axondendriteplus/IC38-Corporate-Agent-Questions huggingface dataset:
Category: Health
Question: 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. 
Answer: option 4
Category: Health
Question: 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. 
Answer: option 3
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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. 
Answer: option 3
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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. 
Answer: option 4
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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. 
Answer: option 2
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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. 
Answer: option 3
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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%
Answer: option 2
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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. 
Answer: option 3
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 2
Category: Health
Question: 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
Answer: option 4
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 3
Category: Health
Question: 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. 
Answer: option 2
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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
Answer: option 1
Category: Health
Question: 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)
Answer: option 2
Category: Health
Question: 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
Answer: option 3
Category: Life
Question: In the olden days, Chinese traders used to keep their goods in different boats while sailing through treacherous waters. Analyse why?
1. Chinese boats were small and they carried heavy goods
2. The Chinese Government mandated that goods should be distributed among multiple shipping companies so that there is equal distribution of business
3. Chinese traders placed their goods in multiple boats because it provided insurance against total loss
4. Chinese traders placed their goods in multiple boats because it was cheap
Answer: option 3
Category: Life
Question: What is the cost of risk directly proportional to?
1. Probability and impact of the loss
2. Impact of the loss alone
3. Probability of loss and object of insurance
4. Impact of loss and the object of insurance
Answer: option 1
Category: Life
Question: Which of the below statement is incorrect?
1. Under mutuality, the funds of various individuals are combined
2. Mutuality is also known as pooling
3. Under mutuality we have funds flow from one source to many
4. Mutuality provides protection against the economic loss arising as a result of one’s untimely death. This loss is shouldered and addressed through having a fund that pools the contributions of many who have entered into the life insurance contract
Answer: option 3
Category: Life
Question: The earliest type of modern insurance was in the form of protection by business guilds or societies in Europe especially _________ in the 14th century. 
1. Spain
2. France
3. Germany
4. Italy
Answer: option 4
Category: Life
Question: In terms of Breach of Utmost Good Faith, which of the following is not correct
1. Concealment is Intentional Non- Disclosure
2. Concealment is Innocent Non-Disclosure
3. Fraudulence is Intentional Misrepresentation
4. Hiding existence of a disease is intentional Non-Disclosure
Answer: option 2
Category: Life
Question: Life Insurance Corporation of India(LIC) was set up under which of the following acts?
1. Life Insurance Corporation Act, 1956
2. The Insurance Act, 1938
3. Life Insurance Companies Act, 1912
4. Indian Insurance Companies Act, 1928
Answer: option 1
Category: Life
Question: Which of the following social security scheme is a Health Insurance plan?
1. PMVVY
2. PMFBY
3. PMJAY
4. PMSBY
Answer: option 3
Category: Life
Question: Explain difference between peril and hazard. 
1. Peril is the cause of loss and hazard is the consequence of that loss
2. Peril is the direct cause of loss while hazard increases/decreases the probability of loss
3. Hazard is the direct cause of loss while peril increases/decreases the probability of loss
4. Peril is probability of loss while hazard is related to impact of loss
Answer: option 2
Category: Life
Question: Losses caused by an earthquake are ______
1. Critical
2. Collaborative
3. Corollary
4. Common
Answer: option 1
Category: Life
Question: Who is protected under the In-Contestability Clause included under a Life Assurance Policy?
1. Insurer
2. Insured
3. Insurance Agent
4. Insurance Broker
Answer: option 2
Category: Life
Question: Who among the Following, is Likely to be Exposed to Accidental Hazard, in His or Her Occupation? Choose the Most Appropriate Option. 
1. Medical-Professional
2. Tourist-Guide
3. Demolition-Experts
4. Marketing-Executive, Who is regularly on the Field. 
Answer: option 3
Category: Life
Question: Who among the Following, is Likely to be Exposed to Health-Hazard, in His or Her Occupation?
1. Yoga-Instructor
2. Film-Stunt-Artist
3. Dancer in a Night-Club
4. Person, Exposed to Mining Dust
Answer: option 4
Category: Life
Question: Why Do, Insurers need Material Information?
1. For Documentation Purposes. 
2. Decide on the Risk- Acceptance, and the Terms and Conditions, Associated. 
3. To Comply with the Regulatory Requirements. 
4. To Improve the Customer-Service. 
Answer: option 2
Category: Life
Question: Compare: Gambling and Insurance. 
1. Gambling and Insurance, Both, are the Same. 
2. Gambling has No Insurable Interest involved, but Insurance does have. 
3. Insurance has Only Profitable Outcomes, while, Gambling could result in Losses. 
4. Gambling is Legally Enforceable, but, Insurance is Not. 
Answer: option 2
Category: Life
Question: Select a Scenario, that showcases the Principle of Uberrima Fides. 
1. Timely Payment of Premium. 
2. Disclosing All Material Information on the Insurance Proposal- Form. 
3. Faking All Material Information on the Insurance Proposal- Form. 
4. Disclosing All Irrelevant Information on the Insurance Proposal- Form. 
Answer: option 2
Category: Life
Question: Label the Interest, that the Insured has, in the Subject-Matter of Life Assurance. Choose the Most Appropriate Option. 
1. Speculative Interest
2. Wager Interest
3. Insurable Interest
4. Indemnity Interest
Answer: option 3
Category: Life
Question: Which priciple of insurance implies if the same property is insured with more than one insurance company
1. Contribution
2. Uberrima fides
3. Subrogation
4. Proximate cause
Answer: option 1
Category: Life
Question: ____________________is a corollary principle of Indemnity
1. Insurable Interest
2. Uberrima fides
3. Subrogation
4. Proximate cause
Answer: option 3
Category: Life
Question: Examine the conditions mentioned below and tell us which is not a valid condition for returning a policy during the free look period. I: Option must be exercised within 15 days of receiving the policy document II: Communication has to be in writing III: Communication can be verbal or written
1. I only
2. II only
3. III only
4. I and III
Answer: option 3
Category: Life
Question: Section 45 (Indisputability Clause) of Insurance Act, protects the Insured, from Rejection of Claim, by the Insurer; provided the Policy has completed --. Choose the Most Appropriate Option. 
1. One Year
2. Three Years
3. Five Years
4. Seven Years
Answer: option 2
Category: Life
Question: As per the Suicide Clause, if the Life-Assured Dies, as a Result of Suicide, After 3 Years of the Issue of Policy, What Does the Beneficiary Receive as the Claim?
1. Nothing
2. Premium, Paid by the Life-Assured. 
3. (2 × Premium), Paid by the Life-Assured. 
4. Full Face-Amount of the Policy. 
Answer: option 4
Category: Life
Question: What Does, First Premium Receipt (F. P. R. ), signify?
1. Free-Look Period has ended. 
2. It is the Evidence, that the Policy-Contract has begun. 
3. Policy cannot be cancelled, Now. 
4. Policy has acquired a Certain Cash-Value. 
Answer: option 2
Category: Life
Question: Identify the Document, that evidences a Contract, between the Insurer and the Insured. 
1. Proposal-Form
2. Claim-Form
3. Nomination-Form
4. Policy-Document
Answer: option 4
Category: Life
Question: Expections stated under Section 59 of the Insurance Rules 1939 for advance payment of premium. 
1. No risk to be assumed unless premium is received in advance
2. Insurance cannot be sold on credit basis in India
3. Accepting premiums in instalment in respect of Sickness Insurance, Group Personal Accident Insurance, Medical Benefits Insurance and Hospitalisation Insurance Schemes subject to certain conditions
4. None of the above
Answer: option 3
Category: Life
Question: Which One of the Following Statements, isIn-Correct, with Regard to Numerical Rating Method of Underwriting?
1. Under this Method, Underwriters assign the Positive Rating-Points for All Negative or Adverse Factors. 
2. Under this Method, Underwriters assign the Positive Points for Any Positive or Favourable Factors. 
3. Under this Method, the Total Number of Points, so assigned, will decide How Much Extra- Mortality-Rating (E. M. R. ), it has been given. 
4. Under this Method, if the Extra-Mortality- Rating (E. M. R. ) is Very High, Insurance may even be declined. 
Answer: option 2
Category: Life
Question: Which One of the Following Statements, isIn-Correct, with Regard to Judgement Method of Underwriting?
1. Under this Method, Subjective Judgement is used. 
2. This Method is especially used in Case of Complex Cases. 
3. In this Method, the Company may seek Expert Opinion of Medical Doctor. 
4. In this Method, the Underwriter assign Positive or Negative Rating-Points to the Adverse Factors. 
Answer: option 4