INSURANCE ON FEMALE LIVES

Transcription

1 INSURANCE ON FEMALE LIVES (Cir: NB&R/161 dated 03/03/2017, NB&R/184 dated 11/05/2018) Female applicants present some distinct problems for Insurance, like: 1. Female lives are prone to hazards related to child birth, particularly in our country where proper medical facilities are not uniformly available and even where ever available are not availed of. 2. The problem of weak insurable interest as most of the female lives to be insured do not have earned income or do not have a family depending on them for support. 3. The element of moral hazard also assumes greater significance. Wherever there is no need for Insurance protection, or insurance sought appears to be speculative, such risks are not entertained. In the matter of risk appraisal of female lives particular attention is paid to: a) Socio-economic status of the applicant. b) Need for Insurance. c) Physical hazards peculiar to females. d) Moral hazard involved. The underwriter must be satisfied that the female life concerned would take care of her health and would use modern medical facilities available, she has a genuine need for insurance and has capacity to pay the premiums regularly. 4. Now that many women are gainfully employed, they require insurance protection in their own right. Also women in possession of wealth are in need to make provision of payment of taxes, requires the facilities of insurance protection. 5. Keeping in view the above changes, LIC of India offers insurance cover to female lives by categorising them as under: Prerana - Underwriting Rules Simplified / 53

2 A. Females with own Income: 1. Eligible Under NMS or Filing ITRs: Employed/ Self Employed/ having income through Investment and/or Property) All Plans, All Riders & E-Term are allowed. Financial Underwriting will be as applicable to adult male lives. Income Proof: For Employed Females ITRs/Form 16 for 3 years OR 3 Months Salary slips with Appointment letter and Corresponding Credit in Bank Account is required. For Investment/Rental Income Supporting evidence such as latest rental agreement/ bank statement/ proof of investment etc is required along with ITRs. If supporting evidences are not available, maximum TRSA should be restricted to 200 lakhs on the basis of average income shown in the ITRs. In such cases family should be insurance minded. Other Conditions: Age Proofs: Standard Only. For Self Employed/ Income through Investment or Property: a) For TRSA upto 200 Lakhs: Special MHR by Competent Authority is required clearly indicating Source of income and social status of proposer b) For TRSA above 200 Lakhs: In addition to (a) above, detailed MHR in the letter format by BM(I/C) regarding social and economic status and exact source of income is required. 54 / Prerana - Underwriting Rules Simplified

3 If funding from husband s income is proposed for more than 50 lakhs, cases should be decided by ZUS/CUS as per FPSO limit and will be decided on the merits of the case considering income sufficiency and need for insurance. 2. Having own income that can be ascertained: All Plans & All Riders are allowed. E-Term not allowed. Max TRSA: 50 Lakhs Incl. Term Plan. Max SA under Term Plan: 25 Lakhs. Max TRSA for Lump Sum received through Death Claim/Compensation etc: 100 Lakhs under Single Premium Plans & No Limit on Immediate/ Deferred Annuity Plans under Single Premium. Income Proof: PFQ/ CA certificate/ salary sheet/ rental agreement/ investment income proof/ pension papers/ proof of lump sum income etc and copy of bank passbook (showing regular similar credit at least for 3 months). Special MHR (as per female lives Annexure-I) by DM Club Agent or above/clia/do/abm(s)/bm(i/c) is required. Other Conditions: i. Only Standard Age proof is acceptable. ii. For TRSA of 50 lakhs and Term Insurance Plan: minimum education qualification should be SSC or equivalent. iii. All proposals under Term Plan (any SA) and if TRSA is above 25 lakhs(including Term Plans) irrespective of the plan proposed should be referred to higher offices as per FPSO. iv. If funding from husband s income is proposed for more than 50 lakhs, cases should be decided by ZUS/CUS as per FPSO limit and will be decided on the merits of the case considering income sufficiency and need for insurance. Prerana - Underwriting Rules Simplified / 55

4 3. Having own income that cannot be ascertained: Only Savings Plans Allowed. Term Plan/ Term rider/ PWB not allowed. Max. TRSA: 15 Lakhs for Education Qualification HSC & above. 10 Lakhs for Education Qualification below HSC. Income Proof: Special MHR (as per female lives Annexure-I) by DM Club agent or above/clia/do/abm(s)/bm(i/c) is required clearly stating source of income, type of occupation, family particulars, need of insurance etc. is required. Other Conditions: i. All age proofs allowed. In case of NSAP restrictions of NSAP will apply. ii. Maximum age at entry: 60 years for regular premium. For Single Premium: Maximum age at entry as per Plan. iii. Proof of education qualification is must for HSC and above. B. Housewives without own income: 1. Graduates and Above: All Plans Allowed including Term rider. CIR, PWB and E-Term are not allowed. Max TRSA: 100 Lakhs Including Term Plan, subject to equivalent husband s insurance. Max SA under Term Plan: 50 Lakhs or 50% of Husband s term insurance whichever is less. 56 / Prerana - Underwriting Rules Simplified

5 Other Conditions: i. Only Standard Age proof will be accepted. ii. Proof of Education Qualification is must. iii. Must possess Passport/ Credit Card/ Driving License/ Mediclaim Policy/ Aadhar card/ Pan Card. iv. In case Husband is uninsurable due to medical reasons, maximum allowable TRSA is Rs.50 lakhs under savings plan only. Such cases are to be referred to ZUS. 2. Below Graduation: Term Plan, All Riders & E-term not allowed. Max TRSA: 60 lakhs subject to equivalent husband s insurance. Other Conditions: i. All age proofs allowed. In case of NSAP restrictions of NSAP will apply. ii. In case Husband is uninsurable due to medical reasons, maximum allowable TRSA is Rs.50 lakhs under savings plan only. Such cases are to be referred to ZUS. Other Conditions for Housewives: i. Insurance ( TRSA) taken from LIC as well as Private insurers can be considered as matching insurance on the life of husband. ii. Income of husband can support the total insurance on his own life as well as on the lives of spouse and dependent children. iii. MHR at least by DM Club Member & above/ CLIA/ Development officer/abm(s)/ BM is to be insisted upon for Sum Assured above Rs.5 lakhs. iv. In case husband is uninsurable, documentary proof of the same along with detailed Special MHR in form 3251 (revised) by BM ( In-charge) is Prerana - Underwriting Rules Simplified / 57

6 to be insisted upon strictly irrespective of sum proposed. Underwriters at their own discretion may call for Special MHR by MM/CM irrespective of sum proposed. v. If husband is uninsurable, cases for sum proposed above Rs.50 lakhs may be referred to NB&R Department, Central Office. Proposals more than TRSA allowed under all Categories of Female Lives can be considered at DO/ZO/CO using discretionary powers within their limits. Insurance to Married Females Category III beyond age 60: (Cir: U&R/61 dated 28/03/2011,) Only ULIP plans under single premium are allowed, provided applicable minimum sum assured is opted for age group 60 & above The maximum single premium must be Rs-2.50 lacs i.e. Sum assured of Rs-2.75 lacs and sum at risk Rs-25,000/- Standard age proof is must. She must be literate i.e. she must be able to read and write. MHR by DO is must mentioning the source of funds. FMR and special reports are required as per rules. All the family members are insured and there is no intentional adverse selection. Females with History of caesarean operation: Period Since Caesarean operation: At Branch office at standard rates, can be considered without FMR. Females with History of Family Planning operation (Tubectomy): Period Since operation: 3 to 6 months: At Branch office with FMR at standard rate. More than 6 months: Can be accepted without FMR at Branch office. Females with History of Abortion: Period since Abortion: More than 6 months At Branch office with FMR at standard rates. 58 / Prerana - Underwriting Rules Simplified

7 Insurance to females will not be entertained in following cases: a) Proposal received within 3 month from the date of last delivery. b) Women who has had many miscarriages. c) A married woman who, though not divorced, is living separately from her husband (The proposal may be considered after ascertaining the reasons). Proposals on the lives of pregnant Ladies: (Cir: Actl/2088/4 dt. 30/10/2006) Proposals on the lives of ladies who are pregnant at the time of proposal will be entertained subject to the following conditions: i) Proposals are submitted within the first twenty four (24) weeks of pregnancy. ii) Proposals will not be entertained under the non-medical scheme. iii) Full medical report (FMR) from our authorized medical examiner / DMR / TPA should be obtained as per existing rules. iv) All other special reports as per the special report chart except Chest X- Ray and CTMT are to be called for. v) Report from the attending gynaecologist in Form No 3341 (Revised) certifying that the lady is under his / her care will be required. vi) Last checkup report from the attending obstetrician / gynaecologist will be required. vii) Reports of any medical tests done during pregnancy will be required to be submitted. viii) Additional report like Sonography to be called for if opined by DMR/ZMR after reviewing the attending gynaecologist s report and other medical tests submitted. ix) The pregnant women should be falling under Female Category A(1) only. x) Maximum cover during the period of pregnancy will be restricted to Rs one crore. The insurance cover granted should be reasonable in relation to the proposer s income. Prerana - Underwriting Rules Simplified / 59

8 xi) Proposals for cover in excess of Rs. one crore during the period of pregnancy could be considered only after referring to the reinsurer. xii) Pure Term Insurance plans and plans having higher term insurance element will not be entertained. xiii) Special Moral Hazard Report by the competent authority in Form No 3251 should be obtained in all cases irrespective of the sum proposed or SUC. In no case the proposal is to be entertained on the basis of the ACR. xiv) Proposals from pregnant ladies who had a normal full time confinement and normal delivery and without any past history of abnormal delivery or abortion (miscarriage) due to septic will be accepted on the same terms as for a woman not pregnant. xv) Proposals from pregnant ladies with past history of complications or caesarian section to be accepted with a single extra of Rs. 2 per thousand (instead of lien of Rs. 500, i.e., imposing of Clause 4A- Form No 3124A) 60 / Prerana - Underwriting Rules Simplified