IC27 Mock Test Sample 15
These questions cover health insurance fundamentals including financing methods, global systems (Germany, France, USA), and Indian schemes like NRHM. Health insurance mainly provides financial protection and improves access, though poor design can reduce coverage. Financing includes government funding, social insurance, private insurance, and out-of-pocket payments. Germany uses payroll-based social insurance, while France has multiple funds. In India, NRHM focuses on reducing rural-urban healthcare gaps. Concepts like outpatient cover, waiting periods, fraud detection, underwriting practices, and reinsurance mechanisms are also highlighted. Additionally, regulatory processes and grievance redressal systems ensure consumer protection and transparency in insurance operations.
1. What is one of the potential implications of a poorly designed health insurance system?
a) Increased affordability of healthcare
b) Decreased access to healthcare for the uninsured
c) Lower costs for healthcare providers
d) Reduced demand for healthcare services
e) Decreased negotiating power for healthcare providers
2. 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
e) To decrease access to healthcare services
3. 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 savings accounts, and out-of-pocket expenses
d) Social health insurance, government grants, private donations, and out-of-pocket expenses
e) Commercial insurance, government revenues, donations, and out-of-pocket expenses
4. 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 insurance
e) Through out-of-pocket payments
5. How is healthcare coverage provided in France?
a) Single fund for all citizens
b) Employer-sponsored insurance
c) Out-of-pocket only
d) Three healthcare funds (workers, self-employed, agricultural)
e) Government universal program
6. What is one major issue faced by the healthcare system in the United States?
a) Excessive regulation
b) Low costs
c) Abundant access
d) Reduction in insured individuals due to rising costs
e) Universal access
7. 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
e) Centralize services
8. In which type of policy is coverage available even without hospitalization?
a) Top-up plans
b) Personal accident cover
c) Disease management cover
d) Outpatient coverage
e) Daily cash cover
9. Mr. Gopal took mediclaim and got hospitalized within 9 days. What amount will be reimbursed?
a) Rs 1,00,000
b) Rs 70,000
c) Rs 25,000
d) Rs 30,000
e) NIL
10. Which report helps insurers detect conflict of interest in underwriting?
a) Commission report
b) Medical reports
c) Proposal form
d) Sales report
e) Financial documents
11. What % of world health expenditure did social insurance contribute in 2010?
a) 18%
b) 20%
c) 25%
d) 27.50%
e) 31%
12. Above what age are first-time buyers required to undergo medical tests in India?
a) 40
b) 45
c) 50
d) 55
e) 60
13. What is it called when insurers exchange proportional reinsurance business?
a) Retrocession
b) Alternative risk transfer
c) Horizontal placement
d) Vertical placement
e) Reciprocity
14. ______ cover is provided under health insurance.
a) Medical expenses
b) Accidental death
c) Natural death
d) Disability
e) Both accidental and medical expenses
15. Which option is fraud at claim settlement stage?
a) Change in address
b) Submission of false claim
c) Health checkups
d) Alterations in sum assured
e) Disclosure at medical stage
16. Measure under technology/process for fraud prevention?
a) Ability to detect fraud
b) Consumer awareness
c) Whistle blower policy
d) Creation of fraud database
e) Judicial action
17. Which statement is correct for NRHM?
a) No integration of disease programs
b) Strict fund usage rules
c) Funds drained via untied funds
d) Reduce urban–semi-urban gap
e) Reduce urban–rural gap
18. Which options are correct for Critical Illness policy?
a) Only 1
b) Only 2
c) Only 3
d) Only 1 and 2
e) All 1, 2 and 3
19. In Germany, over _____ % receive healthcare through _____ insurance.
a) 75, private
b) 90, statutory
c) 80, social
d) 95, out of pocket
e) 80, commercial
20. First point of complaint for policyholder?
a) Insurance Ombudsman
b) Local court
c) Nodal officer
d) Appellate officer
e) Grievance cell of insurer
