IC27 Mock Test Sample 11
These questions focus on advanced concepts in health insurance, including products, underwriting, fraud prevention, and international healthcare systems. Day care procedures include treatments like angioplasty, while critical illness policies provide lump sum benefits on diagnosis or procedures. Group insurance misuse can lead to adverse selection and higher claims. Actuaries play a key role in estimating reserves and future liabilities. Fraud prevention involves technology, data analysis, and monitoring systems. ICD-10 helps classify diseases systematically. Pricing depends on claims cost, expenses, and margins. Globally, systems vary—Germany uses payroll-based contributions, France relies on employer-employee funding, and the USA offers Medicare/Medicaid for specific groups.
1. Day care procedures include:
a) Bariatric surgery
b) Angioplasty
c) Pneumonia
d) Pulmonary embolism
2. With respect to Critical Illness policy, which statements are correct?
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
3. What are the consequences of issuing health insurance to group of convenience?
a) Statement 1 is correct
b) Statement 2 is correct
c) Statements 1 & 3 are correct
d) All the statements are correct
4. Which rider should a person take for protection against serious illness?
a) Waiver of premium
b) Accidental death
c) Critical illness
d) Guaranteed insurability
5. In which year was Mediclaim first launched?
a) 1986
b) 1999
c) 1973
d) 1956
6. Which country provides Medicare/Medicaid for elderly and poor?
a) USA
b) Japan
c) Germany
d) Chile
7. Which is a measure under technology and process interface for fraud prevention?
a) Doctor seeding
b) Training & communication
c) Creation of fraud database
d) Creation of consumer awareness
8. A data warehouse is a _____ of an organization’s data.
a) Section
b) Technique
c) Depository
d) Repository
9. Main role of an actuary in claim reserving is:
a) Set aside reserves for reported claims
b) Calculate future claim payments
c) Estimate IBNR reserves
d) Estimate earned premium reserves
10. Which is NOT under licensing and registration domain?
a) Validate management background
b) Validate proposer background
c) Check integrity of management
d) Check financial strength of management
11. Which analysis helps calculate expected cost for different sum insured?
a) Written premium
b) Claims by age bands
c) Claims by geography
d) Claims probability distribution
12. Important factors in pricing health insurance include:
a) Only statement 1
b) Only statement 2
c) Statements 1 and 3
d) Statements 2 and 3
13. Which is INCORRECT about cashless facility?
a) Available only in network hospitals
b) Insured must pay at discharge
c) Emergency cases involve sudden hospitalization
d) Planned cases are known in advance
14. What perception leads to exaggeration of claims?
a) Insurer pays less even for true loss
b) Insurer pays less even for improper loss
c) Insurer pays more than claimed
d) Insurer pays more even for improper loss
15. ICD-10 coding system is used to:
a) Provide reports to decision makers
b) Classify diseases
c) Integrate insurer data
d) Aggregate insurance data
16. Germany’s health financing redistributes:
a) Wealth from poor to rich
b) Health from sick to healthy
c) Income from old to young
d) Contributions from employed to unemployed
17. Primary source of financing for France healthcare system:
a) Government tax
b) Employer-employee contributions
c) Direct patient payments
d) Private insurance
18. Number of healthcare funds in France:
a) One
b) Two
c) Three
d) Four
19. How are premiums collected in Germany?
a) Based on health risk
b) Payroll tax
c) Based on family status
d) Paid by employers only
20. Role of unions in French healthcare system:
a) Oversee system
b) No role
c) Compete for care management
d) Supervise healthcare funds
