IRDA Exam Mock Test 4 – IC38 Health Insurance Agent (50 Q&A)

1. A proposer deliberately hides a past hospitalization history while filling the proposal form. No claim has yet occurred. What action can the insurer take upon discovery?

2. Two policies cover the same asset and both are active at the time of loss. Which principle ensures proportional sharing of claim?

3. After claim payment, insurer acquires rights to recover loss from third party. This is known as:

4. A fire leads to explosion which causes damage. Which cause is considered for claim settlement?

5. A person insures property of another without any financial interest. The contract will be:

6. An insured becomes careless after buying insurance and increases chances of loss. This is:

7. High-risk individuals purchasing insurance more frequently than low-risk individuals leads to:

8. Incorrect or misleading information given during proposal stage is called:

9. Which term must be strictly complied with, failing which insurer may reject claim?

10. Premium in insurance is determined mainly based on:

11. Which authority regulates insurance sector in India?

12. The proposal form is important because it:

13. Insurance contracts are classified as:

14. Which principle ensures that insured cannot profit from insurance?

15. Nomination is primarily applicable in:

16. A policyholder is hospitalized for 10 hours for a minor surgery listed under day care procedures. What is the correct outcome?

17. An insured has ₹5 lakh cover with ₹50,000 deductible. Hospital bill is ₹2 lakh. Insurer pays:

18. A person hides diabetes at proposal stage and later claims for heart disease. Insurer rejects claim. This is mainly due to:

19. Treatment taken at non-network hospital will be settled as:

20. A family floater policy of ₹8 lakh is used by one member for ₹7 lakh. Another member needs ₹3 lakh. What is payable?

21. A policyholder increases sum insured from ₹3 lakh to ₹6 lakh at renewal. Within 2 months, he undergoes surgery costing ₹4 lakh for a disease covered earlier. How much will insurer pay?

22. An insured has 20% copayment and incurs ₹1.5 lakh hospitalization expense. How much will insurer pay?

23. A hospital charges significantly higher than standard rates for a procedure. Insurer reduces claim citing policy terms. Which clause applies?

24. An insured selects a room category higher than eligibility. The hospital bill increases including doctor fees. What is insurer likely to do?

25. An insurer settles a claim and later recovers money from a third party responsible for the injury.
Which principle is applied?

26. A person has base policy ₹4 lakh and super top-up ₹6 lakh with ₹4 lakh deductible. Total claims in a year = ₹7 lakh. What will super top-up pay?

27. A policyholder undergoes treatment within 10 days of policy purchase for a disease not related to any waiting period. What is correct?

28. A patient is admitted for fever but opts for an unrelated elective surgery during the same hospitalization. How will insurer treat this?

29. An insured misstates age to reduce premium. Later claim arises. Insurer discovers discrepancy.
What is likely outcome?

30. A policy has ₹25,000 deductible and 10% copayment. Claim amount is ₹1 lakh. Insurer pays:

31. An organ transplant requires donor hospitalization. Under standard policy terms:

32. An insured repeatedly files small claims intentionally. This reflects:

33. A policyholder completes waiting period for pre-existing disease after continuous renewal. What happens?

34. An insured undergoes emergency treatment abroad under a policy covering worldwide emergencies. Settlement mode?

35. A claim arises due to accident leading to infection and death. Which cause is considered?

36. A person undergoes cosmetic surgery for appearance reasons and later files claim. What happens?

37. Hospitalization starts before policy expiry but discharge happens after expiry. Claim status?

38. An insured’s bill exceeds standard rates; insurer pays less than billed amount. Reason?

39. Policy upgraded from ₹2 lakh to ₹5 lakh. Claim of ₹3 lakh arises within 6 months. How much payable?

40. An insured chooses luxury room exceeding eligibility. Effect on claim?

41. A policyholder delays renewal and falls sick during gap period. Outcome?

42. No-claim bonus accumulated over years is affected after claim. What happens?

43. Hospital splits one procedure into two admissions to increase billing. Insurer detects this. What will insurer do?

44. Treatment taken at unregistered clinic. Claim filed. Outcome?

45. An insured has ₹6 lakh cover but incurs ₹8 lakh expense. Insurer pays:

46. Deductible and copayment can both apply in the same claim.

47. ICU charges applied without medical necessity. Insurer reduces claim. Why?

48. Policyholder uses portability and increases sum insured simultaneously. Which is correct?

49. Insurer recovers claim amount from third party after settlement. Principle applied?

50. Claim denied as treatment does not follow standard medical practice. Which concept applies?