CU-BBA-SEM-V-Underwriting & Claim Management

Since the IME can be a first-time insight for the patient, and is almost consistently a novel involvement in a specific analyst, the patient will presumably be restless. Knowing something about the patient's set of experiences before the assessment and permitting adequate time for the assessment, the doctor will find the underlying ways to build up some affinity by decreasing strains. Nothing, in any case, works with affinity like great relational abilities, including undivided attention. Regardless of whether the assessment is podiatric or mental, the analyst who passes on the message that the patient has been heard and seen definitely diminishes strain and makes the assessment simpler, yet maybe significantly more dependable. Remember that the patient goes to the assessment with physical as well as mental grievances, yet likely with a demeanour that might have been made partially by guidance's affirmations that the reason for the assessment is to serve the insurance agency and counter what the offended party master or treating doctor is saying. One procedure that may serve to dispel any confusion is ask the patient what he/she has been told in regards to the motivation behind the assessment. Regardless of whether the patient has not been arranged (or one-sided) by lawful advice, he/she might just go to the assessment addressed. The doctor ought not be stunned or irritated by the presence of an outsider, as it is normally the patient's righter than wrong to be joined by an agent. Also, a few principles of common methodology will allow the assessment to be recorded or recorded. On the off chance that the doctor feels scared by this activity, he/she ought not defer the test, however make each endeavour to keep quiet and expert. The doctor is urged to approach the assessment as he/she would under ordinary conditions. Any impedance with the assessment by delegates or the taping interaction can be noted in the report. Great correspondence is fundamental for the social event of a precise history. Despite the fact that doctors would be savvy to recognize patient objections through intelligent tuning in, they need not discover believable all that is advised to them. This is the idea of abstract grumblings versus target discoveries. Notwithstanding, accumulate a set of experiences that has a chronologic request. Critically, that request should start with a careful taking of the examinee's previous clinical history. Past clinical history can be basic to such an extent that if the way toward acquiring this data from both documentation and the patient's memory is limited, the assurance of causality of hindrance itself could be yet to be determined. Past clinical history is vital for a sound assessment, and that which the patient gives ought to be verified by records, including those from an essential consideration doctor. The IME interaction doesn't naturally approve the analyst to complete demonstrative testing, for example, x-beams. The inspector should consider getting consent preceding the assessment for demonstrative testing to keep away from second assessments or deferrals. 101 CU IDOL SELF LEARNING MATERIAL (SLM)

Some nonphysical testing is so essential to the interaction that it most likely won't need approval or result in addressing. For instance, the organization of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), or other target character testing during mental assessments, appears certainly; be that as it may, almost any strategy can be tested, and the inspector ought to be ready to archive difficulties and give steady reasoning’s to the technique, recorded as a hard copy for the most part. Numerous IMEs will request the doctor's assertions with respect to work ability. All things considered, sets of responsibilities with fundamental capacities can be incredibly useful. Doctors surveying physical or exertional hindrance should know the U.S. Branch of Labour meanings of actual work, like stationary, light, and medium. These terms are unequivocally characterized and ought not to be mistaken for vague terms, for example, \"light obligation,\" as they might just be utilized later by professional experts or guarantee chairmen in knowing inability. As expressed above, inability is a word related idea. Doctors ought not make revelations of handicap or, besides, summed up explanations in regards to work, like the patient \"can get back to work,\" without being more explicit in regards to medicinally resolved limitations, assuming any. The doctor ought to likewise try not to make suggestions for a practical limit assessment (FCE) except if all gatherings have concurred in advance that a FCE will be allowable. 6.3.3 Post-examination Regardless of whether quickly following the assessment or accompanying to the assessment, great administrative record-keeping or note-taking is fundamental. On the off chance that the doctor can't take great, solid notes, he/she should direct quickly following the assessment. A few doctors have made it their training to direct their discoveries and reports while the patient is available. This training requires further investigation when one believes the capability of the doctor to be undermined by the presence of the patient or potentially his lawful agent. Post-assessment criticism of any sort can have iatrogenic [induced incidentally by the examiner] ramifications for patient protests and claims of inability. Following IMEs, or besides any assessment that may accordingly include legal declaration, regardless of whether they be free or part of the indicative and treatment measure, inspectors ought not to give \"input.\" So-called criticism meetings can frequently bring about a teaching of patient objections and acceptance of incapacity. Anybody tested with the duty of giving great and reasonable legal discoveries in regards to the patient's hindrances ought not to be examining those weaknesses with the patient. The free clinical analyst is liable for altogether breaking down the entirety of the information assembled and inspected and figuring out what explanations can be made with proficient likelihood or \"sensible clinical assurance.\" The IME doctor should ponder how he/she can authentically uphold his/her discoveries while having sworn to tell the truth in a courtroom. 102 CU IDOL SELF LEARNING MATERIAL (SLM)

Typically, this somewhat scary situation can offer viewpoint to the inspector's discoveries and ends. As a rule, the issues of finding, anticipation, causality, and get back to work are important, however concerning the last mentioned, the doctor should remain inside his/her mastery and characterize explicit limitations as opposed to come to professional end results with respect to work as well as handicap. In the event that the wounds are out of the analyst's field, he/she should adhere to his/her specialized topic. Once more, IMEs ought not to make post-assessment suggestions for FCEs or references to explicit doctors or different fortes, except if this hosts been cleared by elaborate gatherings. The free clinical inspector should attempt to address just inquiries posed. Report composing changes from one essayist to another and forte to strength, however since most cases executives, caseworkers, and legal advisors are deluged by composed reports, they have figured out how to peruse the report from back to front. Consequently, a synopsis of discoveries and ends can be most useful when found toward the finish of the conventional report. 6.4 SUMMARY  Life insurance applications that don't need clinical evaluation for the supplier are regularly alluded to as 'non-clinical life coverage' or 'non-clinical term life coverage'  There might be a few examples where the guarantor requires extra data prior to having the option to offer cover. This may incorporate an actual clinical assessment or acquiring a report from candidates GP is known as non-clinical life coverage  Medical underwriting is the way toward assessing an application for health care coverage inclusion by looking at the candidate's clinical history. The cost of inclusion is controlled by the danger variables of the candidate.  Medical underwriting includes exploring the clinical history of a candidate for protection to recognize hazard factors and value inclusion appropriately.  Medical underwriting additionally is drilled in deciding individual rates for extra security and handicap protection strategies.  Full clinical underwriting includes a careful examination of a person's clinical records. The interaction requires the health care coverage candidate to give a clinical history of returning years, and the guarantor might contact medical care suppliers that the individual has utilized.  When a candidate goes out to purchase a clinical protection strategy, many presumed protection suppliers request that candidates go through certain tests. These pre-clinical trials are required for them to get health care coverage as they are an enormous main consideration in deciding a candidate's qualification 103 CU IDOL SELF LEARNING MATERIAL (SLM)

 Prior to masterminding an IME, an alluding gathering would profit with considering the IME as a three-venture measure: 1. Pre-assessment, 2. Examination,3. post- assessment 6.5 KEYWORDS  Medical Underwriting-Medical guaranteeing is the way toward assessing an application for health care coverage inclusion by analyzing the candidate's clinical history. The cost of inclusion is controlled by the danger elements of the candidate.  Non-Medical Underwriting-Life protection applications measures that don't need clinical evaluating for the supplier are regularly alluded to as 'non-clinical extra security' and this cycle of assessment is known as Non-Medical guaranteeing.  Obama care-The Affordable Care Act of 2010, famously known as Obamacare, restricted the capacity of insurance agencies to set rates dependent on singular wellbeing history for Americans who bought protection through its trades. Age, sex, and cigarette smoking could be thought of  IME (Independent Medical Examination) - IME means \"Autonomous Medical Exam.\" But, consistently recall it is an assessment by a specialist (or specialists) paid by the insurance agency. That isn't \"free.\" Instead, expect the IME specialist to differ with the specialists you have employed to give your clinical consideration.  The American Medical Association (AMA) Guides-The AMA Guides give a solid, repeatable estimation system for lasting impedance in patients who have experienced a physical issue or disease bringing about long haul loss of a body part or decrease of body work. 6.6 LEARNING ACTIVITY 1. As a non-medical underwriter, list down the questions you will ask the applicant ___________________________________________________________________________ ___________________________________________________________________________ 2. As an Independent Medical Examiner how would you examine a nervous applicant, also mention the process of evaluation. ___________________________________________________________________________ ___________________________________________________________________________ 6.7 UNIT END QUESTIONS A. Descriptive Questions Short Questions 104 CU IDOL SELF LEARNING MATERIAL (SLM)

1. What do you mean by Non- medical insurance? 2. What is the role of Independent Medical Examiner in medical insurance? 3. List down 5 important evaluation questions to be asked by evaluator in non-medical insurance? 4. Why honesty is the best policy in non-medical evaluation 5. Describe the role of medical underwriter in processing an insurance policy. Long Questions 1. What types of information underwriter seek in non-medical health insurance? 2. Describe Non-Medical and Medical underwriting. 3. What are the major steps taken in Medical Examination Process? 4. Explain in details post-Examination process. 5. What do you understand by Pre-Examination process in Medical Examination process? B. Multiple Choice Questions 1. Which data points does underwriting look at? a. Life style. b. Both a and d c. Construction of the building. d. Occupation. 2. What is not a one-size-fit-all? a. Tracksuit. b. Policy. c. Recommendation letter. d. Bank statements. 3. Who does underwriting seek report inmedical insurance from? a. Independent Medical Examiner. b. Applicants car model. c. Applicants neighbours. d. Applicants lawyer. 4. What is not there in IMEs? 105 a. Corruption b. Friends CU IDOL SELF LEARNING MATERIAL (SLM)

c. Doctor-patient Privilege. d. Lawyer intervention. 5. What is the last process in the Medical Examination Process? a. Post-Examination. b. Giving disability certificate. c. Starting the process again. d. Erasing application. Answers 1-b, 2-b, 3-a, 4-c, 5-a 6.8 REFERENCES References  INDEPENDENT MEDICAL EXAMINATION: Preliminary Considerations by Jasen M. Walker, Ed.D., C.R.C., C.C.M. (Presented at: Strategies for IMEs Workshop, April 8, 2002)  Yusuf, T.O. &Ajemunigbohun, S.S. (2015). Effectiveness, efficiency and promptness of claims handling process in the Nigerian Insurance industry. European Journal of Business and Economics, 10 (2), 6-10  Yusuf, T.O. (2010). Brokers and the control of post contractual opportunism in the Nigerian Insurance market. Journal of Financial Crime, 17 (2), 223-239. Text Books  Yusuf, T.O., &Babalola, A.R. (2009). Control of insurance fraud in Nigeria: An exploratory study (case study). Journal of Financial Crime, 16 (4), 418-435.  Yusuf, T.O., &Dansu, F.S. (2014). Effect of claim cost on insurers’ profitability in Nigeria. International Journal of Business and Commerce, 3 (10), 1-20  Yusuf, T.O., &Abass, O.A. (2013). Investigating the roles of claims manager in claims handling process in the Nigeria Insurance Industry. Journal of Business and Finance, 1 (2), 69-74. Websites  https://www.quotacy.com/15-underwriters-determine-life-insurance-premium/  https://caspianinsurance.co.uk/what-is-non-medical-life-insurance  https://www.investopedia.com/terms/m/medical-underwriting.asp 106 CU IDOL SELF LEARNING MATERIAL (SLM)

 https://www.hdfcergo.com/blogs/health-insurance/why-medical-test-is-important- while-buying-a-health-cover 107 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 7 – UNDERWRITING THE LIFE INSURANCE PROCESS STRUCTURE 7.0 Learning Objectives 7.1 Introduction 7.2 Issuance of the Policy Document 7.2.1 Benefit Payable 7.3 Summary 7.4 Keywords 7.5 Learning Activity 7.6 Unit End Questions 7.7 References 7.0 LEARNING OBJECTIVES After studying this unit, you will be able to:  Explain the requirement of documents at the stage of proposal.  Describe the importance of age proof at stage of proposal.  Describe the role and services of underwriting in the process of policy documentation.  Elucidate the requirement of documents at the stage of continuance of policy. 7.1 INTRODUCTION Underwriting gives guarantors, a clearer glance at candidate's well-being history and foundation and decides their expenses. An extra security underwriter's fundamental objective is to illustrate the candidate's life. As the financier goes through each progression all the while, they study what applicants' identity is, their clinical foundation, and what they do, which assists them with foreseeing the candidate's future. After candidates apply for life coverage, they go through an interaction called endorsing with the insurance agency. A financier deals with the sake of the extra security organization to decide whether a candidate ought to get exceptional, they initially cited. They assess your application subtleties, wellbeing data, and way of life to give the candidate a protection arrangement, which associates to how possible they will bite the dust before the finish of his/her strategy's term and their premium depends on that. 108 CU IDOL SELF LEARNING MATERIAL (SLM)

All protection items include some level of underwriting to get an image of who you (candidate) depend on your own experience and how it identifies with the sort of protection you (candidate) are buying. A few pieces of the extra security guaranteeing measure require activity on candidate's part to confirm their application answers, while others require the contribution of another person, for example, a candidate's specialist. Despite the fact that endorsing can take a normal of four to about a month and a half to finish, as indicated by Policy genius information in 2021, a protection intermediary can make the interaction simpler by looking at candidates underwriting results to various suppliers to get them the best evaluating. Endorsing incorporates a point-by-point audit of your life coverage application. Each life coverage organization has its own guaranteeing manual or rules to decide your last expenses. What keeps is a standard arrangement of apparatuses and undertakings for a financier, however the points of interest of what's utilized, when, and how will not be something similar across organizations. 7.2 ISSUANCE OF THE POLICY DOCUMENT Documents are important to prove the presence of an agreement. In extra security a few records are stylish. The reports remain as proof of the agreement between the guarantor and the guaranteed. The significant records stylish in extra security are exceptional receipt, protection strategy, supports, and so on Disaster protection is a lawfully enforceable agreement between two parties both of whom are legitimately able to contract. It is consequently, important that the agreements of the arrangement should be appropriately archived in a way that would clarify that the two players to the agreement are Ad-Idem i.e., in total harmony. Advertisement Idem implies that both the gatherings comprehend exactly the same thing in a similar sense or are in total harmony on a similar subject. There should be agreement or Ad-Idem between the gatherings to the agreement. This is conceivable given every one of the agreements, rights and obligations - advantages and commitments are appropriately archived in wording which can be unmistakably deciphered in a courtroom. Between two individuals at some point, quiet means an acknowledgment. Be that as it may, as the safety net provider is a legitimate character qualified for contract verbal conversation between gatherings to the agreement is unimaginable and thus there is a requirement for documentation. Protection is additionally an agreement of most extreme great confidence and authorized distinctly in the far off future. It is consequently essential that the revelations made by both the gatherings ought to be placed in high contrast for future reference. Any concealment, wilful and material will make the agreement void. The protected, subsequently, has an obligation to announce all that he thinks about himself, his wellbeing, his monetary status in addressing questions contained in the proposition structure and other auxiliary records which might be needed by the safety net provider. Types and Advantageous of Life Insurance 109 CU IDOL SELF LEARNING MATERIAL (SLM)

Many different types of life insurance are available to meet all sorts of needs and preferences.  Term Life—Term disaster protection keeps going a specific number of years, then, at that point closes. You pick the term when you take out the arrangement. Normal terms are 10, 20, or 30 years. The best term disaster protection arrangements offset moderateness with long haul monetary strength.  Level Term—The expenses are a similar consistently.  Increasing Term—The charges are lower when you're more youthful and increment as you get more seasoned. This is additionally called \"yearly inexhaustible term.\"  Return of Premium—Return of premium (ROP) arrangements incorporate an implicit reserve funds system. You'll pay a level rate for the length of your strategy, yet not at all like customary term disaster protection, you'll get your cash back toward the finish of the term.  Permanent—This stays in power for the protected's whole life except if the policyholder quits paying the expenses or gives up the approach. It's regularly more costly than term.  Single Premium—For this situation the policyholder pays the whole premium front and center as opposed to making month to month, quarterly, or yearly installments.  Whole Life—Whole disaster protection is a kind of long-lasting extra security that aggregates cash esteem.  Universal Life—A kind of long-lasting disaster protection with a money esteem part that procures revenue, general life coverage has charges that are equivalent to term extra security. In contrast to term and entire life, the expenses and passing advantage can be changed over the long haul.  Guaranteed Universal—This is a kind of widespread life coverage that doesn't construct cash esteem and regularly has lower expenses than entire life.  Variable Universal—With variable all inclusive life coverage, the policyholder is permitted to put away the approach's money esteem.  Indexed Universal—This is a sort of all inclusive life coverage that allows the policyholder to procure a fixed or value ordered pace of return on the money esteem part.  Burial or Final Expense—This is a sort of long-lasting life coverage that has a little passing advantage. In spite of the names, recipients can utilize the demise advantage as they wish.  Guaranteed Issue—A kind of long-lasting extra security accessible to individuals with clinical issues that would somehow make them uninsurable, ensured issue disaster protection won't pay a demise advantage during the initial two years the strategy is in power (except if the passing is coincidental) because of the great danger of guaranteeing 110 CU IDOL SELF LEARNING MATERIAL (SLM)

the individual. In any case, the back up plan will return the arrangement charges in addition to intrigue to the recipients if the protected passes on during that period. Disaster protection Riders Numerous insurance agencies offer policyholders the alternative to redo their arrangements to oblige their requirements. Riders are the most widely recognized way policyholders might change their arrangement. There are numerous riders, yet accessibility relies upon the supplier. The policyholder will regularly pay an extra premium for every rider or a charge to practice the rider, however a few approaches remember certain riders for their base premium.  The coincidental demise advantage rider gives extra life coverage inclusion in the occasion the safeguarded's passing is unintentional.  The waiver of premium rider assuages the policyholder of making premium installments if the guaranteed becomes incapacitated and unfit to work.  The incapacity pay rider pays a month to month pay in the occasion the policyholder becomes unfit to labor for a while or more because of a genuine ailment or injury.  Upon conclusion of terminal disease, the sped up death advantage rider permits the safeguarded to gather a piece or the entirety of the passing advantage.  The long haul care rider is a sort of sped up death advantage that can be utilized to pay for nursing home, helped living, or in-home consideration when the safeguarded needs support with exercises of day by day living, like washing, eating, and utilizing the latrine.  A ensured insurability rider allows the policyholder to purchase extra protection sometime in the not too distant future without a clinical audit. The various kinds of documents which become necessary at three stages of a policy – 1. At the stage of proposal, which if accepted result into a policy, 2. During the duration of the policy where several alterations may become necessary 3. At the end of the policy contract when insurer pays the final claim DOCUMENTS NEEDED AT THE STAGE OF PROPOSAL Proposal form It is the basic format which is filled in by the proposer who wants to take an insurance policy. It can be defined as the application for insurance. A Proposal Form has Three Portions The first gives insights concerning the proposer, his name address, occupation, the insights regarding the kind of protection that he needs to take, and the name of the chosen one to whom the cash is payable in the event that the policyholder doesn't make due to take the development sum. 111 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 7.1: Part Claim form The second bit identifies with the subtleties of the protection strategy that the proposer as of now has, the current medical issue and the individual history of his wellbeing, any ailment or mishap he may have had. This is an itemized survey and the proposer is required to answer to each address honestly and genuinely. A female proposer needs to answer certain extra inquiries explicit to her sex. The last segment of the proposition structure identifies with the revelation. Through this presentation, the proposer: i. Affirms the veracity of the assertions made in the proposition structure in answering the inquiry ii. Affirms that he/she has not stifled, distorted, or hid any reality which might be material to the danger iii. Agrees that this statement alongside the proposition structure will frame the premise of the agreement and if any data is discovered to be bogus the agreement will be invalid and void hence building up the guideline of \"Uberimma Fides\" (Utmost great confidence). iv. Further consents to take the protection on the agreements chose by the guarantor. 112 CU IDOL SELF LEARNING MATERIAL (SLM)

The proposer further consents to keep the backup plan educated regarding any progressions in the position identifying with his wellbeing or his occupation among now and the issuance of the principal premium receipt. It is consequently certain that after the safety net provider has given the primary premium receipt, the agreement is said to have finished up and from there on the backup plan has no privilege to change the conditions of the agreement. Notwithstanding, the safety net provider has a privilege to offer any term and condition before the last acknowledgment of the protection. For instance, in the event of a female proposer, the safety net provider may not consent to acknowledge the danger of the labour. In the event of certain risky occupation like business pilots, the guarantor might get a kick out of the chance to bar the danger to life because of such occupation. In the event of certain distortion, the danger of mishap can be prohibited. These rejections of dangers are not ordinary terms of the strategy contract and in this way need to evoke assent of the proposer. If there should arise an occurrence of an inadequate wellbeing, the backup plan might get a kick out of the chance to acknowledge a decreased danger during the first or two years of the protection. The assent of the protected is an absolute necessity for such constraints to be forced. All such extraordinary conditions or riders are referenced in the approach either by a support or connection to the report. In the event that the safety net provider has taken a Convertible Whole Life Plan which is to be changed over to a blessing plan following 5 years, the vital condition is embraced on the strategy. The agreements as referenced in the arrangement alongside such supports as made at the rear of the strategy oversee the protection contract and are available to be deciphered by a court. Nonetheless, it could be noticed that specialist’s private report and the clinical assessment (secret) report are not piece of the agreement for protection. Age Proof It is a significant factor in choosing the quantum of premium against an approach. The archive demonstrating the age, i.e., age confirmation should be dependable and the undertake needs to embrace concerning its honesty. A backup plan acknowledges these records as standard age verification - i. Certified extract from municipal records, recorded at the time of birth. ii. Certificate of baptism or extract from Family Bible Extract from school or college records. iii. Extract from service register in case of employees, Government or semi government or such other reputed institutions which insist on conclusive evidence of age at the time of recruitment. iv. Identity card issued by Defence department. v. Marriage certificates issued by Roman Catholic Church. vi. Domicile certificate. 113 CU IDOL SELF LEARNING MATERIAL (SLM)

vii. Passport. Non-Standard Age Proofs They are those which are nearly less solid and subsequently the backup plan acknowledges them with a spot of salt. All in all, the safety net provider plays it safe prior to tolerating such age verifications as last. For instance, such age evidences are analysed by a senior official and not acknowledged as an issue of schedule. Another protect is to offer a diminished term of strategy with the goal that the arrangement develops at a relatively early age. The greatest period of development might be fixed at a lower age. The backup plan even may charge an additional premium to make up for the conceivable odd take on the cold, hard truth old enough in such age confirmation. Such non–standard age confirmations are (1) Horoscope, (2) administration records of businesses other than those referenced over (3) ESI card, (4) Marriage Certificate if there should be an occurrence of a Muslim proposer., 5) Elders Declaration, 6) Self Declaration, 7) Driving License, 8) Certificate gave by town panchayat, 9) Electoral job, 10) Ration card. Age confirmation is demanded for finishing of proposition, if the pronounced age of the proposer is under at least 20 than 50 or on the other hand if the aggregate proposed is very high, say over one lakh. Proof of Income This record might become fundamental at whatever point the total proposed is extremely high. Typically, a total proposed which is seven to multiple times of the pronounced pay is worthy for protection. Be that as it may, proposition do go to the backup plan when the known type of revenue of the proposer is significantly less contrasted with the measure of protection wanted. An assistance holder ordinarily doesn't deal with this issue as his types of revenue are unquestionable. In the event of finance managers, the surveyed pay is on occasion significantly less contrasted with what is an advantageous pay for the measure of protection wanted. In such cases the backup plan on occasion calls for surveyed personal expense forms, or Chartered Accountant's authentication and so forth such safeguards are important to dispense with the chance of good danger. Documents Needed During the Continuance of the Policy 1. First Premium Receipts and Renewal Premium Receipt The First Premium Receipt (FPR) is the affirmation of protection. This record is significant as it gives the date of supposition of the danger yet it’s worth is nil once the arrangement report has been given. 2. Policy Contract Strategy record is a nitty-gritty archive and it is the Evidence of the protection contract which specifies every one of the agreements of the protection. The guaranteed purchases are not the strategy contract, but rather the right to the amount of cash and its future conveyance. The backup plan on its part vows to pay an amount of cash, given obviously 114 CU IDOL SELF LEARNING MATERIAL (SLM)

the safeguarded keeps its piece of guarantee of paying the portions of premium as planned. The pre-saunter to the protection contract makes the above assertion understood and expresses that this strategy is given depending upon the conditions and advantages imprinted on the rear of the arrangement. The supports put on the arrangement will likewise be important for the strategy and it additionally makes a reference to the proposition structure saying that that the assertions given in the proposition structure are the premise of the agreement. The timetable which is imprinted on the approach archive recognizes the workplace which has given the strategy. It expresses the name of the policyholder, the date of the beginning of the strategy, an ID number of the arrangement called strategy number. This number is very valuable for making any reference to the safety net provider identifying with this arrangement. This will keep away unnecessary deferral. The recipient's name is additionally referenced alongside the address. It is important to watch that it is right and any mix-up ought to be quickly called attention to for remedy. A misstep in the location might mislead the superior notification and some other future correspondence. It additionally expresses the name of the chosen one and the date up to which premium must be paid. The timetable proceeds to make reference to, the sort of strategy, on the incident of which, the total guaranteed is payable and to whom it is payable. It obviously likewise specifies when and how long the premium is to be paid. The arrangement archive is endorsed by an authority of the guarantor and dated and stepped according to the arrangement of the Stamp Act to make it a totally lawfully enforceable record. 3. Renewal Premium Receipts However, it is the obligation of the guaranteed to pay the recharging premium on the due date the guarantor sends a restoration premium notification to the protected out of politeness and on getting the superior issues a reestablishment premium receipt (RPR) which is a significant record and must be safeguarded as it is the solitary narrative verification that the due instalment has been made. 4. Endorsements Life coverage strategy being a drawn-out agreement, almost certainly, the conditions may so change throughout the time that a modification or change in the approach conditions might be required. The safety net providers regularly license such changes which are in light of a legitimate concern for the policyholders and furthermore all the while don'tunfavourably influence the backup plan's advantage. It must be noted nonetheless, that the guarantor isn't approved to roll out any improvement in the states of the arrangement during its continuation with the exception of such which has been consented to at the start of the approach. A protection strategy, in this sense, is known as a one-sided contract. All such modifications as are talked about from this point forward are influenced by supports on the arrangement record 115 CU IDOL SELF LEARNING MATERIAL (SLM)

All such changes as are talked about from this point forward are influenced by supports on the arrangement archive. The following alterations are not permitted: i. Alterations during the primary year. ii. Alteration starting with one class of affirmation then onto the next where the top notch scale is diminished. iii. Alteration to another arrangement which is more danger situated. iv. Increase in aggregate guaranteed in a similar approach. The following alterations are allowed: i. Limiting the superior paying period, yet date of development staying unaltered; ii. Change in the method of instalment of premium e.g., Half yearly to yearly or half- yearly to quarterly; iii. Alteration because old enough confirmation, whenever required, must be mandatorily done; iv. Alteration or rectification for the sake of the guaranteed/candidate; v. Bringing the approach under compensation reserve funds conspire; vi. Replacing a restricting statement by an additional premium. For instance, the main pregnancy provision can be supplanted by a onetime additional premium of Rs.5/ - per thousand. vii. An additional premium forced for explicit weakness or word related reasons can be eliminated or diminished. For instance, an additional premium forced for hernia or hydrocele can be taken out after careful activity. Also, a word related additional premium can be taken out, in case there is change in occupation to a less risky one. In any case, a word related additional premium can't be forced, after the arrangement has been given, regardless of whether the policyholder takes up a more unsafe work. 5. Duplicate Policy An approach record is an important archive and can be utilized for contract and so forth Loss of strategy record doesn't acquit the safety net provider from the risk of instalment of strategy continues when the case emerges. The case can be chosen the petitioners, outfitting a repayment bond mutually with one guarantee. In the event that an approach is irreversibly lost, a copy strategy can be given, in the wake of following a specific system. The backup plan fulfils itself of the conditions prompting misfortune. Being so fulfilled the backup plan demands a notice in a paper, creation of a repayment bond and 116 CU IDOL SELF LEARNING MATERIAL (SLM)

instalment of strategy planning charges and there after a copy strategy is given. The copy strategy is stepped \"Copy Policy\". 6. Nomination: By and large, designation is made at the hour of taking an arrangement. In the event that it isn't done, it is feasible to make designation along these lines by an underwriting on the approach. It is additionally conceivable to change a selection in this way by an underwriting. After marriage, such change in selection is regularly required. 7. Assignment A task of an approach for someone else or establishment can be influenced by an underwriting on the strategy. Re-task should likewise be possible by an ensuing underwriting on a similar strategy. As a designation is consequently dropped because of a task, after re task, it is important to make a new assignment. 8. Renewal Notice Keeping the approach in power is in light of a legitimate concern for the policyholder and furthermore of the backup plan. The guaranteed loses the important insurance that the existence affirmation strategy guarantees. The backup plan loses in light of the fact that without the recharging premium coming, the hefty costs which it brings about in the start of an arrangement can't be redressed. Each safety net provider will, subsequently, make all potential moves to lessen strategy slips and whenever passed, to get the arrangement resuscitated. A back up plan along these lines conveys ordinary premium notification despite the fact that it's anything but a legitimate prerequisite. i. Premium notice is normally sent before the due date of the premium. A guarantor isn't legitimately obliged to send a top notch notice. It involves politeness and incredibly helps the life guaranteed for convenient instalment of premium. ii. Premium default notice: This notification is sent inside 90 days after the due date reminding the policyholder to pay the premium to forestall the arrangement slips. iii. Issue of Final pass notice If the expense isn't paid inside a half year of the due date, and the arrangement is permitted to slip by, this notification is given to the policyholder mentioning him to resuscitate the approach to re-establish the full protection cover. iv. Intimation to specialist: Agent being indispensably worried about the continuation of an approach; he is additionally reasonably educated each time so he can contact the policyholder for instalment of the premium. 7.2.1 Benefit Payable Benefits payable 1. Death Benefit 117 CU IDOL SELF LEARNING MATERIAL (SLM)

If there should arise an occurrence of heart-breaking occasion of death of the Life Insured during the Policy Term, the accompanying advantages will be payable to the Nominee, subject to Policy being in power. The Death Benefit will be most elevated of: i. 10 times Annualized Premium* ii. 105% of all charges paid as on date of death iii. Absolute sum guaranteed to be paid on death equivalent to the Base Sum Assured under the Policy (as determined in Policy Schedule) iv. Guaranteed Sum Assured on Maturity which is zero under this item Annualized Premium does exclude modular factors and guaranteeing extra The Death Benefit will become payable on/from the date of suggestion of death, subject to acknowledgment of the case by the Company. We will pay the Death Benefit according to the Death Benefit Pay-out Option expressed on your Policy endless supply of the Life Insured gave the Policy is in power as on the date of death of Life Insured. The Nominee will have an alternative to take the Death Benefit (Monthly Income), if any as a singular amount. This alternative will be just accessible at the hour of Death before the instalment of the primary portion. The singular amount will be determined as a current worth of Monthly Incomes limited at 5% per annum pace of revenue. The Policy will endless supply of Death Benefit. 2. Critical Illness (CI) Benefit In the event of event of any of the 34 covered Critical Illnesses, as characterized in Part B Section 2, the advantage will be payable to Life Insured, subject to Policy being in- power and all due expenses till the date of event of the Critical Illness have been paid. The accompanying conditions will be appropriate. i. In instance of event of any Critical Illness (other than Angioplasty), Sum Assured on Critical Illness will be payable solely after fruition of Survival Period. ii. In instance of Angioplasty, pay-out will be equivalent to INR. 5,00,000. The Sum Assured on Critical Illness, in the wake of deducting the Angioplasty pay-out, will be payable for any resulting guarantee other than Angioplasty. In such a situation all future charges will likewise decrease correspondingly in regard of the diminished Sum Assured on Critical Illness. iii. Any Critical Illness can be asserted just a single time iv. Once the Sum Assured on Critical Illness is depleted, the CI advantage will end and no future charges should be paid under this Policy. v. Waiting time of 90 days will be relevant from the Date of Commencement of Risk or date of Revival whichever is later, during which no Critical Illness advantage 118 CU IDOL SELF LEARNING MATERIAL (SLM)

will be payable. Any condition analysed or its signs or side effects happening during the Waiting Period will be barred/not covered under this Policy. In case of event of any covered Critical Illness during the holding up period, the Company will discount the expenses comparing to the Critical Illness Benefit from Date of Commencement of Risk or date of Revival as appropriate. The Critical Illness Benefit will end with quick impact and Base Sum Assured will proceed unaltered. No holding up period applies where Critical Illness is because of Accident. vi. Survival Period will be 30 days from the date of event of covered Critical Illness (contingent upon the meaning of condition covered – either from the date of finding or date of genuine going through activity/medical procedure). In occasion of Death during Survival Period, no Critical Illness (CI) Benefit will be paid. vii. The advantage is payable regardless of the genuine costs caused by the Life Insured. For any case to be legitimate under this Policy, the rate of the condition should be the principal event in the lifetime of the Life Insured. viii. In no conditions Sum Assured on Critical Illness will surpass the Base Sum Assured. The Policy expression for Critical Illness advantage will be equivalent to Policy expression for Death Benefit. ix. If various conditions are analysed inside a time of 30 days from the date of event of the primary condition, all such conditions will be contrasted and the one and the most significant compensation out will be conceded (independent whether the determination is made in a solitary hospitalization or different hospitalizations). x. CI Benefit won't be paid in occasion of event of conditions referenced under the Exclusions as characterized. 3. Waiver of Premium on Critical Illness (CI) Benefit In the event of event of any of the covered Critical Illnesses, as characterized, the future charges for Death Benefit under the Policy will be deferred off. The Policy ought to be in-power as on the date of event of Critical Illness. The Policy will proceed for the Death Benefit; notwithstanding, any connected Rider(s) will be ended. Kindly note, there will be no waiver of premium in the event of a case for Angioplasty. 4. Grace Period Effortlessness period is the time stretched out by the Company to work with the Policyholder to pay the neglected premium, on the off chance that the exceptional/s had not been paid as on the due date. The Policyholder gets 30 days' elegance period to pay the charges which fell due and the advantages under the Policy stay unaltered during this period. In the event that the demise of the Life Insured occurs during the effortlessness time frame, the Death Benefit less the neglected due premium will be payable and the Policy will stand ended. In case of death of the Life Insured while the Policy is in slipped 119 CU IDOL SELF LEARNING MATERIAL (SLM)

by status, no advantage will be payable. In the event of the event of a Critical Illness during the elegance time frame, the Critical Illness Benefit subsequent to deducting the neglected due premium will be payable. In the event of event of Critical Illness while the Policy is in slipped by status, no advantage will be payable. 5. Maturity Benefit There is no advancement advantage payable under this Policy. Development benefits are the total guaranteed alongside rewards that your life coverage supplier pays to you when you endure the arrangement residency. In this manner, development benefits transform normal disaster protection items into saving instruments. Be that as it may, term protection offers unadulterated security with no development benefits. 7.3 SUMMARY  Life insurance being a legitimately enforceable agreement should be recorded with subtleties of the rights and commitments of the gatherings to the agreement. Proposition structure appropriately filled in and endorsed by the proposer is the primary record that shapes the premise of the agreement.  The different sorts of reports which become fundamental at three phases of a policy,1. At the phase of the proposition, which whenever acknowledged outcome into an approach, 2. During the length of the strategy where a few adjustments might become important and 3. Toward the finish of the arrangement contract when the backup plan pays the last case.  Every time, the protected pays the top-notch, he gets a superior receipt. The exception should be paid on schedule, non-instalment of premium prompts strategy slips.  The reports remain as proof of the agreement between the guarantor and the guaranteed. The significant reports stylish in life coverage are top-notch receipt, protection strategy, supports.  Proposal structure is the fundamental organization that is filled in by the proposer who needs to take a protection strategy. It very well may be characterized as the application for protection.  It is consequently, essential that the agreements of the understanding should be reasonably recorded in a way that would clarify that the two players to the agreement are Ad-Idem i.e., in total harmony. Advertisement Idem implies that both the gatherings comprehend exactly the same thing in a similar sense or are in total harmony on a similar subject.  Age is a significant factor in choosing the quantum of premium against an approach. The report demonstrating the age, i.e., age evidence should be solid and the 120 CU IDOL SELF LEARNING MATERIAL (SLM)

guaranteed needs to attempt with respect to its honesty. A guarantor acknowledges these reports as standard age confirmation. 7.4 KEYWORDS  Non–standard age Proofs-They (1) Horoscope, (2) administration records of managers other than those referenced over (3) ESI card, (4) Marriage Certificate if there should arise an occurrence of a Muslim proposer, 5) Elders Declaration, 6) Self Declaration, 7) Driving Licence,8) Certificate gave by town panchayat, 9) Electoral role,10) Ration card.  Ad-idem-Ad idem is a Latin expression of \"agreement.\" If two gatherings to an agreement comprehend the agreements of an agreement in a similar way, then, at that point it is said that the gatherings are \"promotion idem\" on the agreements. Such agreement is fundamental for a substantial agreement.  First Premium Receipt (FPR)-A protection contract initiates when the life coverage organization gives a first superior receipt (FPR). The FPR is the proof that the approach contract has started.  Endorsement-A protection support is a revision or expansion to a current protection contract that changes the terms or extent of the first approach. They are additionally alluded to as riders.  The rule of \"Uberimma Fides\"- Not uncovering known material realities on a protection proposition structure \"Uberimma fides\" is a Latin expression, signifying \"most extreme great confidence\". This implies that every one of the gatherings to a protection contract should bargain in compliance with common decency, making a full revelation of the relative multitude of material realities in the protection proposition. 7.5LEARNINGACTIVITY 1. As an employee of a Giant insurance company list down the permitted and not permitted alteration during the continuance of policy. ___________________________________________________________________________ ___________________________________________________________________________ 2. Make a check list contract documents to keep it safely till insurance contract ends. ___________________________________________________________________________ ___________________________________________________________________________ 7.6 UNIT END QUESTIONS 121 CU IDOL SELF LEARNING MATERIAL (SLM)

A. Descriptive Questions Short Questions 1. What do you mean by FRP in insurance? 2. Define Proposal Form in insurance? 3. What are the different stages where documentation is required? 4. What is endorsement? 5. When can a duplicate policy be issued? Long Questions 1. Why income documents are required to take a policy? 2. Discuss the provisions of sending renewal notices. 3. What are Standard and Non-Standard Age Proofs? 4. Discuss the contents of a Proposal Form. 5. What is the benefit payable? B. Multiple Choice Questions 1. Which one of the following statements is correct? a. The policy is the basis of the insurance contract. b. The proposal is the basis of the insurance contract. c. Both (a) and (b) statements are correct. d. Both (a) and (b) statements are wrong. 2. Which one of the following statements is correct? a. The proposal must be written by the proposer himself/herself. b. The proposal can be written by the Agent. c. Both (a) and (b) statements are correct. d. Both (a) and (b) statements are wrong. 3. Which of the following are confidential and will not be given to the proposer? a. The medical report. b. The agent’s confidential report to the insurer. c. The medical referee’s advice. d. All of these. 122 CU IDOL SELF LEARNING MATERIAL (SLM)

4. What will happen if a policyholder applies for cancellation of policy soon after he receives the FPR? a. The full premium will be refunded. b. The full premium after some small deduction will be refunded. c. The policy will be treated as lapsed from the next premium due date. d. He will be debarred from taking any further insurance policies 5. Which one of the following statements is correct? a. If policy document is lost the insurance contract becomes void. b. The family history appears in the personal statement. c. Both (a) and (b) statements are correct. d. Both (a) and (b) statements are wrong. Answers 1-b, 2-d, 3-a, 4-d, 5-b 7.7 REFERENCES References  Doron Nissim (November 2010) Center for Excellence in Accounting & Security Analysis ANALYSIS AND VALUATION OF INSURANCE COMPANIES  Weiss, M.A, & Choi, B.P. (2008). State regulation and the structure, conduct, efficiency andperformance of US auto insurers. Journal of Banking and Finance, 32(1), 134-156.  Venezia, I., Galai D., & Shapira, Z. (1999). Exclusive vs. independent agents: A separating equilibrium approach. Journal of Economic Behavior and Organization Textbooks  Venezia, I., Galai D., & Shapira, Z. (1999). Exclusive vs. independent agents: A separating equilibrium approach. Journal of Economic Behavior and Organization  Gartner, Inc.: (July 2012) “Hype Cycle for Life Insurance, 2012,” Kimberly Harris- Ferrante  Crockett A. (1997) Why is Financial Stability A Goal of Public Policy (Federal Reserve Bank of Kansas City, Fourth Quarter). Websites  http://www.dreamweaversindia.com/content2014/ic33/ch-12.html 123 CU IDOL SELF LEARNING MATERIAL (SLM)

 https://nios.ac.in/media/documents/VocInsServices/m3-f2.pdf  https://www.bharti-axalife.com/media/our-plans/individual-life 124 CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 8 – STRUCTURE OF AN UNDERWRITING FUNCTION IN A LIFE INSURANCE OFFICE STRUCTURE 8.0 Learning Objectives 8.1 Introduction 8.2 Chief Medical officer (CMO) 8.3 Underwriting 8.4 Support Team 8.5 Underwriting Authorities 8.5.1 IRDAI 8.6 Summary 8.7 Keywords 8.8 Learning Activity 8.9 Unit End Questions 8.10 References 8.0 LEARNING OBJECTIVES After studying this unit, you will be able to:  State the Job function of CMO.  Describe the Organizational Structure of Underwriting and support staff.  Explain the need of underwriting authorities in insurance sector.  Elucidate the role, functions and objective of IRDAI. 8.1 INTRODUCTION One of the administrations that Insurance organizations offer to their customers is an underwriting functional audit. This audit is intended to take a gander at the underwriting interaction - from demand for a quote, hazard examination, proposition, through the sold case, restoration, and, at last, quality confirmation. In doing these kinds of audits, it is of extraordinary premium to realize, how organizations structure their endorsing offices and quality affirmation programs. 125 CU IDOL SELF LEARNING MATERIAL (SLM)

To see how the construction of an underwriting capacity in a life coverage office capacity, we are going through a similar financier office business-related review led by RGA managing staffing to flexibility, to work standards, advancement, and business-related issues. To acquire a more complete and exceptional image of how organizations at present do this, RGA (Reinsurance Group of America, Incorporated (NYSE: RGA) is one of the biggest worldwide life and wellbeing reinsurance organizations) as of late directed an industry study on this theme. 26 U.S. also, 11 Canadian insurance agencies reacted to the overview where RGA posed inquiries relating to guarantors, working environment adaptability, the extent of work, the task of work, authoritative design, The future, and the job of value affirmation. Scarcely any intriguing perceptions came around from this overview poll, first, a large portion of the guarantors was contacting help other division financiers, empowering sidelong learning, and performing various tasks. second work environment adaptability helped in improving productivity,3rd Most organizations depended on tenured guarantors, ranking directors, administrators for quality affirmation, fourth a large portion of the organizations are exceptional to deal with medium to high traffic of customers. Surveys are commonly designated dependent on various documents per financier every month. Inside the audit, organizations are estimating adherence to rules, documentation of work, underwriting examination, and fitting signoff from the legitimate position. About a portion of the U.S. furthermore, a fourth of the Canadian organizations allocate class weightings to the audit. Audit results are ordinarily imparted to the guarantor which gives the financier a chance to question and additionally request the discoveries as the person sees fit. Another new thing that was invigorating in endorsing the division was the acknowledgment of fresher IT innovations in their work circle while adhering to essential solid central standards of the underwriting office in the association. Advancement additionally stood apart as an empowering factor, where associations supported development in the workplace. 8.2 CHIEF MEDICAL OFFICER 126 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 8.1: Organizational structure of insurance company The Chief Medical Officer is a vital individual from the Senior Executive Operations group, occupied with characterizing the general business procedure and course of the association. This position drives the in general clinical vision for the association and gives clinical course to the Insurance organizations, Health care Claims and Underwriting offices, with conceivable extension to different lines of business. The CMO adds to the turn of events and execution of the general business system by cooperating with Risk, Actuarial, Finance, Product Management, Sales, Marketing, IT and different associations division to guarantee all clinical parts of mortality and grimness that sway the maturing populace are considered organization's essential way. CMOs generally reports to higher administration like VP or SVP, Operations. Mission and Vison Statement-They assume significant part will in setting mission and vision articulation of the insurance agency. Coordinated effort - they work broadly with senior pioneers and fabricate collective business organizations across. Responsibilities  Develop and execute a motivating clinical vision and system across the Insurance organization.  Keep side by side of arising models and patterns in medical care that sway mortality and dismalness choices; distinguish and characterize new and creative techniques to lessen hazards and give gainful items to buyers. 127 CU IDOL SELF LEARNING MATERIAL (SLM)

 Define viable danger determination philosophies for Claims and Underwriting dependent on wide, profound clinical and clinical protection information.  Develop a solid industry presence, who can add to upgrading associations' picture and develop the general Health care protection arrangement of the association.  Analyse and convey key clinical experiences and data to distinguish and clarify significant patterns, issues, causes, and results.  Engage with clients, conveyance accomplices, providers, and other market members to foster market-based experiences, recognize key freedoms and carry out far- reaching strategies.  Analyse contender clinical techniques and industry patterns. Stays informed concerning clinical danger determination draws near and consolidate depending on the situation to drive business worth and effect.  Partner with Medical Advisory Council which will give exceptional data from specialists in fields of maturing, perception, and populace insights as they relate to bleakness and imperativeness to different useful accomplices across the association.  Lead a group of scientists and clinical experts that will give clinical direction, backing, and schooling to the association's Claims and Underwriting offices. This incorporates, yet isn't restricted to, helping with case references, particularly on complex cases, helping with the Underwriting manual, and creating and executing preparing projects to work on hierarchical Underwriting and claims qualification choices.  Drive administration and group responsibility. Spur and invigorate the group. Show others how it's done.  Drive strengthening at all levels. Urge colleagues to stir things up. Mentor and foster colleagues, and build up certain outcomes. Give acknowledgment and commend triumphs. Collaborate effectively at all levels. Required Qualifications of CMO  Professional permit as M.D.  15+ years consolidated clinical experience, including clinical and ideally clinical protection, with experience in the mortality and dismalness related with maturing and other wellbeing reasons.  Five in addition to long stretches of protection industry experience (e.g., wellbeing, life, long haul care) 128 CU IDOL SELF LEARNING MATERIAL (SLM)

 Demonstrated experience building clinical methodologies to convey business worth and effect  Demonstrated capacity deciphering clinical information and outer clinical patterns into market cutthroat protection rehearses  Proven experience impacting and teaming up across useful lines  Demonstrated capacity to construct and lead a solid, propelled group Preferred Qualifications  Should have energy for change and persistent improvement and capacity to viably lead/drive change,  Strong administration and activities specialized information, ideally in Underwriting and Claims  Demonstrated capacity to draw in, inspire, hold, and foster an assorted group of partners, pioneers, and specialized experts,  Ability to decipher information and examine patterns.  Effective communicator verbal and composed, formal and casual.  Demonstrated impacting abilities, particularly at chief administration level.  Demonstrated capacity to tackle complex issues with numerous, regularly clashing, prerequisites  Strong authoritative abilities  Strong monetary abilities and business keenness  Fellow Life Management Institute (FLMI) assignment. 8.3 UNDERWRITING Insurance agencies are by and large coordinated in five wide offices: claims, finance, lawful, promoting and endorsing. Promoting and guaranteeing are the \"yes\" divisions, while claims and money are the \"no\" offices. The lawful office is regularly the arbitrator between these contending interests. Guarantors look to foster protection items that can be offered to their clients for a benefit. However numerous standard protection strategies are comprised of structure archives, most guaranteeing divisions will make their own assortment of structures and supports to furnish the promoting office with the capacity to say yes to clients and possible clients. While the guaranteeing and showcasing divisions need to join whatever number insured as could be expected under the circumstances to gather premiums,1 the cases office oversees claims when a protected look to recuperate on its protection resources. 129 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 8.2:Major department of insurance company The endorsing division will say that it has no impact on a choice to pay a case, however this isn't generally so. At the point when convenience on a case is mentioned by a decent client, or by a dealer that brings the transporter a ton of business, the guaranteeing and advertising divisions will at times intervene with the cases office. The promoting and guaranteeing offices are decided by their top notch assortments and maintenance proportions (i.e., the level of insured who restore their arrangements with that back-up plan), while the cases division is decided by how little it brings about settling claims. Accordingly, there is an innate and interminable strain among these offices. These monetary measures drive insurance agency the board and benefits, just as the rewards paid to division the executives. Underwriting Organization Chart. The endorsing group by and large comprise Underwriting Manger followed by Sr. Guarantors, SMEs and Probationary Underwriters, the size of underwriting division depends on cliental it provides food or join in. The office is likewise further group of Underwriters of various kinds of Insurance. 130 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 8.3: Application and acceptance process in life insurance policy Underwriting refers to the process of selecting, classifying, and pricing applicants for insurance the underwriter is the person who decides to accept or reject an application. Statement of Underwriting Policy Underwriting starts with a clear statement of underwriting policy.  An insurer must establish an underwriting policy that is consistent with company objectives. Underwriting  The backup plan's endorsing strategy is dictated by the high-level administration responsible for underwriting.  The underwriting strategy is expressed exhaustively in an endorsing guide that determines the lines of protection to be composed; domains to be created; structures and rating intend to be utilized; worthy, fringe, and disallowed business; measures of protection to be composed; a business that requires endorsement by a senior guarantor; and other underwriting subtleties. Basic Underwriting Principles i. Attain an underwriting profit: 131 CU IDOL SELF LEARNING MATERIAL (SLM)

The essential goal of endorsing is to achieve a guaranteeing benefit. The goal is to deliver a productive book of business. ii. Select prospective insured according to the company’s underwriting standards: The guarantors should choose just those insured whose real misfortune experience isn't probably going to surpass the misfortune experience expected in the rating structure with the reason for lessening antagonistic choice against the safety net provider. iii. Provide equity among the policyholders: Steps in Underwriting After the insurer’s underwriting policy is established, it must be communicated to the sales force. Initial underwriting starts with the agent in the field.  Agent as First Underwriter  Collecting Information’s  Making an Underwriting Decision  Other underwriting Consideration/ 1. Agent as First Underwriter: This progression is regularly called field guaranteeing. The specialist is determined what kinds of candidates are adequate, fringe, or disallowed. In property and loss protection, the specialist regularly has power to tie the organization right away. Consequently, it is significant that the specialist follows organization strategy while requesting candidates for protection. In extra security, the specialist should likewise request candidates as per the organization's guaranteeing strategy. 2. Collecting Information's The guarantor requires certain data in concluding whether to acknowledge or dismiss a candidate for protection. Significant wellsprings of data:  Application. The sort of data required relies upon the kind of protection mentioned. In property protection, gives the actual highlights of the structure and in life coverage gives age; sexual orientation.  Agent's report. Numerous safety net providers require the specialist or representative to give an assessment of the forthcoming protected. In life specialist might be asked how long the person has known the candidate, the candidate's yearly Inspection report.  In property protection, the organization might require a review report by some external office, particularly if the financier speculates moral risk. In extra security, the report might give data on the candidate's monetary condition, conjugal status. 132 CU IDOL SELF LEARNING MATERIAL (SLM)

 Physical investigation. In property protection and setback protection, the financier might require an actual examination before the application is supported.  Physical assessment. In extra security, an actual test might be needed to decide whether the candidate 3. Making an Underwriting Decision After the guarantor assesses the data, a guaranteeing choice should be made. There are three essential endorsing choices regarding an underlying application for protection:  Accept the application:  Accept the application subject to specific limitations or alterations  Reject the application many safety net providers currently utilize electronic guaranteeing for certain close to home lines of protection that can be normalized, like auto and mortgage holder's protection. Therefore, endorsing choices can be 4. Other Underwriting Considerations  Rate sufficiency and endorsing Property and setback back up plans are more able to guarantee new business for a particular line in case rates are considered sufficient.  Reinsurance and endorsing. Accessibility of reinsurance might bring about more liberal endorsing. Be that as it may, if reinsurance can't be acquired on great terms, guaranteeing might be more prohibitive.  Renewal endorsing. In disaster protection, approaches are not cancellable. In property and loss protection, most approaches can be dropped or not. 8.4 SUPPORT TEAM 133 CU IDOL SELF LEARNING MATERIAL (SLM)

Figure 8.4: Support team communication in insurance company Top Management of the Healthcare Insurances. Medical coverage organizations handle the conveyance of health care coverage plan advantages to clients and address any connected client issues. Health care coverage can be given on an individual or gathering (organization or family inclusion) premise. Administrations given by health care coverage organizations to their arrangement individuals incorporate doctor distinguishing proof and choice, family inclusion, sound living instruction and online record the executives, among other different types of wellbeing related help. Medical coverage organizations are likewise liable for keeping up with associations with network medical services suppliers (doctors, facilities, emergency clinics, and so forth) Medical coverage organizations are regularly alluded to as \"Medical services Payers\" since they repay the expense of medical services administrations to suppliers. They are essentially authors, comprising CEO, COO, and CMO. Health Plan Operators Wellbeing Plan Operations alludes to a bunch of fundamental managerial and backing administrations for wellbeing plan individuals and suppliers. The Back Office is liable for dealing with a few exercises, for example, claims preparing, wellbeing plan part administration/support (generally did inside a Call Centre), premium instalment assortment, actuarial, endorsing and application handling. Administrative centre staff individuals support the health care coverage organization's clients, medical care suppliers inside the organization's supplier organization and inner representatives. Job titles: Operations Specialist/Analyst, Customer Service Representative, Insurance Service Representative 134 CU IDOL SELF LEARNING MATERIAL (SLM)

Members Services The Member Services work is answerable for the gathering of approaching calls and demands from current policyholders to help with account refreshes, instalments, protection strategy requests, account alterations, or notices. This capacity helps policyholders in understanding the strategies they have and advises them regarding extra protection items they can offer. Job titles: Member Services Representative, Customer Service Representative, Policyholder Services Specialist, Member Support Specialist New Business Processing The New Business Processing capacity is answerable for on boarding new protection policyholders, or individuals. They gather the imperative data, pass that data to the fitting guaranteeing and application handling staff individuals (in light of utilization type, language necessities and item information) to survey the suitable premium and inclusion levels, then, at that point convey choices and premium/deductible constructions to the imminent policyholder. Job titles: Medical Insurance Application Processor, Medical Underwriter, Application Application Processing The Application Processing capacity is liable for analysing protection applications from expected individuals, or policyholders, to guarantee that they have the entirety of the right data needed for endorsing and endorsement/refusal. Applications come in through different channels - the web, telephone, protection organizations. Applications may likewise be gotten in changing organizations - paper, electronic, PDF, and so on Application Processing workers should be steady in guaranteeing that applications are finished and precise to diminish the quantity of client contact focuses and improve endorsing effectiveness (lower guaranteeing process duration, cost per choice). Job titles: Application Processor, New Business Representative Underwriting The clinical Underwriting capacity is liable for surveying health care coverage candidates and settling on choices on inclusion. The candidate's wellbeing data (and other data submitted with their protection application) is utilized to conclude whether to offer or deny inclusion and what the top notch strategy rate will be. Health care coverage guarantors gauge the likely wellbeing dangers of their candidates against the possible expenses of giving inclusion. They use information and guides created by the Actuarial group to settle on estimating and inclusion choices dependent on chances related with the expected part's wellbeing \"profile\" (age, area, clinical history, every day propensities, and so on). Job titles: Underwriter, Medical Underwriter, Underwriting Analyst, Underwriting Support Specialist 135 CU IDOL SELF LEARNING MATERIAL (SLM)

Member On boarding The Member On boarding capacity is answerable for guaranteeing that recently supported protection policyholders (individuals) get the entirety of the necessary data to start utilizing the advantages of their arrangement. They send ID cards, instructive materials, and data on in-network medical services suppliers to new individuals. They likewise guarantee that the entirety of the necessary record data is inacceptable request and put away in organization frameworks for examination and recovery. Job titles: Member Service Representative, Customer Service Representative, Customer Support Specialist Claim Processing The Claims Processing capacity is entrusted with looking at and handling protection cases, paper and additionally electronic. Processors decide if to return, pend, deny or pay claims inside the customer's strategy rules and decide steps fundamental for mediation. Furthermore, claims preparing thinks about guarantee applications or potentially supplier explanations with strategy documents and different records to assess culmination and legitimacy of guarantee. Job titles: Medical Claims Processor, Medical Claims Auditor, and Medical Claims Examiner Actuarial The Actuarial capacity is entrusted with performing complex numerical demonstrating and factual investigation to help in dynamic in regards to the alleviation of hazard identified with medical coverage expenses and advantages plan. Statisticians evaluate and appoint hazard to specific fragments of wellbeing plan individual’s dependent on clinical history, segment information, family ancestry and a few different elements. Job titles: Actuarial, Actuarial Data Scientist, Actuarial Analyst Sales and Business Development. The Health Insurance Sales and Business Development work is answerable for selling medical coverage items to possible individuals. Health care coverage can be sold through various channels - through the telephone, over the web, through branch workplaces (face to face) or through hostage as well as free health care coverage specialists or merchants. Deals staff work to teach prospective customers on wellbeing plan benefits, premium designs and in-network suppliers. Health care coverage items incorporate individual plans, family designs, bunch plans (for managers) and government-supported alternatives (Medicare, Medicaid) for various inclusion types (wellbeing, dental, vision, drug store, and so on). Job titles: Insurance Agent, Insurance Broker, Sales Support Representative Network Development and Management The organization advancement work evaluates showcases and amasses an organization of medical services suppliers with the suitable consideration (essential consideration, trained 136 CU IDOL SELF LEARNING MATERIAL (SLM)

professionals, scholastic, drug stores, and so forth) and item blends (HMO, PPO, Medicare, and so on), to fit the socioeconomics of their objective market. They work to decide supplier arrangements and meet administrative prerequisites for network sufficiency. As needs be, the organization the board work is liable for the upkeep of the wellbeing plan's unexpected of medical care experts (doctors, guardians, drug stores, and so forth) The capacity attempts to re-establish and review supplier contracts, arrange supplier remuneration levels (regularly medical coverage payers get limited costs for supplier administrations), oversee associations with suppliers and instruct them on help alternatives offered by the medical care payer (i.e., the insurance agency). Job titles: Provider Relations Specialist, Provider Contracting Specialist Provider Contracting The Provider Contracting capacity is liable for recognizing, reviewing and arranging contract subtleties with medical care suppliers (doctors, subject matter experts, drug specialists, dental specialists, emergency clinics, facilities, and so on) that are qualified to join the health care coverage's organization. Medical care suppliers give limited rates to health care coverage organizations in return for a constant flow of patients that are coordinated to utilize their administrations (since they are \"in-network\" suppliers). Agreement subtleties incorporate the rates (i.e., expense plan) at which the supplier will charge the insurance agency for different kinds of administrations (in light of cases codes), contract end rules, and approaches for any out-of-network care delivered by the supplier. Job titles: Provider Contracting Specialist, Provider Contract Analyst Provider Services The Provider Services work creates and conveys administrations to in-network medical care suppliers (doctors, trained professionals, drug specialists, dental specialists, emergency clinics, facilities, and so on), including electronic cases instalments/moves, claims support (accommodation codes, electronic accommodation, self-administration), earlier approval accommodation and preparing, instructive assets and reference entries. Job titles: Provider Support Specialist, Provider Service Representative Patient Education and Wellness The Patient Education and Wellness Programs work creates and carries out instructive projects and different devices pointed toward encouraging solid propensities inside the insurance agency's part populace. They offer assets identified with abstaining from excessive food intake, work out, emotional well-being and medication use - all pointed toward assisting policyholders with understanding approaches to improve and keep up with their wellbeing. Some health care coverage organizations are in any event, beginning to offer prizes programs that boost policyholders to keep a sound and dynamic way of life. Patient Education 137 CU IDOL SELF LEARNING MATERIAL (SLM)

gatherings may likewise create and distribute examines identified with the adequacy of specific medications as well as the impacts of specific sicknesses/conditions. Job titles: Nutritionist, Member Relations Analyst, Research Scientist, Content Specialist 8.5 UNDERWRITING AUTHORITIES In India, Insurance had consistently been a public imposing business model. The Life Insurance Corporation was made in 1956 by amalgamating 245 private area insurance agencies and the General Insurance Corporation was made in 1973. Both were monopolistic bodies when this area was opened to private players with a base capital expected of Rs. 200 crores. The cash put resources into Life Insurance should be used for arranged monetary advancement of our country. This was one of the targets of nationalization and keeping in mind that contributing these public monies which were held in trust, the Corporation was to keep public needs and sensible returns as their excellent destinations. The Insurance Regulatory and Development Authority Act of 1999 has told the IRDA Regulations 2000 and is currently the observing body to control the whole protection business like the Reserve Bank of India controlling the whole Banking System in our country. The bill was before presented by the Janata Government in the Parliament however was permitted to pass. The justification setting up this body was the various grumblings gotten in a help industry like Insurance business where overpowering significance should be given to client support. It was additionally felt that the approach followed by LIC was not controlled by the wellbeing of the policyholders and net yields were bring down that different reserve funds media. A bringing down of premium rates was fundamental for making it really gainful with the end goal of investment funds. It was additionally noticed that the majority of the representatives of LIC and GIC had shaped associations and had guaranteed the most ideal conditions for their administrations. Around 50% of the staff were profiting premium free advances, had vehicles and benefited of considerable recompenses without investing in near amounts of energy. Like clockwork they were getting advanced and getting cumbersome. Along with this the association was congested without relegated obligations. Functional adaptability and the capacity to react to changing conditions seemed, by all accounts, to be absolutely missing. Somewhere around 50% of the staff were arraigned by the Commission absolutely excess and conflicted in relation to time however no activity was impending. The provincial and semi-metropolitan branches were understaffed as all workers were keen on prize postings at local and metropolitan branches. Along these lines, various prohibitive practices had developed which had compelled the productive and financial working of the association. 138 CU IDOL SELF LEARNING MATERIAL (SLM)

The significance of any industry lies it its handiness to individuals and the economy. However long our protection area was shielded from contest and for clients, it took its own choices on what rests to cover, working exclusively on a \"live with or without it' premise. Rivalry chooses what item bids to the client and at what cost. This would guarantee procedure on the standards of hazard and its cover, offering modified administrations relying upon high danger or generally safe cover. As of now, generally safe customers are offered no greater arrangement and they compelled to sponsor the high-hazard customers just as pay through their nose for the gigantic compensation rolls of the organization just as its luxury. By and large, opening of the protection area for rivalry and section of private and unfamiliar houses, will further develop the help principles, create more assets for long haul ventures, use the immense capability of life and general protection and produce greater work. Perceiving these possibilities and the need to make protection accessible for a bigger scope, the Bill opened the business to private players and were overflowed with applications. Significant worldwide guarantor Prudential and Standard Life of UK, Sun Life of Canada, AIG, MetLife and New York Life of the US, restricted with driving organizations in India to contact this tremendous market. Every one of the private safety net providers has acquainted redone items with address the issues of their clients and in accordance with their business targets. Disaster protection is currently being clarified in its actual points of view. Never again is it a quickly done venture, done without a second to spare, to save charges. It's presently turning into a significant component of the absolute monetary arranging of people and corporates that is bought to satisfy explicit level headed and feelings, having clear advantages. A wide scope of items, client centred administrations and expert counsel has become the backbone of the business and the clients from the turn for the technique. On the rear of publicizing efforts, courses and studios, we have seen a sensational expansion in client mindfulness. Infiltration of the disaster protection is starting to cut across financial classed. These are the outcomes so anyone might see for themselves. Items are currently being all the more everything being equal and deftly valued. From a framework that left policyholders running from one place to another to get their strategies adjusted, administration levels are consistently ascending to make the client the focal point of every drive. With rising future, quickly expanding expenses of fundamental necessities like clinical treatment and falling loan fees which don't take care of for expanding living expenses, the significance of monetary arranging has gotten more basic. Anticipating post-retirement circumstances has become a significant factor. Moreover, with little families now the pattern and joint families separating, the significance of preparation, in the possibility of the sole bread worker dying, has become the superb factor. Protection guidelines have guaranteed that the working class larger part gets a respectable arrangement wherein it can contribute, to 139 CU IDOL SELF LEARNING MATERIAL (SLM)

guarantee that his family oversees some way or another, as far as monetary liquidity, after any misfortune. Over completely referenced issues prompted arrangement of administering administrative body, which would manage the casing work, yet additionally secure the premium and reasonable treatment of the policyholder, to control the protection business in decency and guarantee the monetary sufficiency of the business and to consistently outline guidelines to guarantee the business works with no uncertainty. 8.5.1Irdai Figure 8.5: IRDAI IRDAI known as The Insurance Regulatory and Development Authority of India. The Authority goes about as the controller of the protection business in India and directs the working of the Life Insurance and General Insurance organizations working in the country. The principle objective of the IRDA is to ensure the interests of the policyholder and control the protection business. The IRDA or IRDAI routinely gives warnings to insurance agencies if there should arise an occurrence of changes to the standards and guidelines. The controller directs the protection business in advancing the productivity in the lead of protection business meanwhile controlling the rates and different charges identified with protection. This article harps on the working of the IRDA, highlights and advantages just as answers to much of the time posed inquiries toward the finish of this perusing. Establishment of IRDA The Government of India was the controller for the protection business until 2000. In any case, to initiate an independent peak body, the IRDA was set up in 2000 after the suggestion of the Malhotra Committee report in 1999. In August 2000, the IRDA started tolerating 140 CU IDOL SELF LEARNING MATERIAL (SLM)

applications for enlistments through welcomes and permitted organizations from different nations to put up to 26% on the lookout. The IRDA has laid out a few guidelines and guidelines under Section 114A of the Insurance Act, 1938. Guidelines range from enlistment of insurance agencies for working in the country to ensuring policyholder's inclinations. As of September 2020, there are 31 General Insurance organizations and 24 Life Insurance organizations who are enlisted with the IRDA. Insurance Regulatory & Development Authority IRDA since its beginning has worked effectively in completing its obligations, powers and capacities without fizzling. The forces and elements of IRDA are to such an extent that it has the power to issue to the candidate a declaration of enrolment, restore it, change it, pull out, suspend or drop such enlistment. IRDA assumes a significant part in securing the approach holder's inclinations in issue concerning appointing of strategy, designation by strategy holders, insurable premium, and settlement of protection guarantee and different agreements of agreements of protection. IRDA likewise determines the imperative capabilities, set of principles and viable preparing for go-between or protection go-betweens and specialists. It obviously expresses the set of principles for assessors and a misfortune assessor just as advances productivity in the lead of protection business and controls the expert associations associated with the protection and re- protection business. IRDA consistently calls for data identified with undertaking review, directing enquiries and examinations including review of the safety net providers, middle people, protection delegates and different associations associated with the protection business. IRDA completely controls and manages the rates, benefits, agreements that are offered by the safety net providers in regard of general protection business which were prior not really controlled and directed by the Tariff Advisory Committee. IRDA additionally indicates the structure and way where books of record will be kept up with and explanations of records will be delivered by the guarantors and other protection middle people. Presently to talk about a portion of the rules and guidelines outlined by the IRDA in regard of General Insurance Companies, IRDA gave a few guidelines identifying with assurance of strategy holder's inclinations which expressed that a safety net provider or its representative or other go-between will give all material data in regard of a proposed cover to the possibility to empower the possibility to settle on the best cover that would be in their premium. Where the possibility relies on the exhortation of the backup plan or its representative or and protection go-between, such an individual should prompt the possibility impartially. Besides in the event of marine protection cover, whereby current market rehearses don't demand a composed proposition structure, a proposition for award of cover for general business should be proven by a composed report. It is the obligation of a back-up plan to outfit to the safeguarded for nothing, inside 30 days of the acknowledgment of a proposition, 141 CU IDOL SELF LEARNING MATERIAL (SLM)

a duplicate of the proposition structure. Each backup plan ought to have appropriate strategies and viable instrument set up to address objections and complaints of strategy holders effectively with speed. A protected or the inquirer should pull out to the guarantor after any misfortune has happened emerging under the agreement of protection at the most punctual and inside indicated time- frame which might be permitted by the safety net provider. On receipt of such a correspondence, the back-up plan needs to react quickly and give obvious sign to the safeguarded on the systems that the individual ought to follow. In the event that an assessor is selected for evaluating the misfortune, it will be done inside 72hours of the receipt of hint from the guaranteed. On receipt of the overview report, the guarantor should offer a settlement of guarantee to the protected inside a time of 30days. On the off chance that the guarantor under any condition chooses to dismiss or disavow the case under the approach, it needs to do as such inside a time of 30days from the receipt of the study report. Non-Tariff Regime In the year 2005, General Insurance Companies and other partners in the protection market voiced the interest for expulsion of tax as the presence of tax was viewed as in opposition to unrestricted economy standards and protection items should have been evaluated dependent on market influences. IRDA appropriately viewed as moving to a levy free system. IRDA expressed that in a market liberated from levies, all the insurance agencies ought to have set up interior abilities, methodology and controls. It likewise expressed that the elements of guaranteeing and rating of protection business ought to be free of the business advancement work and not be made docile to the business improvement work. Representatives with power were to be prepared to assess recommendations, guarantee and rate the dangers according to the aide tax. Following the choice of the levy warning board to de-duty Marine Hull Insurance, IRDA gave certain rules in regard of Marin Hull Insurance. Every one of the overall safety net providers who had wish to guarantee marine frame business, ought to follow the specific existing strategy phrasings, agreements including provisos, for example, the Institute conditions as it was before de-duty system. It was additionally shown and expressed that all the insurance agencies who needed to guarantee marine body class of business should record independently with the IRDA in regards to the reinsurance courses of action for securing the net record openings. Rules Pertaining to Corporate Agents and Outsourcing of Activities All the non-life safety net providers were coordinated to set down least business necessities for Individual specialists. The said arrangement of least business necessities is stretched out to all Corporate Agents also. Likewise, all the non-life safety net providers were coordinated to set down least business prerequisites for Corporate Agents and screen the presentation of Corporate Agents as frequently as it is required. 142 CU IDOL SELF LEARNING MATERIAL (SLM)

Safety net providers in India progressively utilized re-evaluating, as a method for both decreasing expense and getting to mastery, not accessible inside and to accomplish vital points. IRDA in regard of re-evaluating expressed that; all candidates will continue capacities in regard of protection business including the board of venture, inside its own association. It was seen that specific safety net providers were in any event, rethinking the centre exercises like speculation, guaranteeing and strategy overhauling. IRDA said that it was not alluring to re-appropriate the centre and significant exercises which will massively influence the corporate administration, assurance of strategy holders, dissolvability and income of streams of backup plan. IRDA further expressed that re-appropriating plans ought to neither decrease its capacity to satisfy its commitments to strategy holders nor block compelling oversight by IRDA. Guarantors accordingly were to find ways to guarantee that the specialist organization utilizes similar norms in playing out the administrations as would be utilized by them if the exercises were led in house. Likewise, Insurers were not to take part in re-evaluating that would bring about their inward control, business lead or notoriety being compromised or debilitated. Consequently, IRDA does all that they can to secure the approach holder's advantage just as control the Insurance Industry overall for advancement. Objective of IRDAI The primary goal of the Insurance Regulatory and Development Authority of India is to implement the arrangements under the Insurance Act. The statement of purpose of the IRDAI is:  To ensure the interest and reasonable treatment of the policyholder.  To control the protection business in decency and guarantee the monetary sufficiency of the business.  To consistently outline guidelines to guarantee the business works with no uncertainty. Important Role of IRDA in the Insurance Sector in India: The protection business in India traces all the way back to the mid-1800s and has developed throughout the years with better straightforwardness and spotlight on securing the interest of the policyholder. The IRDA assumes a fundamental part in underscoring the significance of policyholders and their advantage while outlining rules and guidelines. Here are the significant jobs of the IRDA:  To secure the policyholder's advantages.  To help accelerate the development of the protection business in a deliberate style, to assist the everyday person.  To give long haul assets to accelerate the country's economy. 143 CU IDOL SELF LEARNING MATERIAL (SLM)

 To advance, set, implement and screen elevated requirements of trustworthiness, reasonable managing, monetary sufficiency and skill of the protection suppliers.  To guarantee certifiable cases are settled quicker and proficiently.  To forestall misbehaviours and misrepresentation, the IRDA has set up a complaint change gathering to guarantee the policyholder is secured.  To advance straightforwardness, decency and efficient direct of protection in the monetary business sectors.  To construct a trustworthy administration framework to ensure exclusive requirements of monetary security are trailed by guarantors.  To make a sufficient move where such elevated expectations are not kept up with.  To guarantee the ideal measure of self-guideline of the business. Functions of IRDA Below are the important functions of the IRDAI in the insurance industry in India:  Grant, restore, adjust, suspend, drop or pull out enrollment authentications of the insurance agency.  Protecting the interests of the policyholder in issue concerning the award of arrangements, settlement of cases, selection by policyholders, insurable interest, give up worth of the strategy and different agreements of the approach.  Specify set of accepted rules, capabilities and preparing for go-between or protection specialists.  Specify set of accepted rules for misfortune assessors and assessors.  Levying expenses and charges for doing the arrangements of the Act.  Undertaking examination, calling for data, and examinations including a review of insurance agencies, go-betweens, and different associations related with the protection business.  Regulate and control protection rates, agreements, benefits that might be offered by the protection suppliers. Aside from the previously mentioned centre elements of the IRDA, there are a few capacities that the controller performs keeping the policyholder's advantage as its need. How Does IRDA Work? The pinnacle body of the protection business, the IRDA, guarantees it outlines rules and guidelines with no uncertainty towards a specific insurance agency. To guarantee decency and the monetary adequacy of the business, the fundamental work of IRDA spins around the 144 CU IDOL SELF LEARNING MATERIAL (SLM)

policyholder's advantages. Allude to the accompanying jobs that the IRDA is chiefly engaged with:  Issues authentication of enlistment to new insurance agencies.  Sets rules and guidelines to guarantee the interests of the policyholder are dealt with.  Monitors all cases are gotten comfortable all decency and that no guarantor will deny any case on their own freedom of thought.  Regulates the implicit rules of the insurance agencies, protection middle people, and others related with the protection business.  Provides arrangements in the event of debates through the IRDA ombudsman.  Controls and manages the paces of protection to forestall undesirable value climbs in the protection premium.  The peak body is answerable for drawing the base rate line of insurance agencies for General and Life Insurance, accordingly creating both metropolitan and rustic areas. Features & Benefits of IRDA Following are the salient features of the apex body, the Insurance Regulatory and Development Authority of India:  Acts as a regulator for the insurance industry.  Protects the policyholder’s interests.  Rules and regulations are framed by the apex body under Section 114A of the Insurance Act, 1938.  It is entrusted under the Insurance Act to grant the certificate of registration to new insurance companies to operate in India  Oversees the insurance industry’s activities to ensure sustained development of insurers and policyholders. Types of Insurances Regulated by the IRDAI Insurance is mainly divided into Life and Non-Life/General Insurance. These are further classified into other types of insurance. Below are the types of insurance regulated by the IRDAI  Life Insurance  Term Plans  Endowment Policies  Unit-linked Insurance Policies 145 CU IDOL SELF LEARNING MATERIAL (SLM)

 Retirement Policies  Money-back Policies  General Insurance  Health Insurance Policies  Vehicle/Motor Insurance Policies  Car insurance  Bike Insurance  Property Insurance Policies  Travel Insurance Plans  Gadget Insurance Plans New Rules and Guidelines for Health and Mediclaim Insurance by IRDA The IRDA is the pinnacle body which is answerable for outlining new standards and rules for medical coverage in the country. The controller has given new IRDA rules for wellbeing and Mediclaim protection in 2020, and they are:  Rejection of Claims: The backup plan can't dismiss a case if the policyholder has re- established the arrangement for a very long time with no break or slip by. This period will be known as the ban time frame. The backup plan can't engage the IRDA for the dismissal of the case besides in the event of misrepresentation or on the off chance that the case is raised against the rejection of the approach.  Inclusion of Telemedicine: With the approach of digitalization, the clinical benefit has changed and one can counsel a specialist through online meetings. IRDA has requested that guarantors incorporate telemedicine counsels in the protection strategy.  Settlement of Claims: If the backup plan defers settling the case, then, at that point the insurance agency is at risk to pay interest on the case sum. It ought to guarantee the case is settled inside 30 to 45 days from the accommodation of the last archive by the policyholder. 8.6 SUMMARY  The Chief Medical Officer is a critical individual from the Senior Executive Operations group, occupied with characterizing the general business system and heading of the association. This position drives the by and large clinical vision for the association and gives clinical heading to the Insurance organizations. 146 CU IDOL SELF LEARNING MATERIAL (SLM)

 CMO needs to stay informed concerning arising models and patterns in medical care that sway mortality and dreariness choices; distinguish and characterize new and inventive techniques to diminish chance and give helpful items to shoppers.  Insurance organizations are by and large coordinated in five expansive divisions: claims, finance, lawful, advertising and endorsing. Showcasing and endorsing are the \"yes\" divisions, while claims and money are the \"no\" offices.  Agent is the principal financier the specialist is determined what kinds of candidates are satisfactory, fringe, or denied. In property and loss protection, the specialist frequently has position to tie the organization right away.  Underwriting begins with an unmistakable assertion of endorsing strategy. That a backup plan should build up an endorsing strategy that is reliable with organization destinations  The Application Processing support group. Application processing capacity is liable for inspecting protection applications from possible individuals, or policyholders, to guarantee that they have the entirety of the right data needed for endorsing and endorsement/refusal.  There was a need of arrangement of administering administrative body, which would direct the edge work, yet additionally ensure the interest and reasonable treatment of the policyholder.  IRDAI-The Authority goes about as the controller of the protection business in India and manages the working of the Life Insurance and General Insurance organizations working in the country. The primary goal of the IRDA is to secure the interests of the policyholder and control the protection business. 8.7KEYWORDS  Application preparing - The Application Processing capacity is liable for inspecting protection applications from likely individuals, or policyholders, to guarantee that they have the entirety of the right data needed for endorsing and endorsement/disavowal.  New Business Processing - The New Business Processing capacity is liable for on boarding new protection policyholders, or individuals. They gather the imperative data, pass that data to the suitable endorsing and application handling staff individuals (in light of use type, language necessities and item information) to survey the fitting premium and inclusion levels, then, at that point convey choices and premium/deductible constructions to the imminent policyholder.  Actuarial-An individual with skill in the fields of financial aspects, measurements and arithmetic, who helps in hazard appraisal and assessment of charges and so forth for a 147 CU IDOL SELF LEARNING MATERIAL (SLM)

protection business, is called a statistician. Statisticians assume a significant part in the activity and productivity of any protection business.  IRDAI (The Insurance Regulatory and Development Authority of India) -IRDAI known as - . The Authority goes about as the controller of the protection business in India and directs the working of the Life Insurance and General Insurance organizations working in the country.  Health Plan Operators-Health Plan Operations alludes to a bunch of fundamental authoritative and backing administrations for wellbeing plan individuals and suppliers. The Back Office is liable for dealing with a few exercises, for example, claims preparing, wellbeing plan part administration/support (normally completed inside a Call Center), premium installment assortment, actuarial, endorsing and application handling. 8.8 LEARNING ACTIVITY 1. As a CEO of start-up insurance company make an organizational chart for your organization. ___________________________________________________________________________ ___________________________________________________________________________ 2. List down 5 important points to validate the need of regulatory bodies for insurance sector. ___________________________________________________________________________ ___________________________________________________________________________ 8.9 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. What is the role of CMO? 2. Which are the YES Departments in Insurance Company? 3. What is the statement of Underwriting Policy? 4. What are the steps in Medical Underwriting.? 5. Describe the primary role of Regulators in Insurance Sectors? Long Questions: 1. Describe in details Job functions and required qualification of a CMO 2. Describe. The Organizational Chart of Insurance Company. 3. What is IRDAI? Describe its objective. 148 CU IDOL SELF LEARNING MATERIAL (SLM)

4. Describe the role and coordination between 5 Departments of Insurance company. 5. Why there was a need of regulatory bodies, when IRDAI was established? B. Multiple Choice Questions 1. Which one of the following statements is correct? a. There are 2 types of Underwriting. Medical and Financial. b. Fraud is the basis of the insurance contract. c. Dead people can make an insurance contract d. The proposal must be written by the proposer himself/herself 2. Which one of the following statements is correct? a. The agent can act as First Underwriter. b. The proposal can be written by the Agent. c. Underwriters can do a medical check-up of an applicant d. CMO visits applicants for information collection. 3. What does a support team consist of? a. New Claim Processing Team. b. Health Plan Operators. c. Member Services. d. All of these. 4. Under whose recommendation was the IRDA established in? a. BCCI Committee in 2019. b. Covid Prevention Committee in 2020. c. Malhotra Committee in 1999. d. ATS Committee in 2006. 5. Which are the basic underwriting principles? a. Attain an underwriting profit. b. The family history appears in the personal statement. c. Select prospective insured according to the company’s underwriting standards. d. All of these. Answers 149 CU IDOL SELF LEARNING MATERIAL (SLM)

1-a, 2-a, 3-d, 4-c, 5-d 8.10 REFERENCES References  Posey, L.L. &Yavas, A., (1995). A search model of marketing systems in property liability insurance. Journal of Risk and Insurance, 62(4), 666–689.  Goodhart, C., & Schoenmaker, D. (1995) Should The Functions of Monetary Policy and Bank Supervision Be Separated? Vol 47, No. 4, 539-560). Oxford Economic Papers,  IAIS (2015) Insurance Core Principles, www.iaisweb.org/page/supervisory- material/icp-on-line-tool. Textbooks  Nissim, D. (2010a). Implied cost of equity capital in the US insurance industry. Working Paper,  Goodhart C and Schoenmaker D. (1995) “Institutional Separation between Supervisory and Monetary Agencies” Chapter 16 in C. Goodhart ed. (1995), The Central Bank and the Financial System,London, Macmillan.  Cukierman, A. (1992) Central Bank Strategy, Credibility and Independence: Theory and Evidence (MIT Press). Websites  https://www.rgare.com/knowledge-center/media/articles/survey-provides-glimpse-into- underwriting-organizational-structures-and-quality-assurance-programs  https://lensa.com/chief-medical-officer-long-term-care-claims--underwriting-jobs/mc- leanva/hjp/97e8e39cf7a4747f1de560cfd0b8d4f644f0df8e4296f3bd992010dcb59ddf1  https://www.policygenius.com/life-insurance/how-does-the-life-insurance- underwriting-process-work/#the-underwriting-process  https://www.pacificcrosshealth.com/en/company-information/organization-structure/  https://opsdog.com/categories/organization-charts/health- planshttps://btlaw.com/insights/blogs/policyholder-protection/2019/inside-an- insurance-company  https://www.slideshare.net/maryasholevar/chapter-4-40596655 150 CU IDOL SELF LEARNING MATERIAL (SLM)