H03 Health Insurance Products MCQs

Welcome to our comprehensive collection of Multiple Choice Questions (MCQs) on H03 Health Insurance Products, a fundamental topic in the field of IC38 Life Insurance Agent Exam. Whether you're preparing for competitive exams, honing your problem-solving skills, or simply looking to enhance your abilities in this field, our H03 Health Insurance Products MCQs are designed to help you grasp the core concepts and excel in solving problems.

In this section, you'll find a wide range of H03 Health Insurance Products mcq questions that explore various aspects of H03 Health Insurance Products problems. Each MCQ is crafted to challenge your understanding of H03 Health Insurance Products principles, enabling you to refine your problem-solving techniques. Whether you're a student aiming to ace IC38 Life Insurance Agent Exam tests, a job seeker preparing for interviews, or someone simply interested in sharpening their skills, our H03 Health Insurance Products MCQs are your pathway to success in mastering this essential IC38 Life Insurance Agent Exam topic.

Note: Each of the following question comes with multiple answer choices. Select the most appropriate option and test your understanding of H03 Health Insurance Products. You can click on an option to test your knowledge before viewing the solution for a MCQ. Happy learning!

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H03 Health Insurance Products MCQs | Page 16 of 18

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Q151.
What does the term "Network Provider" refer to in the context of health insurance?

a.

Hospitals charging high fees

b.

Hospitals under tie-up with an insurer/TPA for cashless treatment

c.

Hospitals offering out-of-network treatment

d.

Insured patients' homes

Discuss
Answer: (b).Hospitals under tie-up with an insurer/TPA for cashless treatment Explanation:Network providers are hospitals, nursing homes, or day care centers that have a tie-up with an insurer/TPA for providing cashless treatment to insured patients.
Q152.
What is the purpose of a "Preferred Provider Network (PPN)" in health insurance?

a.

To charge higher fees to insured patients

b.

To limit access to healthcare services

c.

To ensure quality treatment and competitive rates

d.

To offer exclusive benefits to the insurer's employees

Discuss
Answer: (c).To ensure quality treatment and competitive rates Explanation:Preferred Provider Networks are created by insurers to ensure quality treatment and competitive rates by selecting a limited group of hospitals based on experience, utilization, and cost.
Q153.
What does "Cashless Service" mean in the context of health insurance?

a.

Free healthcare services for insured patients

b.

Paying all medical expenses directly to the insured

c.

Availing treatment without any payment to the hospitals up to the policy limit

d.

A service only available to preferred provider network hospitals

Discuss
Answer: (c).Availing treatment without any payment to the hospitals up to the policy limit Explanation:Cashless service allows insured individuals to receive treatment up to the policy limit without making payments to the hospitals, but expenses beyond the policy limits are not covered.
Q154.
What is the role of a Third Party Administrator (TPA) in health insurance?

a.

To manage claims for various industries

b.

To process travel insurance claims

c.

To coordinate with hospitals and process health insurance claims

d.

To issue identity cards for car insurance policies

Discuss
Answer: (c).To coordinate with hospitals and process health insurance claims Explanation:A TPA's role in health insurance includes managing claims, issuing identity cards, coordinating with hospitals, and processing health insurance claims on behalf of the insurer and insured.
Q155.
How does a Third Party Administrator (TPA) facilitate a cashless service for health insurance?

a.

By charging additional fees to policyholders

b.

By covering expenses beyond the policy limits

c.

By providing unique identity cards for hospital admissions

d.

By directly paying the network hospital for admissible amounts

Discuss
Answer: (d).By directly paying the network hospital for admissible amounts Explanation:A TPA facilitates cashless service by directly paying the network hospital for admissible amounts, allowing insured individuals to access healthcare services without making payments at the hospital.
Q156.
What is the minimum requirement for the number of inpatient beds in a hospital in towns with a population of less than 10,00,000?

a.

5 inpatient beds

b.

10 inpatient beds

c.

15 inpatient beds

d.

20 inpatient beds

Discuss
Answer: (b).10 inpatient beds Explanation:Hospitals in towns with a population of less than 10,00,000 must have at least 10 inpatient beds.
Q157.
What criteria must a hospital meet to be considered eligible for health insurance coverage?

a.

It must have 5 inpatient beds

b.

It must have a registered medical practitioner round the clock

c.

It must have a qualified nurse on staff round the clock

d.

It must maintain records of patients accessible to insurance company personnel

Discuss
Answer: (d).It must maintain records of patients accessible to insurance company personnel Explanation:To be eligible for health insurance coverage, a hospital must meet various criteria, including maintaining daily records of patients that are accessible to insurance company personnel.
Q158.
Who can be considered a qualified medical practitioner for health insurance purposes?

a.

Anyone who practices medicine

b.

Any registered practitioner

c.

Any close family member of the insured

d.

Anyone holding a valid registration from a medical council within India

Discuss
Answer: (d).Anyone holding a valid registration from a medical council within India Explanation:A qualified medical practitioner for health insurance purposes is someone holding a valid registration from a medical council within India.
Q159.
What is the purpose of restricting registered practitioners from being the insured or close family members?

a.

To ensure that registered practitioners receive healthcare coverage

b.

To prevent fraudulent claims from relatives or self-treatment

c.

To encourage more people to become registered practitioners

d.

To offer better healthcare services to close family members

Discuss
Answer: (b).To prevent fraudulent claims from relatives or self-treatment Explanation:The restriction is in place to prevent fraudulent claims from relatives or self-treatment by insured individuals or their close family members.
Q160.
What does "reasonable and necessary expenses" refer to in a health insurance policy?

a.

Expenses that are subject to reimbursement

b.

Expenses deemed acceptable by the policyholder

c.

Expenses that would be considered reasonable for a particular ailment and location

d.

Expenses that are never covered by the insurance company

Discuss
Answer: (c).Expenses that would be considered reasonable for a particular ailment and location Explanation:"Reasonable and necessary expenses" in a health insurance policy refer to expenses that would be considered reasonable for the treatment of a specific ailment in a particular geographical area.
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