IC27 Mock Test Sample 15
Health insurance provides financial protection against medical expenses and is funded globally through government revenues, social insurance, private insurance, and out-of-pocket payments. Countries like Germany rely on social insurance, while France uses multiple healthcare funds. In India, NRHM focuses on reducing rural-urban healthcare gaps. Policies like outpatient cover and disease management address non-hospitalization needs. Concepts like underwriting, fraud detection, and principles such as utmost good faith and insurable interest are essential for insurance functioning. Challenges include rising healthcare costs and access issues. Effective systems, proper regulation, and awareness ensure better healthcare delivery, financial security, and reduced risk for individuals and insurers alike.
1. What is the primary purpose of health insurance mechanisms?
a) To lower the quality of healthcare
b) To increase the cost barrier for healthcare
c) To reduce affordability of healthcare
d) To provide financial protection for healthcare costs
2. What are the four methods of financing healthcare costs globally?
a) Government revenues, social health insurance, commercial health insurance, and out-of-pocket expenses
b) Government revenues, voluntary contributions, commercial health insurance, and out-of-pocket expenses
c) Tax deductions, social health insurance, private health savings accounts, and out-of-pocket expenses
d) Social health insurance, government grants, private donations, and out-of-pocket expenses
3. How is healthcare financing primarily structured in Germany?
a) Through government subsidies
b) Through private donations
c) Through social health insurance with payroll tax
d) Through commercial health insurance
4. How is healthcare coverage provided in France?
a) Through a single healthcare fund
b) Through employer-sponsored insurance
c) Through out-of-pocket payments
d) Through three healthcare funds
5. What is one major issue faced by the healthcare system in the United States?
a) Excessive regulation
b) Low costs
c) High access
d) Reduction in insured population
6. What is the primary purpose of NRHM in India?
a) Promote urban healthcare
b) Reduce rural spending
c) Urban-only services
d) Reduce rural-urban gap
7. Which policy covers non-hospitalisation expenses?
a) Top-up plans
b) Personal accident cover
c) Disease management cover
d) Outpatient coverage
8. Mr. Gopal took mediclaim and got hospitalized within 10 days. What will be reimbursed?
a) Rs 1 lakh
b) Rs 70,000
c) Rs 25,000
d) Rs 30,000
9. Which report is used to detect conflict of interest in underwriting?
a) Commission report
b) Medical reports
c) Proposal form
d) Sales report
10. What % of world health expenditure came from social insurance (2010)?
a) 18%
b) 20%
c) 25%
d) 27.5%
11. Above what age are medical tests usually required for first-time policyholders in India?
a) 40
b) 45
c) 50
d) 55
12. Exchange of proportional reinsurance business is called:
a) Retrocession
b) Alternative risk transfer
c) Horizontal placement
d) Reciprocity
13. ______ cover is provided under health insurance.
a) Medical expenses
b) Accidental death
c) Natural death
d) Disability
14. Which belongs to fraud at claim settlement stage?
a) Change in address
b) Submission of claim to seek benefit
c) Health checkups
d) Alteration in sum assured
15. Measure under technology/process interface for fraud prevention:
a) Ability to detect fraud
b) Consumer awareness
c) Whistle blower policy
d) Creation of fraud database
16. Which statement is correct for NRHM?
a) No integration of disease programs
b) Strict fund control
c) Misuse of funds
d) Reduces rural-urban healthcare gap
17. Critical Illness (CI) policy correct statement:
a) Only statement 1
b) Only statement 2
c) Only statement 3
d) All 1, 2 and 3
18. In Germany, over _____% residents get healthcare through _____ insurance:
a) 75%, private
b) 90%, statutory
c) 80%, social
d) 95%, out of pocket
19. A policyholder should first approach ______ for complaint.
a) Insurance Ombudsman
b) Local court
c) Nodal officer
d) Grievance cell of insurer
20. Insurance would become gambling without principle of ______.
a) Fixed returns
b) Proximate cause
c) Utmost good faith
d) Insurable interest
