Session 5, this session explain in detail the administration and management of Life assurance contract

1. • a) The Life Policy Document
• Once a proposal has been accepted by the life
office and the first premium paid, the office can
prepare the policy
• A life policy document is not a contract but
evidence of an existing contract between the
assured and a life office.
• Terms and conditions of life policy documents
are similar, although life offices issue them in
different formats.
• The policy contains the following sections:

2. Policy parts:
 Heading,
 The preamble or recital clause,
 The operative clause,
 Exceptions or exclusions,
 Conditions and provisions,
 The policy schedule,
 The signature or attestation clause.

3. • Heading
• The heading specifies the name of the life
office and the address of the head office,
where notices of assignment must be sent.
• The preamble /Recital clause
• The preamble or recital outlines the parties
to the contract and refers to the proposal
form and declaration as the basis of the
contract and to the premium.

4. • The Operative Clause
• The operative clause sets out three
circumstances under which the sum
assured is payable:
the happening of the assured event,
the proof of title, and
the proof of age
• the clause must be read in conjunction
with the schedule.

5. • Exceptions (Exclusions)
Exceptions or exclusions refer to perils-
such as risks associated with AIDS, war,
and aviation-not covered in the ordinary
way.
Exclusion are applied to eliminate physical
and moral hazards which cannot be
covered in a policy.
• The Signature or Attestation
The place in the policy where the
authorized official of the company signs

6. • Conditions and provisions
Details the terms and provisions which
apply to the policy and which must be
complied with by the parties to the contract

7. • The Policy Schedule
• The schedule contains personalized
details of the asssured / life assured that
include the following:
The policy number;
The date of the proposal;;
The life assured’s name, address and
occupation;
The assured’s name address and
occupation

8. The life assured’s date of birth and
whether the age is admitted or not;
Details of sum assured, amount, with or
without profits, the beneficiary;
The assured perils or event;
The amount and the mode of the payment
of the premium;

9. The commencement date of cover/risk,
and
Special provisions, for example,
conversion option.
Date of last premium payment
Maturity date of policy
Type of policy

10. • b) Policy Administration
• Policy Servicing
• Life business is long-term, and, once a
policy is issued and its details are
recorded, a life office must:
 Have appropriate procedures for
collecting premiums and
maintain the policy until a claim is made at
either death or maturity

11. • Renewals
• A policy will show the amount and the due
date of a premium.
• This enables a policyholder to pay the
premium on the due date.
• Normally, the policy will provide days of
grace during which the premium can still
be paid.

12. • The usual period of grace is 30 days for
premium payable annually but 15 days for
premiums payable monthly, quarterly or half
yearly.
• The policy lapses if the premium is not paid
within the days of grace, unless the policy
acquired a surrender value

13. • Policyholder is legally obliged to pay premiums, for a
life office has no legal obligation to send reminders if
premiums are not paid
• In practice the life office will send reminders because it
is good marketing practice.
• Renewal premiums under ordinary branch policies are
payable annually, half yearly, quarterly, or monthly.
• Premiums can be payable weekly under industrial life
assurance policies.
• There are a number of ways in which renewal
premiums can be paid, the most common being cash,
standing orders, and “check-offs”.

14. • Arrears
• All offices have procedures designed to investigate
policies that fall in arrears.
• When a policy falls in arrears a life office will send a
letter to a policyholder showing the amount and
pointing out the consequences of non-payment of
the arrears.
• If the policyholder pays the arrears within a certain
time the policy will continue.
• If the policyholder does not pay the arrears, and the
policy has no surrender value, the policy will lapse
and the office will be ‘off the risk’.
• If the policy has a surrender value the non-forfeiture
provisions will come into effect.

15. • Revival/Reinstatement
• Once a policy has lapsed due to non-payment of
premiums, a life office is off-risk.
• Later, however, the office may receive a request
from the policyholder to reinstate or revive the
policy.
• The reinstatement is entirely at the discretion of
the underwriter-subject to the policyholder’s
payment of the arrears, late payment charge
and satisfactory state of health.

16. • The policyholder will have to declare that
he or she is in good health and, as the
duty of disclosure is also revived, give
details of any deterioration in the risk since
the date of the proposal.
• If a long period has elapsed since the
policy lapsed, the office may be willing to
consider a new proposal based on a
premium rate for the life assured’s current
age, which will be higher than the old
premium.

17. • Assignment
• An assignment is the legal transfer of ownership
of a policy to a third party.
• This often happens on life policies, and life
offices have methods of dealing with
assignments, to ensure they pay the right person
and comply with the law.
• Assignments are effected:
 by way of sale-where A sells a policy to B;
 by way of gift-where A gives a policy to B;
 under trust-where A assigns a policy to B, C and
D for the benefit of A’s children X,Y, and Z; and
 by way of mortgage-where A mortgages own
policy to B as security for a loan given to A by B.
 When A repays B in full, B reassigns the policy
to A.

18. • Endorsements
• It is necessary sometimes to effect
alterations or changes in policies during
the course of cover-although life policies
are long-term contacts.
• The alterations are effected by way of
endorsements such as changes of names,
changes of addresses, and requests for
increase in sums assured.

19. • Some endorsements will be made on the
policy documents at inception, but others
may be added subsequently
• The rule that applies in respect of
endorsements is that in the event of a
contradiction in terms between the
standard printed policy and the
endorsement, it will be assumed that the
endorsement expresses the intention of
the parties to the life assurance contract

20. • If an endorsement contradicts other parts
of the policy, the meaning of the
endorsement will prevail
• Life office valuations
• The law requires every life office to carry
out an actuarial valuation of its assets and
liabilities at least once every year.
• The purpose of valuation is to ensure that
there is a surplus, i.e. the life company is
solvent

21. • A surplus will arise from the following
circumstances:
If the mortality experience is more
favourable than that assumed in the
calculation of premium
If the rate of interest earned is in excess of
the rate assumed in the calculation of
premium
If the actual expenses of the life office are
less than the premium loading for
expenses

22. • The surplus realized by life assurance
company is used to provide the following:
Bonuses for with profit policy holders-
usually 80 to 95% of the surplus
Dividends for share holders
Special resrves

23. • Group Life Assurance
• The purpose of Group life assurance is to
provide death benefits for the dependants of
employees, who die while in the services of their
employer
• Group policies have the following features:
• Issued on the basis of one year renewable
contract
• One policy, known as group or master policy is
issued to the employer as the assured
• A membership certificate is issued to each
employee setting out the sum to be paid at death
and any conditions applicable should the
employee leave the service of the employer
• :

24. • Group life policies are underwritten on a
more lenient basis than individual policies
due to the large number of people involved
and the presumed spread of risk
• Conditions
• The majority of life offices are prepared to
offer a substantial amount of group life
assurance cover without evidence of
health (the free Cover Limit), provided the
following conditions are fulfilled

25. • A stated minimum percentage of those
who are eligible to join the scheme at its
inception do actually join the scheme.
• A minimum of 75% is mostly considered
adequate if the group has more than, for
instance, 100 eligible members do.
• In case of a smaller group, then a higher
percentage might be required.

26. • Requiring sponsor or employer to declare that
individual members are actively at work on the
day when they become eligible for membership.
• Alternatively, the condition might be that all lives
are physically and mentally capable of working,
which would also cover those on normal leave.
• The group of lives to be assured must exist for
some purpose other than assurance, for
example, employees of a firm or members of a
co-operative society.

27. • Evidence of Health
• Evidence of the health will, however, be required
in the following instances:
• Groups of advanced age;
• Groups engaged in hazardous occupations;
• Lives who were ill at the commencement date of
the scheme;
• All lives where the group is small, for instance,
less than 20; and
• Lives proposing for exceptionally high sums
assured (sums assured above The-Free Cover
Limit).

28. • Group Life Policies Administration
• Renewals
• Group schemes are mainly annual policies.
• At the expiry of every policy period, a renewal
becomes necessary in order to keep the cover in
force.
• Renewal evaluation focuses on the same risk
characteristic and claims experience data used
in the underwriting process except that at this
stage there is a likelihood of having access to
more information.

29. • The renewal procedure normally involves
issuance of a renewal notice to the client.
• The renewal notice should be dispatched one
month prior to the scheme’s anniversary so as to
give a policyholder sufficient time to fulfill cover
requirements.
• Renewal notices contain these details:
 the deposit or renewal premium required;
 a notice of changes in the terms and conditions
of the policy, if any; and
 a request for renewal data such as revised
salaries, new entrants.
 Normally 30 days of grace are provided after the
due data for a policy renewable annually.