axondendriteplus/IC38-Insurance-Marketing-Firm-Questions huggingface dataset:
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
Correct answer: 2
Question: When are financial documents usually asked for in insurance
1. When are financial documents usually asked for in insurance
2. Only in high sum assured coverage
3. When there is a mismatch between stated income/occupation and coverage sought
4. Both (B) and (C)
Correct answer: 4
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
Correct answer: 2
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
Correct answer: 4
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
Correct answer: 3
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
Correct answer: 4
Question: What is the main cover under Overseas Travel Insurance policies
1. Life cover
2. Home insurance
3. Health cover
4. Vehicle insurance
Correct answer: 3
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
Correct answer: 3
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
Correct answer: 2
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
Correct answer: 3
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
Correct answer: 1
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. 
Correct answer: 4
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. 
Correct answer: 4
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. 
Correct answer: 3
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
Correct answer: 3
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
Correct answer: 4
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. 
Correct answer: 3
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
Correct answer: 3
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
Correct answer: 3
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. 
Correct answer: 4
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
Correct answer: 3
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
Correct answer: 3
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. 
Correct answer: 2
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
Correct answer: 1
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
Correct answer: 4
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. 
Correct answer: 3
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
Correct answer: 2
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
Correct answer: 4
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
Correct answer: 3
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
Correct answer: 1
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
Correct answer: 3
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%
Correct answer: 2
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
Correct answer: 3
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
Correct answer: 1
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
Correct answer: 4
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
Correct answer: 4
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
Correct answer: 2
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
Correct answer: 3
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
Correct answer: 1
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
Correct answer: 1
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
Correct answer: 2
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
Correct answer: 2
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
Correct answer: 2
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
Correct answer: 4
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
Correct answer: 4
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
Correct answer: 3
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
Correct answer: 2
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
Correct answer: 4
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. 
Correct answer: 3
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
Correct answer: 3
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
Correct answer: 1
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
Correct answer: 4
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
Correct answer: 2
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
Correct answer: 4
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
Correct answer: 1
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
Correct answer: 3
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. 
Correct answer: 2
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
Correct answer: 1
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
Correct answer: 1
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)
Correct answer: 2
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
Correct answer: 3
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
Correct answer: 4
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
Correct answer: 3
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
Correct answer: 3
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
Correct answer: 4
Question: What is the part of both cover notes and policy document?
1. Insurance
2. Contracts
3. Warranty
4. Agreement
Correct answer: 3
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
Correct answer: 3
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
Correct answer: 1
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
Correct answer: 4
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
Correct answer: 2
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
Correct answer: 4
Question: What does Section 64 VB of the Insurance Act-1938 state regarding the payment of insurance premiums?
1. Insurers may assume risks without receiving any premium
2. Insurers may assume risks without guarantee of premium payment
3. Insurers must receive the premium in advance or guarantee of payment before assuming the risk
4. Insurers must receive the premium after the risk is assumed
Correct answer: 3
Question: What is the purpose of the proposal form in insurance?
1. To assess the policyholder's financial stability
2. To gather information about the risk to be insured
3. To determine the premium amount quoted by other insurance companies. 
4. To provide coverage for potential losses
Correct answer: 2
Question: What is the time limit for an insurance agent to deposit the premium collected on behalf of an insurer?
1. 48 hours
2. 24 hours excluding bank and postal holidays
3. 7 days
4. 1 month
Correct answer: 2
Question: How should any refund of premium due to an insured be paid by the insurer?
1. By crediting it to the account of the agent
2. By direct payment to the insured through crossed or order cheque or electronic mode
3. By sending it to the insurer's bank account
4. By deducting it from the premium of a new policy
Correct answer: 2
Question: What is the validity of a cover note?
1. Up to 1 year
2. Up to 6 months
3. Up to 60 days
4. Up to 30 days
Correct answer: 3
Question: In which classes of business are cover notes predominantly used?
1. Health and life insurance
2. Property and liability insurance
3. Marine and motor insurance
4. Homeowners insurance
Correct answer: 3
Question: When are marine cover notes typically issued?
1. When all details required for the policy are known
2. When there is difficulty securing adequate shipping space
3. When the cargo has already been shipped
4. When the cargo is being transported inland
Correct answer: 2
Question: What is the basis of valuation for loss or damage prior to declaration and/or shipment on board the steamer under a marine cover note?
1. Market value of the goods at the time of loss or damage
2. Cost of the goods at the time of loss or damage
3. Prime cost of the goods plus charges actually incurred and for which the assured is liable
4. Value of the goods declared at the time of issuance of the cover note
Correct answer: 3
Question: What is the purpose of the certificate included in the Motor insurance policy?
1. To certify that the insured has paid the premium
2. A certificate of compliance, certifying that the cover note complies with the Insurance Act, 1938
3. A certificate of inspection, certifying that the insured vehicle is in good condition
4. A certificate to the effect that the cover note is issued in accordance with the provisions of Chapters X and XI of the Motor Vehicles Act, 1988
Correct answer: 4
Question: What types of risks are typically covered by fire insurance proposal forms?
1. Complex industrial risks
2. Agricultural risks
3. Standard risks like houses and shops
4. Risks located in remote areas
Correct answer: 3
Question: Which of the following statements is false regarding the Motor Cover Note?
1. It includes the registration mark and number, or description of the vehicles insured
2. It does not mention the effective date and time of commencement of insurance for the purpose of the Act
3. It includes the name and address of the insured
4. It includes limitations as to use and additional risks, if any
Correct answer: 2