Underwriting guidelines in respect of insurance on the lives of minor / major

Underwriting guidelines in respect of insurance on the lives of minor / major
children

A. INSURANCE TO MINOR LIVES

At present there are no medical requirements under CDA plans (Table Nos. 41 & 50). Komal Jeevan (Table No. 159) is allowed to children up to age 10 years without medical examination and for Jeevan Kishore (Table No. 102) no medical examination is required if age at entry is less than 10 years. For other risk plans allowed to minor lives, full medical report and special reports as per the chart of special reports are required.

The above guidelines were reviewed and it has been decided to make the following changes in the rules relating to medical examination / special reports in respect of minor lives:

a. There will be uniform guidelines for all risk plans allowed to minor lives including T 102 & 159. However, Table Nos. 171 and 175 will continue to be allowed as per existing guidelines, i.e., satisfactory DGH.

b. No medical examination / special reports will be required up to SUC Rs. 8 lacs.

c. For SUC between Rs. 8 lacs and Rs. 25 lacs only juvenile FMR will be required for ages between 10 and 17 years.

d. Juvenile FMR will be required for SUC above Rs. 25 lacs in respect of all children irrespective of their age at entry / revival.

e. Special reports will be required for SUC Rs. 50 lacs and above for children with ages at entry / revival 5 years and above.

f. A special format for Full Medical Report for Juvenile lives (Juvenile FMR) has been designed. (Format enclosed).
g. Fees for Juvenile FMR and other guidelines (ME’s limit, requirement of juvenile FMR by DMR, validity of juvenile FMR, etc.) will be the same as applicable to FMR at present.

The revised guidelines in respect of minor lives are as under:

1. DEFERRED RISK (CDA) PLANS (TABLE NOS. 41 & 50)

a. Maximum SA Rs. one crore subject to twice the insurance on parents’ (father and mother put together) lives and adequacy of their income

b. Insurance on the lives of parents will not be insisted upon upto Rs. 2 lacs. However matching insurance is to be insisted upon if the proposer is a widow falling under female category III.

c. Proposals for SA in excess of Rs. one crore may be referred to CUS for individual consideration on merits of the case with special recommendations from MM or SDM.

d. Clause 76 is to be imposed if sum proposed is Rs. one crore or less.

e. Clause 76 is not to be imposed if sum proposed is more than Rs. one crore as medical underwriting is required to be done at proposal stage itself.

Medical requirement chart for CDA plans:

Sum Assured
Age
Below 5 years
5 to 9 years
10 to 17 years

Up to
Rs. 100 lacs

No medical requirements

No medical requirements, but height and weight to be mentioned in the ACR
Copy of latest school report

No medical requirements, but height and weight to be mentioned in the ACR
Copy of latest school report

Above Rs. 100 lacs
to
Rs. 250 lacs

i) Juvenile FMR
ii) Immunization
record of the child
iii) copy of latest
school report, if
attending school

i) Juvenile FMR
ii) copy of latest
school report

i) Juvenile FMR
ii) Haemogram
iii) SBT-12
iv) ECG
v) HbsAg
vi) Copy of latest
school report




2. OTHER PLANS

a. Maximum SA Rs. 50 lacs, but not exceeding the insurance on parents’ (father and mother put together) lives and adequacy of their income.

b. Insurance on lives of parents will not be insisted upon up to Rs. 2 lacs. However matching insurance is to be insisted upon if the proposer is a widow falling under female category III.

c. Proposals for SA in excess of Rs. 50 lacs may be referred to CUS for individual consideration on merits of the case with special recommendations from MM or SDM.

Medical requirement chart for other risk plans allowed to minors
(including T 102 & 159):

Sum Assured
Age Group
Below 5 years
5 to 9 years
10 to 17 years

Up to
Rs. 8 lacs

No medical requirements

No medical requirements, but height and weight to be mentioned in the ACR

No medical requirements, but height and weight to be mentioned in the ACR

Rs. 8,00,001
to Rs. 25 lacs

Immunization record of the child (no other medical requirement)

No medical requirements, but height and weight to be mentioned in the ACR

i) Juvenile FMR
ii) Copy of latest
school report

Rs. 25,00,001 to
Rs. 49,99,999

i) Juvenile FMR
ii) Immunization
record of the child iii) copy of latest
school report, if
attending school

i) Juvenile FMR
ii) Copy of latest
school report

i) Juvenile FMR
ii) Copy of latest
school record


Rs. 50,00,000 to
Rs. one crore

i) Juvenile FMR
ii) Immunization record
of the child
iii) copy of latest
school report, if
attending school

i) Juvenile FMR
ii) ECG
iii) Haemogram
iv) Serum Creatinine v) RUA
vi) Elisa test for HIV vii) HbsAg
viii) Copy of latest
school report

i) Juvenile FMR
ii) ECG
iii) Haemogram
iv) SBT-12
v) HbsAg
vi) Copy of latest
school report
Other restrictions:

i. Minimum entry age – as required for different plans

ii. Table Nos. 14, 48, 75, 93, 178 and 179 will be allowed to standard and sub-standard minor lives attracting EMR up to Class III due to overweight only. The remaining eligible plans will be allowed to standard lives only.

iii. Proposals on the lives of overweight minors attracting EMR Class IV and above may be sent to CUS for special individual consideration with recommendations from Marketing Manager.

iv. The life to be assured should have a properly developed physique (not according to percentage of weight. Lower height in stunted growth gives lower percentage of underweight. But it is not a developed physique).

v. Family History, Personal history of health and medical reports are satisfactory.

vi. All members of the family are adequately insured.

vii. Socio-economic status of the family is satisfactory.

viii. Clause 10(a) to be imposed.

ix. Revival under Table Nos. 102, 113, and 159 is allowed on substandard lives if EMR is due to overweight only.

While allowing insurance to minor children on the basis of parents’ income it should be ensured that all members of the family are adequately insured. As far as possible, parents should propose on the lives of all their children and not on the life of any particular child.


3. Premium Waiver Benefit (PWB) under children plans

At present PWB under children plans is allowed only under medical scheme.

It has now been decided to allow PWB under children’s plans on the lives of parents (males and females falling under Female Category I & II) under non-medical (special) scheme and non-medical (general) scheme to professionals.


B. INSURANCE TO MAJOR CHILDREN UP TO AGE 25 YEARS

At present major children / students are allowed insurance cover under non-medical (general) to others up to maximum SUC of Rs. 3 lacs.

As per the above revised guidelines minors will be allowed risk plans without any medical requirements up to SUC Rs. 8 lacs. In view of this revision it has been decided to allow major students up to age 25 years insurance cover up to SUC Rs. 8 lacs under non-medical (general) as shown below:
Non-medical (general) to Major students

Classes of Lives
Sum Assured (SUC)
Plans allowed

Major students not aged over 25 years

Rs. 8 lacs
All plans excluding Table Nos. 43, 52, 58, 164, 167, 177, Term rider and CI Rider

Notes:
a. A declaration is to be obtained from the major students as well as from their parents that they are regularly attending colleges / technical institutions.

b. Copy of passing certificate / appearance report at the examination of the just completed academic year is to be obtained.

c. Cover will, as usual, be allowed subject to matching insurance on parents’ lives and adequacy of their income.


C. MATCHING INSURANCE FOR ALLOWING COVER TO CHILDREN

At present minor and major children up to age 25 years are allowed insurance cover subject to matching insurance on the life proposer. If proposer is father, then only his insurance and income eligibility is considered. If father and mother both have matching insurance and income eligibility then both have to propose separately.

This matter was reviewed and it has been decided to consider matching insurance on the lives of parents and their income eligibility (insurance on the lives of both father and mother and their combined income eligibility) irrespective of whosoever proposes (father or mother) while allowing insurance cover to children.

D. SPECIAL REPORTS FOR AGES UP TO 35 YEARS

At present for SUC of Rs. 1 crore and above and age at entry up to 35 years CTMT is a manual requirement along with Rest ECG, Haemogram, SBT-18, RUA & Chest X-ray.
It has been decided not to call for CTMT for SUC Rs. 1 crore and above and age at entry up to 35 years.