IC27 - Health Insurance exam - 4

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Q 1. With regards to Credit Risk, which of the below options is correct?

Like in any other business with financial transactions, there is a risk of default by business associates like reinsurers, providers, and suppliers.

Operational and other risks like the risk of losing key human resources, risks of fraud, risks of not keeping up with technology, etc.

Although each risk by itself is not very large there still exists the risk of concentration.

Credit risk mismatch reduces the insurer's ability to get adequate cash to pay its liabilities at short-term notice

Though the insurer may hold good quality assets, holding long-term debt can lead to liquidity risk

Q 2. Which document helps a company to collect details like health status, income, premium, etc?

SAP Report

Sales reports

Proposal form

Medical reports

Financial documents

Q 3. Data is used by Governments for ______.

analyzing claim settlements

analyzing the overall performance of the sector

formulating social schemes

keeping track of market developments

benchmarking the performance of underwriting offices

Q 4. What is/are the reason/s for Health Insurance becoming the fastest growing segment? 1. Due to orders by the Government making it compulsory 2. More focus on marketing by the insurance companies 3. Increase in awareness among the general public

Only statement 1 is correct

Only statement 2 is correct

Only statement 3 is correct

Only statements 1 and 2 are correct

Only statements 2 and 3 are correct

Q 5. Seema was preparing for her medical entrance exams and was staying in a hostel in Kota. Unfortunately, she was not selected and tried to commit suicide. However, she survived but got many injuries and the treatment and hospitalization cost Rs 20000. She had a mediclaim of Rs 1 lac. How much will the insurance company reimburse?

Rs 1 lac

Rs 20000

Rs 20000 + physiotherapy expenses

Rs 50000

NIL

Q 6. Distribution of several claims paid and the corresponding claim amount paid for different ranges of the sum insured' - can be seen from which type of analysis?

Net Premium paid analysis

Claims analysis by sum insured

Claims probability distribution

Earned premium

Claims analysis by age bands

Q 7. Fill in the blanks: Prescribing the correct qualifications helps to ______ and other market conduct issues.

ensure that insurers cannot arbitrarily decline renewals and cancel policies

prevent mis-spelling

have a cap on waiting periods and cost-sharing provisions

protect the access rights of consumers

maintain standardization of definitions/terms

Q 8. Mr. Suraj had insured himself against accident by taking two BENEFIT POLICIES. He took one from Company X for Rs 25000 and one from Company Y for Rs 40000. Later he met with an accident and was hospitalized. The hospitalization expenses were Rs 40000. What amount will be paid by both the companies?

Company X - Rs 16000, Company Y - Rs. 24000

Rs 20,000 by each company

Company X - Rs 25000, Company Y - Rs. 40000

Company X - NIL, Company Y - Rs. 40000

As mentioned in the insurance proposal

Q 9. Name the measure(s) under human interface/process improvisation for fraud prevention.

Comprehensive claims information

Audits

Control business when fraud is not manageable

Vigilance, Compliance checks

Ability to detect fraud effectively

Q 10. Who listens to the appeals against the orders of any District Forum within the State?

State Commission

District Forum

Ombudsman

Nodal officer

National Commission

Q 11. Which of the following statements is/are TRUE with regards to 'health savings on investment linked plans'?

Although the risk premium is allocated to health insurance coverage, the investment amount is diverted to the unit-linked funds which shall pay for future health costs.

These products can also offer other benefits like critical illness benefits, hospitalization allowances, etc.

In such plans, the total premium is split up into risk premium and investment amount.

These types of products discourage savings for expected high costs of medical care in the future.

Statements 1, 2, and 3 all are correct, Statement 4 is Incorrect

Q 12. Consider an example - A cedant has a 10-line surplus treaty which is subject to a maximum cession of 1,000,000. What will be the maximum gross capacity of the cedant for a single risk, if no other reinsurance coverage is in force?

50000

1,10,00,000

1,00,00,000

11,00,000

1,00,000

Q 13. Under Critical Illness benefit, _______ amount is given to the insured on the diagnosis of critical illness like cancer, kidney failure, or on undergoing certain procedures.

Reasonable

Proportionate

Lump sum

Fixed

Survival benefit

Q 14. To which country do the insurance schemes CSMBS, and UCS SSS belong?

India

Bangladesh

Thailand

Japan

USA

Q 15. Who runs/governs the Rashtriya Swasthya Bima Yojana (RSBY)?

Commerce Ministry

Insurers

IRDA

The Stakeholders

Government



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