SYLLABUS

IC38 WEB AGGREGATOR

(LIFE, HEALTH AND GENERAL)

SECTION I COMMON SECTION

CHAPTER 1: INTRODUCTION TO INSURANCE: Life insurance – History and

evolution - History of insurance - Insurance through the ages - Modern concepts of
insurance - History of insurance in India - Life insurance industry - How
insurance works - Risk management techniques - Risk avoidance - Risk retention -
Risk reduction and control - Risk financing - Insurance vs Assurance - Insurance
as a tool for managing risk - Considerations before opting for Insurance - Role of
insurance in society - Insurance and Social Security.

CHAPTER 2: CUSTOMER SERVICE: General concepts - Why Customer Service -

Quality of service - Customer service and insurance - Insurance agent’s role in
providing great customer service - The Point of Sale - Best advice - The proposal
stage - Acceptance stage - The claim stage - Grievance redressal - Integrated
Grievance Management System (IGMS) - The Consumer Protection Act, 1986 - The
Insurance Ombudsman - Communication process - Non-verbal communication -
Ethical behavior.

CHAPTER 3: GRIEVANCE REDRESSAL MECHANISM: Consumer courts,

Ombudsman - Integrated Grievance Management System (IGMS) - The Consumer
Protection Act, 1986 - The Insurance Ombudsman.

CHAPTER 4: REGULATORY ASPECTS OF WEB AGGREGATOR: Definitions-

Eligibility criteria for License of the Web Aggregator- Application seeking Grant of
License- Application seeking Renewal of License- Employees of the Web
Aggregator- Annual Fees- Capital requirements - Professional indemnity
insurance- Duties and Functions of web Aggregators- Nomenclature of Web
Aggregators - Agreement of Insurer with a Web Aggregator- Display of product
comparisons on the web site- Remuneration- Cancellation or suspension of license
with notice- Maintenance of books of account, records, etc- Action against a
person acting as a Web Aggregator without a valid license- Certification of
Compliance-

CHAPTER 5: LEGAL PRINCIPLES OF AN INSURANCE CONTRACT: Insurance

contracts – Legal aspects and special features - Legal aspects of an insurance
contract - Elements of a valid contract - Insurance contracts – Special features -
Uberrima Fides or Utmost Good Faith - Measures implemented to reduce the risk -
Breach of Utmost Good Faith - Insurable interest - Gambling and insurance -
Proximate Cause - Contract of Adhesion – Indemnity – Subrogation.
SECTION 2 LIFE SECTION
CHAPTER 6: WHAT LIFE INSURANCE INVOLVES: Life insurance business –
Components, human life value, mutuality - The Asset – Human Life Value(HLV) -
The Risk - Level premiums - The Principle of Risk Pooling – Mutuality - The Life
Insurance Contract.

CHAPTER 7: FINANCIAL PLANNING: Financial planning and the individual life

cycle – Definition - Types of Goals - Individual’s life cycle - Individual needs -
Financial products - Risk profile and investments - Role of financial planning -
Financial planning - When is the right time to start financial planning - Financial
planning – Types - Cash planning - Insurance planning - Investment planning -
Investment parameters - Retirement planning.

CHAPTER 8: LIFE INSURANCE PRODUCT I: Overview of life insurance products

- What is a product - Purpose of life insurance products and needs covered -
Riders in Life Insurance Products - Traditional life insurance products - Term
insurance plans - Variants of Term Assurance - Whole life insurance - Endowment
assurance - Dividend method of profit participation.

CHAPTER 9: LIFE INSURANCE PRODUCT II: Overview of non-traditional life

insurance products - Limitations of traditional products - The shifts - The appeal –
Needs met - Non-traditional life insurance products – Types.

CHAPTER 10: APPLICATION OF LIFE INSURANCE: Married Women’s Property

Act - Beneficiaries under MWP Act & its features - Key man Insurance – Insurable
Losses - Mortgage Redemption Insurance (MRI).

CHAPTER 11: PRICING AND VALUATION OF LIFE INSURANCE: Insurance

pricing – Basic elements – Premium – Rebates - Determining the premium -
Components of Premium - Mortality and Interest - Guiding Principles for
determining Amount of Loading - Expenses and reserves - Determination of
Surplus and bonus - Ways of Valuing Assets - Allocating the surplus - Bonus -
Types of reversionary bonuses.

CHAPTER 12: DOCUMENTATION – PROPOSAL STAGE: Life insurance –

Proposal stage documentation – Prospectus - Proposal form – Different Reports -
Anti-Money Laundering (AML) - Know Your Customer (KYC) - Free-look period.

CHAPTER 13: DOCUMENTATION – POLICY CONDITION - I: Policy stage

documentation - First Premium Receipt - Policy Document - Policy Document -
Standard Provisions - Specific Policy Provisions.

CHAPTER 14: DOCUMENTATION – POLICY CONDITION – II: Policy conditions

and privileges - Grace period - Policy revival measures - Non-forfeiture provisions -
Special policy provisions and endorsements - Provisions related to nomination –
Assignment - Types of Assignment - Conditions for valid assignment - Nomination
Vs. Assignment - Duplicate Policy – Alteration.

CHAPTER 15: UNDERWRITING: Underwriting purpose - Equity among risks -

Risk classification - Selection process - Fraud monitoring and role of agent as
primary underwriter - Methods of underwriting - Non-medical underwriting -
Conditions for non-medical underwriting - Rating factors in underwriting - Sources
of Occupational Hazards - Medical underwriting - Medical Factors that influence
an Underwriter’s Decision.

CHAPTER 16: PAYMENTS UNDER A LIFE INSURANCE POLICY: Types of claims

and claims procedure - Concept of claims - Risk event and claim - Ascertaining
whether a claim event has occurred - Survival Benefit Payments - Surrender of
Policy - Rider Benefit - Death Claim - Forms to be submitted for Death Claim -
Claim Procedure for Life Insurance Policy - Role of an agent
SECTION 3 HEALTH INSURANCE
CHAPTER 17: INTRODUCTION TO HEALTH INSURANCE: What is health care –
Definition of Health Determinants of Health – Levels of Healthcare – Levels of
health care – Types of health care – Factors affecting the health systems in India –
Evaluation of health insurance in India – Employees State Insurance Scheme -
Central Government health scheme – Commercial health insurance - Health
Insurance Market – Infrastructure Public health sector - Private sector providers –
Pharmaceutical industry – Insurance Providers – Intermediaries – Insurance
selling activities – Insurance Servicing activities – financial product distribution –
Other important organizations which form part of the health insurance market.

CHAPTER 18: INSURANCE DOCUMENTATION: Proposal forms – Standard form

of Declaration – Nature of questions in a proposal form - Elements of Proposal –
Medical Questionnaire – Role of intermediary - Duty of an intermediary towards
prospect (client) – Acceptance of the Proposal –(Underwriting) – Note on
underwriting and processing of proposals – Premium receipts – Definition –
Payment of premium in advance - Method of payment of premium – Policy
Document - Conditions and warranties – Endorsements - Specimen Endorsements
– Interpretation of policies – Renewal Notice – Anti –Money laundering and know
your customer guidelines.

CHAPTER 19: HEALTH INSURANCE PRODUCTS: Classification of health

insurance product – Introduction – Definition – Features of health policies – Broad
classification of health insurance products – IRDA guidelines on standardization in
health insurance – Hospitalization indemnity product – Top up covers or high
deductible insurance plans – Senior citizen policy – fixed benefit covers – hospital
cash – critical illness – hospital daily cash policy – critical illness policy – long term
care insurance – combi-products – Package policies – Micro insurance and health
insurance for poor sections – Rashtriya Swasthya Bima Yojana - Pradhan Mantri
Suraksha Bima Yojana - Pradhan Mantri Jan-Dhan Yojana – Personal accident
and disability cover- overseas travel insurance – Group health cover – Special
products – Key terns in health policies.

CHAPTER 20: HEALTH INSURANCE UNDERWRITING: What is Underwriting –

Definition –need - Underwriting basic concepts – File and use guidelines – Other
health insurance regulations of IRDAI – Basic Principles of Insurance and tools for
underwriting -Underwriting process – Group health insurance – Underwriting of
overseas travel insurance - Underwriting of personal accident insurance.

CHAPTER 21: HEALTH INSURANCE CLAIMS: Claims management in insurance

– stakeholders in claim process – Role of claims management in insurance
company - Management of health insurance claims – Challenges in health
insurance – claims process in health insurance - Documentation of health
insurance claims – Claims reserving – Role of third party administrators – Claims
management –personal accident – overseas travel insurance
SECTION 4 GENERAL SECTIONS

CHAPTER 22: PRINCIPLES OF INSURANCE: Elements of Insurance: –

Definition – Exposure to risk - Degree of risk exposure - Basis of risk
classification- Hazard - Types of hazards – Mathematical principle of insurance
(Risk pooling) - Conditions for insuring a risk – The Insurance Contract –
Insurance Contract legal aspects – Special Features –Indemnity – Uberrima Fides
or Utmost Good Faith – Insurable interest – Proximate cause

CHAPTER 23: DOCUMENTATION: Proposal forms – Roe of Role of intermediary -

Duty of an intermediary towards prospect – Acceptance of the proposal – Premium
receipt – Cover notes-Certificate of Insurance – Policy Document – Warranties –
Endorsements – Interpretation of policies – Renewal notice

CHAPTER 24: THEORY AND PRACTICE OF PREMIUM RATING: – Underwriting

basics – Definition – Rate making basics – Rating factors – Hazard – Moral Hazard
– Physical hazard – Addressing physical hazards - Short Period scales – Minimum
Premium - Sum Insured – Deciding the sum insured

CHAPTER 25: PERSONAL AND RETAIL INSURANCE: HOUSEHOLDER’S

INSURANCE: - Retail Insurance Products - Sum Insured and Premium -
Shopkeeper’s Insurance - Sum Insured and Premium - Motor Insurance – Its
coverages - ‘Third-Party Insurance’ - Exclusions - Sum Insured and Premium.

CHAPTER 26: COMMERCIAL INSURANCE: PROPERTY / FIRE INSURANCE: -

Variants of fire policy - Market Value or Reinstatement Value Policies - Declaration
Policy - Floater Policies - Business Interruption Insurance – Coverages - Burglary
Insurance - Risks covered under burglary insurance - Cash cover - Money
Insurance - Coverage of Money Insurance - Important exclusions - Fidelity
Guarantee Insurance - Bankers Indemnity Insurance - Jewelers’ Block Policy -
Engineering Insurance - Types of engineering insurance policies - Marine
Insurance - Marine Cargo Insurance - Different types of marine policies - Liability
Policies - Statutory liability – Types of Liability Policies.

CHAPTER 27: CLAIMS PROCEDURE: Claims Settlement process – Importance of

settling claims - -limitations or notice of loss – Investigation and assessment –
Surveyors and loss assessors – Claim forms – Loss assessment and claim
settlement - Important Aspects in an insurance claims – categories of claim –
Discharge vouchers – Post settlement action – Selvage – Recoveries – Disputes
related to claims – Other disputes resolution mechanisms