IC27 HEALTH INSURANCE EXAM - 14

Q1.Due to illness, Mr. Mohan had to undergo Aorta Surgery. He had a critical illness policy of Rs 1 lakh. What amount will be paid to him under this policy for his expenses?
   Rs 10,000
   Rs 50,000
   Rs 33,333
   Rs 1,00,000
   NIL
 
Q2.Sometimes insurance companies have to purchase reinsurance to protect them as the total loss against risk may exceed a certain threshold. What is this known as?
   Term Insurance
   Reinsurance Cession
   Coinsurance
   Reinsurance of Insurance
   Reinsurance Accepted
 
Q3.Identify the CORRECT statement with regard to Claim Analysis by hospitals -
  This analysis helps insurers in finding out the high-cost location
  This analysis helps insurers by pointing out the high-cost hospitals and renegotiating terms with them
  This analysis will help insurers to point out the utilization level at different sum insured ranges
   This analysis helps in identifying the frequency and severity of claims from different age bands
  Such analysis can show the amount of claim, the total amount paid and the amount paid for different procedures including room, nursing, surgery, miscellaneous, etc.
 
Q4.Which of these options is NOT CORRECT with respect to usage of the insurance data by the Regulators?
   The data is used to frame policies in regards to solvency margins
   The data is used for customer education and awareness
  The data is used to analyze the overall performance of the sector
   The data is used to keep track of market developments
   The data is used to frame policies in regards to insolvency margins
 
Q5.Which of these statements is/are TRUE with respect to FRAUDs in the insurance industry? 1. No individual, organization, or agency has the resources to single-handedly stop all insurance frauds 2. Today, the situation is such that if a claim is found to be fraudulent, the insurer just repudiates the same 3. The unfortunate reality is the fraudster goes scot-free and continues this practice with another insurer and the vicious cycle keeps repeating
   Only 1
   Only 3
   1 and 2
   2 and 3
   All 1, 2 and 3
 
Q6.___ insurance plan is administered by Municipal Governments in Japan?
   SHI
   GHI
   NHI
   Longlife medical care system
   Both SHI and GHI
 
Q7.No insurance cover is involved in which type of reinsurance cover?
   Employee stop loss
  White labeling
   Social reinsurance
   Group insurance
   Critical illness
 
Q8.Which of these statement(s) is/are correct? 1. Health insurance policies do not offer the benefits of providing coverage in the event of hospitalization/illness for a premium that is required to be paid by the customer 2. The offer seeking coverage is made by the proposer to the insurer, and after evaluating the risk, the insurer accepts it or declines it 3. The offer and acceptance work as per contract law
   Only 1
   Only 2
   Only 3
   2 and 3
   All 1, 2 and 3
 
Q9.__ contains data on pre-existing disease cover.
   Table A
   Table B
   Table C
   Table D
   Both Table A and Table B
 
Q10.Due to which reason does the level of regulatory involvement generally, decrease?
   When insurance companies form a cartel
   Where the regulator m and ates a particular level of corporate governance
  When there is perfect competition in the market
  Due to the infiltration of nonworking government mechanisms
   Due to interference of political influences

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