IC27 Mock Test Sample 1
This set of IC27 Health Insurance questions covers key concepts required for the insurance exam. It focuses on fraud involvement by multiple stakeholders, information asymmetry between insured and insurer, and the role of data systems in decision-making. It highlights complaint mechanisms such as courts and Ombudsman, sources of healthcare financing, and features of group insurance. It also includes regulatory actions, innovations in policies, actuarial science basics, and cost-sharing mechanisms. Important principles like utmost good faith and market imperfections are tested. Additionally, it addresses healthcare costs in India, the role of health authorities, and defines primary care as the first point of contact.
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 & insurers have all the information
e) None have all the information
3. A good data warehouse system should be able to:
- Archive historical data & 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 include:
- Civil & 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 correct
c) Statements 2 and 4 incorrect
d) Both 1 and 2 incorrect
e) All of them
6. Under group health insurance, which is NOT usually asked?
a) Specific health questions
b) Geographical spread
c) Income details
d) Age of members
e) Nature of work
7. Regulatory actions for violations include:
- Warning insurer
- Appoint administrator
- Blacklisting insured
a) Only 1 is correct
b) Only 3 is correct
c) Only 2 and 3 are correct
d) Only 1 and 2 are correct
e) Only 1 and 3 are correct
8. Innovations in personal accident policies include:
a) Spouse retraining expenses
b) Home/vehicle modification
c) Adventure sports cover
d) Hospital confinement allowance
e) All of the above
9. Actuarial science does NOT include:
a) Statistics
b) Finance
c) Mathematics
d) Economics
e) ICD - International Classification of Diseases
10. The health insurance policy covers the cost of room charges following hospitalization. Generally, the insurers cover the room charges up to a limit of:
A) 1% of the sum insured
B) 10% of the sum insured
C) 1% of the sum insured up to a specified limit
D) 5% of the sum insured
E) 15% of the sum insured
a) Only statement A is correct
b) Only statement C is correct
c) Statements A and C are correct
d) Statements B and C are correct
e) Statements A and B are correct, C is incorrect
11. With respect to the rules for reference to the Ombudsman for grievance redressal, which of the following is incorrect?
a) The TPA shall appoint Ombudsman for the purpose of these rules
b) Any person who has a grievance against an insurer may himself make a complaint
c) Legal heirs can make complaint
d) Ombudsman may recommend settlement
e) Ombudsman may pass award
12. Out of pocket medical expenses is very high in India compared to other countries. What percentage is this expenditure in India accounts for?
a) 90%
b) 71%
c) 53%
d) 25%
e) 40%
13. Cost-sharing provisions like sub-limits, co-payment and deductibles. Which statement is true?
- Insured gets reduced indemnity
- Insured is always a loser
- Insured gets benefit of lower premium
a) Only statements 1 and 2 are correct
b) Only statement 1 is correct
c) Only statement 3 is correct
d) All 1, 2 and 3 are correct
e) Only statement 2 is correct
14. Imperfect market in health insurance. Which is NOT a reason?
a) Risk selection
b) Demand-side moral hazard
c) Supply-side moral hazard
d) Information asymmetry
e) Information symmetry
15. Which of the following is a non-standard age proof document?
a) Voter ID Card
b) PAN Card
c) Passport
d) School certificate
e) Domicile certificate
16. Uberrima Fides supports which principle?
a) Principle of utmost good faith
b) Principle of indemnity
c) Principle of subrogation
d) Principle of proximate cause
e) Principle of contribution
17. Which of the following is NOT a cost-sharing mechanism?
a) Sub-limits of surgeries
b) Sub-limits of room charges
c) Sub-limits of ICU charges
d) Co-payment for non-network hospitals
e) Sub-limits of specified surgeries
18. What is the role of Central Council of Health?
- Manages finances
- Link between center & state
- Promotes coordination
a) Only statement 1 is correct
b) Only statement 2 is correct
c) Only statement 3 is correct
d) All the statements 1, 2 and 3 are correct
e) Only statements 1 and 2 are correct
19. Why is health insurance sector considered as a “bleeding” sector?
a) High cost of servicing claims
b) Nature of claims
c) High claim ratio
d) More hospitalization claims
e) More accidental claims
20. Primary care can be described as:
a) Care provided in acute setting
b) Care provided in hospitals
c) First point of contact for healthcare
d) Care provided by doctors
e) Vertical care
