IC27 Mock Test Sample 17
These questions highlight important aspects of health insurance such as waiting periods, exclusions, and cost-sharing mechanisms. Waiting periods prevent immediate claims, while exclusions protect insurers from high-risk or non-essential treatments. Cost-sharing methods like co-payments and sub-limits help control costs and ensure shared responsibility. Benefit policies pay a fixed sum irrespective of actual expenses, unlike indemnity policies. Regulatory milestones like opening the sector to private players in 2001 and policyholder protection rules strengthen the system. Fraud prevention using data analytics (e.g., propensity modeling) is also critical. Overall, health insurance balances affordability, risk management, and comprehensive healthcare coverage.
1. Which aspect of health insurance policies is covered in more detail in Chapter 5?
a) Waiting periods
b) Specific diseases or procedures
c) Cost-sharing provisions
d) Exclusions
e) Benefits and coverage limits
2. What is the primary purpose of including ambulance charges and pre/post hospitalization expenses?
a) Reduce premium cost
b) Cover non-medical expenses
c) Discourage usage
d) Provide comprehensive coverage
e) Limit coverage scope
3. Which is NOT typically excluded in hospitalization policies in India?
a) War/invasion
b) Cosmetic procedures
c) Dental treatment
d) Alcohol/drug influence
e) Adventure sports
4. What is the purpose of a waiting period in health insurance?
a) Delay payment of benefits
b) Discourage purchase
c) Immediate coverage
d) Assess medical history
e) Specify policy duration
5. Which is NOT a common exclusion?
a) Intentional self-injury
b) Dental treatment
c) Alcohol/drug influence
d) Fertility treatment
e) Cosmetic procedures
6. Purpose of exclusions in health insurance?
a) Limit coverage scope
b) Increase premium
c) Encourage alternatives
d) Provide full coverage
e) Protect insurer from high-risk claims
7. Why was Mira’s claim denied?
a) Non-covered illness
b) Premium unpaid
c) Within waiting period
d) Documents missing
e) No hospitalization cover
8. How long was Mira hospitalized?
a) 5 days
b) 10 days
c) 20 days
d) 25 days
e) 30 days
9. Somen’s co-payment (Rs 10,000 bill, in-network hospital)?
a) Rs 1,000
b) Rs 2,000
c) Rs 3,000
d) Rs 4,000
e) Rs 5,000
10. What % of room charges does Somen’s policy cover?
a) 90%
b) 80%
c) 10%
d) 20%
e) 1%
11. Purpose of initial waiting period?
a) Assess medical history
b) Discourage purchase
c) Immediate coverage
d) Define duration
e) Delay benefit payment
12. Which is NOT a cost-sharing mechanism?
a) Room/ICU sub-limits
b) Surgery sub-limits
c) Co-pay (network)
d) Co-pay (non-network)
e) Full coverage without restriction
13. Purpose of cost-sharing mechanisms?
a) Discourage treatment
b) Full coverage
c) Assess history
d) Share cost between insurer & insured
e) Increase premiums
14. Purpose of lump sum in personal accident policy?
a) OPD expenses
b) Temporary disability
c) Medical expenses
d) Accidental death
e) Permanent disability
15. Health insurance opened to private companies in year?
a) 1999
b) 2004
c) 1986
d) 2001
e) 1988
16. Policyholder Protection Regulations enacted in year?
a) 1999
b) 2001
c) 2002
d) 1988
e) 2011
17. Insurance-linked saving plan in health insurance domain?
a) ULIP
b) HSA’s
c) SCSS
d) Micro insurance
e) Top-up plans
18. Problems in India’s public health system?
a) Statement 1 only
b) Statement 2 & 3 only
c) Statement 1 & 3 only
d) All statements correct
e) None
19. Measure under technology for identifying fraudsters using data analytics?
a) Detect fraud logic
b) Propensity modeling
c) Fraud database
d) Claim information
e) RAG analysis
20. Claim amount for Sonia (Benefit policy, SI = Rs 5,00,000, expense = Rs 2,30,000)?
a) Rs 5,00,000
b) Rs 2,30,000
c) Rs 2,70,000
d) Rs 7,30,000
e) Nil
