IRDAI Assistant Manager Insurance and Management (Specialist Stream) Syllabus

Distinguish proportional from non-proportional reinsurance, giving examples.

Proportional: reinsurer shares premiums and losses in a fixed proportion (e.g., quota share, surplus treaty). Non-proportional: reinsurer pays only when losses exceed a retention/threshold (e.g., excess of loss, stop loss).

Define co-insurance and how it differs from reinsurance.

Co-insurance is the sharing of a single large risk among two or more insurers at inception, each directly liable to the insured for its agreed share. Reinsurance is a separate contract between insurers; the original insured has no direct relationship with the reinsurer.

Who is the national reinsurer of India and what is the obligatory cession requirement?

General Insurance Corporation of India (GIC Re). Indian general insurers must cede a regulator-prescribed percentage of every policy (the 'obligatory cession') to GIC Re; the percentage is set by IRDAI from time to time.

Name the four traditional types of life insurance plans.

Term insurance (pure protection), whole life (cover for entire life), endowment (protection plus savings, pays on maturity or death), and money-back (periodic survival benefits plus death cover).

What is a ULIP?

A Unit Linked Insurance Plan combines life cover with market-linked investment; premiums (after charges) buy units in chosen funds, so the maturity value depends on market performance. Returns are not guaranteed and investment risk is borne by the policyholder.

Define an annuity and distinguish immediate from deferred annuities.

An annuity is a series of periodic payments made by an insurer to an annuitant, used to provide retirement income. Immediate annuity payments begin right after a single lump-sum premium; deferred annuity payments begin after an accumulation period.

Differentiate a life annuity from an annuity certain.

A life annuity pays for as long as the annuitant lives (longevity protection). An annuity certain pays for a fixed period regardless of survival, with the balance to nominees if the annuitant dies during the term.

What is the free-look period for a life insurance policy in India?

A period (now 30 days from receipt of the policy document under current IRDAI norms) during which the policyholder may review terms and return the policy for a refund of premium less proportionate risk/medical/stamp charges.

What is a TPA in health insurance?

A Third Party Administrator is an IRDAI-licensed intermediary that provides health-claim services on behalf of insurers, such as issuing ID cards, running the cashless network, and processing and settling claims. TPAs do not sell policies or bear risk.

Distinguish cashless from reimbursement health claims.

In cashless, the insurer/TPA settles the hospital bill directly at a network hospital (subject to pre-authorisation). In reimbursement, the insured pays the hospital first and then claims the amount back from the insurer with bills and documents.

What is a pre-existing disease (PED) waiting period in health insurance?

PEDs are conditions existing before policy inception; they are covered only after a specified continuous waiting period. Under IRDAI's 2024 health regulations the maximum PED waiting period is capped at 3 years.

Explain 'sub-limit', 'co-payment', and 'deductible' in health insurance.

Sub-limit caps the amount payable for a specific item (e.g., room rent). Co-payment is a fixed percentage of each claim the insured must bear. Deductible is a fixed amount the insured pays before the insurer's liability begins.

Under the Motor Vehicles Act, which motor cover is legally compulsory in India?

Third-party liability insurance is mandatory for every vehicle plying on public roads; it covers the insured's legal liability for death/injury to third parties and damage to third-party property. Own-damage cover is optional.

Differentiate 'comprehensive' (package) motor policy from 'third-party only'.

Third-party only covers liability to others. Comprehensive/package adds own-damage cover for the insured vehicle (accident, fire, theft, natural calamities) plus the compulsory third-party section, and usually a personal accident cover for the owner-driver.

What is No Claim Bonus (NCB) in motor insurance?

A discount on the own-damage premium given at renewal for each consecutive claim-free year, ranging from 20% to a maximum of 50%. It attaches to the policyholder, not the vehicle, and is forfeited if a claim is made.

What is the principal document of a marine cargo insurance and the basis of the Indian marine law?

The marine policy (often with a certificate of insurance). Indian marine insurance is governed by the Marine Insurance Act, 1963, modelled on the UK Marine Insurance Act, 1906.

Differentiate average clause application in fire insurance (under-insurance).

If the sum insured is less than the actual value of property at the time of loss, the average clause makes the insured a co-insurer for the shortfall: Claim = (Sum Insured / Actual Value) x Loss. It penalises under-insurance.

What is the standard fire policy in India called and name two add-on perils.

The Standard Fire and Special Perils (SFSP) policy, now offered to large risks as Bharat Sookshma/Laghu Udyam and Standard Fire policies. Common covered/add-on perils include storm/flood, earthquake (add-on), riot/strike/malicious damage, and impact damage.

Define underwriting in insurance.

The process of assessing, classifying, and selecting risks proposed for insurance, deciding whether to accept them, on what terms, and at what premium, to maintain a balanced and profitable portfolio.

What are the possible underwriting decisions on a proposal?

Accept at standard rates, accept with loading (extra premium), accept with modified terms/exclusions or sub-standard rating, postpone the decision, or decline/reject the risk.

List the typical steps in settling an insurance claim.

1) Intimation/notification of loss, 2) Registration and assignment, 3) Survey/investigation and assessment (surveyor for general claims), 4) Submission of documents, 5) Determination of admissibility and quantum, and 6) Settlement/payment or repudiation with reasons.

For general insurance claims above a threshold, who must assess the loss?

An IRDAI-licensed surveyor and loss assessor must assess losses above the prescribed monetary limit (currently Rs 1,00,000) before settlement.

What is an actuary and what is their core role?

A qualified professional who applies mathematics, statistics, and financial theory to assess risk and uncertainty. In insurance, the actuary determines premiums, reserves/liabilities, bonuses, and certifies the financial soundness of the insurer (Appointed Actuary).

What are the main components of a life insurance premium (premium-loading concept)?

The net (pure/risk) premium covers expected claims based on mortality and interest assumptions; the gross (office) premium adds loadings for expenses, contingencies/margins, and profit, with adjustment for the rate of return assumed.

State the basic relationship for pure premium and the role of a mortality table.

Pure premium = Probability of loss x Average severity (expected loss). A mortality table shows the probability of death at each age (and survivors per cohort), which actuaries use to price life cover and reserves.

What is the law of large numbers and why is it central to insurance pricing?

As the number of similar independent exposures increases, the actual average loss converges to the expected (true) loss. It allows actuaries to predict aggregate losses accurately and set credible, stable premiums.

What is the primary purpose of the Insurance Act, 1938?

It is the principal legislation regulating the conduct of insurance business in India, covering registration of insurers, investments, solvency, accounts, licensing of intermediaries, policyholder protection, and powers over insurer operations.

When was IRDA established and under which Act, and what is its current name?

The Insurance Regulatory and Development Authority was established under the IRDA Act, 1999 (constituted as a statutory body in 2000). It is now called the Insurance Regulatory and Development Authority of India (IRDAI).

State the primary mission/duty of IRDAI.

To regulate, promote, and ensure orderly growth of the insurance and re-insurance business while protecting the interests of policyholders, as set out in Section 14 of the IRDA Act, 1999.

What is the minimum paid-up equity capital required to start a life or general insurance company, and for a standalone reinsurer, in India?

Rs 100 crore for a life or general (including health) insurer and Rs 200 crore for a reinsurer, as prescribed under the Insurance Act, 1938.

What is the regulatory solvency margin ratio insurers must maintain in India?

Insurers must maintain a minimum Solvency Ratio of 1.5 (i.e., Available Solvency Margin must be at least 150% of the Required Solvency Margin), the regulatory control level set by IRDAI.

What is the IRDAI Integrated Grievance Management System (IGMS) and the Bima Bharosa portal?

Bima Bharosa (earlier IGMS) is IRDAI's online platform for registering, tracking, and monitoring policyholder complaints across insurers, ensuring grievances are logged and resolved within prescribed turnaround times.

What is the role of the Insurance Ombudsman and the monetary limit on its awards?

The Insurance Ombudsman provides a cost-free, quick, out-of-court mechanism to resolve policyholder complaints against insurers. Under the Insurance Ombudsman Rules, 2017, it can pass binding awards up to Rs 30 lakh.

List the main distribution channels/intermediaries for insurance in India.

Individual and corporate agents, insurance brokers, bancassurance partners, Insurance Marketing Firms (IMFs), web aggregators, point-of-sale persons (POSP), Common Service Centres (CSC), and direct/online sales.

Differentiate an insurance agent from an insurance broker.

An agent represents the insurer and can sell the products of (generally) one insurer per category, earning commission from that insurer. A broker represents the customer, can place business with multiple insurers, and advises the client on the best cover.

List Henri Fayol's five functions of management (POSDC).

Planning, Organising, Staffing (Commanding/Directing), Coordinating, and Controlling. (Often summarised in modern texts as Planning, Organising, Staffing, Directing, and Controlling.)

What is organisational behaviour (OB)?

The systematic study of how individuals and groups act within organisations, and the application of that knowledge to improve effectiveness. It draws on psychology, sociology, and anthropology and operates at individual, group, and organisational levels.

Summarise Maslow's hierarchy of needs.

A five-level pyramid of motivating needs activated in order: physiological, safety, social (belonging), esteem, and self-actualisation. A satisfied need no longer motivates; the next higher need emerges.

Contrast Herzberg's hygiene factors and motivators.

In Herzberg's two-factor theory, hygiene factors (pay, policy, working conditions, supervision) prevent dissatisfaction but do not motivate; motivators (achievement, recognition, responsibility, growth) drive genuine satisfaction and motivation.

What are McGregor's Theory X and Theory Y?

Theory X assumes employees dislike work, avoid responsibility, and need control/coercion. Theory Y assumes employees are self-motivated, seek responsibility, and exercise self-direction when committed to goals.

Name the main leadership styles in the autocratic-democratic-laissez-faire framework.

Autocratic (leader decides alone), Democratic/Participative (leader involves the team in decisions), and Laissez-faire (free-rein; leader delegates and minimally intervenes).

Define communication and list the elements of the communication process.

Communication is the exchange of information and meaning between sender and receiver. Elements: sender, encoding, message, channel/medium, receiver, decoding, feedback, and noise (any barrier distorting the message).

What are the main types/directions of organisational communication?

Formal vs informal (grapevine); and by direction: downward, upward, horizontal (lateral), and diagonal communication.

Define Human Resource Management (HRM) and list its core functions.

HRM is managing people to achieve organisational goals and meet employee needs. Core functions: human resource planning, recruitment and selection, training and development, performance appraisal, compensation/benefits, and employee/industrial relations.

Differentiate recruitment from selection.

Recruitment is the positive process of searching for and attracting a pool of potential candidates. Selection is the negative/screening process of choosing the most suitable candidate from that pool through tests, interviews, and verification.

What is the marketing mix (4 Ps), and the extended 7 Ps for services?

4 Ps: Product, Price, Place, Promotion. The extended 7 Ps for services (including insurance) add People, Process, and Physical Evidence.

Differentiate marketing from selling.

Selling focuses on the seller's need to convert products into cash, emphasising existing products and short-term volume. Marketing focuses on customer needs and satisfaction, starting from the market and aiming at long-term profitable relationships.

Define market segmentation and name common bases.

Dividing a heterogeneous market into homogeneous sub-groups with similar needs to target them effectively. Common bases: geographic, demographic, psychographic, and behavioural segmentation.

Define corporate governance.

The system of rules, practices, and processes by which a company is directed and controlled, balancing the interests of shareholders, management, customers, regulators, and the community, built on transparency, accountability, fairness, and responsibility.

What are the four pillars/principles of good corporate governance?

Transparency, Accountability, Fairness (equity), and Responsibility (often expanded to include independence). They guide board conduct and protection of stakeholder interests.

Define business ethics and distinguish it from law.

Business ethics is the application of moral principles and standards of right and wrong to business conduct. Law sets the minimum enforceable standard; ethics covers a wider domain of what one ought to do even when not legally required.

What is a 'whistle-blower policy' and why is it part of governance?

A formal mechanism allowing employees to report unethical, illegal, or fraudulent conduct confidentially and without retaliation. It strengthens internal control, transparency, and accountability, key elements of corporate governance.

What is the principle of loss minimisation (mitigation) in insurance?

The insured must act as a prudent uninsured person would and take all reasonable steps to minimise or prevent further loss at the time of and after a covered event; the insurer is not liable for additional loss caused by the insured's negligence to mitigate.

Compare life insurance and general insurance on key features.

Life insurance: long-term contract, element of certainty (death is certain, timing uncertain), savings + protection, principle of indemnity does NOT apply (benefit policy). General insurance: usually annual contracts, covers pure risks to property/liability/health, and is governed by the principle of indemnity.