IC27 HEALTH INSURANCE EXAM - 11
| Q1.Under 'human interface/process improvisation', what are the measures for fraud prevention |
| Creation of fraud database |
| Ease of data capture |
| Extract data output in a desirable format |
| Comprehensive claims information |
| Ability to detect fraud effectively |
| Q2.Which type of fraud occurs when people deliberately provide wrong information with regard to the pre-existing illness to influence the underwriting process in the favour of the applicant. |
| Underwriting fraud |
| Hard fraud |
| Soft fraud |
| Internal fraud |
| External fraud |
| Q3.__ report sometimes also depends upon the amount of cover opted |
| Financial documents |
| Sales |
| Proposal form |
| Actuarial |
| Medical |
| Q4.In which year was the Malhotra Committee formed? |
| 1990 |
| 1991 |
| 1992 |
| 1993 |
| 1994 |
| Q5.____ analysis shows the average amount and the percentage of the total amount paid. |
| Claims analysis by age bands |
| Earned premium |
| Earned premium |
| Group size distribution |
| Claims analysis by sum insured |
| Q6.___ is one of the measures under technology and process interface for fraud prevention. |
| Creating fraud database |
| Creating consumer awareness |
| Fraud management philosophy and policy |
| Effective legislation and judicial action |
| Ease of data capture |
| Q7.__ is not a type of Claims Fraud. |
| False claims |
| Collusion with TPAs |
| Insurance speculation |
| Fraud rings |
| Collusion with providers |
| Q8.___ looks after functions like sales, claims intimation, underwriting in case of Social Reinsurance. |
| Social Service Department of the Local Government |
| NGO |
| Insurance agency |
| Healthcare provider |
| Insurance agency |
| Q 9.What should be explained to the customer so that the claim process can become smooth and hassle-free with minimum dissonance? |
| Company philosophy |
| Riders and covered expenses/events |
| Terms and condition |
| Comparison with competitor products |
| Policy tenure |
| Q10.Which of the below statement(s) is/are correct with respect to IRDA's role? 1. IRDA has specified several regulations for non-life insurance companies in many aspects of business 2. IRDA is very crucial in preventing adverse consequences of the health insurance for the cost of care, consumer satisfaction, fraud, and ethical standards, etc. 3. IRDA is not just a regulatory authority but also plays an active ‘development’ role in health insurance |
| Only 1 |
| Only 2 |
| Only 3 |
| Both 1 and 3 |
| Both 2 and 3 |