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 3 of 6

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Q21.
Why should a health insurance customer check if the hospital suggested by their consulting doctor is in the network of the TPA?

a.

To get a discount on treatment cost

b.

To choose a different doctor

c.

To determine the hospital's room rent

d.

To ensure cashless facility for treatment

Discuss
Answer: (d).To ensure cashless facility for treatment Explanation:Checking if the hospital is in the TPA's network is important to ensure cashless facility for treatment.
Q22.
What happens if incorrect details are entered into the pre-authorization form in the cashless facility process?

a.

The hospital covers the additional charges

b.

The TPA denies cashless facility

c.

The patient receives a discount on treatment

d.

The customer can dispute the treatment cost

Discuss
Answer: (b).The TPA denies cashless facility Explanation:If incorrect details are entered into the pre-authorization form, the TPA may deny the cashless facility or raise a query.
Q23.
What should a customer do if they decide to admit a patient to a different hospital after obtaining cashless approval at one hospital?

a.

Inform the consulting doctor

b.

Notify the TPA and the hospital where approval was granted

c.

Submit a new claim to the insurer

d.

Pay the entire treatment cost personally

Discuss
Answer: (b).Notify the TPA and the hospital where approval was granted Explanation:If a customer decides to admit a patient to a different hospital after obtaining cashless approval, they should notify the TPA and the hospital where approval was granted to avoid issues with the subsequent request.
Q24.
What is the most important document required to process a health insurance claim?

a.

Investigation reports

b.

Discharge summary

c.

Receipt for payment

d.

Identity proof

Discuss
Answer: (b).Discharge summary Explanation:The most important document required to process a health insurance claim is the discharge summary.
Q25.
What role do investigation reports play in the health insurance claim process?

a.

They provide the total cost of the treatment

b.

They are used to verify the identity of the patient

c.

They help in comparing the diagnosis and treatment

d.

They serve as legal proof of the treatment

Discuss
Answer: (c).They help in comparing the diagnosis and treatment Explanation:Investigation reports assist in comparing the diagnosis and treatment, thereby providing the necessary information to understand the exact condition that prompted the treatment and the progress made during hospitalization.
Q26.
Which document helps decide the amount to be paid under a health insurance policy?

a.

Discharge summary

b.

Receipt for payment

c.

Claim form

d.

Investigation reports

Discuss
Answer: (b).Receipt for payment Explanation:The document that decides what needs to be paid under the insurance policy is the receipt for payment.
Q27.
Why is identity proof important in the health insurance claim process?

a.

To verify if the hospital is legitimate

b.

To prevent fraudulent claims

c.

To determine the hospital's compliance with regulations

d.

To calculate the total cost of the treatment

Discuss
Answer: (b).To prevent fraudulent claims Explanation:Identity proof is important in the health insurance claim process to prevent fraudulent claims and ensure that the person covered and the person treated are the same.
Q28.
What specific documents may be required for accident claims?

a.

Blood test reports

b.

FIR or Medico-legal certificate

c.

Discharge summary

d.

Pan card

Discuss
Answer: (b).FIR or Medico-legal certificate Explanation:For accident claims, documents like FIR or Medico-legal certificate issued by the hospital to the registered police station may be required.
Q29.
When does the scope of TPA services in health insurance typically begin?

a.

Before the sale of insurance policies

b.

During the insurance proposal stage

c.

After the sale and issue of insurance policies

d.

At the time of policy renewal

Discuss
Answer: (c).After the sale and issue of insurance policies Explanation:The scope of TPA services in health insurance begins after the sale and issue of insurance policies.
Q30.
What is the primary purpose of TPA enrollment of members in health insurance?

a.

To determine premium rates

b.

To issue physical insurance policies

c.

To provide cashless facility

d.

To facilitate processing of claims

Discuss
Answer: (c).To provide cashless facility Explanation:TPA enrollment of members in health insurance is primarily done to provide cashless facility.
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