axondendriteplus/IC38-Insurance-Agent-Questions huggingface dataset:
Category: Life
Question: 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. 
Answer: 4
Category: Life
Question: 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
Answer: 2
Category: Life
Question: 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
Answer: 2
Category: Life
Question: Which factor affects morbidity rates in health insurance
1. Financial status
2. Gender
3. Marital status
4. Educational qualification
Answer: 2
Category: Life
Question: 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
Answer: 3
Category: Life
Question: 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
Answer: 1
Category: Life
Question: Insurers charge lower premiums for which of the following risk types
1. Standard risks
2. Substandard risks
3. Preferred risks
4. Declined risks
Answer: 3
Category: Life
Question: Who plays a critical role in primary underwriting
1. Underwriter
2. Agent or Company representative
3. Policyholder
4. Insurance broker
Answer: 2
Category: Life
Question: 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
Answer: 3
Category: Life
Question: 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
Answer: 4
Category: Life
Question: Who should the insured make a request for porting to
1. The new insurer
2. The old insurer
3. IRDAI
4. Any insurance agent
Answer: 2
Category: Life
Question: 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
Answer: 2
Category: Life
Question: 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
Answer: 4
Category: Life
Question: 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
Answer: 2
Category: Life
Question: 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
Answer: 4
Category: Life
Question: 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
Answer: 3
Category: Life
Question: 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
Answer: 4
Category: Life
Question: What is the main cover under Overseas Travel Insurance policies
1. Life cover
2. Home insurance
3. Health cover
4. Vehicle insurance
Answer: 3
Category: Life
Question: 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
Answer: 3
Category: Life
Question: 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
Answer: 2
Category: Life
Question: 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
Answer: 3
Category: Life
Question: 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
Answer: 1
Category: Life
Question: 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. 
Answer: 4
Category: Life
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: 4
Category: Life
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: 3
Category: Life
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: 3
Category: Life
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: 4
Category: Life
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: 3
Category: Life
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: 3
Category: Life
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: 3
Category: Life
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: 4
Category: Life
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: 3
Category: Life
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: 3
Category: Life
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: 2
Category: Life
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: 1
Category: Life
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: 4
Category: Life
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: 3
Category: Life
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: 2
Category: Life
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: 4
Category: Life
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: 3
Category: Life
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: 1
Category: Life
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: 3
Category: Life
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: 2
Category: Life
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: 3
Category: Life
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: 1
Category: Life
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: 4
Category: Life
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: 4
Category: Life
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: 2
Category: Life
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: 3
Category: Life
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: 1
Category: Life
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: 1
Category: Life
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: 2
Category: Life
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: 2
Category: Life
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: 2
Category: Life
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: 4
Category: Life
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: 4
Category: Life
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: 3
Category: Life
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: 2
Category: Life
Question: Which document may be required for accident claims?
1. Consolidated and detailed bills
2. Identity proof
3. Dialysis/Chemotherapy/Physiotherapy charts
4. FIR or Medico-legal certificate
Answer: 4
Category: Life
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: 3
Category: Life
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: 3
Category: Life
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: 1
Category: Life
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: 4
Category: Life
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: 2
Category: Life
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: 4
Category: Life
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: 1
Category: Life
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: 3
Category: Life
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: 2
Category: Life
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: 1
Category: Life
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: 1
Category: Life
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: 2
Category: Life
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: 3
Category: Life
Question: Which of the following begin with the proposal form of insurance? I. Principle of utmost good faith II. Principle of indemnity III. Duty of disclosure of material information IV. Principle of subrogation
1. Only II
2. I and II
3. I and III
4. I, II, III and IV
Answer: 4
Category: Life
Question: Cover notes are predominantly used in case of which of the below? I. Marine insurance II. Health insurance III. Life insurance IV. Motor insurance
1. I and II
2. III and IV
3. I and IV
4. II and III
Answer: 3
Category: Life
Question: If certain terms and conditions of the policy need to be changed at the time of issuance, it is done by setting out the changes through a document called ____________. 
1. Alteration
2. Addendum
3. Endorsement
4. Modification
Answer: 3
Category: Life
Question: What are the details that are collected by insurance company in a proposal form? I. Age II. Occupation III. Build IV. Premium payment details
1. Only I and II
2. Only III and IV
3. I, II and III
4. I, II, III and IV
Answer: 4
Category: Life
Question: What is the part of both cover notes and policy document?
1. Insurance
2. Contracts
3. Warranty
4. Agreement
Answer: 3
Category: Life
Question: What principle begins with the Proposal form for insurance?
1. Principle of utmost bad faith
2. Principle of utmost honesty
3. Principle of utmost good faith
4. Principle of utmost negligence
Answer: 3
Category: Life
Question: Why does the proposer need to inform details about their previous insurances to the insurer in property insurance?
1. To ensure that the principle of contribution is applied
2. To restrict the amount of coverage depending on other PA policies
3. To give the insurer information about the subject matter of insurance
4. To decide on conducting risk inspections or collecting further details
Answer: 1
Category: Life
Question: What physical features of the subject matter are included in the proposal form?
1. Type and quality of construction
2. Age of the subject matter
3. Presence of fire-fighting equipment
4. All of the above
Answer: 4
Category: Life
Question: What is the time frame within which the insurer must process a proposal according to the Protection of Policyholders’ Interests Regulations, 2017?
1. 10 days
2. 15 days
3. 20 days
4. 30 days
Answer: 2
Category: Life
Question: When should the premium be paid in an insurance contract?
1. After the policy period has ended
2. Before the claim is filed by the insured
3. Before the expiry of the policy. 
4. In advance, before the inception date of the insurance contract
Answer: 4