IC27 - Health Insurance exam - 1

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Q 1. Health insurance is often prone to insurance-related fraud. In health insurance frauds, cooperation is required from ___________ to organize a scam. Which are these?

IRDAI

Policyholder

Only hospitals

Intermediaries only

Multiple stakeholders

Q 2. What do we mean by ? information asymmetry? Under health insurance?

The insurers have all the information about the risk is called information asymmetry.

The insured has all the information about the risk, which is called information asymmetry.

The insured has all the information about the risk & lack of such information with the insurer is called information asymmetry.

Both the insured & the insurers have all the information about the risk, which is called information asymmetry.

None have all the information about the risk, which is called information asymmetry.

Q 3. A good data warehouse system should be able to provide a host of information to various sectors to facilitate reporting and analysis. It should be able to: 1. Archive historical data and keep periodical backups 2. Perform basic and advanced data validation 3. Provide flexibility to the user to access data from different locations

Only statement 1 is correct

Only statement 2 is correct

Only statement 3 is correct

Only statements 1 and 3 are correct

Statements 1, 2 & 3 are correct

Q 4. The channels for registering complaints for personal insurance claims by the policyholders are: 1. Civil and Consumer Courts 2. Only Consumer courts 3. Policyholders can approach the Ombudsman also

Only 1 is correct

Only 2 is correct

Only 3 are correct

Only 1 and 2 are correct

Only 1 and 3 are correct

Q 5. Healthcare costs are financed through various sources and methods. Which of the following option(s) is/are incorrect? 1. Commercial Health Insurance 2. Social Health Insurance 3. Government taxes and revenues 4. Contributions from individuals

Statement 1 is correct; Statements 4 and 3 are incorrect

Only statements 1 and 2 are correct

Statements 2 and 4 are incorrect

Both 1 and 2 are incorrect 

All of them 

Q 7. Many insurers are providing innovation to personal accident policies. Which of the following innovation/s are being offered under the policy?

Spouse retraining expenses

Cost of modification of the house or vehicle to meet the medical needs of the insured after a disabling accident

Coverage of adventure sports performed under the supervision of qualified trainer

Accidental hospital confinement allowance

All of the above

Q 8. Actuarial science is a blend of four subjects. Which of the following is not a subject to consider?

Statistics

Finance

Mathematics

Economics

ICD - International Classification of Diseases

Q 9. The health insurance policy covers the cost of room charges following hospitalization. Generally, the insurers cover the room charges up to a limit of A) 1% of the sum insured B) 10% of the sum insured C) 1% of the sum insured up to a specified limit D) 5% of the sum insured E) 15% of the sum insured   

a) Only statement A is correct

b) Only statement C is correct

c) Statements A and C are correct 

d) Statements B and C are correct 

e) Statements A and B are correct, C is incorrect 

Q 11. Concerning the rules for reference to the Ombudsman for grievance redressal, which of the following is incorrect?

The TPA shall appoint an Ombudsman for these rules

Any person who has a grievance against an insurer may himself make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the insurer complained against is located

Any person who has a grievance against an insurer may through his legal heirs make a complaint in writing to the Ombudsman within whose jurisdiction the branch or office of the insurer complained against is located

The Ombudsman may make a recommendation through mediation

He may pass an award which the Ombudsman thinks is fair as per the facts and circumstances of the claim

Q 12. Cost-sharing provisions like sub-limits on hospital costs, co-payments, and deductibles reduce the amount of claims payable to the insured. Which of the following statement/s is/are true in the above context? 1. No way, the insured is getting a reduced indemnity 2. Since the benefit is reduced to the extent of deductible, the insured is always a loser 3. The insured is getting the benefit of reduced liability in the form of a reduction in premium

Only statements 1 and 2 are correct

Only statement 1 is correct

Only statement 3 is correct

All 1, 2, and 3 are correct

Only statement 2 is correct

Q 13. Under group health insurance, which of the following questions are not usually asked in the proposal form?

Specific health questions from the individual group member

Geographical spread

Income details

Age of group members

Nature of work

Q 14. An imperfect market is what economists have described as health insurance for various reasons. Which of the following is not a reason for being an imperfect market?

Risk selection

Dem and side of the moral hazard

Supply-side of the moral hazard

Information asymmetry

Information symmetry

Q 16. Regulatory actions for breaches or violations can include: 1. Issuing warnings to the insurer 2. Appoint Liquidator/ Observer/ Administrator etc. 3. Blacklisting the insured

Only 1 is correct

Only 3 are correct

Only 2 and 3 are correct

Only 1 and 2 are correct

Only 1 and 3 are correct


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