Review of underwriting guidelines in respect of female lives | Insurance to pregnant ladies

Review of underwriting guidelines in respect of female lives

A. Insurance to pregnant ladies

At present insurance to pregnant ladies is allowed if the proposal is submitted within first 24 weeks of pregnancy. All special reports as per the chart of special reports are required to be submitted for giving underwriting decision.

We have received representations for waiving certain special reports like CTMT and X-ray of chest as it is not advisable to undergo these reports during pregnancy. It has therefore been decided not to call for CTMT and X-ray of chest from pregnant ladies. However, reports of other tests done during the period of pregnancy are required to be submitted.

The rules regarding medical underwriting of pregnant ladies are revised as under:

Proposals on the lives of ladies who are pregnant at the time of proposal will be entertained subject to the following conditions:

i. Proposals are submitted within the first twenty four (24) weeks of pregnancy

ii. Proposals will not be entertained under the non-medical scheme.

iii. Full medical report (FMR) from our authorized medical examiner / DMR / TPA
should be obtained as per existing rules.

iv. All other special reports as per the special report chart except Chest X-Ray and
CTMT are to be called for.

v. Report from the attending gynaecologist in Form No 3341 (Revised) certifying
that the lady is under his / her care will be required.

i. Last check up report from the attending obstetrician / gynaecologist will be required.

ii. Reports of any medical tests done during pregnancy will be required to be submitted.

iii. Additional report like Sonography to be called for if opined by DMR/ZMR after reviewing the attending gynaecologist’s report and other medical tests submitted.

iv. The pregnant women should be falling under Female Category I & II only.

v. Maximum cover during the period of pregnancy will be restricted to Rs one crore. The insurance cover granted should be reasonable in relation to the proposer’s income.

vi. Proposals for cover in excess of Rs. one crore during the period of pregnancy could be considered only after referring to the reinsurer.

vii. Pure Term Insurance plans and plans having higher term insurance element will not be entertained.

viii. Special Moral Hazard Report by the competent authority in Form No 3251 should be obtained in all cases irrespective of the sum proposed or SUC. In no case the proposal is to be entertained on the basis of the ACR.

ix. Proposals from pregnant ladies who had a normal full time confinement and normal delivery and without any past history of abnormal delivery or abortion (miscarriage) due to septic will be accepted on the same terms as for a woman not pregnant.

x. Proposals from pregnant ladies with past history of complications or caesarian section to be accepted with a single extra of Rs. 2 per thousand (instead of lien of Rs. 500, i.e., – imposing of Clause 4A- Form No 3124A)


B. General guidelines in respect of female lives:

i. Clause 4 (B) is to be imposed on married women (housewives) falling under
Female Category III aged 18 years and above but less than and up to 30
years nearer birthday on the date of proposal

i. Guidelines for caesarian section and hysterectomy will be as given in the DMR guidelines.
ii. There is no change in the financial underwriting guidelines given in Circular ref. 1994/4 dated 1st March 2005.