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stringlengths 1
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|---|---|---|---|---|---|
201
|
What is a family floater policy
|
{
"1": "Only the individual can be covered under this policy",
"2": "Only the dependent family members can be covered under this policy",
"3": "A policy that offers a single sum insured which floats over the entire family",
"4": "None of the above"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
202
|
In a family floater policy, how is the premium calculated
|
{
"1": "Based on the age of the oldest member of the family",
"2": "Based on the age of the youngest member of the family",
"3": "Based on the sum insured chosen for each individual insured",
"4": "None of the above"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
203
|
Why do insurance companies collect details of pre- existing diseases
|
{
"1": "To charge improper premiums",
"2": "To exclude coverage for any future diseases",
"3": "To provide free treatment for such diseases",
"4": "To decide on accepting the proposal for insurance"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
204
|
What is a pre-existing disease
|
{
"1": "Any disease suffered by an insured person within 12 months prior to commencement of the policy",
"2": "Any disease suffered by an insured person within 48 months prior to commencement of the policy",
"3": "Any disease suffered by an insured person within 24 months prior to commencement of the policy",
"4": "Any disease suffered by an insured person within 36 months prior to commencement of the policy"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
205
|
What is disease-specific capping in health insurance
|
{
"1": "A limit on the premium charged for policies covering certain diseases",
"2": "A limit on the number of claims that can be made for a particular disease",
"3": "A limit on the amount of coverage provided for specific diseases",
"4": "A limit on the number of diseases that can be covered under a policy"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
206
|
What is co-payment in health insurance
|
{
"1": "The portion of the claim amount that the policyholder/insured has to bear",
"2": "A separate policy taken by the policyholder to cover specific diseases",
"3": "The percentage of the premium paid by the policyholder/insured",
"4": "The amount deducted from the Sum Insured after every claim"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
207
|
Which of the following is a cost-sharing provision in a health insurance policy
|
{
"1": "Waiting period",
"2": "Coverage for Day care procedure",
"3": "Deductible/ Excess",
"4": "Pre-policy check-up cost"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
208
|
Who bears the cost of a pre-policy medical check- up in a health insurance policy
|
{
"1": "Prospective client",
"2": "Insurer",
"3": "Government",
"4": "Healthcare provider"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
209
|
What is a top-up cover in health insurance
|
{
"1": "A policy that covers only pre-existing conditions",
"2": "A policy that covers only day-care procedures",
"3": "A policy that provides cover for high sums insured over and above a specified amount",
"4": "A policy that covers only accidents"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
210
|
What is the entry age for Elderly health insurance plans
|
{
"1": "50 years",
"2": "55 years",
"3": "60 years",
"4": "65 years"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
211
|
What is the claim amount in a fixed benefit insurance plan
|
{
"1": "A fixed sum irrespective of the amount spent by the insured for the named treatment",
"2": "The amount spent by the insured for the named treatment",
"3": "A variable amount based on the severity of the ailment",
"4": "No claim amount is given"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
212
|
What is the proof required to process a claim in a fixed benefit insurance plan
|
{
"1": "Detailed bills and invoices of the treatment",
"2": "Proof of Hospitalization and coverage of ailment under the policy",
"3": "Doctor's prescriptions and medical reports",
"4": "None of the above"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
213
|
What is a critical illness policy
|
{
"1": "A policy that provides daily cash benefit to the insured person during hospitalization",
"2": "A policy that provides a fixed sum on diagnosis of certain named critical illness",
"3": "A policy that covers treatment costs for minor illnesses",
"4": "A policy that covers only pre-existing conditions"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
214
|
What is the waiting period for Corona Kavach and Corona Rakshak
|
{
"1": "90 days",
"2": "30 days",
"3": "15 days",
"4": "60 days"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
215
|
What is the maximum sum insured option available under Corona Rakshak
|
{
"1": "Rs. 1 lakh",
"2": "Rs. 2. 5 lakh",
"3": "Rs. 2 lakh",
"4": "Rs. 1. 5 lakh"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
216
|
What is the lump sum benefit payable under the standard policy for vector-borne diseases on positive diagnosis requiring hospitalization for a minimum of 72 hours
|
{
"1": "50% of the sum insured",
"2": "75% of the sum insured",
"3": "100% of the sum insured",
"4": "125% of the sum insured"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
217
|
What do Health plus Life Combo Products offer
|
{
"1": "Life insurance cover only",
"2": "Health insurance cover only",
"3": "Both life and health insurance covers",
"4": "None of the above"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
218
|
What is the aim of Micro-insurance products?
|
{
"1": "To aim for the protection of high- income people from urban sectors. ",
"2": "To aim for the protection of low- income people from rural and informal sectors. ",
"3": "To aim for the protection of middle- income people from semi-urban sectors. ",
"4": "To aim for the protection of people from developed sectors. "
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
219
|
Which of the following policies was launched by the Government to provide health insurance coverage for the below poverty line (BPL) families in association with insurance companies?
|
{
"1": "Ayushman Bharat Scheme",
"2": "Rashtriya Swasthya Bima Yojana (RSBY)",
"3": "Jan Arogya Bima Policy",
"4": "Bima Kavach Yojana"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
220
|
What is the Sum Insured amount for Rashtriya Swasthya Bima Yojana (RSBY)?
|
{
"1": "Rs. 5, 00, 000",
"2": "Rs. 1, 00, 000",
"3": "Rs. 50, 000",
"4": "Rs. 30, 000"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
221
|
Which of the following schemes was launched to achieve the vision of Universal Health Coverage (UHC)?
|
{
"1": "Ayushman Bharat Scheme",
"2": "Money Back Scheme",
"3": "Endowment Scheme",
"4": "Bima Kavach Yojana"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
222
|
What is the premium amount for Pradhan Mantri Suraksha Bima Yojana (PMSBY)
|
{
"1": "Rs. 10/- per annum per member",
"2": "Rs. 12/- per annum per member",
"3": "Rs. 15/- per annum per member",
"4": "Rs. 20/- per annum per member"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
223
|
What is the maximum sum insured provided for death under Pradhan Mantri Suraksha Bima Yojana (PMSBY)
|
{
"1": "Rs. 1 Lakh",
"2": "Rs. 3 Lakh",
"3": "Rs. 5 Lakh",
"4": "Rs. 2 Lakh"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
224
|
Who can avail an Overseas Travel Insurance policy
|
{
"1": "Only Indian citizens travelling abroad for holiday",
"2": "Only Indian citizens travelling abroad for business",
"3": "Indian citizens travelling abroad for business, holiday or studies and employees of Indian employers sent on contracts abroad",
"4": "Only employees of Indian employers sent on contracts abroad"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
225
|
What is the most common form of group health insurance
|
{
"1": "Individual policy",
"2": "Group policy taken by employers covering employees",
"3": "Personal policy",
"4": "Family policy"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
226
|
From the below given age proof documents, identify the one which is classified as non-standard by insurance companies.
|
{
"1": "School certificate",
"2": "Identity card in case of defence personnel",
"3": "Ration card",
"4": "Certificate of baptism"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
227
|
Out of following underwriting methods the process of underwriting is speedy but the premiums may be relatively higher except
|
{
"1": "Medical underwriting",
"2": "Non medical underwriting",
"3": "Numerical rating method",
"4": "Group insurance"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
228
|
Group insurance is underwritten mainly on _________________.
|
{
"1": "Law of Uberrima fides",
"2": "Law of Insurable interest",
"3": "Law of averages",
"4": "Law of mutual benefit"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
229
|
Which One of the Following Statements, isIn-Correct, with Regard to Critical Illness (C. I. ) Rider? Choose the Most Appropriate Option.
|
{
"1": "A Specified Amount is Paid, as per the Policy- Terms, in the Event of Diagnosis of a Critical Illness. ",
"2": "The Illness should have been covered in the List of Critical Illnesses, specified by the Insurance Company. ",
"3": "Critical Illness (C. I. ) Rider is an Example of the Claims, that may occur, during the Policy- Term. ",
"4": "The Life Assurance Policy Contract Terminates, After the Rider-Payments are Made. "
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
230
|
Third-Party Administrators (T. P. A. s) are Regulated, by Which of the Following Bodies?
|
{
"1": "Life Insurance Council and General Insurance Council, Jointly. ",
"2": "Insurance Regulatory and Development Authority of India (I. R. D. A. I. )",
"3": "Insurance Brokers Association of India",
"4": "Finance Ministry"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
231
|
Why is underwriting necessary
|
{
"1": "To create a large pool of risks for the insurance company",
"2": "To prevent the insurance company from becoming insolvent",
"3": "To accept all risks, regardless of premiums",
"4": "To offer insurance at the lowest possible premium"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
232
|
Which factor affects morbidity rates in health insurance
|
{
"1": "Financial status",
"2": "Gender",
"3": "Marital status",
"4": "Educational qualification"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
233
|
What is moral hazard in health insurance
|
{
"1": "The physical hazards associated with a health risk",
"2": "The cost associated with a health risk",
"3": "The deliberate intention of taking insurance just to collect a claim",
"4": "The risk assessment and pricing done by the underwriter"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
234
|
Which of the following statements is true about moral hazard in health insurance
|
{
"1": "It can prove costly to the insurance company",
"2": "It refers to the physical hazards of a health risk",
"3": "It has no impact on the insurance company",
"4": "It can be beneficial to the insurance company"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
235
|
Insurers charge lower premiums for which of the following risk types
|
{
"1": "Standard risks",
"2": "Substandard risks",
"3": "Preferred risks",
"4": "Declined risks"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
236
|
Who plays a critical role in primary underwriting
|
{
"1": "Underwriter",
"2": "Agent or Company representative",
"3": "Policyholder",
"4": "Insurance broker"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
237
|
Before issuing a policy, the specific consent of the policyholder for any underwriting loading charged over and above the premium must be obtained. This regulation is for the benefit of
|
{
"1": "The insurance company",
"2": "The regulator",
"3": "The policyholder",
"4": "The insurance agent"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
238
|
When can porting be done
|
{
"1": "Anytime during the policy period",
"2": "Only at the time of policy issuance",
"3": "Only after a break in the policy",
"4": "Only at the time of policy renewal"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
239
|
Who should the insured make a request for porting to
|
{
"1": "The new insurer",
"2": "The old insurer",
"3": "IRDAI",
"4": "Any insurance agent"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
240
|
What is the consequence of breach or concealment of information by the insured in insurance
|
{
"1": "Increase in premium",
"2": "Policy becomes void",
"3": "Decrease in premium",
"4": "Policy remains unaffected"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
241
|
When are financial documents usually asked for in insurance
|
{
"1": "Only in high sum assured coverage",
"2": "When there is a mismatch between stated income/occupation and coverage sought",
"3": "Both (B) and (C)",
"4": "None of the above"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
242
|
What is the purpose of medical underwriting in health insurance
|
{
"1": "To determine the premium amount",
"2": "To determine whether to offer coverage or not",
"3": "To determine the number of family members to be covered",
"4": "To determine the type of hospital where the insured can be admitted"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
243
|
What are the different categories of risk into which the underwriter can classify a proposal
|
{
"1": "Accept risk at standard rates, extra premium, or decline the cover",
"2": "Accept risk at an extra premium",
"3": "Postpone the cover for a stipulated period/ term",
"4": "All of the above"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
244
|
In which cities are the premiums for certain products higher due to higher claims cost
|
{
"1": "Small towns and villages",
"2": "Tourist destinations",
"3": "Metros and 'A Class' cities",
"4": "Industrial hubs"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
245
|
Which of the following non-employer groups can be offered group health insurance
|
{
"1": "Employer welfare associations",
"2": "Customers of a particular business where insurance is offered as an add- on benefit",
"3": "Borrowers of a bank",
"4": "All of the above"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
246
|
What is the main cover under Overseas Travel Insurance policies
|
{
"1": "Life cover",
"2": "Home insurance",
"3": "Health cover",
"4": "Vehicle insurance"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
247
|
Which risk group does a person working in underground mines belong to
|
{
"1": "Risk group I",
"2": "Risk group II",
"3": "Risk group III",
"4": "None of the above"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
248
|
What is the general age limit for the working population in employer-employee groups
|
{
"1": "5-70",
"2": "18-70",
"3": "30-70",
"4": "50-70"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
249
|
For a claim to be processed, which of the following are most important documents? I. Documentary evidence of illness II. Payment made to the hospital III. Further advice for treatment IV. Payment proofs for implants
|
{
"1": "Only I and II",
"2": "Only I and IV",
"3": "I, II and III",
"4": "I, II, III and IV"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
250
|
Which of the following statement/s is / are correct with regards to 'claim processing and payment services' provided by a TPA? I. TPAs normally receive advance money from the insurer for claim settlement. The TPA is expected to keep an account of the monies and provide periodic reconciliation of the amounts received from the insurance company II. The money can be used for purposes of payment of approved claims and providing other services to the customers
|
{
"1": "Only I",
"2": "Only II",
"3": "Both I and II",
"4": "Neither I nor II"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
251
|
Hospital-Admission-Intimation can be made to an Insurance Company, through, Which of the Following Channels?
|
{
"1": "Fax",
"2": "Calling the Call-Centre",
"3": "E-Mail",
"4": "Any of the Above. "
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
252
|
For a Health Insurance Claim to be Processed, Which of the Following, are the Most Important Documents? I. Documentary Evidence of Illness. II. Treatment-Provided. III. In-Patient Duration. IV. Investigation-Reports.
|
{
"1": "Only, I and II. ",
"2": "Only, I and IV. ",
"3": "I, II, and IV. ",
"4": "I, II, III, and IV. "
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
253
|
Identify the True Statement: I. Morbidity increases due to Various Adverse Factors, such as, Being Over-Weight or Under-Weight, Personal History of Certain Past and Present Diseases or Ailments. II. Morbidity decreases due to Certain Favourable Factors, like, Lower Age, a Healthy Life-Style, etc.
|
{
"1": "Only Statement-I is True. ",
"2": "Only Statement-II is True. ",
"3": "Both: Statement-I and Statement-II, are True. ",
"4": "Both: Statement-I and Statement-II, are False. "
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
254
|
What is the true test of an insurer's performance in insurance?
|
{
"1": "The colour of the insurance company's logo",
"2": "The number of employees the insurance company has",
"3": "The claims paying ability of the insurance company",
"4": "Location of Company office premises"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
255
|
Who is the first stakeholder and receiver of the claim?
|
{
"1": "The insurance agent who sold the policy",
"2": "The person who processes the insurance claim",
"3": "The insurance company's shareholders",
"4": "The customer who buys the insurance policy"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
256
|
Which of the following statements is true regarding Health insurance claim servicing?
|
{
"1": "Claims can only be serviced by the insurance company itself. ",
"2": "Claims can only be serviced by Third Party Administrators (TPAs). ",
"3": "Claims can be serviced by either the insurance company or TPAs authorized by the insurance company. ",
"4": "Claims can only be serviced by providers/hospitals. "
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
257
|
What happens from the time a health claim is made known to the insurer/TPA to the time the payment is made as per the policy terms?
|
{
"1": "The claim is rejected immediately",
"2": "The payment is made without any verification",
"3": "The claim goes through a set of well- defined steps",
"4": "The insurer/TPA ignores the claim"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
258
|
What is claim intimation in the insurance claim process?
|
{
"1": "The final stage of the claim process",
"2": "The process of investigating a claim",
"3": "The act of informing the insurance company of a planned or emergency hospitalization",
"4": "The process of determining the amount to be paid for a claim"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
259
|
Which of the following statements is true regarding claim intimation in health insurance?
|
{
"1": "Claim intimation is not mandatory",
"2": "Claim intimation is required before 48 hours of hospitalization in case of an emergency",
"3": "Claim intimation is required within 48 hours of hospitalization in case of an emergency",
"4": "claim intimation is required before hospitalization in case of planned admission, and within 24 hours of hospitalization in case of an emergency. "
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
260
|
How is claim intimation to Insurer / TPA possible according to the statement?
|
{
"1": "Only Through telegrams",
"2": "Only Through fax",
"3": "Through Mobile Apps/ call centres/ internet/ e-mail",
"4": "Only Through postal mail"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
261
|
What happens after a company or TPA receives an intimation about Mr. X's claim?
|
{
"1": "The claim is immediately approved",
"2": "The documents are ignored",
"3": "The details are matched for accuracy and a reference number is generated",
"4": "The claimant is asked to provide more documents"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
262
|
Which of the following is true regarding the scrutiny of claims for final settlement on a reimbursement basis?
|
{
"1": "Claims are accepted without any scrutiny or verification of documents. ",
"2": "Claims are scrutinized for admissibility, sum assured, deductibles, and sub-limits. ",
"3": "Claims are only scrutinized for admissibility, but not for sum assured, deductibles, and sub-limits. ",
"4": "Claims are scrutinized for sum assured, but not for admissibility, deductibles, and sub-limits. "
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
263
|
What action is taken by the company in case the intimation is for a planned surgery under the Cash- less scheme?
|
{
"1": "Pre-authorization of likely expenditure is given to the hospital",
"2": "The claim is directly processed",
"3": "The hospital is contacted for more information",
"4": "The claim is rejected"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
264
|
Which of the following alternative modes of treatment may be covered by health insurance policies, but may have sub-limits?
|
{
"1": "Unani",
"2": "Siddha",
"3": "Homeopathy",
"4": "All of the above"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
265
|
What is the recent directive of IRDAI regarding telemedicine in medical insurance policies?
|
{
"1": "Insurers are not allowed to cover telemedicine in their policies. ",
"2": "Telemedicine is allowed only for non- coronavirus-related medical consultations. ",
"3": "Telemedicine is allowed wherever regular medical consultation is allowed. ",
"4": "Policyholders are required to visit the hospital for all medical consultations. "
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
266
|
Which of the following is NOT a factor that decides the claim amount payable?
|
{
"1": "Sum insured available for the member under the policy",
"2": "Deductible amount",
"3": "Balance sum insured available under the policy for the member after taking into account any claim made already",
"4": "Sub-limits"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
267
|
What are Reasonable and Customary Charges?
|
{
"1": "Charges that are higher than the prevailing charges in the geographical area",
"2": "Charges for services or supplies that are unique to a particular provider",
"3": "Charges that are decided solely by the insurer",
"4": "Charges for services or supplies that are consistent with the prevailing charges in the geographical area for identical or similar services"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
268
|
What has been standardized under IRDAI Health Insurance Standardization Guidelines?
|
{
"1": "Sum insured available for the member under the policy",
"2": "Balance sum insured available under the policy for the member after taking into account any claim made already",
"3": "Non-payable items in health insurance",
"4": "Deductible amount"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
269
|
How are payments made for a payable claim amount?
|
{
"1": "By cheque or bank transfer",
"2": "By cash only",
"3": "Only by cheque",
"4": "By transferring the claim money to the insurance company's account"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
270
|
Which of the following is not a possible reason for denial of health insurance claims?
|
{
"1": "No active treatment; admission is only for investigation purpose",
"2": "Illness treated is excluded under the policy",
"3": "Hospitalization is more than 24 hours",
"4": "The cause of illness is abuse of alcohol or drugs"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
271
|
What percentage of submitted health claims are usually denied?
|
{
"1": "5% to 10%",
"2": "10% to 15%",
"3": "15% to 20%",
"4": "20% to 25%"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
272
|
What is the time frame within which investigations for suspect claims should be completed?
|
{
"1": "30 days from the date of receipt of claim intimation",
"2": "60 days from the date of receipt of claim intimation",
"3": "90 days from the date of receipt of claim intimation",
"4": "120 days from the date of receipt of claim intimation"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
273
|
Within how many days of completing the investigation should a claim be settled?
|
{
"1": "30 days",
"2": "15 days",
"3": "60 days",
"4": "90 days"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
274
|
What are some examples of frauds committed in health insurance?
|
{
"1": "Impersonation",
"2": "Fabrication of documents",
"3": "Inflation of expenses",
"4": "All of the above"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
275
|
What options are available for customers if their claim is denied?
|
{
"1": "IRDAI",
"2": "The Consumer Commissions",
"3": "Insurance Ombudsman",
"4": "All of the above"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
276
|
What is the first step for a customer covered under health insurance to avail the cashless facility?
|
{
"1": "The customer approaches the treating doctor for admission",
"2": "The customer approaches the hospital’s insurance desk with insurance details",
"3": "The customer pays the hospital charges in advance",
"4": "The customer contacts the TPA directly"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
277
|
Who takes the decision on whether the cashless authorization could be provided or not?
|
{
"1": "The hospital",
"2": "The patient",
"3": "The TPA",
"4": "The insurer"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
278
|
What does the hospital do when the patient is ready for discharge?
|
{
"1": "Check the amount of credit in the account of the patient approved by the TPA against the actual treatmnet charges covered by Insurance",
"2": "Request the patient to pay the entire treatment charges in cash",
"3": "Ask the patient to undergo further treatment",
"4": "Transfer the patient to another hospital"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
279
|
What is the purpose of reserving in the context of insurance companies?
|
{
"1": "To make provisions for all claims in the books of the insurer based on the status of the claims",
"2": "To hold claim amounts until payments are due",
"3": "To ensure that policyholders pay their premiums on time",
"4": "To estimate the profits that the insurer will earn from investments"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
280
|
What does the TPA do after studying the information provided in the cashless authorization form?
|
{
"1": "Approves the cashless authorization without delay",
"2": "Takes a decision on whether cashless authorization could be provided and, if so, for how much amount",
"3": "Rejects the cashless authorization immediately",
"4": "None of the above"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
281
|
What should mr. X do if he doesn't have his insurance details with him?
|
{
"1": "He should contact the hospital",
"2": "He should contact the TPA through a 24 hour helpline",
"3": "He should wait until they have their insurance details",
"4": "He should pay for the treatment out of pocket"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
282
|
What should Mr. X do if the hospital suggested by his doctor is not in the TPA network?
|
{
"1": "He should choose another hospital in the network of the TPA",
"2": "He should contact the TPA to check for options where cashless facility is available",
"3": "He should pay for the treatment out of pocket",
"4": "He should contact the consulting doctor for further advice"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
283
|
When should a customer inform the TPA about the discharge?
|
{
"1": "After the patient is discharged",
"2": "Before the patient is admitted to the hospital",
"3": "At the time of filling the pre- authorization form",
"4": "In advance of the discharge and request the hospital to send to the TPA any additional approval that may be required"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
284
|
What is the most important document required to process a health insurance claim?
|
{
"1": "Investigation report",
"2": "Consolidated and detailed bills",
"3": "Receipt for payment",
"4": "Discharge summary"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
285
|
What is the purpose of investigation reports in health insurance claims?
|
{
"1": "To provide a summary of the patient's condition",
"2": "To provide a break-up of the bills",
"3": "To assist in comparing the diagnosis and treatment",
"4": "To verify the identity of the patient"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
286
|
What is the purpose of the claim form in health insurance claims?
|
{
"1": "To provide a summary of the patient's condition",
"2": "To request processing of the claim",
"3": "To provide a break-up of the bills",
"4": "To assist in comparing the diagnosis and treatment"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
288
|
Which document may be required for accident claims?
|
{
"1": "Consolidated and detailed bills",
"2": "Identity proof",
"3": "Dialysis/Chemotherapy/Physiotherap y charts",
"4": "FIR or Medico-legal certificate"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
289
|
What is the purpose of having a membership with the TPA?
|
{
"1": "To obtain discounts on medical treatment at hospitals. ",
"2": "To receive reimbursement for medical expenses not covered by the policy. ",
"3": "To avail cashless facility for hospitalization or treatment covered by the policy, and to process claims when required. ",
"4": "To receive medical advice and consultation from a team of healthcare professionals. "
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
290
|
What document does the TPA issue to the hospital for cashless treatment?
|
{
"1": "Medical report",
"2": "Discharge summary",
"3": "Pre-authorization or Letter of Guarantee",
"4": "Prescription for medication"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
291
|
What is claims investigation about?
|
{
"1": "Determining the validity of the claim and finding out the real cause and extent of the loss",
"2": "Assessing the credibility of the claimant's occupation",
"3": "Verifying the authenticity of the claimant's identity documents",
"4": "Calculating the premium to be charged for the policy"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
292
|
What documents are required for name and address verification for AML (Anti-money laundering) purposes?
|
{
"1": "Birth certificate and rental agreement",
"2": "Passport and bank statement",
"3": "Aadhar card and credit card statement",
"4": "PAN card and telephone bill"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
293
|
What is the role of assistance companies in overseas claims?
|
{
"1": "They process claims on behalf of insurance companies",
"2": "They provide assistance to customers in case of contingencies covered under the policy",
"3": "They offer tie-up arrangements with hospitals for cashless treatment",
"4": "They provide legal assistance to customers during claims process"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
294
|
Which of the following is NOT a service provided by assistance companies during overseas travel insurance claims?
|
{
"1": "Medical service provider referrals",
"2": "Interpreter Referral",
"3": "Delivery of Essential Medicines",
"4": "Rental car booking"
}
|
4
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
295
|
What is the fee charged by assistance companies for their services?
|
{
"1": "It varies depending on agreement with the particular insurance company, benefits covered etc. ",
"2": "It is a fixed amount for all customers of the insurance company",
"3": "It is determined by the insurance company and is the same for all assistance companies",
"4": "There is no fee charged for the services provided by assistance companies"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
296
|
Which of the following steps is necessary for hospitalization in case of a travel insurance claim?
|
{
"1": "Submit a written request to the insurance company",
"2": "Visit any hospital of choice",
"3": "Intimate the call centre and proceed to a specified hospital with a valid travel insurance policy",
"4": "None of the above"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
297
|
How do hospitals verify the validity of an overseas travel insurance policy?
|
{
"1": "The hospitals do not verify the validity of the policy before treatment",
"2": "The hospitals contacts the assistance companies/ insurers on the call centre numbers to check the validity of the policy and verify coverages. ",
"3": "The hospitals call the insured's family or friends to confirm the policy details",
"4": "The hospitals relies on the insured's word that they have a valid policy. "
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
298
|
Which type of claim payment is made in foreign currency?
|
{
"1": "Cashless claims",
"2": "Reimbursement claims",
"3": "Both cashless and reimbursement claims",
"4": "None of the above"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
299
|
What is the currency conversion rate used while processing reimbursement claims?
|
{
"1": "The rate as on date of loss",
"2": "The rate as on date of filing the claim",
"3": "The rate as on the date of discharge from the hospital",
"4": "The rate as on the date of admission to the hospital"
}
|
1
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
300
|
What currency is used for payments for admissible claims in reimbursement claims for overseas travel insurance?
|
{
"1": "British Pound (GBP)",
"2": "Indian Rupee (INR)",
"3": "United States Dollar (USD)",
"4": "Euro (EUR)"
}
|
2
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
301
|
Which document is required to certify the disability of an insured individual?
|
{
"1": "Birth certificate",
"2": "Passport",
"3": "Permanent disability certificate from a civil surgeon or equivalent competent doctors",
"4": "Driving license"
}
|
3
|
IC- 38 -WA-Eng-Composite.md
|
Composite
|
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