IC27 Mock Test Sample 6
This set of IC27 Health Insurance questions covers advanced concepts like high-deductible plans, underwriting methods, and risk management practices. It highlights critical illness policies, innovative insurance products, and public health schemes like CGHS and NHRM. The questions also explain regulatory roles, Ombudsman jurisdiction, and the importance of data in underwriting decisions. Key concepts include business risks, fraud prevention, and healthcare financing. Historical developments like Mediclaim introduction and growth in insurance products are also covered. Overall, it emphasizes product features, policy structures, and the evolving health insurance landscape in India, helping learners understand both theoretical and practical aspects of health insurance.
1. The most suitable cover with high deductible hospital indemnity cover is most attractive for which of the following persons?
a) Persons suffering with chronic diseases
b) Low income people from rural areas
c) Senior citizens
d) Persons with low sum insured in indemnity policies
e) Persons with high income and high sum insured
2. Under health insurance, which is a business environment risk?
a) Reinsurance program becomes expensive
b) Risk of default by business associates
c) Fraud, technology risk, loss of key resources
d) Reckless underwriting
e) Risk from complex investment products
3. Under numerical rating method, which statement is correct?
- High BP gives credit
- High BP gives debit points
- Applicant starts at point 1
a) Only 1 is correct
b) Statements 1 and 3 are correct
c) None are correct
d) Only 2 is correct
e) All are correct
4. Critical illness benefit products – which is true?
- Payment after treatment
- Lump sum can be used freely
- Paid on diagnosis/procedure
a) Only 1 is true
b) 1 and 2 are correct
c) 1 and 3 are correct
d) Only 2 and 3 are correct
e) All are correct
5. What do we understand by SHI in Japan?
a) Social Health Insurance
b) Society Health Insurance
c) Society Managed Health Insurance
d) Scientific Health Insurance
e) Systematic Health Insurance
6. NSSO refers to:
a) National Sample Survey Officer
b) National Small Survey Office
c) National Sample Survey Office
d) National Saving Survey Office
e) National Sample Saving Office
7. CGHS was introduced in:
a) 2010
b) 1956
c) 1954
d) 1973
e) 1938
8. Mr. Sanjay’s accident policy expired before accident. Claim accepted?
a) 100%
b) 50%
c) 25%
d) 10%
e) NIL
9. Which statement justifies managing health insurance risks?
- Top management involvement
- Independent regulator
- Employee involvement
a) Only 1
b) Only 2
c) Only 3
d) Only 1 and 2
e) 1, 2 and 3
10. Ombudsman jurisdiction is:
a) All insurance complaints
b) Only general insurance
c) Only life insurance
d) Personal insurance claims up to ₹20 lakh
e) Final authority with no appeal
11. Why opt for stand-alone CI policy?
- Some policies don’t cover CI
- Long-term care not covered
- CI very frequent
a) Only 1
b) 2 and 3 correct
c) Only 2 correct
d) Only 2 incorrect
e) None correct
12. Which is NOT an innovative product?
a) High deductible cover
b) Daily cash benefit
c) Disease management
d) Physician fee (in-patient)
e) OPD
13. Major development reducing rural-urban healthcare gap:
a) ESIS
b) CGHS
c) NHRM
d) UCG
e) None
14. Which is NOT a party in health insurance?
a) TPA
b) Healthcare provider
c) Insured
d) Government
e) Insurer
15. Government uses health insurance data for:
a) Claim analysis
b) Sector performance
c) Social schemes formulation
d) Market tracking
e) All of the above
16. Correct statement about underwriting and data:
a) Data collected only from IRDAI
b) Use of statistical tables
c) No need to review applications
d) Ignore medical reports
e) Analyze application and collect more data
17. First standardized health insurance product launched in:
a) 1954
b) 1967
c) 1986
d) 1994
e) 2007
18. Name of first standardized product (1986):
a) HealthGuard
b) HealthCare Plus
c) Mediclaim
d) MedProtect
e) WellnessShield
19. Primary focus of hospitalization indemnity policy:
a) Dental care
b) Vision care
c) Maternity
d) Pre-existing diseases
e) Outpatient services
20. Number of health insurance products in India today:
a) More than 100
b) More than 200
c) More than 300
d) More than 500
e) More than 1000
