சி 38 - Home - Insurance Institute of India · ைாப்பீட்ு வரலாறு...
681
i ஐசி -38 காபீ மகவக - பபா ஒபகை இத பாடதிடதி மகபயி உள இதிய ைாபதி நிவன தயாரத திரதபட பாடதிட அடபகடயாை கைாடத G – Block, Plot No. C-46, Bandra Kurla Complex, Bandra (E), Mumbai – 400 051.
Transcript of சி 38 - Home - Insurance Institute of India · ைாப்பீட்ு வரலாறு...
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i
-38 -
G Block, Plot No. C-46,
Bandra Kurla Complex, Bandra (E), Mumbai 400 051.
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ii
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- 38
: 2016
, . .
IRDAI .
: ., , , , - 46, , () - 400 051
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iii
, . - ,
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III- - . .
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Chapter no. Title Page no.
1 1 2
2 34
3 82
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6 I 140
7 171
8 214
9 297
10 333
3 11 405
12 455
13
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14 543 15 594 16 644
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iv. .
()
1.
2.
3.
4.
5.
13.
14.
15.
16.
-
146
6.
7.
8.
9.
10.
11.
12.
17.
18.
19.
20.
21. ...
22.
23. -
24.
()
(1)
(2)
(3)
(4)
(5)
-
147
() :
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11. .
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
-
148
B.
" " . Health ? ' Health ' ' 'hoelth' - .
, ' ' . (460- 370 ) . , , , .
, : , , . , .
, , . 1948- ; " , , ". ,
-
149
.
(WHO) : , , .
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-
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. , , .. , .
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-
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, GDP ''.
.
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-
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-
153
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-
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-
155
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-
156
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c) , .
3.
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b) 30 60 .
c) ' ' .
d) '' ( ) .
-
157
F.
, . . :
a) (Employees State Insurance Corporation) , 1947- ESI , 1948 .
ESIC ( ) / .
. 15,000 . 1.75% 4.75% ; 12.5% .
:
a) ESIS
b)
c)
-
158
d)
e)
. 2012 ESIS 65.5 .
b)
ESIS- 1954- (CGHS) , . ( ) .
CGHS- , .
, , , , .
- .15 .150 .
2010-, CGHS 3 800,000 .
-
159
c)
- . , .
1986- , ( ). , , , , . , 2012- .
, , - , . , ,
2001- , ,
-
160
. , (add-on covers) ..
, 300- .
G.
, , . . . :
A. :
1.
, , . . :
a) (ICDS) ( 1000 1).
-
161
b) (BirthAttendants -TBA) ( ).
c) NRHM (National Rural Health Mission - ) , , ASHA ( ) , - .
5000 ( . 3,000 ) - (ANM) .
- 30,000 ( . 20,000 ) . PHC- , - . 14 ( , -, , ) .
PHC- , . ( 1 ) 30 , ,
-
162
, , , , 21 - ,
- / / ( 2000 ) - ;
( 300) . .
, , (/ ) , . , .
2.
- , . , - ,
-
163
, , , , ( ) . 77% (... ) . 75%- . 82% 2. 52% - .
( / / / ) , 7 . , .
, .
7,000- . , .
3. , 1950-
-
164
10 , . 55,000 ( ) . 6000 5 .
, (NPPA) () . (500 76 ) , - . . .
B. :
. . - - - .
C. :
. , IRDA . :
-
165
1. . . . . .
2. . , . , , . .
3. , 2001 . . , TPA- ,
-
166
. , , ( ) , TPA- . TPA- .
4. Insurance Web Aggregators are one of the newest types of service providers to be governed by IRDAI regulations. Through their web site and/or telemarketing, they can solicit insurance business through distance marketing without coming face to face with the prospect and generate leads of interested prospects to insurers with whom they have an agreement. They also display products of such insurance companies for comparison. They may also seek IRDAI authorization to perform telemarketing and outsourcing functions for the insurers such as premium collection through online portal, sending premium reminders and also various types of policy related services. They are remunerated by insurance companies based on the leads converted to business, display of insurance products as well as the outsourcing services performed by them.
5. Insurance Marketing Firms are the latest types of intermediaries to be governed by IRDAI. They can perform the following activities by employing individuals licensed to market, distribute and service such products:
Insurance Selling Activities: To sell by engaging Insurance Sales Persons (ISP) insurance products of two Life, two General and two Health Insurance companies at any point of time, under intimation to the Authority. In respect of general insurance, the IMF is allowed to solicit or procure only retail lines of insurance products as given in the file & use guidelines namely motor, health, personal accident, householders, shopkeepers and such other insurance products approved by the Authority from time to time. Any change in the engagement with the insurance companies can be done only with the prior approval of the Authority and with suitable arrangements for servicing existing policyholders. Insurance Servicing Activities: These servicing activities shall be only for those insurance companies with whom they have an agreement for soliciting or procuring insurance products and are enumerated below: a. undertaking back office activities of insurers as allowed in the Guidelines on
Outsourcing Activities by Insurance Companies issued by the Authority;
-
167
b. becoming approved person of Insurance Repositories; c. undertaking survey and loss assessment work by employing on their rolls
licensed surveyor & loss assessors; d. any other insurance related activity permitted by the Authority from time to
time. Financial Products Distribution: To distribute by engaging Financial Service Executives (FSE) who are individuals licensed to market, distribute and service such other financial products namely: a. mutual funds of mutual fund companies regulated by SEBI; b. pension products regulated by PFRDA; c. other financial products distributed by SEBI licensed Investment Advisors; d. banking/ financial products of banks/ NBFC regulated by RBI; e. non-insurance products offered by Department of Posts, Government of India; f. any other financial product or activity permitted by the Authority from time to
time.
D.
, :
1. (IRDAI), . 2000- .
2. (General Insurance and Life Insurance Councils), IRDAI- .
3. Insurance Information Bureau of India was promoted in year 2009 by IRDA and is a registered society with a governing council of 20 members mostly from the insurance sector. It collects analyses and creates various sector-level reports for the insurance sector to enable data-based and scientific decision making including pricing and framing of business strategies. It also provides key inputs to the Regulator and the Government to assist them in policymaking.
-
168
The Bureau has generated many reports, both periodic and one-time, for the benefit of the industry.
IIB handles the Central Index Server which acts as a nodal point between different Insurance Repositories and helps in de-duplication of demat accounts at the stage of creation of a new account. The Central Index Server also acts as an exchange for transmission/routing of information pertaining to transactions on each policy between an insurer and the insurance repository. IIB has already launched its hospital unique ID master programme by enlisting the hospitals in 'the preferred provider network' serving the health insurance sector.
The latest initiative of IIB would be maintaining a health insurance grid connecting TPAs, insurers and hospitals. The aim of the initiative is to help the health insurance sector to come out with a system of insurance claims management with transparency in treatment costs and efficient pricing of health insurance products.
4. .
5. TPA-, .
6. , .
-
169
1. 1000 . .
2. , .
3. .
4. , , , . ,
5.
6. , .
7. , , , , , .
-
170
1.
2.
3.
4. ,
5.
6.
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9.
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-
171
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, :
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-
172
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-
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-
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-
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-
188
F.
. . , 1938 - .
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-
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:
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-
190
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-
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192
:
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iv. (Credit or debit cards);
v. ;
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, / / , / / .
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-
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-
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, (the insured), .
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-
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-
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-
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-
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-
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M.
N.
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-
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A.
-
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.
-
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-
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-
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.
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-
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iii) RSBY
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, . , . , , , . .
, , TPA- , , , , , . , 2013- .
:
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2.
-
221
3.
4. -
5.
6.
7. TPA-,
8. - (IRDAI)
.
C.
. PSU . , .
. ,
-
222
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. , ( , ) .
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, . . 1.25 . . 1 . 25,000- .
-
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:
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iii. , , , ,
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-
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viii. /
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, (OPD) , . , ,
-
225
.
2.
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. , .
:
, :
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ii) - .
, , . .
i.
-
226
, .
,
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ii) - .
, .
, , , . .
, , , .
-
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, . , , .
, . , , , , , , , , , , .
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-
228
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48 / , / / , ().
: , 48 , ().
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iv. ,
-
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vi. ( )
vii.
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-
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-
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.
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. . ,
-
232
.
i.
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ii. -
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iii. :
/ .
-
233
CPAP, CAPD, , , , , , , , , , , , , / / / / .
, , /
, /
.
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, . , .. .
ii.
-
234
, . 2 3 .
iii.
. , - .
iv.
. , ( ), ( ), , , ( ) . 150- .
v.
. , , , 50% 100% . - , 50%- .
-
235
vi.
60 90 . , .
vii.
. :
: , , .
: .
: ( ) .
AYUSH :
-
236
AYUSH .
viii.
. , .
: - . .
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2. : /
-
237
10 .
3. : .
4. : / .
5. : , . .
6. : . , , /, . / .
-
238
D.
- (high deductible) . - (Co-pay) . , , . .5,00,000- . , . . ( ) .
. , ( ). , .
, (
-
239
) .
. 3 . . . 10 .
. 5 , . 3 . , . 2 .
. 10 . . 10 .
. .
, . , . 3 .
-
240
(Aggregate based) (Super top-up) . , , . 3 , .
, . , , .
E.
(.. 60 ) . .
. 60 . . 50,000 . 5,00,000 . . : 1
-
241
, 2 .
. : , .
. - . , 30/60 60/90 .
F. ,
. , . , , . , , .
-
242
. , . , ENT, , ,
. .
:
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ii) ,
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iv) ,
v)
, , .
-
243
,
. 75 200 .
/ . . .
:
A.
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. . 1,500 () . 5,000 . , .
ii)
,
-
244
. , / .
iii)
, . , . .
iv)
, . , - .
v)
, , . , ,
-
245
. , .
B.
(trauma) .
, , . . , .
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ii) :
-
246
, CI ( ) CI . . , 20 . ( ).
, ( ) . , .
i) , , , ..
ii) ,
-
247
.
iii) , :
/
. , . .
i)
-
248
, . .
ii) 21 65 .
iii) , .
iv) 100% . 25% 100% .
v) , 90 30 . , ()
-
249
.
vi) 45 . , , .
vii) , . , .
viii) .
G.
, , . , , .
-
250
. , , .
:
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ii)
( ) . .
- . 1990- , , . , .
i)
-
251
. 25 55 .
i)
55 60 , 4 . . .
ii)
. / . .
iii) (withdrawal)
, , . 7 .
-
252
iv) (assignment)
.
v) (Exclusions)
- , 30 . , .
vi) (Group insurance variant)
, .
H. (Combi-products)
, . .
, , / .
. , .
-
253
I.
, .
, , , , , . .
.
, / / , - , , / , , .
J.
.
-
254
. , , . , 2005- .
, 2005- .30,000- . (NGO-) . , .
PSU- :
1.
:
i) .
ii) .
iii) .
-
255
iv) 70 ..
v) .
vi) .5,000- .
2.1
46
46-55 56-65 66-70
70 100 120 140
/ 70 100 120 140
25
50 50 50 50
2+1
190 250 290 330
2+2
240 300 340 380
80- . .
1. (UHIS)
-
256
100 . UHIS .
:
, / .30,000 .
2.2
Limit
, . 150/-
. 300/-
, , , ,
/ . 4,500/-
, , , OT , ,
/ .
-
257
, , , , ,
4,500/-
. 15,000/-
( ) : .25,000/- .
/ , 15 .50/- .
2.3
.365/-
.548/-
-
258
( )
( )
.730/-
BPL
K.
, . , . (BPL) , RSBY .
:
i. BPL . 30,000
ii. .
-
259
iii. - ,
iv.
v.
vi.
vii. .100/ .
viii. .
ix. .
x. .
xi. 3:1 . . 565/- .
xii. : 25 . 750
xiii. / . 30/-
xiv. .
xv. . 60/- .
-
260
xvi. . . 1 .
xvii. 31 . . , 31 .
TPA . .
60 .
L.
(PA) , . .
PA , 100% , ,
-
261
, .
,
1.
:
i. (PTD): . , , , / / .
ii. (PPD): . .. , , .
iii. (TTD): . .
.
2.
PA . , 60 . ,
-
262
. .
3.
, . , , , , , (PTD, PPD) .
4.
. . / . , , .
5.
, . , , .
6.
:
-
263
i.
ii.
iii. , , .
iv. , ,
v. .
vi. , , ( ) , , , , , , , , , .
vii. . , , , .
viii. , // .
-
264
ix. / , .
x. -, ( )
xi.
xii. ( ), , ,
.
PA , .
PA . .
-
265
i) .
ii) .
iii) , . , ( ) .
iv) , . , , ( ) , .
v) . .
M.
1.
, , , . / , .
-
266
,
2.
, :
i. / ,
ii. / ,
iii. - ,
iv. -
v. (passport) ,
vi. ,
vii.
viii.
3.
, .
4.
, . .
5.
-
267
, , USD 100,000 USD 500,000 . , S.I. . , . :
- /
- /
, Schengen .
6.
/ . . .
, .
/ .
-
268
, .
.
OMP- . .
. ,
N.
1.
, , , , .
.
2.
/, / -
-
269
.
3. - (Tailor-made cover)
. ,
4.
. , , - . , .25,000 .50,000 .
5.
. , , .
6. ,
, , ,
-
270
- .
7.
, . , , .
8.
, . ,
, - .
,
-
271
.
9.
, . , . , , .
10.
, . / .
11.
- , .
-
272
:
. .
, .
:
i) , .
ii) .
iii) .
iv) .
-
273
12. (BUFFER)
, . .1 5 . , .
, , .
.10 . , . / .
. ..
-
274
14.
- . . / .
:
i) - , . .
ii) HSA - , .
iii) ( ) HSA HSA - . HSA - .
. ,
-
275
OPD . , .
, .
1.
, , , . 5 20 . , LDL, , . ,
2.
26 65 70 . .50,000 .5,00,000 . . (), , ,
-
276
.
- 1
, ______________
I.
II.
III.
IV.
K. 16.
1.
/TPA / / . / TPA . , .
-
277
2. (PPN)
. , , .
3.
. . , . , . .
4. (TPA)
TPA .
-
278
. TPA- .
, TPA :
i. .
ii. .
iii. .
TPA . TPA .
2001 . - . TPA - .
TPA - TPA .
MOU-
-
279
. () () , .
5.
/ . , :
i. 10,00,000 10 15 ;
ii. 24 ;
iii. 24 ;
iv. ;
v. .
6.
-
280
; .
7.
.
8.
.
, , , .
9.
-
281
. , , . , , / . , / , . . . 15 . , .
/ .
10.
, . ,
-
282
. 1%- .
11.
. 5% . 50% . .
.5,000 .3 . , , .5,000 .3.15 ( 5% ) . .4.5 .
12. / ( Malus/ Bonus)
, . , , .
-
283
, .
, , . , .
13.
.
14. - / -
- . . -
- , . , , - .
-
284
15. /
, , - . , , .10,000 , .10,000- . , .80,000- , .10,000- .70,000- .
16. (Franchise)
. , , , , . .10,000 , .9,000- , , .10,001- .
17.
. , .
-
285
, . 1% , .1,000 . , .
18.
. ( ) .
19.
, , .
.
, ,
-
286
. .
20.
, , ?
. :
1. . 3 1 .
2. 15 .
3. .
4.
i)
ii)
iii)
21.
-
287
. , , .
, 30 .
30 . .
, .
, , - . , - .
17.
, , , , .
-
288
.
. . , . , , .
:
1. , .
2. .
i. , . ,
-
289
.
ii. .
3. CEO . .
4.
1) , .
2) .
3) ,
-
290
4) .
5. . , .
6. , , , , , , .
- 2
IRDA, , ________ .
I.
II.
III.
IV.
-
291
1. / .
2. : , ,
3. / .
4. ( 30 )
5. ( 60 ) .
6. /, .
7. .
8. .
-
292
9. (high deductible) - ( ) .
10. , .
11. (PA) , .
12. , .
13. , , , .
14. (BUFFER)
15. , , , /
16. .
-
293
17. , .
18. .
- 1
II.
, 30
2
I.
, 30 .
- 1
?
I.
II.
-
294
III.
IV. .
2
?
I.
II.
III.
IV. ,
3
?
I. , -
II.
-
295
III.
IV.
4
PPN .
I.
II.
III.
IV. 5
?
I.
II.
III.
IV. .
- 1
II.
-
296
,
2
I.
( ).
3
IV.
,
4
II.
PPN
5
III.
I, II IV . III
-
297
9
. . , , . ..
I. ?
II. -
III.
IV.
V.
, :
)
)
-
298
)
)
)
-
299
48 . , . , , - , , .
, , .
. . , , , . , , .
, . , , ,.
-
300
, . , .
I. ?
1.
. . , . , , .
. .. , ( ) , , ,
-
301
. ,
. , .
2.
, . , , . , .
, , . . .
3. -
-
302
. , .. , , . ,
, . , .
, .. .. , ..
,
-
303
. , (insurable interest) . 3.
( ) :
i) : . .. . , , 45 .
ii) : . , ,
iii) : , .
iv) : , .. , , ,.
-
304
, , ,
v) : , , . .
vi) : , .
vii) : , .. .. , .
viii) : .
ix) : .
- 1 ___________
-
305
I.
II.
III.
IV.
II.
1.
.
i. -
ii.
.
- ,
, ,
-
306
,
, , .
2. ""
. "" . . . .
)
, , .
i.
( ),
ii.
-
307
,
iii.
, . ( ) .
iv.
, . , .
3.
:
1
-
308
)
. . . .
. , .
, .. , .
-
309
?
, , , , . .
. .
. , , .
' . , , , . .
-
310
. .
. , .
)
. .
III.
1.
, , . , .
1. ( )
2.
-
311
. :
)
. ( , , , , , , ) . / , . . , .
)
. .
, . . :
-
312
) : , , , PAN
) : , , ,
)
, . ,
i)
ii)
iii) .
)
. .
)
. ,
-
313
, .
- 2
___________
I.
II.
III.
IV.
- 3
____________ .
I.
II.
III.
IV.
L. IV.
, . :
1.
-
314
. , , . .
, . , , '-' ( ) , .
. , , - .
, . ,
-
315
.
, / , . , ,
40 , 45 ( 50 55 ). . .
, . 45-50 , , . - .
-
316
, . , . .
2.
. - , .
, , . , , . ,
, . , ,
-
317
' ' . ,
, , , . , , , , .
3.
.
, , , , , , , , - .
4.
,
-
318
. , :
i)
ii) () ,
iii)
iv) /
v)
vi) ( )
vii) ()
, . .
, . , . . .
-
319
5.
. . .
.
- 4
. ?
I. .
II. .
III. .
IV. .
1
-
320
-
321
V.
1.
, , . , , .
, , .
:
i)
ii)
iii)
iv)
v) ,
vi)
-
322
vii) , , , , ,
viii)
ix) ( )
x)
. ( ) , . , .
. - , .
,
-
323
. - , . , .
2. -
- . , , . , , , .
- , : , , - , , , .
. ,
-
324
.. RSBY,
, :
i) ( )
ii)
iii) -
iv)
, groups of convenience ' ' . , - :
i)
ii)
iii)
iv)
-
325
, . ' ' - . , , . .
- 5
1) , - .
2) - .
I. 1 2
II. 2 1
III. 1 2
IV. 1 2
, , :
: .
-
326
, . - 60% - 60% , . , , . 40% - .
: . ? . .
i)
ii) .
-
327
iii) .
iv) , , , , , , , .
v) - .
vi)
vii) : , , , (Subrogation)
viii) : , , , .
ix) .
x)
xi) .
-
328
xii) ,
xiii) , , .
- 1
III.
. 2
III.
3
I.
4
-
329
IV.
,
5
IV.
, .
- , : , , , .
-
1
?
I.
II. ,
III.
IV.
-
330
2
, __________ .
I.
II.
III.
IV.
3
________________ .
I.
II.
III.
IV.
4
___________________ .
I.
-
331
II.
III. ,
IV. .
5
?
I. .
II. .
III. .
IV. .
- 1
II.
-
332
2
I.
, .
3
IV.
. .
4
III.
, .
5
II.
.
-
333
10
, , . TPA
1. 2. 3. 4. 5. 6. (TPA)
,
i.
ii.
iii.
iv.
-
334
v. vi. TPA
A.
. . . .
1.
, .
1 -
-
335
.
. , , .
-
336
, , , ,
( ) :
.
/
/ , .
-
337
/
, TPA , .
. .
1.
65%- 120%- , 100%- . .
, , .
- 1
?
-
338
I. II. III. IV. TPA
2. 1.
. . :
i. , . .
ii. -, . , .
iii. , . , .
-
339
iv. , . , , , , , .
v. . . , .
vi. . .
. . . . , .
-
340
100,000 , 300,000 , 20,000 ! , .
. .
