Rider Underwriting Guidelines Comprehensive Comprehensive Protection Rider Health Rider Life Insured Benefit Option Comprehensive Protection Rider Comprehensive Self Life ADB ATPD CPB Health Rider HCB Event Covered Event Covered Accidental Accidental Critical Hospitalization Death Disability Illness Amount & Only Lump sum NA NA NA Payout Lumpsum + Income NA NA Only Income WOP* Tax-free Annuity (Partner care) Premium ROP Refund Please Note PPT Allowed with Regular/Limited /Single Pay (can be <= base plan Rider Term subject to rider term) Can be < = base plan term subject to max maturity age (for WOP = PPT subject to max maturity age) *WOP can be taken on Proposer if policy is non self Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 51
Rider Underwriting Guidelines Options Available under the Rider Benefit Lumpsum Income Lumpsum + Waiver of Partner Option Income Premium (WOP) Care ROP ROP ADB Non ROP Non ROP ROP X ROP Non ROP X Non ROP ATPD ROP ROP ROP Non ROP Non ROP ROP Non ROP ROP Criticare Plus Non ROP ROP Non ROP Benefit ROP ROP Non ROP Non ROP Non ROP ROP X ROP Hospicare Non ROP X Non ROP ROP X Non ROP X X X X X Important Points Partner Care Waiver of Premium Benefit on ATPD / CPB ❑ Standard Age proof is ➢ Health Annexure of proposer is mandatory. required in Non-Self policy ❑ Partner Age should be within ➢ Rider guidelines applicable for 45-90 years the proposer ❑ Relationships Allowed – Parents, Siblings, Spouse, Children, Father in Law, Mother in Law Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 52
Rider Underwriting Guidelines Risk Aggregation Product Risk Aggregation With Accidental Total and Permanent All accidental disability plans (ATPD) Disability Benefit (ATPD)/ [Max Accidental Disability Benefit per WOP on ATPD life is 2Cr] Accidental Death Benefit (ADB) All accidental Death plans (ADB, ADDL) [Max Accidental Death Benefit per life CritiCare Plus Benefit (CPB)/ Inbuilt is 2Cr] CI FG+ Option 2/ WOP on CritiCare Plus All Critical Illness plans ( CPB, Inbuilt CI FG+ option 2, WOP on Criticare Plus) Hospicare Benefit [Max Critical Illness Benefit per life is 1Cr] All Hospitalisation Benefit Plans (Hospicare) [Max Hospitalisation Benefit per life is 40L] Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 53
Rider Underwriting Guidelines NML MER Grid 18-40 20L 10L 41-45 15L 10L 46-50 10L 5L 18-40 TELE MER Grid 41-45 46-50 50L 40L 20L 15L 15L 10L (Above is applicable irrespective of the base plan they are attached to) 18-40 25L 50L 41-65 25L NA ((Above grid is derived basis WOP on Criticare Plus Medical Sum at risk Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 54
Rider Underwriting Guidelines Medical Underwriting - Example Base Criticare Plus / Inbuilt CI FG+ Hospicare Medical Decision Option 2/WOP on CI NML NML NML NML NML NML Tele-Eligible Tele-Eligible NML Tele-Eligible Tele-Eligible Tele-Eligible Tele-Eligible Tele-Eligible NML Tele-Eligible Tele-Eligible Tele-Eligible NML Tele-Eligible Tele-Eligible Tele-Eligible NML Tele-Eligible Tele-Eligible Tele-Eligible Medical NML NML Tele-Eligible Medical Tele-Eligible Tele-Eligible Medical of Rider Grid Applicable Medical NML Medical of Rider Grid Applicable NML Medical Medical of Rider Grid Applicable Medical Medical of Base Grid Applicable Medical NML NML Medical of Base Grid + Rider Grid Applicable. Unique set will be shared with TPA for medicals. Medical NML If ECG- R & ECG-X both are applicable only ECG-X will be shared with TPA for medicals. Medical of Base Grid + Rider Grid Applicable. Medical NML Medical Unique set will be shared with TPA for medicals. If ECG- R & ECG-X both are applicable only ECG-X will be shared with TPA for medicals. Medical Medical Medical Medical of Base Grid + Rider Grid Applicable. Unique set will be shared with TPA for medicals. If ECG- R & ECG-X both are applicable only ECG-X will be shared with TPA for medicals. Medical + VMER NML NML Medical of Base Grid Applicable + VMER Medical + VMER Medical Medical of (Base Grid + Rider Grid Applicable) + VMER. NML Unique set will be shared with TPA for medicals. If ECG- R & ECG-X both are applicable only ECG-X will be shared with TPA for medicals. Medical + VMER NML Medical Medical of (Base Grid + Rider Grid Applicable) + VMER. Unique set will be shared with TPA for medicals. If ECG- R & ECG-X both are applicable only ECG-X will be shared with TPA for medicals Medical + VMER Medical Medical Medical of (Base Grid + Rider Grid Applicable) + VMER. Unique set will be shared with TPA for medicals. If ECG- R & ECG-X both are applicable only ECG-X will be shared with TPA for medicals Medical + VMER Tele-Medical NML Medical + VMER Medical + VMER Tele-Medical Tele-Medical Medical + VMER Medical + VMER NML Tele-Medical Medical + VMER Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 55
Rider Underwriting Guidelines Medical Grid Application Scenario 1:- Sampoorna Raksha Supreme opted by Customer of 35 years Plan Name SRS ADB ATPD Criticare Plus Hospicare Sum Assured 2Cr 2Cr 1Cr 40L 5Cr Grid Applicable NA NA ME, BPB, CBC, ECG-X Tele-Eligible ME, BPB, HBA1c, ECG-R, Cotinine +VMER Final Grid Applicable:- ME, BPB, HBA1c, ECG-X, Cotinine, CBC + VMER Scenario 2:- Sampoorna Raksha Supreme opted by salaried/graduate customer of 40 years with 12L income Plan Name SRS ADB ATPD Criticare Plus Hospicare Sum Assured 2.25Cr 1.5Cr 1.5Cr 1Cr 40L Grid Applicable VMER NA NA ME, BPB, CBC, ECG-X Tele-Eligible Final Grid Applicable :- ME, BPB, CBC, ECG-X Scenario 3:- Fortune Guarantee Plus plan opted by Customer of 50 years Plan Name FGP ADB ATPD Criticare Plus Hospicare Sum Assured 10Cr 2Cr 2Cr 15L 10L ME, BPB, CBC, HBA1c, Grid Applicable ECG-X NA NA Tele-Eligible Tele-Eligible Final Grid Applicable :- ME, BPB, CBC, HBA1c, ECG-X Scenario 4:- Value Income plan opted by Customer of 50 years Plan Name VIP ADB ATPD Criticare Plus Hospicare Sum Assured 1Cr 1Cr 1Cr 10L 5L Grid Applicable NML NA NA NML NML Final Grid Applicable :- NML Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 56
Rider Underwriting Guidelines Criticare Plus & Hospicare Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 57
Rider Underwriting Guidelines ADB & ATPD Rider Medical Grid Criticare Plus/Inbuilt CI FG+ Option 2/WOP on CI (Proposer) Medical Sum at Risk 18 to 40 Years 41 to 50 years 51 to 65 years Upto 5,00,000 MER, ECG-R, CBC, BPB 5,00,001 to 10,00,000 MER, ECG-R, CBC, BPB 10,00,001 to 15,00,000 MER, ECG-R, CBC, BPB 15,00,001 to 20,00,000 MER, ECG-Exe, CBC, MER, ECG-Exe, CBC, MER, ECG-Exe, CBC, 20,00,001 & Above BPB BPB BPB Medical Sum at Risk Hospicare All Sum Assured 18-45 Years Above 45 Years MER, ECG-R, CBC, BPB MER, ECG-Exe, CBC,BPB (Above grid is applicable above NML/Tele limits & for adverse health) Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 58
Rider Underwriting Guidelines Financial Multiplier Age Group (in years) Income Multiplier Income Multiplier 18-35 (Smart Sampoorna Raksha) (Criticare Plus/Hospicare) 36-40 25 12 41-45 20 10 46-50 15 10 51-55 12 7.5 56-65 10 5 5 5 E.g.,51 year old Customer with income 10L wants to purchase Sampoorna Raksha Supreme. Eligibility would be calculated as :- Eligibility Income Income Multiplier Coverage Eligibility Max Allowed for the plan SRS 10L 10 1Cr No Limit ADB 10L NA 1Cr 2Cr ATPD 10L NA 1Cr 2Cr Criticare Plus 10L 5 50L 1Cr Hospicare 10L 5 40L 40L Back to Index This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 59
FAQs Contd. 60
FAQs Example- Mr Ramchandran Das is a customer from the bank. He wishes to apply for a Term insurance plan. He wants to know the vaccination requirements from TATA AIA Life before applying for the plan: Answer: Vaccination is not mandatory. The customer can apply for a term plan with TATA AIA Life. Example - Ms. Chitra has recently joined TATA AIA as a CAM. In one of the bank branches, she meets a customer who wants to apply for a term plan. The customer shares that he has taken his second dose of vaccination 2 days ago. The customer wants the case to be logged in. What should Ms. Chitra do? Answer- In this situation where you know that the customer got vaccinated recently and it’s not been 7 days from the date of vaccination, hence, we will not be able to issue the term policy to the customer. In TATA AIA there is a specific underwriting guidelines if the customer has taken 1st dose, then 7 days of waiting period will be applicable from the date of vaccination whereas if the customer has taken 2nd dose, then 7 days of waiting period will be applicable from the date of vaccination. Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 61
FAQs Example - Mr. Karan 66 years old and wants to apply for a term plan as he is a Silent partner is his business currently and wants to safeguard the interest of his family by booking a term plan. Answer - No, he is not eligible as the maximum entry age is 65 years. Example - Mr. Khanna is a Businessman (10th pass) and runs a chain of logistics in FMCG sector and files an ITR of 20 lacs every year, he has a dependent family which includes a wife and three children and he is the only bread winner in his family. Currently, he lives in Mumbai and taking care of his business and travels a lot because of business requirements. By analysing the entire scenario, how much cover will you offer him? Answer - As per the guidelines we can’t offer the plan to Mr. Khanna because the minimum qualification which is required for a term plan is 12th pass but there is an exception which can be considered here for the customer who is 10th pass and having an average ITR of 10 lacs ( last 2 years average) plus- 1. Mandatory Standard income proof required 2. Financial waiver OR any kind of Financial surrogate income shall not be accepted 3. Mandatory Medicals + VPSC required 4. The Risk Score of TALIC is within acceptable limit 5. Video PSC Mandatory/Video MER and/or PIV as per underwriter’s discretion 6. Final decision is subject to underwriting Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 62
FAQs Example - You have recently joined a bank branch and in the morning huddle Branch Manager asked about the minimum salary criteria for his employees to ensure that responsibly everyone should go for a protection solution. What will be your answer 5 lacs or 3 lacs? Answer - Here in this scenario we are not talking about the customers but we are referring to the bank staff i.e. our partner employees, so, for them the minimum annual package requirement is of 3 lacs p.a. with max cover upto 1 Cr with mandatory medicals and should be a Graduate The correct answer will be 3 lacs in this case Example - Mr. Rajesh 43 years old, HSC passed and currently he is self employed and owns a garment shop in one of the busy localities in Mumbai Being a businessman, his ITR for last two years are 2019- 9 lac, 2020- 3 lac (hit loss due to pandemic), Is he eligible to buy the term plan? Answer - Mr. Rajesh is eligible to buy a term plan as his average business profit for last two years is INR 6 Lac (9+3 lacs/2) which is more than the minimum eligibility amount i.e. INR 5 Lac. Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 63
FAQs Example - A customer who is salaried and having an annual income of 7.5 lacs and opting for a sum assured of 2.25 Cr, will he be eligible for VMER & Financial waiver? Answer - Yes, the customer is eligible for VMER & Financial Waiver/ Standard financial documents might be required, provided he fulfils the above mentioned conditions in previous Q&A Pls refer the below table for more info- Age Brand Grid Guideline 1 Guideline 2 Lower of declared/ Lower band of Income : Salaried: 7.5 L: Self Employed: 7.5 L Estimated income basis Self Employed: 10 L 18-40 Yrs VMER only + FW / Std >=1 Cr to 2.5 Cr =1 Cr Financial Document 41-45 Yrs VMER only + FW / Std >=1 Cr to 1.5 Cr NA Financial Document Medical + Grid Medicals + VMER + <>1 Cr Financial Waiver FW [ If applicable upto 1 <1 Cr All Sum Assured conditions as per Cr] / SFE 1 Cr applicable as Grid Medicals + VMER + per below Grid FW [ If applicable upto 1 <1 Cr and >1.5 Cr Cr] / SFE Above 45 yrs to 55 yrs Grid Medicals + VMER + FW [ If applicable upto 1 Cr] / SFE Above 55 years No Financial Waiver Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 64
FAQs Example - Mr. Raghav, aged 62 years is done with VPSC while applying for the term plan. Is it mandatory to go for physical medicals & Video MER? Answer - Yes, as the customer is 62 years old. Refer the guidelines for age 61 to 65 Years:- • VMER mandatory + Medical. • Whole life cover not allowed. • For SA > 1Cr, Policy Term will be allowed as per Reinsurer decision. • Standard Financials mandatory. Financial surrogates not allowed. Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 65
FAQs Example - Mrs. Asha Prasad is a homemaker and a wife of a successful businessman Mr. Kamal Prasad, who is into retail chain of FMCG products and wants to apply for a term policy to have a secure future. Mr. Prasad also wanted to cover his wife in the same policy. As a CAM or Insurance specialist what will you suggest in such scenario Answer - As an Insurance specialist you must make you customer aware about the homemaker guidelines- • Homemaker should be graduate or above • PSC will be mandatory • 50% of husband’s Term Cover* OR INR 50 Lac whichever is lower [*With TALIC/any other with life insurance company/ies] • Husband’s Cover - May or may not be from TALIC. If husband’s term cover is not from TALIC, a copy of the policy schedule with Sum Assured and Terms of Acceptance to be attached [policy to be less than 5 years old] • Only Life Option is available (Sampoorna Raksha Supreme) • Case will be fully underwritten Medically Example - If husband is covered for INR 1 Crore with TALIC and intends to take an INR 50 Lac cover on his wife with TALIC, he needs to be eligible for INR 1.5 Crore basis his earned income. Standard Financial documents of the husband will be required. Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 66
FAQs Example - Mr. Ram is an agriculturist, earns well up to INR 12 Lac through agriculture in his 10 acres of land. If he wishes to go for a term plan, what is the amount of Sum Assured Capped at and other documents required? Answer - If the customer is an Agriculturist the following conditions need to be taken of- • Minimum Income Criteria - Being self-employed, INR 10 Lac will be applicable • Education - Graduate • Verified Income - ITRs and Form J* will be considered for Min. Income Criteria • Land ownership papers, mandi receipts in LAs name to be submitted • Sum Assured - Capped at INR 50,00,000 based on eligibility • Medical mandatory Example - Mr. Ravi is 33 years old and self employed in a cloth manufacturing business with 4.40 lacs of income (ITR) wishes to apply for a term plan, is there any provision where the customer can apply for the same with 1 Cr term cover as his annual income is not 5 lacs which is a basic eligibility? Answer - Yes, now we can add surrogates with the plan to bridge the financial gap to reach the eligibility. So ,in this case using surrogate income, 20% income can be bridged (88,000) , new Income: 4,40,000 + 88,000 = 5,28,000 as the required eligibility for Term plan is 5,00,000 by using surrogates customer is eligible for the term plan now Financial Eligibility: 5,28,000 x 25 = 1,32,00,000 Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 67
FAQs Example - Mr. Rakesh Sharma (30 years old) is your customer and earns 5 lacs of annual income and wants to apply for the term plan, while having a discussion with the customer, what Sum Assured will you suggest him an how will you calculate? Answer - The Sum assured/Life cover is calculated basis the multiplier factor as per the age of the customer, Rakesh Sharma is 30 years old therefore as the standard financial eligibility table the multiplier is 25 times Sum Assured=25*5 lacs= 1.25 Cr Refer the table below fir the multiplier at different ages- Age at Entry (years) Max Income Multiple* 18 – 35 25 36 – 40 20 41 – 45 15 46 – 50 12 51 – 55 10 56 - 65 5 Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 68
FAQs Example - Mr. Jacob Jose is an NRI and presently in India to visit his family, he wants to book SRS plan with TATA AIA Life but his passport renewal is under process, what will you consider as an age proof document in this case? Answer - When our customer is an NRI/OCI/PIO, in such cases the only standard age proof which can be considered is a PASSPORT and no other document will be applicable as passport is a mandatory document. In the above-mentioned case study, the passport is not available therefore you will have to wait for the renewal of the same Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 69
FAQs Example - An RM has joined the bank recently and wants to understand list of documents that is acceptable as an income proof in TATA AIA. You as a CAM need to illustrate the same Answer - The list of documents acceptable as an income proof are as follows- • Answer Recent Appointment Letter (Not more than 3 months old) with at least 1 months’ salary slip with Provident Fund deduction • Latest salary revision letter (Not more than 3 months old) with at least 1 months’ salary slip with Provident Fund deduction • Last 3 months’ salary slips (With Provident Fund Deduction, average income will be considered) • Last 6 months Bank statements reflecting salary credit at regular periodic interval. Only copies of salary slip (without bank credit proof) cannot be considered. • Latest Form 16/Form 16 A • Income Tax Returns (ITR) along with CA certified (as applicable) Computation of income for last three years – Average Income of 2 years will be considered for computing eligibility • CA certified/Audited Profit and Loss (P&L) account & audited Balance Sheet for last 2 years. (average income will be considered Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 70
FAQs Example - Mr. X who is an NRI walks into the bank branch to inquire about our SRS term plan and understand the basic eligibility criteria wrt to income to apply for the same. As a CAM, pls specify the conditions- Answer - If the customer is an NRI, the minimum annual verified income for Salaried, Professional, Business Owner or self-employed should be minimum 10 lac Example - Mr. C is a PIO and wishes to apply for a term cover of 2 Cr and wants to know about the documents to be submitted while processing the same as he is planning to travel back in the next week. Pls specify the mandatory documents Answer - If the TSAR is above 2 Cr which is there in this scenario, then copy of all pages of passport with entry and exit details+ travel questionnaire is required Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 71
FAQs Example - Mr. Ramanujam who is 40 years old is a PIO from Singapore and decides to purchase TATA AIA SRS plan with 2 Cr Sum Assured Limited 5 pay with a policy term of 40 years. Is he eligible for the term plan? If yes, pls specify, also, Is Video MER mandatory in this case? Answer - Yes, he is eligible for the term plan as the entry age for PIO/NRI/OCI is 18 to 60 years. Also, Singapore is a part of Set A countries and we can offer a Sum Assured upto 5 Cr Set A Countries: [Singapore, Hong Kong, China, UAE, Oman, Qatar, Saudi Arabia, Sri Lanka, Maldives, New Zealand, & Australia, Papua New Guinea, Fiji, Brunei, Thailand, Taiwan, Vietnam, Mauritius, South Korea, Bahrain, Kuwait, France, Germany, Switzerland, Austria, Hungary, USA, Canada] can be accepted upto 5 Cr, for higher Sum assured final decision subject to reinsurer approval Video MER is mandatory in all the cases of NRI/PIO/OCI Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 72
FAQs Example - If you are offering SRS under Keyman Insurance and the customer is interested to know the maximum coverage term then till what age you can provide the coverage? Answer - In Keyman insurance if we are offering a term plan then we have to ensure to communicate that 65 years is the maximum age at maturity for the customer. For increased tenure upto age 75 years, conditions are as follows: a. Family owned company only. b. Affidavit needs to be completed by company for each key person cover. Example - a customer who is a businessman and files an ITR of 5 lacs every year has approached you and looking for a plan which can offer him a protection and savings at the same time but the customer is 12th pass, can you offer any such plan to the customer? Answer - Yes, we can offer PR plus as the minimum education is HSC and minimum average of ITR required is 3 lacs (5+5/2=5 lacs) Contd. This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 73
FAQs Example - A customer is looking for a term plan where he can have an additional cover over and above the existing term plan that is already there as the customer has been promoted as a AVP and with the increase in package he also wants to increase his cover by 10 lacs, do you have any plan in TATA AIA which can offer him a cover of 10 lacs? Also can we add any additional benefit in form of riders? Answer - Yes, TATA AIA has recently launched Saral Jeevan Bima in which customer can easily opt for a sum assured of 10 lacs as the minimum sum assured in the plan is of 5 lacs and maximum is 25 lacs. You can also add riders in this plan i.e. ADB & ATPD. Example - TATA AIA has launched various features in the existing 4 riders- ADB, ATPD, Criticare & Hospicare , those are lumpsum option, income +lumpsum option, income option, waiver of premium & partner care, if customer is opting for HospiCare rider in this case will partner care option is available if not then with which riders it is available. Answer - No, partner care feature is not available with HospiCare , this feature in only available with ADB, ATPD & CritiCare. Back to Index This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 74
FAQs Pension Profile SRS (all PR PR Plus SJB PAR / Plans ULIPs options) Y Non-PAR (SAP, FG Pension) Resident Y Y YY Y Y Indian Y N NRI / OCI / PIO Y N NN Y Y Y N Foreign N N NN Y Y Y National Y Y Housewife Y N NN Y Y Y Minor as Life N NN Y N Y Assured Y NN N N N Keyman (only Life YN Y Y Y Employer – Option) Employee Y HUF Y YY Y Y Y Partnership Y NN N N N (only Life Option) Back to Index This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 75
Important Information Back to Index This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 76
Important Information Back to Index This is an internal training document created only for the sales employees of Tata AIA. This should be not used for solicitation. 77
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