• "General Insurance" also known as non-life insurance, offers a gamut of insurance covers against eventualities such as illness, property damage, motor accidents, etc. Assets have a value of their own and are susceptible to damages. The specific General Insurance cover can protect the economic value of the asset and prevent huge financial loses.
• For example, a home insurance policy can protect your home and the valuables inside from calamities and theft. That means, if something goes wrong, you're much less likely to have to spend your savings or your investments, borrow money, ask family or friends for financial help, or sell your assets to pay for repairs, treatment or outstanding loans. Suitable General Insurance covers are necessary for every family. It is important to protect one's property, which one might have acquired from one's hard earned income. A loss or damage to one's property can leave one shattered. Losses created by catastrophes such as the tsunami, earthquakes, cyclones, etc. have left many homeless and penniless. Such losses can be devastating but insurance could help mitigate them. A Health Insurance policy can provide financial relief to a person undergoing medical treatment whether due to a disease or an injury.
• Most General Insurance covers are annual contracts. However, there are few products that are long-term.

Types of general insurance products

• Motor Insurance
• Health Insurance
• Personal Accident Insurance
• Home Insurance
• Travel Insurance
• Crop Insurance
• Property Insurance
• Fire Insurance
• Burglary Insurance
• Marine Insurance

Motor Insurance

Travelling by vehicle is inevitable and a routine for most of us now. While they are essential for commuting, they also expose us to multiple risks - bodily as well as financial. Hence, security becomes a necessity in case of vehicle damage, loss of vehicle, third-party liability, etc. A Motor Insurance safeguards your finances and gives you the desired coverage in the event of such incidents

In extreme situations, vehicle owners may find themselves saddled with high financial liability if proper care is not taken. What is the way out for vehicle owners against such potential risks related to vehicles? Motor Insurance deals with the insurance covers for the loss or damage caused to the vehicle or its parts due to natural and man-made calamities. It provides accident cover for individual owners of the vehicles while driving and also for passengers and third-party legal liability.

Driving a motor vehicle without insurance in a public place is a punishable offence in terms of the Motor Vehicles Act, 1988.

It is better to be safe, than sorry. Accidents happen unexpectedly, and it can heavily weigh on your finances. To attain peace of mind when it comes to getting the right coverage, take a Third Party or Comprehensive insurance that meets your requirements.

Motor Insurance protects you financially from:

• Damage to your own car
• Damage to someone else's car or property
• Injuries/ Death of Insured resulting from an accident
• Injury or Death of Third Party (Pedestrians/ Cyclists etc.)

Risks associated with Motor Vehicle & the relevance to Insurance

• Motor Insurance has evolved due to the necessity of meeting the liabilities towards pedestrians or formally speaking third parties, arising out of an accident, enforceable by law or statute
• The vehicle which causes or meets with an accident, also suffers damage besides injury to the driver or other occupants. There is a necessity to take care of these contingencies as well
• Two distinct types of policies have emerged or got developed to take care of contingencies/ risks described above
• Liability only Policy: This is also known as Act only policy & only covers third party liabilities. This is a statutory obligation of the owner of the vehicle. This is subject to the limit as specified & includes claimants cost & expenses
• Package Policy: It is a comprehensive policy that takes care of the damage to the vehicle also known as own damage besides other extensions along with personal accident cover, third party or statutory liability
• Long term policy: Generally motor insurance is an annual policy with yearly renewal, however there is now a new product available for two wheelers with a tenure of 2 or 3 years. Insured can buy a policy for longer tenure and be worry-free from remembering annual renewal date customer also enjoys benefit of additional discount and protection from yearly increment of premium. Option of long term standalone third party or package policy cover has also been made available

Let's examine these both with some more details

• Liability only policy covers
  • Death or bodily injury to person of any third party which would be constrained by liability as incurred
  • Damage to property other than belonging to the Insured with a cap of Rs 1 lakh for two wheelers & Rs 7.5 lakhs for all other vehicles
  • All legal costs & expenses
  • Passengers in a passenger carrying vehicle
  • Personal Accident cover to owner/ driver to all individually owned vehicles. The coverage would include death, loss of two limbs/ sight of two eyes/ one limb & one eye and permanent total disability. The total compensation would not exceed Rs 1,00,000 in case of two wheeler & Rs 2,00,000 in case of all other vehicles. This is subject to:
    • The owner driver being registered owner & holding a valid license at the material point of time
    • The owner driver is the named insured in the policy
    • Any other person driving must have consent of the Insured

Every insurer who has the license to write motor business in India is obligated by IRDAI to write specific amount of motor liability premium. The premium is derived basis previous year industry’s total motor liability premium and market share which is average of previous year motor share & its overall business share. The obligation is set by IRDAI to increase motor liability premium of the industry and to compel insurers to penetrate more in motor liability business.

• Package Policy: It is a comprehensive cover applicable to all categories in almost same structure.
• Own Damage: The Insurer would pay or in technical terms, indemnify Insured against damage/s to the Insured Motor car and/ or its accessories, during the policy period due to the following perils or contingencies or events:

• Fire, explosion, self ignition, or lightning
• Burglary, housebreaking, theft
• Riot & strike
• Earthquake, fire & shock
• Flood, typhoon, hurricane, storm, tempest, inundation, cyclone, hailstorm, frost
• Accidental external means
• Terrorist activity
• Landslide & rockslide
• In transit by road, rail, inland waterway, lift, elevator or air
• The principle that is followed in payment, in case of any of the above contingencies operating, is derived from the principle of Indemnity. The Insured would be placed in the same position as he was before the peril happening or accident taking place
• In case of damage to a part when a new part is replaced, applicable depreciation as per age of the vehicle/ part is put to arrive at the actual amount payable

The % of depreciation is defined with respect to each category:

• All rubber/ nylon/ plastic parts, tyres & tubes, batteries: 50%,
• All fibre glass component: 30%
• All glass items: Nil
• All other parts including wooden parts:

Age	Rate of depreciation
6 m - 1 yr	5%
1 yr to 2 yrs	10%
2 to 3 yrs	15%
3 to 4yr	25%
4 to 5 yrs	35%
5 to 10 yrs	40%
beyond 10 yrs	50%

• Paint material: 12.5%
• Losses or damages to accessories are covered only if they are provided by the manufacturer as a standard feature or fitted separately & cover under elec./ non elec. accessories
• Damage to tyres is not allowed unless the motor car is damaged at the same time & this is subject to the limit of 50%
• Exclusions which means that the Insurer would not be liable for any payment in respect of
• Consequential loss: Indirect loss which is in addition to the incurred loss like alternative transport expenses
• Depreciation: loss of value of vehicle or part/s due to age
• Wear & tear: This is a natural wearing off due to age
• Mechanical & electrical breakdown: Operational failure of mechanical or electric parts due to metal fatigue
• Mechanical & electrical breakdown: Operational failure of mechanical or electric parts due to metal fatigue
• Failure & breakage: Damage to internal parts for example may be due to failure of the oil pump or breakdown of a propeller shaft
• Known or deliberate accidents like arson or fire to an old car to defraud Insurer
• Intoxicated driver who is under influence of liquor/ drugs/ medicines
• Loss when vehicle is driven by a person without valid license: It is illegal to drive a vehicle without a valid license and any loss suffered while driving without valid license shall not be covered
• Loss when vehicle is being used beyond the permitted usage as per registration: Each vehicle is registered under separate categories and can be used as per the permitted usage. E.g.: if a vehicle is registered as a private car then it cannot be used to as a taxi. If any such violation is done then any loss or damage suffered shall not be covered
• Compulsory excess: Each motor policy has a compulsory excess. This means any loss or damage up to the amount of compulsory excess shall not be covered under the policy. If loss amount is higher than compulsory excess then the loss shall be paid by insurer after deducting compulsory excess. This provision is to ensure that insured takes reasonable care of the vehicle and also do not claims for minor damages
• Any accident outside the geographical area specified. As per standard policy the specified geographical area is India. Any accident happening if the vehicle is outside India is not covered
• Some of these exclusions may be covered by purchasing add-on covers. Add-on covers allows zero depreciation against payment of additional premium
• Insurer will bear all reasonable cost as protection & removal expenses to take the damaged car to repair workshop. Limited to Rs 1500 for private cars, Rs 2500 for commercial vehicle, Rs 300 for two wheelers
• Every time insured claims, a small fixed amount gets deducted from his claim paid amount, this fixed amount is called as compulsory deductible. The amount is deducted to avoid cost of attending to very low value claims

General Exceptions:

• Any accident, loss or damage sustained or incurred outside the geographical area as described in the policy is not payable
• Any claim out of any contractual liability is beyond the scope of the policy
• Any claim arising out use beyond limitations as specified or being driven by an unauthorized person
• Nuclear risks
• War risks

The company would not be responsible for any excess or deductible as mentioned. However there are some exclusions can be covered at an additional cost known as add on covers. Let us look at some of them:

• Depreciation reimbursements: It covers the depreciation amount on parts and paint as described above by payment of additional premium
• Return to invoice: In the event of the insured vehicle being a Total Loss/ Constructive Total Loss, the Insurer will pay the difference between the claim admissible & the sale invoice price or new replacement value of same make. First registration fee & road tax would also be paid subject to limitation of the age of the vehicle up to 3 years
• No claims bonus protection: No claim bonus would be allowed to be retained by the insured in case where it is proved by the insured of not having any fault in the accident resulting in damages or loss to insured vehicle with contingencies as specified in wording
• Loss of use and down time protection: If the insured is not able to use his vehicle in case the damage to his insured vehicle then a fixed value (as per the cover selected) will be paid to him as a daily compensation (5 days in case of repair and 15 days in case of Total Loss/ Constructive Total Loss maximum)
• Engine and gearbox protection: Consequential damage due to water entering into engine or leakage of lubricating oil due to damage to engine/ gearbox due to accidental means
• Cost of Consumables Item: Some of the parts like nut bolt screw washer clips, coolant are not age in any accident but while the vehicle parts are removed/ refitted in the workshop these are required to be replaced at times. The collective amount of these small parts is at quite sizable. The cost of such items gets covered in this add on cover
• Emergency Assistance: Add-on provides road side emergency assistance services like Onsite repairs, Battery jump start, Duplicate key, Tyre change, Lock/ Lost key, Fuel delivery, Towing of the vehicle up to 50 kms is not charged to the insured beyond with insured has to bear the cost for extract kms. The services are available at additional cost of Rs 350 for private car & Rs 80 + Tax for a two wheeler

Some relevant concepts in Motor Insurance

• No Claim Bonus: No claim bonus is an incentive given to an insured for maintaining a claim-free/ less claim record. One important aspect is that the histories of no claim need to be continuous. The % would vary from 20% to 50%. No claim made in previous year, previous consecutive 2yrs, 3yrs, 4yrs, 5yrs would attract 20%, 25%, 35%, 45% & 50% respectively.

No claim bonus can be transferred as per following rules:

• In the event of transfer of business, new Insurer can give the NCB as per renewal notice, or letter confirming the %
• In case the vehicle is sold & not replaced immediately, NCB may be granted in subsequent insurance provided the same is done within 3 years of the expiry of previous insurance
• In case the vehicle is sold & the policy needs to be transferred, the NCB would be paid by new owner
• Insured Declared Value (IDV): IDV of the vehicle is deemed to be the sum insured for the purpose of the policy. The same is agreed before inception of the policy. In case of a vehicle which is less than 5 years old, depreciation % is applied on the ex showroom price to arrive at the sum insured which is depicted in the below table:

Age	Rate of depreciation
6 m - 1 yr	5%
1 yr to 2 yrs	15%
2 to 3 yrs	20%
3 to 4yr	30%
4 to 5 yrs	40%
Upto 5 yrs	50%

Vehicles which are over 5 years, obsolete models are insured at prevailing market rate subject to agreement between Insurer & Insured.

• Arriving at the rate of premium: 
  The Own Damage premium rate would be done based on:
• Insured Declared Value
• Area of operation or location of vehicle registration
• Age of the vehicle
• Make & Model
• Fuel type
• Gross Vehicle Weight (GVW), Licensed carrying capacity (LCC)
• No Claim Bonus
• Business type

The Third Party and personal accident cover premium is fixed by IRDA.

Health Insuarance

You're young, you spend more time in the gym than an Olympic athlete, you rarely get anything worse than a cold. Why bother spending money on Health Insurance? Aren't the odds pretty good that you'll never get seriously sick?

We hope so. But every day, thousands of perfectly healthy people break bones, need stitches, get into car accidents, find out they have illnesses, or are told they need surgery.

You may never be one of them. But what if you are? Medical bills from even a minor car accident can mess up your finances. A major illness can wipe out your family's savings. Insurance may be expensive, but not having it might cost way more.

Health Insurance is a way to pay for health care and associated costs. It protects you from paying the full costs of medical services when you’re injured or sick. Just like car insurance or home insurance, you choose a plan and agree to pay a certain rate, or premium. In return, your health insurer agrees to pay a portion of your covered medical costs. The idea behind health insurance is simple: Medical care can be expensive. Most people can't pay for it all out of their own pockets. But if a group of people gets together, and each person pays a fixed amount (whether they need medical care at that time or not), the risk is spread out over the whole group. Each person is protected from high health care costs because the burden is shared by many.

Health Insurance is the fastest growing portfolio in General Insurance industry. It is sourced as retail as well as Group Insurance. It is but natural that with steep growth in number of customers, policies and claims the number of complaints and litigations are also on the rise. A serious insurer in the health space, thus, needs to master customer support and grievance handling mechanism with dynamically changing customer expectations. It is understood by the insurers that one who would be able to meet the implicit, explicit and latent expectations of the customers will be able to make one's presence felt in the marketplace.

Health insurance essentially deals with sickness and accident. Prior to opening up of the sector, the products available in the market were restricted to hospitalization benefits, limited pre and post hospitalization expenses and very restricted domiciliary hospitalization benefits. With opening up of the sector and entry of players keenly interested in health coverage, the products have widened the coverage.

In India, initial Health Insurance was first introduced by the 4 Public Sector Insurance Companies in the year 1986. The product was designed to provide reimbursement of medical expenses incurred in India by the insured, which included:

• Treatment of any disease or illness or accidental bodily injuries
• Treatment at any hospital/nursing home
• Treatment as an inpatient
• Treatment upto sum insured or limit of indemnity opted for a period of policy
• Domiciliary hospitalization was also covered for a specified amount.

Expenses towards outpatient treatment were excluded under the policy and sub limits were applicable under various heads of medical expenses. This covers medical treatment cost incurred during treatment at home in a situation where though the illness requires attention at a hospital but

• the condition of the patient is such that he cannot be moved to a hospital, or
• there is lack of accommodation in hospitals
• Pre and post hospitalization expenses cover the cost of medical expenses towards illness and/ or accident incurred prior to hospitalization and post discharge from the hospital. Medical expenses, incurred for pre and post hospitalization expenses for 30 and 60 days respectively, include:
• Consultation fees
• Medicine cost
• Medical investigation cost

With the privatization of insurance industry in the year 2000, more changes were seen, primarily in introduction of a third party administrator & cashless claims services. The main objectives were:

• Ease of customer: Cashless service released the financial burden of borrowing money to meet the treatment expenses
• bring innovation in product and services

IRDA regulated Third Party Administrators (TPA) for insurance company to outsource the claims servicing at remuneration to be decided between the TPA and insurer.

Coverages under a Health Insurance policy:A Health Insurance Policy covers costs associated with hospitalization, whether due to accidents or sickness. Usually, a 24-hour hospitalization treatment is required for the coverage to set in. However, due to medical advancements, there are newer treatment modes available that do not require patients to be hospitalized for 24 hours. Common example is Cataract surgery wherein the patient goes home post-surgery. These are referred as “Day Care” procedures which are also covered in the policy.

Types of Health Insurance

• Individual Health Insurance generally covers an individual or a family for a specific sum insured against each individual. Here each family member is separately covered up to the sum insured mentioned and do not share the sum insured with other family members. For e.g., John has a family of four members having his spouse and two kids. John can buy a individual health policy for a sum insured of Rs 4,00,000 for each member which means the policy shall provide protection against unforeseen medical expenses up to Rs 4,00,000 for each member during the policy period. In this policy the maximum liability of insurance company shall be Rs 16,00,000 if all the members claim during the same policy period.
• Family Floater Policy is a policy that provides protection to a family for a fixed sum insured. However in this policy the entire family is covered under single sum insured or in other words all family members are jointly covered under a single sum insured. The term "floater" means the sum insured floats over all the members. For e.g., if John opts for a family floater cover then the sum insured of Rs 4,00,000 shall be available to all family members, so each family member can claim up to Rs 4,00,000. However jointly all family members can't claim more than Rs 400,000 during the same policy period.
• Group Health Policy is a policy generally taken by a group administrator for a specific group of people. Generally these policies are taken by employers for all employees as part of employment benefits.

Terminology associated with Health insurance

• Sum Insured (SI): The Sum Insured offered may be on an individual basis or on floater basis for the family as a whole
• Cumulative Bonus (CB): Cumulative bonus is an increase in the sum insured by a specified percentage for every claim free year, subject to a maximum limit without any additional premium
• Cashless Facility: Cashless hospitalization is a facility provided by the Insurance Company wherein the Insured can get admitted and undergo the required treatment without paying directly for the medical expenditure. The eligible medical expenses incurred are settled by the Insurance Company directly with the hospital
• Inpatient: Insured who undergoes treatment after getting admitted in the hospital

New products in last one decade:A number of new features were also introduced in the Indian health insurance market by the insurance companies. Some of the features were Hospital Cash, Critical Illness, Sr. Citizen specific products, Top up & Super Top up policies and specialized policies for diabetes or HIV.

Criticle Illness Policy:

Major illnesses which entail high cost of hospitalization, disability, dismemberment and loss of earning are called critical illnesses. Usually, it is a policy which pays a lump sum amount upon diagnosis of certain named critical illnesses. However, some policies are in the form of reimbursement and hence are indemnity covers.

This policy is sold stand alone or as an add-on to indemnity policies and a very popular policy from the perspective of life insurers. Some critical illnesses are cancers of specified severity, heart attack, bypass surgery, renal failure, and stroke. Survival clause up to 30 days from the date of diagnosis is an important condition of the policy. This policy involves strict medical underwriting and detailed tests for policies taken post 45 years of age and the policy aims to compensate only once for any one or more diseases.

Hospital daily cash policy:

Hospital cash policy provides a fixed sum to the insured person for each day of hospitalization and is unrelated to the medical expenses incurred in the hospital. The market accepted these policies to supplement a regular hospital expenses policy to compensate for incidental expenses and expenses not admissible under hospitalization cover.

Some insurers sell Hospital Cash policy as a standalone cover while others sell it in combination to indemnity policies. Easy marketability of the product and easier serviceability of the product has made it a popular product.

Top up and super top up covers:

A high deductible cover is a top-up cover. These policies are complementary to a basic policy and come into effect only when the medical cost crosses the basic medical cover due to a single illness. The cover is available on individual and family basis. An interesting use of it in the market has been the employees who opt for it over and above the limit specified in their coverage taken by the employee.

A super top up cover is one in which coverage is offered not only over and above the deductible chosen in the case of a single event exceeding the deductible but a series of hospitalization during the policy period exceeding the chosen deductible.

Group Health Insurance

In India, Group Health Insurance is offered in the form of basic hospitalization cover and/ or critical illness insurance cover.

IRDAI has laid down definition of a group for granting group accident and health covers. This definition states that a group consists of persons with a commonality of purpose. Further, group organizer should have the mandate from a majority of the members of the group to arrange insurance on their behalf. It is not permitted to form a group with the purpose of availing insurance.

Thus, group owner could be an employer, or non-employer-employee group viz. an association, a bank's credit card division etc, where a single policy covers the entire group of individuals. In India, regulatory provisions strictly prohibit formation of groups primarily for the purpose of taking a group insurance cover. When group policies are given to other than employers, it is important to determine the relation of the group owner to its members. In group policies, there are provisions for discounts on premium based on size of the group and also the claims experience of the group.

Group insurance reduces the risk of adverse selection, as the entire group is covered in a policy and enables the group holder to bargain for better terms. However, this segment has seen high loss ratios and hence premiums too have hardened substantially leading to review of covers by employers.

The most common form of group health insurance is the policy taken by employers covering employees, and even their families including dependent spouse, children and parents/ parents-in-law. Group policies are often tailor-made covers to suit the requirements of the group. Thus in group policies, one will find several exclusions of the individual policy covered.

One of the most common extensions in a group policy is the maternity cover. This is now being offered by some insurers under individual policies as explained above, but with a waiting period of two to three years. In a group policy, it normally has a waiting period of nine months only and in some cases, even this is waived. Maternity cover would provide for the expenses incurred in hospitalization for delivery of child and includes caesarian section delivery. Sum insured for maternity is opted as per the requirement within the overall Sum insured of the family.

Children are covered from age three months only in health policies. In group policies, coverage is given to babies from day one, sometimes restricted to the maternity cover limit, but sometimes extended to include the full Sum insured of the family.

Several exclusions such as the pre-existing disease exclusion, thirty days waiting period, two years waiting period, congenital diseases are all waived in a group policy. The premium charged for a group policy is based on the age profile of the group members, the size of the group and most importantly the claims experience of the group. Also appropriate loading is done for waiver of waiting period, coverage for maternity and pre-existing ailments. Tailor-made group policies offer covers such as dental care, vision care, cost of health check up, and critical illness cover too at additional premiums. Group policies are flexible for mid-term addition and deletion as and when new employee joins or existing employees resigns.

Corporate Floater or Buffer Cover:

In most group policies, each family is covered for a defined sum insured, varying from Rs 1,00,000 to Rs 5,00,000 or more. There arise situations where the sum insured of the family is exhausted, especially in the case of major illness of a family member. In such situations, the buffer cover brings relief, whereby the excess expenses over and above the family sum insured are met from this buffer amount. Amounts are drawn from the buffer, once a family’s sum insured is exhausted. However this utilization is usually restricted to major illness/ critical illness expenses where a single hospitalization exhausts the sum insured. The amount that could be utilized by each employee from this buffer is also capped, often up to the original sum insured. Such buffer covers should be given for medium sized policies and a prudent underwriter would not provide this cover for low sum insured policies.

As per the Regulation, every insurer should have a grievance redressal system in place to address the complaints of the policy holders. The IRDA has a Grievance Redressal Cell, which facilitates taking up complaints against insurer with respective companies for speedy resolution. The IRDAI also stipulated certain Turn Around Times for various services that an Insurance company renders to policy holder.

The costs associated with the medical treatment which includes the following are covered: Expenses incurred for room and operation theatre Fees for the services of doctors e.g. surgeon, anaesthetist, physician, consultants, specialists and nurses Costs for medicines, blood, oxygen, surgical appliances, diagnostic materials, X-ray etc Pre and Post Hospitalization charges - Expenses incurred on diagnostics, medicines, doctor consultations etc. before and after the hospitalization, up to a maximum number of days and sum insured are also covered.

Types of Health Insurance

• Individual Health Insurance generally covers an individual or a family for a specific sum insured against each individual. Here each family member is separately covered up to the sum insured mentioned and do not share the sum insured with other family members. E.g., John has a family of four members having his spouse and two kids. John can buy a individual health policy for a sum insured of Rs. 4,00,000 for each member which means the policy shall provide protection against unforeseen medical expenses up to Rs. 4,00,000 for each member during the policy period. In this policy the maximum liability of insurance company shall be Rs. 16, 00,000 if all the members claim during the same policy period.
• Family Floater Policy is a policy that provides protection to a family for a fixed sum insured. However in this policy the entire family is covered under single sum insured or in other words all family members are jointly covered under a single sum insured. The term "floater" means the sum insured floats over all the members. In the above example, if John opts for a family floater cover then the sum insured of Rs. 4,00,000 shall be available to all family members, so each family member can claim up to Rs. 4,00,000 however jointly all family members can't claim more than Rs. 4,00,000 during the same policy period.
• Group Health Policy is a policy generally taken by a group administrator for a specific group of people. Generally these policies are taken by employers for all employees as part of employment benefits.

Terminology associated with Health InsuranceSum Insured (SI)The Sum Insured offered may be on an individual basis or on floater basis for the family as a whole.

Cumulative Bonus (CB)It is an increase in the sum insured by a specified percentage for every claim free year, subject to a maximum limit without any additional premium.

Cashless FacilityCashless hospitalization is a facility provided by the Insurance Company wherein the Insured can get admitted and undergo the required treatment without paying directly for the medical expenditure. The eligible medical expenses incurred are settled by the Insurance Company directly with the hospital.

InpatientInsured who undergoes treatment after getting admitted in the hospital

Tax Benefits for Health Insurance Health Insurance comes with attractive tax benefit as an added incentive, under Section 80D with an annual deduction of Rs. 25,000 from the taxable income for payment of Health Insurance premium for self, spouse and dependent children. For senior citizens, this deduction is higher, and is Rs. 30,000

Exclusions under a Health Insurance policy

• 30 Day waiting period is applicable for hospitalisation claims during the first 30 days. However, there is no waiting period for hospitalization due to accidental injury.
• 2 year Exclusions: Claims for certain named diseases like Tonsils, Sinus, Internal Tumors etc are not payable within the first 2 years of the policy.
• Pre-existing diseases: Any hospitalisation for conditions existing prior to purchase of health insurance is not covered
• Treatment related to HIV or AIDS
• Dental treatment unless requiring hospitalisation
• Plastic surgery or cosmetic surgery unless necessary as part of treatment of burns, cancer or accident
• Conditions for which hospitalisation is not required
• Hospitalisation primarily for diagnosis purpose and not related to any illness
• Vaccination and immunizations expenses
• Naturopathy treatment
• Intentional self-injury, use of intoxicating drugs/ alcohol

Renewal and Grace Period Health Insurance policies are usually annual policies. Some policies may offer a 2 year coverage as well. The insured is required to renew the policy before expiry to ensure continuation of policy benefits.

The Insurance Company also provides a 30 days period for renewal of expired policies for the benefit of policy holders. However, coverage would not be available for the period for which no premium is received by the Insurance Company. The policy will lapse if the premium is not paid within the grace period.

Free look period in Health Insurance policies A 15-day period is provided from the date the policy is received by the customer for him to review the policy terms and conditions. In case the customer decides not to continue with the policy, the Insurance Company will refund the premium in full. This is to ensure that there are no fake promises made to the customer at the time of selling the policy and also provide an opportunity for the customer to review the policy and decide without losing any money.

Portability in Health Insurance As you are aware that with passage of time, the coverage under Health Insurance policy increases and various waiting periods are either reduced or completed thereby providing full coverage to the insured. This is called "Continuity Benefit". When you change your Health Insurance policy from one insurance company to another, you should not lose the benefits you have accumulated with previous insurer across the previous years. In the past in health insurance policies, such a move resulted in you losing the "continuity benefits". Now, as per IRDAI regulations, you can port your policy to another insurer of your choice along with full continuity benefits.

Personal Accident Insurance

Accidents don't come scheduled. They happen anytime and anywhere. The personal accident policy covers a number of eventualities, including train and road accidents, plane crashes, murder and even a slip in the bathroom.

In the event of you being bedridden, your income will stop. Who will provide for the financial commitments of your family? Buying such a policy is the best way to prepare yourself against any eventualities in life. This becomes more important if you are the only earning member in your house and have many dependents. Your entire family's future financial goals depend on your income stream and should that stop because of an accident you meet with; they would be unable to meet any of their future dreams.

Why risk it? While minor accidents can affect you temporarily, major ones can severely impact your life and well-being. The value of the human life is immeasurable, but with a view to provide some relief to the injured person or a dependent, insurance companies offer a personal accident policy. It refers to an insurance which offers compensation in the event of accidental death, bodily injuries or temporary/ permanent disablement. Accidents caused by rail, road, air travel, or injuries due to collision, falls, burns, drowning etc is covered under the policy.

You should buy a personal accident policy because it plugs an important hole in your insurance portfolio. Firstly, it will provide financial support to the policyholder if he is disabled after an accident. Secondly, the magnitude of the mishap doesn't matter; even minor ones like falling off a bicycle and breaking an arm, or fracturing a leg while playing football are covered by the policy.

Coverage and Exclusions:

A personal accident cover provides compensation in the event of unforeseen accidents in the form of Accidental Death (AD) benefit (death due to accident) and disability benefit.

Unlike health insurance, which covers both sickness and accident, personal accident insurance covers loss arising out of accident as defined above only.

Types of disability which are normally covered under the policy are:

• Permanent total disability (PTD): Totally disabled for lifetime viz. physical severance or loss of use of limbs; total loss of speech, etc.
• Permanent partial disability (PPD): Partially disable for lifetime viz. loss of fingers, toes, phalanges, etc.
• Temporary total disability (TTD): Totally disabled for temporary period of time. This section of cover is intended to cover the loss of income during the disability period.
• While death benefit and PTD is payment of the sum insured, in the event of PPD compensation varies from a fixed percentage of sums insured
• Weekly compensation means payment of a fixed sum per week or actual weekly income whichever is lower to a maximum number of weeks for which the compensation would be payable. Some insurer only offers fixed benefit
• Sum insured for PA policies are offered on the basis of gross monthly income. Typically, 5 to 10 times the annual income in such policies sum insured for each section of cover varies as per the plan opted
• If a person has more than one policy with different insurer, in the event of accidental, death, PTD, PPD, claims would be paid under all the policies
• Often these policies provide some form of accidental medical expenses cover along with the accident benefit which is paid on fixed limit or actual whichever is higher; fixed limit or actual expense or certain percentage of the actual claims (AD, PTD, PPD or TTD) whichever is higher
• Many insurer also covers value added benefits like hospital cash on account of hospitalization due to accident:
• Cost of transportation of mortal remains
• Education benefit for a fixed sum
• Ambulance charges on the basis of actual or fixed limit whichever is lower
• Hospital cash benefit
• Broken bone benefit, etc.

Common exclusion under PA policies:

• Any existing disability prior to the inception
• Death or disability due to mental disorders or any sickness
• Directly or indirectly caused by venereal disease, sexually transmitted diseases, AIDS or insanity
• Death or disability caused by radiation, infection, poisoning except where these arise from an accident
• Any injury arising or resulting from the Insured or any of his family members committing any breach of law with criminal intent
• Death or disability or Injury due to accidental injury arising out of or directly or indirectly connected with or traceable to war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrests, restraints and detainments
• In the event the insured person is a victim of culpable homicide, i.e. where the insured dies due to act committed against him, which act is committed with the intention of causing death or with the intention of causing bodily injury as is likely to cause death, or with the knowledge that such act is likely to cause death
• Death/ Disablement/ Hospitalization resulting, directly or indirectly, caused by, contributed to or aggravated or prolonged by child birth or from pregnancy or in consequence thereof
• While the insured in participating or training for any sport as a professional, operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft; or Scheduled Airlines; or serving in any branch of the Military or Armed Forces of any country, whether in peace or War
• Intentional self-injury, suicide or attempted suicide (whether sane or insane)
• Abuse of intoxicants or hallucinogens including influence of drug and alcohol
• Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world

Certain policies also exclude loss arising out of driving any vehicle without a valid driving license. A typical PA policy offers cover on the lines of the table given below:

Cover	Payable in case of claim
Accidental Death (AD)	Capital Sum Insured paid once the loss is established
Permanent total disability (PTD)	Capital Sum Insured once the loss is established
Permanent partial disability (PPD)	Paid % of Capital sum insured depending upon the loss. Total amount not  exceeding the capital sum insured
Temporary total disability (TTD)	Weekly compensation maximum up to specified weeks not exceeding the capital sum insured

Home insuarance

Whether you own or rent, our homes and our possessions are precious. Choosing to insure them, and making sure you have the right insurance products for your circumstances, offers peace of mind and lowers the financial pain of repairing your home and replacing damaged or stolen belongings. You can choose to insure your property, its contents, or both.

Common types of coverage available are

• Fire insurance Covers financial losses associated with damage or loss of a property you own
• Contents insurance Covers financial losses caused by the loss, theft or damage of your possessions

Methods of fixing the Sum InsuredThe sum insured should represent the replacement value for building and contents except personal affects.

For personal belongings the sum insured should be based on market value

Travel insurance

Whether you need to travel overseas for business or for personal reasons, any trip away from your home involves planning, expense and some risk.

Travel insurance can cover you for financial losses caused by a wide range of events that can affect your trip, whether they occur before, during or even after your trip. These might include travel modification, cancellation or interruption, medical expenses, baggage damage or theft & more.

Travel insurance should be a priority in all travel arrangements, whether you travel regularly, occasionally or you are setting off on a once-in-a-lifetime trip.

You should purchase a travel insurance policy as soon as you have paid for your trip. That way you may be covered for unused travel and accommodation in the event that you must cancel your trip due to a covered event, such as illness or a natural disaster.

Most travel insurers offer policies that cover families and couples, and some also offer multi-trip and annual policies for frequent travellers.

Most international travel insurance policies cover overseas medical and dental expenses, lost or stolen luggage, liability cover, accidental death or disability, and expenses if you incur a financial loss due to delays, cancellations or rescheduled arrangements.

Some travel insurers offer additional services, such as 24-hour medical emergency translation, which can make a huge difference to the quality of treatment you get while travelling.

Medical treatment in some countries can be exceptionally expensive and in some cases it can be difficult to be admitted to a hospital and receive treatment unless you are able to guarantee payment. When you travel overseas, you are personally liable for covering your medical costs. It's not uncommon for even a short stay in, for example, an American hospital to cost tens of thousands of dollars.

Travellers who are not covered by insurance are personally liable for covering the medical and associated costs they incur overseas.

• Persons up to 70 years can be covered
• Premium is payable in Rupees but cover is in US dollars
• Age and duration of trip are factors deciding the premium
• The cover given is either worldwide excluding USA and Canada OR including USA and Canada

Travel policies are primarily meant for accident and sickness benefits, but most products available in the market package a range of covers within one product.

Usually, the covers offered are:

• PA cover Accidental death/ disability
• Accident and Sickness Medical Expense (Hospitalization and OPD)
• Repatriation of mortal remains and evacuation
• Dental Treatment
• Hospitalization Daily Allowance
• Personal Accident
• Personal Liability to cover Third party liability for property/ personal damages
• Loss of checked in baggage
• Delay in arrival of checked in baggage
• Loss of passport and documents
• Trip Cancellation & interruption
• Trip Delay
• Hijack cover

Coverage:

• The cover is granted in US Dollars under different plan of the policy for medical coverage with nominal deductibles
• Sum insured and deductible for other section are also defined against each section
• Cashless benefit for medical expense can be availed with prior notification to service provider identified by insurer services the policies

If expenses are claimed on reimbursement basis, foreign currency in which expenses are incurred are converted to Indian rupees and paid. The currency conversion rates are taken as on the date of loss.

Specific exclusion, terms and condition are applicable under each section of coverage. Common exclusions under the medical section of travel insurance product include pre-existing diseases. The coverage is provided for medical treatment for emergency situations and does not cover planned treatment abroad.

Geographical coverage is usually of two types:

• World-wide excluding USA/ Canada
• World-wide including USA/ Canada

Some products provide for cover specific for

• Asian countries
• African countries
• Schengen countries

Premiums for USA/ Canada plans are always higher as these countries are known for high costs of medical treatment. Premiums are paid in Indian rupees. The policies are taken for Business trip and Holiday trip as well as the study plans.

• Individual Policy & Family floater Policy:It's a comprehensive Single Trip cover for an Individual going abroad on business or holiday trip. In family floater policy, coverage is granted for entire family going abroad on business or holiday trip under single policy and one premium. Unlike an individual policy, Sum Assured (Coverage Amount) is shared by all the family members. Duration of cover can be opted for a minimum of one week or less to a maximum of 180 days. Where extension beyond 180 days is required, the same is granted for a further 180 days only.
• Student policy:  It provides a Comprehensive cover for up to 2 years for Indian students travelling to study abroad. It covers much more and cost much less than the medical covers available in abroad.
• Frequent flier/ Multi-Trip Policy/ Annual Multi-Trip Policy:The Multi-Trip Travel Insurance plan designed for the frequent international traveler. The policy is valid for 1 year (365 Days). It saves frequent flier time money as you pay an annual one-time premium and can secure as many trips throughout the year.

What is not covered?

• Intentional self-injury
• Injury or sickness while under the influence of intoxicating liquor or drug
• Injury or sickness while participating in any sport as a professional player
• Injury sustained while participating in any criminal act, violent labour disturbance, riot, civil commotion or public disorder
• Bodily injury sustained while participating in any hazardous sport like parachuting, hangliding, parasailing, skiing or bungee jumping
• Medical expenses incurred due to pre-existing diseases
• Injury due to terrorism
• Bodily injury or sickness due to war
• Bodily injury or sickness due to pregnancy
• Bodily injury or sickness due to HIV/ AIDS

Crop Insurance

Crop or Agriculture Insurance covers risks of anticipated loss in yield of various crops. Almost the entire of Crop Insurance business comes from 'Schemes' or 'Programme'. These Schemes operate on principles of 'Area Approach'. Coverage is compulsory for farmers taking crop loans from Rural Financial Institutions (RFIs) for cultivation of crops, i.e., loanee farmers.

Non-loanee farmers can also insure their crops under the same schemes. The main Schemes available to farmers in respect of crop insurance are as under:

National Agricultural Insurance Scheme (NAIS) of Government of India

National Crop Insurance Programme (NCIP) of Government of India

• Modified National Agricultural Insurance Scheme (MNAIS),
• Weather Based Crop Insurance Scheme (WBCIS) and
• Coconut Palm Insurance Scheme (CPIS)

Which crops are coveredThe scheme covers all food, oilseeds and annual commercial/ horticultural crops for which historical yield data is available and crop cutting experiments are planned for the current year. State Governments issue notifications containing names of crops, areas eligible for insurance, rates of premium etc. at the beginning of each cropping season.

Marine Insurance

Marine Insurance is broadly of two types:

• Marine Cargo Insurance
• Marine Hull Insurance

Marine Cargo Insurance provide insurance cover in respect of loss of or damage to goods during transit by rail, road, sea or air.
Marine Hull Insurance is concerned with the insurance of ships (hull, machinery, etc.).

Important factors considered in Marine cargo insurance:
Type of cargo, like edible items, cement, glass, bulk cargo like wheat etc, electrical, electronic items, garments, jewellery, petroleum products etc Type of packaging, cartons, boxes, bags, containers etc Type of journey - by sea, rail, road or air Class of ocean going vessel

How Marine Cargo Insurance helpsCargo can be damaged on exposure to a wide variety of risks, including an accident of the vehicle carrying the cargo, damage due to jolts, jerks etc. In the international trade, both consignor and consignee need to ensure safety of the goods. Marine Insurance protects both parties and in case of any loss to the cargo, the equivalent compensation is paid by the insurer which provides financial stability to both consigner and consignee.

 

What is covered in a Marine Cargo policy? Generally all risk policies are taken which covers loss or damage due to all causes except if caused by listed exclusions. The exclusions are as under:

• Loss or damage due to wilful misconduct of insured
• Ordinary leakage, ordinary loss in weight or volume, ordinary wear and tear
• Loss or damage due to insufficiency or unsuitability of packing
• Loss or damage due to inherent vice or nature of the subject matter
• Loss or damage caused by delay
• Loss or damage due to insolvency or financial default of owners/ operators of vessel
• Loss or damage due to war, strikes, riots and civil commotion
• Loss or damage due to nuclear perils
• Loss or damage due to unseaworthiness of the vessel

Duration of coverage in Marine InsuranceMarine Insurance covers do not provide fixed period coverage like fire insurance and generally covers the goods from warehouse to warehouse. The coverage stages when the goods leave the warehouse and ends when the goods are delivered to the warehouse at destination.

Servicing TATs

General

Services	Maximum Turn around
Processing of proposal and communication of decision including the requirements/Issue of policy/cancellation	15 days
Obtaining copy of the proposal	30 days
Post policy issue service requests concerning mistakes/refund of proposal deposits and non claims related service request	10 days

Claims

Services	Maximum Turn around
Survey report submission	30 days
Insurer seeking addendum report	15 days
Offer of settlement/rejection of claim after receiving first/addendum survey report	30 days

Grievances

Services	Maximum Turn around
Acknowledgment of grievance	3 days
Resolution of grievance	15 days

In case of any deficiency of services by Insurance Company, policy holder must be provided with inexpensive and speedy mechanism for complaint disposal related to policy and/or claims.