IC27 Mock Test Sample 13
Health insurance involves concepts like underwriting, fraud detection, and risk management. IRDAI regulations ensure consumer protection through features like grace periods and continuity benefits. Tools like data warehouses and analytics help insurers monitor claims, detect fraud, and improve decision-making. Schemes like ESIS provide healthcare to industrial workers, while policies such as floater plans allow flexible usage among family members. Fraud prevention relies on indicators like abnormal hospital stays or mismatched diagnostics. Reinsurance helps insurers manage risk exposure. Understanding waiting periods, co-payment strategies, and IBNR claims is essential for insurance operations, ensuring financial stability while delivering effective healthcare coverage to policyholders.
1. What is the grace period (in days) which IRDAI has mentioned from the date of renewal with continuity in benefits?
a) 7 days
b) 15 days
c) 20 days
d) 30 days
2. Insurance contracts are different from other contracts because _____ .
a) It does not result in profit for any of the parties
b) It is based on the principle of 'Utmost Good Faith'
c) It protects the assets
d) It covers uncertain losses
3. Which of the following parameters can be used as a trigger to detect fraudulent claims?
a) Availability of post-operative histopathology reports
b) Lower per patient average medical tests
c) Costlier investigations with justifications
d) Medical bills in serial order
4. IBNR claims are ______ .
a) Incurred But Not Reviewed
b) Incurred But Not Reported
c) Involved But Not Responsible
d) Incurred But Not Responsible
5. When did life and non-life insurance companies arrive in modern form?
a) Early 17th century
b) Early 18th century
c) Early 19th century
d) Early 20th century
6. Strategy where employees share cost of medical care and premiums is called ______ .
a) Deferred vesting strategy
b) Co-payment strategy
c) Deferred co-payment strategy
d) Deferred payment strategy
7. What is the repository of an organization's electronically stored data?
a) Data exchange
b) Data warehouse
c) Data center
d) Servers
8. Health expenditure in India (2008–09) was about _____ of GDP.
a) 2.75%
b) 2.12%
c) 3.54%
d) 4.13%
9. Fraud done by medical consumable vendors is classified as ______ .
a) Hard fraud
b) Soft fraud
c) External fraud
d) Internal fraud
10. Waiting period for first-time mediclaim policy is ____ days.
a) 15
b) 30
c) 45
d) 60
11. ______ helps identify average premium per person for group and individual policy.
a) Earned premium analysis
b) Age distribution analysis
c) Claims probability distribution analysis
d) Group size distribution analysis
12. ESI provides comprehensive medical care to ______ .
a) Employees of industrial sector and their families
b) Employees of private sector
c) All adult citizens
d) Army employees
13. Which is true about sum insured in a floater policy?
a) It has an investment component
b) It is transferable to relatives
c) It is limited to 2 members
d) It can be used by any member when required
14. KYC helps prevent which type of fraud?
a) Health checkups undergone
b) Cash defalcation
c) Cash favors
d) Providing wrong address to claim benefit
15. Which option is NOT used to detect fraud?
a) No relation between diagnosis and investigation
b) Less than expected hospital stay
c) Higher per patient visits
d) Excessive patients per doctor
16. Technical head of district health system is ______ .
a) Chief medical officer
b) Chief technical advisor
c) Main district doctor
d) Health officer
17. ESIS provides services through ______ .
a) Only hospitals
b) Only private hospitals
c) Dispensaries and hospitals
d) Private hospital network only
18. Cashless health cover minimizes need to keep surplus ______ .
a) Funds in mutual funds
b) Medicines
c) Insurance covers
d) Liquidity
19. General Insurance Business (Nationalisation) Act was promulgated in ______ .
a) 1961
b) 1972
c) 1984
d) 1987
20. Which of the following is NOT correct about reinsurance?
a) It is a risk transfer mechanism
b) It does not require underwriting skills
c) It is a transaction between insurers
d) It is insurance for insurers
