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 |