Insurance Intermediaries

Quality Assurance Scheme

Life Insurance Examination

Study Notes
 PREFACE

These Study Notes have been designed to prepare candidates for the Insurance
Intermediary Qualifying Examination in the subject of “Life Insurance”. They are intended
to give candidates a general introduction to the subject and reference materials, where
identified in these Notes, serves to provide candidates with a wider coverage of the syllabus
and can be used selectively by candidates who wish to investigate a topic in particular
detail. The examination, however, will be based on these Notes.

Some parts of these Study Notes are reproduced, with the kind consent of the Office
of the Commissioner of Insurance of Hong Kong, from the text prepared for the purpose of
the Quality Assurance Scheme. Appreciation is also due to the Macau Insurers’
Association, Macau Insurance Agents and Brokers Association, and Federation of Macau
Professional Insurance Intermediaries for their valuable advice and assistance in the
preparation of these Notes.

It should be noted that new editions or amendments of the Notes will be published
from time to time where necessary. Although we have exercised diligence in the
preparation of these Notes, errors or omissions may still be inevitable. We would
appreciate your feedback on these Notes, in order that improvements can be made in the
next edition or amendments of these Study Notes.

First Edition: December 2001

© 1999, 2001 Office of the Commissioner of Insurance of Hong Kong

© 2001 Monetary Authority of Macau.

These Study Notes can be downloaded free of charge from the website of the AMCM
(http://www.amcm.gov.mo). No part of the Study Notes may be reproduced for the
purposes of selling or making profit without the prior permission of the Monetary Authority
of Macau and Office of the Commissioner of Insurance of Hong Kong.

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 TABLE OF CONTENTS

Chapter

1. INTRODUCTION TO LIFE INSURANCE

1.1 Definition of Life Insurance
1.1.1 Needs for Life Insurance
1.2 Principles of Life Insurance
1.2.1 Insurable Interest
a. Beneficiary Designation
1.2.2 Duty of Disclosure
1.2.3 Other Insurance Principles
1.3 Calculation of Life Insurance Premium
1.3.1 Premium
a. Mortality, Interest and Expenses
b. Other Factors
1.3.2 Natural and Level Premium Systems
a. The Natural Premium System
b. The Level Premium System

2. TYPES OF LIFE INSURANCE

2.1 Traditional Types
2.1.1 Term Insurance
a. Level/Decreasing/Increasing Term Insurance
b. Renewable/Convertible Term Insurance
2.1.2 Endowment Insurance
2.1.3 Whole Life Insurance
2.1.4 Annuities and Pensions
a. Annuities
b. Pensions

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 2.2 Non-Traditional Insurance
2.2.1 Universal Life
2.2.2 Unit-Linked Policy
2.3 Group and Individual Insurance Plans

3. BENEFIT RIDERS AND OTHER PRODUCTS

3.1 Disability Benefits
3.1.1 Waiver of Premium
3.1.2 Disability Income Benefit
3.2 Accident Benefits
3.2.1 Accidental Death and Dismemberment
3.2.2 Other Accident Benefits
3.3 Accelerated Death Benefits
3.3.1 Critical/Terminal Illness/Dread Disease
a. Critical/Terminal Illness (TI) Benefit
b. Dread Disease (DD) Benefit
3.3.2 Long-Term Care (LTC)
3.4 Medical Benefits
3.5 Insurability Benefits
3.5.1 Guaranteed Insurability Option
3.6 Inflationary Adjustment
3.6.1 Cost of Living Adjustment (COLA)

4. EXPLAINING THE LIFE INSURANCE POLICY

4.1 The Entire Contract
4.2 Incontestability
4.3 Grace Period
4.4 Beneficiary Designation
4.5 Nonforfeiture Benefits
4.6 Policy Loan
4.7 Reinstatement
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 4.8 Misstatement of Age or Sex
4.9 Assignment
4.10 Dividend Options
4.11 Settlement Options
4.12 Suicide Clause

5. LIFE INSURANCE PROCEDURES

5.1 Company Operation
5.1.1 Typical Company Operational Structure
5.2 Application
5.2.1 Application Procedure
5.2.2 Receipts and Policy Effectiveness
5.2.3 Customer Service - Policies and Standards
a. The Importance of Customer Service
b. How to Achieve Quality Customer Service
5.2.4 Cooling-Off Period
5.2.5 Policy Switching
5.3 Underwriting
5.3.1 Factors Considered
5.3.2 Medical Reports
5.3.3 Sub-Standard Life and Underwriting Measures
5.4 Policy issurance
5.4.1 Policy Delivery
5.5 After sales service
5.5.1 Policy Changes
5.6 Claims
5.6.1 Maturity Claims
5.6.2 Death Claims
5.6.3 Surrenders

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6. INTRODUCTION TO PRIVATE PENSION FUND ORDINANCE

6.1 Need for Retirement Protection

6.2 Key Features of Private Pension Fund Ordinance
6.2.1 Coverage
6.2.2 Definition of Terms
6.2.3 Types of Private Pension Plan
6.2.4 Types of Private Pension Fund
6.2.5 Vesting
6.2.6 Withdrawal of Benefits
6.2.7 Advantages of Private Pension Plans

6.3. Regulatory Framework under Private Pension Fund Ordinance

6.3.1 Approval of Service Providers
6.3.2 Approval of Private Pension Funds
6.3.3 Registration of Private Pension Plans
6.3.4 Functions/Duties of Fund Managers and Custodians
6.3.5 Disclosure to Members of Private Pension Plans
6.3.6 Transitional Arrangement

GLOSSARY (i) to (xxx)

INDEX (1) to (4)

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v
 NOTE

If you are taking this Subject in the Insurance Intermediaries Qualifying

Examination, you will also be required, unless exempted, to take the Subject "Principles
and Practice of Insurance". Whilst the examination regulations do not require you to
take that Subject first, it obviously makes sense to do so. That Subject lays a foundation
for further studies and many of the terms and concepts found in that Subject will be
assumed knowledge with this Subject.

For your study purposes, it is important to be aware of the relative “Weight” of the
various Chapters in relation to the Examination. All Chapters should be studied carefully,
but the following table indicates areas of particular importance:

Chapter Relative Weight

1 15%

2 15%

3 25%

4 25%

5 15%

6 5%

Total 100%

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1 INTRODUCTION TO LIFE INSURANCE

1.1 DEFINITION OF LIFE INSURANCE

In the first of an excellent series of textbooks produced by the U.S. Life Office
Management Association Inc. (LOMA), life insurance is defined as follows:

"Life insurance provides a sum of money if the person who is insured dies whilst
the policy is in effect."

Anybody who has some knowledge about life insurance will be tempted to say
"Yes, BUT.....". In other words, surely this is too brief an explanation for a financial
service that provides a very sophisticated range of savings and investment products, as
well as mere compensation for death. "Yes, but ....." let us remember the objectives of
these Study Notes, and this Quality Assurance Scheme. The more we think about this,
the more appropriate the above definition becomes, as a starting point.

The definition captures the original, basic, intention of life insurance: i.e. to
provide for one's family and perhaps others in the event of death, especially premature
death. Originally, policies were for short periods of time, covering temporary risk
situations, such as sea voyages. As life insurance became more established, it was
realized what a useful tool it was for a number of situations, which would include:

(a) Temporary needs/threats: the original purpose of life insurance remains an

important element in life insurance and estate planning, as things like children's
education etc. occupy responsible people's thoughts.

(b) Savings: providing for one's family and oneself, as a long-term exercise,
becomes more and more relevant as society evolves from a tribal, clan, family
orientated community to relatively affluent individual independence.

(c) Investment: the accumulation of wealth and safeguarding it from the ravages of
inflation become realistic goals as living standards rise.

(d) Retirement: provision for one's own later years becomes increasingly necessary,
especially in a changing cultural and social environment.

So our purpose, as we begin this study, is not so much to remember certain facts,
but rather to understand something of the fundamentals of long term (life) insurance,
and to appreciate its role in a modern society.

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 1.1.1 Needs for Life Insurance

Whilst 1.1 above outlines the developing appreciation of the many uses of
life insurance, the modern scene tends to look upon available life insurance
products from the perspective of meeting various needs. These we may think of
as:

(a) Personal needs:

(i) dependants living expenses;

(ii) final (end of life) expenses;

(iii) educational funds;

(iv) retirement income;

(v) mortgage repayment fund;

(vi) emergencies fund;

(vii) disability income.

(b) Business needs:

(i) key persons;

(ii) business owners;

(iii) partnerships;

(iv) employee benefits.

1.2 PRINCIPLES OF LIFE INSURANCE

In the Core Subject for this Quality Assurance Scheme "Principles and Practice
of Insurance", the principles of insurance were studied in detail. By way of reminder,
but not detailed comment at this stage, these principles are:

(a) Insurable Interest: the legal right to insure;

(b) Utmost Good Faith: the requirement to reveal material information;

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(c) Proximate Cause: determining the effective reason for a loss;

(d) Indemnity: providing an exact financial compensation;

(e) Contribution: insurers sharing an indemnity payment;

(f) Subrogation: the insurer taking over rights against third parties.

1.2.1 Insurable Interest

In simple terms, insurable interest is that relationship with the subject

matter (a person, in the case of life insurance) which is recognized at law and
gives rise to a legal right to insure that person. This is a general law concept that
has applied for centuries and is obviously based on common sense. If you have
no relationship with a given person, why should you have the right to insure him
and thus profit from his death? Some particular points to be noted with this
principle are:

(a) Insurable interest in oneself: we all have an insurable interest in our own
lives. From the law concept that husband and wife are one person, it
follows that there is also an insurable interest in one's spouse.

(b) Insurable interest in others: to have an insurable interest in other people,

the law requires some financial involvement which could be at risk by the
other person dying. Some examples which may be reasonably common
are:

(i) debtors: if a person owes you money, you may insure him for the
amount of the loan, plus reasonable interest;

(ii) business partners: especially where personal services are involved,

such as musicians, lawyers, medical practitioners etc;

(iii) contract relationships: if another person's services have been

engaged under contract (booking a singer for a concert,
professional sportsperson etc.), that person's death may cause the
other contract party to suffer financially. That potential loss is
insurable.

Note: This heading would include a common life insurance product known as
Key Person Insurance, where an employer insures an important employee, in
case of loss to the company from the employee's death.

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(c) A parent or guardian of a minor (person aged under 18) is given an
insurable interest in that young person. Apart from one’s spouse, only the
relationships mentioned (parent/guardian of a minor) constitute insurable
interest arising from blood or family connection.

(d) When is the interest needed? : this is a key question, and very important
consequences flow from its answer. The answer is that insurable interest
is only needed when the contract begins, and becomes irrelevant
thereafter. What could be the (quite legal) consequences of this? Some
examples are:

(i) Divorce: a spouse, who insures his/her spouse and then becomes
divorced, can keep the policy in force and be perfectly entitled to
collect the benefit in due time.

(ii) Debts: it is legally possible to insure your debtor, have the debt
repaid, keep the policy in force, and be "paid again" in due time.

(iii) Assignment: it is quite legal to transfer a properly arranged life

insurance to a third party, provided this was not intended at the
outset.

1.2.1a Beneficiary Designation

This will be discussed in rather more detail in 4.4, but in the

context of insurable interest we may say that:

(a) in most cases the beneficiary, as one nominated by the policyowner

to receive the benefit under the policy, does not need an insurable
interest;

(b) the exception is where the insurance is being arranged on the life of
someone other than the applicant. This relates to what becomes
known as a third party policy. In such cases the beneficiary does
need insurable interest.

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1.2.2 Duty of Disclosure

This concerns another important insurance principle, that of utmost good

faith. Simply expressed, utmost good faith requires the disclosure of all material
facts, whether they are requested by the insurer or not. A material fact is one
that would influence the judgement of a prudent underwriter in deciding whether
to insure a particular risk, or the terms on which to insure it. Some points to
note:

(a) What to disclose: clearly, the insurer wishes to know all important facts,
but you cannot be expected to disclose what you reasonably cannot be
expected to know. Some medical conditions, for example, may be easily
recognizable to qualified doctors, but the average layman cannot be
expected to self-diagnose and reveal such things.

(b) Non-medical application: if the insurance is arranged without a physical

examination of the applicant, the insurer will normally have great
difficulty in alleging that anything not covered by questions on the
application or personal physician's form is material.

(c) Medical application: if the insurance is arranged with a physical

examination of the applicant, the insurer cannot hold against the applicant
any omissions or mis-diagnosing by the medically qualified person
concerned.

(d) Medical tests: the insurer is entitled to supplement information supplied

verbally with reasonable medical examinations or tests.

(e) Breach of the duty: technically, this constitutes a breach of utmost good
faith, which normally renders the contract voidable by the insurer. If
fraud is involved, this situation remains true in Macau and the insurer
might well void the contract. But with most policies in Macau regard has
to be taken of the Incontestability Clause (see 4.2), which means that the
policy cannot be contested after it has been in force for a specified period
(unless there is proof of fraud).

1.2.3 Other Insurance Principles

(a) Indemnity: this means an exact financial compensation for the loss
sustained and is very important in most Non-life insurance policies. As far
as life insurance is concerned, however,

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 (i) it is immediately obvious that the policy proceeds in no way pretend
to (or can) represent an exact financial compensation. That is why
life insurances are called benefit policies, not indemnities;

Note: Every life insurance claim is a “total loss”, in the sense that the full
sum insured is payable. The actual payment, however, may be more than
the sum insured in some cases, e.g. where policy dividends (or bonuses)
apply, or where death is from an accident and accidental death benefits
have been added to the policy.

(b) Indemnity corollaries: a corollary is a sub-principle and indemnity has

two corollaries, Contribution and Subrogation. To remind or inform you:

(i) Contribution: in most Non-life Insurance classes, if by some

chance a person has more than one policy covering the loss (called,
helpfully, double insurance in marine insurance) he does not get
paid twice. Each policy contributes to (shares) the loss rateably. If
he has more than one policy not by chance, it could well be an
indication of intended fraud!

In life insurance, the policies do not represent indemnities, so it is

quite normal for a person to have more than one life policy and
each must pay in full upon the insured event happening.

(ii) Subrogation: this relates to the right of the insurer who provides an
indemnity to take over any remedies the insured possesses against
third parties, to seek to recover his payment to the insured. This
does not apply to life insurances.

If, for example, a third party negligently smashes a person's car

(which has comprehensive cover), the person's motor insurer must
pay but can attempt to recover his payment from the third party. In
that same accident if an innocent victim in the car is killed, his life
insurer must pay, but the life insurer has no right of recovery from
the third party.

(c) Proximate cause: this principle is concerned with the discovery of the
dominant effective cause that produced the loss being claimed for under
the insurance. The principle does apply to every class of business, but it
is likely to have rather less significance with life insurance. The
application of proximate cause is very much concerned with different
kinds of perils (causes of loss):

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 (i) Insured Perils: are those which are covered by the policy. Non-life
policies may specify the perils which are covered, and one of those
must be the proximate cause of the loss. In life insurance, the
cause of death is probably not critical.

(ii) Excepted (or Excluded) Perils: in non-life insurances all policies

will carry some exclusions. If one of these is involved with a claim,
the insurer is not liable. Life insurance policies will seldom have
exclusions (but see Note 1 below).

(iii) Uninsured Perils: these are causes of loss which are not included
but are also not excluded, for example water damage with a fire
insurance. If property is damaged by water (e.g. by rain) with no
other cause involved, the damage is not covered. But if the water
damage is proximately caused by an insured peril (say fireman
fighting a fire with water hoses), the water damage is covered.
Such complexities are unlikely to arise with life insurance claims.

Note: 1 Suicide is an exception to the general statement that life policies

seldom have exclusions, so proximate cause will be important in
determining whether death arose from suicide or not. However,
even here the principle does not have full impact, because suicide is
only excluded for a limited time period with life policies (see 4.12).

2 We may conclude that the principles of insurance, especially those

concerned with claims, have less application in life insurance.

1.3 CALCULATION OF LIFE INSURANCE PREMIUM

The individual premium to insure a given life may have to take into account
individual features which make the risk better or worse than the average for a person of
that age and sex. That, however, is essentially a matter of underwriting, which we shall
consider in more detail in 5.3. Life insurance rates, which may be thought of as the
normal or standard premiums applicable according to age and sex, are subject to certain
common features considered below.

1.3.1 Premium

The classic criteria usually applied to life insurance premiums is that they
should be:

(a) adequate: so that the insurer will be able to pay the benefit and meet other

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 obligations under the contract; and
(b) equitable (fair): so that each policyowner is paying an amount in line with
the risk and contracted benefit involved.

To achieve these criteria, a number of factors must be taken into account.

1.3.1a Mortality, Interest and Expenses

(a) Mortality: perhaps more accurately phrased as the Rate of

Mortality, this indicates the rate at which insured lives are expected
to die. Whilst this sounds very morbid, it will be immediately
obvious that this is absolutely at the heart of life insurance premium
calculation. To know, on average, when your insured may be
expected to die is a crucial factor in determining the correct
premium to charge.

Of course, individual lives may live much longer or shorter than the
average, but following the "law of averages" (which is sometimes
called the "law of large numbers") reasonable predictions and
calculations can be made. These are greatly facilitated by the use of
mortality tables, which are published tables showing the expected
rate of mortality at any given age.

As mentioned above, individual risks may call for special terms and
consideration, but that is an underwriting matter. Premium rating,
as a concept, deals with normal risks and normal expectations.

(b) Interest: in very simple terms, life insurance involves collecting

money now, and at specified intervals, to provide for a benefit at
some time or upon some event in the future. This, by definition,
means we have some time, and as the old saying goes "time is
money"!

How much time we have, on average, largely concerns (a) above.

The fact that we have some time means we have an opportunity for
investment. The interest earned on invested premiums and previous
interest earnings is another crucial factor in determining premium
rates. If the anticipated returns of investment are good, we can
charge lower premium rates than our competitors, and/or make
more profit for our shareholders.

Note: The above two factors combined will produce what is called the net
premium (sometimes called the pure premium), i.e. the money necessary

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to meet death claims arising under normal statistical expectations. But
there is more to consider.

(c) Expenses: the net premium has to be subject to a loading

(surcharge or additional sum) to take care of all expected and
possible expenses. These will include all internal operating costs,
commissions, tax and overheads to which any business is subject.
With life insurance there is also the possibility (however remote) of
unusual mortality rates from some new disease or other disaster -
and existing premiums cannot be increased later to deal with
changed circumstances. Loading the net premium will include an
amount to cover that kind of contingency.

Note: The loading added to the net premium produces the gross
premium, which takes into account all three basic factors mentioned
above.

1.3.1b Other Factors

As mentioned, premiums (other than Term policies) for existing

policies cannot be changed. Life insurance is long term business, and this
implies that the contract not only is likely to last several years, but also it
cannot be cancelled or amended by the insurer without the consent of the
policyowner. Therefore, other factors which may arise from time to time
can only affect new policy premiums. Some of the influences which might
have an effect on life premium rating are mentioned below:

(a) PAR or NON-PAR: this is extremely important. One unique

feature of life insurance is that the insured has the choice to select
whether to effect a "participating" or "non-participating" (PAR or
NON-PAR) policy. Policies which are "participating" are entitled
to receive a share of ("participate" in) the divisible surplus (profits)
of the insurer. These are in the form of dividends. Participating
policies, naturally, are subject to higher premium rates than Non-
Participating policies.

Note: 1 Insurers using U.K. style practice call such policies With Profits
or Without-Profits. The concept is the same, although there are
differences. Bonuses are payable, rather than dividends, for
example. The former are also usually reversionary (payable only
when the policy benefit is payable), whereas dividends are
payable at once.

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 2 Not all life insurance policies can be par or non-par. Term
insurances (see 2.1.1) are normally not on a participating basis.

(b) Competition: no insurer enjoys a monopoly position. What the

market is charging cannot be ignored.

(c) Economic changes: extended times of affluence or recession will

doubtless have an impact on all product prices, including insurance.

(d) Public health: abnormal developments in this area (e.g. the AIDS
epidemic) cannot be ignored in rating.

(e) Fiscal changes: a lasting increase in tax levels must be reflected in

higher premium rates (although this can only be for new clients).

(f) Company objectives: if a company is determined to increase its

market share, premium rating is an obvious area of concentration.

1.3.2 Natural and Level Premium Systems

These systems for life insurance premium calculations might well be

described as "ancient" and "modern", for reasons that will be clear shortly.

1.3.2a The Natural Premium System

This was the system used by some life insurers in the early days of
the business. It was very logical, but it was doomed to failure because of
built-in features which virtually guaranteed that it could not work long-
term in practice. Its features were:

(a) Premiums: these were not to be constant throughout the policy

term, but individually calculated each year so that they reflected the
natural risk position (age etc.) of the life insured at each policy
renewal.

(b) Short-term consequences: with increasing age there is increased

mortality risk. Premiums therefore increased every year.

(c) Longer-term consequences: these, in hindsight, were very

predictable and included:

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 (i) increasing premiums, with increasing age and in later years
decreasing resources, often presented real problems with
renewals;

(ii) the system was ripe for anti-selection (also known as

selection against the insurer), whereby the better risks -
those in good health and with real prospects of a long life -
dropped out of the scheme as it became more expensive, and
the bad risks would decide to continue, for obvious reasons.
This creates an imbalance of risks, with predictable results.

(d) Present day: the Natural Premium System is no longer practised, at

least not for policies which are truly "long-term".

Note: We may be tempted to be scornful of a scheme which we can now

see to have such obvious defects. But it is easy to live life in retrospect.
Problems and shortcomings usually only appear through experience.

1.3.2b The Level Premium System

This is now the norm and its features are described below:

(a) Basic concept: by the judicious use of mortality tables and

actuarial calculations, it was realized that it was possible to quote a
premium that would remain level (unchanged) for the duration of
the contract, based upon the age, sex and individual underwriting
features of the life to be insured. This, of course, assumes that the
death benefit also remains unchanged.

Compared with the cumbersome and unsatisfactory features of the

natural premium system, the advantages and attractiveness of such
a system are obvious. It quickly superseded the old system.

(b) Short-term consequences: clearly, the level premium system

envisages a long-term contract, where an unchanging premium will
effectively "average out" over the years. In other words, the
premium is "too much" for the risk involved in the early years, and
may be "too little" for the risk involved in later years.

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(1/13)
 Of course this is a simplification, but it is not inaccurate. From this
concept it may be seen that once the initial expenses and costs of
setting up the policy have been utilised, the early "excess"
premiums and interest earnings thereon start to create a fund or
reserve against the future liability.

With other types of insurance, the premium is calculated each year

and at the end of the year the premium is considered fully earned
by the insurer. The life policy, under the level premium system,
soon begins to build up a cash value (or surrender value) for the
policyowner.

(c) Longer-term consequences: some of the implications and products

of (b) above will be examined in more detail in Chapter 4, but we
may briefly mention the features that developed from the early
years "surplus" premiums found with the level premium system:

(i) Cash value (also known as surrender value): the insurer

cannot cancel a life policy, but the policyowner can. If he
does, and the policy has been in force long enough to "clear"
the set-up costs, part of the premiums etc. paid can be
considered to be "not yet earned" by the insurer. Therefore,
there should be a cash or surrender value payable to the
policyowner, representing a refund of premiums etc.
"unearned" by the insurer at that time.

Note: This is not true for Term Insurances (see 2.1.1), where the
premium is geared only to the risk of death during a specified
period of cover. Such policies have no cash value.

(ii) Policy loan: the cash value is excellent collateral security

for a loan. Borrowing money from the insurer using the cash
value as security is now a right under modern policy terms.

(iii) Nonforfeiture: without specific policy provisions to the

contrary, the policy will lapse if renewal premiums are not
paid. However, the cash value may be used, voluntarily and
sometimes automatically under policy terms, to keep the
insurance intact (see 4.5).

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(iv) Paid-up insurance: should the policyowner decide he cannot
or does not wish to pay any further premiums, as an
alternative to policy surrender he may have what is termed a
fully paid policy. This means he pays no more premiums and
the policy stays in force exactly as before, except that the
sum insured (the face amount) is lower, in line with the
premiums paid to date. This is largely possible because the
premiums are not "fully earned" by the insurer in the earlier
years of the policy.

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2 TYPES OF LIFE INSURANCE

To the public and perhaps inexperienced insurance intermediaries, there must

seem to be a bewildering variety of life insurance contracts. Certainly, it is a
sophisticated and well developed market, but a few basic guide rules should prove
helpful:

(a) Basic functions: it is good to distinguish the various products offered by life
insurers by what the products seek to do. Another way of thinking about that is to
ask the question "Under what circumstances is/are the benefit(s) payable?". Some
basic formats are:

(i) payment on death only if it occurs during a specified period;

(ii) payment on death at any time;

(iii) payment on a specified date or on earlier death;

(iv) monthly payments (or at other specified intervals), for life or other specified
period, after the insurer has received a lump sum (paid all at once or by a
series of instalments).

(b) Basic variables: some additions/modifications to the above are:

(i) the type of policy (called the plan) may be convertible, i.e. able to be
changed into a different plan, at the policyowner's option;

(ii) renewable, if originally for a limited time period (e.g. one year);

(iii) Par or Non-par: see 1.3.1b(a);

(iv) various Riders, i.e. endorsements, may be added to the policy, either to
provide additional cover or to make certain provisos.

(c) Basic questions: much heartache and misunderstanding in the whole business of life
insurance selling would be avoided if insurers and intermediaries clearly put the
following two questions to potential policyholders (and of course acted in
accordance with the answers):

(i) "What do you want the insurance to do for you?", i.e. what is it for?

(ii) "How much are you able and willing to invest by way of premium?", i.e.
what can you afford?

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Note: The other basic question “How much life insurance do you need?” is of course
important, but this is usually answered by the intermediary rather than the applicant after
completing a financial needs analysis with the applicant.

Given these important preliminaries, we may now think about specific policy types.
We should just say, however, that we shall only be considering an outline of the various
covers, so that you may be in a position to identify and broadly distinguish the various
types of plan available. Professional skill and discrimination can only be obtained through
experience.

2.1 TRADITIONAL TYPES

These will consist of the four basic formats mentioned in (a) above, although there
are many possible variations and combinations of the different types of cover. The major
traditional types we shall consider are as follows:

2.1.1 Term Insurance

Such a policy plan provides cover for a specified period or term only, and
may also be described as temporary insurance. The policy benefit is only payable
if:

(a) the insured person dies during the specified period, or term; and

(b) the policy is valid (in force) at the time of death.

This form of cover is an exception to the general rule that a life insurance
always results in a claim. Indeed, in the great majority of cases, term insurances
run their course without a claim. For these reasons, it is the cheapest form of cover
available (but, of course, its limitations must be understood).

In theory, the term could be for any period of time, even a few hours to
cover an aircraft flight, for example. In practice, it is rare to find a term insurance
for a period of less than one year.

2.1.1a Level/Decreasing/Increasing Term Insurance

(a) Level term insurance: this policy plan is perhaps the most
popular term insurance. It involves a level (unchanging)
premium and benefit throughout the policy period. In the

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 event of death during the term, the face amount of the policy
is payable. If the term is for more than one year, the renewal
premium is the same each year.

Popular largely because of its simplicity, this is a useful

answer to a temporary need which neither increases nor
decreases to any significant extend over the period of time
involved (perhaps a loan which is not being repaid by
instalments).

(b) Decreasing term insurance: under this plan, the premium is level
(constant) throughout the term, but the benefit decreases annually, or
at other specified times. Because the benefit is continually decreasing
and is payable only on death during the term, this is the cheapest
form of life insurance available. It is particularly suited for a
temporary need which is reducing. Some typical examples are:

(i) Credit life: designed to repay the balance of a loan direct to

the lender should the borrower die before all repayment
instalments have been made. This plan is usually sold to
lending institutions on a group basis to cover the lives of
borrowers.

(ii) Family income: perhaps linked with other policy plans which
provide a lump sum payment, this plan provides a stated
monthly benefit for the remainder of a specified period, in the
event of say a husband's death (the total amount payable is
therefore decreasing as time goes by).

(iii) Mortgage redemption: a typical mortgage loan is being

reduced by monthly or other periodic payments. This plan
covers the balance of loan outstanding in the event of death.
This may be on a joint-life basis (e.g. husband and wife), the
benefit being payable when the first life dies. This is an
obvious and most popular form of cover.

Note: The above form of cover must not be confused with Mortgage
Indemnity Insurance. This is quite different, being an insurance for banks
and similar lenders. It covers the possibility of non-repayment of mortgage
loans, where the mortgaged property has to be sold in adverse market
situations, thereby resulting in a loss to the bank etc.

(c) Increasing term insurance: this plan, as the name suggests, involves
a benefit which increases annually, or as otherwise agreed. The

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 premium also increases proportionately. The increases may be at a
fixed percentage, or in line with an agreed index (e.g. Consumer
Price Index). The basic idea is to keep the benefit in line with the
value of money, especially in case of inflation.

2.1.1b Renewable/Convertible Term Insurance

(a) Renewable term insurance: at first sight, this seems to be a

contradiction, because a term insurance is for a fixed period, and
this extends the period. The key point, however, is that the right to
renew the policy is without submitting evidence of insurability
(health) and the premium for the further period is increased to reflect
the increased age of the life insured. (The new premium is said to be
based on the attained age.)

Because such a plan can involve anti-selection (see 1.3.2a(c)(ii)),

there may be some limitations applied, such as:

(i) renewals may only be for equal or smaller face values;

(ii) the number of renewals permitted may be restricted (e.g. three

times);

(iii) premium rates may be higher than those for non-renewable

policies.

Frequently, one-year term policies are made renewable, either

by a basic policy provision or an added rider. These have the
obvious name Yearly Renewable Term (YRT) or Annually
Renewable Term (ART) insurance.

(b) Convertible term insurance: such a plan includes a conversion

privilege, which gives the policyowner the right to convert (change)
the policy to a permanent (non-term) plan without evidence of
insurability (health). If this privilege is exercised, the premium for
the wider plan must be the standard rate for such a plan and the
attained age of the life insured.

Because anti-selection is again a possibility with these plans, there

may be restrictions:

(i) conversion may not be possible beyond a certain age (say 55

or 65);

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(2/5)
 (ii) conversion may not be possible after the policy has been in
force for say 50% of its specified term (or a specified number
of years);

(iii) the face amount of the new plan (permanent insurance) will
be limited to that for the term insurance (probably less after the
term policy has been in force for some specified time).

2.1.2 Endowment Insurance

An endowment plan provides for the payment of the face amount at the end
of a specified term or upon earlier death. Should the insured person survive the
term, the policy is said to mature. Thus, a claim may arise under such a plan either
by death or maturity. As with a term insurance, the description of the policy must
include reference to the number of years of the term involved, e.g. a 20-year
endowment provides for payment of the face value after 20 years (on maturity) or
upon earlier death. Features to be noted with this plan are:

(a) Premiums: are not cheap, since under normal circumstances a claim must
arise not later than the specified number of years in the future; premiums are
level, normally paid annually, although single premium endowments are
possible;

(b) Technically: the plan is a combination of a term insurance and a pure

endowment for equal amounts. (A pure endowment is a contract under
which the benefit is only payable if the life insured survives the term);

(c) Par or non-par: such a plan may be on a participating (with-profits) or

non-participating (without-profits) basis, at an appropriate premium;

(d) Popularity: because in principle such a plan provides the best of both worlds
(premature death protection and personal savings for the life insured if the
policy matures), these have an apparent attraction.

2.1.3 Whole Life Insurance

Such a plan, quite literally, involves a policy that is designed to last the
whole of one's life (sometimes it is called whole of life insurance). The
fundamental feature is that the face amount is paid on death, whenever that occurs,
and not before. Such policies, therefore, may be in existence for many years, even
several decades. The relevant features to note are:

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(a) Premiums: are level, but may be subject to different provisions, including:

(i) payable throughout life: in which event the policy may be called a
straight life insurance, or a continuous premium whole life policy;

(ii) payable for a limited period: the policy may specify a number of
years, after which no more premiums are payable, although the
benefit is not paid until death takes place;

(iii) premium subject to an age related limitation: instead of specifying

the number of years, the policy may stipulate a certain age (say 65)
after which no more premiums are required. As with (ii) above, no
further premiums are payable if death occurs before the specified
years/age;

(b) Par or non-par: either form of cover is permissible;

(c) Variations: many variations are possible, such as premiums which increase,
or face amounts which change, at specified times during the policy's life, to
cater for different needs as time goes by. One such variation is called a
graded-premium policy, where the premium increases (against a level face
amount) on a regular basis, say every three years, until it reaches an amount
that becomes the level premium for the rest of the life of the policy.

2.1.4 Annuities and Pensions

Each refers to income or other financial provision (usually) for retirement or

old age. A simple definition of each term is:

(a) Annuity: A series of periodic payments to an annuitant, for life or other

agreed term or conditions, in return for a single payment (premium) or series
of payments.

(b) Pension: A monthly (or other periodic) income benefit payable to a person in
retirement, until that person's death.

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 2.1.4a Annuities

In the insurance industry, the term ‘annuity’ means a contract under which
one party – the insurer – promises to make a series of periodic payments in
exchange for a premium or series of premiums.

The terms of an annuity contract govern the rights and duties of the
contracting parties. The parties to an annuity contract are (1) the insurer that
issued the contract and (2) the person, known as the contractholder, who applied
for and purchased the contract. The contractholder can be either an individual or
an organisation that purchases the annuity on behalf of a group of individuals.

Annuities are classified according to various criteria:

(a) How the annuity was purchased

Most annuities today are purchased as single-premium annuities. A single-

premium annuity is an annuity that is purchased by the payment of a single,
lump sum premium. Benefit payments under a single-premium annuity may begin
shortly after the premium is paid or may begin many years after the premium is
paid.

An annuity also can be purchased by paying periodic premiums over a period of

years.

(b) How often periodic annuity benefits are to be paid

The frequency of periodic annuity benefit payments depends on the length of the
annuity period. An annuity period is the time span between each of the payments
in the series of periodic annuity benefit payments. The annuity period is typically
either one month (monthly annuity) or one year (annual annuity), but other
options, such as quarterly or semiannual, are also available.

(c) When annuity benefit payments are scheduled to begin

The date on which the insurer begins to make the annuity benefit payments is
known as the annuity’s maturity date or the annuity date. An annuity can be
classified as either an immediate annuity or a deferred annuity, depending on
when the insurer is to begin making periodic annuity benefit payments.

An immediate annuity is an annuity which benefit payments are scheduled to

begin one annuity period after the annuity is purchased.

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 A deferred annuity is an annuity under which periodic benefits are scheduled to
begin more than one annuity period after the date on which the annuity was purchased.
Although a deferred annuity typically specifies the date of which benefit payments are
scheduled to begin, the contractholder usually can change this date at any time before
those benefit payments begin. People often purchase deferred annuities during their
working years in anticipation of the need for retirement income later in their lives.

(d) When benefit payments end

The length of the payout period depends on the payout option that the contractholder
selects. Under the three general types of payout options available, the annuity benefits will
be paid as either (1) a life annuity, (2) an annuity certain, or (3) a temporary life annuity.

A life annuity is an annuity that provides periodic benefit payments for at least
the lifetime of a named individual. Some life annuities also provide further payment
guarantees.

An annuity certain can be purchased to provide periodic payments over a period

of time that is unrelated to the lifetime of an annuitant. The named individual whose
lifetime is used as the measuring life in a life annuity is called the annuitant. An annuity
certain is an annuity that is payable for a stated period of time, regardless of whether an
individual lives or dies. The stated period over which the insurer will make benefit
payments is called the period certain. At the end of the period certain, annuity payments
cease. The annuity certain is useful when a person needs an income for a specified
period of time. An annuity certain also might be purchased to provide income during a
specified period until some other source of income, such as a pension, becomes
payable.

A temporary life annuity provides periodic benefit payments until the end
of a specified number of years or until the death of the annuitant, whichever occurs
first. Once the stated period expires or the annuitant dies, the annuity benefits cease.
For example, under the terms of a five-year temporary life annuity, five years is the
maximum length of time during which annuity benefits will be payable. If the
annuitant dies before the end of that five-year period, no further annuity benefits
will be payable.

(e) The number of annuitants covered by the annuity policy

When a couple purchases a life annuity, they usually want the annuity to provide
benefit payments throughout both of their lives. A joint and survivor annuity,
which is also known as a joint and last survivorship annuity, provides a series of
payments to two or more individuals, and those payments continue until both or

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 all of the individuals die.

(f) Whether annuity values are guaranteed or variable.

People who purchase annuities have different purposes in mind for the funds they place in
an annuity. Annuity contractholders also have different capacities for assuming a financial
risk when they place money in their annuities. Thus, many insurers offer 2 general options
to annuity purchasers: (1) the insurer will guarantee to pay at least a stated interest rate on
the annuity funds it holds or (2) the insurer will pay interest at a rate that is not guaranteed;
instead, the interest rate will vary according to the earnings of certain investments held by
the insurer.

A fixed-benefit annuity is an annuity under which the insurer guarantees that at

least a defined amount of monthly annuity benefit will be provided for each dollar
applied to purchasing the annuity. When an insurer provides interest rate guarantees in
an annuity policy, the insurer agrees to assume the investment risk of the policy.

A variable annuity is an annuity under which the amount of the policy’s

accumulated value and the amount of the monthly annuity benefit payment will fluctuate
in accordance with the performance of an investment account. The individual who
purchases a variable annuity assumes the investment risk of the policy.

2.1.4b Pensions

In Macau pensions are often considered to be more in the Government realm

(for example for Civil Servants etc.). More common in the private sector, are
Provident Fund Schemes, which provide a lump sum benefit on retirement or other
specified time, rather than an income.

2.2 NON-TRADITIONAL INSURANCE

Life insurance, more or less in its present form, has been practised for
approximately 400 years. During that time, the basic policy formats have become very
established and they still form a practical and useful role in providing this important form
of cover. However, the pattern of economic and social life does not stand still and new
products have been developed, often providing a more flexible approach to life insurance
cover and associated investment. We look at two such examples.

2.2.1 Universal Life

In an attempt to provide greater consumer choice and flexibility, this

product has been developed. It has been well described as a life insurance

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contract which:

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(a) is subject to a flexible premium;

(b) has an adjustable benefit; and

(c) accumulates a cash value.

We examine these and other features of this innovative product:

(a) Flexible premium: subject to certain limitations, the policyowner may pay
more or less than the premium stated in a given year, after the first year. At
his option, he can even omit premium payment for a particular year (again
subject to certain conditions).

(b) Adjustable benefit: subject to certain limits, the death benefit may be
increased or decreased, although proof of insurability may be required for
any increase in benefit.

(c) Loading disclosed: the calculation of life insurance premiums includes an

item for expenses, called loading (see 1.3.1a(c)). Normally this is not
disclosed to the insured, but with universal life insurance the expenses and
other charges element is specifically disclosed to a purchaser.

(d) "Unbundled" cover: the cover is so described because it separates and

individually discloses, both in the policy and in an annual report (see (g)
below) to the policyowner the three basic elements of the contract, i.e.:

(i) the pure cost of protection (covering the death risk);

(ii) investment earnings; and

(iii) company expenses.

(e) Cash value: the intention is that the policy should acquire an increasing cash
value. This of course is heavily influenced by the amount of premiums paid
by the insured. After the first premium, additional premiums (subject to an
individual limit) can be paid at any time. These, with interest earnings, are
added to the cash value after the deduction of:

(i) a specified percentage expense charge;

(ii) the pure cost of protection (deducted monthly).

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(f) Death benefit: according to the plan the insured chooses, this may be a face
amount plus the cash value, or the face amount only.

(g) Annual report: each year the policyowner receives a report which shows
the status of the policy. The information given includes:

(i) the death benefit option selected;

(ii) the specified amount of insurance in force;

(iii) the premiums received during the year;

(iv) the expenses charged during the year;

(v) the guaranteed and excess interest credited to the cash value;

(vi) the pure cost of insurance deducted;

(vii) the cash value balance.

It will be seen that this is a sophisticated product, allowing great choice to the
policyowner to adjust his insurance according to his needs and financial resources as
time goes by. Intermediaries are advised to consult their principals on local forms of
this modern insurance plan.

2.2.2 Unit-Linked Policy

This plan offers a policy with its value directly linked to investment
performance. This may be achieved by formally linking the policy value to units in
a special unitized fund run by the life insurer concerned, or linking with the units in
a unit trust. The value of the units is directly related to the value of the underlying
assets of the fund. This value may fluctuate according to the performance of the
investments concerned.

A detailed study of this sophisticated financial product is beyond the needs of

this study, and again intermediaries should obtain advice and instruction from their
principals, as necessary. Some features, however, we may note:

(a) Common principle: unit-linked policies may come in a variety of forms, but
there is a common factor. All or part of the premiums will be used to purchase
units in a fund at the price applicable at the time of purchase. The value of the
policy will then fluctuate according to the value of the units allocated to it.

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 (b) Types of funds: a variety of funds may be used for linking purposes,
including equities (ordinary shares), fixed interest investments and a whole
range of cash and other asset funds.

(c) Types of policy: in theory any kind of life insurance product may be unit-
linked. The most common in practice are whole life and endowments,
sometimes with a guaranteed minimum value, however unit prices may
move.

Special care must be taken with products which are essentially

investments, so that the consumer is aware that values may go up or down.

2.3 GROUP AND INDIVIDUAL INSURANCE PLANS

The majority of the plans we have considered so far have been with applications for
the insurance of individuals, either insuring themselves or another person. This remains a
key element in the field of life insurance, but group insurance is playing an increasing role.
This is especially so with employee benefit plans, where an employer provides a form of
life insurance, often as an additional benefit supplementing salaries and wages. Again, this
is a complex area, but certain features we may note:

(a) Basic difference: the most obvious difference between individual and group
insurances is that the latter covers a number of people under a single policy.
Sometimes this is called a master group insurance contract.

(b) Contract parties: these are the insurer and the group policyholder, usually an
employer, but possibly a club or other organization insuring its members. The
persons within the group who are covered may be referred to as group insureds or
sometimes group life insured or persons insured.

(c) Different plans: plans may be contributory (where the employees or other persons
insured pay a share of the premium) or non-contributory (where individual
members do not contribute towards the premium).

(d) Eligible groups: usually this concerns a single employer, covering his staff
members, but other associated persons (clubs, unions, sports associations, etc.)
could equally be considered. Multiple-employer groups, with different companies
participating in a single plan are also possible.

(e) Underwriting: doing business "in bulk" means that the high degree of underwriting
attention applicable to individual insurances is neither possible nor necessary.
Detailed individual information is usually not required with group plans.

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(f) Individual eligibility: eligibility is usually decided by the employer, but the usual
criterion for admission to group coverage is known as an actively-at-work
provision. This means that the individual was not only employed, but also at work
(not ill or on leave) when coverage became effective.

(g) Declined coverage: an eligible person (particularly with contributory schemes)

may initially decline coverage. Should that person change their mind later, evidence
of insurability may be required (to counteract anti-selection).

(h) Termination of cover: for individual persons insured, their cover may terminate
upon ceasing to be eligible (leaving the employer or group) or failing to pay any
required premium. Some plans allow individuals to convert their previous group
cover into individual coverage, often without proof of insurability but normally
within a specified time period.

-o-o-o-

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3 BENEFIT RIDERS AND OTHER PRODUCTS

Note: The term “policyowner-insured”, as readers will come across in this chapter, refers
to cases in which the life insured and the policyowner are the same person. Most life
insurance policies are issued to policyowners who are also the life insured. However,
readers should also be aware that when one person purchases insurance on the life of
another person -- as in the case of third-party policy [see 1.2.1a (b)] -- the person who
purchases the insurance is the policyowner and the person whose life is insured is the life
insured.

3.1 DISABILITY BENEFITS

A rider is an endorsement to a policy, providing for some additional benefit or

making certain stipulations. We shall consider two such riders applicable to situations
where the policyowner-insured becomes subject to some form of physical disability.

3.1.1 Waiver of Premium (Known as WP Benefit Rider)

A waiver means that some form of legal right has been given up. In this
particular context it means that the insurer waives his right to premiums otherwise
payable whilst the policyowner-insured is totally disabled. This does not mean that
the policy is suspended. It remains in force and benefits continue to accumulate.
(So, effectively, the insurer is paying the premium.)

There are normally some limitations, as follows:

(a) Waiting period: this is a time period (usually three or six months) from the
time the policyowner-insured is disabled before the premiums are waived.
The original thinking behind this probably was that most people continue to
receive salaries and wages for at least short periods of disablement and so
can still afford to pay premiums. But in fact some insurers will refund
premiums paid during this waiting period if the disablement extends beyond
the waiting period. (Technically, this makes it a kind of "time franchise".)

(b) Age limitation: waiving premiums is only permitted if the policyowner-

insured is between 15 and 65 years of age (the age range varies with
insurers).

(c) Premium frequency: changes in the frequency of premium payments (say

from annual to monthly) are not permitted whilst disablement applies.

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 (d) Exclusions: the cover given by this rider is similar to personal accident or
medical insurance, so it normally carries some similar exclusions, such as:

(i) intentional self-inflicted injuries;

(ii) injuries sustained whilst engaged in criminal activities;

(iii) pre-existing conditions;

(iv) injuries resulting from war while the policyowner-insured is in

military service.

The WP rider may be added to virtually all types of life insurance policies.

3.1.2 Disability Income Benefit

Whereas the WP rider gives relief from expenditure during total disability,
the Disability Income Benefit rider (as the name suggests) provides an actual
income during periods of disability. The usual provisions relating to this rider are:

(a) Definition: "total disablement" as understood by this rider means that the
policyowner-insured is unable to perform the essential acts of his own
occupation, or any occupation for which he is reasonably fitted by
education, training or experience.

(b) Income benefits: are paid monthly as a stated dollar amount, usually having
a relationship to the policy face amount (say HK$10 per HK$1,000).

(c) Waiting period: similar in concept to that applicable with the WP rider, but
the period varies from one to six months.

(d) Not a loan: the policy remains in full force during the disability and should
death occur during a period of disability the full face amount is payable. No
deductions are made in respect of income benefits received.

Again, this rider may be added to virtually all types of life insurances.

3.2 ACCIDENT BENEFITS

Accident benefits that are commonly added to any kind of life insurance policy
relate to accidental death and dismemberment. Frequently they are combined in a single
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rider, known (obviously) as the Accidental Death and Dismemberment (AD&D) Rider.
3.2.1 Accidental Death and Dismemberment

To consider these separately, although they are frequently combined:

(a) Accidental death benefit (ADB): this normally undertakes to pay a benefit
equal to the face amount of the policy as an additional sum should death be
caused by an accident. The customary provisions are:

(i) death must be caused directly and independently of all other causes,
by an accidental bodily injury;

(ii) customary personal accident insurance exclusions apply, including:

(1) intentional self-inflicted injuries (i.e. suicide);

(2) war-related injuries;

(3) injuries during illegal activities;

(4) aviation injuries (except as a fare-paying passenger);

(iii) death must follow within a specified period of the injury, typically 3
months or 90 days. This is to be reasonably sure that the death was
really the result of the accident (although obvious circumstances, such
as an extended coma for an accident victim before death, would
certainly meet with every sympathy and merit payment of the benefit).

Note: 1 This benefit is often called the Double Indemnity Benefit. It is

evident how the name arose, but we know from earlier studies (see
1.2.3(a)) that this title is technically inaccurate as far as Macau is
concerned, since life insurances are not indemnities.

2 Also referring to previous studies (see 1.2.3(c)), proximate cause

becomes important with this rider. The cause of death for the basic
face amount of the policy is in most cases probably not relevant.

(b) Dismemberment: literally "dismemberment" means losing one or more

members (limbs), but the term within the AD&D rider relates to both the
loss of limbs and the loss of sight. The usual provisions are:

(i) Basic cover: normally, a sum equal to the death benefit is payable if
the life insured loses any two limbs or the sight in both eyes as a result
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of an accident.

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 (ii) Modified cover: often policies provide for payment of half the death
benefit if an accident results in the loss of one limb or the loss of sight
in one eye.

(iii) Definition: the loss of a limb may be described as the actual loss of
limb (by physical severance at or above the wrist or ankle) or the loss
of the use of the limb.

(iv) Combination: normally, the policy provides that the insurer will not
pay both the dismemberment and death benefits for injuries sustained
in the same accident.

3.2.2 Other Accident Benefits

Various forms of cover may be provided by different insurers, but a typical

rider giving other accident benefits has the following features:

(a) Benefit schedule: the cover is injury from accidental bodily injury and a
schedule (or list) of specified injuries is given, with a corresponding benefit
against each. The list usually includes :

(i) Death - for example, benefit might be US$100,000;

(ii) Loss of Two Limbs - " US$100,000;

(iii) Total Loss of Sight - " US$100,000;

(iv) 1 Limb & Sight in 1 Eye - " US$100,000;

(v) 1 Limb or Sight in 1 Eye - " US$ 50,000;

(vi) Various specified lesser injuries - see below

Lesser injuries: comprise a detailed list of possible injuries, ranging from

serious impairments (e.g. loss of a thumb or index finger) to relatively minor
ones (e.g. loss of a single finger joint). On the above scale, the benefits for
these might range from say US$3,000 for minor injuries to US$25,000.

(b) Other benefits: cover may include one or more of the following:

(i) Serious Burns - at least 3rd degree burns, say US$100,000;

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 (ii) Weekly Benefits - during disability, say US$1,000 (for 52 weeks);

(iii) Hospital Benefit - daily benefit of US$100 (for 1,000 days maximum);

(iv) "Double Indemnity" - all benefits (except hospital stay) doubled, if the
injury arose whilst travelling on regular public transport or in the
burning of certain public places (cinemas, etc.).

(c) Exclusions: a number of exclusions, commonly found with personal accident

covers, are normally applicable, including:

(i) Self-inflicted injuries (including suicide, at any time);

(ii) War – related injuries;

(iii) Injuries whilst involved in illegal activities;

(iv) Disease or illness (unless caused by an accident);

(v) Childbirth & Pregnancy;

(vi) Injuries resulting from hazardous sports - as defined.

3.3 ACCELERATED DEATH BENEFITS

The meaning of this is that in certain serious situations, all or part of the death
benefit under the policy may be payable to a policyowner-insured, although death has not
yet occurred. Provisions for this are contained in accelerated death benefit riders, also
known as living benefit riders. Common features with the different riders concerned are:

(a) Basic reasons: the benefits are released at times of great personal stress, under
grave and life-threatening circumstances. They are to assist with related expenditure
and to provide at least partial relief from the extra burden of financial worry at
times which are already grief-laden.

(b) Eligible plans: the riders are only likely to be permitted with policies having a
significant face amount, i.e. the larger policies, with a face amount of perhaps the
equivalent of US$100,000 or more.

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(c) Beneficiaries: since pre-death payments to the policyowner-insured will have an
impact upon the expectations of named beneficiaries, the latter is usually required to
sign a release form, acknowledging that the death benefit stands reduced by the
amount of the accelerated death benefit payment.

(d) Assignees: similar considerations to those in (c) above arise with any assignee, who
must also sign such a release form.

(e) Types of benefits: we shall consider three such accelerated death benefits, namely
the critical/terminal illness, the dread disease, and the long-term care benefits.

3.3.1 Critical/Terminal Illness/Dread Disease

3.3.1a Critical/Terminal Illness (TI) Benefit

The basic features of this rider are:

(a) Meaning: a stated portion of the death benefit is paid to a

policyowner-insured who is suffering from a terminal illness and has a
life-expectancy of 12 months or less.

(b) Medical evidence: a statement from an attending physician is

necessary, confirming the medical condition and the specified life
expectancy.

(c) Premium: the payment for this rider is different from other
supplementary policy benefits. With the latter, an additional premium
charge is customary in respect of each supplementary benefit given.
With the TI benefit an administrative charge is made only when the
policyowner-insured elects to exercise the benefit.

(d) Amount of benefit: this will vary between companies. Some allow
the full death benefit to be paid. Most, however, restrict the amount to
between 25% and 75% of the face amount. It is invariably paid as a
lump sum.

3.3.1b Dread Disease (DD) Benefit

The basic features of this rider are:

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(a) Meaning: a stated portion of the death benefit is paid to a
policyowner-insured who is suffering from a specified disease or is
undergoing certain medical procedures. These are known as
insurable events.

(b) Insurable events: the list of such events is not identical with all
insurers, but it is likely to include all or most of the following:

(i) life-threatening cancer;

(ii) AIDS (possibly with some limitation as to its origin);

(iii) end-stage kidney (renal) failure;

(iv) heart attack (myocardial infarction);

(v) stroke;

(vi) coronary bypass surgery;

(vii) vital organ transplants;

(viii) Alzheimer's disease.

(c) Restrictions: again, these are not universal, but typically they may
include:

(i) DD coverage is only available up to age 70;

(ii) DD coverage is only available to standard risks;

(iii) payments may not be made for multiple/recurring events.

(d) Amount of benefit: similar considerations to those with 3.3.1a(d)

arise, except that some insurers pay the benefit in monthly instalments
over a period of 6 to 12 months.

(e) Premium waiver: some insurers offer to waive all renewal premiums
payable after the accelerated death benefit payment. Others do this,
but stipulate that premiums must resume if the policyowner-insured
recovers from the affliction.
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 3.3.2 Long-Term Care (LTC)

This is not a very common product in Macau at present, but the basic
features of this rider are:

(a) Meaning: a stated portion of the death benefit is paid to a policyowner-

insured who requires constant care for a medical condition.

(b) Types of care: these will be specified in the rider, e.g. in an approved
nursing home or in the policyowner-insured's home by a duly authorized
carer.

(c) Medical evidence: often the rider specifies that the care needs to be
medically necessary. Confirmation of this is not always easy. Sometimes, the
approval of the policyowner-insured's physician is acceptable, but many
insurers require that the policyowner-insured be unable to perform a certain
number of activities of daily living (ADLs) before the need is established.
(ADLs will include basic human needs and functions, such as washing,
dressing and mobility.)

(d) Amount of benefit: typically, this may be 2% of the death benefit per
month for nursing home care and 1% for home health care. The maximum
total payments may range between 50% and 100%.

(e) Waiting period: usually there is a 90-day waiting period before LTC
benefits are payable. Also, some insurers require the policy to have been in
force for one year or more before qualifying for LTC benefits.

(f) Premium waiver: it is common for premiums to be waived, both for the
rider benefit and the basic insurance policy, during the period that these
benefits are being made to the policyowner-insured.

3.4 MEDICAL BENEFITS

In earlier days, medical benefits would not be provided under life insurance
policies. Such cover was considered to be part of the "Accident" (Personal Accident)
portfolio. In more recent times, the boundary lines between various classes of business has
become less clearly marked. It is therefore quite common for life insurers to consider
medical benefits insurance part of their "insurances of the person" range of products.
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Cover may be given as a rider to a life insurance, or separately as a general insurance
policy (for which type of insurance the insurer must of course be authorized).

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 A typical form of cover found in Macau at present is likely to include most of the
following features:

(a) Basic plan: Intended to cover the expenses related to medical treatment and
hospitalization, the Basic Plan has a number of headings under which cover is
given, typically as follows:

(i) Hospital charges: these are likely to have three different categories,
according to choice and premium paid, the usual descriptions being Private
Room, Semi-Private Room or Ward Bed. Cover includes Room and Board,
Miscellaneous Hospital Services and an available supplement for Intensive
Care treatment.

(ii) Private nursing: again with three categories, this includes nursing treatment
at home, in hospital by a qualified nurse or as recommended by the attending
medical practitioner.

(iii) Surgeon's, anaesthetist's and operating theatre fees: Maximum benefit

cover is specified according to the three categories and the seriousness of the
operation involved.

(iv) In-patient physician's fees: for non-surgical cases.

(v) In-patient specialist's fees: for treatment, consultations etc.

(vi) Out-patient follow-up care: within 6 weeks of hospital discharge.

(vii) Free worldwide assistance: a number of benefits and covers to help in the
event of emergency needs whilst abroad. These range from instant telephone
assistance to the return of mortal remains.

(b) Optional medical plan: Various titles may be given to this option, available at extra
premium. The basic intention is to provide coverage for much increased limits
under the various headings and categories of the Basic Plan.

(c) Major exclusions: There are limits to the time during which various benefits under
the Basic and Other Plans may be paid, but these are part of the description of
cover. Specific exclusions are likely to include the following:

(i) Pre-existing conditions;

(ii) Pregnancy and childbirth related expenses;

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 (iii) Drug or other substance abuse, self-inflicted injury and sexually
transmitted diseases;

(iv) AIDS or HIV related conditions (sometimes only excluded for say the first
five years of the insurance);

(v) Congenital abnormalities treatment.

3.5 INSURABILITY BENEFITS

Insurability is virtually self-explanatory, it means that by normal underwriting and

business standards a particular risk is acceptable for insurance. The usual feature that
affects this is, of course, the health of the person who is to be the life insured. Checking
whether a person is insurable is a basic element in underwriting (see 5.3). Sometimes the
question of insurability, however, arises for an existing client (perhaps with policy
reinstatement - see 4.7 or on other occasions). This question, however, may be avoided if
the policy is made subject to the Guaranteed Insurability (GI) Benefit.

3.5.1 Guaranteed Insurability Option

The GI benefit is sometimes referred to as a Guaranteed Insurability Option

(GIO). The basic features of this rider are:

(a) Meaning: the policyowner has the right to purchase additional insurance (of
course for an additional premium) on specified option dates, without having
to supply evidence of insurability.

(b) Limitations: the amount of additional cover may be limited (to the existing
policy's face amount, or less). Also the right may only be available until the
life insured reaches a certain age (typically aged 40).

(c) Not automatic: if the policyowner does not effect the extra cover on a
particular option date, that particular right is lost. He may, however,
exercise the right on the next option date.

(d) Option dates: these are specified in the rider, either as particular dates or for
particular events (such as marriage, or the birth of a child).

(e) Temporary cover: some insurers grant term insurance cover automatically
to cover the policyowner-insured during the period allowed for exercising his
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 purchase option, so that if he dies before completing the option he has the
extra cover.
(f) Policy with WP: if the insurance also has a Waiver of Premium rider (see
3.1.1) and the policyowner-insured is disabled at the time he is to exercise
his option for additional cover, the additional cover is issued automatically.
The WP rider also provides for all premiums to be waived, until the
recovery or death of the policyowner-insured.

3.6 INFLATIONARY ADJUSTMENT

Inflation reduces the purchasing power of money. It is therefore an important

element to be considered with any long-term insurance linked to a specific face amount.
Bearing in mind that policies may continue for many years, perhaps many decades, before
they become payable, it will be realized that what was once a significant amount may in
real terms have been reduced to a small or even trivial sum, because of inflation.

Clearly, this is a problem needing serious attention to the whole of one's life
insurance programme, but in the context of this Chapter on Benefit Riders, provision has
been made in relation to disability income benefits being paid, as follows:

3.6.1 Cost of Living Adjustment (COLA)

This rider or policy provision provides for periodic increases in the disability
income benefits being paid to disabled policyowner-insured. As the name suggests,
the increases are linked to increases in a recognized independent index, such as a
Consumer Price Index. In recent years, inflation has become much less of an issue
for Macau, but it would be foolish to take a short-term view of a long--term
problem, especially when issuing long-term insurances.

-o-o-o-

(3/13)
4 EXPLAINING THE LIFE INSURANCE POLICY

It should be mentioned at the outset of this Chapter that the Macau Life Insurance
market tends to use policy wordings commonly found in the North America. The General
Insurance market, on the other hand, mostly uses policy styles originating in the U.K. For
the purposes of this study (the Life Insurance Policy), we shall follow the more common
"U.S. style" policy provisions, making appropriate comments relating to possible
variations should a local insurer be using U.K. style life insurance policy wordings.

4.1 THE ENTIRE CONTRACT

A Life Insurance Policy is a most important document. The contract is Long Term,
i.e. lasting many years, perhaps decades. Unlike most other classes of business, it is
essential that the original policy document be presented when a claim is made. The "entire
contract" provisions are therefore very important. They provide that:

(a) the entire contract consists of the policy and the copy of the application attached;

(b) only certain specified senior officials of the company are authorized to make
changes to the contract;

(c) no change to the contract can be made unless the policyowner agrees.

4.2 INCONTESTABILITY

This means that within the terms of these provisions the validity of the contract
cannot be contested (challenged) by the insurer. Disputes over the validity of an insurance
contract may arise with an alleged breach of utmost good faith, i.e. certain material facts
have been omitted or misrepresented. The basic provisions of the Incontestability Clause
are that:

(a) the insurer cannot (normally - see below) dispute the validity of the contract after it
has been in force for 2 years;

(b) that minimum period of two years must be during the lifetime of the insured;

(c) under Macau laws (not U.S. law) the claimant cannot rely upon this Clause in the
event of fraud. Macau law will not support fraud, whatever a contract may say.

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[Example: suppose a non-medical insurance is arranged solely on the basis of health
information declared by the Insured. He fails to reveal certain material information which,
for example, would have meant that the insurer would not have insured him. The man dies
after three years. Under the normal rules of Utmost Good Faith the insurer could deny the
contract. In the absence of fraud, they cannot. If fraud is established, the insurer may deny
the contract if the applicable law is that of Macau.]

4.3 GRACE PERIOD

Under U.K. style policies, this is also called "Days of Grace". Essentially, this
relates to a period of time after the date on which a premium is due, when cover is kept
operative. Normally, the policy would lapse (terminate) if the premium is not paid by the
due date, so these provisions allow for the late payment of premium without penalty. The
features of these provisions are:

(a) the grace period is usually a minimum of 30 or 31 days;

(b) the grace period does not apply to the initial premium for the policy;

(c) payment of premium within the grace period is deemed to be payment on time;

(d) this is not a period of free insurance; for example

(i) if the insured dies within the grace period before payment of the premium,
the claim is paid but the premium due is deducted;

(ii) if the premium is not paid during the grace period (and subject to any other
policy provisions, such as nonforfeiture, see 4.5 below) the policy will lapse
from the date the premium was due.

Note: There seems to be some doubt as to the exact time the policy will lapse, if the
due premium is not paid during the grace period. Under the traditional U.K.
practice, non-payment of the premium during the permitted days of grace meant that
the policy lapsed from the date the premium was due (the “renewal”, or policy
anniversary date). Under the U.S. system it seems clear that the policy would lapse
at the end of the grace period. The matter is likely to be of academic interest only,
but the market consensus on this point in Macau seems to be that the U.S. position
would apply (i.e. termination at the end of the grace period).

(e) special provisions may arise with less traditional types of policy, e.g. universal life.

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4.4 BENEFICIARY DESIGNATION

A beneficiary is the proposed recipient of the proceeds of a life insurance policy.

The beneficiary is usually named ("designated") in the policy. Various complexities may
arise with beneficiaries, under different circumstances, but the basic provisions to note are:

(a) if the applicant is the proposed life insured, he may nominate anybody as
beneficiary;

(b) if the applicant is not the proposed life insured (such a policy is called a third party
policy), the proposed beneficiary must have an insurable interest;

(c) class designations (e.g. "my children" etc.) are permitted;

(d) a primary (or first) beneficiary receives the proceeds, when payable (if more than
one is designated, shares will be equal unless otherwise specified);

(e) a beneficiary cannot inherit if he is not living at the time of the death of the insured,
so contingent beneficiaries may be designated, in case the primary beneficiary(ies)
dies/die first.

(f) A ‘revocable beneficiary’ is a life insurance policy beneficiary whose designation as

beneficiary may be cancelled by the policyowner at any time prior to the insured’s
death.

(g) An ‘irrevocable beneficiary’ is a life insurance policy beneficiary whose designation

as beneficiary may not be cancelled by the policyowner unless the beneficiary
consents.

4.5 NONFORFEITURE BENEFITS

Most conventional life insurances (other than term insurances) acquire a cash value
after an initial period in force. That cash value is important for a number of reasons,
discussed elsewhere in these Study Notes, and has special relevance to the question of
nonforfeiture. If something is "forfeited", it means that it is lost or rights to it are taken
away. "Nonforfeiture" therefore means that rights are not lost under certain circumstances,
in this instance the discontinuance of premium payments.

Without specific provisions to the contrary, non-payment of premium means that the
policy will lapse if the premium is not paid within the grace period. The customary
nonforfeiture provisions are that:

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 (a) the policy does not lapse because of non-payment of premium. Unless instructions
are received to the contrary, the cash value of the policy is used to pay premiums for as
long as the cash value lasts, keeping the policy in force for the full amount;

Note: Some insurers do not regard this as a nonforfeiture benefit, but treat it as a quite
separate policy provision known as an automatic premium loan (APL).
(b) the owner of a policy which has a cash value, who decides not to pay any more
premiums in respect of the policy, has certain options. These options are:

(i) cash surrender value: the cash value is paid upon terminating the policy;

(ii) reduced paid-up insurance: the cash value is used as a single premium to
purchase life cover on the same basis as the policy (for a lower amount);

(iii) extended term insurance: the cash value is used as a single premium to
purchase term insurance for the same amount as the policy amount, for such
period as the cash value will provide.

Note: These options arise when a conscious decision is made to discontinue premium
payments. If premium payments merely stop, with no information from the insured, the
automatic provision in (a) above may be put into operation. If the policy has no such
clause, or the policyowner fails to choose any option, many policies provide that option
(b)(iii) above should apply automatically.

4.6 POLICY LOAN

Another feature directly arising from the existence of a policy cash value, is the
facility of borrowing money from the insurer, using the cash value as security. The concept
arises with the APL feature mentioned in 4.5(a) above, but the customary Policy Loan
provisions are:

(a) the policyowner has a right to borrow money from the insurer;

(b) the loan may be for any purpose;

(c) the loan may be up to the policy cash value (less one year's loan interest);

(d) the only security required for the loan is the policy cash value;

(e) the loan may be repaid at any time, or not, as the policyowner decides;

(f) if not repaid, the amount of the loan and any outstanding interest is deducted from
the policy benefit, when payable.

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4.7 REINSTATEMENT

Under U.K. life insurance practice, this is also known as "Policy Revival". The
concept is that a policy which has lapsed ("died") can be brought back to "life" under
certain circumstances. Of course, this can always happen by the mutual consent of the
insurer and the policyowner. The term "reinstatement", however, normally implies the
right of the policyholder to have a lapsed policy brought back into force. The usual policy
provisions which apply to this are:

(a) there is a time limit within which this may be demanded;

(b) that period may vary between insurers, but 5 years is quite representative;

(c) the right normally applies only to lapsed (not surrendered) policies;

(d) the reinstatement may be subject to any of the following conditions:

(i) evidence of continued insurability (good health);

(ii) payment of any outstanding loan, plus interest;

(iii) payment of back premiums, plus interest;

(iv) payment of a reinstatement fee;

(v) a further contestable period (see 4.2) from the reinstatement date;

(vi) a further suicide exclusion period (see 4.12) from the reinstatement date.

4.8 MISSTATEMENT OF AGE OR SEX

Please note that this is a misstatement of age or sex. In the event of a voluntary sex
change operation to an existing life insured, the advice of the insurer concerned should be
obtained.

Obviously, a different age or sex from that indicated when the insurance was
arranged can have a significant impact on the policy premium and/or benefit. The
customary provisions in these circumstances are:

(a) If the error is discovered after a claim arises: the amount of the benefit is adjusted
(up or down) to reflect the amount payable had the correct age/sex been given and
the same premium paid.

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Note: If the insurer is following traditional U.K. practice on this issue, the benefit would
only be adjusted downwards. If the age/sex mistake indicates that too much premium was
paid, a refund of the overpaid premium (without interest!) was paid. Again, this might be a
point to check with any insurer using U.K. forms etc.

(b) If the error is discovered before a claim arises: the policyowner is usually given the
choice of

(i) leaving the face amount unchanged and receiving or paying the appropriate
adjustment after calculating the correct premium that should have been paid;
or

(ii) adjusting the face amount of the policy to reflect the correct figure, given the
age/sex of the life insured and the premium paid.

Note: The U.K. practice on this point will be the same.

4.9 ASSIGNMENT

A life insurance is an asset of the policyowner. It is true that the interest in such an
asset may be reversionary, i.e. full rights of enjoyment and disposal may not be acquired
until some date or event in the future, but legal ownership exists now. Therefore, the
policyowner has the legal right, as with any other asset, to assign or transfer that asset to
another (as a sale - for a payment - or as a gift). If this happens, the policyowner is the
assignor and the third party is the assignee.

Certain features of assignment that we should note, arising from policy provisions
and otherwise, are as follows:

(a) Notice of assignment: the insurer cannot legally prevent an assignment, but the
policy says that the insurer is not bound to honour an assignment until it receives
notice of it. This should be in writing (the policy usually requires a "copy of any
assignment").

(b) Validity of the assignment: the insurer is not responsible for this.

(c) Rights of assignee: these are subordinate to those of the insurer regarding the
proceeds of the policy, i.e. any overdue premiums and/or loans and interest must be
deducted before any payment is made. The assignee is said to receive the net policy
proceeds.

(d) Limitations on the assignment: the assignment

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 (i) must not violate any vested right of any beneficiary (especially of any
irrevocable beneficiary - one that cannot be changed);

(ii) must not be for illegal purposes;

(iii) may be restricted to involve only a lump sum payment to the assignee, i.e.
no other settlement options.

(e) Types of assignment: there are two types:

(i) absolute assignment: the arrangement is permanent and the assignee

becomes the new policyowner;

(ii) collateral assignment: the arrangement is temporary, usually where the

policy is used as collateral security for a loan (not from the insurer). Here
the assignee's interest is limited to the loan plus interest. The policyowner
cannot have a policy loan or surrender the policy whilst a notified collateral
assignment is in force.

4.10 DIVIDEND OPTIONS

Participating policies, in due time, should qualify for dividends. Unlike bonuses
under U.K. style "with-profit" policies, which are almost invariably reversionary (i.e. not
at the policyowner's disposal until the policy benefit is payable), dividends become the
disposable property of the participating policyowner immediately. The policy, however,
normally presents some options in respect of such dividends. They may be:

(a) paid in cash at once;

(b) applied towards future premiums (renewals) of the policy;

(c) left with the insurer to earn interest;

(d) used to buy paid-up additional insurance;

(e) used to purchase one-year term insurance.

Note : If the policyowner makes no selection from the available options, most policies
make provision for what is known as an automatic dividend option to apply. In Macau,
practice seems to vary, but the likely alternative applications are:

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 (i) option (c) above, leaving the dividends with the insurer to earn interest; or

(ii) option (d) above, the purchase of paid-up additional insurance.

Intermediaries should check with their respective principals.

4.11 SETTLEMENT OPTIONS

When the policy benefit becomes payable, there are different possibilities for the
beneficiary and/or policyowner. These are:

(a) a lump-sum settlement: a single payment, to complete the whole contract;

(b) an interest option: the proceeds are left with the insurer, who pays interest annually
or at agreed more frequent intervals;

(c) a fixed period option: the proceeds (and interest) are paid in instalments over an
agreed period of time;

(d) a fixed amount option: the proceeds (and interest) are paid in agreed amount
instalments for as long as the money lasts;

(e) a life income option: the proceeds (and interest) are paid in agreed instalments for
the lifetime of the designated person - effectively this is purchasing an annuity.

4.12 SUICIDE CLAUSE

One of the features of life insurance is that the benefit may be payable even if the
cause of the claim was the deliberate act of the insured life. This arises from the
underlying reason for life insurance, which originally was primarily to make provision for
dependants, rather than to benefit the insured personally.

With a long term contract and under those circumstances, it would be unfair to
penalize the family in the tragic event of the insured person taking his own life. On the
other hand, certain safeguards against the effecting of life insurance with suicide in mind
are perfectly reasonable. The usual provisions are:

(a) suicide is excluded for an initial period of the policy;

(b) that period may vary with insurers, but 1 year is very representative;

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(c) should suicide occur after that period the policy amount is payable;

(d) should suicide occur during that period the policy amount is not paid, but it is
normal for the policy terms to say that premiums paid (less any outstanding loan and
interest) are refunded.

Note: 1 Being a policy exclusion, it is for the insurer to prove that death was by suicide
- not always an easy thing to do.

2 Bearing in mind the overall intention of the exclusion (to defeat arranging a
policy when suicide was contemplated), it is not unknown for an insurer to pay
for a proved suicide which can reasonably be assumed to be attributable to
events arising after the policy commenced. Of course, this would be ex gratia
(i.e. not legally required) and the circumstances would have to be quite unusual.

-o-o-o-

(4/9)
5 LIFE INSURANCE PROCEDURES

5.1 COMPANY OPERATION

The way a company operates is determined by the company itself and there is no set
pattern or formal structure that must be adopted. Therefore, the following comments are
only representative of a company's operations. Before looking at the internal organization
of a typical life insurer, however, we should just mention two important types of company,
according to their constitutional basis:

(a) Mutual insurance companies: a mutual insurance company has no shareholders.

Legally, it is owned by its participating policyholders, although in practice control is
exercised by its Board of Directors and senior management. Being a mutual has
certain advantages, especially for policyholders, who do not have to share company
profits with shareholders. It has certain disadvantages as well, particularly with
regard to the raising of new capital, should this be required.

Note: The fact that a company has the word "Mutual" in its title is not conclusive evidence
that it is a "mutual", as defined above. Whilst this may well be the case, and all companies
having "Mutual" in their title undoubtedly began as such a business unit, some "mutuals"
world-wide have de-mutualized, changing their constitutional status, to become as below.

(b) Proprietary or joint-stock companies: these companies are much more common
business structures, consisting of a limited liability company owned by its
shareholders. "Limited liability" means that the shareholders cannot be made to
contribute anything further towards company losses or capital requirements once
their shares are "fully paid-up".

5.1.1 Typical Company Operational Structure

Since company structures cover a great number of inter-related activities and

there is no set pattern to follow, we shall briefly mention various departments or
functions, in alphabetical order only:

(a) Actuarial department: As mentioned before, life insurance is profoundly

involved with mathematical calculations and projections. The actuarial
department therefore has a key role in company operations, its involvement
including:

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 (i) Product pricing: probably sub-divided between the various major
types of product offered, e.g. Individual Life, Group Life, Health,
Personal Accident and Retirement Benefits.

(ii) Valuation: a core function, required by statute, valuation consists of

the calculation of the value of assets and liabilities. The way this is
done is critical to the solvency margin of the company and the crucial
matter of determining the profits, from which dividends (or bonuses)
can be paid - although the Board of Directors makes the actual
decisions in this respect.

(iii) Claims and reinsurance: calculations and projections of reserves and

needs in these areas are obviously of great importance.

(iv) Management reporting: this could be within the area of the company
accounting staff, but whoever performs the function, it is a critical
one. Unless top management are supplied with reliable data on
reserves, surpluses and other key matters, effectively the company
cannot operate (at least not efficiently, and that probably means "not
for long"!).

(b) Accounts department: According to company policy and structures, an

Accounts department may represent the relatively routine (but important)
role of bookkeeping and financial record maintenance, or (more likely) it
will include Management Accounting, with responsibilities in the key areas
of budgeting and investment etc. Standard functions of the Accounts
Department include:

(i) Receipts: monitoring and recording all payments due to the company,
by way of premiums, reinsurance, loan repayments, etc.

(ii) Payments: monitoring and recording all payments to be made by the

company, including claims, salaries, agency commissions, purchases,
etc.

(iii) Financial returns: every insurer must submit audited accounts each
year, as required by the Macau Insurance Ordinance. This is a major
function and responsibility of the Accounts department.

(c) Agency training and control: The great majority of individual life insurance
contracts are sold through field agents (intermediaries). They at one and the
same time represent almost the "lifeblood" of the company, and a major
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 responsibility regarding their appointment, training and discipline. Details of
requirements are given elsewhere in these and other Study Notes, but very
important matters in this area include:

(i) Training programmes: arranging, organizing and administering, with

all the logistical and personal details involved.

(ii) Examinations: both with regard to their being accepted as

intermediaries (this Quality Assurance Programme, for example) and
other professional qualifications.

(iii) Resources and facilities: the provision of suitable materials, premises

and opportunities for training and career development have obvious
applications.

(d) Claims: Without claims we have no business! Perhaps a slight

oversimplification, but there is truth in the remark. This important area
includes:

(i) Routine administration: all the required enquiries, checking and

general supervision to confirm all is in order.

(ii) Various types of claim: such as death claims, maturities and

surrenders, which may require different kinds of expertise.

(iii) Investigative work: sometimes detailed forensic or other enquiries

need to be made in verifying the validity of a claim.

(e) Client services (also known as POS : see 5.5): This involves a variety of
functions, including:

(i) Changes to policies: these may relate to financial or non-financial

changes, all of which are important to efficiency.

(ii) Communication: this will involve both correspondence and

telephone/personal enquiries, and complaints.

(iii) Documentation: policy duplicates (with all attendant checks and

enquiries) and other document requests.

(iv) Policy renewals: the important process relating to the retention of

business.

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 (f) Marketing: This is a general term that can signify many things. It usually
includes:

(i) Product research: and development of new sales products.

(ii) Promotions/publicity: producing the materials and physically attending

to all logistic and other details involved.

(iii) Advertising: closely related to (ii) but with special features such as
media involvement and sponsoring.

(iv) Public relations: news conferences, media interviews, public talks and
seminars, for example.

(v) Market research: examining needs, demands and results.

(g) Underwriting: This is considered as a technical exercise in 5.3 below, but as

an element in company operations this department includes:

(i) Risk assessment: the technical matter of selection, rating and imposing
terms, as necessary.

(ii) Medical requirements: arranging and monitoring such medical

examinations and related documentation as may be required.

(iii) Reinsurance: the extent to which reinsurance may be required or

arranged with individual risks.

Note: The above departments are representative, as previously mentioned. They do not
form a comprehensive list and are not intended to represent the operational structure of any
particular insurer.

5.2 APPLICATION

Some insurers might refer to an application as a proposal form. Either term may be
found in the Macau market, although "application" is perhaps more widely used. Both
refer to the request for insurance cover from an intending insured. A number of significant
issues and considerations are involved with this important matter, made more important by
the fact that a life insurance cannot be cancelled by the insurer once it becomes operative.

5.2.1 Application Procedure

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 Competition and the desire for efficiency has led to questions on the
application being kept to the minimum. Often, questions are phrased so that a "No"
answer means that no further enquiry needs to be made in that topic, whereas a
"Yes" answer may need further details or enquiry.

(a) General rules for application procedures: the application/proposal is the

main, and sometimes virtually the only, source of information for
underwriting purposes. The intermediary should therefore take great care in
his advice and general assistance to the client when the form is being
completed, noting the following:

(i) All material facts should be given. "Yes" answers in response to

enquiries on health and other matters must be accompanied by full
explanations, including any relevant dates (see: 1.2.2(e)).

(ii) Normally the applicant should complete the form personally.

Sometimes the agent is asked to assist by writing things at the client's
dictation. Great care must be taken with this, to ensure that the client
realizes that the form is his statement and the answers are his.

(iii) Alterations and amendments should be avoided, if possible. If not,

they must be very clear. Anything incorrect must be clearly crossed
through or deleted and the alteration should be signed and dated by
the applicant. (A replacement form may be advisable in many cases.)

(iv) All questions should be answered, as fully as required. Failure to

observe this rule can only result in delay. Information with life
insurances is too important to be waived.

(b) Key points to be considered: Some areas requiring special attention include:

(i) The desired commencement date should be clearly indicated. It is

normal for insurers to allow a policy to be back-dated for a certain
period (which may vary with the insurer concerned).

(ii) The identity of the applicant and life to be insured is important to

establish. Any available I.D. Card should be inspected by the agent
(some insurers require a copy to be attached to the application).

(iii) Age next (or sometimes last) birthday is an important element

affecting the premium. Sometimes in Macau this may not be easy to
establish. It is not uncommon to find that only the year of birth is
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known. In that event, insurers are likely to regard the birthday as
being the 1st January that year.

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 (iv) Other personal details, including occupation, residential address and
family medical history all have a significance which is self-
explanatory.

(v) Signature of both the applicant and the life to be insured (if different)
must be obtained. If the insured is a minor (under 18 years old), the
signature of his/her legal representative must also be obtained. If the
intended signatory cannot write, an appropriate fingerprint mark of
the person together with the signature of the notary is required.

(c) Supplementary requirements: These may involve a number of issues,

detailed instructions about which will be supplied by the intermediary's
principal. Some areas likely to be involved, however, include such
matters as:

(i) Life underwriter's report: signed by the agent.

(ii) Mode of premium payment: whether autopay facilities apply.

(iii) Proof of insurability: establishment of an insurable interest.

(iv) Underwriting forms: additional questionnaires for "Yes"

replies relating to certain medical conditions/ailments, or other
matters (e.g. hazardous sports).

5.2.2 Receipts and Policy Effectiveness

The fact that a life insurance policy cannot be cancelled by the insurer once
it has commenced is a matter of recurring importance. In connection with receipts
issued by insurers, for example, in Non-Life insurance a receipt is merely an
acknowledgement that some money has been received. This is not inevitably
connected with the inception date of the insurance, which could have already
commenced some time ago, or could be intended to commence in the future.
Moreover, even if the (Non-Life) policy has commenced, there is usually a policy
condition allowing cancellation if need be. Not so with Life Insurance.

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 In life insurance a premium receipt is a written acknowledgment that an
insurer has received the initial premium submitted with an application for
insurance. By custom, there are two types of premium receipt:

(a) Conditional premium receipt: With this type of receipt the insurer agrees that the
insurance will commence at the time of application. BUT this is true only provided
that the applicant is subsequently found to have been insurable on standard terms at
the time of application. Two things follow from this:

(i) if the applicant is found to be insurable, but only for a different plan,
premium or amount of cover, then the insurance is not effective from
the date of application. Technically, we may say that the offer has
not been accepted on its exact terms, so the contract does not
commence until any revised terms have been agreed;

(ii) if the applicant, subsequent to the application becomes uninsurable

or even dies he is covered provided he is found to have been insurable
at the time of application.

(b) Binding premium receipt: This may be known by other names, such
as a Temporary Insurance Agreement (TIA) or an Unconditional
Premium Receipt. Whatever the title used, the basic features
surrounding such a receipt are:

(i) this is a contract, separate from any subsequent insurance

policy that may be issued;

(ii) cover begins from the date the application was signed and the
date that the premium was paid;

(iii) cover is not conditional upon the applicant subsequently

proving to be, or to have been, insurable; but

(iv) cover is limited to a maximum specified number of days (say

60 or 90 days);

(v) the cover may terminate earlier than the final day of the period
specified:

(1) from the date the insurer returns the premium;

(2) a specified number of days after mailing a notice of

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 termination;

(3) from the date when coverage begins under the issued
policy.

Note: In Non-Life insurance a similar document is used to give temporary,

unconditional but cancellable cover. There it is called a Cover Note, although it is
usually only for 30 days cover and may or may not be conditional upon any
premium payment.

5.2.3 Customer Service - Policies and Standards

Customer services has been described as the range of activities a company

engages in to keep its customers satisfied.

5.2.3a The Importance of Customer Service

This may have a number of considerations, including the following:

(a) Customer loyalty: the customer who is happy with you tends to stay
with you. Continuity and the conservation of business is very
important in life insurance, where the most of the costs and expenses
are "up front" (when the policy is first arranged).

(b) Customer "prospecting": "prospecting" may be described as the

search for new customers. If existing customers are happy with you,
they immediately become your "unpaid prospectors" with their
friends and families.

(c) Productivity/Profitability: quality service leads to fewer mistakes and

fewer complaints. That in itself means that effort can be directed to
more productive activity, with its consequent impact on profitability.

5.2.3b How to Achieve Quality Customer Service

There is no simple answer to this, but certainly the following will

greatly assist in achieving desired goals in this area:

(a) Corporate culture: this should always be customer-orientated.

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 (b) Delegation: of more authority and accountability to front-line
employees.

(c) Systems: should be created to monitor customer satisfaction.

(d) Training: and technology appropriate to these goals should be

available.

Note: The above recommendations apply primarily to the insurer, but the
underlying principles are easily adapted and applicable to intermediaries.

5.2.4 Cooling-Off Period

One of the popular conceptions, and certainly a popular fear in the general
public, is that life insurance salesmen may be too assertive, even aggressive, in their
selling. The perceived result from this could be that persons might be pressurized
into purchasing a life insurance that they do not really want, or cannot really afford.

To counteract this perceived possibility, the AMCM has issued what is

termed the "cooling-off rights” directive. The substance of this directive and
related matters are:

(a) policyholders are given a period during which they may reflect and, if
desired, change their mind about a life insurance policy that they have
purchased or applied for;

(b) the period allowed for such change of mind is:

(i) 21 days following the completion of the application form; or

(ii) 14 days following the issue of the policy; or
(iii) 7 days after the delivery of the new policy or of the notice to
the Policyholder or his legal representative, informing either of
them of the availability of the policy and of the expiry date of
the Cooling-off Period, whichever is later.

(c) where the right is exercised by the policyholder/applicant within the

permitted time period, the whole contract is cancelled and any
premium paid is refunded subject to a “market value adjustment” as
elaborated in Item 4 of the Cooling-Off Rights Directive (see Note
below);

(d) the right to this "cooling-off" period must be explained to the client,
and its provisions are now a standard item on application forms
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 (usually as part of the Declaration signed by the applicant);

(e) when the policy is issued, the policyowner must be advised of the
Cooling-off Rights attaching to the policy. This may be done by way
of a letter from the insurer, mailed direct to the policyowner, or a
statement on the policy jacket or policy cover.

Note: Item 4 of the Cooling-Off Rights Directive reads as follows:

4.1 For all non-linked policies other than non-linked single

premium policies, policyowners will have the right within the
Cooling-Off period to receive a refund of 100% of the
premiums paid.

4.2 For all linked policies and all non-linked single premium life
insurance policies, the insurer will have the right to apply a
"market value adjustment" (MVA) to the refund of premiums.

4.3 Any such MVA must be calculated solely with reference to the
loss the insurer might make in realizing the value of any assets
acquired through investment of the premiums made under the
life policy. It shall therefore not include any allowance for
expenses or commissions in connection with the issuance of the
contract.

4.4 In the case of a linked policy, the insurer's right to apply an

MVA must be disclosed in the Principal Brochure, and the
basis of calculation must be available for disclosure to the
potential policyholder prior to the completion of the
Application form.

4.5 For non-linked single premium policies, potential policyowners

must be made aware that the insurer has the right to apply an
MVA before the policyowner signs the application. This may
be done by letter, or within the product brochure.

[Example: A person is sold a life insurance policy, about which he subsequently

has doubts. He wishes to call the whole thing off and have his money back. Can he
do so if he notifies his change of mind:

(i) 20 days after he completed the application form;

(5/11)
(ii) 40 days after he completed the application form, which was 10 days
after the policy was issued;

(iii) 60 days after he completed the application form, which was 20 days
after the policy was issued?

(5/12)
Under the provisions of the “cooling-off directive”, the answer to (i) and (ii) above
is “Yes”, and the answer to (iii) is “No”.]

5.2.5 Policy Switching

With a competitive and innovative market, obviously there can be genuine

and quite legitimate cases where an intermediary can in all conscience recommend a
client to "switch" (change) his present life insurance policy to one offering better
terms or prospects.

This form of "switching" will meet the approval of all unbiased people and
create no problem for regulators. "Switching" which does not comply with the
above criteria is a matter of profound concern. This is more commonly known as
"twisting", and may be defined as: "The inappropriate replacement of life
insurance policies."

(a) "Twisting" defined: In colloquial English "twisting" is another word for

"cheating" or "swindling" and this is most apt in the present context. The
Code defines twisting as:

"The making of misleading statements, non-disclosures, misrepresentations

and incomplete comparisons to induce an insured to replace existing life
insurance with other life insurance resulting in disadvantage to the insured."

(b) "Replacement": Replacement also involves any policy which has lapsed,
been surrendered or converted to paid-up insurance.

(c) Customer protection declaration (CPD): This is a most important

document which must be completed before the client agrees or makes a
decision in relation to the purchase of a new life insurance policy to replace
an existing one. Features to note with the CPD are:

(i) it should disclose any replacement being recommended;

(ii) it should ensure that the agent has explained the important
consequences, these are:

(1) Financial implication: the agent may use 2 times the annual
premium of the existing policy(ies) to illustrate the financial
implication, or compare the net change in values of the new
and existing policies in 5 years.
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 (2) Insurability implication: the new insurer may review the
insured's current state of health, occupation and recreational
activities. If any significant change has occurred, the insured
may be denied some coverages or be charged a premium higher
than the standard one.

(3) Claims eligibility implication: a new policy may have different

policy provisions and also may result in a new start of the
incontestability and suicide clause time periods. This could
result in a claim being denied that would have been paid under
the existing policy(ies).

(iii) if the agent has said there is no disadvantage in making the change, he
must give reasons for this conclusion in writing;

(iv) the original copy of the CPD will be held by the selling office, with a
copy for the client, attached to the policy.

5.3 UNDERWRITING

Underwriting may be simply described as the assessment of risks for the purposes
of insuring them or deciding what insurance terms should apply. Another way of
describing the term is to say that it is determining the insurability of proposed risks. Since
life insurance involves a long-term contract that cannot be cancelled by the insurer, we
may say that normally life insurance underwriting for an individual risk can only be done
once. It is therefore important to get it right first time.

5.3.1 Factors Considered

Underwriting is said to have the following two aspects:

(a) Identifying the degree of risk: from experience life insurance underwriters
can identify degrees of risk with applications, usually under two headings:

(i) Physical hazard: this concerns largely objective factors that are likely
to increase the risk of the insured event (death) happening. These
will include obvious features such as known health dangers,
including:

(1) significantly overweight;

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(2) heavy smoker;

(5/15)
 (3) substance abuse (alcohol, drugs etc.);

(4) very dangerous occupation or leisure pursuits;

(5) adverse inheritable family or personal medical history.

(ii) Moral hazard: this concerns rather more subjective factors

surrounding the basic honesty or honourable intentions of the person
to be insured. Whilst suicide is not a common potential problem (and
is in any event covered to some extent by policy provisions - see
4.12), there are other considerations. For example, the person may
deliberately hide important information or submit false information to
obtain cover. It is, of course, less easy to determine moral hazard
than physical hazard.

(b) Classifying the proposed risk: classifying proposed risks into appropriate
categories enables the insurer to determine an equitable premium. Insurers
tend to have four categories of risks, as follows:

(i) Standard risks: these present no abnormal features, and are perfectly
acceptable at the appropriate premium according to the age and sex of
the applicant.

(ii) Sub-standard risks: because of the adverse sound of such a term,

some insurers call these special class risks. In either case, what is
implied are risks that cannot be insured under normal terms. They are
insurable, but only subject to certain considerations, discussed in
5.3.3 below.

(iii) Declined risks: as the name indicates, these are risks that are
unacceptable. Insurers generally try to give cover if they reasonably
can, but obviously there are some applications where health or other
factors make it impossible to accept.

(iv) Preferred risks: not all insurers use this category, which implies an
above average risk application that merits a discount or other
favourable terms. This may include confirmed non-smokers or
individuals who otherwise represent better prospects of long years
before a claim is likely to arise.

Note: The above may be said to represent technical underwriting, involving an

assessment of the intrinsic and perceived hazards presented by individual risks. We
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should also note what is called Financial Underwriting.

This term relates to an assessment of the amount of the proposed insurance

in relation to various matters, including:

1 the perceived ability of the insured to meet premium obligations;

2 the degree of risk presented (and therefore whether reinsurance

might be advisable/available);

3 accumulation of policy plans for the same person;

4 whether it is in excess of usual levels for persons corresponding to the

age and general circumstances of the applicant. We cannot say that
any life insurance is too much, but if it is very high by customary
standards this may put the insurer on enquiry.

5.3.2 Medical Reports

Many life insurances are arranged on a non-medical basis. That is, the
information supplied on the application and other circumstances surrounding the
proposal (age, apparent health, sum to be insured etc.) allow the underwriter to
proceed without further enquiry.

Sometimes, however, further information is required from qualified medical

practitioners. The source of such enquiry may be:

(a) an attending physician, by which is meant a doctor or other qualified medical

person who usually or has previously supplied medical care to the applicant;

(b) an examining physician, by which is meant a physician who conducts a

medical examination (the U.S. term commonly used is a physical) at the
request of the insurer, who pays for this.
A number of factors need to be considered with this subject:

(a) A sensitive subject: it is human nature to become anxious at the thought of a

medical examination. This is quite illogical, as it must be for one's good to
know the truth, but that is not how most of us think. Insurers are quite aware
of this and only request medical information if it is deemed really necessary.

(b) Attending Physician's Statement (APS): this is the most frequently required
medical report and the usual reasons for requesting it are:
(5/17)
 (i) specific medical disclosures on the application need further enquiry;

(ii) the amount of insurance requested is high;

(iii) the applicant is at a certain age (say, over 50).

(c) Specialized medical questionnaire: the examining (or attending) physician

may be supplied with a separate questionnaire specifically designed to obtain
information on a particular illness or condition that needs to be considered
with the applicant concerned. This may relate to any of a number of
conditions, ranging from blood pressure to cancer, being conditions that
previously disclosed information suggests a need for further enquiry.

(d) Confidentiality: obviously, medical information is very private and the

information obtained must be treated with the utmost confidence. However,
if and when medical tests are suggested, the applicant has the right to know
what tests are to be done, what the information is needed for, and (if he
wants to know) the results of any tests.

5.3.3 Sub-Standard Life and Underwriting Measures

Usually for medical, but sometimes for other reasons, a particular applicant
may prove to be below the required standard for acceptance at normal rates. There
are a number of possible underwriting reactions to this situation, including:

(a) Refuse to insure: sometimes called declinature. This is a drastic measure

that insurers prefer to avoid if at all possible. Most life applications can be
accommodated, although sometimes the terms of the insurance may have to
be more severe.

(b) Load the premium: increasing the premium is a very standard way of
dealing with sub-standard risks. The extra premium, which may be quite
modest or quite substantial according to circumstances, can normalize the
abnormal, for insurance purposes.

(c) Other options: the above two reactions are the most common, but there is
wide range of possibilities, which might include one or more of the
following:

(i) a "debt" on the policy, reducing each year so that it disappears the
nearer the insured comes to living a normal life span;
(5/18)
 (ii) specific exclusions, perhaps of death from a particularly dangerous
pastime or leisure pursuit (this would be very rare, since it tends to
defeat the object of the cover);

(iii) offering a different plan: short term cover may be possible, whereas
the medical evidence indicates that very long-term insurance is
doubtful;

(iv) decline to accept at present, i.e. to defer a decision, if the applicant

is severely injured or otherwise has a (hopefully) temporary adverse
medical condition.

5.4 POLICY ISSUANCE

Once the underwriting process is complete and cover has been approved, the policy
can be prepared and then delivered to the policyowner. The important fact that a policy
cannot be cancelled or amended after its issue without the agreement of the policyowner,
once more needs to be mentioned. Issuing and delivering the policy in some respects may
be looked upon as the "point of no return" for the insurer. Careful policy checking and
confirmation is therefore needed before this happens.

5.4.1 Policy Delivery

This may be considered with policy issuance as the two are very closely
connected. Using modern technology, policy documents can be produced with great
speed and accuracy. The in-house system should create the client's record and
verify that the first premium has been received. Policies are mostly in standard
format within the class and plan concerned. Therefore, only variations affecting the
particular client alters the routine format. All of this can be dealt with by an
automated system. Some slight differences in procedure should be noted as follows:

(a) Individual policy covers (including annuities): the production and delivery
is straight-forward, delivery normally usually being made by the marketer.

(b) Group policy covers: here the process involves enrolling individual
employees (or other group persons). The technology system must therefore
produce not only the master policy, but also a certificate and perhaps an
enrolment card for each insured person. Each such person receives a
certificate and completes an enrolment card, the process normally being
overseen by the marketer or group representative.
(5/19)
(5/20)
5.5 AFTER SALES SERVICE

The conservation of existing business has been mentioned before (see 5.2.3a(a)).
This, for reasons given, is very important and the quality of after-sales service is a vital
element in this area. Such service is within the responsibilities of Customer Service
personnel (see 5.1.1e above), whose department might well now be called Policyowner
Service, or POS. By way of reminder, the duties of POS may include:

(a) Correspondence: and other communication with customers.

(b) Documentation: duplicate policies, surrenders, converting etc.
(c) Premium payments: handling all aspects of this.
(d) Benefit administration: cash values, loans and dividends.
(e) Policy changes: see below.

5.5.1 Policy Changes

These changes may be relative trivial, amending some administrative detail,

or may have a significant effect upon contract terms. The changes usually requested
include changing the

(a) type of insurance cover: obviously of considerable significance;

(b) address: of the policyowner or beneficiary, for example;

(c) beneficiary: clearly this must be a permissible change, under contract terms;

(d) amount of cover: after any due underwriting consideration;

(e) owner of the policy: another obviously important change.

Note: All changes must be carefully processed. The change requested may seem
very straightforward, but there is always the possibility that it will have legal or
other implications, ranging from underwriting or reinsurance matters even to
potential attempted fraud (money laundering, etc.).

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5.6 CLAIMS

With Non-Life insurances, claims are not expected under most policies. There the
cover is "in case" there is need and generally speaking neither party wishes to experience a
claim situation. The latter may be true in some respects for Life insurance, but there a
claim (except for term insurances) is inevitable if the policy is kept in force. Indeed, with
many contracts having a savings element, the policyowner often looks forward to making
the claim. Claims may be considered under three headings, as follows :

5.6.1 Maturity Claims

Mostly concerning endowment insurances, these involve situations where

the life insured is still living and (if also beneficiary) able to collect the proceeds
personally. With these, as with all procedures dealt with under this Chapter, each
insurer may have their own system, but typically the following considerations arise
with maturity claims:

(a) Near the date: a month or so in advance of the date the insurer writes to the
policyowner, in order to:

(i) remind him of the maturity date;

(ii) state the amount payable;

(iii) list any requirements for payment;

(iv) enclose a relevant form of discharge.

(b) Legal title the insurer can only deal with the person having legal title to the
policy proceeds. Also, the actual policy will be required. This is an
important document of title and only assignments duly recorded can be
recognized.

(c) Adjustments: the payment may have to be subject to deductions for any
outstanding items, such as loans, unpaid premiums and interest owing. Of
course, any beneficiary interest has to be respected and processed.

(d) Proof of age: if the policy is marked "age not admitted" this means that
formal proof of age was not given at policy inception. Some insurers may
not require confirmation of age if the policy has matured, but it should be
requested because misstatements of age could have an impact on the policy
(5/22)
 benefit (see 4.8).

(e) Unpaid maturities: a suitable monitoring and follow-up procedure must be

in existence for any maturity claims where the policyowner does not respond
to (a) above.

5.6.2 Death Claims

Maturity claims, for obvious reasons, are normally processed in a "happy"

atmosphere. Death claims on the other hand inevitably have a serious and
sometimes tragic background. Whilst this must not intrude unduly into the
professional way in which the claim is processed, insurers and intermediaries
should be sensitive to the situation. The specific points needing attention with such
claims are:

(a) Date of death: this must be established, as it can affect the amount payable,
e.g. with decreasing term insurances, and with any dividend/bonus
calculations. Indeed, with term insurances the policy could have expired.

(b) Proof of death: normally, this is fairly easy to obtain, with the death
certificate (the original document must be produced). Problems may arise
over death certificates, however, where death arises or is alleged to have
arisen overseas. This has on occasions been a particular area for fraud.

(c) Cause of death: this will be shown on the death certificate and it may be
important for a number of reasons, including:

(i) suicide: if the policy is still within the exclusion period (see 4.12
above);

(ii) accident: the policy may be subject to an ADB rider (see 3.2.1(a)
above);

(iii) suspicious or surprising: death shortly after the policy was issued, or
where the cause would normally develop over a longer period than
that for which the policy has been existence, will put the insurer on
enquiry. Fraud must always be a possibility in such circumstances.
Even if fraud does not apply, the policy may still be within a
contestable period (see 4.2 above);

(iv) murder: in most cases this will not affect the validity of the claim, but
if the murderer is proved to have been the beneficiary, the law
(5/23)
 ("Criminal Code" or other specific law of same nature) will not
allow the murderer to benefit personally.

(d) Presumption of death: where no death certificate can be issued and it is

assumed the life insured has died, this may have to be resolved by the court.

(e) Proof of age: see comments in 5.6.1(d) above. Normally, proof of age is
easily obtained by producing a birth certificate, or the deceased's I.D. card
or passport.

5.6.3 Surrenders

Many of the considerations arising with maturity claims have relevance

here, as the claimant is still living. Specifically, areas needing attention are:

(a) Proof of title: only the person legally entitled may receive the cash value;

(b) Adjustments: unpaid premiums, loans and interest must be taken into
account;

(c) Discharge: an appropriate discharge and release form is obtained. Special

care must be taken to protect any assignee or beneficiary interest;

(d) Other enquiries: the insurer or intermediary should take special care with
applications for surrender of the policy. Obviously, the policyowner has
every right to discontinue cover, but it may be helpful and productive to
make discreet and courteous enquiries.

Sometimes, the insurance meets a real need for the client, but he meets
unexpected life situations and his first thought is to cancel his insurance. That may
not be in his best interests and other more suitable alternatives may be available
(policy loan, use of nonforfeiture provisions, etc.).

-o-o-o-

(5/24)
6. INTRODUCTION TO PRIVATE PENSION FUND ORDINANCE

6.1. Needs for retirement protection

The aging population is being a problem to many places in the world. Saving for
the rainy day is not just a wise saying but is prudent and essential to do so.

As in most countries, three pillars structure the old-age protection program in

Macau:

a) Social security;
b) Private pension plans; and
c) Individual savings and assets.

The social security provides the basic minimum benefit. Personal thrift has played
and probably always will play a major role in providing for old-age security.
Then, the private pension schemes supplement an adequate level of old-age
income.

6.2. Key features of Private Pension Fund Ordinance

6.2.1. Coverage

The legal framework for private pension funds will regulate the setting up,
management and winding up of private pension funds and pension plans.

6.2.2. Definition of Terms

Pension Plan: a retirement program which defines the conditions for

formation of the right to receive a pension.

Pension Fund: a fund which can invest in many different types of financial
securities and can own assets directly exclusively for the fulfillment of one or
more pension plans but should not be used to meet any other obligation,
namely those of associates, members, contributors, fund managers and asset
custodians.

Associate (or sponsor): corporate entity whose pension plans are financed by
pension funds.

(6/1)
 Participant: individual whose personal and professional circumstances
determine the rights arising under the pension plans, regardless of whether
they contribute or not to the fund.

Contributor: individual or corporate entity who contributes towards the fund.

Beneficiary: individual who has the right to receive benefit set out in the
pension plan, regardless of whether they are participants or not.

Retirement age: participant who has reached the age of 65.

6.2.3. Types of Pension Plan

Based on the types of guarantees provided, pension plans shall be classified as:

a) Defined benefit plan: retirement plan under which benefits are

predefined and contributions to be made are calculated so as to guarantee
the respective payments;

b) Defined contribution plan: retirement plan under which contributions to

be made are predefined and the benefits are determined according to such
contributions and the corresponding accumulated earnings;

c) Mixed plan: retirement plan which combines the features of the two
plans mentioned above.

On the other hand, based on the forms of financing, pension plans shall be
classified as:

a) Contributory plan: retirement plan under which both the employer

(associate) and the employees (participants) make contributions;

b) Non-contributory plan: retirement plan under which an employer

(associate) pays the entire direct cost of the plan, employees (participants)
do not share in the cost.

6.2.4. Type of Pension Fund

Pension funds can be either closed or open funds.

(6/2)
(6/3)
 a) Closed Fund - a fund which the respective plan concerns only one
sponsor (associate) or, if there are a number of sponsors, when there is
a business, associative, professional or social connection between them
and their consent is necessary for new sponsors to join the fund.

Closed pension funds may be set up at the initiative of a company,

group of companies, groups of social or professional associations, or by
agreement between employer and employee associations.

b) Open Fund - a fund where there is no requirement for any link between
the various members of the respective plan, and membership of the fund
is solely dependent on acceptance by the pension fund manager.

Open pension funds may be set up at the initiative of any entity entitled
to manage pension funds. The total net value of the fund shall be
divided into units of participation represented by certificates.

6.2.5. Vesting

The participants are entitled to receive the benefits accrued from

contributions in accordance with the terms set out in the respective pension
plan.

However, the vesting schedule should be depending upon the terms and
conditions in the respective pension plan. It could be based on the length of
service or the age of participant.

6.2.6. Withdrawal of benefits

The participants may withdraw the benefits accrued from contributions in

form of a lump sum payment or in other forms indicated in the respective
pension plans. Withdrawals will be permitted under the following
circumstances:

a) Early retirement;

b) Old-age retirement;

c) Permanent incapacity;
(6/4)
d) Death;

(6/5)
 e) Serious illness;

f) Long-term unemployment;

g) Permanent departure from the Macau SAR; or

h) Participant shall have the option either to receive the benefits or transfer
the same to a new pension fund on termination of employment with the
associate for reasons other than those referred in above items a) to g).

6.2.7. Advantages of Private Pension Plans

Private pension plans can provide the following advantages:

a) Retirement protection: Employees can have a better financial

protection for their old-age security. On the other hands, employers
can provide better benefit for employees’ retirement with relatively
lower costs and step up the motivation of employees;

b) Effective and secure: An independent managed pension fund under

prudential regulation and supervision is most effective and secure way
to offer retirement protection to employees;

c) Energize local market: Investment of private pension funds can

energize the local financial market as well as to promote the global
development of economy in Macau;

6.3. Regulatory Framework under Private Pension Fund Ordinance

6.3.1 Approval of Service Providers

Life insurance companies operating in the Macau SAR are entitled to be fund
managers of private pension fund. Besides, fund management companies
established under the provisions of Decree-Law no. 27/97/M of 30 June
relating to life insurance companies can also act on the management of
private pension funds.

6.3.2 Approval of Private Pension Funds

a) The AMCM is the authority with competency to authorise the

(6/6)
 constitution of pension funds;

b) Authorisation to closed pension fund shall be granted based on the

joint petition from the fund manager(s) and the sponsors (associates);

c) Authorisation to open pension fund shall be granted based on the

petition from the fund manager(s);

d) Either the constitution contract of closed pension fund or the

management regulation of open pension funds shall be published in
the Official Gazette once the respective authorisation granted.

6.3.3 Registration of Private Pension Plans

Private Pension Plan can be registered with the AMCM when it is financing
by pension fund(s) constituted and authorised under the Private Pension
Fund Ordinance (Decree-Law no. 6/99/M of 8th February).

6.3.4 Functions/Duties of fund managers and custodians

a) Fund manager – A fund management company shall engage in all acts

in name of and on behalf of the associates, participants, contributors and
beneficiaries. As the administrator and legal representative of the fund,
it can negotiate on any assets or real estate, make bank deposits in the
name of the fund and exercise all rights directly and indirectly related to
the fund.

b) Custodian (Depository) - The main duties of a custodian of pension

funds shall include:

i) To receive on deposit or register the financial instruments and

documents pertaining to the funds;

ii) To maintain up-to-date chronological record for all the transactions

carried out and to prepare every quarter a detailed inventory of
assets of the funds.

6.3.5 Disclosure to members of Private Pension Plans

The management company shall compulsorily provide to the contributors and

(6/7)
 participants of pension plan the following information:

a) Contents of the deed of constitution or of the management regulation

and the respective amendments;

b) Balance of contributions in their individual accounts;

c) Their shares in the total value of the fund; and

d) Upon request, all the information necessary for a complete

understanding of the contract.

6.3.6 Transitional arrangement

All private pension funds and pension plans constituted under the previous
legislation shall have a period of up to 31st December 2002 to adapt to the
rules of present law.

-o-o-o-

(6/8)
 GLOSSARY

Absolute Assignment An assignment which is permanent, the assignee becoming the

new policyowner. 4.9(e)(i)

Accelerated Death Benefits These are life insurance death benefits which may, under
certain circumstances (e.g. life threatening health situations), be payable in part or in
full even though death has not yet occurred. 3.3

Accident Benefits Additional benefits that may be added to a life policy by

means of the Accidental Death (ADB) or Accidental Death and Dismemberment
(AD&D) Rider. 3.2

Accidental Death and Dismemberment (AD&D) Rider The accidental death

benefit under this rider is a sum equal to the face amount for the policy (providing what
is termed a "double indemnity"). The dismemberment benefit relates to loss of limbs
and/or sight. 3.2

Accidental Death Benefit (ADB) An addition to a life policy, providing a double

benefit should the insured life die from an accident. 3.2.1(a)

Accounts Department An important area of company administration, including work

associated with the receipt and payment of monies and the making of required financial
returns. 5.1.1(b)

Actively-at-Work Provision A provision in group life insurance that to be admitted

to the plan the employee concerned must have been present at work on the day when
coverage became effective. 2.3(f)

Activities of Daily Living (ADLs) Basic human needs and functions (e.g.
washing, dressing etc). Inability to perform these could be grounds for a payment
under a Long Term Care rider. 3.3.2(c)

(i)
Actuarial Department An extremely important department for life insurers. An
actuary must be appointed for life insurers, by law, and the work of this department is
significant (amongst other things) in product pricing, and especially in the required
valuation of the company's assets and liabilities. 5.1.1(a)

Adequate (Premiums) One of the classic criteria usually applied to life insurance
premiums, i.e. sufficient to meet claims and other obligations under the contract.
1.3.1(a)

After Sales Service The important process of maintaining good communications

and relations with policyowners, to assist with the conservation of existing business.
5.5

Age Next (Last) Birthday An important detail obtained from the application,
having a significant effect on the premium to be charged. 5.2.1(b)(iii)

Age-Related Limitation Whole life insurance where the premium is no longer

payable after a specified age.
2.1.3(a)(iii)

Agency Training and Control An important area of company administration,

especially bearing in mind the necessity for training of an extensive field staff. The
department will especially be concerned with training programmes and professional
examinations. 5.1.1(c)

Annual Annuity An annuity where the time span between each of the payments in
the series of periodic annuity benefit payments is one year. 2.1.4a(b)

Annual Report A feature of universal life insurance, whereby the policyowner

receives such a report each year, outlining several headings of information, e.g. death
benefit option selected, premiums received during the year, cash value balance etc.
2.2.1(g)

Annually Renewable Term (ART) An alternative title for the Yearly Renewable
Term (YRT) rider. 2.1.1b(a)
(ii)
Annuitant The person entitled to receive annuity payments. 2.1.4(a)

Annuity A series of periodic payments (frequently for life), paid in return for a
single lump-sum initial "premium" (perhaps paid by a series of instalments). 2.1.4a

Annuity Certain A variation of an annuity, where the benefit is paid for a fixed
number of years, whether the annuitant lives or dies during that period. 2.1.4a(d)

Anti-Selection Occurs where the "bad" risks tend to continue with the insurer,
whilst the "better" risks tend not to. This is a real danger with the natural premium
system. Also known as Selection Against the Insurer. 1.3.2a(c)(ii)

Application The more usual term in Macau life insurance for a proposal form,
by means of which preliminary information is obtained regarding a proposed life
insurance. 5.2

Approved Nursing Home A nursing home as specified in the Long Term Care
(LTC) rider, as a type of care acceptable to the cover provided. 3.3.2(b)

Assignee The person to whom an insurance contract has been assigned. In life
insurance, an assignee does not have to have insurable interest. 4.9

Assignment The transfer of all rights under an insurance to a third party, either
for reward or with no fee involved. 4.9

Assignor The person assigning an insurance policy to the assignee. 4.9

Associate A corporate entity whose pension fund plans are financed by pension
funds. 6.2.2

Attained Age The age of the life insured at the time the insurance is
completed/renewed. 2.1.1b(b)

(iii)
Attending Physician's Statement (APS) An "attending physician" is a doctor or
other qualified medical person who has previously supplied medical care to the
applicant. An APS may be required if information disclosed indicates that further
medical information is needed, or for other abnormalities (e.g. relatively advanced age
of the applicant, relatively high amount of insurance requested). 5.3.2(b)

Automatic Dividend Option If the policyowner gives no indication of his

preference regarding his dividend options, the policy provides for a particular option to
be applied automatically. Often such an option means that paid-up additional insurance
is purchased with the dividend or leaving the dividends with the insurer to earn interest.
4.10 Note

Automatic Premium Loan (APL) A policy provision to the effect that in the
event of non-payment of a due premium, and in the absence of other instructions, the
cash value of the policy is used to pay the premium and keep the policy in force. 4.5(a)
Note

Basic Functions Essentials formats of life insurance, e.g. benefit payable on death in
a specified period, payable on death at any time, payable on a specified date or earlier
death, and monthly payments in return for a lump sum "premium". 2(a)

Basic Plan Cover for the expenses of medical treatment and hospitalization,
under a medical benefits insurance. 3.4(a)

Basic Questions Fundamental enquiries that should be made when arranging life
insurance, i.e. "What is the insurance for?", "How much premium are you willing and
able to pay?" and "How much life insurance do you need?". 2(c)

Basic Variables Modifications to the basic functions of life insurance, e.g.

convertibility, renewability, PAR or NON-PAR and various riders. 2(b)

Beneficiary The person nominated to receive the policy benefit in the event of a
claim under the policy. 4.4

Beneficiary Designation The naming of a designated beneficiary in the policy

(iv)
documents. 4.4

Benefit Policies Policies which do not pay claims on an indemnity basis, but on a
stipulated benefit basis (e.g. in life insurance policies) 1.2.3(a)(i)

Benefit Riders Endorsements to a life insurance policies, granting various benefits,

e.g. Accidental Death Benefit (ADB) rider. 3

Binding Premium Receipt A premium receipt which confirms that cover applies.
It therefore fulfils some of the features found with cover notes in general insurance.
The cover with such receipts is temporary, with provisions which will enable the
insurer to come off risk earlier than the end of the specified period, if necessary. Also
known as Unconditional Premium Receipt and Temporary Insurance Agreement
(TIA).
5.2.2(b)

Bonuses The approximate equivalent of dividends with participating policies,

bonuses are reversionary amounts added to the ultimate benefit payable under the
policy, and earned by with-profit policyowners. They are usually declared as a
percentage, which is applied to the sum insured by the policy. 1.3.1b(a) Note 1

Business Needs The use of life insurance contracts to meet various business
situations, e.g. key person's insurance, partnerships, employee benefits etc. 1.1.1(b)

Cash Value The amount payable to the policyowner should he decide to

terminate the policy prematurely. Not all policies will have a cash value, e.g. term
insurances. It may also be called the Surrender Value. 1.3.2b(c)(i)

Cause of Death A potentially important detail with death claims, possibly affecting
the validity or amount of the claim, e.g. an early suicide, death from accident etc.
5.6.2(c)

Certificate See Enrolment Card. 5.4.1(b)

Claims A crucial area for life insurers. The department concerned will be
involved in all aspects of claims investigation, processing and settlement. 5.1.1(d)

(v)
Class Designation A description of beneficiaries by group association rather
than by name, e.g. "my children", "my brothers and sisters" etc. 4.4(c)
Client Services See POS. 5.1.1(e)

Closed Fund A Fund which the respective plan concerns only one associate or if
there are a number of sponsors, where there is a business associate, professional or
social connection between them and their consent is necessary for new sponsors to join
the fund.
6.2.4

Collateral Assignment An assignment which is likely to be temporary, as collateral

security for a loan. The assignee's interest with such an assignment is limited to the
amount of the loan plus interest. 4.9(e)(ii)

Collateral Security The collateral assignment of a life policy provides collateral

security for a loan given to the policyowner. 4.9(e)(ii)

Conditional Premium Receipt A receipt for premium which confirms that insurance
will begin from the time of the application, provided the life insured is subsequently
found to have been insurable on standard terms at that time. 5.2.2(a)

Conservation The retention of existing business, i.e. avoiding policy lapses and
surrenders. 5.2.3a(a)

Contestable Period The period of time specified in the Incontestability Clause

during which the validity of the policy may be contested. 4.2, 4.7(d)(v)

Contingent Beneficiary A beneficiary who inherits if the primary beneficiary is not

living when the policy proceeds become payable. 4.4(e)

Continuous Premium Whole Life Policy Whole life insurance where the
premiums continue to be payable throughout the lifetime of the life insured. 2.1.3(a)(i)

Contractholder An individual or an organization who applied for and

(vi)
purchased the annuity contract. 2.1.4(a)

(vii)
Contribution An insurance principle which means that two or more insurers
covering the same insured for the same loss share that loss rateably. However, this is in
providing an indemnity, to which life insurance is not subject. The existence of more
than one life insurance does not affect the amount payable by the individual insurer.
1.2(e)

Contributor An individual or corporate entity who contributes towards the

pension funds. 6.2.2

Contributory Plans Group life, or employee benefit schemes where the premium
is paid in part by the employees. 2.3(c)

Convert (Conversion) Changing a policy plan in accordance with permitted policy

provisions, or by mutual consent with the insurer. 2(b)(i), 2.1.1b(b)

Convertible Term Insurance A term insurance with rights to convert the policy
plan into permanent cover, without evidence of insurability. 2.1.1b(b)

Cooling-Off Directive A Directive initiated by the AMCM to grant certain

privileges to life insurance policyowners regarding the cancellation of arranged
contracts, within a permitted period. 5.2.4

Cooling-Off Period A provision under the "Cooling-Off Directive", which

allows a customer a stipulated time period to change his/her mind about a completed life
insurance contract during which he/she may cancel the policy with a full refund of
premium (subject to any market adjustment). 5.2.4

Cost of Living Adjustment (COLA) A rider providing for periodic increases in the
disability income benefits being paid to a disabled insured. The increases are linked to
a recognized independent index, such as the Consumer Price Index. 3.6.1

Cover Note A term from general insurance, indicating a document giving

formal evidence of the existence of insurance, the approximate equivalent in life
insurance being the Binding Premium Receipt. 5.2.2 Note

(viii)
Credit Life Insurance A form of decreasing term insurance on a group basis
arranged by lending institutions to cover the outstanding balance of loans should
customers die. The benefit is payable direct to the lending institution. 2.1.1a(b)(i)

Critical/Terminal Illness (TI) Benefit A rider allowing a stated portion of the

death benefit to be paid to a policyowner-insured suffering from a terminal illness, with
a life expectancy of 12 months or less. 3.3.1a

Custodian An entity whose main duties in a pension fund fund includes

maintaining up-to-date chronological record for all the transactions carried out and to
receive on deposit or register the financial instruments and documents pertaining to the
funds. 6.3.4

Customer Prospecting The search for new customers for insurance, either from
existing contacts or by other marketing endeavours. 5.2.3a(b)

Customer Protection Declaration (CPD) An important document that must be

completed and signed before a customer agrees or makes a decision in relation to the
purchase of a new life insurance policy to replace an existing one. It is part of the
concern of the insurance industry to preserve high ethical and professional standards,
and to control inappropriate replacement of insurance policies. 5.2.5(c)

Customer Service The range of activities a company engages in to keep its

customers satisfied. It involves attention to the corporate culture (customer-orientated),
authority being given to front-line employees and systems designed to monitor customer
satisfaction. 5.2.3

Date of Death An important point to be established with life insurance death

claims, especially with term or decreasing term insurances, where the validity or
amount of the claim may be affected. 5.6.2(a)

Days of Grace See Grace Period. 4.3

Death Benefit The basic amount payable under the insurance in respect of the
death of the life insured. This may be subject to additional factors, e.g. accidental
death benefits etc. 2.2.1(f)

(ix)
Death Claims The most common type of claim with life insurance, requiring
detailed processing and verification of matters such as date of death, cause of death,
proof of death etc. 5.6.2

Debt (on Policy) An underwriting measure with a sub-standard risk, whereby a

"debt" is placed against the face amount, possibly reducing to extinguishment as the
policy years go by without a claim. 5.3.3(c)(i)

Declaration The part of an application form signed by the prospective

policyowner, confirming various statements and understandings, including the existence
of a cooling-off period. A similar declaration appears on Illustration Documents,
confirming understanding of the information supplied. 5.2.4(f)

Declinature Refusal to insure a given risk. This is a last resort, as insurers

prefer to offer terms if at all possible, but clearly there will be some risks which are
uninsurable. 5.3.3(a)

Declined Risks Risks which are impaired to such an extent that they lack
insurability. 5.3.1(b)(iii)
Decreasing Term Insurance A term insurance where the face amount reduces each
year or at specified times. The cheapest form of life cover, useful to meet a
diminishing temporary need, e.g. a mortgage loan which is being repaid over a period
of years. 2.1.1a(b)

Defer Decision An option for the life underwriter where a risk is not insurable
owing to a temporary condition (e.g. accident injuries). The risk is not permanently
refused, but it will need reassessment at a later date. 5.3.3(c)(iv)

Deferred Annuity An annuity where the payments begin at some specified

future time or specified age of the annuitant. 2.1.4a(b)

Defined Benefit Plan A retirement plan under which benefits are pre-defined and
contributions to be made are calculated so as to guarantee the respective payments.
6.2.3

(x)
Defined Contribution Plan A retirement plan under which contributions to be
made are predefined and the benefits are determined according to such contributions
and the corresponding accumulated earnings. 6.2.3

De-mutualized A mutual insurance company which has changed its mutual status,
to become a proprietary company with shareholders. 5.1(a)Note

Different Plan An underwriting option with a sub-standard risk, which proves

unacceptable for the plan requested but may be insurable under another plan.
5.3.3(c)(iii)

Disability Income Benefit A policy rider providing an income during the

insured's period of disability. 3.1.2

Dismemberment The loss of one or more limbs, but within the AD&D Rider
provisions the term also applies to loss of sight. 3.2.1(b)

Dividend Options The choices available to the policyowner of a participating

policy, for which dividends have been earned. These choices include: receiving the
dividends in cash, applying them towards future premiums,leaving them to earn interest
with the insurer etc. 4.10

Dividends Similar meaning to that applicable with equities, whereby the

policyholder (with a participating policy) earns a specified amount according to the
profits made by the insurer. Usually expressed as a percentage of the premium paid.
4.10

Double Indemnity Benefit The provision of an additional sum, equal to the

policy face amount, should death occur as a result of an accident. An alternative name
for Accidental Death Benefit. 3.2.1(a)Note 1

Dread Disease (DD) Benefit A rider allowing payment of a stated portion of the
death benefit to a policyowner-insured suffering from a specified disease or undergoing
certain specified medical procedures (called Insurable Events). 3.3.1b

(xi)
Duty of Disclosure The practical implications of the principle of utmost good
faith, which requires the parties to an insurance contract to reveal to the other all
material information, whether requested or not. 1.2.2

Employee Benefit Plans Group life insurance for employees within the same
organization or industry. 2.3

Endowment Insurance Life insurance where the face amount is payable after a fixed
period of years (at maturity) or on earlier death. 2.1.2

Enrolment Card (alternatively Certificate) Documents used with group life

insurances, providing evidence of cover to individual insured persons. Separate from
the Master Policy. 5.4.1(b)

Entire Contract Provisions Part of the terms of a standard life insurance policy,
making reference to the policy and application and indicating the circumstances under
which changes to the policy are possible. 4.1

Equitable (Premiums) One of the classic criteria for life insurance premiums, i.e.
each policyowner is paying an amount in line with the risk and contracted benefit
involved. 1.3.1(b)

Equities Ordinary shares in a proprietary company. As an investment vehicle, they

carry more risk than some types of investment, but usually offer long-term growth
prospects. Where more speculative, they offer prospect of considerable gain (or loss!).
2.2.2(b)

Ex Gratia A payment, usually of a claim, which is made "out of grace or favour",

i.e. where there is no legal liability to make such payment. 4.12 Note 2

Examining Physician The qualified medical professional conducting a medical

examination on behalf of the insurer. 5.3.2(b)

(xii)
Excepted/Excluded Perils Cause of loss specifically excluded by the policy.
Whilst there are not many such perils likely to affect a life insurance, suicide is
excluded within the first year or so of the policy's existence. 1.2.3(c)(ii)

Excess Interest Interest earned over and above the guaranteed interest. Must be
notified in the Annual Report with universal life insurance. 2.2.1(g)(v)

Exclusions Risks or causes of claims specifically removed from the cover of the
policy. These are relatively rare with life insurance, but may more commonly be found
with rider benefit, e.g. suicide with accidental death benefits. 5.3.3(c)(ii)

Expenses The loading to be added to the net premium, to cover all additions
necessary when calculating life premiums. 1.3.1a(c)

Extended Term Insurance An option under non-forfeiture benefits, whereby the

cash value is used as a single premium to purchase term insurance for the same amount
as the policy amount, for such period as the cash value will provide. 4.5(b)(iii)

Face Amount An equivalent term for the sum insured under the policy.
1.3.2b(c)(iv)

Family Income Insurance A variation of decreasing term insurance, usually

linked with other lump sum benefit plans. The decreasing term element pays a monthly
benefit in the event of death, for the remainder of a specified period of time.
2.1.1a(b)(ii)

Financial Underwriting Underwriting concentrating more on the implications

arising from the amount of insurance requested, e.g. whether the insured can meet
premium obligations, whether reinsurance may be required, whether the amount seems
excessive by normal criteria with such class of risks etc. 5.3.1(b) Note

First Beneficiary See Primary Beneficiary. 4.4(d)

(xiii)
Fixed Benefit Annuity An annuity under which the insurer guarantees that at
least a defined amount of monthly benefit will be provided for each dollar applied to
purchasing the annuity. 2.1.4a(f)

Fixed Interest Investments One type of fund that may be used for linking
purposes with unit-linked insurances. 2.2.2(b)

Fully Earned An expression to indicate that the premium paid is equal to the risk
borne in any period, so there is no "surplus" to provide for a cash value or other benefit
common with the level premium system in many types of life insurance. The term
applies to general insurance and may also be said to be applicable with term life
policies. 1.3.2b(b)

Fully Paid Policy A policy for which no more premiums have to be paid. One option
under non-forfeiture provisions, where the insured does not wish to continue paying
premiums on the original policy, in which case the face amount of the policy will be
reduced to reflect the premiums paid to date. Another term for Reduced Paid-Up
Insurance. 1.3.2b(c)(iv)

Fully Paid-Up Shares Shares in a proprietary/joint stock company, for which no

amount remains "on call", i.e. the full price of the shares has been paid. 5.1(b)

Fund Manager A fund management company which is the administrator and

legal representative of the Pension Fund. 6.3.4

Grace Period A period of time after a premium is due, during which the premium
may be paid and cover kept continuous, without penalty. Also known as Days of
Grace. 4.3

Graded-Premium Policy A variation of whole life insurance, where the

premium increases on a regular basis, e.g. every three years, but the face amount
remains unchanged. 2.1.3(c)

Gross Premium The premium in life insurance after taking into account the three
rating factors of mortality, interest and expenses. 1.3.1a(c)Note
(xiv)
Group Insurance Plan Life insurance of a number of persons forming a
recognizable group, e.g. employees etc. 2.3

Guaranteed Insurability Option (GIO) Under this rider the policyowner has the
right to purchase additional insurance on specified option dates, without having to
supply evidence of insurability. 3.5.1

Immediate Annuity An annuity where the instalments commence one annuity

period immediately following the payment of the purchase sum. 2.1.4a(c)

Incontestability Clause Provisions in a life policy where after an initial period,

usually two years, the validity of the policy may not be contested, on the grounds of a
breach of utmost good faith for example, (except, in Macau, where fraud is alleged).
4.2

Increasing Term Insurance Term insurance where the premium and face amount
increases annually or as otherwise agreed. Increases may be linked to an agreed index
(e.g. Consumer Price Index). 2.1.1a(c)

Indemnity An insurable principle not normally applicable with insurances of

the person. It relates to providing an exact financial compensation, which is not
possible with life insurance, for example. 1.2(d)

Indemnity Corollaries Sub-principles of the parent principle indemnity, i.e.

contribution and subrogation. As with indemnity, neither is likely to have any
application with life insurance policies. 1.2.3(b)

Individual Insurance Plans Life insurances arranged on the life of an individual

person, as opposed to a group scheme. 2.3

Inflation An important economic consideration, since its effect can drastically

reduce the real value of life insurance over an extended period. Planning a life
insurance programme should therefore take this into account. 3.6

(xv)
Insurability The physical and/or other conditions which indicate that the life
insured is an acceptable risk for the insurance plan concerned. 2.2.1(b)

Insurability Benefits A rider guaranteeing insurability under certain

circumstances, see Guaranteed Insurability Option. 3.5

Insurable Events Medical conditions giving rise to a payment under the

Dread Disease (DD) Benefit. These events are likely to include such medical
conditions as life threatening cancer, some forms of AIDS, heart attack etc. 3.3.1b(b)

Insurable Interest The legal right to insure an individual's life. It is required at

the commencement of any such insurance, although it is not needed when the claim
arises. 1.2.1

Insurable Interest (In Oneself) One has an unlimited insurable interest in oneself, so
in theory an insurance could be effected for any amount. In practice, the amount is
likely to be governed by the ability to pay the premium and the insurer's willingness to
insure very high amounts. 1.2.1(a)

Insurable Interest (In Others) One has an unlimited insurable interest in one's
spouse. There is also an insurable interest where a financial relationship exists (e.g. in
respect of a loan), but this is limited to the financial involvement plus reasonable
interest. By law, in Macau a parent or guardian of a young person under the age of 18
has an insurable interest in that young person. 1.2.1(b)

Insured Perils Causes of loss covered by the policy: an important consideration in

establishing proximate cause. 1.2.3(c)(i)

Interest With long term insurance, where the policies are not cancellable and the
fixed premium cannot be changed, the anticipated interest earnings on premiums is a
critical factor in determining premium rates. 1.3.1a(b)

Investment One aspect of certain life insurance covers, making financial

provision for the future by investing in a life insurance policy, especially one which
participates in the insurer's profits. 1.3.1a(b)
(xvi)
Irrevocable Beneficiary A beneficiary who cannot be changed without his/her
consent. 4.9(d)(i)

Joint and Survivor Annuity An annuity which provides a series of payments to two
or more individuals, and those payments continue until both or all of the individuals die.
4.1.2a(e)

Joint-Life Basis A life insurance covering two (or more) persons, the benefit being
payable upon the first death. A frequent use is with mortgage redemption insurances.
2.1.1a(b)(iii)

Key Person Insurance Insurance of an individual who represents a significant

financial investment to the insured, e.g. an important employee, a leading professional
sportsperson to their club etc. 1.2.1 Note

Lapse The termination of a life insurance because the premium has not been paid
within the permitted time period (including the Grace Period and subject to any
applicable policy provisions). 4.7(c)

Level Premium System The normal method of charging for life insurance, whereby
(for the same benefit) the annual premium is established at inception and does not vary
throughout the life of the policy. 1.3.2b

Level Term Insurance A term insurance where neither the benefit nor the premium
changes during the term of the policy. 2.1.1a(a)

Life Annuity An annuity that provides periodic benefit payments for at least the
lifetime of a named individual 2.1.4a(d)

Life Insurance An insurance contract providing a benefit payable upon the death of
the life insured or upon survival to a stipulated date. 1.1

Life Office Management Association Inc. (LOMA) U.S. life insurance educational
organization, noted for its professional examination for life insurance personnel. 1.1
(xvii)
Limited Payment Policies Whole life insurances, where the premiums cease to
be payable at a certain age or after a certain number of payments. 2.1.3(a)(ii), (iii)

Living Benefit Riders Another name for Accelerated Death Benefits. 3.3

Loading The surcharge or additional sum added to life insurance net premiums to
take account of expenses, commissions etc. 1.3.1a(c)

Long Term Care (LTC) A rider allowing a stated portion of the death benefit to be
paid to a policyowner-insured who requires constant care for a medical condition. 3.3.2

Market Value Adjustment (MVA) A permitted right of insurers under the cooling-
off initiative to make an adjustment with the refund of premiums, in relation to linked
policies and non-linked single premium life insurances. 5.2.4 Note

Marketing An important department for a life insurer, dealing with such

matters as product research, advertising and public relations etc. 5.1.1(f)

Master Policy The primary insurance document with a group life insurance plan.
5.4.1(b)

Material Fact A fact that would influence the mind of a prudent underwriter in
determining whether to accept a risk or on what terms to accept it. 1.2.2

Mature (Maturity) Relates to the situation when an endowment insurance

becomes payable because the designated period has expired and the life insured is still
living. 2.1.2

Maturity Claims Claims under endowment type insurances, where the full number of
years specified have been completed and the life insured is still living. 5.6.1

Medical Application A proposal for life insurance where a physical medical

examination of the life to be insured is required. 1.2.2(c)

(xviii)
Medical Benefits Benefits traditionally (and may still be) insured under a general
insurance policy, but which may be added as a rider to a life insurance. Such benefits
are likely to consist of a basic plan, with an optional medical plan and be subject to
certain major exclusions. 3.4

Medical Reports Reports from qualified medical professions in cases where this is
deemed necessary, especially with insurances normally on a non-medical basis. 5.3.2

Medical Tests These may be needed in connection with a life insurance

application. 1.2.2(d)

Misstatement of Age/Sex The policy provisions regarding errors of this nature.

Most policies provide that in such circumstances the face amount be adjusted to reflect
that which would have applied to the correct age/sex. 4.8

Mixed Plan A retirement plan which combines the features of Defined

Benefit Plan and Defined Contribution Plan 6.2.3

Money Laundering The illegal practice of "cleansing" money obtained illegally

(e.g. through drugs) by the use of business or financial instruments such as life
insurances. Insurers must take great care in trying to detect and eliminate such
practices. 5.5.1Note

Monthly Annuity An Annuity where the time span between each of the
payments in the series of periodic annuity benefit payments is one month. 2.1.4a(b)

Moral Hazard Rather more subjective features concerning human attitudes,

behaviour and conduct which may have a bearing on the risk. 5.3.1(a)(ii)

Mortality An important consideration in determining life insurance premium

rates. It refers to the rate at which insured lives may be expected to die. The term,
therefore, may more accurately be described as Rate of Mortality. 1.3.1a(a)

Mortality Tables Published statistics on mortality, indicating the expected rate

of mortality at given ages. 1.3.1a(a)
(xix)
Mortgage Indemnity Insurance Insurance arranged by banks and other lending
institutions to cover potential losses to them on mortgage loans, should the customer die
or otherwise be unable to repay the loan and the property has to be sold in adverse
market situations. 2.1.1a(b)Note

Mortgage Redemption Insurance A popular form of decreasing term insurance,

with the benefit linked to the outstanding balance of a mortgage loan. Often issued on a
joint-life basis, payable on the first death. 2.1.1a(b)(iii)

Multiple-Employer Groups (Insurance) Group life insurance where different

employers participate in a single plan covering their respective employees. 2.3(d)

Murder For the most part, murder of the life insured is regarded as an accident” as
far as any ADB rider is concerned. However, if it is proved that the murderer was the
beneficiary, Criminal Code will not allow the latter to have the policy benefit.
5.6.2(c)(iv)

Mutual Insurance Company An insurance company with no shareholders,

technically owned by its participating policyholders. 5.1(a)

Natural Premium System A system of life insurance premium charging,

whereby the premium each year changes according to the age of the insured life and
other features. This is unworkable from a practical point of view and may be
considered an academic concept. 1.3.2a

Natural Risk The intrinsic risk presented by the life insured at a particular point
in time, related to the person's age, health and other factors. 1.3.2a(a)

Net Policy Proceeds The entitlement of an assignee under a life insurance policy,
i.e. his interests are subordinate to those of the insurer regarding overdue premiums,
loans and interest payable. 4.9(c)

Net Premium Sometimes called the Pure Premium, this may be described as the
basic premium to be charged exactly to cover the cost of death claims arising under
normal statistical expectations, with no allowances for expenses or profit. 1.3.1a(b)Note

(xx)
Non-Contributory Plans Group life, or employee benefit, plans where the employees
do not contribute towards the premiums. 2.3(c)

Nonforfeiture A consequence of the level premium system and policies having a

cash value. In the event that "renewal" premiums are not paid, the policy does not
lapse (become forfeit), because the cash value may be used to keep the policy in force.
4.5

Nonforfeiture Options These are the choices available to the policyowner who does
not wish to continue payment of premiums under a policy which has a cash value.
These options include: taking the cash value, accepting reduced paid-up insurance and
accepting extended term insurance. 4.5(b)

Nonforfeiture Provisions The available choices where premiums are not to be

continued under a policy having a cash value. These provisions stipulate the procedure
should there be no indication from the policyowner which option he chooses.
1.3.2b(c)(iii)

Non-Medical Application A request for a life insurance which (subject to certain

stipulations) does not have to be accompanied by a physical medical examination of the
life to be insured. 1.2.2(b)

Open Fund A fund where there is no requirements for any link between various
members of the respective plan, and membership of the fund is solely dependant or
acceptance by the pension fund manager. 6.2.4

Option Dates Dates specified under a Guaranteed Insurability Option on which

additional insurance may be purchased without evidence of insurability. Often such
dates are linked with important life events, e.g. marriage, childbirth etc. 3.5.1(d)

Optional Medical Plan Available cover under a medical benefits insurance, mostly
consisting of increased limits for the various headings of cover under the basic plan.
3.4(b)

(xxi)
Paid-Up Insurance Insurance for a reduced amount, with no further premiums
to pay but otherwise on the same terms as the original insurance. Another consequence
of the level premium and cash value system, paid-up insurance is possible because the
premium is not "fully earned" under the former system. 1.3.2b(c)(iv)

PAR/NON-PAR The customary abbreviation for policies that are participating or

non-participating. 1.3.1b(a)

Participant An individual whose personal and professional circumstances

determine the rights arising under the pension plans 6.2.2

Participating/Non-Participating Also known as With-Profits or Without-

Profits, the terms indicate whether or not the policies concerned share in the profits of
the insurer or not. If they do, dividends or bonuses are payable. 1.3.1b(a)

Participating Policyholders Those policyholders whose policies are participating

(or with profits). If the insurer is a mutual company, they are the legal owners of the
company. 5.1(a)
Pension A monthly or other periodic payment to a person in retirement, until
death. 2.1.4(b)

Pension Fund A fund which can invest in many different types of financial
securities and can own assets directly exclusively for the fulfilment of one or more
pension plans. 6.2.2

Pension Plan A retirement program which defines the conditions for formation
of the right to receiver a pension. 6.2.2

Permanent Insurance (Plan) Life insurance which is not on a term basis, i.e.
whole life etc, whereby a claim is certain provided premiums continue to be paid.
2.1.1b(b)(iii)

Personal Needs An important aspect of life insurance for the individual, i.e. to
make provision for various life needs (e.g. children's education, personal retirement,
provision for dependants with premature death etc). 1.1.1(a)

(xxii)
Physical Hazard The objective measurable factors that are likely to increase the risk
of the insured event happening, such as obviously known health dangers (e.g. heavy
smoking, serious overweight etc). 5.3.1(a)(i)

Policy Changes One of the duties of the POS (Policyowner Service Department),
including such matters as minor amendments of address to significant issues such as
change of beneficiary, and assignments. 5.5.1

Policy Delivery After policy preparation, delivery of individual policy covers is

normally by the marketer. Group policies involve a master policy for the employer or
group concerned, with perhaps certificates and enrolment cards for each insured person,
delivery being overseen by the marketer or group representative. 5.4.1

Policy Issuance The process of preparation, checking and delivery of the policy
document. An important operation, since policies cannot be cancelled and may be
assigned. 5.4

Policy Loan Policies having a cash value usually also include rights for the
policyowner to borrow money from the insurer against the security of the cash value.
The loan may be for any purpose and need not be repaid until the policy benefit is due
(when interest will be added and the total deducted from the claim payment).
1.3.2b(c)(ii), 4.6

Policy Revival See Reinstatement. 4.7

POS (Policyowner Service) The Customer Service Department, responsible for

such matters as documentation, correspondence, premium payments etc. 5.1.1(e), 5.5

Pre-Existing Conditions A common exclusion with medical benefit policies,

designed to eliminate expenses relating to medical problems that existed before the
insurance commenced. 3.4(c)(i)

Preferred Risks Above average risks, constituting highly desirable types of business
for the insurer (e.g. confirmed non-smokers in excellent health). 5.3.1(b)(iv)

(xxiii)
Premium The amount payable by the policyowner for (usually annual) coverage.
Classic understandings of life insurance indicate that life premiums should be adequate
and equitable. 1.3

Premium Waiver Contract provisions whereby premium otherwise payable is

not required by the insurer under certain circumstances, e.g. during the period when
long-term care benefits are payable under a policy with a LTC Rider. 3.3.2(f)

Premiums for Life Whole life insurance where the premiums continue to be
payable for as long as the life insured lives. Also known as Straight Life Insurance.
2.1.3(a)(i)

Presumption of Death Where no death certificate can be issued, it may be possible

to have a presumption of death by the courts (after disappearance etc). 5.6.2(d)

Primary Beneficiary (or First Beneficiary) The designated beneficiary having

priority in the payment of the policy proceeds. 4.4(d)

Proof of Age Documentary or other evidence to satisfy the insurer as to the life
insured's age. This may be provided at any time, but it is normally required before any
claim under the policy can be made. 5.6.1(d)

Proof of Death Normally provided by a death certificate, this is an obvious

requirement in substantiating a death claim. 5.6.2(b)

Proof of Title Title may be defined as the legal entitlement to a benefit etc. Such
title is important, for example, with a person claiming the cash value under a surrender
claim. 5.6.3(a)

Proprietary (Joint-Stock) Company A company having shareholders, who have

their liability towards the company's debts limited to the extent of any amounts unpaid
in respect of their company shares. 5.1(b)

Provident Fund Scheme A retirement provision, but unlike a pension the benefit is in
the form of a lump-sum amount payable at retirement or other specified time. 2.1.4b
(xxiv)
Proximate Cause Is the principle which seeks to establish the dominant reason
for a loss occurring. The cause of death may be important in life insurance, for
example, especially if the policy provides additional benefits for accidental death (or if
the policy is still within the contestable and suicide provisions period). 1.2(c)

Pure Endowment A rare form of life insurance where the benefit is only payable if
death does not occur during the period (term) specified. 2.1.2(b)

Pure Premium or Pure Cost of Insurance (Protection) See Net Premium.

1.3.1a(b) Note

Rates (Life Insurance) The normal or standard premiums applicable, according to

age and sex, to life insurance. 1.3

Reduced Paid-Up Insurance One of the non-forfeiture options, implying that the
available cash value be used to purchase insurance for which no further premiums are
required (although the face amount will obviously be less than that for the original
policy). 4.5(b)(ii)

Reinstatement The restoration of a lapsed policy into full force. Also known, with
UK style policies as Policy Revival. This is provided for under policy conditions, but
is subject to certain limitations, e.g a specified time period (perhaps five years),
repayment of back premiums and interest, and perhaps other measures (e.g. suicide
clause is reinstated). 4.7

Reinsurance The process of insuring again all or part of a risk insured, to

protect the insurer's net position. Much more commonly used in life insurance as an
underwriting tool with individual risks with adverse features, e.g. extremely high face
amounts, severe health problems etc. 5.1.1(g)(iii)

Release Form Documentary confirmation from a beneficiary that the policy's

death benefit stands reduced by the amount of any accelerated death benefit payment.
Alternatively, a discharge given by a benefit recipient, e.g. with a policy surrender,
death claim etc. 3.3(c), 5.6.3(c)

(xxv)
Renewable Term Insurance A term insurance having the right of renewal for
further period(s) without evidence of insurability. 2.1.1b(a)

Replacement Replacement also involves any policy which has lapsed, been
surrendered or converted to paid-up insurance. 5.2.5(b)

Retirement One objective with life insurance, i.e., to provide a lump sum
(perhaps through an endowment policy), which may be used to purchase an annuity.
1.1(d)

Retirement Age Age 65 for the purpose of the Private Pension Fund Ordinance
6.2.2

Reversionary Ownership rights which exist now, but which cannot be fully
exercised until some time or specific event in the future. 4.9

Reversionary Interest (or Bonus) A financial interest which exists now, but
where full enjoyment and privileges of ownership is deferred until some future time or
event, e.g. bonuses under with-profits policies, which are more correctly termed
"reversionary bonuses". 4.10

Rider An endorsement or addition to the policy, frequently adding further

benefits to the cover (e.g. accidental death benefits). 3.1

Savings One function of life insurance covers, where the insured is providing
financially for the future, e.g. with endowment insurances. 1.1(b)

Settlement Options The choices available to the policyowner when the policy
proceeds become available. These options include : lump sum single payment,
proceeds left to earn interest with the insurer, proceeds paid in instalments over a fixed
period etc. 4.11

Single Employer Plans Group life insurance where all insured persons are
employees of the same employer. 2.3(d)

(xxvi)
Single Premium Annuity An annuity that is purchased by the payment of a
single, lump sum premium. 2.1.4a(a)

Single Premium Endowments An endowment insurance plan involving a

single premium payable at policy inception, regardless of the term specified. 2.1.2(a)

Special Class Risks See Sub-Standard Risks. 5.3.1(b)(ii)

Standard Risks Risks presenting no abnormal features and insurable on normal

terms. 5.3.1(b)(i)

Straight Life Insurance See Premiums for Life. 2.1.3(a)(i)

Subrogation An insurance principle which allows an insurer who has provided

an indemnity to take over for his own benefit rights the insured has against third parties.
As indemnity does not apply to life insurance, so this corollary of indemnity does not
apply to it either. 1.2(f)

Sub-Standard Risks Risks which for some adverse reason cannot be considered
standard, although possibly insurable with special terms. Sometimes called Special
Class Risks. 5.3.1(b)(ii)

Sub-Standard Risks Underwriting Measures The options available to the

underwriter to try to "normalize" a sub-standard risk for insurance purposes, e.g.
loading the premium, different plan etc. 5.3.3

Suicide An excluded peril for the first year or so of a life insurance policy's
existence, but is a permanent exclusion in respect of any accidental death benefit
addition. 1.2.3(c)Note 1

Suicide Clause This constitutes the provisions of a life policy in respect of death by
suicide, which is normally excluded for the first year or so of the policy's existence, but
not excluded thereafter (unless reintroduced for a further period after policy revival).
4.12

(xxvii)
Supplementary Requirements Consisting of a number of issues that an
underwriter may need including life underwriter's (agent's) report, mode of premium
payment, proof of insurability etc. 5.2.1(c)

Surrender Claims Termination of the insurance at the request of the

policyowner. Whilst entitled to do this, other options are likely to be explained to the
policyowner first. 5.6.3

Surrender Value See Cash Value. 1.3.2b(c)(i)

Switching (Policy Switching) Changing an existing life policy for a replacement

one. The term, however, has an undesirable implication whereby policyowners are
persuaded to make the change which may be more for the benefit of the agent/insurer
than the policyholder. The latter practice is known as Twisting (i.e. the inappropriate
replacement of life insurance policies). 5.2.5

Technical Underwriting Assessment of the intrinsic and perceived hazards of

given risks, as to their insurability and terms. 5.3.1(b) Note

Temporary Insurance Agreement (TIA) See Binding Premium Receipt.

5.2.2(b)

Temporary Life Annuity It is a annuity that provides periodic benefit payments

until the end of a specified number of years or until the death of the annuitant,
whichever occurs first. 2.1.4a(d)

Temporary Risk Situations Situations where premature death might cause undue
financial burdens and therefore suitable for temporary (term) life insurance, e.g. whilst
a loan is outstanding or there are educational needs for children. 1.1

Term Insurance Life insurance where the benefit is payable only if the life insured
dies during the period (term) specified. Also known as Temporary Insurance. 2.1.1

(xxviii)
Third Party Policy A policy where the insurance is on the life of a person other
than the applicant. 1.2.1a(b), 4.4(b)

Total Disablement As defined under the Disability Income Benefit Rider, this
means that the insured is unable to perform the essential acts of his own occupation, or
any occupation for which he is reasonably fitted by education, training or experience.
3.1.2(a)

Twisting See Switching. 5.2.5(a)

"Unbundled" Cover A feature of universal life insurance, whereby the insurer

separately discloses the pure cost of protection, the investment earnings and company
expenses relating to the insurance contract. 2.2.1(d)

Unconditional Premium Receipt See Binding Premium Receipt. 5.2.2(b)

Underwriting Concerned with the selection of risks and terms to be imposed, this
department will be involved with risk assessment (for insurability and terms), medical
requirements and reinsurance arrangements. 1.3.1a(a), 5.1.1(g), 5.3

Uninsured Perils These are causes of loss neither specifically covered by a

policy nor specifically excluded. An important consideration with non-life insurances
and the principle of proximate cause, but unlikely to have any significant application to
life insurance. 1.2.3(c)(iii)

Unit-Linked Policy A life insurance plan where the value is directly linked to
investment performance. The value is linked to a unitized fund run by the life insurer
or with units in a unit trust. 2.2.2

Universal Life Insurance A life insurance contract which is subject to a flexible

premium, has an adjustable benefit and which accumulates a cash value. 2.2.1

(xxix)
Utmost Good Faith The common law principle with insurance contracts,
whereby each party must reveal to the other all material facts, whether these are
requested or not. Breach of this principle normally makes the contract voidable, but
this provision may be affected by the Incontestability Clause. 1.2(b)

Valuation A core function of the Actuarial Department, relating to the calculation of

the value of the company's assets and liabilities. 5.1.1(a)(ii)

Variable Annuity An annuity under which the amount of the policy’s accumulated
value and the amount of the monthly annuity benefit payments will fluctuate in
accordance with the performance of an investment account. 2.14a(f)

Waiting Period A qualification to the Waiver of Premium Rider, whereby

premiums are not waived until the insured has been disabled for a period of three (or
six) months. Some insurers refund premiums paid during the waiting period if the
disability lasts longer, so that policy premiums begin to be waived. 3.1.1(a)

Waiver of Premium Rider (WP Benefit Rider) An endorsement to a life policy

waiving premiums otherwise payable whilst the insured is totally disabled, keeping the
insurance in full force. 3.1.1

Whole (of) Life Insurance Life insurance where the benefit is payable only on
death, whenever that occurs. 2.1.3

With Profits The equivalent term in U.K. insurance terminology of a

participating insurance. 1.3.1b(a) Note 1

Without Profits The equivalent term in U.K. insurance terminology of a non-

participating insurance. 1.3.1b(a) Note 1

Yearly Renewable Term (YRT) Policy rider indicating that the insurance is a
one year term insurance with guaranteed insurability renewal provisions. Also know as
Annually Renewable Term (ART). 2.1.1b(a)

(xxx)
 INDEX

Absolute assignment 4.9(e)(i) Business needs 1.1.1(b)

Accelerated death benefits 3.3 Cash value 1.3.2b(c)(i)
Accident benefits 3.2 Cause of death 5.6.2(c)
Accidental death and Certificate 5.4.1(b)
dismemberment (AD&D) rider 3.2 Charges/rate of return 5.2.6c(c)
Accidental death benefit (ADB) 3.2.1(a) Claims 5.1.1(d)
Accounts department 5.1.1(b) Class designation 4.4(c)
Actively-at-work provision 2.3(f) Client services 5.1.1(e)
Activities of daily living (ADLs) 3.3.2(c) Closed fund 6.2.4
Actuarial department 5.1.1(a) Collateral assignment 4.9(e)(ii)
Adequate (premiums) 1.3.1(a) Collateral security 4.9(e)(ii)
After sales service 5.5 Conditional premium receipt 5.2.2(a)
Age next (last) birthday 5.2.1(b)(iii) Conservation 5.2.3a(a)
Age not admitted 5.6.1(d) Contestable period 4.2, 4.7(d)(v)
Age-related limitation 2.1.3(a)(iii) Contingent beneficiary 4.4(e)
Agency training and control 5.1.1(c) Continuous premium whole
Annual Annuity 2.1.4a(b) life policy 2.1.3(a)(i)
Annual report 2.2.1(g) Contractholder 2.1.4a
Annually renewable term (ART) 2.1.1b(a) Contribution 1.2(e)
Annuitant 2.1.4(a) Contributor 6.2.2
Annuity 2.1.4a Contributory plans 2.3(c)
Annuity certain 2.1.4a(c) Convert (conversion) 2(b)(i), 2.1.1b(b)
Anti-selection 1.3.2a(c)(ii) Convertible term insurance 2.1.1b(b)
Application 5.2 Cooling-off directive 5.2.4
Appointed actuary 5.2.6b(c) Cooling-off period 5.2.4
Approved nursing home 3.3.2(b) Cost of living adjustment (COLA) 3.6.1
Assignee 4.9 Cover note 5.2.2 Note
Assignment 4.9 Credit life insurance 2.1.1a(b)(i)
Assignor 4.9 Critical/terminal illness
Associate 6.2.2 (TI) benefit 3.3.1a
Attained age 2.1.1b(b) Custodian 6.3.4
Attending physician's Customer loyalty 5.2.3a(a)
statement (APS) 5.3.2(b) Customer prospecting 5.2.3a(b)
Automatic dividend option 4.10 Note Customer protection
Automatic premium loan (APL) 4.5(a)Note declaration (CPD) 5.2.5(c)
Basic functions 2(a) Customer service 5.2.3
Basic plan 3.4(a) Date of death 5.6.2(a)
Basic questions 2(c) Days of grace 4.3
Basic variables 2(b) Death benefit 2.2.1(f)
Beneficiary 4.4 Death claims 5.6.2
Beneficiary designation 4.4 Debt (on policy) 5.3.3(c)(i)
Benefit policies 1.2.3(a)(i) Declaration 5.2.4(f)
Benefit riders 3 Declinature 5.3.3(a)
Binding premium receipt 5.2.2(b) Declined risks 5.3.1(b)(iii)
Bonuses 1.3.1b(a) Note 1 Decreasing term insurance 2.1.1a(b)
(1)
 INDEX

Defer decision 5.3.3(c)(iv) Hospital charges 3.4(a)(i)

Deferred annuity 2.1.4a(c) Immediate annuity 2.1.4a(a)
Defined Benefit Plan 6.2.3 Inception date 5.2.2
Defined Contribution Plan 6.2.3 Incontestability clause 4.2
De-mutualized 5.1(a) Note Increasing term insurance 2.1.1a(c)
Different plan 5.3.3(c)(iii) Indemnity 1.2(d)
Disability income benefit 3.1.2 Indemnity corollaries 1.2.3(b)
Dismemberment 3.2.1(b) Individual insurance plans 2.3
Dividend options 4.10 Inflation 3.6
Dividends 4.10 Insurability 2.2.1(b)
Double indemnity benefit 3.2.1(a) Note 1 Insurability benefits 3.5
Double insurance 1.2.3(b)(i) Insurable events 3.3.1b(b)
Dread disease (DD) benefit 3.3.1b Insurable interest 1.2.1
Duty of disclosure 1.2.2 In oneself 1.2.1(a)
Employee benefit plans 2.3 In others 1.2.1(b)
Endorsements 2(b)(iv) When needed 1.2.1(g)
Endowment insurance 2.1.2 Insurance Companies Ordinance 1.2.1(a)
Enrolment card 5.4.1(b) Insured perils 1.2.3(c)(i)
Entire contract provisions 4.1 Interest 1.3.1a(b)
Equitable (premiums) 1.3.1(b) Investment 1.3.1a(b)
Equities 2.2.2(b) Irrevocable beneficiary 4.9(d)(i)
Ex gratia 4.12 Note 2 Joint and Survivor Annuity 2.1.4a(e)
Examining physician 5.3.2(b) Joint-Life basis 2.1.1a(b)(iii)
Excepted/excluded perils 1.2.3(c)(ii) Key person insurance 1.2.1 Note
Excess interest 2.2.1(g)(v) Lapse 4.7(c)
Exclusions 5.3.3(c)(ii) Law of averages (large numbers) 1.3.1a(a)
Expenses 1.3.1a(c) Level premium system 1.3.2b
Extended term insurance 4.5(b)(iii) Level term insurance 2.1.1a(a)
Face amount 1.3.2b(c)(iv) Life Annuity 2.1.4a(d)
Family income insurance 2.1.1a(b)(ii) Life insurance 1.1
Financial underwriting 5.3.1(b) Note Life Insurance Council 5.2.5
First beneficiary 4.4(d) Life Office Management
Fixed Benefit Annuity 2.1.4a(f) Association Inc. (LOMA) 1.1
Fixed interest investments 2.2.2(b) Limited payment policies 2.1.3(a)(ii), (iii)
Flexible premium 2.2.1(a) Living benefit riders 3.3
Fraud 4.2(c) Loading 1.3.1a(c)
Fully earned 1.3.2b(b) Long term care (LTC) 3.3.2
Fully paid policy 1.3.2b(c)(iv) Lump sum 2(a)
Fully paid-up shares 5.1(b) Mandatory Provident Fund Scheme 2.1.4b
Fund Manager 6.3.4 Market value adjustment
Grace period 4.3 (MVA) 5.2.4 Note
Graded-premium policy 2.1.3(c) Marketing 5.1.1(f)
Gross premium 1.3.1a(c) Note Master policy 5.4.1(b)
Group insurance plan 2.3 Material fact 1.2.2
Guaranteed insurability option (GIO) 3.5.1 Mature (maturity) 2.1.2
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 INDEX

Maturity claims 5.6.1 Policy issuance 5.4

Medical application 1.2.2(c) Policy loan 1.3.2b(c)(ii), 4.6
Medical benefits 3.4 Policy revival 4.7
Medical reports 5.3.2 Policy switching 5.2.5
Medical tests 1.2.2(d) POS (Policyowner Service) 5.1.1(e), 5.5
Misstatement of age/sex 4.8 Pre-existing conditions 3.4(c)(i)
Mixed Plan 6.2.3 Preferred risks 5.3.1(b)(iv)
Money laundering 5.5.1 Note Premium 1.3
Monthly Annuity 2.1.4a(b) Premium waiver 3.3.2(f)
Moral hazard 5.3.1(a)(ii) Premiums for life 2.1.3(a)(i)
Mortality 1.3.1a(a) Presumption of death 5.6.2(d)
Mortality tables 1.3.1a(a) Primary (first) beneficiary 4.4(d)
Mortgage indemnity Private nursing 3.4(a)(ii)
insurance 2.1.1a(b) Note Proof of age 5.6.1(d)
Mortgage redemption Proof of death 5.6.2(b)
insurance 2.1.1a(b)(iii) Proof of title 5.6.3(a)
Multiple-employer groups 2.3(d) Proposal form 5.2
Murder 5.6.2(c)(iv) Proprietary (joint-stock) company 5.1(b)
Mutual insurance company 5.1(a) Provident fund scheme 2.1.4b
Natural premium system 1.3.2a Proximate cause 1.2(c)
Natural risk 1.3.2a(a) Pure cost of insurance (protection) 2.2.1
Net policy proceeds 4.9(c) Pure endowment 2.1.2(b)
Net premium 1.3.1a(b) Note Pure premium 1.3.1a(b) Note
Non-contributory plans 2.3(c) Quality Assurance Programme 5.1.1(c)(ii)
Nonforfeiture 4.5 Rate of mortality 1.3.1a(a)
Nonforfeiture options 4.5(b) Rates (life insurance) 1.3
Nonforfeiture provisions 1.3.2b(c)(iii) Reduced paid-up insurance 4.5(b)(ii)
Non-Contributory Plan 6.2.3 Reinstatement 4.7
Non-medical application 1.2.2(b) Reinsurance 5.1.1(g)(iii)
Open Fund 6.2.4 Release form 3.3(c), 5.6.3(c)
Option dates 3.5.1(d) Renewable term insurance 2.1.1b(a)
Optional medical plan 3.4(b) Replacement 5.2.5(b)
Paid-up insurance 1.3.2b(c)(iv) Retirement 1.1(d)
Par/non-par 1.3.1b(a) Retirement age 6.2.2
Participant 6.2.2 Reversionary 4.9
Participating/non-participating 1.3.1b(a) Reversionary interest (bonus) 4.10
Participating policyholders 5.1(a) Rider 3.1
Pension 2.1.4(b) Savings 1.1(b)
Pension Fund 6.2.2 Selection against the insurer 1.3.2a(c)(ii)
Pension Plan 6.2.2 Settlement options 4.11
Permanent insurance (plan) 2.1.1b(b)(iii) Single employer plans 2.3(d)
Personal needs 1.1.1(a) Single premium annuity 2.1.4a(a)
Physical hazard 5.3.1(a)(i) Single premium endowments 2.1.2(a)
Policy changes 5.5.1 Special class risks 5.3.1(b)(ii)
Policy delivery 5.4.1 Standard risks 5.3.1(b)(i)
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 INDEX

Standard terms 5.2.2(a)

Straight life insurance 2.1.3(a)(i)
Subrogation 1.2(f)
Sub-standard risks 5.3.1(b)(ii)
Sub-standard risks underwriting
measures 5.3.3
Suicide 1.2.3(c) Note 1
Suicide clause 4.12
Supplementary requirements 5.2.1(c)
Surrender claims 5.6.3
Surrender value 1.3.2b(c)(i)
Switching (policy switching) 5.2.5
Technical underwriting 5.3.1(b) Note
Temporary insurance agreement
(TIA) 5.2.2(b)
Temporary life annuity 2.1.4a(d)
Temporary risk situations 1.1
Term insurance 2.1.1
Third party policy 1.2.1a(b), 4.4(b)
Time franchise 3.1.1(a)
Total disablement 3.1.2(a)
Twisting 5.2.5(a)
"Unbundled" cover 2.2.1(d)
Unconditional premium receipt 5.2.2(b)
Underwriting 1.3.1a(a), 5.1.1(g), 5.3
Uninsured perils 1.2.3(c)(iii)
Unit-linked policy 2.2.2
Universal life insurance 2.2.1
Utmost good faith 1.2(b)
Valuation 5.1.1(a)(ii)
Variable Annuity 2.1.4a(f)
Waiting period 3.1.1(a)
Waiver of premium rider
(WP Benefit Rider) 3.1.1
Whole (of) life insurance 2.1.3
With profits 1.3.1b(a) Note 1
Without profits 1.3.1b(a) Note 1
Yearly renewable term (YRT) 2.1.1b(a)

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 ACKNOWLEDGEMENTS

Gratitude is given to the representatives of the following

organizations for their contributions towards these Study Notes:

1. Office of the Commissioner of Insurance of Hong Kong

2. The Hong Kong Federation of Insurers
3.The Insurance Institute of Hong Kong
4. Vocational Training Council (HK)
5. Insurance Training Board
6.The Hong Kong Confederation of Insurance Brokers
7. Professional Insurance Brokers Association Limited
8. The Hong Kong General Insurance Agents Association Limited
9. The Life Underwriters Association of Hong Kong
10. General Agents & Managers Association of Hong Kong
11.FLMI Society of Hong Kong
12.The Macau Insurers’ Association
13.The Macau Insurance Agents & Brokers Association
14.The Federation of Macau Professional Insurance
Intermediaries