IC27 Mock Test Sample 8
These questions cover operational, underwriting, and regulatory aspects of health insurance. They highlight specialized institutional hospitals, importance of proposal forms, and various analytical tools like claims analysis. Key risk concepts such as credit risk, liquidity risk, and fraud prevention measures are emphasized. The role of government data usage and reasons behind rapid growth of health insurance—like awareness and marketing—are included. Practical scenarios explain claim settlement rules, exclusions (e.g., suicide), and benefit policies. International healthcare systems and schemes like RSBY are also discussed. Overall, the set focuses on real-world applications, risk management, underwriting tools, and global as well as Indian health insurance practices.
1. Which type of hospitals in India are often restricted to employees of large organizations and their dependents?
a) Rural hospitals
b) Specialty and teaching hospitals
c) Primary Health Centres (PHCs)
d) Sub-centres (SC)
e) Hospitals and dispensaries of railways, defense, and similar departments
2. Which document helps a company collect details like health status, income, premium, etc.?
a) SAP Report
b) Sales reports
c) Proposal form
d) Medical reports
e) Financial documents
3. Distribution of claims by sum insured is seen in which analysis?
a) Net premium paid analysis
b) Claims analysis by sum insured
c) Claims probability distribution
d) Earned premium
e) Claims analysis by age bands
4. With regard to Credit Risk, which option is correct?
a) Risk of default by business associates
b) Risk of fraud and technology issues
c) Risk of concentration
d) Cash mismatch risk
e) Liquidity risk due to long-term assets
5. Data is used by Governments for:
a) Analyzing claim settlements
b) Sector performance analysis
c) Formulating social schemes
d) Tracking market developments
e) Benchmarking underwriting performance
6. Reasons for health insurance growth include:
- Government compulsory orders
- Better marketing
- Increased awareness
a) Only 1
b) Only 2
c) Only 3
d) Only 1 and 2
e) Only 2 and 3
7. Measure under human interface/process improvement for fraud prevention:
a) Comprehensive claims info
b) Audits
c) Control business
d) Vigilance and compliance checks
e) Fraud detection ability
8. Who hears appeals against District Forum orders?
a) State Commission
b) District Forum
c) Ombudsman
d) Nodal officer
e) National Commission
9. Maximum gross capacity under surplus treaty is:
a) 50000
b) 1,10,00,000
c) 1,00,00,000
d) 11,00,000
e) 1,00,000
10. Seema’s suicide attempt case – reimbursement amount?
a) Rs 1,00,000
b) Rs 20,000
c) Rs 20,000 + physiotherapy
d) Rs 50,000
e) NIL
11. Prescribing correct qualifications helps to:
a) Prevent arbitrary renewals
b) Prevent mis-selling
c) Cap waiting periods
d) Protect access rights
e) Standardize definitions
12. Benefit policies – amount paid by both companies?
a) 16,000 & 24,000
b) 20,000 each
c) 25,000 & 40,000
d) NIL & 40,000
e) As per proposal
13. Health savings investment-linked plans – correct statement:
a) Investment goes to unit funds
b) Additional benefits available
c) Premium split into risk + investment
d) Discourage savings
e) Statements 1, 2, 3 correct
14. Under Critical Illness benefit, amount paid is:
a) Reasonable
b) Proportionate
c) Lump sum
d) Fixed
e) Survival benefit
15. CSMBS, UCS, SSS belong to which country?
a) India
b) Bangladesh
c) Thailand
d) Japan
e) USA
16. Who governs RSBY?
a) Commerce Ministry
b) Insurers
c) IRDA
d) Stakeholders
e) Government
17. Healthcare in UK is primarily funded by:
a) Commercial insurance
b) Tax system
c) Out-of-pocket
d) Social insurance
e) Welfare organizations
18. Which is NOT a key underwriting tool?
a) Financial documents
b) Medical reports
c) Commission reports
d) Sales reports
e) Proposal form
19. Manusmrithi refers to ______ and ______ resources:
a) Collection, usage
b) Stocking, distributing
c) Pooling, distributing
d) Usage, collecting
e) Distribution, using
20. Main disadvantage of reinsurer withdrawing in soft market:
a) Hard to re-enter later
b) Loss of all business
c) Expensive retrocession
d) Difficulty in bad market
e) Loss of claim recovery
