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Questions and Answers

Which statement regarding group health insurance is correct?

  • Only hospitalization expenses are covered.
  • Hospitalization expenses are covered from the first year, and pre and post hospitalization expenses are covered from the second year if the first year is claim free. (correct)
  • Hospitalization expenses are covered and a lumpsum amount is paid to family members in the event of insured's death.
  • Hospitalization as well as pre and post hospitalization expenses are covered.
  • Primary care can be described as:

  • Care provided by Doctors
  • Care provided in hospitals
  • Care provided to patient in an acute setting
  • First point of contact for people seeking healthcare (correct)
  • Statement 1 is true and statement 2 is false.

    True

    Which of the following refers to a hospital/health care provider enlisted by an insurer to provide medical services to an insured on payment by a cashless facility?

    <p>Network provider</p> Signup and view all the answers

    Which documents are not required for Permanent Total Disability claim?

    <p>Fitness certificate from the treating doctor certifying that the insured is fit to perform his normal duties</p> Signup and view all the answers

    Risk transfer through risk pooling is called __________.

    <p>insurance</p> Signup and view all the answers

    What is underwriting in insurance?

    <p>Underwriting is the process of risk selection and risk pricing in insurance.</p> Signup and view all the answers

    Match the risk reduction measures with their descriptions:

    <p>Risk retention = Accepting the risk and absorbing the losses if they occur Loss prevention = Taking steps to prevent or reduce the occurrence of risks Risk transfer = Transferring the risk to another party (like an insurer) Risk avoidance = Taking actions to avoid the risk altogether</p> Signup and view all the answers

    The duration of cover for pre-hospitalization expenses would typically vary from insurer to insurer, but the most common cover is for ________ pre-hospitalization.

    <p>fifteen days</p> Signup and view all the answers

    Gender is a factor that affects the morbidity of an individual.

    <p>True</p> Signup and view all the answers

    Match the following documents with their description:

    <p>Investigation report = Details all treatment for in-patient Settlement sheet = Financial settlement document Case paper = Medical case documentation Hospital registration certificate = Proof of hospital registration</p> Signup and view all the answers

    Health insurance is designed to handle which of the following risks?

    <p>Morbidity</p> Signup and view all the answers

    Which of the below group would not be eligible for a group health insurance policy?

    <p>Group of unrelated individuals formed for the purpose of availing group health insurance</p> Signup and view all the answers

    Who cannot be covered under a family floater policy?

    <p>Maternal uncle</p> Signup and view all the answers

    As per IRDA regulations issued in February 2013, what is the grace period allowed beyond the expiry date of the policy, for renewal?

    <p>15 days</p> Signup and view all the answers

    Identify the form of insurance that is depicted in the following scenario: Patient pays the health provider and is subsequently reimbursed by the health insurance company.

    <p>Indemnity</p> Signup and view all the answers

    Moral hazard by health insurance companies can result in:

    <p>Abuse of health insurance</p> Signup and view all the answers

    Which of the below elements promote trust?

    <p>Politeness, affirmation and communication</p> Signup and view all the answers

    Active listening involves paying attention to the speaker, giving an occasional nod and smile, and providing feedback.

    <p>True</p> Signup and view all the answers

    Expand the term IGMS.

    <p>Integrated Grievance Management System</p> Signup and view all the answers

    _____ is reflected in the caring attitude and individualized attention provided to customers.

    <p>Assurance</p> Signup and view all the answers

    Match the following: A pair of jeans - ஜீன்ஸ் ஒரு தாடி

    <p>I. Ethical behaviour = காப்பீடு விற்கும் தாற்றத்ளத சாத்தியமற்றது II. Reliability = ேம்பகத்தன்ளம III. Empathy = பச்சாதாபம் IV. Responsiveness = பபாறுப்புடன் பசயல்படுவது</p> Signup and view all the answers

    What is the main purpose of insurance?

    <p>To enjoy peace of mind and plan one's business more effectively</p> Signup and view all the answers

    Which of the following statements is correct with regards to the territorial jurisdiction of the Insurance Ombudsman?

    <p>Insurance Ombudsman has District jurisdiction</p> Signup and view all the answers

    What is the origin of modern insurance business?

    <p>Lloyds, Bottomry, Rhodes, Malhotra Committee</p> Signup and view all the answers

    What is meant by 'risk retention' in the context of insurance?

    <p>One decides to bear the risk and its effects</p> Signup and view all the answers

    How is the complaint to be launched with an insurance ombudsman?

    <p>The complaint is to be made in writing</p> Signup and view all the answers

    Insurance prevents loss of asset.

    <p>False</p> Signup and view all the answers

    What is the time limit for approaching an Insurance Ombudsman?

    <p>Within one year of rejection of the complaint by the insurer</p> Signup and view all the answers

    Out of 400 houses, each valued at Rs. 20,000, on an average 4 houses get burnt every year resulting in a combined loss of Rs. 80,000. What should be the annual contribution of each house owner to make good this loss?

    <p>Rs. 80/-</p> Signup and view all the answers

    Which among the following is not a pre-requisite for launching a complaint with the Ombudsman?

    <p>II.</p> Signup and view all the answers

    Which of the following statements is true?

    <p>Insurance is a method of sharing the losses of a few by many</p> Signup and view all the answers

    Why do insurers arrange for survey and inspection of the property before acceptance of a risk?

    <p>To assess the risk for rating purposes</p> Signup and view all the answers

    Which of the following options best describes the process of insurance?

    <p>Sharing the losses of few by many</p> Signup and view all the answers

    What is meant by customer lifetime value?

    <p>Sum of economic benefits that can be achieved by building a long term relationship with the customer</p> Signup and view all the answers

    In a customer's mind, there are two types of feelings and related emotions that arise with each service failure on the part of the insurance company. These feelings are:

    <p>Sense of unfairness and hurt ego</p> Signup and view all the answers

    What does not go on to make a healthy relationship?

    <p>Scepticism</p> Signup and view all the answers

    Which among the following is not an element of active listening?

    <p>Being extremely judgmental</p> Signup and view all the answers

    Insurance is a tangible good.

    <p>False</p> Signup and view all the answers

    Study Notes

    Overview of IC-38 Question Bank

    • The IC-38 exam consists of 50 questions to be attempted in 1 hour
    • For all correct answers, candidates obtain 50 marks
    • There is no negative marking for wrong answers
    • Candidates must 'mouse-click' the appropriate answer option on the computer screen
    • Candidates can make changes to their answers before clicking 'Submit'
    • After 1 hour, candidates cannot attempt any more questions or check their answers
    • Candidates will receive a score card/result sheet immediately after submitting the exam
    • Candidates are provided a backup sheet in case of power or system failure
    • Candidates can only ask the Test Administrator questions before the exam starts

    Section 3: Health Insurance (10 questions)

    • Health insurance covers risks related to mortality, morbidity and medical expenses

    • Group health insurance policies cannot cover unrelated individuals formed to avail coverage

    • Family floater policies cannot cover parents-in-law or maternal uncles

    • As per IRDA, the grace period for renewing a lapsed policy is 30 days

    • Indemnity is the form of health insurance where the insured is reimbursed for expenses

    • Moral hazard by insurers can lead to adverse selection and abuse of coverage

    • Primary care refers to the first point of contact for people seeking healthcare

    • Network providers are hospitals/clinics enlisted by insurers for cashless treatment

    • Underwriting is the process of risk selection and pricing for insurance policies

    • Pre-hospitalization cover is typically for 30 days prior to hospital admission### Insurance Policy Terms and Modifications

    • Insurance policies can have certain terms and conditions that need to be modified at the time of issuance

    • This modification is done through an endorsement

    • Other methods of modifying policy terms include:

      • Warranty
      • Alteration
      • Modifications are not possible in some cases

    Provisioning for Insurance Claims

    • The amount set aside in the insurer's books to account for all pending claims is known as provisioning or reserving
    • This is done based on the status and expected payouts of the various claims

    Grace Period for Health Insurance Renewal

    • As per IRDA guidelines, individual health insurance policies are allowed a 30-day grace period for renewal

    Health Insurance Coverage

    • Health insurance deals with both morbidity (illness/disease) and mortality (death)
    • It covers hospitalization expenses as well as pre and post-hospitalization expenses

    Group Health Insurance

    • In group health insurance, any individual in the group could potentially anti-select against the insurer
    • Group health insurance provides coverage only to employer-employee groups

    Hospitalization Expenses Policy Coverage

    • Hospitalization expenses policy covers:
      • Hospitalization expenses
      • Pre and post-hospitalization expenses
    • It may also provide a lump-sum payment to family upon the insured's death

    Documents for Permanent Disability Claim

    • Documents not required for permanent total disability claim include:
      • Fitness certificate from treating doctor
      • Proof of performing normal duties

    Renewal Notice Requirements

    • As per regulations, insurers are legally required to send a renewal notice to the insured 30 days before the policy expiry

    Health Insurance Entry Age

    • The minimum and maximum entry age for a health insurance policy is 18-80 years### Insurance Regulatory Terminology

    • Insurance is a method of sharing losses of a 'few' by 'many'

    • Insurers inspect and survey property before accepting risk to assess the level of risk

    • The insurance process involves sharing the losses of a few by many

    • Customer lifetime value refers to the total economic benefits that can be achieved by building a long-term relationship with the customer

    • Active listening involves paying attention to the speaker, providing feedback, and giving occasional nods and smiles

    Consumer Grievance Redressal

    • District Forum handles consumer disputes up to Rs. 20 lakhs
    • State Commission handles consumer disputes between Rs. 20 lakhs and Rs. 100 lakhs
    • Charging above the Maximum Retail Price (MRP) can form a basis for a valid consumer complaint
    • Shopkeeper not advising on the best product in a category cannot form the basis for a valid consumer complaint
    • The most appropriate option for a customer to lodge an insurance policy related complaint is the Integrated Grievance Management System (IGMS)

    Ethical Behavior in Insurance

    • Ethical behavior helps build trust between the insurance agent and the insurer
    • Ethical behavior is expected not just from top management but from all insurance agents
    • Unethical behavior while selling insurance is not impossible, but it is necessary to maintain ethical standards

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