H05 Health Insurance Claims MCQs

Welcome to our comprehensive collection of Multiple Choice Questions (MCQs) on H05 Health Insurance Claims, 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 H05 Health Insurance Claims 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 H05 Health Insurance Claims mcq questions that explore various aspects of H05 Health Insurance Claims problems. Each MCQ is crafted to challenge your understanding of H05 Health Insurance Claims 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 H05 Health Insurance Claims 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 H05 Health Insurance Claims. You can click on an option to test your knowledge before viewing the solution for a MCQ. Happy learning!

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H05 Health Insurance Claims MCQs | Page 2 of 6

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Q11.
In case of deficiency in claim documents, how should the insurer communicate with the claimant?

a.

Communicate together, not in piecemeal

b.

Communicate piecemeal for clarity

c.

Send a notice through postal mail

d.

Wait for the claimant to contact the insurer

Discuss
Answer: (a).Communicate together, not in piecemeal Explanation:When there is a deficiency in claim documents, the insurer should communicate together and not in a piecemeal manner with the claimant.
Q12.
What are the factors that decide the claim amount payable in health insurance?

a.

The policyholder's age and occupation

b.

The insurer's profitability

c.

The sum insured available under the policy

d.

The hospital's location

Discuss
Answer: (c).The sum insured available under the policy Explanation:The claim amount payable depends on factors like the sum insured, sub-limits, cumulative bonus, and other expenses covered under the policy.
Q13.
What are "Reasonable and Customary Charges" in the context of health insurance claims?

a.

Charges for services that are excessively high

b.

Charges for services that are lower than the standard rates

c.

Charges for services that are consistent with prevailing charges in the area

d.

Charges for services that are set by the insurance company

Discuss
Answer: (c).Charges for services that are consistent with prevailing charges in the area Explanation:"Reasonable and Customary Charges" refer to charges for services that are consistent with prevailing rates in the geographical area for similar services.
Q14.
How is the claim payment typically made in health insurance?

a.

By issuing a policy renewal notice

b.

By transferring the money to the policyholder's bank account

c.

By sending a claim payment card

d.

By delivering a physical cheque to the policyholder

Discuss
Answer: (b).By transferring the money to the policyholder's bank account Explanation:Claim payments are typically made by transferring the claim amount to the policyholder's bank account.
Q15.
What percentage of health insurance claims are usually found not to meet the policy terms?

a.

5% to 10%

b.

15% to 20%

c.

10% to 15%

d.

20% to 25%

Discuss
Answer: (c).10% to 15% Explanation:Approximately 10% to 15% of health insurance claims do not meet the terms of the policy and may be denied for various reasons.
Q16.
What should the insurance company do if it denies a claim?

a.

Inform the policyholder verbally

b.

Keep the denial reason confidential

c.

Inform the policyholder in writing

d.

Deny the claim without any communication

Discuss
Answer: (c).Inform the policyholder in writing Explanation:The insurance company must inform the policyholder in writing about the denial of a claim and provide the reason for the denial.
Q17.
What is the primary purpose of cashless settlement in health insurance?

a.

To increase treatment expenses

b.

To avoid diagnosis expenses

c.

To simplify claim settlement

d.

To settle claims after payment

Discuss
Answer: (c).To simplify claim settlement Explanation:The primary purpose of cashless settlement in health insurance is to simplify the claim settlement process for the insured.
Q18.
How does the cashless facility work in health insurance?

a.

The patient pays the full treatment cost, and the insurer reimburses later.

b.

The hospital pays the treatment cost and is reimbursed by the patient.

c.

The insurer pays the treatment cost directly to the hospital.

d.

The patient pays the treatment cost directly to the hospital.

Discuss
Answer: (c).The insurer pays the treatment cost directly to the hospital. Explanation:In the cashless facility, the insurer pays the treatment cost directly to the hospital.
Q19.
In the cashless settlement process, what is the role of the Third Party Administrator (TPA)?

a.

Treating the patient

b.

Verifying patient eligibility

c.

Approving treatment costs

d.

Discharging the patient

Discuss
Answer: (c).Approving treatment costs Explanation:The TPA in the cashless settlement process plays a role in approving treatment costs for the patient's care.
Q20.
What should a health insurance customer do if they don't have their insurance details with them when seeking treatment?

a.

Contact the hospital directly for assistance

b.

Visit the nearest TPA office for assistance

c.

Call the doctor for guidance

d.

Contact the TPA through a 24-hour helpline for details

Discuss
Answer: (d).Contact the TPA through a 24-hour helpline for details Explanation:If a customer doesn't have their insurance details with them, they can contact the TPA through a 24-hour helpline for assistance.
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