Life insurance is contract,”wherby the insurer , in consideration of a premium paid by the policy holder , pays the claim to claimant/policy holder as per term of the contract on the event of death or maturity whichever happens ealier.
What is underwriting:
Underwriting is an art/proceed to select and categorize the potential risk in suitable group through submitted proposals.
.basic of underwriting are;
A highly responsible technocrat with a role of a silent custodian of life fund.his freedom to underwriter is paramount therefore ,the under writer will have discretion to decline ,reduce ,modify the proposal or cut out of rider.even if the case appears to acceptable ,if he/she believes that assurance is excessive in relation to the economic status or other wise not bona-fide. Similarly he/she has the discretion to make whatever measure (including asking for further medical/other requirements) he/she deems appropriate on medical occupational or any other ground whatsoever.
Selection is the term used to describe the consideration given to proposal form for insurance to determine whether the life proposal is insurable or not .if insurable , what term are offered? The selection process is necessary under the principle that every assured should contribute his fair share towards risk involved only those lives who are exposed to comparable degree of risk should be placed in the same premium class.
The assumption based on mortality ratio and other factors used in setting the premium rates and the sales objectives of the corporation require that the lives proposed for the insurance be properly screened so that mortality ratio remains within the anticipated limits and at the same times sales objectives are met.
A life normal in all respects having no abnormality in accordance with the SWISS RE medical manual exposed to comparable degree of risk is considered to be standard life.
Those lives having a higher than normal mortality are classified to be sub standard or impaired risk as their chances of surviving form year to year are impaired. Such lives are either accepted only with extra premium or with some restrictions, or postponed or declined as the merit of individual case warrants.
Insurable interest is defined as one”s financial interest in the subject matter of insurance .in life insurance , subject matter of insurance is one “s life .accordingly a creditor has an insurable interest in the debitor”s life to the extent of his debt. A partner has an insurable interest in the life of other partner(S) to the extent of his stake in the business.the proposer in such cases shall be beneficiaries. Unless the beneficiary stands to lose rather then the gain by the death of assured , the insurance contract without adequate insurable interest and insurance without insurable interest is a “mere wager/gamble”prohibited by law.
A person has an unlimited insurable interest in his /her own life but there should be proper relationship between the amount of assurance probable loss and the proposer “s capacity to pay the premiums.
Characteristics of insurability:
1-there should be exist a possibility of financial loss on death or disability of the life proposed .
2-the proposer /life proposed would not like the loss to occur and irrespective of sentiment of good intention bound to do everything possible to avoid and avert the loss.
3-the quantum of loss is measurable and is well excess of the proposed cover.
4-the proposer has the capacity to bear the cost of desired cover easily.
5-there is sufficient number of broadly similar lives, seeking insurance, so as to allow the law of large number tomoperate.
Absence of first to factors signifies moral hazard which is just un-insurable. The third and forth factor depend upon the nature and extent of income and financial status of the life proposed as well as of the proposer . they are meant to ensure that in case of a possible claim. No one benefits beyond the insurance cover which partly compensates/replace the income and /or financial loss.
Reinsurance market insists that financial underwriting is at least as important ,if not more, as the medical underwriting the federal ombudsman (wafaqi mohtasib)has also taken very serious view of some lapses on this account and on number of occasions, has directed greater scrutiny and checking of the financial status, which should commensurate with the desire insurance.
Hence , while handing proposal with extra ordinary feature and/or higher sums at risk, reliable information and evidence be sought to establish income and financial status ,justify the desired cover the report submitted by the field personnel must also be first hand reports and not be in retrospect.
The fifth factor refer to limitation within which an insurer has to operate there may exist some risk and genuine needs, which may not be insurable just because insurer doses not have sufficiently large portfolio of similar risks, insuring one or two uncommon risks in isolation is more akin to gambling rather then assurance.
Factors influenceing insurability:
Occupation-accident &health hazard associated with the poor environment, which is usally dependent on occupation.
Plan of insurance
Amount of insurance
Place of residence
2-medical examination and declaration:
identification of the person to be examined.
Height , built,weight and its distribution
Family history —the influence of inherited characteristics and environmental factors.
Physical condition or characteristics such as pulse rate heart sound blood pressure , condition of lungs and other organ .
Personal history of illness ,ailments/surgeries, accident and resultants.
Report of marketing executives:
Including confidential reports of SM/AM to SH& ZH
Verification of financial worth to prevent speculation.
Evidence of insurability /medical aspects
Moral hazard and anti-selection.
The underwriter must evaluate the proposal form medical examination/declaration and agents report to determine the PURPOSE of the insurance and asses the amount of insurance including that already in-force or applied for.
Since the proposal form together with proposal statement of health , forms the basis of contract between the proposer and the corporation wherein case of any incorrect or misleading answers. No claim would be payable if the policy was issued on the basis of untrue statements.
duty of marketing personnel:
marketing personnel are bound to place business with complete disclosure of facts i.e medical & financial aspects. Any proved falsification , misstatement , concealment in procuring and reporting the business by them will result in strict action that may include their termination /demotion or forteiture of benefits.
Under the provisions of section 72 of insurance ordinance 2000, the policy holder can nominee person whom he/she desires the benefits under his/her policy be paid in case of a claim by his/her death. similarly the policy holder has got the right to change or cancel the previous nomination or substitute by a fresh one, naming person on revised basis according to his/her requirements. The right can be exercised by the policy holder at any time and for as many time and for as many times as he/she desires provided the policy in in-force but there must exist a definite relationship between assured and the nominee the CNIC number of the nominee must be incorporated at proposal stage.
policies affected for the benefit of minor children without appointment of guardian, result into difficulties by the claimant in obtaining guardianship certificate form competent courts. In order to safeguard against such a situation, the appointment of a guardian shall be lawful in the light of section 72of life insurance ordinance 2000 and must be insisted at the time of proposal CNIC number and consent(signature)of guardian in writing required.
Assignment conventionally are two types absolute and collateral.to protect the assignee fully, written notice must be given to the corporation .assignment of a policy whether with or without consideration ,may be mad only by endorsement upon the policy itself or by a separate instrument ,signed in either case , by the assignor and dully attested(means attested in the manner required for financial future obligation by article 17 of the qanoon-e-shahadat order,1984) specifically setting forth the fact of assignment.
On reassignment it is incumbent on the policy holder to re designate the nominee in the absence of which death proceed become payable only to the E”state” of the assured.
COMPLETION OF PROPOSAL FORM:
1-proposal form should be filled and signed clearly with one ink and the same pen and in one hand writing preferably in block letters. Proposal forms filled in and signed with different ink & pen should be intertained.
2-answer to question should be simple , clear and free form ambiguities. Answer tend to create confusion should be avoided. For example against the column relating to occupation ,word like business service should be avoided. Full description of work /duties should be given. Like wise the answer shoulf be given in YES or NO(dash nil n/a are not accepted).
3-every proposal form must accompany an attested and self attested Photostat copy of CNIC as proof of age .no policy shall be issued without age admission. A rubber stamp reading “ONLY FOR LIFE INSURANCE” be affixed on the copy CNIC.
Complete names and code of the field channels should be written on proposal forms agency channel should be verified by the agency department, in no case subsequent change(S) be allowed unless it is proved documentarily that it happened by mistake.
4-A non medical proposal form must be used where the proposer qualifies for non- medical scheme and likewise a medical proposal form for a case falling under medical scheme.
5-all Photostat copies of CNIC and documents submitted by the applicant must bear his/her signature also ;apart form attestation by authorized SM/AM.
6-Copies of document ,signature and thumb impressions should be attested/verified by the Area-manger or eligible sales manger. Such a attestation will be assumed to have been made after the attesting officer has seen the genuine .orignal document and signature or thumb impressions affixed before him.any excuse in good faith is not acceptable.
7-where the nominee is a minor a guardian should be name with his/her CNIC number in the proposal form who must also affix his/her signature /thumb impression in the relevant space .thumb impression must be verified by SM/AM.
8- thumb impression should be clear , neat and affixed with the help of a stamp pad . in exceptional circumstance , where stamp pad is not available ,any other ink may be used in a manner so that grooves of thumb are clearly seen in the impression.
9-No alteration , cutting easer etc.or used of white fluid in the answer is acceptable however correction after clear cutting at the original writings may be accepted ,if verified by the proposer under his /her signature.
10-in case ,signature of the proposer on proposal form, CNIC and other document differ the concerned area manger/ sector head should be certify those under his/her signature and official stamp with following wording;
I identifyMr————as proposer under proposal no———/holder of policy no———-and certify that he/she has signed the proposal form —-personal statement —– declaration of good health before me . preferably the pre-printed proforma (NB-58)for the purpose be used.
11-proposals of life assurance form retired defense personnel, should always preferably carry a self attested.
12-Copy of discharge certificate of service book in which medical category of life proposed assured is clearly mentioned.
13-If answer relating to supplementary contracts at the proposal form, is first ticked and then crossed out or deleted, a confirmation in waiting from the proposer would be sought preferably on amendment form . alteration of any kind must be avoided . a straight line should cross out the question other then those ticked
14-if the propser signs the paper in urdu or affixes his/her thumb impressions the vernacular declaration must also be signed by the same person who is witnessing the proposal.
15-if a non-medical proposal is procured form out side of Pakistan it shall either witnessed by the respective consulate office of Pakistan /kafeel/HR department of the employer (in case of well established firm )by authorized no tary public office or by an agent/employer of agent of state life accompanied by a copy of passport of showing his/her presence in business procuring country.
Treatment regarding expired CNIC:
UNDERWRITING INSTRUSTIONS regarding CNICs(reference cir/po/14/2012)dated 27/12/2012
The proposer should be accompanied with the token/receipt issued by NADRA for renewal. the expired CNIC and token of NADRA must be self-attested and dully verified by concerned AM/SH.
An undertaking be submitted by concerned Area manger that a self attested and duly verified copy of renewed CNIC will submitted within 03 month of policy issuance date as per format.
For a minor lives , their registration number with NADRA along with birth certificate ,school certificate, etc,may be considered as age proof .
Document in evidence of age should normally be submitted in original. These will be returned after scrutiny.if however a Photostat or true copy is submitted, it must bear signature /thumb print of the proponent and attested by a gazetted officer or an authorized officer of state life.
Any such a document as domicile certificate ,passport, identity card, etc issued within one year before date of proposal or subsequent to that date, requires extra card and caution but may be accepted at the discretion of the underwriter , if age is verified by the sector head.
If a document bears the year of birth without the date and month 1st January of that year will be assumed as the date of birth.
Treatment regarding recently issued CNIC
With the inception of NADRA and introduction of CNIC s strict verification processes ensure the authenticity of an individual .the document itself is verifiable at any point and through NADRA . keeping in view it has been decided to withdraw the requirement of FMR on proposal submitted with CNIC s issued with in 13 month with immediate effect this will only be applicable on proposal where the family number is mentioned on CNIC.
The underwriter however may exercise his /her discretion power to call FMR on any casewhere he/she feel that further clarification /scrutiny is required.
Full detail of previous policies /proposal must be given in reply to the question asked inn proposal form.
If more than one proposal forms are submitted on one s life necessary to give cross reference of all proposal also a part form all the due requirements a separate personal statement dully completed (in original)must be submitted ,for each submitted proposal photostat copies are not acceptable .
A proposal under GPFor salary saving scheme must accompany a Photostat copy of CNIC dully attested by an authorized officer of the proposer s organization also, detailed statement of accounts on the latter head of that organization dully signed by its authorized officer should accompany the cheque. The chque amount shal not be accepted without such a list on simple paper shall not be accepted.
Where medical /clinical report have been called for at proposer own cost the proposer should be asked to attach with the proposal form relevant receipt s obtained from doctor/laboratory as a proof of payment made .
An additional medical requirement call for by under writer (other than the due requirements) shallbe done at the proponent s own cost .
RECONSIDERATION OF DEFERRED OR DECLINED CASES:
No fresh medical /clinical test should be arranged in deferred /decline cases unless permission form the same has been obtained form functional head of new business department similarly medical examination /clinical test should not be arranged on the lives falling in non medical scheme unless specifically asked in written by the underwriter otherwise , the cost in all such a case shallbe debited to the concerned field channel . reasons for such uncalled for examined will be called by the under writer.
No proposal form amendment form personal statement DGH or any other form shall be accepted unless the signature /thumb impression by the proposer or attested officer bear the date under his/her signature or in the columns provided for.
While completing agents /field officer confidential report at the end of the proposal form or a separate confidential report by those higher ups in the channel . utmost care must be exercised to extract and report true state of affairsin response to each question after make necessary inquiries /investigation . while undertaking the risk under writer assumes that the reporting official has given the report after make a such inquiry.
Instead of usual procedure of calling random medical reports in non-medical scheme below menitioned additional would also be required
The field worker know the proponent for less than 6 months than invariably cal lfor FMR(reference CIR/PHS/PO28/08/1989)
Proposer s signature on documents submitted with the proposal:
All documents in support of financial status , Photocopies of age proof and identification , medical reports etc . must bear the proposer s signature and submitted dully attested by the authorized sales mangers and above. The under writer has the discretion to call for the original to compare them with copies submitted .
Over writing and blank column(S) in proposal form:
To help in underwriting (for fair assessment of the risk) each and every question in proposal form must be clearly answered column(s) left blank or marked with dash over writing erasing or use of white fluid in any column of the proposal form are not acceptable these will entail fresh requirements there by delaying the process of the proposal and causing inconvenience to the office ,field personnel and proposer.however, any correction made in any column of the proposal form after cutting the original writing under full signature of the proposer shall be acceptable.
Amendment to proposal form:
Whenever any changes is desired before issuance of a policy , an amendment form (ANNEXURE A). stating the full particular of the change duly signed by the life proposed and the proposer in the same form and style as on the original proposal be obtained the amendment may be allowed if it is in conformity with the underwriting rule .
If a proposal has not been result into policy for any reason within 6(SIX) months of the date of receipt(in any underwriting department)of the proposal and fresh proposal is/are received on the same life under agencies other than those in which proposal was received, it /these will dealt with as under :
1-the sum-assured and F.Y.P given in subsequent proposal(s)is equal to less than those given in the 1st proposal when submitted then full credit on completion there fore will be given to the sales represntative who secured the first proposal.
2-if the sum assured and F.Y.P given in subsequent proposal is more than that given in the first proposal , the credit on completion will be given to the sales representative whose first proposal received for the balance , if any, credit will be given the sales representative who submitted subsequent proposal(s).
3-it may be clarified that any amendment (s)received one the first proposal with the regard to sum assured or F.Y.P before the receipt of 2nd or subsequent proposals will not be taken into consideration while the credit and sum assured and the F.Y.P shown in the first proposal when received in the underwriting department as described hereafter.
the priority of submission of proposal under non-medical scheme shall be determine on the which the proposal form and personnel statement completed in all respect along with the payment of the first premium in full .was received by the underwriting department however, in case the policy is to be financed out of G.P FUND(where it is not necessary that the full first premium be deposited with proposal) the right for credit of the first securing agent shall stand till the validity of letter of acceptance.
The priority of submission of proposal shall be determine on the basis of date on which the proposal form completed in all respects with the medical reports and other routine medical requirement as per underwriting rules, is received in the respective underwriting department .
Incomplete or cancelled proposal:
If a proposal is not finalized into policy within six 6 months of its proposal date , it may be filled as a”not taken up case” not taken up fee equal to full medical expense or Rs500/whichever is higher , will be realize form the deposit , it will be debited to and recoverable form the account of concerned sales representative .
Not taken up fee will not be charged where:
Some additional medical requirements such as x-rays ECG etc where called at the proposers own cost:
The case has been counter offered with the extra premium. Or lien
The proposal is post pond or declined however, if there was history of previous declinature or postponement and the fresh medical was arranged without prior permission of the under writer the concession will not apply;
Under non-medical proposal , if the sales representative could not collect full premium, acceptance latter may be issue at his/her request on written undertaking that not taken up fee of RS500/- it may be charged if the case may remain incomplete after thee months.
Previous declined or postponed cases:
If the life proposed has ever been declined or refused insurance permanently or temporarily , the sales representative while soliciting his fresh proposal should be;
Ensure that a period of at least one year has elapsed since the declinature and the specified period of postponement has been completed .
Get only proposal and personel statement completed.
Obtained full detailed of all previous proposals/policies if necessary , a separate not may be obtained form the life proposed ,
Submit the proposal and personal statement along with the complete details of all previous proposal /policies to underwriting department:
Not arrange any medical examination without the advice of the under writer.
The medical and other requirements will be quoted by the underwriting department after assessment of the facts given in the proposal and the personal statement,
Minimum age is at entry is 18 years
Lives between the age of exact 18 years and nearest birthday 19 years may be entertained at the rate of premium charged for age 20 years.
Maximum age at entry (exact age)
|Standard lives||Normal condition Special condition||60 years 65 years|
|Sub standard lives||Normal condition Special condition||55 years 60 years|
Special condition mean:
1-Where all examination and test have been conducted by the most reliable examiner , laboratories etc. of the area named by the underwriter and under supervision of senior field personnel with the minimum routine requirements of FMR, PUR , ECG, and BS, including SGPT.
2-Definite and authentic age proof is provided other than CNIC.
3-the under writer may call for any additional requirement deemed necessary for the assessment of the risk.
4- the cost of FMR and PUR will be borne by state life .the cost of chest X-rays ECG, BS and other medical requirement shall be borne by the proposer which will be reimbursed only if proposal is compeleted for a sum-assured RS,250,000/-
5-TIR may be allowed up to entry age 60 and FIB/AIB/ADB up to age 55.
a person below the age of 18 years i. e before reaching their 18th birth day come under the category of minor lives may be entertained within the following rules;
available tables and age limitations.
|TABLE||AGE NEAREST BIRTHDAY AT ENTRY|
|01||01 YEARS||BELOW 18 YEARS|
|03||01 YEARS||BELOW 18 YEARS|
|07||01 YEARS||15 YEARS|
Only first class standard lives be entertained no sub standard life be permitted.
Preferably real father or mother should be propose for assurance of children.
The proposer under table 01/03 should have existing assurance on his/her own life for double the sum proposed on minor life unless he/she is proved uninsurable .
There should be a balanced assurance program for the family e. g all insurable brother/sisters are insured for an equal amount instead of singling out of any one child unless there are legitimate reasons for such a preference , and the underwriter have had an opportunity , to satisfy him / her –self through necessary investigations.
Maximum sum assured available to minor life below 10 years is 1.0 million and below the 18 years is RS2.0million , may be considered by fulfilling all due requirements. For other consideration regarding enhancement of sum assured cases may be referred to PHS PO after compliance of all due requirements (refer circular #PHS/PO/CIR23/2010 dated 15.12.2010)
Finance status of the proposer shall have to be established.
Non-medical scheme is not available for juveniles applying for a separate insurance policy .for children aged 10 years (nearest birthday )and above minimum requirement will be full medical report by an authorized medical examiner.
For children aged below 10 years ( nearest birthday) proposed under child protection policy (07) or endowment policy (03)and three payment plan(05) non – medical scheme is available up to sum-assured of RS300,00/- on completion of prescribed non- medical juvenile proposal form.
Definite and authentic age proof of the minor life must be furnished with the proposal.
ADB supplementary contract can be allowed if desired at the age of five years or more to the child.
GI rider can be issued if desired on minor lives who have crossed their 10th birthday.
Underwriter shall satisfy him/herself about the existence of the source of income to continue payment of premium in the absence of payer .
Working minor are not entertained .
An additional supplementary proposal in plan 01 and 03 as the case may be required (form003 from propser)
1-Non- medical scheme applies to all lives proposed except where otherwise provided in minor lives and female lives rules.
2-as a part of routine study the underwriter should have a random medical check of approximately one-tenth of non-medical cases and arrange physical investigation of medical cases of at least 3%of cases of each area and the finding be report to concerned zonal head and regional in-charge –PHS under intimation to Division head (PHS), Principal office, on monthly basis.
3-besides calling for medical report as a random check, the under writer may call for medical examination under supervision in cases of doubt nature or where unfavorable feature are involved.
4-lives aged below 18 years(except table 07 where non- medical limit is RS 1,50,000/-TSAR) & fifty- five (55) will always be medical examined .
5-flight crew would mean only pilots , co-pilots, flight engineer, navigators etc but not air hostesses stewards pursers etc.
6-attested copy of CNIC for identification purpose must accompany the proposal.
7- a non-medical proposal will be processed only if accompanied with the premium. This condition will not apply if the policy is to be financed through provident fund but NTU fee of RS500/ will be charged if such proposal remain incomplete after 3 months if a proposal is submitted without full premium deposit the same may be processed at the request and on written undertaking by the sales representative that not taken up fee of RS 500/-may be charged to his account if the case remain incomplete after 3 months a part form all medical expense incurred on proposal if it could not be recovered from the sales Representative then it to be recovered from sales officer and/or sales manger.
8-AIB,ADB,WP,TIR,RPR,&GI may be attached according to nature of plan.sum assured under TIR,RPR,& GI will be counted in calculation of the total sum at risk.
9-FIB may be allowed up to 50% of the sum assured of basic policy subject maximum of 60% of steady yearly earned income if FIB exceed 25%, the commuted value of whole of FIB will be accounted for in calculation of total sum at risk.
10-SWP may be allowed up to half of the relevant non-medical limits.
11-the additional requirement for substandard lives will be determined on case to case basis by the underwriter.
For lives below the age 18 years reference by made to minor lives insurance guidelines.
The limits indicate will embrace all in-force policies proposed within last three years.
Determination of routine underwriting requirements
Routine underwriting requirements shall be determined on the basis of SAR (sum at risk) , which includes:
Sum-assured desired under the basic policy.
Commuted value or entire FIB ,if proposed in excess of 25% of basic sum- assured . corresponding concession shall be available to child protection and child education & marriage plan , which have an in built10% and 24% FIB respectively .total FIB on life should not exceed 60 % of approximate steady annual income .
For example under 20 years endowment for 300,000/- with AIB and FIB of RS 30,000/-per annum (10%) the TSAR for underwriting requirements purpose will be RS-300,000/- how ever if the amount of FIB is increased to RS-90,000/-per annum 30%. TSAR for under writing purpose under this policy will be as below:
|COMMUTED VALUE UNDER FIB 90,000 X 11.78||RS.1,060,200/-|
|TSAR FOR UNDER WRITING REQUIREMENT PURPOSE||RS.1,360,200/-|
Sum-assured under term insurance rider and GI rider if desired 50% of sum assured if RPR is desired. Total sum at risk under all existing policy/ies with the corporation (including FIB and TIR etc if attached ) for determination the medical requirements, the total sum at risk all such policies on the same life , which were issued three or within at risk under all such policies on the same life ,which were issued three or more years before the date of new proposal will not be taken into consideration .
For instance, for a policy applied for January 1,2015 policies issued before January 1, 2012 will not be taken into account for determination the total sum at risk.
One and half times of sum- assured will be taken at sum at risk for underwriting purpose , under MUHFIZ PLUS plan (table 78)and case of refund of premium supplementary contract similarly under SHADABAD PLAN (table 36)double of the sum –assured shall be taken into account.
Substandard cases the additional medical requirements will be determined by the under writer om individual merits.
ADB , AIB , WP supplementary contract will not be taken into account for this purpose
Sum at risk for reinsurance purposes:
Sum at risk for reinsurance purpose includes:
1-basic sum assured
3-FIB (including in-built and supplementary contract) please note that whole amount of FIB is ceded to the reinsure
4-in-built fixed period income in MUHAFIZ PLUS plan .
5 – sum at risk of all previous in-force policies irrespective of period.
If sum at risk on the basis of above calculation exceed the retention limit of RS5,000,00/-then the excess amount will be ceded and all underwriting requirement will based on the total sum at risk example of sum at risk for reinsurance purpose is given below:
|Supplementary contract||AIB,FIB15% FOR 20 YEARS TIR ONE TIME|
|Previous policies||RS-800,000( issued in 2010N without rider ) RS-600,000(issued in2011 with AIB)|
Basic sum assured +TIR(one time)+commuted value of FIB=1,000,000+1,000,000+1,767,000/=3,767,000
Previous policies =800,000+600,000= 1,400,000
Sum at risk for reinsurance 3,767,000+1,400,000=5,167,000/-
Underwriting requirement shall be based on RS 5,167,000/-
|TERM OF FIB||FACTOR||TERM OF FIB||FACTOR||TERM OF FIB||FACTOR|
This chart is exclusively for determine the SAR for medical and reinsurance purposes.
Guidelines regarding medical examination:
1-services of only authorized medical examiners and clinics should be availed for the purpose of medical examination /reports and in no case , unauthorized doctor /clinics be approached for the purpose .also remember that no female doctor is allowed to examine males lives proposed.
2-no reimbursement be made for utilizing the doctor /clinics not on our panel.
3-a proposer should be taken for a medical examination only to authorized examiner in the proposer own locality unless necessitated and explained otherwise .
4- medical examination should be carried out only at the doctor ‘s clinic
5-medical examination of the proposer at his residence , office ,at any place other than the consulting room or dispensary of the medical examiner would not be permitted . a lady doctor should not be asked under any circumstance to be examine a male life . such a report will not be accepted no fee will be paid thereon.
6-in case of medical examination on the field personnel’s own life the underwriter shall decided by which examiner he is to be examined .
7-medical reports from a medical examiner shall not be accepted in case , where:
A-he is related to any member of field channel.
B-he has financial interest in the case beyond his medical fees.
C-the proposer or agent is his employer. Employee or immediate colleague in the service.
8- the medical examiner should be instructed to forwards the report when completed ,direct to the concerned underwriting department of the corporation under sealed envelope.
9-the abbreviations used for a medical /clinical examination in this underwriting guideline stand for the following;
FMR—— full medical report by an authorized examiner appropriate
PUR—-pathological urinalysis report
ECG—-electro cardiogram at rest (12 leads)
EX-ECG——-electro cardiogram after exercise with double master ‘s exercise test on Swiss Re pattern.
BS—–blood studies (ESR,CBC,FBS,HB) cholesterol blood urea
HIV—-human immune deficiency virus antibody test
LFT—-liver function test, billirubin (total direct indirect Gamma GT ALT AST ALIKINE PHOSPHATES
Medical examination of subsequent proposals:
A standard full medical report and PUR remain in-force for six month and all other test remain in-force for one year .further proposal within the medical examiner ‘s limit can be entertained during that periods for standard lives. Other medical test remain valid for one year if standard in nature.
Guideline regarding special medical examination:
in case of certain proposal, depending upon the age ,sum assured and adverse feature in the family history or medical reports, special medical reports may be necessary in addition to the usual routine medical reports.
It should be noted that the under writer has discretion to call for such or other additional special medical report if the special circumstance of any particular case warrants the need of such reports.
A policy may be back dated for a period not exceeding six months provided;
1-proposer send a separately signed request specifying the desired date of the commencement.
2-full late fee is paid at the current rate if the back dating period stretched back beyond 15 days however,no late fee will be charged for 3 months of the backdating on case issued in june and December .
Separate receipt for late fee may be issue if required.
In order to remove any possible doubt it is clarified that through as a matter of practice , the date of issue of a latter of acceptance or the date of receipt of full premium is taken as the date of commencement , yet for the purpose of backdating request to commence the policy form a date prior to the date of proposal will be considered as backdate and the period of backdating will be equal to the difference between the date of receipt of proposal (new business) and date of commencement ,if ealier.
In the event of backdating , the medical requirement shall be based on actual age entertained on the date of receipt of proposal ,as well as M/extra shall be charged at entertained age . Backdate is not allowed even for a day in ND scheme except during December closing .where instruction contained in CIRCULAR#PHS/PO/24/2014 BE followed.
In view of the cost involved in the issuance of receipt and maintenance of account and realizing the fact that policies with greater frequency and lesser amount of premium are more prone to lapse , the minimum acceptable installment of premium with yearly mode of payment is RS9,000/-while other than yearly mode is RS7500/-=w.e.f 1st jully 2016.
This rustication shall not apply to policies to be issued under mortgage protection plan (table 22&23) nighban plan ,salary saving plan (table 24&25) include state life ‘s staff rebate policies.
Insurance of female lives :
Insurance will be available to females as per following categorization.
Those with independent and self-earned income from employment in government department , reputable school , collages, universities , multinational companies ,banks well established private firms or by practicing as a qualified lawyer ,qualifier medical practitioner qualified accountant or owner of business (if actively managed by her)should be treated at par with males .qualification must normally be substantiated with the proof of vocation.
Those with independent earned income from business as sleeping partner (or not actively engaged ) form land ,investment ,share ,or service in private un-regulated ,non recognized small organization .
No restriction to plan insurance supplementary contract and sum assured would apply however, qualifications must be normally be substantiated with proof of source of income ,health requirements to be treated at par with males up to 05 lac full medical report /other test shall apply beyond (05) lac sum at risk.
House and other with no independent earned income having unsteady source of income from vocation like tailoring ,handicraft, milk selling ,animals &birds breeding tutoring working in unregulated madrass ‘s small low lines school /institutions etc. fall under this category ,full medical report /other test sales mangers/area mangers report shall be required and the sum at risk will be rusticated to (01)millon without any rider .
In case of house wives in table 19 following provision shall be apply:
House wives at least matric.
Treat, at par with males without any rider , full medical report by lady doctor and other test etc. applicable and proof of education is required .
Under matric (including illiterate ) house wives.
Polices without any rider on females lives up to 1 million sum assured may be entertained provided medical on female life is conducted by the lady doctor and sales manger ‘s satisfactory report is submitted . in case of illiterate proponent , sector head ‘s separate satisfactory moral hazard exclusion report will be required however, the underwriter should be more vigilant while underwriting such a cases.
EQUIVALENT INSURANCE ;
Insurance equal to the insurance of husband be given to married ladies which fall under the category “C “( inclusive literate and illiterate )as per other conditions illustrated at category “C”
House wives or females lives having steady income should be considered in the light of laid down female rules . however , annual premium of house wife should not exceed 8% of her husband income .
1-the standard females lives proposals will be accepted at the lower premium rate applicable to their ages reduced by 2 years for basic plan of insurance and riders.
2-If lady proposed is pregnant , exclusion clause for one year will be applied form the date of issue consent of the proposer should be obtained in writing .
3- in jeevansathi policies , if female life is pregnant but otherwise insurable a joint life policy deferred until three months , after child birth . in the meantime a single life policy may be issued on males life .the single life olicy may be converted to joint life policy, such as table 19, three months after childbirth after completing medical requirements.
4-where medical examination is necessary to females A&B category on the same term as for males ,where , the SWP is desired , the premium will be charged at double rate of males .
5-sub-standard lives will be acceptable subject to appropriate rating . conession of 2 year in age will not be allowed to substandard lives and for H&S rider .
6- other term and condition will be the same as for males lives.
Medical examination of females lives;
Females life should be examined only by appointed lady doctor or male gynecologist authorized to examine ladies however, males medical examiner may examine the female lives with the sum assured upt o 500,000/-provided the female life has no objection to the effect the NOC shall be in writing and attached with the proposal ,
N.D policies to female lives:
ND policies to female lives under the category A,B &C’ are available ;
Discount in age;
(2) year discount in age is permissible to adult standard life females only.
For the purposes of premium calculation, following point will apply;
1-actual age will be shown in proposal form and policy schedule .two year age discount (rate down) will be given for premium calculation only .
2-two year age discount (rate down) will not apply for H&S and SWP rider and SWP premium rate will be charged at double the males rate.
3-where, tabular rate is minimum 20 years the minimum rate will apply even if a female is 21 years or less.
4-under child protection plan, two years age discount (rate down) will apply females payer only and not to female child.
5-under the table 17,age discount (rate down)will be apply both to determine term of insurance and rated down age for premium rate , please see the following illustration.
|Actual age &term applied for||Rated down age &term of insurance applicable||premium|
|30 years/40 years||28 years / 40 years||Rs. 26.40|
|35 years /35 years||33 years /37 years||RS 29.28|
Under jeevan sathi and joint life policies female ‘s age will be reduced by two years (if standard )before applying the uniform seniority table .please see the following illustration:
|Male life||Female life||difference in age||Deduct from the age of older life|
|Actual age||Reduced age|
|40 years||35years||33years||7 years||3 years|
|35 years||32years||30 years||5 years||2 years|
If initial age of a female is higher than the maximum permitted under the table ,she can’t get the benefit of two years age discount (rate down) merely to get benefit of the table.
Moral hazard and other related risk loom large in case of illiterate lives .this entail a greater responsibility on the agent ,as he/she must exercise great care in selecting illiterate lives (rerf;DHS/PO/CIR/023/2011 dated 16/06/2011)
All information on proposal from should be truly mentioned in regard to medical and financial aspect.
Thumb impression of the life proposed on the proposal from should be attested be the sales manger .thumb impression where required should carefully be a fixed with the help of stamp pad , so as to ensure that thumb grooves are seen distinctly and tally with those on the NIC.
Each policy issued by state life carries stipulation that no benefits will be payable unless the age of the assured is admitted .hence,the age proof should be obtained with the proposal and no policy should be issued unless satisfactory age proof is made available .
a-for standard adult lives below 60 years and substandard lives below 55 years of the age ,following document listed in order of preference may be entertained as age proof.
- Computerized national identity card issued by Pakistan government of Pakistan is invariable required with every proposal for identification purpose and it should as such as also attested /and verified by the field personnel.
- Certificate of qualification or a certified extract form the record of any board of secondary & higher education / universities ,if the date of birth is stated therein.
- Certified extract form the government records such as service book civil list, etc or form the service record of autonomous bodies ,local bodies ,semi-government institutions etc
- Domicile and PRC or nationality certificate ,if it bear the date of birth ,issued by the competent government authority /ies
- Passport issued at least a year ago.
- Any other document like driving license ,government permit or license bearing age or date of birth ,which was issued at least 2 years or more years before the date of proposal.
- For minor lives their registration number with the NADRA along with certificate ,school certificate etc. may be considered as age proof.
- For standard lives of 60 years or over and substandard lives of 55 years or over ,documents listed at 2 and 3 would be acceptable.
- Document in evidence of age should normally be submitted in original these will be return after scrutiny,if however a Photostat of true copy is submitted it must bear signature /thumb print of the proponent and attested by gazzetted officer or authorized officer of state life .
- Any such document as domicile certificate, passport, identity card etc. issued within one year before the date of proposal or sub sequent to that day, require extra care and caution but may accepted at the discretion of the under writer ,if age is verified by sector head.
- If a document bear the year of birth of birth without the date and month ,1st January of that year will be assumed as the date of birth .
While underwriting a proposal underwriter has to take into consideration the amount of insurance payable on death of the assured in comparison with possible loss of income which would otherwise be suffered by the legal heirs on death of the life assured.
1-financial worth of a proposer should commensurate with TSAR which includes sum assured +FIB+TIR+SWP+RPR and TSAR reserved on previous policies .
2-annual premium of present proposal and previous should not preferably be more than 20% of proponent ‘s income ,otherwise check the possibility of moral hazard and over insurance .such a case should be referred to zonal underwriting committee to eliminate the above aspect. However ,possibility of understanding the income should kept in mind while underwriting such a case .
3-AIB cover (on proponent’s life) should not be more than three time of the proponent annual income and be according to the sum assured maximum accident cover available under ADB/AIB is rupees 10 million.
4- case up to five (5) lacs TSAR may be accepted on the sales officer report and witness . case up to ten (10) lacs TSAR may be accepted on sales officer’s report dully witnessed by the sales manger .
5-it is preferred to have documentary evidence of the financial worth in all exceeding RS 10 lacs (total sum at risk) including sum assured +FIB(above 25%)+TIR+TSAR of previous policies .
6-the TSAR is up to RS 25 lacs and the sales manger ‘s confidential report on prescribed performa dully verified by the area manger is submitted .
7-where, the TSAR exceed RS 25 lacs but is below RS 50 lacs the area manger should give a separate confidential report on prescribed proforma dully verified by the sector head.
8-where ,TSAR is between RS 50 lacs to RS 75 lacs , the sector head should give confidential report on prescribed porforma , however ,the case of TSAR over RS.75lac up to RS 1 crore may be accepted on sector head report dully verified by the zonal head .
9- where, TSAR is over RS 1 crore all the due requirements including following are to furnished ;
A-independent confidential report by the zonal head on the format (reports based on telephonic discussion and reference will not be entertained )
B-Swiss-Re financial questionnaire form.
C-direct evidence of income OR financial worth justifying the cover applied for.
In order to keep a check /control the legitimacy of confidential report submitted by the procedure up to sector head ,10%of the submitted report must be counter checked /confirmed by the zonal head .a comprehensive report regarding authenticity of these reports should be submitted to divisional head (marketing) and divisional head (phs)on monthly basis by the zonal head . this activity by made MIS by new business department.
- Non-medical case where the field officer ‘s report has been completed by newly promoted S.O need to be underwritten cautionusly.
- A random check through enquiry by the underwriter may be made to verify the authenticity of the financial worth as reported in the confidential reports ,either before or after issuance of the policy and any material variation should be reported to Zonal head for necessary action.
Specimen of formats of confidential report referred above are annexure .
Payments of outstanding premiums:
New proposal is submitted and premium of previous policy (ies) are due the case may be entertained subject to payment of out- standing premiums under the previous policy (ies).
Change of agency in postponed cases:
In a post pond case ,if the requirements are not furnished within two months of the expiry of postponed period fresh proposal in different agency may be entertained .
Cost of all medical examination /test arranged without prior permission will be realized from the deposit if any,or recovered form the sales Representative ‘s account unless the proposal result in a policy justifying all such requirements.
Acceptance with extra:
When it is necessary to levy extra premium or lien of standardized physical extra ,following requirements be call for;
1-an acceptance letter (two copies)be issued by new business department .consent of the proposer on the prescribed format signed by the proposer in the same form and style as on the original proposal from.
2-decleration of good health signed by the proposer in the same form and style as on the original proposal form from after 31 days of last decleration.
Unless these requirements are submitted and satisfactory ,the policy will not be issued even if the balance of premium received.
Short premium debit to SR:
Short premium shall be allowed to the extent of RS1,000/-(Rupees one thousand only )under the policies having annual premium up to 20,000/-in just case where the premium is more than RS20,000/-5% of the premium subject ,to maximum of RS 25,000/=(Rupees twenty five thousand only)will be debited to the commission after obtaining the written request of the sales Representative duly verified by the concerned Area mangers or Sector head while allowing the debit for short premium ,margin for deduction of tax at source should be kept in view to avoid any debit balance in commission record .for further guideline ,please refer circular no DH/PHS/PO/CIR10/20/2010 dated 11/05/2010.
Surrender /paid up /forfeiture/lapsed of old policies:
If a previous policy/policies on the same life has/ have been converted into paid up ,surrendered , lapsed or forfeit under the non-forfeiture prevision of the policy /policies within a periods of 12 months before and after the selling of new policy no commission and over -riding commission etc will be payable to any field worker to the extent of the premium applicable to the lapsed /surrendered/auto-paid up/auto surrendered sum assured of previous policy(ies) where the commission has been paid on such policy ,it will be recovered from the field worker concerned in lump sum as soon as irregularity is detected.
The commission and over –riding commission etc on the new policy will not be payable , in case it is financed by surrendering a paid up policy even if it was converted paid up insurance more than 12 months ago.
Previous lapsed /auto paid and auto surrendered policies:
If previous policies are lapsed ,auto paid up or auto surrendered condition for less than five years , than the proposer should be insisted to upon to revive /reinstate his previous policy/ ies , before issuance of the new policy.
Issuance of the new policy may be considered after reinstatement /revival of paid up , auto-surrendered and lapsed policy (ies)
Policies under the peovision of the married women’s property act 1874:
Policies under section 6 of the MWP act 1874 can be issued to the males male lives only for the absolute benefit of their wives or children.
A MWP declaration should be submitted along with the proposal form . in column meant for nomination on the proposal ,instead of writing the name of nominee(s) under section 72 of insurance 2000, the words under married women property act 1874 should be written
A female can effect a policy under section 5 of the MWP act on her life or on the life of her husband for her own benefits in the ordinary manner.
Revival /re-instatement of policies :
A policy may be revived or reinstated within five years of laps ,auto surrender or auto paid up date .in special cases where policy remain auto surrendered or paid up for more than five years consideration for revival /reinstatement may be given subject to the condition that remaining term to maturity will not be less than 10 years.
Important points for revival/re-instatement;
1-all underwriting requirement while considering revival or reinstatement should be based on attained age and remaining term.
2-if a policy is rated up at the time of revival then extra mortality shall also be calculated on current age .extra premium will be charged from the current due premium and not arrears of premiums.
3-Fuctional head in PHS deptt. can approved DGH/non-medical application for revival reinstatement to conserve the business .all case involving medical consideration invariably be referred to CMA before forwarding it to functional head (PHS) for further process.
4-requirement under paid up policy should be based on the difference between the total sum at risk and the paid up value before reinstatement of original sum assured and benefits .
5-if a female is pregnant at the time of revival /reinstatement of the policy than it may be revived /reinstated subject to pregnancy exclusion clause under table 03& 05where as cases under table 19be deferred .
6-all case of higher ages and more than RS1,0millon sum assured referred to new business department.
7-premium of ADB/AIB/TIR for the period under which policy remained lapsed or auto surrendered or auto paid up should not be charged as arrears
8-Decision of the underwriter will be final and he/she may call for any requirements as deemed fit.
9-A lapsed or paid up policy (issued under regular scheme) may be revived /reinstated under ND scheme.
A brief summary of the usual underwriter requirements is given here under;
|S#||Period of lapsed /auto-surrender /paid -up||Underwriting requirements|
|01||Premium being paid after grace period but with in 3months||declaration of good health||declaration of good health sub-standard life|
|02||Premium being paid after 3month but with in 6 months of laps,auto-surrender ,auto paid up||1-latefee 2-decelaratrion of good health||1-late fee 2-declaration of good health in standard class Sub-standard life 1-late fee 2-medical revival application (FMR)|
|03||Premium being paid after 6 months but with in 9 months of lapse ,auto-surrender ,Auto paid up date.||1-late fee 2-non-medical Revival application||Standard life Same as non-medical requirements Sub-standard life 1-late fee 2-application of medical revival 3-all medical reports According to current age or as prescribed by the underwriter|
|04||Premium being paid after 9 months but with in 12 months of lapse auto-surrender ,auto- paid up||1-late fee 2-non-medical revival application||Standard life 1-late fee 2-application for revival Substandard life 1-late fee 2-application for medical revival 3-all medical reports According to current age as prescribed by underwriter|
|05||Premium being paid after 12 months of laps,auto-surrender auto –paid up update||1-late fee 2-non-medical Revival application||Standard & substandard life 1-late fee 2-application for medical revival 3-all medical reports According to current age or as prescribed by the under writer|