IC27 HEALTH INSURANCE EXAM - 12
| Q1.The collection of data from the insurer's TPA’s is currently done by ___ . |
| IRDAI |
| TAC |
| Ministry of Health & Family Welfare |
| National Health Insurance |
| Insurance Information Bureau (IIB) |
| Q2.The possibility of fraud at the proposal and policy stage can be by ____. |
| Cash defalcation |
| Submit the claim so as to get the benefit |
| Health checks undergone |
| Sum assured alterations |
| Change in address and contact details |
| Q3.Regulation __ of IRDA Protection of Policy Holders Interests Regulation 2002, states that all insurers should have in place a grievance redressal system to address the complaints of policy holders. |
| 10 |
| 5 |
| 7 |
| 3 |
| 2 |
| Q4.What do the regulatory actions for breaches or violations include? 1. Ordering removal or change of personnel 2. Levying fines and penalties on the insured 3. Restricting business activities by the insurer |
| Only statement 1 is correct |
| Only statement 2 is correct |
| Only statement 3 is correct |
| Both statements 1 and 3 are correct |
| Both statements 1 and 2 are correct |
| Q5.The data provided in Table C is related to ___. |
| Information on claims made by the members covered |
| Policy level information |
| Detailed information of the individual members covered under the policy |
| The claim amount outstanding at the start and close of each financial year and the total amount paid during the year in aggregate |
| Both 1 and 4 are correct |
| Q6.Which one of these options CANNOT be a trigger to detect fraud in claims? |
| There is a higher per-patient cost in hospital |
| Short term policy holders with lower sum insured |
| There are excessive number of patients per doctor in the hospital |
| The residence of the patient and the hospital, chemist address are in the same location |
| There is a higher per-patient average visit numbers |
| Q7.Which type of health cover policy will suit a person who is from a low income and rural background? |
| Normal health cover policy |
| Outpatient coverage |
| Deferred indemnity product |
| Personal accident cover |
| Microinsurance product |
| Q8.Under which section of the IRDA Act does IRDA have vested powers to seek information and returns. |
| Section 19 B |
| Section 13(1) |
| Section 11 A |
| Section 14(2) |
| Section 16 B |
| Q9.A rating agency has given a reinsurer a good financial strength rating. This means that the reinsurer will most likely ____. |
| to offer new options to conventional reinsurance |
| to maintain best underwriting policies |
| to settle all submitted claims in time |
| to remain solvent even in difficult economic times |
| tp only underwrite short-tall reinsurance business |
| Q10.What forms the basis of the rate calculation for sum-insured policies? |
| Age distribution |
| Written premium |
| Claims probability distribution |
| Group size distribution |
| Earned premium |