White Paper Insurance

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Insurance WhitePaper

Project name: FM - InsuranceSectorPrepared by: Group 2, Roll no 8-15Checked by: Prof. SuyashBhattIssue: 1.0

MMM-II

Prof-Suyash Bhatt

Chirag Bhuva - 09

Sachin Chavan - 11Vishal Chavan - 12Chetan Shape - 13Christine Glenn -15


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File name: FM - InsuranceSectorPrepared by: Group 2, Roll no8-15Checked by: Prof. SuyashBhattIssue: 1.0

Table of contents:

1. Introduction to Insurance2. Concept - Life Insurance3. Insurance Operations4. Regulatory Authority5. Market Players Local & International6. Current Market Scenario

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OVERVIEW OF INSURANCE SECTOR IN INDIA

INTRODUCTION: -

The Insurance sector in India governed by Insurance Act, 1938, the Life Insurance

Corporation Act, 1956 and General Insurance Business (Nationalisation) Act, 1972,

Insurance Regulatory and Development Authority (IRDA) Act, 1999 and other related

Acts. With such a large population and the untapped market area of this population

Insurance happens to be a very big opportunity in India. Today it stands as a

business growing at the rate of 15-20 per cent annually. Together with banking

services, it adds about 7 per cent to the countrys GDP .In spite of all this growth the

statistics of the penetration of the insurance in the country is very poor. Nearly 80%

of Indian populations are without Life insurance cover and the Health insurance. This

is an indicator that growth potential for the insurance sector is immense in India. It

was due to this immense growth that the regulations were introduced in the

insurance sector and in continuation Malhotra Committee was constituted by the

government in 1993 to examine the various aspects of the industry. The key element

of the reform process was Participation of overseas insurance companies with 26%

capital. Creating a more efficient and competitive financial system suitable for the

requirements of the economy was the main idea behind this reform.

Since then the insurance industry has gone through many sea changes .The

competition LIC started facing from these companies were threatening to the

existence of LIC .since the liberalization of the industry the insurance industry has

never looked back and today stand as the one of the most competitive and exploring

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industry in India. The entry of the private players and the increased use of the new

distribution are in the limelight today. The use of new distribution techniques and the

IT tools has increased the scope of the industry in the longer run.

Introduction To Insurance

HISTORY OF INSURANCE SECTOR: -

The business of life insurance in India in its existing form started in India in the year

1818 with the establishment of the Oriental Life Insurance Company in Calcutta.

Some of the important milestones in the life insurance business in India are given in

the table 1.

Table 1: milestones in the life insurance business in India

Year Milestones in the life insurance business in India

1912 The Indian Life Assurance Companies Act enacted as the first statute to

regulate the life insurance business

1928 The Indian Insurance Companies Act enacted to enable the government

to collect statistical information about both life and non-life insurance

businesses

1938 Earlier legislation consolidated and amended to by the Insurance Act

with the objective of protecting the interests of the insuring public.

1956 245 Indian and foreign insurers and provident societies taken over by

the central government and nationalised. LIC formed by an Act of

Parliament, viz. LIC Act, 1956, with a capital contribution of Rs. 5 crore

from the Government of India.

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The General insurance business in India, on the other hand, can trace its roots to the

Triton Insurance Company Ltd., the first general insurance company established in

the year 1850 in Calcutta by the British. Some of the important milestones in the

general insurance business in India are given in the table 2.

1. Introduction to insurance sector

What is insurance - Insurance is related to the protection of theeconomic value of assets.

What is asset - As asset is something that provides benefits tothe owner and has an monetary value.

Definition - Insurance is a mechanism that helps reduce theeffects of adverse situations and promises to pay to the owneror beneficiary of the asset, a certain sum if the loss occurs.

Asset can be of multiple types as represented under

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Assets have a specific lifespan, but it is possible that during thelifespan, the asset may:

- Be destroyed- Become non functional

Any destruction or no-functionality of an asset cause economic ormonetary loss to the owner.

Insurance is a mechanism that helps reduce the impactand effect of such adverse situation.

What is Perils & Risks?

Perils

Assets are insured because they are likely to be destroyed ormade non-functional before expected life time, throughaccidental occurrence.

Such possible occurrences are called PERILS. For example: Fire, floods, lightening, breakdowns etc.

Risks

Risks are consequential losses or damages.

Risks only indicate that there is a possibility of loss or damage,however, the damage may or may not happen.

For example: Earthquake may occur, but building may notbe damaged.

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Examples of Perils

Purpose & Need of Insurance

The damage that are caused due to these perils is the Risk that theasset is exposed to

The economic/financial loss due to the damage can becompensated by taking proper insurance

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Non-economic losses, such as emotional loss, are not coveredunder insurance

Insurance is necessary:

As it compensates, to some extent, the monetary lossescaused by external causes

As it helps reduce the consequences of adverse situations

Insurance as a Risk Sharing device

People exposed to the same risk come together and agree that ifany one member suffers a loss; the same will be shared byothers, who will make good to the person who lost.

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Insurance as a Business of Sharing

1000 workers working in a textile mill traveled to work onbicycles

It was noted that every month 2 bicycles on an average werestolen from the company premises.

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Whoever lost their bicycle was compensated from the commonfund.

Thus, one persons loss was shared by many, saving him fromfinancial burden.

The law of large numbers

Insurance is based on law of large numbers.

The premiums payable by an individual for insurance is based on

expectations of the losses. These expectations are based on studies of occurrences in the

past, and the use of statistical principles.

In statistics there is a Law of Large Numbers.

If a coin is tossed, the chance of it coming down as a heador tail is half.

If the same coin is tossed 10 times, we cannot say for surethat heads will come 5 times.

If the coin is tossed 1 million times, the number of heads will becloser to half a million. The variation will also be less as apercentage.

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How does insurance work?

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Insurance is based on occurrence of perils and protectionof risks.

Insurance works on the following criteria:

The occurrence of the peril has to be random

The occurrence of peril has to Accidental

The peril should not be a deliberate creation of theInsured person

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We just saw why we need insurance to protect physical assets andhow insurance works on a risk sharing mechanism.

Now lets take a look at Human Beings as Assets!

Human life is an income generating asset.

A Human being is an economic asset as well.

This asset is perishable as it can be lost or affected by death or

sickness or accidents leading to disability. Accidents may or may not happen, but death is certain.

Only the time of death is not certain.

Humans as assets face the following risks:

Early death

Living too long

Disabilities

Sickness

Unemployed

Life Insurance takes care of:

Living too long

Dying too early

We just saw that human beings are income generating assets andhence need insurance.

Now lets take a look at business side of insurance and seehow it actually works.

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Insurance companies are called the insurers.

They bring together persons with common interests(sharing the same risks)

Collect the share of contribution (called premium)

Pay out compensation (called claims)

The insurer acts as a trustee and manages the entire fund

The Trustee ensures that:

The premium claim paid is genuine and no suspiciousclaims are paid

The premium charged is fair and reasonable

The life fund is safe and secured

The life fund earns the maximum interest and providesgood returns

Reinsurance

The insurance companies are taking risks

They have to pay claims as and when they occur They cannot be sure when the claim will occur and how big the

claim may be

Insurers are normally financially sound

However, a claim like Tsunami, or earthquake can bring in claimsworth crores

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Insurers protect themselves from such situations by reinsuringrisks with other insurers.

When on insurer insurers his risks with another insurer it is calledreinsurance.

There are certain companies that are exclusively in business ofreinsurance

Indian Insurance business

When a breadwinner of the family dies, the income of the familydies as well.

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The economic condition of the family is thus affected. The family may be pushed into the lower strata of society, which

creates a cost for the society.

Insurance prevents this by stepping in and providing the familywith the sum assured.

Insurance is one of the a social security tool that benefits thesociety, the individual and the business.

Advantages of Life Insurance

Life insurance has no competition from any other business.

It offers quick settlement of claims in the event of death.

It encourages financial discipline, as premiums are required to bepaid regularly.

Creditors cannot claim life insurance money. The money can beprotected against attachment by courts.

Marketability and liquidity are better. A life insurance policy isproperty and can be transferred or mortgaged. Loan can be takenagainst it

Life Insurance Contract

A life insurance contract is a contract between the insured andthe insurer, which promises that the insurer will pay the insureda certain sum of money in case the person dies or any otherspecified contingency happens.

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Insurance contract is subject to two principles in addition to theessentials of contract that we have seen.

Insurance is a special type of contract.

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The two principles are: These principles apply to all insurances life and non-life

Insurance Contracts

Most of the facts related to health, habits, personal history,family history etc., which form the basis of insurance contract,are known only to the proposer.

The insurer cannot know them unless the proposer chooses todisclose them.

For example: History of past sickness that can affect lifeexpectancy and increase risk for the insurer.

Non-disclosure of such facts would put the insurer as well ascommunity of policyholders at a disadvantage.

When a proposer, knowingly puts an insurer at a disadvantage,the contract becomes unfair and gives rise to adverse selection.

To avoid adverse selections and bring a disadvantage to theentire community of policyholders the law imposes a greaterduty on the parties to an insurance contract information.

This duty is the one of utmost good faith or Uberrimae Fides.

In case the insured fails to disclose all important facts thecontract can be held void ab initio (null & void).

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There are two types of facts:

Material Facts

Non-material facts

Certain important material facts are:

Facts of higher Risk or external Factors that make the riskhigher risky job, hobby

Any refusal/special terms imposed on previous proposals

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Existence of other policies Normal facts like age, height, etc. and other health related

facts

The proposer cannot defend non-disclosure by contending thathe did not think that the fact was material

Non Material Facts

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Declaration

The proposal form is the basis of an insurance contractThe proposer makes a declaration to the effect that all statements inthe proposal form are true, and that the insurer can treat the contractas null and void, if any statement is found to be untrue

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Material Fact Dispute

The insurers right to cancel the contract, is limited by theprovisions of Section 45 of the Insurance Act, 1938.

Principle of Insurable Interest

Wagering Contract & Insurance Contract

All risks are not insurable

Speculative risks are not insurable Insurance is thus, not a wagering contract or betting.

A wagering contract is speculative in nature and is illegal interms of Section 30 of Indian Contract Act.

What distinguishes an insurance contract from a wageringcontract is that the insured person must have an insurableinterest in the subject of insurance.

What is Insurable Interest??

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Insurable Interest is the monetary interest. In life insurance business insurable interest is required only at

the time of entering an insurance contract.

Who have Insurable Interest?

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When do these principles apply in life Insurance?

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Principle of Indemnity

Insurance is meant to compensate the losses; hence, themechanism of Insurance cannot be used to make profits. Thisbroadly is the Principle of Indemnity.

Amount of claim cannot exceed the amount of loss incurred

Insurance makes good the loss

In Life Insurance, insurable interest on own life is unlimited,hence, Principle of Indemnity does not apply. However, it does

apply in General Insurance.

Risks

Life insurance business deals with risks relating to life of humanbeings.

The circumstances (perils) that create the loss or damage (risks)are mainly old age and death.

Insurance does not prevent the risks but mitigates theconsequences in those circumstances.

Needs

Risks arise because there are needs to be fulfilled

The risk attached to early death arises because of the need tomaintain the family that is left behind.

If there were no needs, there would be no risks.

Insurance is therefore, related to the needs of individuals

Needs of the people are not the same, they vary.

Needs depend on personal values, demands of the society,

family, age, occupation, habits etc. It is necessary to be sensitive to needs.

Classification of Needs

Broadly, needs of individuals can be classified as:

Protection of standard of living, which is at risk on early death.

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Future expenses, on account of childrens education, marriage,starting a business and so on.

Continuance of business, when financers as for life insurancepolicies as collateral security.

Substitute income when earning capacity ceases due to old ageor disabilities.

What is Premium?

In an insurance contract, the insurer promises to pay to the

policyholder a specified sum of money, in an event of a specifiedhappening.

The policyholder has to pay a specified amount to the insurer, inconsideration of this promise.

Premium is the name given to this consideration that thepolicyholder has to pay in order to secure the benefits offered bythe insurance contract.

Premium can be looked upon as the price of the insurance policy,often paid regularly over a period of time.

A default in premium can endanger the continuance of thepolicy.

Risk Premium

Risk Premium refers to the amount of premium that is used tocover the risk of death during a given year for a given age.

This is based on probabilities of death at various ages.

This information is provided in mortality tables.Net Premium

The balance amount of premium after providing for the risk canbe invested to earn interest.

The overall premium can be reduced to the extent of theinterest that is likely to be earned on it.

The amount of premium worked out after taking into account theinterest is called the pure or net premium.

Office Premium

Office premium is the premium arrived at after loading the pureor net premiums.

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Loadings

The insurance companys administration expenditure has to bemet out of the premiums paid to them by policyholders.

To this extent, the premium collected from the policyholders willbe higher.

Such additions to the pure premium are called loadings.

Loadings can also be due to other reasons like unexpected

contingencies and fluctuations- such as earthquakes orepidemics which may cause more deaths than normal.

Due to this, the risk premium based on mortality tables would beinadequate to meet catastrophic claims.

Insurers would, therefore, provide for such contingencies bysuitably loading the premium.

Concept of Level Premiums

In case of any insurance policy, normally, the risk premium wouldbe lower in the initial stages if the age is lesser.

As the age increases, the risk premium will also be increased

proportionately. In later years, the risk premium may become too heavy to pay

and may lead to policy lapses.

Therefore the insurance companies spread the risk premium on auniform basis over the term of the policy, to offset the problem.

This is called Level Premium.

Level premiums are charged for the following reason.

It is possible that healthier people may drop out in the lateryears, as they would find the premium too burdensome to pay.

This would mean an adverse selection against the insurer.

The remaining policyholders would not be the same kind ofpopulation as the mortality tables would assume and thecalculations would go awry.

Extra Premiums

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Extra premiums will be charged, if any additional benefit, lifeaccident benefits or premium waiver benefit have been optedfor.

These are known as Riders, which provide supplementarybenefits.

Extra premiums may be charged due to underwriting decisionsas well.

If the underwriting reveals a greater risk or if the risk of life isassessed to be more due to the nature of job or health,

underwriters may charge extra premiums. These are usually stated as Rs. 2 per thousand and will be

added to the premium otherwise chargeable.

Calculation of Age

The premium charged differs with age.

If the age is found to be different from the age stated in theproposal, after the policy is issued, the premium mentioned inthe policy shall be changed from inception.

Either the shortfall will be collected or the excess will be

refunded. The age has to be determined as on the date of commencement

of the policy.

This could be the age last birthday, age next birthday or the agenearest birthday.

How to calculate Age?

Age can be calculated in the following manner:

Age = Date of Commencement of the Policy Date of Birth

Lets take an example:

Date of Commencement (DOC): 24/10/2008

Date of Birth (DOB): 10/3/1982

Age = 24/10/2008 10/03/1982 = 26 years, 7 months and14 days

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Premium Calculations

Bonus

The surplus amount, determined after the valuation, isdistributed amongst the policyholders by declaration of bonus.

Bonuses are payable only to those policyholders, who haveparticipating or with profit policies.

There are different types of Bonuses.

Simple Reversionary Bonus

Compounded Reversionary Bonus

Terminal Bonus

Interim Bonus

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Life Insurance Products

Life insurance products are referred to as Plans of insurance

The life insurance plans have two basic elements

Term Insurance Plan

Plans of insurance that provide only death cover are calledTerm Assurance Plans

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The nominee of the insured gets the specified amount, ifthe insured dies within the policy term.

If the insured does not die within the specified period, nopayment is made under a term assurance plan.

For example: Mr. A has purchased a term assurance planfor a 20 year term. If he dies within the 20 years, hisnominee gets the entire Sum Assured. However, if he doesnot die in the 20 year term, no payment is made to him atall.

Endowment Plans

Plans of insurance that provide only survival benefit are calledPure Endowment Plans

The insured get the specified amount if he lives or survivesthe policy period.

If the insured dies within the specified period, no paymentis paid under pure endowment plan.

For example: Mr. B has purchased a pure endowment planfor a 20 year term. If he dies within the 20 years, he does

not get any payment. However, if he does not die in the 20year term, he gets the entire sum assured.

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Some Popular Products

All insurers do not offer all the plans.

Further, the same plan can be called by different names bydifferent insurers.

Term Assurance

Term assurance plan is the cheapest and most commoninsurance plan.

In this plan, the sum assured is paid to the nominee on deathduring the chosen term.

However, if death does not occur during the term, no payment ismade to the insured.

Term Assurance Plans by themselves are no very popular asthere is no saving element in the plan.

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They are useful only when death cover is required and otherarrangements are available for survival benefits.

Endowment Plans

The Sum Assured becomes payable on survival to the end of theterm or on earlier death.

The premiums are usually payable till the end of the term of theplan.

The amount payable on death may not be the same.

Survival benefits can be more than death benefits and viceversa.

Survival benefits can also be paid at intervals during the term,without affecting the sum assured on death.

Whole Life Plans

The Sum Assured is paid on death or on maturity of the policy(i.e. attaining a certain age.)

The premiums are normally payable till a claim arises.

Some plans offer shorter premium payment terms as well.

Marriage Endowment Plans

The plan stipulates the date on which the Sum Assured will bepayable, even if the life insured dies early.

The date can be chosen to coincide with the age of a son ordaughter, for whose marriage the sum assured may come inhandy.

The policy can be taken to meet any other financial goal as theplan has nothing to do with contingency of marriage.

Education Annuity Plans

It is not really an annuity plan, but an ordinary endowment planwhich states that the sum assured will be paid in installments,commencing from a date.

The date may be chosen as a likely date when the child will beold enough for higher education.

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Convertible Plans

Convertible plans are those plans which can be converted intoanother plan after or within a certain period of time aftercommencement.

The advantage of such plans is that when the right to conversionis exercised, there is no further underwriting decision to bemade.

There would be no medical examination - so the right to thepolicy cannot be denied to him even if he has an adversemedical condition.

Such policies are usually taken by people in the early stages of theircareers, who expect their financial conditions to improve soon, but donot want to delay the benefits of insurance till then

Without Profit and with Profit Policies

Without profit or Non Participating policies are not entitled tobonuses, which are declared after actuarial valuations.

With profit or participating policies require slightly higherpremium for the right to participate in the progress of theinsurer.

With profit policies are popular because the bonuses areexpected to be more than the extra premium paid.

With profit policies, where the premium is payable for limitedperiod, will continue to participate even after the premiums have

ceased.

Joint Life Policies

Two or more lives can be covered under one policy.

Such policies usually cover married couples or business partners.

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The Sum Assured is paid on death of any of the insured personsduring the term or at the end of the term.

Some plans continue the payment of the Sum Assured on deathof one life and policy is continued to cover the second life tillmaturity, without further premium payment.

In case of joint life insurances:

A joint life declaration is necessary for creating a jointinterest in the policy.

In case of partnership, the partnership deed will beexamined to ascertain the nature of financial interest of

each partner. Each life will be underwritten separately and the bonuses

will accrue on the single basic sum assured onlyChild Insurance Plans

Insurance can be taken on life of children who are minors.

The proposal will have to be made by a parent of a guardian.

In these plans, risk on the life of the insured child will begin onlywhen child attains specified age.

The time gap between commencement of the policy andcommencement of the risk is called Deferment Period.

For example, if the child is 6 years old when the policy istaken, and the insurance cover starts when the child is 15years old, the deferment period will be 9 years.

The date on which risk will commence at the end of thedeferment period is called Deferred Date.

The Deferred Date will be the policy anniversary.

There is no cover during the Deferment Period.

In case of death during this period, the premiums are returned.

Risk commences automatically on Deferred Date without anymedical examination.

The main advantage of this plan is that premiums are relativelylow and cover will be obtained irrespective of the state of thechilds health.

The title will automatically be passed on to the insured child, onhis attaining majority.

This process is called Vesting, which cannot be before age of 18year.

The deferred date ca be fixed without any such limitations.

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After vesting, the policy becomes a contract between insuredand insurer.

Variable Insurance Plans

A very common objection to life insurance is that the returns arenot good.

Although life insurance is not an investment and criteria onreturns is inappropriate, the concern is real, particularly incontext of inflation.

The sum assured considered adequate today may have muchlower value on maturity, after 20 to 25 years.

The Unit Trust of India started the Unit Linked Insurance Plan in1971.

In this plan a small par of the contribution was utilized forproviding life cover and the balance was invested in units. Wewill learn more about Unit Linked plans in another chapter.

Industrial Assurance Plans

These are designed for workers with low incomes.

The policies are issued with low sum assured and weeklypremiums are payable.

The agents visit the house or place of work of the workers everyweek to collect the premium.

The administrative costs are higher and the remunerationstructure is different because of this reason.

Both mortality and lapsation rates tend to be higher too.

These policies have not become popular in India.

Riders

A rider is a clause or condition that is added on to a basic policyto provide an additional benefit, at the proposers choice.

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For example, a rider can be A provision that in the event ofdeath by accident, the sum assured would be double which canbe added on to a policy under any plan.

Riders can be with regard to additional payments on disability orsickness, or waiver of future premiums, partly or fully, undercertain conditions.

Riders add variety and attractiveness to the policy plan.

Insurers often find it convenient to have a small number of basicplans, with riders being offered as options, so that the prospecthas number of options to choose from.

In fact, 5 basic plans and 7 riders, effectively provide 300 ormore options.

Riders provide the policyholder with options to customize hisplan.

IRDA Regulations on Riders

As per the regulations made by the IRDA in April 2002 andamended in October 2002,

The premium on all the riders relating to health or criticalillnesses, in the case of term or group products shall notexceed more than 100% of the premiums paid on mainpolicy.

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The premium on all the other riders put together shouldnot exceed 30% of the basic premium.

The benefits arising under each of the riders shall notexceed the sum assured under the basic product.

This virtually puts a limit on the number of riders that can beoffered with any policy.

Annuities

Annuities are practically the same as pensions.

Pensions provide regular periodical payments to employees, whohave retired.

They are paid as long as the recipient is alive. Sometimes a pension is also paid to the dependants after the

pensioners death.

Annuities are also periodical payments, not necessarily monthly,and are not related to employment.

Annuities are called the reverse of life insurance.

In Insurance, the insured makes a series of payments to theinsurer in return for a lump sum on his/ her death.In annuities, the insured pays a lump sum amount to theinsurer in return for a series of periodic payments to him/ her

as long as he/ she live. The annuity payments are paid by the insurer in monthly,

quarterly, half-yearly or annual installments, as per thepolicyholders choice.

An annuity can be made payable:

Plans Covering Handicapped people

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Physically handicapped persons can also be insured.

Some extra premium may be charged in some cases like

Loss of both arms

Deaf in both ears

Blind in both eyes etc.

Partially handicapped persons are mostly accepted without anyextra premium, except in case of certain plans.

Group Insurance

Group insurance is a plan of insurance that provides cover to alarge number of individuals under a single policy called theMaster Policy.

The individuals covered under the master policy are not partiesto the contract.

The contract is between the insurer and the body that representsthe group of individuals covered.

The individuals are beneficiaries and play no role in thenegotiation of the contract.

Thus, the policyholder may be the employer, association ofindividuals, trade of professional association, etc.

It can also be a bank or financer who wants to protect hisinterests against defaults occurring because of death of thedebtors.

The policyholder pays the premiums.

He may or may not recover the premium amount from theindividual beneficiaries.

However, if individuals do contribute to the premiums, it isusually deducted from their salaries or loan interests etc.

The ownership of the policy is with the policyholder.

The extent of cover, terms and conditions are determined by thepolicyholder.

Broadly, there are 4 different types of group insuranceschemes:

One year renewable Group Term Insurance Scheme (OYRGTIS)

Group Savings-Linked Insurance Schemes (GSLIS)

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Group Gratuity Schemes Group Superannuation Schemes

OYRGTIS - One Year Renewable Group Term Insurance SchemeGSLIS - Group Savings-Linked Insurance SchemeGroup Gratuity Schemes

Group gratuity schemes are also offered to employees and arerelated to the gratuity of employees.

Gratuity is paid to employees who retire or die after long years ofservice.

Since 1972, payment of gratuity has been made compulsory bythe Payment of Gratuity Act.

The amount of gratuity is linked to the number of years ofservice and the salary drawn during the last few years.

The Scheme provides 2 advantages:

It can guarantee a certain amount of gratuity which wouldbe more than what the rule provides, particularly for thosewho die young and with relatively less services.

It makes it easier to fund the gratuity liability of the

employer.

Group Superannuation Schemes

These Schemes are offered to Employers and are related topayment of pensions to employees as pension as it is fastbecoming a preferred retirement benefit.

Lump sum benefits like provident fund and gratuity may beinadequate to last longer life span.

Group superannuation schemes offered by insurers are intendedto help employers administer the pension funds.

Employers may fix the contribution they would make annually,generally as a percentage of salary.

The benefit available to the employees would be equal to whatthis contribution can buy on the date of his retirement.

Alternatively, the benefit to be given to the employees may befixed and the appropriate contribution made annually by theemployer, all by himself or partly by the employee also.

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Special Schemes

Employee Deposit Linked Insurance (EDLI) scheme is applicableto all organizations contributing Provident Fund underEmployees Provident Fund And Miscellaneous ProvisionsAct,1952

The scheme provides for an insurance cover to a maximum ofRs. 60,000.

The Act empowers the Central provident Fund Commission to

exempt an employer from EDLI, if he opts for group insurancescheme of L.I.C. which is more beneficial for employees.

The cover ranges from Rs. 5,000 to Rs. 20,000, depending onlength of the service and current salary.

The scheme has the advantage of low premium in many casesand the easy settlement of claims, compared to the providentfund.

Underwriting

When the insurer receives a proposal for insurance:

It does not immediately agree to grant the cover. It has to ensure that every new entrant into the pool of

policyholder is subject to similar exposures as the others.

The process of verifying the risk is called Selection orUnderwriting

If the risk is wrongly assessed, the premium charged would beinappropriate.

A lower premium would affect solvency and the additionalrisk would have to be borne by the rest of the members inthe same group.

Therefore, if the insurer feels that there are adverse featuresthat increase the risk, the premium charged would be different.

In some cases, the insurer may decline the cover.

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Financial Underwriting

One of the indicators of moral hazard is the size of the insuranceproposed compared to income.

Financial underwriting is checking the financial situation of theproposer:

The premium for the insurance policy is paid from thecurrent income, so the source of these premiums needs tobe checked.

If someone else is paying the premium, the source of thepremium needs to be checked, as there could be issues ofInsurable Interest.

The underwriter needs to be satisfied that the need forinsurance is related to the current situation and not adesirable situation in the future.

In case of large sum assured the underwriter may:

Ask for additional medical reports

Consult senior officials (for moral hazard) as a matter ofroutine.

Officials are also expected to make enquiries about the proposedinsured, family, occupation/business, income, lifestyles, etc.

Proofs may be sought to substantiate the reports on theseaspects of the proposed Insured.

A report from the insurance agent is a must in all the cases

In some cases, the report of the agent may be sufficient, if theagent is experienced enough.

Assessing the risk

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The underwriter decides on the level of risk in a particular caseafter examination and interpretation of the data available.

For this purpose, the underwriter would avail of the assistance ofdoctors associated with Life Insurance companies and havingspecialized knowledge about the effect of medical conditions onmortality.

These doctors are called medical referees who are on the panelsof insurers.

In case of very high Sum Assured, the insurer may even refer the

case to the specialists in the panel of reinsurers.

Non-Medical Underwriting

Insurers have found that more than 90% proposals are acceptedas O.R. (Ordinary Rate) after medicals.

To overcome the problems associated with medicalexaminations, LIC had been underwriting proposals without anymedical examination, relying entirely on personal statementsand declarations made by the proposer.

Non-medical underwriting is limited to younger ages, less than

45 years old. There are limits on sum assured as well. The limits are higher for

those in employment in reputed organisations, with leaverecords, medical check at entry and so on.

These limits are not sacrosanct. The conditions for non-medicalinsurance are decided by insurers from time to time, dependingon experience.

Underwriting Female Lives

Insurers were cautious when insuring female lives because of:

High pregnancy related deaths, particularly in remoteareas.

History of frauds.

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These practices are have changed over the last 50 years.Working women and men are now treated at par.

Some women who do not have any earned income are alsoconsidered, provided their husbands are adequately insured.

Women in purdah are considered.

These are not rigid rules or principles and every insurer will have theirown experiences and practices. Some insurers allow lower premiumrates for working women.

Role of an Agent underwriter

The agent is the first level underwriter.

He/she has to inform the insurer about the factors that affect therisk of the subject matter of the insurance.

This is done by submitting an unambiguous report and also byensuring that the proposal papers do not conceal anyinformation.

The agents report is an important source of data for theunderwriter in the office.

For the agent, this is an important obligation to the insurer aswell as the insured.

Otherwise, in the event of an early claim, the insurer may allegethat certain important factors were concealed and deny theclaim. The claimant may allege that the fault was that of theagent.

Proposal Form

The proposal form is the basis of the Insurance contract.

Usually a standardized application form is used for all insurancecontracts.

It has to be filled up in own handwriting.

Must be signed in presence of a witness.

The proposal form contains a declaration at the end stating thatall the statements mentioned in the form are true

If any statement is found untrue then the insurer candeclare the contract null and void.

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Declaration

If the proposal form is filled in by another person on his/herbehalf, then the person filling in the form requires to give adeclaration to that effect.

What does proposal Form Contain?

Name and address of proposer

Name of the person to be insured (if different)

Details of the person to be insured like occupation date of birthetc.

Plan, term, Sum Assured

Riders to be added

Details about earlier proposals of insurance

According to the Regulations issued by the IRDA in April 2002, a copyof the proposal is to be given to the policyholder within 30 days ofcompletion of contract.

Personal statement

The personal statement is to be completed along with theproposal.

It includes the following particulars about the insured:

State of health of the person

His family history, his personal habits medicalconsultations

His absence of work due to medical reasons

In case a medical examination is done for underwriting purposes,

the report becomes part of the documentation In case of Female Lives, some additional questions are asked.

The following are the other reports that are consideredconfidential.

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First Premium Receipt

If the underwriter has accepted the risk at OR, the policy can becommenced immediately after the full premium has been paid,after which the FPR will be issued.

If the risk has been accepted at modified terms, the proposer hasto agree to these terms and pay the balance premium if any.After this the FPR will be issued.

The FPR is evidence that the proposal has been accepted andpremium received.

The IRDA Regulations require that the decision on the proposal shouldbe made by the insurer within 15 days

Free Look Period

Free look period is the option given to the Policy owner to withdrawfrom the policy contract within 15 days of the issue of the policy.

In case of withdrawal, the policy owner is refunded the premium paid,less cost of risk for the short period and expenses towards medicalexamination and Stamp Duty.

The Insurer is not legally bound to remind the policyholder aboutpremium due dates.

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Section 14 of IRDA Act, 1999 lays down the duties, powers andfunctions of IRDA..(1) Subject to the provisions of this Act and any other law for thetime being in force, the Authority shall have the duty to regulate,promote and ensure orderly growth of the insurance business and re-insurance business.(2) Without prejudice to the generality of the provisions contained insub-section (1), the powers and functions of the Authority shall include,-

(a) issue to the applicant a certificate of registration, renew, modify,withdraw, suspend or cancel such registration;

(b) protection of the interests of the policy holders in mattersconcerning assigning of policy, nomination by policy holders, insurableinterest, settlement of insurance claim, surrender value of policy andother terms and conditions of contracts of insurance;

(c) specifying requisite qualifications, code of conduct and practicaltraining for intermediary or insurance intermediaries and agents;

(d) specifying the code of conduct for surveyors and loss assessors;(e) promoting efficiency in the conduct of insurance business;(f) promoting and regulating professional organizations connected

with the insurance and re-insurance business;(g) levying fees and other charges for carrying out the purposes of

this Act;(h) calling for information from, undertaking inspection of,

conducting enquiries and investigations including audit of the insurers,intermediaries, insurance intermediaries and other organizationsconnected with the insurance business;

(i) control and regulation of the rates, advantages, terms andconditions that may be offered by insurers in respect of generalinsurance business not so controlled and regulated by the TariffAdvisory Committee under section 64U of the Insurance Act, 1938 (4 of1938);

(j) specifying the form and manner in which books of account shall bemaintained and statement of accounts shall be rendered by insurersand other insurance intermediaries;

(k) regulating investment of funds by insurance companies;(l) regulating maintenance of margin of solvency;(m) adjudication of disputes between insurers and intermediaries or

insurance intermediaries;(n) supervising the functioning of the Tariff Advisory Committee;

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(o) specifying the percentage of premium income of the insurer tofinance schemes for promoting and regulating professionalorganisations referred to in clause (f);

(p) specifying the percentage of life insurance business and generalinsurance business to be undertaken by the insurer in the rural orsocial sector; and

(q) exercising such other powers as may be prescribed

Current Market Scenario

LIC (Life Insurance Corporation of India) still remains the largest life insurance company

accounting for 64% market share. Its share, however, has dropped from 74% a year

before, mainly owing to entry of private players with innovative products and better salesforce.

ICICI Prudential Life Insurance Co Ltd is the biggest private life insurance company inIndia. It experienced growth of 58% in new business premium, accounting for increase in

market share to 8.93% in 2007-08 from 6.97% in 2006-07.

Bajaj Allianz Life Insurance Co Ltd has reported a growth of 52% and its market share

went up to 6.98% in 2007-08 form 5.66% in 2006-07. The company ranked second (afterLIC) in number of policies sold in 2007-08, with total market share of 7.36%.

SBI Life Insurance Co Ltd in terms of new number of policies sold, the company ranked

6th in 2007-08. New premium collection for the company was Rs 4,792.66 crore in 2007-

08, an increase of 87% over last year.

Reliance Life Insurance Co Ltd Total collected was Rs 2,792.76 crore and its market

share went up to 2.96% from 1.23% a year back. It now ranks 5th in new businesspremium and 4th in number of new policies sold in 2007-08.

HDFC Standard Life Insurance Co Ltd with an income of Rs 2,680 crore in FY2007-08,registering a year-on-year growth of 64%. Its market share is 2.88% and it ranks 6 thamong the insurance companies and 5th amongst the private players.

Birla Sun Life Insurance Co Ltd market share of the company increased from 1.22% to2.11% in 2007-08. The company moved to the 7th position in 2007-08 from 8the a year

before, pushing down Max New York Life insurance company.

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Max New York Life Insurance Co Ltd has reported growth of 73% in 2007-08. Total newbusiness generated was Rs 641.83 crores as against Rs 387.51 crores. The company was

pushed down to the 8th position from 7th in 2007-08.

Kotak Mahindra Old Mutual Life Insurance Ltd the fiscal 2007-08, the company reported

growth of 80%, moving from the 11th position to 9th. It captured a market share of1.19% in 2007-08. Last year the company doubled its branch network to 150 from 74.

Aviva Life Insurance Company India Ltd ranking dropped to 10th in 2007-08 from 9thlast year. It has presence in more than 3,000 locations across India via 221 branches and

close to 40 banc assurance partnerships. Aviva Life Insurance plans to increase its capital

base by Rs 344 crores. With the fresh investment, total paid-up capital of the insurerwould go up to Rs 1,348.8 crores.

MARKET SHARE OF INDIAN INSURANCE INDUSTRY


The introduction of private players in the industry has added value to the industry.

The initiatives taken by the private players are very competitive and have given

immense competition to the on time monopoly of the market LIC. Since the advent

of the private players in the market the industry has seen new and innovative steps

taken by the players in this sector. The new players have improved the service

quality of the insurance. As a result LIC down the years have seen the declining

phase in its career. The market share was distributed among the private players.

Though LIC still holds the 75% of the insurance sector but the upcoming natures of

these private players are enough to give more competition to LIC in the near future.

LIC market share has decreased from 95% (2002-03) to 81 %( 2004-05).The

following companies has the rest of the market share of the insurance industry.

Table 3 shows the mane of the player in the market.

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TABLE NO: 3 NAME OF THE INSURANCE COMPANY AND THE SHARE

HOLDING PATTEN

Name of the Insurance Company Shareholding

Agricultural Insurance Co Bank and Public Ins Co

Bajaj Allianz General Insurance Co. Ltd. Privately Held

Cholamandalam MS General Insurance Co. Ltd. Privately Held

Export Credit Guarantee Company Public Sector

HDFC Chubb General Insurance Co. Ltd. Privately Held

ICICI Lombard General Insurance Co. Ltd. Privately Held

IFFCO-Tokio General Insurance Co. Ltd. Privately Held

National Insurance Co. Ltd. Public Sector

New India Assurance Co. Ltd. Public Sector

Oriental Insurance Co. Ltd. Public Sector

Reliance General Insurance Co. Ltd. Privately Held

Royal Sundaram Alliance General Insurance Co.

Ltd.Privately Held

Tata AIG General Insurance Co. Ltd. Privately Held

United India Insurance Co. Ltd. Public Sector

There are a total of 13 life insurance companies operating in India, of which one is a

Public Sector Undertaking and the balance 12 are Private Sector Enterprises.

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List of Companies are indicated below:-

TABLE NO: 4 NAME OF THE LIFE INSURANCE COMPANY AND THE SHARE

HOLDING PATTEN

Name of the company Nature of Holding

Allianz Bajaj Life Insurance Co Private

Aviva Life Insurance Private

Birla Sun Life Insurance Co Private

HDFC Standard Life Insurance Co Private

ICICI Prudential Life Insurance Co Private

ING Vysya Life Insurance Co. Private

Life Insurance Corporation of India Public

Max New York Life Insurance Co. Private

MetLife Insurance Co. Private

Om Kotak Mahindra Life Insurance Private

Reliance insurance Private

SBI Life Insurance Co Private

TATA- AIG Life Insurance Company Private

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TABLE 5. NAME OF THE PLAYER MARKET SHARE (%)

Name of the Player Market share (%)

LIFE INSURANCE CORPORATION OF INDIA 82.3

ICICI PRUDENTIAL 5.63

BIRLA SUN LIFE 2.56

BAJAJ ALLIANZ 2.03

SBI LIFE INSURANCE 1.80

HDFC STANDARD 1.36

TATA AIG 1.29

MAX NEW YARK 0.90

AVIVA 0.79

OM KOTAK MAHINDRA 0.51

ING VYSYA 0.37

MET LIFE 0.21

Global Standards: -

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While the world is eyeing India for growth and expansion, Indian companies are

becoming increasingly world class. Take the case of LIC, which has set its sight on

becoming a major global player following a Rs280-crore investment from the Indian

government. The company now operates in Mauritius, Fiji, the UK, Sri Lanka, Nepal

and will soon start operations in Saudi Arabia. It also plans to venture into the

African and Asia-Pacific regions in 2006.

The year 2005 was a testing phase for the general insurance industry with a series of

catastrophes hitting the Indian sub-continent.

However, with robust reinsurance programmes in place, insurers have successfully

managed to tide over the crisis without any adverse impact on their balance sheets.

With life insurance premiums being just 2.5% of GDP and general insurance

premiums being 0.65% of GDP, the opportunities in the Indian market place is

immense. The next five years will be challenging but those that can build scale and

market share will survive and prosper.

Top Ten Global Insurance Companies by Market Value - 2009

Since the recent financial meltdown which began in September 2008, a reshuffling ofthe market value of the world's largest insurance companies has occured. Below is a

list of the top ten insurance companies:

Rank Company

MarketValue($Billions)

Country

1American IntlGroup

$172.24 United States

2 AXA Group $66.12 France

3AllianzWorldwide

$65.55 Germany

4ManulifeFinancial

$50.52 Japan

5GeneraliGroup

$45.45 Italy

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6PrudentialFinancial

$39.70 United States

7 MetLife $37.94 United States

8 Aviva $33.10UnitedKingdom

9Munich ReGroup

$30.99 Germany

10 Aegon $26.40 Netherlands

(1) Based on an analysis of companies in the Forbes Global 2000.

(2) Based on market value in billions. Rankings based on sales, profits, orassets will be different.

List of insurance companies over the world:

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Company Name Country

21 ST CENTURY INSURANCE USA

ACE Bermuda

Aegon Netherlands

Aflac United States

Aioi Insurance Japan

Allianz Worldwide Germany

Allmerica Financial United States

Allstate United StatesAmbac Financial Group United States

American Finl Group United States

American Intl Group United States

American Natl Ins United States

AmerUs Group United States

AMP Australia

Aon United States

Arch Capital Group Bermuda

Assurant United States

Aviva United Kingdom

AXA Group France

Axis Capital Holdings Bermuda

Bbloise Group Switzerland

Berkshire Hathaway United States

Britannic Group United Kingdom

Cathay Financial Taiwan

Cattolica Assicurazioni Italy

China Life Insurance China

Chubb United States

Cincinnati Financial United States

CNP Assurances France

Conseco United States

Converium Holding Switzerland

Corporation Mapfre Spain

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EXAMPLES-1

In a village, there are 400 houses, each valued at Rs.20,000. Every yr, on the

average. =, 4 houses get burnt, resulting into a total loss of Rs. 80,000. If all the

400 owners come Together and contribute Rs.200 each, the common fund would be

Rs.80,000. This is Enough to pay Rs.20,000 to each of the 4 owners whose houses

got burnt. Thus, the risk Of 4 owners is spread over 400 houses owners of the

village.

EXAMPLE-2

There are 100 person who are all aged 50 and are heakthy. It is expected that of

these,

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10 persons may die during the year. If the economic value of the loss suffered by the

Family of each dyinig persoon is taken to be Rs.20,000 the total loss would work out

to

Rs.2,00,000.If each person in the group contributed Rs.200 a year, the common

fund would be Rs.2,00,000. This would be enough who die. Thus, the risks in the

cash of the Ten persons who die. Thus, the risks in the case of 10 person, are shared

by 1000 persons

APPLICATION OF INFORMATION TECHNOLOGY IN INSURANCE SECTOR

There is a evolutionary change in the technology that has revolutionized the entire

insurance sector. Insurance industry is a data-rich industry, and thus, there is a need

to use the data for trend analysis and personalization.

With increased competition among insurers, service has become a key issue.

Moreover, customers are getting increasingly sophisticated and tech-savvy. People

today dont want to accept the current value propositions, they want personalized

interactions and they look for more and more features and add ones and better

service

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The insurance companies today must meet the need of the hour for more and more

personalized approach for handling the customer. Today managing the customer

intelligently is very critical for the insurer especially in the very competitive

environment. Companies need to apply different set of rules and treatment

strategies to different customer segments. However, to personalize interactions,

insurers are required to capture customer information in an integrated system.

With the explosion of Website and greater access to direct product or policy

information, there is a need to developing better techniques to give customers a

truly personalized experience. Personalization helps organizations to reach their

customers with more impact and to generate new revenue through cross selling and

up selling activities. To ensure that the customers are receiving personalized

information, many organizations are incorporating knowledge database-repositories

of content that typically include a search engine and lets the customers locate the all

document and information related to their queries of request for services. Customers

can hereby use the knowledge database to mange their products or the company

information and invoices, claim records, and histories of the service inquiry. These

products also may be able to learn from the customers previous knowledge

database and to use their information when determining the relevance to the

customers search request.

The Insurance Industry- World

The global insurance industry is one of the largest sectors of finance. It ranges from

consumer to corporate and industrial insurance, and even reinsurance, or insurance

of insurance.

The major insurance markets of the world are obviously the US, Europe, Japan, and

South Korea. Emerging markets are found throughout Asia, specifically in India and

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China, and are also in Latin America.

With the internet and other forms of high-speed communication, companies and

individuals are now able to purchase insurance and related financial products from

almost anywhere in the world. Increasing affluence, especially in developing

countries, and a rising understanding of the need to protect wealth and human

capital has led to significant growth in the insurance industry.

Given the evolving and growing socio-economic conditions worldwide, insurance


companies are increasingly reaching out across borders and are offering more

competitive and customized products than ever before.

Over the past ten years, global insurance premiums have risen by more than 50%,

with annual growth rates ranging between 2 and 10%.In 2004, global insurance

premiums amounted to $3.3 trillion.

The majority of insurance comes from developed nations such as most of Europe, the

US, and Japan. In 2004, premiums in North American amounted to $1,217 billion,

while the European Union generated $1,198 billion, and Japan produced $492 billion.

The UK amounted to $295 billion.

The four biggest generators of insurance premiums comprised almost two-thirds of

premiums for 2004, the US and Japan amount to half, while they only make up 7%

of the worlds population.

In contrast, the emerging markets that make up 85% of the worlds population

produced only 10% of the premiums.

Insurance in the World

Insurance Types Auto Insurance Dental Insurance

Home Insurance

Travel Insurance

Medical Insurance

US State Insurance Alabama Insurance

Arizona Insurance Arkansas Insurance California Insurance Colorado Insurance

Country Insurance

Australia Insurance

Brazil Insurance Canada Insurance China Insurance

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plans/asset classes (diversified equity funds, balanced funds, debt funds) either at anominal or no cost.

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