COMPLIANCE, GOVERNANCE AND RISK RISK MANAGEMENT IN INSURANCE
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1 COMPLIANCE, GOVERNANCE AND RISK MANAGEMENT IN INSURANCE SUBJECT CODE IRCC 01 IRCC 02 IRCC 03 SUBJECT NAME FUNDAMENTALS OF INSURANCE INSURANCE REGULATIONS GOVERNANCE AND COMPLIANCE RISK MANAGEMENT IN INSURANCE 1
2 IRCC 01:- FUNDAMENTALS OF INSURANCE Year of Edition: 2015 Contents: Chapter 1: Introduction to Risk and Insurance: Basic concept of risk Assets Risks and Perils Risk and Uncertainty Risk as Statistical Dispersion - Classification of Risks - Nature of Risk Environment - Static and dynamic risks Fundamental and Particular Risks Hazards - role of Insurance - Insurance and the burden of risk - mechanism of insurance. Chapter 2: Risk Management and Insurance: Risk Management and Insurance Management - Steps in the Risk Management Process - Laying the objectives - Identification of risks - Evaluating and measuring the risk - Loss Frequency - Loss Severity - Classifying the Risk - Managing the Risk - Risk Control Retention - Insurance as a tool. Chapter 3: Principles of General Insurance: General insurance the legal definition - Heterogeneity of Risk Exposures - Heterogeneity and Risk Classification Solidarity - Claims Frequency and Size - Distribution of Claims - Credibility theory - Risk Theory and the concept of Ruin The Pure risk premium - The Office Premium - Class and Individual Rates Reserves. Chapter 4: Life Insurance An Introduction: Life Insurance and its customers The Economic Life Cycle The Asset Defining and Measuring HLV The Risks Mortality verses other risks Age and mortality risk Level Premiums Types of Life Insurance - Pooling and financial risks The contract The Buy Term Debate. Chapter 5: Principles of Life Insurance: Premiums: Determination of Premiums Premiums and Price Elements of Premium Mortality The Mortality Table Standard Mortality Table Calculation of Mortality Costs Interest - Future and Present Value of Annuity The Net Premium Net single Premium Net Level Annual Premium Gross Premiums Reasons for Loading Loading for Expenses Loading for contingencies Bonus Loading. Chapter 6: Principles of Life Insurance: Profit and Returns: The Actuarial Control Cycle Reserves Net and Gross Premium Reserves Assets Shares and Surrenders Valuation and Surplus Analysis of Surplus Sources of Surplus Determining the divisible surplus Factors influencing retention of surplus Free Assets Distribution of surplus The Bonus mechanism Reversionary Bonus Cardinal principles in bonus 2
3 distribution Re valorisation The contribution method Investment and Unit Linked Insurance. Chapter 7: Legal Foundation of Insurance: Sources of Law Elements of Insurance Contract The Principle of Adhesion The Principle of Uberrims Fides Material Facts Breach of Utmost Good Faith Mis-Representation - Representation and Warranty The principle of Insurable Interest The Principle of Subrogation The Principle of Contribution Proximate Cause. Chapter 8: Pension Health and Group Insurance: Pensions and Old Age Income Security Public Pensions Occupational Pensions Personal Pension Pensions the value proposition Morbidity and Insurance Medical Expenses Insurance Managed Care and Medical Expenses Living Benefits Long Term Care Discuss the Group Insurance. Chapter 9: The Financial Market Place and Insurance: Introduction of Finance and Financial Products Basic Categories of Financial Products Distinctive Features of Financial Products Attributes of Financial Assets Risk Liquidity Convenience Tax Benefit Fiduciary Responsibility Financial Market-A Taxonomy Primary and Secondary Market Money and Capital Markets. Chapter 10: Insurance: The Changing Context: Demographics and other changes Life Cycle Changes Family Changes The Three Pillars Changing Profit of Non-Life Risks Financial Market Changes Implication and Industry Responses. Annexure - Pension Fund Regulatory and Development Authority Act
4 IRCC 02: INSURANCE REGULATIONS GOVERNANCE AND COMPLIANCE First Edition: 2015 Contents: Chapter1: Overview of legal environment: Objectives- Nature of insurance contract - essentials for a valid contract - Constitution of the insurance regulatory and development authority of India- Duties, powers and functions of the authority - Insurance ombudsmen and consumer courts - Procedural matters before the Ombudsman - What is a complaint - consumer disputes redressal agencies - Power of civil court to district forum - Relief to the complainant - Other legislations applicable to insurance companies act, Authentication of documents on behalf of a company (section 21)- Private placement - further issues of capital - Transfer and transmission of shares - nomination by shareholders - Notice of shareholders meetings - Minutes of meetings Dividends - Corporate social responsibility (CSR)- Statutory auditors - Board of Directors - Appointment of Directors - Retirement of Directors - Additional, Alternate and Casual Vacancy Directors - Board meetings - Audit Committee & Nomination and Remuneration Committee - Powers of the Board - Appointment and Remuneration of Managing or Whole time Directors - Competition Act - Memorandum of Foreign Exchange Regulations Relating to Life Insurance in India - Memorandum Of Exchange Control Regulations Relating to General Insurance in India - Premiums on Marine Policies Covering Exports & Imports - Claims On Policies Covering Merchanting Trade - Non-Marine Insurance - Baggage And Valuables In Transit - Risks insurance on Marine hulls Reinsurance - Remittance of Reinsurance Premia by Local Brokers - Foreign Currency Accounts and Investments Abroad - Applicable TRAI Regulations - Indian Stamp Act and J&K Stamp Act - Financial Services Authority (FSA) Principles of Good Regulation - International Association of Insurance Supervisors (IAIS) - Key Core Principles Chapter 2: Incorporation of Insurance Companies: Definition - Requirement of registration of Insurance companies under the Act - Meaning of a Public Limited Company - Important requirements as to Memorandum and Articles of Association - Application for registration and documents to be annexed thereto - Stages in registration - Method of calculating foreign equity in Indian insurance companies - Quantum of Foreign Direct Investment - Obligation to commence business within 12 months of date of registration- Circumstances when IRDAI may suspend or cancel the registration of an insurer - Regulation 20 of IRDAI Regulations, Chapter 3: Corporate Governance in Insurance Companies: Principles of Corporate Governance - Provisions relating to Directors - Directors representing small shareholder - Provisions relating to appointment and remuneration of Whole time and 4
5 Managing Director - Provisions concerning holding of meetings - Internal Audit and Statutory Audit & Audit Committee - Miscellaneous rights of Shareholders - Constitution of Committees - Role of Appointed Actuary. Chapter 4: Compliance Organisation: Activities of compliance - Compliance organization - Role of compliance function - Compliance risk management Chapter 5: Investment Related Compliances: Introduction - Investment categories based on type of business - Minimum and maximum investments based on Credit rating - Operational level controls - Risk Management systems review Chapter 6: Products And Actuarial Related Compliances : General guideline on products - Waiting period for launch of insurance products- Product structure for Life insurance companies- Participating products (With Profits Products or Par products) - Minimum Death Benefit under Non-linked insurance products - Minimum sum assured under Linked insurance products - Obligations of the insurer for revival of the policy - Obligations of an insurer upon discontinuance of a policy - Options under Pension products - Financial Planning- Group insurance products - Group Savings Variable Insurance Products - Group Insurance Products Administration - Approval of Innovative products - System readiness certification before launching the product - Prohibition on variations in tariff coverages, wordings, endorsements and warranties - Filing of products - File and use requirement - Responsibility for compliance - Classification of products - role of Appointed Actuary - Documents required to be filed Reinsurance. Chapter 7: Distribution Related Compliances: Definition- Application for appointment as Individual Agents- Appointment letter & Identity card issued by the Insurance Company - Code of Conduct for Insurance Agents - Other compliances of a Corporate Agent- Insurance Brokers Regulations- functions of the Reinsurance Brokers Remuneration - Conduct in matters relating to clients relationship / Sales practices/ Furnishing of information/ Explanation of insurance contract / Renewal of policies/ Claim by client / Receipt of complaints / To documentation / Advertising/ Receipt of remuneration / Training - IRDAI (Micro Insurance) Regulations, Web Aggregators. Chapter 8: Customer Complaints Handling, Claims and Redressal: Definition principles -Claims procedure of life insurance policy & general insurance policy - Chapter 9: Accounting Related Compliances: Compliance with the requirements of the Accounting Standards - Accounting and Disclosure Requirements - Guidelines for preparation of financial statements - Conditions to be met for declaration of bonus to the policyholders - Disclosures in the Notes to Accounts - Guidelines for Disclosure 5
6 requirements - Clarifications on Ceiling on expenses of management - Other disclosures in Financial Statements - Asset Classification - Additional Disclosures In Financial Statements - Disclosures for ULIP business - Public Disclosures - Chapter 10: Other Key Compliances in Insurance: Introduction - Anti Money Laundering (AML) - Office Details Solvency Advertisement- Outsourcing Guidelines - Rural & Social Sector Obligations Chapter 11: Key Compliances - Other than Insurance: Governance Risk And Compliance - Importance Of Compliance In Business - Public Issues By General Insurance Companies - Commodity Exchanges - Foreign Assets Tax Compliance Act (FATCA) - IFRS Reporting - Indian Accounting Standards - Impairment Of Reinsurance Assets - Discretionary Participation Features In Insurance Contracts 6
7 IRCC 03: RISK MANAGEMENT IN INSURANCE First Edition: 2015 Contents: Chapter 1: Risks in an Insurance Enterprise: Enterprise risk management - Classes of risks - Rating of a risk - Evaluation and quantification of risks - Preparation of Risk registers - Risk Governance - Risk related Committees - Role of a Chief Risk Officer - Risks in Insurance Business Chapter 2: Financial Risks I (General): Assets under Management (AUM) - Types of Financial Risks - Reserving / Provisioning - Risk Appetite Framework for Life Insurance Companies - Objective - Application of shocks on financial parameters - Fixed Income Credit Risk Framework - Rating - Modulation of the Exposure limits Chapter 3 : Financial Risks II (General) : Accounting Standard - International Financial Reporting Standards - Benefits of Convergence with IFRS - Comparison of IFRS, Indian GAAP and Ind AS - Indian Accounting Standards - Financial Management Concepts in India - Capital Budgeting - Working Capital Management - Financing Decision - Objectives of Financial Management Chapter 4: Operational Risk: Qualitative Risk Assessment - Analysis of Risks - Evaluation and Quantification of Risks - Monitoring And Reporting Risks - Quantitative Risk Assessment Steps Chapter 5 :Actuarial Risks : Concept of Actuarial Risks in Insurance - Key Factors Influencing Actuarial Risks - Burning Cost - Concept of Pricing - Experience Rating of a Health Insurance Policy - Pricing Risk - Solvency Risk Chapter 6: Other Risks: Reputation Risk - Stakeholders Management And Reputation Risks - Benefits Of Reputation Management - Monitoring Actual And Potential Risks - Benefits of Monitoring - Risk Prioritization - Benefits, Examples of Risk Mitigation Actions - Compliance Risk Management - Anti-Money Laundering (AML) Related Risks - Important AML Risk- Emerging Risks Chapter 7: Business Contingency Planning & Disaster Recovery Planning: Introduction - Backup Computer Processing Choices - Contingency Planning Process - Detailed Outline of a Disaster Recovery Plan - Business Continuity Plan - Contingency Planning Process Chapter 8: Risk Containment Measures: Characteristics of Risk Containment Measures - Fraud Risk Risk Containment - Insurance Fraud - Types of Insurance Fraud - Example of Fraud Indicators - Benefits of Conducting a Fraud Risk Assessment - Important Aspects of The Anti-Fraud Policy - Theft Recovery - Types of Auto Insurance in India - Theft Claims 7
8 Chapter 9: Risk Management Techniques: Risk Appetite Framework - Characteristics of Risk Appetite Framework - Components of Risk Appetite Framework - Risk Management Techniques- Risk Transfer - Methods of Risk Transfer - Types of Reinsurance Contracts - Treaty Reinsurance - Types of Proportional Reinsurance - Concept of Own Risk Solvency Assessment (ORSA) Features/ Objectives of ORSA / Conclusion on Risk Management Updated as on
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