GIPSA
PRE-PROMOTIONAL
MODEL QUESTION PAPER ON HEALTH INSURANCE
1.
Under Mediclaim Policy,
pre hospitalization expenses are available up to
a.
60
days
b.
45
days
c.
30 days
d.
105
days
2.
Which one of the
following expenses is not covered under Standard Mediclaim Policy-
a. Expenses
towards HIV Test of patient before operation which is covered under this policy
b. Registration
Charges of Hospital
c. Dialysis
Charges in case of renal failure
d. Angioplasty
expenses
3.
Which of the following diseases is not covered in the first year after inception of a health policy
a. Cataract,
Piles and Hernia
b. Diabetes,
Jaundice and Stroke
c. Kidney
Failure, Cataract and Piles
d. Hypertension,
Stroke and Piles
4.
Income tax benefit under Section 80(D) of IT Act
is admissible
a. If premium is
paid in cash
- If premium is paid by
cheque
- (a) and (b)
- None of the above
5.
Which of the following is
covered under mediclaim insurance policy
a. Dental treatment
b. Cost of Spectacles
c. Cost of Pacemaker
d. Cosmetic Surgery
6.
Post Hospitalisation and Pre Hospitalisation expenses are
covered for the following number of days under the Medi claim policy
a. 45/45
b. 60/30
c. 30/30
d. 75/15
7.
Which of the following statement is TRUE in respect of a claim
under a new mediclaim policy
a. The coverage
starts after 15 days from inception of
the policy
b. There is a
waiting period of 30 days except for accidents
c. There is a
waiting period of 60 days
d. None of the
above
8.
Which of the following is excluded in the Standard Medi Claim
Policy
a. Simple Tooth
Extraction
b. Cataract
Operations
c. Hysterectomy
d. All the above
9.
Which of the following
is / are exclusion/s in the Overseas Medi Claim policy
a. All pre
existing disease
b. Travel against
Medical Advice
c. First USD 100
on every claim
d. All of the
above.
10.
Following is not an ADD ON COVER under OMP
a. Personal
Accident
b. Loss of Check
in Baggage
c. Delay of
checked in Baggage
d. Loss of
Spectacles
11. Premium rate under the Overseas Medi
claim policy does not depend on
a. Country of
Visit
b. Trip band
c. Age band of
the insured
d.
Family status of the proposer
12. Claim are settled under the Overseas
Mediclaim Policy
a. By the Policy
Issuing Office
b. Overseas Claim
Settlement Agent
c. Insured pays
to the Hospital and seek reimbursement
d. Lloyds of
London
13. In the first year of commencement of
the Policy, the Mediclaim policy does not cover
a. Accidents
b. Cataract
c. Heart diseases
d. Fractures
14.
Which of the following expenses are ‘not’ payable under
Maternity Benefit*?
a)
Cesarean
b)
Abdominal operation for extra-uterine pregnancy
c)
Miscarriages due to accident
d)
Pre-natal expenses prior to hospitalization
15.
Anatomy is a science, which deals
with: -
a. Matter
pertaining to TV Antenna.
b. Matters
pertaining to Aviation.
c. Deals with
structure and position of body.
d.
None of above
16.
For admissibility of expenses on
hospitalization, the period of hospitalization should be
a. For a Minimum
24 inpatient consecutive hours in all the cases
b. Minimum 24 inpatient
consecutive hours except for specified procedures for a period less than 24
hours.
c. Minimum 12
inpatient consecutive hours except for day care.
d. No such
condition
17.
Which of the following is a deferred
mediclaim policy
a. Bhavishya
Arogya
b. Jan Arogya
c. Cancer medical
policy
d.
Overseas mediclaim
18. In individual
health insurance , normally which contingency is not automatically covered
a. Cancer
b. Maternity
c. Minor surgery
d. Accidental
fall
19.
What is the
cost of Health check-up under Individual Mediclaim?
a. 1% OF Average SI
b. 2% OF SI
c. 5% OF SI
d. MAXIMUM Rs.2500.
20.
When
Insured opts for Mediclaim cover with cashless facility the Premium amount is loaded by
a. 12.5%
b. 6.5%
c. 5.5%
d. 7.5%
21.
What is the
waiting period in respect to Maternity Benefit extension under Group Medical
Policy
a. 10 MONTHS
b. 12 MONTHS
c. 7 MONTHS
d. 9 MONTHS
22. How many Critical Illness terms have been
standardized to be adopted uniformly across industry, if offered under the
product?
a. 9
b. 10
c. 11
d. None
23. A Day care treatment refers to medical treatment, and/or surgical
procedure which is:
a. Undertaken under General or Local Anesthesia in a hospital/day
care centre in less than 24 hrs because o f technological advancement, and
b.
Which
would have otherwise required a hospitalization o f more than 24 hours.
c.
Both
of the above
d.
None
of the above
24. Domiciliary hospitalization means medical treatment for an
illness/disease/injury which in the normal course would require care and
treatment at a hospital but is actually taken while confined at home
under any of the following circumstances:
a. the condition o f the
patient is such that he/she is not in a condition to be removed to a hospital
b. the patient takes treatment at home on account of non
availability of room in a hospital.
c. Admission is not required due to Medical advancement
d. Both a and b above
25. Grace period means
(i)-the specified period of time immediately following the premium due
date during which a payment can be made to renew or continue a policy in force
without loss o f continuity benefits such as waiting periods and coverage of pre
existing diseases. (ii)Coverage is not available for the period for which
no premium is received.
a. Only (i) is
true
b. Only (ii) is
true
c. None is true
d. Both (i) &
(ii) is true
26. A hospital means any institution established for in-
patient care and day care treatment o f sickness and / or injuries
and which has been registered as a hospital with the local authorities,
wherever applicable, and is under the supervision o f a registered and
qualified medical practitioner AND must comply with all minimum criteria
as under:
a. has at least 10 inpatient beds, in those towns having a
population of less than 10,00,000 and 15 inpatient beds in all other places;
b. has qualified nursing staff under its employment round the clock;
has qualified medical practitioner (s) in charge round the clock; has a fully
equipped operation theatre of its own where surgical procedures are carried out
c. maintains daily records of patients and will make these
accessible to the Insurance company’s authorized personnel.
d. All above
27. Pre existing disease is any condition, ailment or injury or
related condition(s) for which within 48 months to prior to the first policy
issued by the insurer
a. you had signs or symptoms
b. you were diagnosed
c. you received medical advice / treatment
d. all above
28. What is Acute condition
a. A medical condition that can be cured by Treatment
b. a disease, illness, or injury needs ongoing or long-term
monitoring through consultations, examinations, check-ups, and /or tests
c. It needs ongoing or long-term control or relief o f symptoms
&it requires your rehabilitation or for you to be specially trained to cope
with it
d. it comes back or is likely to come back
29. Which is not a
chronic condition
a. A medical condition that can be cured by Treatment
b. a disease, illness, or injury needs ongoing or long-term
monitoring through consultations, examinations, check-ups, and /or tests
c. It needs ongoing or long-term control or relief o f symptoms
&it requires your rehabilitation or for you to be specially trained to cope
with it
d. it comes back or is likely to come back
30. Newborn Baby , as per standard definition in Health
Regulations, means those babies born to you and your spouse during the Policy
Period
a. Aged between 1 day and 90 days.
b. Aged between 1 day and 30 days
c. Aged between 1 day and 60 days
d. Aged between 1 day and 120 days
31. Maternity expense / treatment, as per standard definition in
Health Regulation shall include the following Medical treatment Expenses
a. Medical Expenses for a delivery (including complicated
deliveries and caesarean sections) incurred during Hospitalization;
b. The lawful medical termination o f pregnancy during the
Policy Period limited to 2 deliveries or terminations or either during the
lifetime of the Insured Person;
c. Pre-natal and post-natal Medical Expenses for delivery or
termination.
d. All of the above
32. The right accorded to an individual health insurance policy
holder (including family cover) to transfer the credit gained by the insured
for pre-existing conditions and time bound exclusions if the policyholder
chooses to switch from one insurer to another insurer provided the previous
policy has been maintained without any break is clause
a. Portability
b. Subrogation
c. Contribution
d. Pre-existing condition
33.
STROKE
RESULTING IN PERMANENT SYMPTOMS defined in critical illness in Health
Regulations, 2013 includes
a. Transient ischemic attacks (TIA)
b. Traumatic injury of the brain
c.
Vascular
disease affecting only the eye or optic nerve or vestibular functions.
d.
Infarction
of brain tissue, thrombosis in an intracranial vessel, haemorrhage and
embolisation from an extracranial source.
34
Who regulates the Health insurance
business in India
a.
TPAs
b.
GIPSA
c.
G.I.Council
d.
IRDA
35
SLA means
a.
Standard Legal assessment
b.
Service Level agreement
c.
Standard Level assessment
d.
None
36
What is covered in Standard Group Medi
claim policy
a.
Diagnostic expenses not followed by
active treatment during hospitalization period.
b.
Surgery for correction of eye sight.
c.
Psychosomatic disorders
d.
None
37
What is IRDA Regulation 5 which finds
a mention in Health Policies
a.
Portability
b.
Protection of Policy Holder Interest
c.
Health Regulation, 2013
d.
None
38
During the period of insurance cover,
the expenses on which of the following are excluded only for one year in
standard GMC policy.
a.
Piles
b.
Diabetes
c.
Polycystic ovarian disease
d.
Joint Replacement
39
Who shall repudiate the health claim,
if serviced by TPA and if the claim is not maintainable as per the terms of the
cover
a.
TPA
b.
Ombudsman
c.
Insurer
d.
Hospital under PPN
40
Preferred Provider Network is
agreement between Health care providers, TPAs and Insurance Companies. Which
insurance companies relate to it
a.
PSU Insurers
b.
Standalone health insurers
c.
Both Private and Public health
insurers
d.
IRDA licensed insurance companies
41
The insurers’ natural preference in
case of health insurance is for lower risk proposers and there is reluctance to
insure those with high risk. This is termed as
a.
Adverse selection
b.
Cherry picking
c.
Information asymmetry
d.
All the above
42
Health care providers provide more
services in case they observe that the patient has an insurance cover. This
abuse is termed as
a.
Demand side moral hazard
b.
Supply side moral hazard
c.
Both the above
d.
None of the above
43
Health underwriting is a process of
a.
Risk selection
b.
Risk Rating
c.
Both of the above
d.
None of the above
44
Unlike Clinical protocols, the health
insurance risk assessment is based on prognosis i.e on forecast of probable
cause of illness and chance of recovery.
a.
True
b.
False
c.
Neither false nor true
d.
There is no risk assessment in health
insurance
45
Factors which effect Morbidity and
which are considered while assessing health risk
a.
Age
b.
Gender
c.
Current health status
d.
All of the above.
46
Retail health insurance policies for
persons less than 30 years are generally based and underwritten on
a.
Medical underwriting
b.
Non medical underwriting
c.
Both
d.
None
47
Retail Health Hospitalization product
generally excludes
a.
Drug abuse
b.
Out patient treatment
c.
HIV/Aids
d.
All of the above
48
Common conditions which are not covered in Critical illness
policies are:
a.
Coronary Artery Bypass Grafting
b.
Kidney failure
c.
Stroke
d.
None
49
Benefit Policies offers lumpsum
payouts irrespective of the expenses incurred
a.
True
b.
False
c.
No benefit policies in Health
insurance
d.
It is long term cover
50
Who is the data repository for Health
insurance data
a.
IRDA
b.
GIPSA
c.
IIB
d.
GI Council
51
IBNR in heath business is calculated
a.
By totaling claims reported in April
of Next financial year
b.
By TPAs MIS
c.
By Surveyors assessment
d.
By using actuarial methods
52
Companies doing health insurance
business are not required to have
a.
Licensing and registration by
Regulator
b.
Health insurance Underwriting Policy
duly approved by Board
c.
Anti Fraud policy duly approved by
Board
d.
None of the above
53
If two or more policies are taken by
insured during a period from one or more insurer the contribution clause will
not be applicable where cover benefit offer
a.
Is fixed in nature
b.
Does not have any relation to the
treatment cost
c.
Both of the above
d.
None of the above
54
Health Insurance business as defined
by Health Regulation means
a.
Sickness benefits or medical, surgical
or hospital expenses including long term care
b.
Travel insurance
c.
Personal accident
d.
All of the above
55 Organ transplant surgeries fall under the scope of _________
health care.
a. Primary
b. Secondary
c. Tertiary
d. None of the above
56 RSBY stands for _____________.
a. Rajya Swasthya Bima Yojana
b. Regional Swasthya Bima Yojana
c. Rashtriya Sarva Bima Yojana
d.
Rashtriya
Swasthya Bima Yojana
57 Which of the below statement is correct with regards to cashless
insurance?
a. All treatments are provided free of cost by the hospital
b. Payments to the hospital are done by cheques
c. The policy is given free to the patient
d.
The
patient does not pay for treatment
58 Claims are a function of ___________.
a. Frequency
b. Severity
c. Both I and II
d.
None
of the above
59 Which of the following is not a mechanism to reduce moral hazard?
a. Co-insurance
b. Deductible
c. No claim bonus
d.
Claim
rejection
60 Preferred Risk exhibits _____ morbidity rate than that assumed in
pricing
a. Higher
b. Lower
c. Equal
d.
Is
not linked
61 Identify the correct full form of PPN with regards to hospitals in
health insurance.
a. Public Preferred Network
b. Preferred Provider Network
c. Public Private Network
d.
Provider
Preferential Network
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