IC-38 Health Insurance Mock Test – English

Subject: Health Insurance
Total Questions: 50
Total Marks: 50
Time: 60 Minutes
Question Type: Multiple Choice Questions (MCQs)

Instructions

• Each question has four options.
• Select the one best answer.
• Check the answer key only after completing the test.
• This is a practice mock test and not an official examination paper.

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Question 1

What is the primary purpose of Health Insurance?

A. To provide investment returns only
B. To provide financial protection against eligible healthcare expenses
C. To provide motor vehicle protection
D. To provide property ownership

Question 2

What does Sum Insured mean in Health Insurance?

A. Agent’s commission
B. The amount or limit of insurance coverage available under the policy
C. Hospital’s total income
D. Customer’s bank balance

Question 3

What is a Premium?

A. Claim amount
B. Amount paid by the policyholder for insurance coverage
C. Hospital bill
D. Doctor’s fee

Question 4

What does Cashless Treatment generally mean?

A. Treatment is always free
B. Eligible treatment expenses may be settled directly with a network hospital through the insurer/TPA arrangement
C. No premium is required
D. Every hospital provides cashless treatment

Question 5

What is a Network Hospital?

A. A hospital included in the insurer/TPA network
B. Only a government hospital
C. A hospital located outside India
D. A small clinic only

Question 6

What is a Reimbursement Claim?

A. The insured pays eligible expenses and subsequently seeks reimbursement according to policy terms
B. The hospital refunds the premium
C. The agent pays the claim
D. The insurer always pays in cash

Question 7

What is a Waiting Period?

A. A specified period during which certain coverage may not be available, as per policy terms
B. Time spent waiting at a hospital
C. Time taken to pay the premium
D. Time taken to print the policy

Question 8

What is a Pre-existing Disease (PED)?

A. A disease or medical condition existing before policy commencement, as defined by the policy
B. Every disease occurring after policy commencement
C. An accident only
D. A seasonal illness only

Question 9

What is an Exclusion in Health Insurance?

A. A condition, treatment, or event that is not covered under the policy
B. An additional benefit
C. A premium discount
D. A claim settlement

Question 10

What is a Deductible?

A. A specified amount that the insured must bear as per policy terms before the insurer’s liability applies
B. An insurer’s bonus
C. A hospital discount
D. An agent’s commission

Question 11

What is Co-payment?

A. A specified percentage or portion of an eligible claim that the insured must bear
B. Premium paid by two insurance companies
C. Premium paid by a hospital
D. Claim filed by an agent

Question 12

What is a Room Rent Limit?

A. A policy-defined limit on eligible room charges during hospitalization
B. A limit on house rent
C. A limit on doctor’s fees
D. A limit on premium payment

Question 13

Why can a room rent limit be important?

A. It may affect the amount payable under a claim according to policy terms
B. It determines agent commission
C. It determines the policy number
D. It determines the customer’s ID

Question 14

What are Pre-hospitalisation Expenses?

A. Eligible medical expenses incurred before hospitalization for the covered condition
B. Expenses incurred after discharge only
C. Travel expenses only
D. Food expenses only

Question 15

What are Post-hospitalisation Expenses?

A. Expenses incurred before admission
B. Eligible medical expenses incurred after discharge, as specified by the policy
C. Premium payments
D. Room rent only

Question 16

What is Day Care Treatment?

A. A covered medical procedure that may require less than 24 hours of hospitalization, subject to policy terms
B. Treatment performed only at home
C. A doctor’s consultation only
D. Emergency treatment only

Question 17

What does Hospitalisation generally mean?

A. Admission to a hospital for medical treatment, subject to policy terms
B. Visiting a doctor only
C. Buying medicines from a pharmacy
D. Visiting an insurance office

Question 18

What does TPA stand for?

A. Third Party Administrator
B. Total Policy Administrator
C. Treatment Payment Agency
D. Third Premium Authority

Question 19

What may be a role of a TPA?

A. Assisting with administration of health claims and related services
B. Setting all insurance premiums
C. Building hospitals
D. Diagnosing diseases

Question 20

What may generally be required for cashless treatment?

A. Treatment at a network hospital and fulfilment of applicable eligibility/approval requirements
B. Visiting any shop
C. Permission from an agent only
D. Always paying the entire bill in cash

Question 21

What is Pre-authorisation?

A. A prior approval process for eligible cashless treatment through the insurer/TPA
B. Appointment of a new insurance agent
C. Premium refund
D. Policy cancellation

Question 22

What should an insured generally do in case of emergency hospitalisation?

A. Inform the insurer/TPA as soon as reasonably possible according to the policy’s claim procedure
B. Never inform the insurer
C. Inform only the agent
D. Cancel the policy

Question 23

Why are hospital bills important in a health insurance claim?

A. They provide evidence of treatment and expenses
B. They determine agent commission
C. They create the policy number
D. They automatically increase the Sum Insured

Question 24

What is the main purpose of a Claim Form?

A. To provide information required for processing a claim
B. To open a bank account
C. To obtain a premium discount
D. To select a hospital

Question 25

What does Claim Intimation mean?

A. Informing the insurer about an insured event or claim
B. Buying a policy
C. Increasing the premium
D. Surrendering the policy

Question 26

What is a Family Floater Policy?

A. A policy where one Sum Insured may be shared among covered family members, subject to policy terms
B. A policy requiring a separate insurer for every family member
C. A one-day insurance policy
D. A policy with no premium

Question 27

In an Individual Health Insurance Policy:

A. A separate Sum Insured may be available for each insured person
B. Only one person in the family can ever be insured
C. No premium is required
D. Only the hospital is insured

Question 28

What does Policy Renewal mean?

A. Continuing coverage after the policy period according to applicable terms and conditions
B. Cancelling a claim
C. Changing hospitals
D. Permanently closing the policy

Question 29

What may happen if the renewal premium is not paid within the applicable period?

A. Coverage may be affected or the policy may lapse according to its terms
B. Sum Insured automatically doubles
C. All claims are automatically approved
D. Premium is permanently waived

Question 30

What is No Claim Bonus (NCB) generally associated with?

A. A benefit that may be provided for an eligible claim-free policy period
B. Hospital salary
C. Agent commission
D. Medical examination only

Question 31

What is a Cumulative Bonus?

A. A benefit that may increase coverage for eligible claim-free years, subject to policy terms
B. A reduction in every premium to zero
C. An increase in hospital bills
D. A method of rejecting claims

Question 32

What is a Sub-limit?

A. A policy-defined limit applicable to a particular treatment, expense, or category
B. A premium bonus
C. Agent salary
D. Policy duration

Question 33

What is a Specific Disease Waiting Period?

A. A specified waiting period applicable to certain diseases or treatments
B. Hospital discharge time
C. Premium payment time
D. Time after claim settlement

Question 34

What is the general purpose of Critical Illness Insurance?

A. To provide a benefit upon diagnosis of specified critical illnesses, subject to policy terms
B. To cover every minor illness without limits
C. To repair vehicles
D. To cover travel expenses

Question 35

When is a benefit under a Critical Illness Policy generally payable?

A. When a covered critical illness is diagnosed and applicable policy conditions are satisfied
B. Every time the insured visits a doctor
C. Only when premium is paid
D. Immediately upon purchasing the policy

Question 36

Personal Accident Insurance primarily relates to:

A. Covered accidental death or bodily injury
B. Common illnesses only
C. Property damage only
D. Room rent only

Question 37

What does Maternity Benefit generally relate to?

A. Eligible pregnancy and childbirth-related expenses, subject to policy terms
B. Motor accidents
C. Property damage
D. Baggage loss

Question 38

Why can a waiting period be important for maternity benefits?

A. The policy may specify a waiting period before maternity coverage becomes available
B. Hospitals are always closed during pregnancy
C. No premium is required
D. Claims are always paid immediately

Question 39

When may Ambulance Charges be covered?

A. When an eligible ambulance benefit is included and policy conditions are met
B. In every situation without limit
C. Only for private vehicles
D. Never

Question 40

What does Medical Necessity generally mean?

A. Treatment is medically necessary according to applicable policy terms and medical circumstances
B. Treatment is expensive
C. Treatment is provided outside India
D. Treatment is requested by the patient regardless of medical need

Question 41

What are Reasonable and Customary Charges?

A. Charges that are generally reasonable for similar services in the same locality, subject to policy terms
B. Any amount charged by a hospital
C. Government charges only
D. Doctor’s commission

Question 42

If a customer hides material medical information in the proposal form, what may happen?

A. It may create problems during underwriting or claim assessment
B. Sum Insured automatically increases
C. Premium always decreases
D. Claim automatically doubles

Question 43

How is the principle of Utmost Good Faith followed in Health Insurance?

A. By honestly disclosing relevant health and risk information
B. By hiding medical conditions
C. By providing false medical history
D. By altering documents

Question 44

Which is an example of Mis-selling?

A. Hiding exclusions or limitations and making false promises about benefits
B. Explaining all exclusions clearly
C. Understanding the customer’s needs
D. Providing accurate information

Question 45

What should a Health Insurance agent explain to a customer?

A. Coverage, exclusions, limits, waiting periods, and other important policy terms
B. Premium only
C. Policy number only
D. Commission only

Question 46

Why is assessing a customer’s needs important when buying Health Insurance?

A. To help select suitable coverage based on healthcare and financial needs
B. Only to increase commission
C. To prevent claims
D. To increase hospital profits

Question 47

What does IRDAI stand for?

A. Insurance Regulatory and Development Authority of India
B. Indian Risk Development Authority of Insurance
C. Insurance Revenue Department of India
D. Indian Regulatory Department of Assurance

Question 48

What is a major role of IRDAI?

A. Regulation and development of the insurance sector in India
B. Operating hospitals
C. Collecting income tax
D. Providing medical treatment

Question 49

What should a good Health Insurance agent do?

A. Provide accurate, clear, and transparent information according to the customer’s needs
B. Sell only high-premium policies
C. Hide exclusions
D. Guarantee every claim

Question 50

What is the most appropriate approach to Health Insurance?

A. Recommend suitable coverage based on the customer’s healthcare and financial needs
B. Give every customer the same policy
C. Select a policy only according to commission
D. Fill in the proposal form without explaining it

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Answer Key

Q.	Ans.	Q.	Ans.
1	B	26	A
2	B	27	A
3	B	28	A
4	B	29	A
5	A	30	A
6	A	31	A
7	A	32	A
8	A	33	A
9	A	34	A
10	A	35	A
11	A	36	A
12	A	37	A
13	A	38	A
14	A	39	A
15	B	40	A
16	A	41	A
17	A	42	A
18	A	43	A
19	A	44	A
20	A	45	A
21	A	46	A
22	A	47	A
23	A	48	A
24	A	49	A
25	A	50	A