the government nationalized the sector in 1986.

    Ø In the second phase (liberalization) reforms were initiated and IRDA set up as the regulator of the insurance sector.  Private participation was invited and also FDI.

    Ø In the third phase (post-liberalization) many private companies started insurance operations with a foreign partner in  joint ventures. Currently there are 23 life insurance companies operating in India .

Role of financial services and insurance

v  The financial service sector has a major role to play In the overall economic growth of the country

v  The insurance sector can provide investment to companies and projects thanks to the money  invested in the insurer by individuals buying protection and investment products

Saturday, 10 January 2015

Insurable vs. Uninsurable Risks

                                                         Not every negative economic event is insurable. For risk pooling to be effective, the risk should be unforeseen and infrequent. If a negative event can be predicted in a certain case, it's not a risk, but certainty -- and certainties are not insurable (with the possible exception of death, which is insurable because its timing is uncertain). Furthermore, if a risk is too frequent, it cannot meaningfully be transferred to an insurance company, since the insurance company would only pass on the cost of the negative occurrence to the pool of insureds, along with their expenses and profits. If nearly everyone in a risk pool is filing a claim, then they are likely better off not attempting to pool their risks at all but setting aside sufficient reserves to pay for them themselves.

Modern Insurance Policies



                                                    The insurance industry grew enormously, as individuals and businesses sought to protect themselves from economic catastrophe by transferring their risks to an insurance pool. We still have commercial shipping insurance -- just as we did in the ancient world -- and we also insure against such diverse risks as fires, floods, theft, auto accidents, kidnap and ransom schemes, defaults on the part of our debtors, lawsuits and judgments, dying too early and even against the risk of living too long.

Risk Pooling

In insurance, the term "risk pooling" refers to the spreading of financial risks evenly among a large number of contributors to the program. Insurance is the transference of risks from individuals or corporations who cannot bear a possible unplanned financial catastrophe to the capital markets, which can bear them easily -- at least in theory. The capital markets, meanwhile, are generally happy to take on risk from individuals and corporations -- in exchange for a premium they believe is sufficient to cover the risk.
             
                                           Risk pooling is essential to the concept of insurance. The earliest known insurance policies were written some 5,000 years ago, to protect shippers against the loss of their cargo and crews at sea. Any one of them would be devastated by the loss of a ship. But by pooling their resources, these ancient businessmen were able to spread the risks more evenly among their numbers, so each paid a relatively small amount. Under the Babylonians, those receiving a loan to fund a shipment would pay an additional amount in exchange for a rider cancelling the loan if a shipment should be lost at sea.

What Is Life Insurance


Life insurance is a contract that pledges payment of an amount to the person assured (or his nominee) on the happening of the event insured against.

The contract is valid for payment of the insured amount during:
Ø  The date of maturity, or
Ø  Specified dates at periodic intervals, or
Ø  Unfortunate death, if it occurs earlier.
Among other things, the contract also provides for the payment of premium periodically to the Corporation by the policyholder. Life insurance is universally acknowledged to be an institution, which eliminates 'risk', substituting certainty for uncertainty and comes to the timely aid of the family in the unfortunate event of death of the breadwinner.
By and large, life insurance is civilisation's partial solution to the problems caused by death. Life insurance, in short, is concerned with two hazards that stand across the life-path of every person:
  1. That of dying prematurely leaving a dependent family to fend for itself.
  2. That of living till old age without visible means of support.


About Life Insurance


Life insurance in India made its debut well over 100 years ago.

In our country, which is one of the most populated in the world, the prominence of insurance is not as widely understood, as it ought to be. What follows is an attempt to acquaint readers with some of the concepts of life insurance, with special reference to LIC.

It should, however, be clearly understood that the following content is by no means an exhaustive description of the terms and conditions of an LIC policy or its benefits or privileges.

For more details, please contact our branch or divisional office. Any LIC Agent will be glad to help you choose the life insurance plan to meet your needs and render policy servicing.



Sunday, 30 November 2014

Free-Look Period

You have bought a new insurance policy and received the policy document and find that the terms and conditions are not what you wanted.
What do you do? Grin and bear it?
Not at all.
IRDA has built into its regulations a consumer-friendly provision that takes care this problem.
If you have bought a policy and realise you don’t want it you can return it and get a refund.
There are conditions though.
  • This applies only to Life insurance policies and
  • To Health insurance policy that are for a term of at least 3 years
  • You can exercise this option within 15 days of receiving the policy document
  • You have to communicate to the company in writing
  • The premium refund will be adjusted for
    • proportionate risk premium for the period on cover
    • expenses incurred by the insurer on medical examination and
    • stamp duty charges

How To Make a Claim - Life Insurance

Formalities for a death claim
When a person with a life insurance policy – called a life assured – dies, a claim intimation should be sent to the insurance company as early as possible. The assignee or nominee under the policy can do this. So can any close relative or the agent who handles the policy.
The claim intimation should contain information like the date, place and cause of death. The insurance agent has the duty to help the life assured’s family/ assignee to deal with the insurance company to fulfil the formalities for a claim.
The insurance company will respond to this intimation and will ask for the following documents:

  • Filled-up claim form (provided by the insurance company)
  • Certificate of death
  • Policy document
  • Deeds of assignments/ re-assignments if any
  • Legal evidence of title, if the policy is not assigned or nominated
  • Form of discharge executed and witnessed
Other documents such as medical attendant's certificate, hospital certificate, employer's certificate, police inquest report, post mortem report etc could be called for, as applicable.
Formalities for a maturity claim
Where a life insurance policy is maturing, the insurance company will usually send intimation to the policyholder along with a discharge voucher at least two to three months in advance of the date of maturity giving details like the maturity amount payable.
The policyholder has to sign the discharge voucher – which is like a receipt – have his signature witnessed and send it back to the insurance company along with the original policy bond to enable it to make the payment.
If the policy has been assigned in favour of any other person or entity – like a housing loan company – the claim amount will be paid only to the assignee who will give the discharge.

How to buy life insurance and from whom



Insurance Intermediaries
  • Insurance is a complex product representing a promise to compensate the insured or third party according to specified terms and conditions in the event of the occurrence of a covered contingency. In most insurance transactions there is usually an intermediary - an insurance agent (individual or corporate) or an insurance broker.
  • Insurance intermediaries serve as a bridge between consumers (seeking to buy insurance policies) and insurance companies (seeking to sell those policies).
  • Isurance brokers are licensed by the IRDA and governed by the Insurance Regulatory and Development Authority (Insurance Brokers) Regulations, 2002. Individual insurance agents and corporate agents are also licensed by the IRDA and governed by the Insurance Regulatory and Development Authority (licensing of Individual Insurance Agents) Regulations, 2000 and the Insurance Regulatory and Development Authority (Licensing of Corporate Agents) Regulations, 2002, respectively. These Regulations lay down the Code of Conduct for the respective intermediaries.
  • An intermediary has a distinct role to play in the entire life cycle of a product, from the point of sale through policy servicing, up to claim servicing. An intermediary shall provide all material information with respect to a proposed cover to enable the prospect to decide on the best one. The intermediary is expected to advise the prospect with complete disclosures and transparency.. After the sale is effected, the intermediary must coordinate effectively between the customer and the insurer for policy servicing as well as claim servicing.
  • IRDA has prescribed regulations for protecting the interests of policyholders casting obligations not only on Insurers but also Intermediaries. These prescribe obligations at the point of sale as well as policy servicing and claims servicing.

Unit Linked Insurance Policy (ULIP)




Unit Linked Insurance Policies (ULIPs) offer a combination of investment and protection and allow you the flexibility and choice on how your premiums are invested. . IN UNIT LINKED PLANS, THE INVESTMENT RISK PORTFOLIO IS BORNE BY YOU AS YOU ARE THE INVESTOR Typically, the policy will provide you with a choice of funds in which you may invest. You also have the flexibility to switch between different funds during the life of the policy. The value of a ULIP is linked to the prevailing value of units you have invested in the fund, which in turn depends on the fund's performance. In the event of death or permanent disability, the policy will provide the Sum Assured (to the extent you are covered) so that you can take comfort in knowing that your family is protected from sudden financial loss. A ULIP has varying degrees of risk and rewards. There are various charges applicable for Unit Linked Policies and the balance amount out of the premium is only invested in the fund/funds chosen by you.  It is important to ask your insurer or agent or broker questions to understand the sum total of charges that you have to incur. It is important to assess your risk appetite and investment horizon before deciding to buy a ULIP policy. You must also read the terms and conditions of the policy carefully to understand the features of the policy including the lock-in period, surrender value, surrender charges etc.

Why Buy Life Insurance



Life Insurance is a financial cover for a contingency linked with human life, like death, disability, accident, retirement etc. Human life is subject to risks of death and disability due to natural and accidental causes. When human life is lost or a person is disabled permanently or temporarily, there is loss of income to the household.
Though human life cannot be valued, a monetary sum could be determined based on the loss of income in future years. Hence, in life insurance, the Sum Assured ( or the amount guaranteed to be paid in the event of a loss) is by way of a ‘benefit’.  Life Insurance products provide a definite amount of money in case the life insured dies during the term of the policy or becomes disabled on account of an accident.

Why you should buy Life Insurance:
All of us face the following risks:
Dying too soon
Living too long

Life Insurance is needed :
  • To ensure that your immediate family has some financial support in the event of your demise
  • To finance your children’s education and other needs
  • To have a savings plan for the future so that you have a constant source of income after retirement
  • To ensure that you have extra income when your earnings are reduced due to serious illness or accident
  • To provide for other financial contingencies and life style requirements
Who needs Life Insurance:
Primarily, anyone who has a family to support and is an income earner needs Life Insurance. In view of the economic value of their contribution to the family, housewives too need life insurance cover. Even children can be considered for life insurance in view of their future income potential being at risk.

How much Life Insurance is needed:
The amount of Life Insurance coverage you need will depend on many factors such as:
  • How many dependents you have <="" li="">
  • What kind of lifestyle you want to provide for your family
  • How much you need for your children’s education
  • What  your investment needs are
  • What your affordability is
You should seek the help of an insurance agent or broker to understand your insurance needs and suggest the right type of cover

Monday, 24 November 2014

The Process



If your insurance company does not resolve your complaint to your satisfaction you can escalate your complaint to IRDA.
·  If your complaint is suitable for taking to the Insurance Ombudsman IRDA will help you resolve it by taking it up with the insurance company
·  For disputes where enquiry or adjudication are required you should approach the Consumer Forum or Courts.

The Process



The Framework



IRDA’s regulations stipulate the Turnaround Times (TAT) for various services that an insurance company has to render to you, the consumer.
These are part of the IRDA Protection of Policyholders’ Interests (PPHI) Regulations 2002.
Insurance companies are also required to have an effective Grievance Redressal Mechanism and IRDA has created the guidelines for that too.

Here are the TATs for an insurance company to deal with various types of complaints




Guidelines for Grievance Redressal by Insurance Companies - Download PDF (474.5 Kb)
IRDA PPHI Amendment Regulations 2002 - Download PDF (152.3 Kb)
IRDA PPHI Regulations 2002 - English - Download PDF (1012.6 Kb)
IRDA PPHI Regulations 2002 - Hindi - Download PDF (2088 Kb)