Life Insurance Individual Agent - Pre-Recruitment Syllabus

IC-38 CONTENT Question Bank

Chapter No. Title No. Of Questions

Section -1 Common Chapters
1 Introduction to Insurance 15
2 Customer Service 16
3 Grievance Redressal Mechanism 11
4 Regulatory aspects of Insurance Agents 10
5 Legal Principle of an Insurance Contract 16
Section -2 Life Insurance
6 What Life Insurance Involves 11
7 Financial Planning 13
8 Life Insurance Products – I 12
9 Life Insurance Products – II 12
10 Applications of Life Insurance 11
11 Pricing and Valuation in Life Insurance 12
12 Documentation – Proposal Stage 11
13 Documentation – Policy Condition – I 11
14 Documentation – Policy Condition – II 11
15 Underwriting 13
16 Payments Under a Life Insurance Policy 11
Section -3 Health Insurance
17 Introduction to Health Insurance 7
18 Insurance Documentation 4
19 Health Insurance Products 5
20 Health Insurance Underwriting 10
21 Health Insurance Claims 10
Total No. Of Questions 232
 Chapter -1 Introduction to Insurance 7. The measures to reduce chances of occurrence of
risk are known as _____.
1. Which among the following is the regulator for the I. Risk retention
insurance industry in India? II. Loss prevention
I. Insurance Authority of India III. Risk transfer
II. Insurance Regulatory and Development IV. Risk avoidance
Authority of India
III. Life Insurance Corporation of India 8. By transferring risk to insurer, it becomes possible
IV. General Insurance Corporation of India ___________.
I. To become careless about our assets
2. Which among the following is a secondary burden II. To make money from insurance in the
of risk? event of a loss
I. Business interruption cost III. To ignore the potential risks facing our
II. Goods damaged cost assets
III. Setting aside reserves as a provision for IV. To enjoy peace of mind and plan one’s
meeting potential losses in the future business more effectively
IV. Hospitalisation costs as a result of heart
attack 9. Origins of modern insurance business can be
traced to __________.
3. Which among the following is a method of risk I. Bottomry
transfer? II. Lloyds
I. Bank FD III. Rhodes
II. Insurance IV. Malhotra Committee
III. Equity shares
IV. Real estate 10. In insurance context “risk retention‟ indicates a
situation where _____.
4. Which among the following scenarios warrants I. Possibility of loss or damage is not there
insurance? II. II. Loss producing event has no value
I. The sole bread winner of a family might die III. III. Property is covered by insurance
untimely IV. IV. One decides to bear the risk and its
II. A person may lose his wallet effects
III. Stock prices may fall drastically
IV. A house may lose value due to natural 11. Which of the following statement is true?
wear and tear I. Insurance protects the asset
II. Insurance prevents its loss
5. Which of the below insurance scheme is run by an III. Insurance reduces possibilities of loss
insurer and not sponsored by the Government? IV. Insurance pays when there is loss of asset
I. Employees State Insurance Corporation
II. Crop Insurance Scheme 12. Out of 400 houses, each valued at Rs. 20,000, on
III. Jan Arogya an average 4 houses get burnt every year resulting in
IV. All of the above a combined loss of Rs. 80,000. What should be the
annual contribution of each house owner to make
6. Risk transfer through risk pooling is called good this loss?
________. I. Rs.100/-
I. Savings II. Rs.200/-
II. Investments III. Rs.80/-
III. Insurance IV. Rs.400/-
IV. Risk mitigation
13. Which of the following statements is true? 3. As per the Consumer Protection Act, 1986, who
I. Insurance is a method of sharing the losses cannot be classified as a consumer?
of a „few‟ by „many‟ I. Hires goods / services for personal use
II. Insurance is a method of transferring the II. A person who buys goods for resale
risk of an individual to another individual purpose
III. Insurance is a method of sharing the losses III. Buys goods and services for a
of a „many‟ by a few consideration and uses them
IV. Insurance is a method of transferring the IV. Uses the services of another for a
gains of a few to the many consideration

14. Why do insurers arrange for survey and 4. What does not go on to make a healthy
inspection of the property before acceptance of a relationship?
risk? I. Attraction
I. To assess the risk for rating purposes II. Trust
II. To find out how the insured purchased the III. Communication
property IV. Scepticism
III. To find out whether other insurers have
also inspected the property 5. Which among the following is not an element of
IV. To find out whether neighbouring property active listening?
also can be insured I. Paying good attention
II. Being extremely judgmental
15. Which of the below option best describes the III. Empathetic listening
process of insurance? IV. Responding appropriately
I. Sharing the losses of many by a few
II. Sharing the losses of few by many 6. Which among the following is not a characteristic
III. One sharing the losses of few of ethical behaviour?
IV. Sharing of losses through subsidy I. Making adequate disclosures to enable the
clients to make an informed decision
Chapter -2 Customer Service II. Maintaining confidentiality of client’s
1. What is meant by customer lifetime value? business and personal information
I. Sum of costs incurred while servicing the III. Placing self-interest ahead of client’s
customer over his lifetime interests
II. Rank given to customer based on business IV. Placing client’s interest ahead of self
generated interest
III. Sum of economic benefits that can be
achieved by building a long term 7. _____________ is not a tangible good.
relationship with the customer I. House
IV. Maximum insurance that can be II. Insurance
attributed to the customer III. Mobile Phone
IV. A pair of jeans
2. Identify the scenario where a debate on the need
for insurance is not required. 8. _______________ is not an indicator of service
I. Property insurance quality.
II. Business liability insurance I. Cleverness
III. Motor insurance for third party liability II. Reliability
IV. Fire insurance III. Empathy
IV. Responsiveness
9. In India _______________ insurance is II. Ethical behaviour is not necessary for
mandatory. insurance agents
I. Motor third party liability III. Ethical behaviour helps in developing trust
II. Fire insurance for houses between the agent and the insurer
III. Travel insurance for domestic travel IV. Ethical behaviour is expected from the top
IV. Personal accident management only

10. One of the methods of reducing insurance cost of 16. Active Listening involves:
an insured is __________ I. Paying attention to the speaker
I. Reinsurance II. Giving an occasional nod and smile
II. Deductible III. Providing feedback
III. Co-insurance IV. Paying attention to the speaker, giving
IV. Rebate an occasional nod and smile and
providing feedback
11. A customer having complaint regarding his
insurance policy can approach IRDA through Chapter -3 GRIEVANCE REDRESSAL
I. IGMS MECHANISM
II. District Consumer Forum 1. The ______________ has jurisdiction to entertain
III. Ombudsman complaints, where value of the goods or services
IV. IGMS or District Consumer Forum or and the compensation claimed is up to Rs.20
Ombudsman laths.
I. District Forum
12. Consumer Protection Act deals with: II. State Commission
I. Complaint against insurance companies III. Zillah Paris had
II. Complaint against shopkeepers IV. National Commission
III. Complaint against brand
IV. Complaint against insurance companies, 2. Expand the term IGMS.
brand and shopkeepers I. Insurance General Management
System
13. ___________ has jurisdiction to entertain II. Indian General Management System
matters where value of goods or services and the III. Integrated Grievance Management
compensation claim is up to 20 laths System
I. High Court IV. Intelligent Grievance Management
II. District Forum System
III. State Commission
IV. National Commission 3. Which of the below consumer grievance
redressed agencies would handle consumer
14. In customer relationship the first impression is disputes amounting between Rs. 20 lakhs and Rs.
created: 100 lakhs?
I. By being confident I. District Forum
II. By being on time II. State Commission
III. By showing interest III. National Commission
IV. By being on time, showing interest and IV. Zilla Parishad
being confident

15. Select the correct statement:

I. Ethical behaviour is impossible while
selling insurance
4. Which among the following cannot form the IV. Within one month of rejection of the
basis for a valid consumer complaint? complaint by the insurer
I. Shopkeeper charging a price above the
MRP for a product 9. Which among the following is not a pre-requisite
II. Shopkeeper not advising the customer for launching a complaint with the Ombudsman?
on the best product in a category I. The complaint must be by an individual
III. Allergy warning not provided on a drug on a „Personal Lines‟ insurance
bottle II. The complaint must be lodged within 1
IV. Faulty products year of the insurer rejecting the
complaint
5. Which of the below will be the most appropriate III. Complainant has to approach a
option for a customer to lodge an insurance consumer forum prior to the
policy related complaint? Ombudsman
I. Police IV. The total relief sought must be within
II. Supreme Court an amount of Rs.20 lakhs.
III. Insurance Ombudsman
IV. District Court 10. Are there any fee / charges that need to be paid
for lodging the complaint with the Ombudsman?
6. Which of the below statement is correct with I. A fee of Rs 100 needs to be paid
regards to the territorial jurisdiction of the II. No fee or charges need to be paid
Insurance Ombudsman? III. 20% of the relief sought must be paid
I. Insurance Ombudsman has National as fee
jurisdiction IV. 10% of the relief sought must be paid
II. Insurance Ombudsman has State as fee
jurisdiction
III. Insurance Ombudsman has District 11. Can a complaint be launched against a private
jurisdiction insurer?
IV. Insurance Ombudsman operates only I. Complaints can be launched against
within the specified territorial limits public insurers only
II. Yes, complaint can be launched against
7. How is the complaint to be launched with an private insurers
insurance ombudsman? III. Complaint can be launched against
I. The complaint is to be made in writing private insurers only in the Life Sector
II. The complaint is to be made orally over IV. Complaint can be launched against
the phone private insurers only in the Non-Life
III. The complaint is to be made orally in a Sector
face to face manner
IV. The complaint is to be made through CHAPTER – 4 REGULATORY
newspaper advertisement ASPECTS OF INSURANCE AGENTS

8. What is the time limit for approaching an 1. The Designated Official of the insurer, on receipt
Insurance Ombudsman? of the application, shall satisfy himself that the
I. Within two years of rejection of the applicant:-
complaint by the insurer I. Has furnished the Agency Application
II. Within three years of rejection of the in Form I-A complete in all respects;
complaint by the insurer II. Has submitted the PAN details along
III. Within one year of rejection of the with the Agency Application Form;
complaint by the insurer III. Has passed the insurance examination
as specified under Regulations 6;
 IV. All the above documents submitted to the insurer for
acceptance of the proposal;
2. The designated official of insurer may process the III. Become or remain a director of any
agency application and grant appointment to the insurer;
applicant as an insurance agent by issuing an IV. All of the above
appointment letter within _______ of receipt of
all documents from the applicant. 6. No Insurance agent can force a policyholder to
I. 15 Days terminate the existing policy and to effect a new
II. 30 Days policy from him within _______ from the date of
III. 60 Days such termination of the earlier policy
IV. 90 Days I. One year
II. Three year
3. The pass certificate issued by the Examining Body III. Five year
shall be in force for a period of __________, for IV. Six months
the purpose of seeking appointment as an agent
with any insurer for the first time 7. In case of suspension of agency, Insurer shall :
I. 3 months I. Force a policyholder to terminate the
II. 6 months existing policy and to effect a new
III. 9 months policy from him within three years
IV. 12 months from the date of termination of the
earlier policy
4. Every agent shall adhere to the code of conduct II. The insurer shall also inform other
which states: insurers, Life or General or Health
I. Show the agency identity card to the Insurer or mono-line insurer with
prospect, and also disclose the agency whom he/she is acting as an agent, of
appointment letter to the prospect on the action taken against the Insurance
demand Agent for their records and necessary
II. Disclose the scales of commission in action
respect of the insurance product III. recover the appointment letter and
offered for sale, if asked by the Identity card from the agent whose
prospect; appointment has been cancelled under
III. Bring to the notice of the insurer every these Regulations within 7 days of
fact about the prospect relevant to issuance of final order effecting
insurance underwriting, including any cancellation of appointment
adverse habits or income inconsistency IV. All of the above
of the prospect, within the knowledge
of the agent, in the form of a report 8. In case a suspension is revoked in respect of any
called “Insurance Agent’s Confidential agent on conclusion of disciplinary action by way
Report” along with every proposal of issuance of a speaking order by Designated
submitted to the insurer wherever Official, the details of such agent:
applicable I. Shall continue to be in blacklist for next
IV. All of the above 12 months
II. Shall be removed from list of black
5. No Insurance agent shall : listed Agents as soon as the Speaking
I. Behave in a discourteous manner with Order revoking his/her suspension is
the prospect issued
II. Induce the prospect to submit wrong III. Shall be removed from list of black
information in the proposal form or listed Agents after 90 days
IV. Shall never be removed from blacklist
 I. Fraud
9. Any insurer or any representative of the insurer II. Undue influence
acting on behalf of the insurer, who appoints an III. Coercion
individual as an insurance agent not permitted to IV. Mistake
act as such or transact any insurance business in
India shall be liable to penalty which may extend 6. Which among the following is true regarding life
to ______ rupees insurance contracts?
I. One Crore I. They are verbal contracts not legally
II. One Lakh enforceable
III. Ten Thousand II. They are verbal which are legally
IV. One Thousand enforceable
III. They are contracts between two
CHAPTER – 5 LEGAL PRINCIPLES OF AN INSURANCE parties (insurer and insured) as per
CONTRACT requirements of Indian Contract Act,
1872
1. Which among the following is an example of IV. They are similar to wager contracts
coercion?
I. Ramesh signs a contract without having 7. Which of the below is not a valid consideration for
knowledge of the fine print a contract?
II. Ramesh threatens to kill Mahesh if he I. Money
does not sign the contract II. Property
III. Ramesh uses his professional standing III. Bribe
to get Mahesh to sign a contract IV. Jewellery
IV. Ramesh provides false information to
get Mahesh to sign a contract 8. Which of the below party is not eligible to enter
into a life insurance contract?
2. Which among the following options cannot be I. Business owner
insured by Ramesh? II. Minor
V. Ramesh‟s house III. House wife
I. Ramesh‟s spouse IV. Government employee
II. Ramesh‟s friend
III. Ramesh‟s parents 9. Which of the below action showcases the principle
of “Uberrima Fides”?
3. Which element of a valid contract deals with I. Lying about known medical conditions
premium? on an insurance proposal form
I. Offer and acceptance II. Not revealing known material facts on
II. Consideration an insurance proposal form
III. Free consent III. Disclosing known material facts on an
IV. Capacity of parties to contract insurance proposal form
IV. Paying premium on time
4. _____________ relates to inaccurate statements,
which are made without any fraudulent intention. 10. Which of the below is not correct with regards to
I. Misrepresentation insurable interest?
II. Contribution I. Father taking out insurance policy on
III. Offer his son
IV. Representation II. Spouses taking out insurance on one
another
5. ________________ involves pressure applied III. Friends taking out insurance on one
through criminal means. another
 IV. Employer taking out insurance on 16. Indemnity might take from which of the
employees following modes of settlement:
I. Repair of a damaged item
11. When is it essential for insurable interest to be II. Replacement of the lost or damaged
present in case of life insurance? item
I. At the time of taking out insurance III. Restoration,
II. At the time of claim IV. All of the above
III. Insurable interest is not required in
case of life insurance CHAPTER – 6 WHAT LIFE INSURANCE INVOLVES
IV. Either at time of policy purchase or at
the time of claim 1. How does diversification reduce risks in financial
markets?
12. Find out the proximate cause for death in the I. Collecting funds from multiple sources
following scenario? and investing them in one place
Ajay falls off a horse and breaks his back. He lies II. Investing funds across various asset
there in a pool of water and contracts classes
pneumonia. He is admitted to the hospital and III. Maintaining time difference between
dies because of pneumonia. investments
I. Pneumonia IV. Investing in safe assets
II. Broken back
III. Falling off a horse 2. Which of the below is not an element of the life
IV. Surgery insurance business?
I. Asset
13. A policy of insurance may be called in question II. Risk
at any time within ____ years from the date of III. Principle of mutuality
issuance of the policy or the date of IV. Subsidy
commencement of risk or the date of revival, of
the policy or the date of the rider to the policy, 3. Who devised the concept of HLV?
whichever is later, on the ground of fraud. I. Dr. Martin Luther King
I. Two II. Warren Buffet
II. Three III. Prof. Hubener
III. Four IV. George Soros
IV. Five
4. Which of the below mentioned insurance plans
14. Principle of indemnity is applicable for: has the least or no amount of savings element?
I. Life Insurance only I. Term insurance plan
II. Non- Life Insurance only II. Endowment plan
III. Both a & b III. Whole life plan
IV. Health Insurance only IV. Money back plan

15. Process which an insurance company uses to 5. Which among the following cannot be termed as
recover claim amounts paid to a policy holder an asset?
from a negligent third party is known as: I. Car
I. Insurable Interest II. Human Life
II. Indemnity III. Air
III. Subrogation IV. House
IV. Utmost Good Faith
6. Which of the below cannot be categorised under
risks?
 I. Dying too young CHAPTER -7 FINANCIAL PLANNING
II. Dying too early
III. Natural wear and tear 1. Which among the following would you
IV. Living with disability recommend in order to seek protection against
unforeseen events?
7. Which among these statements is true? I. Insurance
I. Life insurance policies are contracts of II. Transactional products like bank FD‟s
indemnity while general insurance III. Shares
policies are contracts of assurance IV. Debentures
II. Life insurance policies are contracts of
assurance while general insurance 2. When is the best time to start financial planning?
policies are contracts of indemnity I. Post retirement
III. In case of general insurance the risk II. As soon as one gets his first salary
event protected against is certain III. After marriage
IV. The certainty of risk event in case of IV. Only after one gets rich
general insurance increases with time
3. Which among the following is not an objective of
8. Which among the following methods is a tax planning?
traditional method that can help determine the I. Maximum tax benefit
insurance needed by an individual? II. Reduced tax burden as a result of
I. Human Economic Value prudent investments
II. Life Term Proposition III. Tax evasion
III. Human Life Value IV. Full advantage of tax breaks
IV. Future Life Value
4. An individual with an aggressive risk profile is
9. Which of the below is the most appropriate likely to follow wealth _______ investment style.
explanation for the fact that young people are I. Consolidation
charged lesser life insurance premium as compared II. Gifting
to old people? III. Accumulation
I. Young people are mostly dependant IV. Spending
II. Old people can afford to pay more
III. Mortality is related to age 5. Which among the following is a wealth
IV. Mortality is inversely related to age accumulation product?
I. Bank Loans
10. Which of the below is not an advantage of cash II. Shares
value insurance contracts? III. Term Insurance Policy
I. Safe and secure investment IV. Savings Bank Account
II. Inculcates saving discipline
III. Lower yields 6. Savings can be considered as a composite of two
IV. Income tax advantages decisions. Choose them from the list below.
I. Risk retention and reduced consumption
11. Which of the below is an advantage of cash value II. Gifting and accumulation
insurance contracts? III. Spending and accumulation
I. Returns subject to corroding effect of IV. Postponement of consumption and parting
inflation with liquidity
II. Low accumulation in earlier years
III. Lower yields 7. During which stage of life will an individual
IV. Secure investment appreciate past savings the most?
I. Post retirement
 II. Earner
III. Learner CHAPTER – 8 LIFE INSURANCE PRODUCTS – I
IV. Just married
1. Which among the following is an intangible
8. What is the relation between investment horizon product?
and returns? I. Car
I. Both are not related at all II. House
II. Greater the investment horizon the larger III. Life insurance
the returns IV. Soap
III. Greater the investment horizon the smaller
the returns 2. The premium paid for whole life insurance is
IV. Greater the investment horizon more tax _____________ than the premium paid for term
on the returns assurance.
I. Higher
9. Which among the following can be categorised II. Lower
under transactional products? III. Equal
I. Bank deposits IV. Substantially higher
II. Life insurance
III. Shares 3. ___________ life insurance pays off a
IV. Bonds policyholder's mortgage in the event of the person's
death.
10. Which among the following can be categorised I. Term
under contingency products? II. Mortgage
I. Bank deposits III. Whole
II. Life insurance IV. Endowment
III. Shares
IV. Bonds 4. The ________ the premium paid by you towards
your life insurance, the ________ will be the
11. Which of the below can be categorised under compensation paid to the beneficiary in the event of
wealth accumulation products? your death.
I. Bank deposits I. Higher, Higher
II. Life insurance II. Lower, Higher
III. General insurance III. Higher, Lower
IV. Shares IV. Faster, Slower

12. __________ is a rise in the general level of prices 5. Which of the below option is correct with regards
of goods and services in an economy over a period of to a term insurance plan?
time. I. Term insurance plans come with life-long
I. Deflation renewability option
II. Inflation II. All term insurance plans come with a built-
III. Stagflation in disability rider
IV. Hyperinflation III. Term insurance can be bought as a stand-
alone policy as well as a rider with another
13. Which of the below is not a strategy to maximise policy
discretionary income? IV. There is no provision in a term insurance
I. Debt restructuring plans to convert it into a whole life
II. Loan transfer insurance plan
III. Investment restructuring
IV. Insurance purchase
6. In decreasing-term insurance, the premiums paid III. It has both a death benefit as well as a
____________ over time. survival component
I. Increase IV. It is similar to a term plan
II. Decrease
III. Remain constant 12. Which of the below is an example of an
IV. Are returned endowment assurance plan?
I. Mortgage Redemption Plan
7. Using the conversion option present in a term II. Credit Life Insurance Plan
policy you can convert the same to __________. III. Money Back Plan
I. Whole life policy IV. Whole Life Plan
II. Mortgage policy
III. Bank FD CHAPTER – 9 LIFE INSURANCE PRODUCTS – II
IV. Decreasing term policy
1. Which among the following is a non-traditional life
8. What is the primary purpose of a life insurance insurance product?
product? I. Term assurance
I. Tax rebates II. Universal life insurance
II. Safe investment avenue III. Endowment insurance
III. Protection against the loss of economic IV. Whole life insurance
value of an individual’s productive abilities
IV. Wealth accumulation 2. Which of the below statement is incorrect?
I. Variable life insurance is a temporary life
9. Who among the following is best advised to insurance policy
purchase a term plan? II. Variable life insurance is a permanent life
I. An individual who needs money at the end insurance policy
of insurance term III. The policy has a cash value account
II. An individual who needs insurance and has IV. The policy provides a minimum death
a high budget benefit guarantee
III. An individual who needs insurance but has
a low budget 3. What does inter-temporal allocation of resources
IV. An individual who needs an insurance refer to?
product that gives high returns I. Postponing allocation of resources until
the time is right
10. Which of the below statement is incorrect with II. Allocation of resources over time
regards to decreasing term assurance? III. Temporary allocation of resources
I. Death benefit amount decreases with the IV. Diversification of resource allocation
term of coverage
II. Premium amount decreases with the term 4. Which among the following is a limitation of
of coverage traditional life insurance products?
III. Premium remains level throughout the I. Yields on these policies is high
term II. Clear and visible method of arriving at
IV. Mortgage redemption plans are an surrender value
example of decreasing term assurance III. Well defined cash and savings value
plans component
IV. Rate of return is not easy to ascertain
11. Which of the below statement is correct with
regards to endowment assurance plan? 5. Where was the Universal Life Policy introduced
I. It has a death benefit component only first?
II. It has a survival benefit component only I. USA
 II. Great Britain IV. ULIP policy structure is transparent with
III. Germany regards to the insurance expenses
IV. France component

6. Who among the following is most likely to buy 10. As per IRDAI norms, an insurance company can
variable life insurance? provide which of the below nontraditional
I. People seeking fixed return savings life insurance products are permitted in
II. People who are risk averse and do not India?
dabble in equity Choice I: Unit Linked Insurance Plans Choice
III. Knowledgeable people comfortable with II: Variable Insurance Plans
equity I. I only
IV. Young people in general II. II only
III. I and II both
7. Which of the below statement is true regarding IV. Neither I nor II
ULIP‟s?
I. Value of the units is determined by a 12. What does unbundling of life insurance products
formula fixed in advance refers to?
II. Investment risk is borne by the insurer I. Correlation of life insurance products with
III. ULIP‟s are opaque with regards to their bonds
term, expenses and savings components II. Correlation of life insurance products with
IV. ULIP‟s are bundled products equities
III. Amalgamation of protection and savings
8. All of the following are characteristics of variable element
life insurance EXCEPT: IV. Separation of the protection and savings
I. Flexible premium payments element
II. Cash value is not guaranteed
III. Policy owner selects where savings reserve Chapter – 10 APPLICATIONS OF
is invested LIFE INSURANCE
IV. Minimum Death benefit is guaranteed
1. What is the objective behind Mortgage
9. Which of the below is correct with regards to Redemption Insurance?
universal life insurance? I. Facilitate cheaper mortgage rates
Statement I: It allows policy owner to vary II. Provide financial protection for home loan
payments Statement II: Policy owner can earn borrowers
market based rate of return on cash value III. Protect value of the mortgaged property
I. I is true IV. Evade eviction in case of default
II. II is true
III. I and II are true 2. The sum assured under key man insurance policy
IV. I and II are false is generally linked to which of the following?
I. Key man income
10. All of the following is true regarding ULIP‟s II. Business profitability
EXCEPT: III. Business history
I. Unit holder can choose between different IV. Inflation index
kind of funds
II. Life insurer provides guarantee for unit 3. Mortgage redemption insurance (MRI) can be
values categorised under ________.
III. Units may be purchased by payment of a I. Increasing term life assurance
single premium or via regular premium II. Decreasing term life assurance
payments. III. Variable life assurance
 IV. Universal life assurance IV. Neither I nor II is true

4. Which of the below losses are covered under key 9. Ajay pays insurance premium for his employees.
man insurance? Which of the below insurance premium will not be
I. Property theft treated deductible as compensation paid to
II. Losses related to the extended period employee?
when a key person is unable to work Choice I: Health insurance with benefits payable to
III. General liability employee
IV. Losses caused due to errors and omission Choice II: Key man life insurance with benefits
payable to Ajay
5. A policy is effected under the MWP Act. If the I. I only
policyholder does not appoint a special trustee to II. II only
receive and administer the benefits under the policy, III. Both I and II
the sum secured under the policy becomes payable IV. Neither I nor II
to the _____________.
I. Next of kin 10. The practice of charging interest to borrowers
II. Official Trustee of the State who pledge their property as collateral but leaving
III. Insurer them in possession of the property is called
IV. Insured _____________.
I. Security
6. Mahesh ran a business on borrowed capital. After II. Mortgage
his sudden demise, all the creditors are doing their III. Usury
best to go after Mahesh’s assets. Which of the below IV. Hypothecation
assets is beyond the reach of the creditors?
I. Property under Mahesh’s name 11. Which of the below policy can provide protection
II. Mahesh’s bank accounts to home loan borrowers?
III. Term life insurance policy purchased under I. Life Insurance
Section 6 of MWP Act II. Disability Insurance
IV. Mutual funds owned by Mahesh III. Mortgage Redemption Insurance
IV. General Insurance
7. Which of the below option is true with regards to
MWP Act cases? CHAPTER – 11 PRICING AND VALUATION IN LIFE
Statement I: Maturity claims cheques are paid to INSURANCE
policyholders
Statement II: Maturity claims cheques are paid to 1. What does a policy lapse mean?
trustees I. Policyholder completes premium payment
I. I is true for a policy
II. II is true II. Policyholder discontinues premium
III. Both I and II are true payment for a policy
IV. Neither I nor II is true III. Policy attains maturity
IV. Policy is withdrawn from the market
8. Which of the below option is true with regards to
MWP act cases? 2. Who bears the investment risk in case of ULIPs?
Statement I: Death claims are settled in favour of I. Insurer
nominees Statement II: Death claims are settled in II. Insured
favour of trustees III. State
I. I is true IV. IRDA
II. II is true
III. Both I and II are true
3. What does the term “premium” denote in relation Which of the below statement is correct with regards
to an insurance policy? to interest rates?
I. Profit earned by the insurer I. Lower the interest rate assumed, lower the
II. Price paid by an insured for purchasing the premium
policy II. Higher the interest rate assumed, higher
III. Margins of an insurer on a policy the premium
IV. Expenses incurred by an insurer on a policy III. Higher the interest rate assumed, lower
the premium
4. Which of the below is not a factor in determining IV. The interest rates don’t affect premiums
life insurance premium?
I. Mortality 10. Which of the below statement is correct?
II. Rebate I. Business strain is the difficulty faced by the
III. Reserves companies in securing new business
IV. Management expenses II. Business strain arises at the end of the
policy term.
5. What is a policy withdrawal? III. Business strain arises because of excess
I. Discontinuation of premium payment by premium
policyholder IV. Business strain arises because of excess
II. Surrender of policy in return for acquired expenses at the new business stage.
surrender value
III. Policy upgrade 11. With regards to valuation of assets by insurance
IV. Policy downgrade companies, __________ is the value at which the life
insurer has purchased or acquired its assets.
6. Which of the below is one of the ways of defining I. Discounted future value
surplus? II. Discounted present value
I. Excessive liabilities III. Market value
II. Excessive turnover IV. Book value
III. Excess value of liabilities over assets
IV. Excess value of assets over liabilities 12. In case of __________, a company expresses the
bonus as a percentage of basic benefit and already
7. Which of the below is not a component of ULIP attached bonuses.
premiums? I. Reversionary bonus
I. Policy allocation charge II. Compound bonus
II. Investment risk premium III. Terminal bonus
III. Mortality charge IV. Persistency bonus
IV. Social security charge
CHAPTER -12 DOCUMENTATION – PROPOSAL STAGE
8. Life insurance companies may offer rebate to the
buyer on the premium that is payable on the basis of 1. During the _________ period, if the policyholder
___________. has bought a policy and does not want it, he / she
I. Sum assured chosen by the buyer can return it and get a refund.
II. Type of policy chosen by the buyer I. Free evaluation
III. Term of the plan chosen by the buyer II. Free look
IV. Mode of payment (cash, cheque, card) III. Cancellation
chosen by the buyer IV. Free trial

9. Interest rates are one of the important 2. Which of the below is an example of standard age
components used while determining the premium. proof?
I. Ration card
 II. Horoscope I. Illegal, illegal
III. Passport II. Legal, legal
IV. Village Panchayat certificate III. Illegal, legal
IV. Legal, illegal
3. Which of the below can be attributed to moral
hazard? 9. In case the policyholder is not satisfied with the
I. Increased risky behaviour following the policy, he / she can return the policy within the free-
purchase of insurance look period i.e. within ________of receiving the
II. Increased risky behaviour prior to the policy document.
purchase of insurance I. 60 days
III. Decreased risky behaviour following the II. 45 days
purchase of insurance III. 30 days
IV. Engaging in criminal acts post being IV. 15 days
insured
10. Which of the below statement is correct with
4. Which of the below features will be checked in a regards to a policy returned by a policyholder during
medical examiner’s report? the free look period?
I. Emotional behaviour of the proposer I. The insurance company will refund 100%
II. Height, weight and blood pressure of the premium
III. Social status II. The insurance company will refund 50% of
IV. Truthfulness the premium
III. The insurance company will refund the
5. A __________ is a formal legal document used by premium after adjusting for proportionate
insurance companies that provides details about the risk premium for the period on cover,
product. medical examination expenses and stamp
I. Proposal form duty charges
II. Proposal quote IV. The insurance company will forfeit the
III. Information docket entire premium
IV. Prospectus
11. Which of the below is not a valid address proof?
6. The application document used for making the I. PAN Card
proposal is commonly known as the __________. II. Voter ID Card
I. Application form III. Bank passbook
II. Proposal form IV. Driving license
III. Registration form
IV. Subscription form CHAPTER -13 DOCUMENTATION – POLICY
CONDITION – I
7. From the below given age proof documents,
identify the one which is classified as non-standard 1. What does a first premium receipt (FPR) signify?
by insurance companies. Choose the most appropriate option.
I. School certificate I. Free look period has ended
II. Identity card in case of defense personnel II. It is evidence that the policy contract has
III. Ration card begun
IV. Certificate of baptism III. Policy cannot be cancelled now
IV. Policy has acquired a certain cash value
8. Money laundering is the process of bringing
_______ money into an economy by hiding its 2. Which of the following documents is an evidence
_______ origin so that it appears to be legally of the contract between insurer and insured?
acquired. I. Proposal form
 II. Policy document
III. Prospectus 7. What will happen if the insured person loses the
IV. Claim form original life insurance policy document?
I. The insurance company will issue a
3. If complex language is used to word a certain duplicate policy without making any
policy document and it has given rise to an changes to the contract
ambiguity, how will it generally be construed? II. The insurance contract will come to an end
I. In favour of insured III. The insurance company will issue a
II. In favour of insurer duplicate policy with renewed terms and
III. The policy will be declared as void and the conditions based on the current health
insurer will be asked to return the declarations of the life insured
premium with interest to the insured IV. The insurance company will issue a
IV. The policy will be declared as void and the duplicate policy without making any
insurer will be asked to return the changes to the contract, but only after a
premium to the insured without any Court order.
interest
8. Which of the below statement is correct?
4. Select the option that best describes a policy I. The policy document has to be signed by a
document. competent authority but need not be
I. It is evidence of the insurance contract compulsorily stamped according to the
II. It is evidence of the interest expressed by Indian Stamp Act.
the insured in buying an insurance policy II. The policy document has to be signed by a
from the company competent authority and should be
III. It is evidence of the policy (procedures) stamped according to the Indian Stamp
followed by an insurance company when Act.
dealing with channel partners like banks, III. The policy document need not be signed
brokers and other entities by a competent authority but should be
IV. It is an acknowledgement slip issued by the stamped according to the Indian Stamp
insurance company on payment of the first Act.
premium IV. The policy document neither needs to be
signed by a competent authority nor it
5. Which of the below statement is correct? needs to be compulsorily stamped
I. The proposal form acceptance is the according to the Indian Stamp Act.
evidence that the policy contract has
begun 9. Which of the below forms the first part of a
II. The acceptance of premium is evidence standard insurance policy document?
that the policy has begun I. Policy schedule
III. The First Premium Receipt is the evidence II. Standard provisions
that the policy contract has begun III. Specific policy provisions
IV. The premium quote is evidence that the IV. Claim procedure
policy contract has begun
10. In a standard insurance policy document, the
6. For the subsequent premiums received by the standard provisions section will have information on
insurance company after the first premium, the which of the below?
company will issue __________. I. Date of commencement, date of maturity
I. Revival premium receipt and due date of last premium
II. Restoration premium receipt II. Name of nominee
III. Reinstatement premium receipt
IV. Renewal premium receipt
 III. The rights and privileges and other 4. When is a policy deemed to be lapsed?
conditions, which are applicable under the I. If the premiums are not paid on due date
contract II. If the premiums are not paid before the
IV. The signature of the authorised signatory due date
and policy stamp III. If the premium has not been paid even
during days of grace
11. “A clause precluding death due to pregnancy for IV. If the policy is surrendered
a lady who is expecting at the time of writing the
contract” will be included in which section of a 5. Which of the below statement is correct with
standard policy document? regards to grace period of an insurance policy?
I. Policy schedule I. The standard length of the grace period is
II. General provisions one month.
III. Standard provisions II. The standard length of the grace period is
IV. Specific policy provisions 30 days.
CHAPTER -14 III. The standard length of the grace period is
DOCUMENTATION - POLICY one month or 30 days.
CONDITION – II IV. The standard length of the grace period is
one month or 31 days.
1. Under what circumstances would the policyholder
need to appoint an appointee? 6. What will happen if the policyholder does not pay
I. Insured is minor the premium by the due date and dies during the
II. Nominee is a minor grace period?
III. Policyholder is not of sound mind I. The insurer will consider the policy void
IV. Policyholder is not married due to non-payment of premium by the
due date and hence reject the claim
2. Which of the below statement is false with II. The insurer will pay the claim and waive off
regards to nomination? the last unpaid premium
I. Policy nomination is not cancelled if the III. The insurer will pay the claim after
policy is assigned to the insurer in return deducting the unpaid premium
for a loan IV. The insurer will pay the claim after
II. Nomination can be done at the time of deducting the unpaid premium along with
policy purchase or subsequently interest which will be taken as 2% above
III. Nomination can be changed by making an the bank savings interest rate
endorsement in the policy
IV. A nominee has full rights on the whole of 7. During the revival of a lapsed policy, which of the
the claim below aspect is considered most significant by the
insurance company? Choose the most appropriate
3. In order for the policy to acquire a guaranteed option.
surrender value, for how long must the premiums be I. Evidence of insurability at revival
paid as per law? II. Revival of the policy leading to increase in
I. Premiums must be paid for at least 2 risk for the insurance company
consecutive years III. Payment of unpaid premiums with interest
II. Premiums must be paid for at least 3 IV. Insured submitting the revival application
consecutive years within a specified time frame
III. Premiums must be paid for at least 4
consecutive years 8. For an insurance policy nomination is allowed
IV. Premiums must be paid for at least 5 under _________ of the Insurance Act, 1938.
consecutive years I. Section 10
II. Section 38
 III. Section 39 II. An obese person
IV. Section 45 III. A person suffering from AIDS
IV. Housewife with no income of her own
9. Which of the below statement is incorrect with
regards to a policy against which a loan has been 2. Which of the following is an example of moral
taken from the insurance company? hazard?
I. The policy will have to be assigned in I. Stunt artist dies while performing a stunt
favour of the insurance company II. A person drinking copious amounts of
II. The nomination of such policy will get alcohol because he is inured
cancelled due to assignment of the policy III. Insured defaulting on premium payments
in favour of the insurance company IV. Proposer lying on policy document
III. The nominee’s right will affected to the
extent of the insurer’s interest in the policy 3. Why is heredity history of importance in medical
IV. The policy loan is usually limited to a underwriting?
percentage of the policy’s surrender value I. Rich parents have healthy kids
II. Certain diseases can be passed on from
10. Which of the below statement is incorrect with parents to children
regards to assignment of an insurance policy? III. Poor parents have malnourished kids
I. In case of Absolute Assignment, in the IV. Family environment is a critical factor
event of death of the assignee, the title of
the policy would pass to the estate of the 4. Which of the following denotes the underwriter’s
deceased assignee. role in an insurance company?
II. The assignment of a life insurance policy I. Process claims
implies the act of transferring the rights II. Decide acceptability of risks
right, title and interest in the policy (as III. Product design architect
property) from one person to another. IV. Customer relations manager
III. It is necessary that the policyholder must
give notice of assignment to the insurer. 5. Which of the following is not an underwriting
IV. In case of Absolute Assignment, the policy decision?
vests absolutely with the assignee till I. Risk acceptance at standard rates
maturity, except in case of death of the II. Declinature of risk
insured during the policy tenure, wherein III. Postponement of risk
the policy reverts back to the beneficiaries IV. Claim rejection
of the insured.
6. Which of the following is not a standard age
11. Which of the below alteration will be permitted proof?
by an insurance company? I. Passport
I. Splitting up of the policy into two or more II. School leaving certificate
policies III. Horoscope
II. Extension of the premium paying term IV. Birth certificate
III. Change of the policy from with profit
policy to without profit policy 7. Which of the following condition will affect a
IV. Increase in the sum assured person’s insurability negatively?
I. Daily jogs
CHAPTER -15 UNDERWRITING II. Banned substance abuse
III. Lazy nature
1. Which of the following cases is likely to be IV. Procrastination
declined or postponed by a life insurer?
I. Healthy 18 year old
8. Under what method of underwriting does an III. Any of the above method since an illness
underwriter assign positive rating points for all like diabetes does not play a major role in
negative or adverse factors (negative points for any the underwriting process
positive or favourable factors)? IV. Neither of the above method as diabetes
I. Judgment cases are rejected outright
II. Arbitrary
III. Numerical rating 12. Santosh has applied for a term insurance policy.
IV. Single step His anticipated mortality is significantly lower
than standard lives and hence could be charged a
9. Under risk classification, ___________ consist of lower premium. Under risk classification, Santosh
those whose anticipated mortality corresponds to will be classified under ___________.
the standard lives represented by the mortality I. Standard lives
table. II. Preferred risks
I. Standard lives III. Substandard lives
II. Preferred risks IV. Declined lives
III. Sub-standard lives
IV. Declined lives CHAPTER -16 PAYMENTS UNDER A
LIFE INSURANCE POLICY
10. Amruta is pregnant. She has applied for a term
insurance cover. Which of the below option will be 1. Which of the below statement best describes the
the best option to choose for an underwriter to offer concept of claim? Choose the most appropriate
insurance to Amruta? Choose the most likely option. option.
I. Acceptance at ordinary rates I. A claim is a request that the insurer should
II. Acceptance with extra premium make good the promise specified in the
III. Decline the proposal contract
IV. Acceptance with a restrictive clause II. A claim is a demand that the insurer should
make good the promise specified in the
11. Which of the below insurance proposal is not contract
likely to qualify under non-medical underwriting? III. A claim is a demand that the insured
I. Savita, aged 26 years, working in an IT should make good the commitment
company as a software engineer specified in the agreement
II. Mahesh, aged 50 years, working in a coal IV. A claim is a request that the insured should
mine make good the promise specified in the
III. Satish, aged 28 years, working in a bank agreement
and has applied for an insurance cover of
Rs. 1 crore 2. Given below is a list of policies. Identify under
IV. Pravin, aged 30 years, working in a which type of policy, the claim payment is made in
departmental store and has applied for an the form of periodic payments?
endowment insurance plan for a tenure of I. Money-back policy
10 years II. Unit linked insurance policy
III. Return of premium policy
11. Sheena is suffering from acute diabetes. She has IV. Term insurance policy
applied for an insurance plan. In this case the
underwriter is most likely to use ____________ 3. Mahesh has bought a life insurance policy with a
for underwriting. Choose the most appropriate critical illness rider. He has made absolute
option. assignment of the policy in favour of Karan. Mahesh
I. Judgment method suffers a heart attack and there is a claim of Rs.
II. Numerical method 50,000 under the critical illness rider. To whom will
the payment be made in this case?
 I. Mahesh 8. Shankar bought a 10 year Unit Linked Insurance
II. Karan Plan. If he dies before the maturity of the policy
III. The payment will be shared equally by which of the below will be paid?
Mahesh and Karan I. Lower of sum assured or fund value
IV. Neither of the two because Mahesh has II. Higher of sum assured or fund value
suffered the heart attack but the policy is III. Premiums paid will be returned with 2%
assigned in favour of Karan. higher interest rate as compared to a
bank’s savings deposit
4. Praveen died in a car accident. The beneficiary IV. Surrender value
submits documents for death claim. Which of the
below document is an additional document required 9. based on classification of claims (early or non-
to be submitted in case of accidental death as early), pick the odd one out?
compared to natural death. I. Ramie dies after 6 months of buying a term
I. Certificate of burial or cremation insurance plan
II. Treating physician’s certificate II. Manor dies after one and half years of
III. Employer’s certificate buying a term insurance plan
IV. Inquest Report III. David dies after two and half years of
buying a term insurance plan
5. Which of the below death claim will be treated as IV. Proven dies after five and half years of
an early death claim? buying a term insurance plan
I. If the insured dies within three years of
policy duration 10. Given below is a list of documents to be
II. If the insured dies within five years of submitted for a normal death claim by all
policy duration beneficiaries in the event of death of life insured.
III. If the insured dies within seven years of Pick the odd one out which is additionally required
policy duration to be submitted only in case of death by accident.
IV. If the insured dies within ten years of I. Inquest report
policy duration II. Claim form
III. Certificate of burial or cremation
6. Given below are some events that will trigger IV. Hospital’s certificate
survival claims. Identify which of the below
statement is incorrect? 11. As per IRDAI (Protection of Policyholders
I. Claim paid on maturity of a term insurance Interests) Regulations, 2002, a claim under a life
policy policy shall be paid or be disputed, within 30 days
II. An installment payable upon reaching the from the date of receipt of all relevant papers and
milestone under a money-back policy clarifications required.
III. Claim paid for critical illnesses covered I. 7 days
under the policy as a rider benefit II. 15 days
IV. Surrender value paid on surrender of an III. 30 days
endowment policy by the policyholder IV. 45 days

7. A payment made under a money-back policy upon CHAPTER -17 INTRODUCTIONS TO HEALTH
reaching a milestone will be classified under which INSURANCE
type of claim?
I. Death claim 1. Factors determine the health of any individual:
II. Maturity claim I. Lifestyle factors
III. Periodical survival claim II. Environmental factors
IV. Surrender claim III. Genetic factors
IV. All of the above
 CHAPTER -18 INSURANCE DOCUMENTATION
2. ___________ refers to the healthcare services
provided by medical specialists and other health 1. As per guidelines, an insurance company has to
professionals who generally do not have first contact process an insurance proposal within __________.
with patient I. 7 days
I. Primary healthcare II. 15 days
II. Secondary Healthcare III. 30 days
III. Tertiary healthcare IV. 45 days
IV. General healthcare
2. In case the premium payment is made by cheque,
3. _________ is specialized consultative healthcare, then which of the below statement will hold true?
usually for inpatients I. The risk may be assumed on the date on
I. Primary healthcare which the cheque is posted
II. Secondary Healthcare II. The risk may be assumed on the date on
III. Tertiary healthcare which the cheque is deposited by the
IV. General healthcare insurance company
III. The risk may be assumed on the date on
4. Employees‟ State Insurance Scheme, introduced which the cheque is received by the
vides: insurance company
I. Insurance act’ 1938 IV. The risk may be assumed on the date on
II. IRDA act’ 1999 which the cheque is issued by the proposer
III. The ESI Act, 1948
IV. None of the above 3. Which of the below statement is correct with
regards to a warranty?
5. Which among these is true for ESI scheme? I. A warranty is a condition which is implied
I. All workers earning wages up to Rs. 15,000 without being stated in the policy
are covered under the contributory II. A warranty is a condition expressly stated
scheme in the policy
II. Employee and employer contribute 1.75% III. A warranty is a condition expressly stated
and 4.75% of pay roll respectively; in the policy and communicated to the
III. state governments contribute 12.5% of the insured separately and not as part of the
medical expenses policy document
IV. All the above IV. If a warranty is breached, the claim can still
be paid if it is not material to the risk
6. Public health sector includes:
I. Anganwadi workers 4. If certain terms and conditions of the policy need
II. Trained Birth Attendants to be modified at the time of issuance, it is done by
III. ASHA setting out the amendments through __________.
IV. All of the above I. Warranty
II. Endorsement
7. _________are not authorized to sell insurance but III. Alteration
provide administrative services to insurance IV. Modifications are not possible
companies.
I. Insurance Brokers
II. Third Party Administrators
III. Insurance Web Aggregators
IV. Insurance Marketing Firms
 CHAPTER -19 HEALTH INSURANCE PRODUCTS IV. The insured does not pay and the
insurance company settles the bill
1. Which of the below statement is correct with directly with the hospital
regards to a hospitalization expenses policy?
4. Identify the correct full form of PPN with regards
I. Only hospitalization expenses are to hospitals in health insurance.
covered
II. Hospitalization as well as pre and post I. Public Preferred Network
hospitalization expenses are covered II. Preferred Provider Network
III. Hospitalization as well as pre and post III. Public Private Network
hospitalization expenses are covered IV. Provider Preferential Network
and a lump sum amount is paid to the
family members in the event of 5. Identify which of the below statement is
insured’s death incorrect?
IV. Hospitalization expenses are covered
from the first year and pre and post I. An employer can take a group policy
hospitalization expenses are covered for his employees
from the second year if the first year is II. A bank can take a group policy for its
claim free. customers
III. A shopkeeper can take a group policy
2. Identify which of the below statement is for its customers
correct? IV. A group policy taken by the employer
for his employees can be extended to
I. Health insurance deals with morbidity include the family members of the
II. Health insurance deals with mortality employees
III. Health insurance deals with morbidity
as well as mortality CHAPTER – 20 HEALTH INSURANCE UNDERWRITING
IV. Health insurance neither deals with
morbidity or mortality 1. Underwriting is the process of ___________.
I. Marketing insurance products
3. Which of the below statement is correct with II. Collecting premiums from customers
regards to cashless service provided in health III. Risk selection and risk pricing
insurance? IV. Selling various insurance products

I. It is an environment friendly go-green 2. The principle of utmost good faith in

initiative started by insurance underwriting is required to be followed by
companies to promote electronic ___________.
payments so that circulation of physical I. The insurer
cash notes can be reduced and trees II. The insured
can be saved. III. Both the insurer and the insured
II. Service is provided free of cost to the IV. The medical examiners
insured and no cash is to be paid as the
payment is made by the Government 3. Insurable interest refers to ____________.
to the insurance company under a I. Financial interest of the person in the
special scheme asset to be insured
III. All payments made by insured have to II. The asset which is already insured
be made only through internet banking III. Each insurer’s share of loss when more
or cards as cash is not accepted by the than one company covers the same
insurance company loss
 IV. The amount of the loss that can be I. Age proof documents
recovered from the insurer II. Financial documents
III. Previous medical records
4. Which of the following statements about IV. Proposal form
medical underwriting is incorrect?
I. It involves high cost in collecting and 9. The underwriting process is completed when
assessing medical reports. ___________________.
II. Current health status and age are the I. All the critical information related to
key factors in medical underwriting for the health and personal details of the
health insurance. proposer are collected through the
III. Proposers have to undergo medical proposal form
and pathological investigations to II. All the medical examinations and tests
assess their health risk profile. of the proposer are completed
IV. Percentage assessment is made on III. The received information is carefully
each component of the risk assessed and classified into
appropriate risk categories
5. 1) In a group health insurance, any of the IV. The policy is issued to the proposer
individual constituting the group could anti- after risk selection and pricing.
select against the insurer.
2) Group health insurance provides coverage 10. Which of the following statements about the
only to employer-employee groups. numerical rating method is incorrect?
I. Statement 1 is true and statement 2 is I. Numerical rating method provides
false greater speed in the handling of a large
II. Statement 2 is true and statement 1 is business with the help of trained
false personnel.
III. Statement 1 and statement 2 are true II. Analysis of difficult or doubtful cases is
IV. Statement 1 and statement 2 are false not possible on the basis of numerical
points without medical referees or
6. Which of the following factor does not affect the experts.
morbidity of an individual? III. This method can be used by persons
I. Gender without any specific knowledge of
II. Spouse job medical science.
III. Habits IV. It ensures consistency between the
IV. Residence location decisions of different underwriters.

7. According to the principle of indemnity, the CHAPTER -21 HEALTH INSURANCE CLAIMS
insured is paid for __________.
I. The actual losses to the extent of the 1. Who among the following is not a stakeholder in
sum insured insurance claim process?
II. The sum insured irrespective of the I. Insurance company shareholders
amount actually spent II. Human Resource Department
III. A fixed amount agreed between both III. Regulator
the parties IV. TPA
IV. The actual losses irrespective of the
sum assured 2. Which of the following document is maintained at
the hospital detailing all treatment done to an in-
8. The first and the primary source of information patient?
about an applicant, for the underwriter is his I. Investigation report
__________. II. Settlement sheet
 III. Case paper IV. Nothing could be done in case of case
IV. Hospital registration certificate denial

3. The amount of provision made for all claims in the 8. During investigation, of a health insurance claim
books of the insurer based on the status of the presented by Rajiv Mehto, insurance company finds
claims is known as ________. that instead of Rajiv Mehto, his brother Rajesh
I. Pooling Mehto had been admitted to hospital for treatment.
II. Provisioning The policy of Rajiv Mehto is not a family floater plan.
III. Reserving This is an example of ___________fraud.
IV. Investing I. Impersonation
II. Fabrication of documents
4. Which of the following documents are not III. Exaggeration of expenses
required to be submitted for Permanent Total IV. Outpatient treatment converted to in-
Disability claim? patient / hospitalization
I. Duly completed Personal Accident
claim form signed by the claimant. 9. Under which of the following condition, is
II. Attested copy of First Information domiciliary hospitalization is covered in a health
Report if applicable. insurance policy?
III. Permanent disability certificate from a I. The condition of the patient is such
civil surgeon or any equivalent that he/she can be removed to the
competent doctors certifying the Hospital/Nursing Home , but prefer not
disability of the insured. to
IV. Fitness certificate from the treating II. The patient cannot be removed to
doctor certifying that the insured is fit Hospital/Nursing Home for lack of
to perform his normal duties. accommodation therein
III. The treatment can be carried out only
5. ________________ are paid upfront by Assistance in hospital/Nursing home
Company and later claimed from insurance IV. Duration of hospitalization is exceeding
company. 24 hours
I. Bail bond cases
II. Personal accident claims 10. Which of the following codes capture the
III. Overseas travel insurance claims procedures performed to treat the illness?
IV. Untenable claims I. ICD
II. DCI
6. Who among the following is considered as primary III. CPT
stakeholder in insurance claim process? IV. PCT
I. Customers
II. Owners
III. Underwriters
IV. Insurance agents/brokers

7. Girish Saxena‟s insurance claim was denied by

insurance company. In case of a denial, what is the
option available to Girish Saxena, apart from the
representation to the insurer?
I. To approach Government
II. To approach legal authorities
III. To approach insurance agent
 Chapter -1
1. II 3. II 5. III 7. II 9. II 11. IV 13. I 15. II
2. III 4. I 6. III 8. IV 10. IV 12. II 14. I
Chapter -2
1. III 3. II 5. II 7. II 9. I 11. I 13. II 15. III
2. III 4. IV 6. III 8. I 10. II 12. IV 14. IV 16. IV
Chapter– 3
1. I 2. III 3. II 4. II 5. III 6. IV 7. I 8. III 9. III 10. II 11. II
Chapter -4
1. IV 2. I 3. IV 4. IV 5. IV 6. II 7. IV 8. II 9. III 10. I
Chapter – 5
1. II 3. II 5. III 7. III 9. III 11. I 13. II 15. III
2. III 4. I 6. III 8. II 10. III 12. III 14. II 16. IV
Chapter - 6
1. II 2. IV 3. III 4. I 5. III 6. III 7. II 8. III 9. III 10. III
11. IV
Chapter – 7
1. I 2. II 3. III 4. III 5. II 6. IV 7. I 8. II 9. I 10. II 11. IV 12. II 13. IV
Chapter- 8
1. III 3. II 5. III 7. I 9. III 11. III
2. I 4. I 6. III 8. III 10. II 12. III
Chapter -9
1. II 2. I 3. II 4. IV 5. I 6. III 7. III 8. I 9. III 10. II 11. III 12. IV
Chapter – 10
1. II 2. II 3. II 4. II 5. II 6. III 7. II 8. II 9. II 10. II 11. III
Chapter – 11
1. II 2. II 3. II 4. II 5. II 6. IV 7. IV 8. I 9. III 10. IV 11. IV 12. II
Chapter – 12
1. II 2. III 3. I 4. II 5. IV 6. II 7. III 8. I 9. IV 10. III 11. II
Chapter – 13
1. II 2. II 3. I 4. I 5. III 6. IV 7. I 8. II 9. I 10. III 11. IV
Chapter – 14
1. II 2. IV 3. II 4. III 5. IV 6. II 7. I 8. III 9. II 10. IV 11. I
Chapter – 15
1. III 2. II 3. II 4. II 5. IV 6. III 7. II 8. III 9. I 10. IV 11. II 12. I 13. II
Chapter – 16
1. II 2. I 3. II 4. IV 5. I 6. I 7. III 8. II 9. IV 10. I 11. III
Chapter – 17
1. IV 2. II 3. III 4. III 5. IV 6. IV 7. II
Chapter – 18
1. II 2. I 3. II 4. II
Chapter – 19
1. II 2. I 3. IV 4. II 5. III
Chapter -20
1. III 2. III 3. I 4. IV 5. IV 6. II 7. I 8. IV 9. III 10. II
Chapter – 21
1. II 2. III 3. III 4. IV 5. I 6. I 7. II 8. I 9. II 10. III