IC27 - Health Insurance exam - 7

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Q 1. In which type of policy there is coverage even in case of non-hospitalization?

Top up plans

Personal accident cover

Disease management cover

Outpatient coverage

Daily cash cover
 
Q 2. Mr. Gopal took a mediclaim on 15th September '17 for Rs 1 lac. On 24 September '17, he unfortunately got dengue and was hospitalized which cost him Rs 30,000. What amount will be reimbursed to him?

Rs 1 lac

Rs 70,000

Rs 25000

Rs 30000

NIL
 
Q 3. Which report has to be considered by insurance companies to watch out for conflicts of interest while underwriting?

Commission report

Medical reports

Proposal form

Sales report

Financial documents
 
Q 4. What % of the world health expenditure did social insurance contribute in the year 2010? ( As per WHO data )

18%

20%

25%

27.50%

31%
 
Q 5. If a person is above the age of _____ years in India and he is enrolling for the first time then he is usually required to undergo some pathological tests to assess his health risk and to get his current health status.

40

45

50

55

60
 
Q 6. Point out the measures under the technology and process interface for fraud prevention.

Ability to detect fraud effectively

Creation of consumer awareness

Robust whistle-blower policy

Creation of a fraud database

Effective legislation and judicial action
 
Q 7. Which of these options is correct for NRHM?

NRHM was not focused on the integration of vertical disease control programs

NRHM was strict in terms of usage of the allotted funds by the community-level bodies

NRHM drained out funds from the health care schemes via United funds

NRHM tries to reduce the gap between the health care available in urban and semi-urban areas

NRHM tries to reduce the gap between the health care available in urban and rural areas
 
Q 8. Which of the below options is correct concerning the Critical Illness (CI) policy ? 1. It provides a lump sum payment on diagnosis of a covered condition 2. It can come as an Accelerated CI benefit product, as a rider to a health insurance policy 3. It can also be taken as a stand-alone CI product

Only statement 1 is correct

Only statement 2 is correct

Only statement 3 is correct

Only 1 and 2 are correct

All 1, 2, and 3 are correct
 
Q 9. What is the term known as when an insurer exchanges proportional reinsurance business with another insurer?

Retrocession

Alternative risk transfer

Horizontal placement

Vertical placement

Reciprocity
 
Q 10. ________ cover is provided under health insurance.

Medical expenses

Accidental death

Natural death

Disability

Both accidental and medical expenses are covered
 
Q 11. Which of the below options belongs to frauds at the claim settlement stage?

Change in address and contact details

Submission of claim to seek benefit

Health checks undergone

Alterations in sum assured

Disclosure of material information at the medical stage
 
Q 12. In the European country Germany, it has been observed that over _____ % of the residents receive healthcare through _____ health insurance.

75, private

90, statutory

80, Social

95, out of pocket

80, commercial
 
Q 13. When a policyholder has a complaint to make, he should first approach the _____.

Insurance Ombudsman

Local court

Nodal officer

Appellate officer

Grievance or Consumer Complaints cell of the insurer
 
Q 14. Insurance would become a gambling transaction if there was no principle of ______.

Fixed returns

Proximate clause

Uberrima Fides

Insurable interest

Indemnity
 
Q 15. What could be a reason for partial reductions in the claimed amount?

Lack of liquidity in insurance companies

Lack of proper documentation by the insured

Misguided advice by TPA

Lack of proper documentation by TPA

Lack of proper documentation by the hospital


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