IC27 HEALTH INSURANCE EXAM - 07
| Q1.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 |
| Q2.Insurance would become a gambling transaction if there was no principle of ___. |
| Fixed returns |
| Proximate clause |
| Berrima Fides |
| Insurable interest |
| Indemnity |
| Q3.What could be a reason for partial reductions in claimed amount? |
| Lack of liquidity in insurance companies |
| Lack of proper documentation by insured |
| Misguided advice by TPA |
| Lack of proper documentation by TPA |
| Lack of proper documentation by hospital |
| Q4.When a person has a cashless medical cover, he need not keep surplus ___. |
| hospital list |
| insurance covers |
| medicines |
| prescriptions |
| liquidity |
| Q5.Which of the following is NOT a core principle and does not form an integral part of an insurance contract? |
| Berrima Fides |
| Indemnity |
| Benefit |
| Insurable interest |
| Contribution |
| Q6.Which of the below statements is/are CORRECT in relation to administrative location. This should be in the context of the regulatory system. |
| In the context of a small country with limited regulatory manpower or in the case of regulators dealing with integrated insurers which also underwrite non-health businesses, having a health insurance regulator within the overall insurance regulatory structure is mandatory |
| A health insurance regulator can’t be housed within a health ministry or in an insurance regulatory agency |
| In the case of several countries, an independent health insurance agency located outside the health ministry and also outside the regulatory mechanism for non-health insurance entities is also an option |
| Both 1 and 2 are correct |
| Both 1 and 3 are correct |
| Q7.A score of 4.1 was received by which of the following options in context to - 'Taking measures for post-sales dissonance of health insurance – Customer Feedback'? |
| Call recording and quality check on health telesales personnel |
| Regular assessment of all enrolled hospitals |
| Customer complaints & grievance handling system |
| Process of getting online customer feedback on the website |
| Regular health insurance customer satisfaction surveys |
| Q8.For which type of health insurance are 'health status' and 'age' important underwriting considerations? |
| Family |
| Individual |
| Community |
| Corporate |
| Group |
| Q9.Consider a scenario - 'The insurer is claiming that the proposer suppressed or provided misleading or false information on any matter material to grant of a cover'. In such cases, the onus of providing the proof lies with ___. |
| concerned insurance agent |
| Signatory of the contract |
| Insurer |
| Insured |
| Health care provider |
| Q10.___ depends on the mix of investment options chosen by the insurer, as also the general environment in the economy. |
| Investment risk |
| Liquidity risk |
| Speculative risk |
| Insurance risk |
| Business environment risk |