QuestionBank 1 3.pdf

252. Which of the following is an example of moral hazard? a. Stunt artist dies while performing a stunt b. A person drinking copious amounts of alcohol because he is inured c. Insured defaulting on premium payments d. Proposer lying on policy document 253. Why is heredity history of importance in...

252. Which of the following is an example of moral hazard? a. Stunt artist dies while performing a stunt b. A person drinking copious amounts of alcohol because he is inured c. Insured defaulting on premium payments d. Proposer lying on policy document 253. Why is heredity history of importance in medical underwriting? a. Rich parents have healthy kids b. Certain diseases can be passed on from parents to children c. Poor parents have malnourished kids d. Family environment is a critical factor 254. A payment made under a money policy upon reaching a milestone will be classified under which type of claim? a. Death Claim b. Maturity Claim. c. Periodical Survival Benefit. d. Surrender Claim 255. Generally insurance companies do not hold the premium in case of a fraud or misrepresentation. However, due to which of the following circumstances the insurer can retain the premium of the policyholder. a) Fraudulent claim b) Indisputability clause c) Redressal procedure d) Pending decision from Ombudsman 256. What is meant by a claim under insurance policy? a. A demand to fulfill the policyholder’s obligations. b. A demand to fulfill the insurer’s obligations. c. Any demand made by the policyholder on the insurer. d. All of the above. 257. After how many years any missing person is presumed to be dead? a) 5 Years b) 8 Years c) 12 Years d) 7 Years 24 258. After submission of all relevant documents , what is the maximum duration that insurer take to settle the claim. a) 30 days b) 10 days c) 15 days d) 10 days 259. Under which type of Policy, the claim payment is made in the form of periodic payments? a. Money back policy. b. Return of Premium Policy. c. Term Insurance Policy. d. ULIP 260. Which of the below statement best describes the concept of claim? Choose the most appropriate option. a. A claim is a request that the insurer should make good the promise specified in the contract b. A claim is a demand that the insurer should make good the promise specified in the contract c. A claim is a demand that the insured should make good the commitment specified in the agreement d. A claim is a request that the insured should make good the promise specified in the agreement 261. Given below is a list of policies. Identify under which type of policy, the claim payment is made in the form of periodic payments? a. Money-back policy b. Unit linked insurance policy c. Return of premium policy d. Term insurance policy 262. Mahesh has bought a life insurance policy with a critical illness rider. He has made absolute assignment of the policy in favour of Karan. Mahesh suffers a heart attack and there is a claim of Rs. 50,000 under the critical illness rider. To whom will the payment be made in this case? a) Mahesh b) Karan c) The payment will be shared equally by Mahesh and Karan d) Neither of the two because Mahesh has suffered the heart attack but the policy is assigned in favour of Karan. 263. Praveen died in a car accident. The beneficiary submits documents for death claim. Which of the below document is an additional document required to be submitted in case of accidental death as compared to natural death. a. Certificate of burial or cremation. b. Treating Physician’s certificate c. Employer’s certificate d. Inquest Report. 264. Which of the below death claim will be treated as an early death claim? a. If the insured dies within three years of policy duration b. If the insured dies within five years of policy duration c. If the insured dies within seven years of policy duration d. If the insured dies within ten years of policy duration 265. Given below are some events that will trigger survival claims. Identify which of the below statement is incorrect? a. Claim paid on maturity of a term insurance policy b. An installment payable upon reaching the milestone under a money-back policy c. Claim paid for critical illnesses covered under the policy as a rider benefit d. Surrender value paid on surrender of an endowment policy by the policyholder 266. A payment made under a money-back policy upon reaching a milestone will be classified under which type of claim? a. Death claim b. Maturity claim c. Periodical survival claim d. Surrender claim 25 267. Shankar bought a 10 year Unit Linked Insurance Plan. If he dies before the maturity of the policy which of the below will be paid? a. Lower of sum assured or fund value b. Higher of sum assured or fund value c. Premiums paid will be returned with 2% higher interest rate as compared to a bank’s savings deposit d. Surrender value 268. Based on classification of claims (early or non-early), pick the odd one out? a. Ramya dies after 6 months of buying a term insurance plan b. Manoj dies after one and half years of buying a term insurance plan c. David dies after two and half years of buying a term insurance plan d. Pravin dies after five and half years of buying a term insurance plan 269. Given below is a list of documents to be submitted for a normal death claim by all beneficiaries in the event of death of life insured. Pick the odd one out which is additionally required to be submitted only in case of death by accident. a. Inquest report b. Claim form c. Certificate of burial or cremation d. Hospital’s certificate 270. As per IRDA (Protection of Policyholders Interests) Regulations, 2002, a claim under a life policy shall be paid or be disputed, within 30 days from the date of receipt of all relevant papers and clarifications required. a. 7 days b. 15 days c. 30 days d. 45 days 271. Who initiates the process of Maturity Claim? a. Customer. b. IRDA c. Agent d. Insurer 272. IRDAI stands for __________. a. International Regulatory & Development Authority b. Indian Regulatory & Development Authority c. Insurance Regulatory & Development Authority of India d. Income Regulatory & Development Authority 273. The term TPA refers to ________. (Answer with regards to health insurance) a. The Primary Associate b. To Provide Assistance c. Third Party Administrator d. Third Party Assistance 274. What is the government contribution to ESIC Scheme ? a. 12.5% b. 50% c. 75% d. 25% 275. Who is custodian to Insurance Information Bureau of India formed in year 2009 ? a. Insurer b. TPA c. IRDAI d. Govt of India 276. As per IRDA regulations issued in February 2013, what is the grace period allowed beyond the expiry date of the policy, for renewal? a. 15 days b. 30 days c. 45 days d. 60 days 277. Identify the form of insurance that is depicted in the following scenario. Scenario: Patient pays the health provider and is subsequently reimbursed by the health insurance company. a. Service Benefit b. Direct contracting c. Indemnity d. Casualty 278. Moral hazard by health insurance companies can result in _________. a. Community rating b. Adverse selection c. Abuse of health insurance d. Risk pooling 26 279. Primary care can be described as ____________. a. Care provided to patient in an acute setting b. Care provided in hospitals c. First point of contact for people seeking healthcare d. Care provided by Doctors 280. ________________ is an insured who undergoes treatment after getting admitted in a hospital. a. Inpatient b. Outpatient c. Day patient d. House patient 281 _________ refers to a hospital/health care provider enlisted by an insurer to provide medical services to an insured on payment by a cashless facility. a. Day care centre b. Network provider c. Third Party Administrator d. Domiciliary 282. Health insurance is designed to handle which of the following risks? a. Mortality b. Morbidity c. Infinity d. Serendipity 283. How many staffs are recommended and appointed under PHC a. 15(1 medical officer & 14 para medical staff) b. 18(2medical officer & 16para medical staff) c. 21((5 medical officer & 16 para medical staff) d. 12 (1 medical officer & 11 para medical staff) 284. How many members are there in the governing council of Insurance Information Bureau of India? a. 30 members b) 40 members a. 20 members b. 10 members 285. Any individual that an insurance agent comes across and who has any financial need is known as a) Customer b) Suspect c) Prospective client d) Client 286. Which is the first standardized health insurance product for individual & family launched in India a) Hospital plus b) Family health plan c) Health care d) Mediclaim 287. Which is the central price regulator for pharmaceutical industry in India? a) NAPP b) CGHS c) ESIC d) PHC 288. Factors determine the health of any individual: a. Lifestyle factors b. Environmental factors c. Genetic factors d. All of the above 289. ___________ refers to the healthcare services provided by medical specialists and other health professionals who generally do not have first contact with patient a. Primary healthcare b. Secondary Healthcare c. Tertiary healthcare d. General healthcare 290. _________ is specialized consultative healthcare, usually for inpatients a. Primary healthcare b. Secondary Healthcare c. Tertiary healthcare d. General healthcare 291. Employees‟ State Insurance Scheme, introduced vides: a. Insurance act’ 1938 b. IRDA act’ 1999 c. The ESI Act, 1948 d. None of the above 293. Which among these is true for ESI scheme? a. All workers earning wages up to Rs. 15,000 are covered under the contributory scheme b. Employee and employer contribute 1.75% and 4.75% of pay roll respectively; c. state governments contribute 12.5% of the medical expenses d. All the above 294. Public health sector includes: a. Anganwadi workers b. Trained Birth Attendants c. ASHA d. All of the above 27 295. _________are not authorized to sell insurance but provide administrative services to insurance companies. a. Insurance Brokers b. Third Party Administrators c. Insurance Web Aggregators d. Insurance Marketing Firms 296) As per guidelines, an insurance company has to process an insurance proposal within __________. a. 7 days b. 15 days c. 30 days d. 45 days 297) __________ is the consideration or amount paid by the insured to the insurer for insuring the subject matter of insurance, under a contract of insurance. a. Rebate b. Loan c. Premium d. Top up 298) In case the premium payment is made by cheque, then which of the below statement will hold true? a. The risk may be assumed on the date on which the cheque is posted b. The risk may be assumed on the date on which the cheque is deposited by the insurance company c. The risk may be assumed on the date on which the cheque is received by the insurance company d. The risk may be assumed on the date on which the cheque is issued by the proposer 299) What does Section 64 VB of Insurance Act, 1938 say about Premium Payment? a. It should be paid after due date. b. It should be paid after the start of the insurance cover. c. It should be paid after the policy becomes lapsed. d. It should be paid before the start of the insurance cover. 300) Which of the below statement is correct with regards to a warranty? a. A warranty is a condition which is implied without being stated in the policy b. A warranty is a condition expressly stated in the policy c. A warranty is a condition expressly stated in the policy and communicated to the insured separately and not as part of the policy document d. If a warranty is breached, the claim can still be paid if it is not material to the risk 301) If certain terms and conditions of the policy need to be modified at the time of Issuance, it is done by setting out the amendments through __________. a. Warranty b. Endorsement c. Alteration d. Modifications are not possible 302) Which of the below statement is correct with regards to renewal notice? a. As per regulations there is a legal obligation on insurers to send a renewal notice to insured, 30 days before the expiry of the policy b. As per regulations there is a legal obligation on insurers to send a renewal notice to insured, 15 days before the expiry of the policy c. As per regulations there is a legal obligation on insurers to send a renewal notice to insured, 7 days before the expiry of the policy d. As per regulations there is no legal obligation on insurers to send a renewal notice to insured before the expiry of the policy 303) Non-disclosure of facts material to the assessment of the risk, providing misleading information, fraud or non-co-operation by the insured will __________. a. nullify the cover under the policy issued b. increase the risk of insured c. help insured to get cover easily. d. reduce risk of insurer. 304) A delivery man of a fast-food restaurant is__________ than accountant of the same restaurant. a. More Risk b. Less Risk c. No Risk d. Constant Risk 28 305) An agent or other intermediary shall provide all material information in respect of a proposed cover to the prospect to __________. a. enable the prospect to know him better b. enable the prospect to decide on the best cover that would be in his or her interest c. enable the prospect to know the means of fraud d. enable the prospect to get the discounts available with the policy. 306) The application document used for making the proposal is commonly known as the _________. a. Application form b. Proposal form c. Registration form d. Subscription form 307. Though the duration of cover for pre-hospitalization expenses would vary from insurer to insurer and is defined in the policy, the most common cover is for ________ pre-hospitalization. a. Fifteen days b. Thirty days c. Forty Five days d. Sixty days. 308. Identify which of the below statement is correct? a. Health insurance deals with morbidity b. Health insurance deals with mortality c. Health insurance deals with morbidity as well as mortality d. Health insurance neither deals with morbidity or mortality 309. In health insurance, the policy holder has the right to transfer the credit gained for pre existing conditions and time bound exclusions from one company to another. This facility is called a. Portability b. Transferability c. Switching d. Reassignment. 310. 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 311. Which of the below statement is correct with regards to a hospitalization expenses policy? a. Only hospitalization expenses are covered b. Hospitalization as well as pre and post hospitalization expenses are covered. c. Hospitalization as well as pre and post hospitalization expenses are covered and a lump sum amount is paid to the family members in the event of insured’s death. d. 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. 312. Which of the below statement is correct with regard to cashless service provided in health insurance? a. It is an environment friendly go –green initiative started by insurance companies to promote electronic payments so that circulation of physical notes can be reduced and trees can be saved. b. Service is provided free of cost to the insured and no cash is paid as the payment is made by the Government to the insurance company under a Special scheme. c. All payments made by the insured have to be made only through Internet banking or card as cash is not accepted by the insurance company. d. The insured does not pay and the insurance company settles the bill directly with the Hospital. 313. How the Daily hospitalization cash benefit will provide benefits to policyholder who is hospitalized. a. Entire change are refunded. b. Entire charges less bed charges will be paid. c. A Fixed amount on a daily basis is paid irrespective of the actual cost of treatment. d. Only Hospital bill will be paid. 29 314. Which is the correct statement in the case of Portability in Health Insurance? a. In case of waiting period for a certain disease or treatment in the new policy is longer than that in the earlier policy for the same disease or treatment the additional waiting period will added as per the new policy norm. b. In the case of waiting period for a certain disease or treatment in the new policy is longer than that in the earlier policy for the same disease or treatment the additional waiting period will not be added and will remain same as per the earlier policy norms. c. In case of waiting period for a certain disease or treatment in the new policy is longer than that in the earlier policy for the same disease or treatment the additional waiting period will not be added and will remain same as per the earlier policy norm but a extra premium will charged for this period. d. None of the Above. 315. How the Daily hospitalization cash benefit will provide benefits to policyholder who is hospitalized. a. Entire change are refunded. b. Entire charges less bed charges will be paid. c. A Fixed amount on a daily basis is paid irrespective of the actual cost of treatment. d. Only Hospital bill will be paid. 316. The place where atleast 4 specialists, a surgeon, a physician, and a pediatrician, supported by 21 paramedical and other staff work is called a. Speciality Hospital b. Community Health Center c. Primary health Center d. Hospital 317. Identify which of the below statement is incorrect? a. An employer can takes a group policy for his employees. b. A bank can take a group policy for its customer c. A shopkeeper can take a group policy for his customers. d. A group policy taken by the employer for his employees can be extended to include the family members of the employees. 318. Which of the following medical factors do not influence an underwriter's decision a. Family history b. Personal characteristic c. Spouse's History d. Personal History 319. Cardio vascular disease refers to the disease which affect a. Heart and circulatory system(Blood) b. Lungs and respiratory system c. Kidney and excretory system d. Stomach, intestine and digestive system 320. Why is heredity history of importance in medical underwriting? a. Rich parents have healthy kids b. Certain diseases can be passed on from parents to children c. Poor parents have malnourished kids d. Family environment is a critical factor 321. Which of the following is not an underwriting decision? a. Risk acceptance at standard rates b. Declinature of risk c. Postponement of risk d. Claim rejection 322. Which of the following is not a standard age proof? a. Passport b. School leaving certificate c. Horoscope d. Birth certificate 323. Health insurance is based on the concept of a. Mortality b. Risk c. Morbidity d. personal history 324. Important factor for health insurance underwriting is a. Age b. Gender c. Habits d. all of the above 30 325. underwriting is the process of______________ a. Marketing b. collecting premium from customers c. selling various insurance products d. Risk selection and risk pricing 326. Purpose of underwriting is a. prevent anti selection b. to classify risks and ensure equity among risk c. Both are correct d. Both are correct 327. The deliberate intention of taking insurance just to collect a claim is part of a. Physical hazard b. Moral hazard c. Occupation hazard d. Fraud 328. The insurer should follow FILE & USE guidelines at the time of a. Introducing a product b. Modification of product c. Withdrawal of a product d. all of the above 329. FILE & USE guidelines are issued by a. IRDAI b. Insurer c. Policy holder d. None of the above 330. Portability can be opted at the time of_____________ a. Inception b. Renewal c. Surrender d. Maturity 331. Find out the correct statement a. Insurers are charging loading for Porting b. Insurers are charging loading for Porting c. Both are correct d. both are wrong 332. Basic principles for Underwriting are _________ a. Utmost good faith b. Insurable interest c. Both are wrong d. Both are correct 333. Standard age proofs are a. school certificate b. passport c. Domicile certificate d. all of the above 334. Financial documents required for a. personal accident covers b. High sum assued coverage c. Mismatch in income and occupation as compared to coverage d. all of the above 335. The principle of utmost good faith in underwriting is required to followed by a. The insurer b. The insured c. Both insurer and insured d. medical examiner 336. Insurable interest refers to ______ a. Financial interest of a person in the asset to be insured b. The asset which is insured c. Each insurers share of loss d. The amount of loss covered by the insurer 337. The underwriter clasifies the risk into _________ a. Accept risk at standard rates b. Accept risk at an extra premium c. Decline the cover d. all of the above 338. state which statement is wrong a. It involes high cost in collecting and assessing medical reports b. Health status and age are key factors for medical underwriting c. Medical examination is compulsory for health insurance d. percentage assessment is made each component of risk 339. Group insurance is underwritten mainly on the _____ a. Law of averages b. Individual c. Group d. Insurer 31 340. Traditional and common groups offered group health insurance are___________ a. Labour unions b. Trusts c. Employer-employee groups d. Professional association 341. The example for group health insurance schemes sponsored by government is a. RSBY b. Yeshaswini c. Both are correct d. Both are wrong 342. State which statement is correct in case of Overseas travel insurance a. Premium for Overseas travel insurance is depend on the age and the duration of foreign travel b. Premium rates are high compared to domestic health insurance c. Both are correct d. Both are wrong 343. The main factor for Personal accident insurance coverage is a. Occupation b. Family History c. Personal history d. Gender 344. Person working in high voltage electricity is coming under__________ a. Risk group I(Normal) b. Risk group II(Medium) c. Risk group III(High) d. None of the above 345. State which statement is correct a. Medical examination is compulsory for P.A insurance b. War risk cover may be covered to Indian personnel working abroad c. In PA insurance main factor consider for rating is Age d. Drivers of truck and heavy vehicles, sportsmen are coming under RISK group I 346. The proposal form contains a. Personal details b. physical condition c. habits and pastimes d. all of the above 347. Group discount is available a. Employer-employee groups b. Members of registered co operative society c. Number of members exceeds 100 d. all of the above 348. The principle of 'all or none' is applies in_______ a. Health insurance b. Personal insurance c. Group insurance d. Life insurance 349. 1. Group health insurance provides coverage only to employee groups. 2. In a group health insurance any of the individual constituting the group could anti select against the insurer a. Statement 1 is true and statement 2 is false b. statement 2 is true and 1 is false c. statement 1 and 2 are true d. statement 1 and 2 are false 350. Accepting the risk by more than one insurer is known as a. Life insurance b. Coinsurance c. Reinsurance d. Health insurance 351. Reinsuring the risk with other insurance companies is known as __________ a. Reinsurance b. Coinsurance c. Group insurance d. Life insurance 352. Which of the following statements about medical underwriting is incorrect? a. It involves high cost in collecting and assessing medical reports. b. Current health status and age are the key factors in medical underwriting for health insurance. c. Proposers have to undergo medical and pathological investigations to assess their health risk profile. d. Percentage assessment is made on each component of the risk 32 353. Which of the following factor does not affect the morbidity of an individual? a. Gender b. Spouse job c. Habits d. Residence location 354. According to the principle of indemnity, the insured is paid for __________. a. The actual losses to the extent of the sum insured b. The sum insured irrespective of the amount actually spent c. A fixed amount agreed between both the parties d. The actual losses irrespective of the sum assured 355. The first and the primary source of information about an applicant, for the underwriter is his ________________. a. Age proof documents b. Financial documents c. Previous medical records d. Proposal form 356. The underwriting process is completed when ___________________. a. All the critical information related to the health and personal details of the proposer are collected through the proposal form b. All the medical examinations and tests of the proposer are completed c. The received information is carefully assessed and classified into appropriate risk categories d. The policy is issued to the proposer after risk selection and pricing. 357. Which of the following statements about the numerical rating method is incorrect? I. Numerical rating method provides greater speed in the handling of a large business with the help of trained personnel. II. Analysis of difficult or doubtful cases is not possible on the basis of numerical points without medical referees or experts. III. This method can be used by persons without any specific knowledge of medical science. IV. It ensures consistency between the decisions of different underwriters. 358. Who among the following is not a stakeholder in insurance claim process? a. Insurance company shareholders b. Human Resource Department c. Regulator d. TPA 359. Which of the following document is maintained at the hospital detailing all treatment to an in-patient? a. Investigation report b. Settlement sheet c. Case paper d. Hospital registration certificate 360. The amount of provision made for all claims in the books of the insurer based on the status of the claim is known as a. Pooling b. Provisioning c. Reserving d. Investing 361. Which of the following documents are not required to be submitted for Permanent Total Disability claim? a. Duly completed Personal Accident claim form signed by the claimant. b. Attested copy of First Information Report if applicable c. Permanent disability certificate from a civil surgeon or any equivalent competent doctors certifying the disability of the insured. d. Fitness certificate from the treating doctor certifying that the insured is fit to perform his normal duties. 33 362. ______________________are paid upfront by Assistance Company and later claimed from insurance company. a. Bail bond cases b. Personal accident claims c. Overseas travel insurance claims d. Untenable claims 363. Who among the following is considered as primary stakeholder in insurance claim process? a. Customer b. Owners c. Underwriters d. Insurance agents/brokers 364. Girish Saxena’s insurance claim was denied by insurance company. In case of a denial, what is the option available to Girish Saxena, apart from the representation to the insurer? a. To approach Government b. to approach legal authorities c. To approach insurance agent d. Nothing could be done in case of case denial 365. During investigation, of a health insurance claim presented by Rajiv Mehto, insurance company finds that instead of Rajiv Mehto, his brother Rajesh Mehto had been admitted to hospital for treatment. The policy of Rajiv Mehto is not a family floater plan. This is an example of _________________fraud. a. Impersonation b. Fabrication c. Exaggeration of expenses d. Outpatient treatment converted to in-patient/hospitalization 366. Under which of the following condition, is domiciliary hospitalization is covered in a health insurance policy? a. The condition of the patient is such that he/she can be removed to the Hospital/Nursing Home, but prefer not to b. The patient cannot be removed to Hospital /Nursing Home for lack of accommodation therein c. The treatment can be carried out only in hospital/Nursing home d. Duration of hospitalization is exceeding 24 hours 367. Which of the following codes captures the procedures performed to treat the illness? a. ICD b. DCI c. CPT d. PCT