This document discusses key provisions in insurance contracts that may result in policyholders receiving compensation less than actual losses. These include deductibles, where the policyholder bears an initial amount of loss, and coinsurance, where losses are shared between the insurer and policyholder. It provides examples of calculating compensation with these provisions for different types of insurance like health, motor, and property insurance. Overall, deductibles and coinsurance allow lower premiums but increase the financial risk to the policyholder.
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SCE1034 BIOLOGI I
MENGKAJI DAN MEMERHATI SEL HAIWAN (SEL PIPI) DAN SEL TUMBUHAN (SEL BAWANG)
By: Atifah Ruzana binti Abd Wahab, PPISMP Sains Ambilan Jun 2014, IPG Kampus Kent Tuaran Sabah
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Introduction to insurance, why it is important, and various problems leading to market failure. Also includes the problem of hidden action, principal-agent problem, economic model describing the case under perfect and imperfect information and equilibrium analysis. Further, the relation between a country's GDP to the premium paid is analyzed.
Presentation on Insurance in Cambodia. Terminology of Insurance contracts. Roles of Agents and Brokers. Size of insurance industry worldwide and in Cambodia. Insurers in Cambodia and size. Growth of Insurance market in Cambodia.
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2. STANDARD PEMBELAJARAN
3.1.3 Menyelesaikan masalah yang melibatkan insurans termasuk deduktibel dan ko-
insurans.
KRITERIA KEJAYAAN
• Pelajar dapat mengira bayaran pampasan melibatkan deduktibel dan ko-
insurans
3.
4. Terdapat beberapa peruntukan dalam kontrak insurans
yang menyebabkan pemegang polisi mungkin menerima
pampasan kurang daripada kerugian sebenar dan perlu
menanggung sebahagian daripadanya.
PERUNTUKAN
DALAM KONTRAK
DEDUKTIBEL
KO-INSURANS (Insurans
Bersama)
5. suatu jumlah yang perlu ditanggung oleh pemegang polisi sebelum layak
membuat tuntutan daripada syarikat insurans
insurans harta
insurans perubatan dan kesihatan,
insurans motor
insurans hayat
insurans liabiliti diri
DEDUKTIBEL
6. Contoh 4, m/s 86
Puan Suhaila telah membeli insurans motor untuk keretanya yang mempunyai peruntukan deduktibel sebanyak
RM300. Sepanjang tempoh insurans tersebut, Puan Suhaila telah mengalami tiga kali kemalangan. Kerugian yang
dialami adalah pada bulan Mac, Julai dan Ogos masing-masing sebanyak RM2 800, RM250 dan RM400. Nyatakan
sama ada Puan Suhaila boleh membuat tuntutan terhadap kerugian yang dialami atau tidak. Jika ya, nyatakan
jumlah bayaran pampasan yang boleh dituntutnya bagi setiap kerugian yang dialami.
Bulan Kerugian (RM) Boleh buat
tuntutan ?
Bayaran
pampasan
Mac 2 800 Boleh 2 500
Julai 250 Tidak Tiada
Ogos 400 Boleh 100
7. Bagi insurans motor
dikenakan mengikut budi bicara syarikat insurans.
Pemegang polisi
bertanggungjawab menanggung deduktibel wajib
sebanyak RM400 sekiranya kenderaan yang diinsuranskan
itu dipandu oleh
• individu yang tidak dinamakan dalam polisi,
• individu tersebut dinamakan dalam polisi tetapi
berumur bawah 21 tahun,
• pemegang lesen memandu sementara (L) atau
• pemegang lesen memandu penuh yang kurang dari 2
tahun.
Bagi insurans lain (selain insurans motor)
8. Contoh 5, m/s 86
Cher Lin mempunyai polisi insurans perubatan dengan deduktibel sebanyak RM30 000
setahun dengan had tahunan bernilai RM300 000. Pada tahun pertama dalam tempoh
insuransnya, Cher Lin telah dimasukkan ke hospital untuk pembedahan apendiks dan
dikenakan kos rawatan sebanyak RM8 000. Pada tahun berikutnya, Cher Lin perlu melakukan
pembedahan jantung dan dikenakan kos rawatan sebanyak RM210 000. Nyatakan jumlah
yang perlu ditanggung oleh Cher Lin dan jumlah yang dibayar oleh syarikat insurans bagi
tahun pertama dan kedua tempoh insuransnya.
Pada tahun pertama
Kos rawatan = RM 8 000
Jumlah yang perlu ditanggung oleh Cher Lin = RM 8 000
9. Cher Lin mempunyai polisi insurans perubatan dengan deduktibel sebanyak RM30 000
setahun dengan had tahunan bernilai RM300 000. Pada tahun pertama dalam tempoh
insuransnya, Cher Lin telah dimasukkan ke hospital untuk pembedahan apendiks dan
dikenakan kos rawatan sebanyak RM8 000. Pada tahun berikutnya, Cher Lin perlu melakukan
pembedahan jantung dan dikenakan kos rawatan sebanyak RM210 000. Nyatakan jumlah
yang perlu ditanggung oleh Cher Lin dan jumlah yang dibayar oleh syarikat insurans bagi
tahun pertama dan kedua tempoh insuransnya.
Pada tahun kedua:
Kos rawatan = RM 210 000
Jumlah yang perlu ditanggung oleh Cher Lin = RM 30 000
Jumlah yang perlu ditanggung oleh Syarikat insurans
=𝑅𝑀 210 000 − 𝑅𝑀 30 000
= 𝑅𝑀 180 000
11. KO-INSURANS
DALAM HARTA
“pemegang polisi dikehendaki menginsuranskan hartanya
pada suatu jumlah tertentu berdasarkan peratusan ko-
insurans yang telah ditetapkan oleh syarikat insurans daripada
nilai boleh insurans harta tersebut.”
Fasal Ko-insurans Dalam Insurans Harta
Fasal (clause) adalah bahagian daripada
bab dalam undang-undang.
nilai sebenar aset, kos penggantian aset
atau nilai lain yang dinyatakan dalam fasal
penilaian polisi insurans.
12. Harta tersebut akan dinilai dulu oleh pihak penilai insurans, pihak insurans akan
memberikan peratusan ko-insurans berdasarkan ciri-ciri yang telah ditetapkan
mereka
Pemegang polisi perlu
menanggung sebahagian
daripada kerugian
Bersama-sama syarikat
tersebut
Jika tidak di patuhi
Menginsuranskan hartanya
mengikut peruntukan ko-
insuransnya.
Pampasan penuh
13. Nilai
diinsuranskan = Jumlah insurans
yang harus dibeli
1
Bayaran
pampasan = Jumlah kerugian - Deduktibel
Jumlah kerugian kurang atau sama dengan
jumlah insurans yang dibeli
Bayaran pampasan dikira mengikut tiga situasi berikut
14. Nilai diinsuranskan < Jumlah insurans yang
harus dibeli
2
Bayaran
pampasan =
𝐽𝑢𝑚𝑙𝑎ℎ 𝑖𝑛𝑠𝑢𝑟𝑎𝑛𝑠 𝑦𝑎𝑛𝑔 𝒕𝒆𝒍𝒂𝒉 𝑑𝑖𝑏𝑒𝑙𝑖
𝐽𝑢𝑚𝑙𝑎ℎ 𝑖𝑛𝑠𝑢𝑟𝑎𝑛𝑠 𝑦𝑎𝑛𝑔 𝒉𝒂𝒓𝒖𝒔 𝑑𝑖𝑏𝑒𝑙𝑖 - (Deduktibel)
Pampasan yang diterima semakin kecil
jumlah
-
Dikenakan penalti ko-insurans
Mengalami
kerugian
menyeluruh
3
Bayaran
pampasan = Jumlah insurans
yang telah dibeli - Deduktibel
15. Deduktibel + Ko-insurans :
Premium yang dibayar menjadi rendah
Bayaran maksimun
pampasan = jumlah Nilai Muka
insurans yang telah dibeli
Prinsip Indemniti
Bayaran maksimun
pampasan =
=
16. Contoh 6, m/s 88
(a)Jumlah insurans yang harus dibeli =
80
100
× 𝑅𝑀350 000
= 𝑅𝑀280 000
17. Nilai
diinsuranskan = Jumlah insurans yang
harus dibeli
Bayaran pampasan = Jumlah kerugian - Deduktibel
(i) Bayaran pampasan = 𝑅𝑀25 000 – 𝑅𝑀2 000
= 𝑅𝑀23 000
18. Nilai diinsuranskan < Jumlah insurans yang harus dibeli
Bayaran
pampasan
=
𝐽𝑢𝑚𝑙𝑎ℎ 𝑖𝑛𝑠𝑢𝑟𝑎𝑛𝑠 𝑦𝑎𝑛𝑔 𝒕𝒆𝒍𝒂𝒉 𝑑𝑖𝑏𝑒𝑙𝑖
𝐽𝑢𝑚𝑙𝑎ℎ 𝑖𝑛𝑠𝑢𝑟𝑎𝑛𝑠 𝑦𝑎𝑛𝑔 𝒉𝒂𝒓𝒖𝒔 𝑑𝑖𝑏𝑒𝑙𝑖 - (Deduktibel)
jumlah
-
RM150 000 < RM280 000
20. KO-INSURANS DALAM INSURANS
KESIHATAN
“pemegang polisi dikehendaki menanggung sebahagian
daripada kos perubatan yang dilindungi kontrak mengikut
suatu kadar yang dipersetujui selepas mengambil kira
peruntukan deduktibel, sekiranya ada.”
Fasal Penyertaan Peratusanko-insurans Dalam
Insurans Kesihatan
25. Pelan polisi XX adalah lebih baik
• walaupun kedua-duanya memberikan had tahunan keseluruhan yang sama, iaitu
RM50 000
• premium tahunan bagi XX adalah lebih kecil berbanding dengan YY.
• faedah yang ditawarkan juga adalah lebih baik dari segi tempoh perlindungan, iaitu
sepanjang tahun bagi bilik hospital dan makanan, dan elaun tunai harian di hospital
kerajaan.
• tiada had perlindungan bagi unit rawatan rapi kerana pampasan dibayar mengikut
caj rawatan yang dikenakan kepada pemegang polisi, berbeza dengan polisi YY yang
mempunyai had sebanyak RM400 bagi tempoh perlindungan yang sama.
Penyelesaian