IC27 Mock Test Sample 11
This set of questions covers key concepts of health insurance, actuarial roles, fraud prevention, and global healthcare systems. Day care procedures include treatments like angioplasty. Critical illness policies provide lump sum benefits on diagnosis or procedures. Group insurance misuse can lead to adverse selection and higher claims. Mediclaim was introduced in 1986. Fraud prevention uses tools like data analytics and fraud databases. Actuaries estimate future claims and reserves such as IBNR. Pricing factors include benefit cost, admin cost, and profit margin. Cashless treatment is limited to network hospitals. ICD-10 classifies diseases. International systems like Germany and France rely on social insurance contributions and structured healthcare funds.
Q1. Day care procedures includes:
a) Bariatric surgery
b) Angioplasty
c) Pneumonia
d) Pulmonary embolism
Q2. With respect to Critical illness policy, which statement(s) is/are correct?
- Lump sum on diagnosis
- Lump sum on procedure
- Cannot be under accelerated CI
a) Only statement 1 is correct
b) Only statement 2 is correct
c) Only statement 3 is correct
d) Only statements 1 and 2 are correct
Q3. Consequences of group of convenience:
- Adverse selection
- Higher claim ratio
- Increased penetration & cost efficiency
a) Statement 1 is correct
b) Statement 2 is correct
c) Statements 1 & 3 are correct
d) All statements are correct
Q4. Suitable rider for serious illness protection:
a) Waiver of premium
b) Accidental death
c) Critical illness
d) Guaranteed insurability
Q5. Year Mediclaim was launched:
a) 1986
b) 1999
c) 1973
d) 1956
Q6. Country with Medicare & Medicaid:
a) USA
b) Japan
c) Germany
d) Chile
Q7. Measure under technology/process for fraud prevention:
a) Doctor seeding
b) Training & communication
c) Creation of fraud database
d) Propensity modeling
Q8. A data warehouse is a _____ of stored data:
a) Section
b) Technique
c) Depository
d) Repository
Q9. Main role of actuary in claim reserving:
a) Set reserve for reported claims
b) Calculate future claim payments
c) Estimate IBNR reserves
d) Estimate earned premium reserves
Q10. Which is NOT under regulator licensing tools?
a) Validate management background
b) Validate proposer background
c) Validate integrity of management
d) Check financial strength
Q11. Data analysis for expected cost by sum insured:
a) Written premium
b) Claims analysis by age bands
c) Claims analysis by geography
d) Claims probability distribution
Q12. Pricing factors in health insurance:
- Cost of benefits
- Profit margin
- Administrative cost
a) Only statement 1 correct
b) Only statement 2 correct
c) Statements 1 and 3 correct
d) Statements 2 and 3 correct
Q13. Incorrect statement about cashless facility:
a) Only in network hospitals
b) Insured pays at discharge
c) Emergency = sudden hospitalization
d) Planned = known in advance
Q14. Reason customers exaggerate claims:
a) Company pays less even if correct
b) Company pays less even if improper
c) Company pays more if correct
d) Company pays more if improper
Q15. Function of ICD-10 system:
a) Report generation
b) Classify diseases with codes
c) Data integration
d) Aggregate analysis
Q16. Germany’s model redistributes:
a) Wealth low → high income
b) Health sick → healthy
c) Income old → young
d) Contributions employed → unemployed
Q17. France healthcare financing source:
a) Govt tax
b) Employer & employee contributions
c) Direct payments
d) Private insurance
Q18. Number of healthcare funds in France:
a) One
b) Two
c) Three
d) Four
Q19. Germany premium collection method:
a) Based on health risk
b) Payroll tax from employees
c) Based on marital status
d) Paid fully by employers
Q20. Role of unions in France healthcare:
a) Oversee entire system
b) No role
c) Compete with each other
d) Supervise healthcare funds
