SECTION I
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: PRINCIPLES OF INSURANCE: Elements of Insurance: – Definition – Exposure to risk - Degree of risk exposure - Basis of risk classification- Hazard - Types of hazards – Mathematical principle of insurance (Risk pooling) - Conditions for insuring a risk – The Insurance Contract – Insurance Contract legal aspects – Special Features –Indemnity – Uberrima Fides or Utmost Good Faith – Insurable interest – Proximate cause
CHAPTER 7: DOCUMENTATION: Proposal forms – Roe of Role of intermediary - Duty of an intermediary towards prospect – Acceptance of the proposal – Premium receipt – Cover notes-Certificate of Insurance – Policy Document – Warranties – Endorsements – Interpretation of policies – Renewal notice
CHAPTER 8: THEORY AND PRACTICE OF PREMIUM RATING: – Underwriting basics – Definition – Rate making basics – Rating factors – Hazard – Moral Hazard – Physical hazard – Addressing physical hazards - Short Period scales – Minimum Premium - Sum Insured – Deciding the sum insured
CHAPTER 9: PERSONAL AND RETAIL INSURANCE: HOUSEHOLDER’S INSURANCE: - Retail Insurance Products - Sum Insured and Premium - Shopkeeper’s Insurance - Sum Insured and Premium - Motor Insurance – Its coverages - ‘Third-Party Insurance’ - Exclusions - Sum Insured and Premium.
CHAPTER 10: COMMERCIAL INSURANCE: PROPERTY / FIRE INSURANCE: - Variants of fire policy - Market Value or Reinstatement Value Policies - Declaration Policy - Floater Policies - Business Interruption Insurance – Coverages - Burglary Insurance - Risks covered under burglary insurance - Cash cover - Money Insurance - Coverage of Money Insurance - Important exclusions - Fidelity Guarantee Insurance - Bankers Indemnity Insurance - Jewelers’ Block Policy - Engineering Insurance - Types of engineering insurance policies - Marine Insurance - Marine Cargo Insurance - Different types of marine policies - Liability Policies - Statutory liability – Types of Liability Policies.
CHAPTER 11: CLAIMS PROCEDURE: Claims Settlement process – Importance of settling claims - -limitations or notice of loss – Investigation and assessment – Surveyors and loss assessors – Claim forms – Loss assessment and claim settlement - Important Aspects in an insurance claims – categories of claim – Discharge vouchers – Post settlement action – Selvage – Recoveries – Disputes related to claims – Other disputes resolution mechanisms
SECTION 3
CHAPTER 12: 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 13: 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 14: 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 15: 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 16: 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