Difficulty: Mixed
What is the main purpose of health insurance?
A Help pay covered healthcare costs
B Guarantee every treatment
C Replace medical advice
D Prevent all illness
Answer: A. Help pay covered healthcare costs. Health insurance helps pay eligible costs as defined by the policy.
What is a health-insurance premium?
A Hospital’s total bill
B Payment to maintain coverage
C Claim reimbursement amount
D Policy deductible
Answer: B. Payment to maintain coverage. The premium is the price paid to maintain insurance coverage.
What is a deductible?
A Monthly premium
B Named hospital
C Amount paid before insurer share
D Policy expiry date
Answer: C. Amount paid before insurer share. A deductible is an amount the insured may pay before coverage contributes, per terms.
What does a copayment mean?
A Annual coverage limit
B Premium-free period
C Claim document
D Fixed share paid by insured
Answer: D. Fixed share paid by insured. A copayment is a specified amount the insured pays for a covered service.
What is coinsurance?
A Percentage share of covered costs
B Fixed annual premium
C Policy renewal period
D Hospital network list
Answer: A. Percentage share of covered costs. Coinsurance is a percentage of eligible costs paid by the insured.
What does sum insured commonly limit?
A Every possible treatment
B Maximum stated policy coverage
C Premium due date
D Hospital’s full charges
Answer: B. Maximum stated policy coverage. The sum insured is a stated coverage limit subject to policy wording.
What is a sublimit?
A Extra premium date
B Beneficiary’s address
C Limit for a specific expense
D Policyholder’s income
Answer: C. Limit for a specific expense. A sublimit caps payment for a specified treatment or expense.
What does a health-policy exclusion identify?
A Covered hospital network
B Premium payment mode
C Claim reference number
D Uncovered service or situation
Answer: D. Uncovered service or situation. Exclusions describe services or situations the policy does not cover.
What is a waiting period?
A Time before some coverage applies
B Time to pay every claim
C Hospital visiting hours
D Policy application date
Answer: A. Time before some coverage applies. Some benefits may apply only after a policy-specific waiting period.
What is a pre-existing condition?
A A future accident
B Condition present before coverage
C A hospital network
D An unpaid premium
Answer: B. Condition present before coverage. Policies define pre-existing conditions and their treatment in the wording.
Where can policy-specific health limits be found?
A Hospital reception sign
B Insurance advertisement
C Policy schedule and wording
D Doctor’s prescription
Answer: C. Policy schedule and wording. The schedule and wording describe benefits, limits, and conditions.
Who is the insurer?
A Patient’s doctor
B Hospital cashier
C Named beneficiary
D Company providing health cover
Answer: D. Company providing health cover. The insurer provides coverage under the insurance contract.
Who is an insured person?
A Person covered by policy
B Claim investigator
C Hospital administrator
D Premium collector
Answer: A. Person covered by policy. An insured person is listed as covered under the plan.
What is a network hospital?
A Any clinic worldwide
B Hospital contracted with insurer
C A government regulator
D A policy agent’s office
Answer: B. Hospital contracted with insurer. A network hospital has an arrangement with the insurer or administrator.
What does cashless treatment generally mean?
A All expenses become free
B No documents are needed
C Insurer settles eligible bills directly
D Every hospital is included
Answer: C. Insurer settles eligible bills directly. Cashless service may route eligible bills directly, subject to approval and limits.
What is reimbursement in health insurance?
A Hospital sets premium
B Insurer issues diagnosis
C Policy renews automatically
D Insured submits eligible expenses
Answer: D. Insured submits eligible expenses. For reimbursement, the insured pays first and submits eligible expense documents.
What is preauthorization?
A Request for treatment approval
B Premium payment receipt
C Policy renewal form
D Hospital discharge summary
Answer: A. Request for treatment approval. Preauthorization asks the insurer to review planned treatment under policy terms.
What may a TPA do in health insurance?
A Set national law
B Administer selected claim services
C Provide every treatment
D Guarantee policy renewal
Answer: B. Administer selected claim services. A third-party administrator may handle services such as claim processing for an insurer.
What is a health-insurance claim?
A A premium quotation
B A diagnosis itself
C Request for covered benefits
D A policy brochure
Answer: C. Request for covered benefits. A claim asks the insurer to pay or reimburse eligible expenses.
Which record commonly supports a hospital claim?
A Unrelated grocery receipt
B Another person’s policy
C Old advertisement
D Itemized medical bill
Answer: D. Itemized medical bill. Itemized bills help show charges submitted for claim review.
What may a room-rent limit affect?
A Eligible room expense payment
B Premium payment frequency
C Beneficiary designation
D Hospital’s visiting hours
Answer: A. Eligible room expense payment. A room limit may restrict payment for room charges under the policy.
Does a network hospital guarantee full payment?
A Yes, every bill
B No, policy limits still apply
C Only for cashless claims
D Only for renewals
Answer: B. No, policy limits still apply. Network access does not remove exclusions, limits, or cost-sharing.
What is a family floater policy?
A Separate policy for each hospital
B Coverage for all relatives automatically
C Shared cover for listed family
D A premium refund plan
Answer: C. Shared cover for listed family. A family floater shares a stated limit among covered members.
What is an individual health policy?
A A shared travel policy
B A hospital discount card
C A group premium receipt
D Coverage assigned to one person
Answer: D. Coverage assigned to one person. Individual plans provide benefits for the person named as insured.
What is group health insurance?
A Cover arranged for a group
B A single hospital bill
C A policy for one doctor
D A claim document
Answer: A. Cover arranged for a group. Group health coverage is arranged for eligible members of a group.
What should be checked before using cashless service?
A Only hospital paint color
B Hospital and approval rules
C A friend’s claim result
D Social-media comments
Answer: B. Hospital and approval rules. Check network status and preauthorization requirements with the insurer.
Can every policy cover outpatient visits?
A Yes, always
B Only in every group plan
C No, benefits vary
D Only without limits
Answer: C. No, benefits vary. Outpatient coverage depends on the product and policy terms.
Are preventive checkups covered by every policy?
A Yes, without limits
B Only after claims
C No plan can cover them
D No, check policy wording
Answer: D. No, check policy wording. Check the policy to see whether preventive checkups are included and limited.
Why disclose medical history accurately?
A Support proper risk assessment
B Guarantee claim payment
C Remove waiting periods
D Lower every premium
Answer: A. Support proper risk assessment. Accurate disclosure helps the insurer assess the application.
What may happen if key application details are inaccurate?
A Premium disappears
B May affect coverage or claims
C All treatment becomes covered
D Policy limits double
Answer: B. May affect coverage or claims. Inaccurate information can create problems under policy terms and applicable rules.
What is a day-care procedure?
A Routine doctor consultation
B Every emergency visit
C Treatment not needing overnight stay
D Long-term home care
Answer: C. Treatment not needing overnight stay. Some procedures may qualify as day care without a full overnight admission.
Does a health policy pay every hospital charge?
A Yes, all charges
B Only in network hospitals
C Only after renewal
D No, terms and limits apply
Answer: D. No, terms and limits apply. Coverage depends on benefits, exclusions, limits, and claim requirements.
How do deductible and copayment differ?
A Different forms of cost-sharing
B They are always identical
C Both are premium dates
D Neither affects payment
Answer: A. Different forms of cost-sharing. A deductible and copayment are separate cost-sharing structures.
What does a restoration benefit do?
A Refund every premium
B May reinstate used coverage
C Remove policy exclusions
D Guarantee every claim
Answer: B. May reinstate used coverage. Some plans restore a limit under specific conditions.
Can restoration benefits have restrictions?
A No, always unlimited
B Only premium applies
C Yes, check the wording
D Restrictions are illegal
Answer: C. Yes, check the wording. Eligibility and use of restored coverage depend on policy terms.
Why check a hospital’s network status before treatment?
A Hospitals set every policy
B Claims require no network
C Premium is hospital-owned
D Network lists can change
Answer: D. Network lists can change. Network status may change; confirm with the insurer before relying on cashless access.
What should happen before renewing a health policy?
A Review updated terms and premium
B Assume all terms unchanged
C Ignore payment date
D Cancel without replacement
Answer: A. Review updated terms and premium. Review renewal terms, costs, and coverage details.
How can continuity affect waiting periods?
A Waiting periods never apply
B Prior cover may matter
C Premiums are refunded
D All exclusions vanish
Answer: B. Prior cover may matter. Continuity rules may affect waiting periods, subject to current law and contract terms.
Can portability rules be identical everywhere?
A Yes, globally
B Only premiums vary
C No, jurisdiction and terms matter
D No documents are needed
Answer: C. No, jurisdiction and terms matter. Portability rules depend on applicable regulations and policy conditions.
Which plan feature should be compared besides premium?
A Logo design
B Agent’s personal preference
C Website color
D Limits and cost-sharing
Answer: D. Limits and cost-sharing. Compare benefits, exclusions, limits, and out-of-pocket costs, not price alone.
What is an appropriate first step for a claim question?
A Contact insurer’s official channel
B Trust unknown callers
C Post policy number publicly
D Pay an online stranger
Answer: A. Contact insurer’s official channel. The insurer can explain claim documents and official procedures.
What should policyholders do with original medical documents?
A Discard them immediately
B Keep them organized and safe
C Share them publicly
D Send them to strangers
Answer: B. Keep them organized and safe. Organized documents can help with claim submission and follow-up.
What may a claim settlement explain?
A Future diagnoses
B Hospital quality scores
C Approved and nonpayable amounts
D Premium tax rules
Answer: C. Approved and nonpayable amounts. A settlement statement may show how the insurer calculated payment.
What can cause part of a claim to be unpaid?
A The patient used email
B Policy has a title
C Hospital has a logo
D Limits or exclusions apply
Answer: D. Limits or exclusions apply. Policy limits, exclusions, and cost-sharing may affect payment.
Where should an unresolved policy grievance go first?
A Insurer’s grievance channel
B Unknown payment link
C Anonymous social account
D Unverified agent
Answer: A. Insurer’s grievance channel. Use the insurer’s official complaint process and keep records.
What should buyers compare in policy documents?
A Only the brochure design
B Coverage, exclusions, and limits
C Agent’s personal opinion
D Hospital wall colors
Answer: B. Coverage, exclusions, and limits. Policy wording provides detailed coverage terms beyond marketing summaries.
How can a policyholder check whether a treatment is covered?
A Assume all care qualifies
B Ask an unknown caller
C Review wording or ask insurer
D Rely only on a friend
Answer: C. Review wording or ask insurer. The insurer and policy wording can clarify coverage before planned care.
Which statement about health insurance is accurate?
A Every claim is paid
B All hospitals are covered
C Premiums guarantee treatment
D Benefits follow policy terms
Answer: D. Benefits follow policy terms. Benefits depend on coverage, limits, exclusions, and claim requirements.
What matters when choosing a health plan?
A Needs, costs, and terms
B Lowest premium only
C A friend’s choice
D Most colorful brochure
Answer: A. Needs, costs, and terms. Compare likely needs, premium, cost-sharing, network, and contract terms.
Which source can clarify current portability rules?
A Anonymous online comments
B Regulator or insurer resources
C A hospital advertisement
D A friend’s old policy
Answer: B. Regulator or insurer resources. Use current official regulator or insurer guidance because rules can change.