IC27 Mock Test Sample 1
Health insurance involves multiple stakeholders, making it prone to fraud due to information asymmetry where the insured knows more than the insurer. Data systems, grievance mechanisms, and regulatory actions ensure transparency and efficiency. Costs are financed through insurance, government, and individuals, but high out-of-pocket expenses remain a concern in India. Cost-sharing tools like deductibles reduce premiums but also claims. The sector is considered “bleeding” due to high claim ratios. Principles like utmost good faith are critical. Regulatory bodies and Ombudsman handle disputes. Innovations and structured policies improve coverage, while primary care serves as the first point of healthcare access.
1. Health insurance is often prone to insurance related frauds. In health insurance frauds, co-operation is required from ___________ to organize a fraud. Which are these?
A. IRDAI
B. Policy holder
C. Only hospitals
D. Intermediaries only
E. Multiple stakeholders
2. What do we mean by “information asymmetry” under health insurance?
A. The insurers have all the information about the risk
B. The insured have all the information about the risk
C. The insured is in possession of all the information about the risk & lack of such information with the insurer
D. Both insured & the insurers have all the information about the risk
E. None have all the information about the risk
3. A good data warehouse system should be able to:
- Archive historical data and keep backups
- Perform data validation
- Provide flexible access
A. Only statement 1 is correct
B. Only statement 2 is correct
C. Only statement 3 is correct
D. Only statements 1 and 3 are correct
E. Statements 1, 2 & 3 are correct
4. Channels for registering complaint for personal insurance claims:
- Civil and Consumer Courts
- Only Consumer courts
- Ombudsman
A. Only 1 is correct
B. Only 2 is correct
C. Only 3 is correct
D. Only 1 and 2 are correct
E. Only 1 and 3 are correct
5. Healthcare costs are financed through various sources. Which is incorrect?
- Commercial Insurance
- Social Insurance
- Government taxes
- Individual contributions
A. Statement 1 correct; 3 & 4 incorrect
B. Only 1 and 2 are correct
C. Statements 2 and 4 are incorrect
D. Both 1 and 2 are incorrect
E. All of them
6. Under group health insurance, which question is NOT usually asked?
A. Specific health question from individual member
B. Geographical spread
C. Income details
D. Age of members
E. Nature of work
7. Regulatory actions include:
- Warning insurer
- Appoint administrator
- Blacklisting insured
A. Only 1
B. Only 3
C. Only 2 and 3
D. Only 1 and 2
E. Only 1 and 3
8. Innovations in personal accident policies include:
A. Spouse retraining expenses
B. House/vehicle modification
C. Adventure sports cover
D. Hospital cash allowance
E. All of the above
9. Which is NOT part of actuarial science?
A. Statistics
B. Finance
C. Mathematics
D. Economics
E. ICD
10. Room rent limit in health insurance:
A. 1% of sum insured
B. 10%
C. 1% with cap
D. 5%
E. 15%
Options:
a. Only A
b. Only C
c. A and C
d. B and C
e. A and B
11. Incorrect statement about Ombudsman:
A. TPA appoints Ombudsman
B. Complaint by policyholder
C. Legal heirs can complain
D. Mediation allowed
E. Ombudsman can pass award
12. Out-of-pocket expenses in India:
A. 90%
B. 71%
C. 53%
D. 25%
E. 40%
13. Cost-sharing statements:
- No reduction in indemnity
- Insured always loser
- Lower premium benefit
A. Only 1 and 2
B. Only 1
C. Only 3
D. All
E. Only 2
14. Which is NOT a reason for imperfect market?
A. Risk selection
B. Demand side moral hazard
C. Supply side moral hazard
D. Information asymmetry
E. Information symmetry
15. Non-standard age proof:
A. Voter ID
B. PAN
C. Passport
D. School certificate
E. Domicile
16. Uberrima Fides relates to:
A. Utmost good faith
B. Indemnity
C. Subrogation
D. Proximate cause
E. Contribution
17. Which is NOT cost-sharing?
A. Surgery sub-limits
B. Room rent limits
C. ICU limits
D. Co-pay for non-network
E. Surgery sub-limits
18. Role of Central Council of Health:
- Finance management
- Link center-state
- Promote coordination
A. Only 1
B. Only 2
C. Only 3
D. All 1, 2, 3
E. Only 1 and 2
19. Why is health insurance a “bleeding sector”?
A. High servicing cost
B. Nature of claims
C. High claim ratio
D. More hospitalization
E. More accidents
20. Primary care means:
A. Acute care
B. Hospital care
C. First point of contact
D. Doctor care
