Health Insurance Mock Exam

HEALTH INSURANCE
(4th Edition)

Mock Exam 2

AXA Life Insurance Singapore Pte Ltd

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Health Insurance Mock Exam 2

Mock Exam 2
C1/3.1
1. Primary Care Partnership Scheme does not cover treatment for :

A. Cancer Treatment
B. Diabetes Mellitus
C. Hypertension
D. Lipid Disorders

C9/5.1
2. What is included in the “Entire Contract Clause” in a Health Insurance Contract?

A. Policy Document and Proposal Form

B. Policy Document and Fact Find Form
C. Policy Document and Insuring clause
D. Policy Document and Schedule of Benefits

C10/3.5
3. Which of the following will decrease premium?
A. Decrease in investment income
B. Increase in persistency
C. Increase in morbidity
D. Increase in benefits covered

C2/3.9
4. What is the period during which a MEI Policy wil not pay out benefits?

A. Waiting period
B. Deferred period
C. Survival period
D. Benefit period

C13/2.1.1(b)
5. Under the LIA & GIA Guidelines on Disclosure Requirements and Needs Based Sales
Process for A & H Products, what information must be submitted to the insurer after the close
of sale for Individual Business?

A. Your Guide to Health Insurance

B. Fact Find Form
C. Product Summary
D. Benefit Illustration

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Health Insurance Mock Exam 2

C2/3.9
6. Which of the following scenarios will the waiting period be waived for Medical Expense
Insurance?

A. Keith was hopsitalised for drug abuse

B. John was hospitalised for kidney failure
C. Lisa was hospitalised for food poisoning
D. Jane was hospitalised after a miscarriage

C14/4.1.5(iii)/5.1.1
7. During need analysis, when recommending a Critical Illness Product, what must an advisor
advise a client?

A. Claims procedures
B. Underwriting considerations
C. Mode of Payment
D. Coverage

C4/5.4
8. Mr. Tang chooses a Disability Income Policy with a shorter benefit period. What should the
insurer do?

A. Reduce the premium

B. Increase the benefit amount
C. Reduce the deferred period
D. Increase coverage

C2/3.5
9. Which of the following is Not part of expense participation?

A. Deducibles.
B. Co-insurance
C. Pro- ration factor
D. Co-ordination of benefits

C2/3.5.1
10. Which of the Medical Expense Insurance’s deductible is the most expensive?

A. Per Annum
B. Per Disability/ Per Year
C. Per Disability/Per Claim
D. Per Variety Sickness

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Health Insurance Mock Exam 2

C3/4.3
11. Medisave can be used to pay for which of the following plan?

A. Portable Medical Benefit Scheme

B. Medical Expense Insurance
C. Medical Expense Benefit Insurance
D. Transferable Medical Insurance Scheme

C3/2
12. Which one is not a feature of Group Medical Insurance Policy?

A. Policy continues after one employee makes a claim

B. All employees must undergo medical examination
C. There are many life insureds in one master contract
D. The policy covers all employees below the statutory retirement age

C12/2
13. Which of the following is considered an Accident and Health Policy?

A. Term
B. Endowment
C. Whole Life Insurance
D. Medical Expense Insurance

C2/3.11
14. Premiums for Medical Expense Insurance are based on :

A. Level Premium Basis

B. Higher as one grows older every year
C. Premium rate is guaranteed
D. Age Band Basis

C8/4.1
15. Mr. X was hospitalised and stayed in a C class ward. He had insufficient Medisave savings to
pay. What should he apply?

A. Medifund
B. Medishield
C. Eldercare fund
D. Mediguard

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Health Insurance Mock Exam 2

C7/4.2
16. What are Preferred Provider Organisations(PPOs)?

A. PPOs are gatekeepers

B. PPOs allow clients to see specialist with referrals
C. PPOs require greater “out of pocket” payments from members
D. PPOs allow clients to choose to stay in the network or outside the network at point of
service.

C2/3.8
17. A client was hospitalised overseas. The insurer is able to pay for the expenses overseas
based on _______

A. Discussion between the insurer and the insured

B. Reasonable and customary charges for the treatment locally
C. The amount he can claimed in the country
D. The amount stated in the contract

C4/Eg4.3
18. The following data is to be used for this question and Qn. 19 and 20.
Mary, a lecturer bought a DI Policy, became disabled on 30/6/08. Her details as follows:

Salary : $8000 per month ;

Her expenses: $3000 per month;
Annual Escalation Benefit : 3% ;
6 Month Deferred Period chosen

When will she received the first payment from the insurer and for how much?

A. 1/1/2009 for $8000

B. 1/1/2009 for $6000
C. 31/12/2008 for $6180
D. 31/12/2008 for $2250

19. When will the escalation benefit kicked in and how much will she get?

A. 30/6/2009 for $8240

B. 31/12/2008 for $5150
C. 1/2/2009 for $6080
D. 1/1/2010 for $6180

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Health Insurance Mock Exam 2

20. Mary subsequently on 1/2/2010 found a job as a tutor which pays her $2000 a month.
Calculate partial disability benefit payable on 1/2/2010

A. $3,090
B. $4,500
C. $4,635
D. $4,180

C4/2 & 6.2

21. Peter is covered with a Disability Income and has been receiving benefits. However, he
recovered from his disability,

A. the insurance cover will continue covering if Peter starts paying premium.
B. policy will terminate as maximum limit of benefit reached
C. policy continues paying benefits to Peter
D. policy provides for a reduced benefit to be paid to Peter.

C13/2.2.1
22. When recommending a Group A&H Policy, what must be given to the client before the client
applies for the product?

A. Group Fact Find Form

B. Your Guide to Health Insurance
C. Benefit Illustrationn
D. Product Summary

C4/T4.1
23. Which of the following is a characteristic of Disability Income Insurance?

A. Maximum sum assured is based on the salary

B. Choice of deferred period
C. Partial disability is not covered
D. Incorporated into life policies

C5/3.2.1
24. Which factor is the most important factor affecting premium for LTCI Plans?

A. Renewability
B. Number of exclusions
C. Number of Activities of Daily Living
D. Insured’s choice of distribution channels

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Health Insurance Mock Exam 2

C7/4.1
25. Which of the following type is the most restrictive under Managed Healthcare Plans?

A. Point of Service Plans

B. Preferred Provider Organisations
C. Health Maintenance Organisations
D. Traditional Medical Expense Insurance

C5/4
26. What is Extended Care Benefit under Long Term Care Insurance?

A. 2 times of the monthly benefit payable to assist the insured to perform an ADL.
B. An extra monthly benefit given to the insured
C. To extend the payout period of Eldershield
D. To increase the monthly payment under Eldershield

C8/3
27. Which of the following CANNOT be paid using Medisave?

A. Medishield
B. Eldershield
C. Income Shield
D. Disability Income

C6/5.1
28. Group Dental Care Insurance covers:

A. Replacement of dentures
B. Pre- existing dental conditions
C. Medicine
D. Hospital Charges

C7/3.2
29. To control increasing medical costs, which of the following is not used by Managed
Healthcare?

A. Capitation
B. Salary
C. Profit Sharing
D. Fee Schedule

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Health Insurance Mock Exam 2

C8/3.1.6
30. Which of the following is a feature of Eldershield?

A. No non forfeiture features

B. Max entry age 75 years old
C. 14 free look period
D. 75 days grace period allowed for payment of overdue premiums

C2/2.1.1(i)
31. Under Medical Expense Insurance, what is not included in Daily Room and Board Charges?

A. Meals
B. Medicines and drugs
C. General nursing services
D. In hospital doctor’s visit fees

C3/T3.2
32. Which of the following is not true of Group Insurance?

A. The group must have been formed for some purpose other than to obtain insurance.
B. Underwriting of the group on the whole is based on gender and age.
C. Premium is age related.
D. The individual life insured’s coverage stop when he leaves the group.

C8/Eg8.1
33. Jenny went to Johor Bahru and while on her way back to Singapore, she met with an accident
on March 2008. She incurred a bill of $6,300. Policy came with a deductible of $1500 and a
co-insurance as follows:

$1000 - $3000 : 15%:

$3001 - $6000 : 20%

How much would the insurer have paid her?

A. $3,840
B. $3,940
C. $3,990
D. $4,080

C7/6.1
34. Managed Healthcare Insurance offers some benefits, which of the following is Not True?

A. Primary Care
B. Preventive Care
C. Emergency Care
D. Inpatient Care

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Health Insurance Mock Exam 2

C8/3
35. Medisave cannot be used for which purposes?

A. Premium for Hospital Cash (Income) Insurance

B. Premium for Medishield Insurance
C. Premium for Eldershield
D. Premium for Shield Plans

C14/Eg14.3
36. Mr. Tan has an income of $7000 per month, he wants to buy insurance for his daughter aged
2 until the girl is 21 years old. Monthly expenses is $2500. Inflation rate is 3%. Expected rate
of return is 6%. Calculate maintenance cost?

A. $442,605
B. $476,323
C. $796,689
D. $1,239,295

C3/T3.2
37. What is the key difference between an Individual and Group Insurance?

A. Premium bought under Group Insurance is unit related

B. Many contracts are issued in Group Insurance
C. All members of Group Insurance have to go for medical check up
D. Individual members’ health is evaluated for Group Insurance?

C4/5
38. Which of the following is the most restrictive in the definition of Total Disability under Disability
Income Insurance?

A. Own Occupation
B. Any Occupation
C. Modified Occupation
D. Similar Occupation

C9/3
39. In a Health Insurance Policy Contract, what is included in Policy Schedule?

A. Name and NRIC of Insured

B. Name and NRIC of Beneficiaries
C. Nature and objective of plan
D. Risks of the product

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Health Insurance Mock Exam 2

C11/4.4
40. An underwriter needs to know more about a client’s medical history which the medical
examination was not able to reveal. What form does he need?

A. Agent’s Statement
B. Attending Physician’s Statement
C. Supplementary Questionnaires
D. Fact Find Form

C2/2.2.1
41. Major Organ Transplant under Medical Expense Insurance covers:

A. Donor Costs
B. Cost of Surgeries
C. Acquisition of Organ
D. Recipient Costs

C13/3
42. Penalties for non compliance with LIA & GIA Guidelines:

A. 1st offence – counseling

B. 1st offence – retraining on health insurance
C. 1st offence – letter of warning
D. 1st offence – three months suspension

C8/2.1.4
43. Which of the following regarding restrictions of Medisave is true?

A. Covers limited outpatient treatments

B. Pays for more than 10 hours
C. Maximum limit of $3000 per admission
D. Cover a maximum of 4 operations

C13/2.2.1
44. Which document must be completed and duly signed and submitted to the insurer for a group
Health Insurance Policy?

A. Fact Find Form

B. Our Reasons and Why Form
C. Group Fact Find Form
D. Product Summary

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Health Insurance Mock Exam 2

C2/2.1.1
45. Which of the following is part of the catastrophic outpatient expenses under Medical Expense
Insurance?

A. Outpatient liver treatment charges

B. Outpatient kidney treatment charges
C. Outpatient Hepatitis B Vaccination
D. Outpatient assisted conception procedures

C14/6
46. Which of the following is a systematic process to explain your recommendations?

A. Brief the client on the benefits and limitations of the product

B. Give a detailed explanation on the options with all products
C. Give a summary of the reasons why a product is not recommended
D. Explain the danger of switching products

C6/3.1.1
47. Which of the following situation will be covered during the waiting period for a Hospital Cash
Insurance Policy?

A. Kidney failure
B. Miscarriage
C. Food poisoning
D. None of the above

C8/3.1
48. Government has came up with differrent plans to help the poor and needy in Singapore.
Which of the following is Not one of the resources?

A. Medifund
B. Mediguard
C. Eldershield
D. Eldercare Fund

C9/9
49. What are endorsements found in a Health Insurance Policy Contract?

A. Promise to pay by insurer

B. Restrict the scope of coverage
C. Actively At Work
D. Legal actions which insured can take against insurer

C5/4
50. In Long Term Care Insurance, Financial Assistance with Adaptation Benefit is:

A. An extra specified amount paid daily

B. An extra monthly benefit
C. A specified amount, 2 times the monthly benefit
D. A specified sum more than the sum assured payable in special interval time

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Health Insurance Mock Exam 2

Mock Exam 2 Answers

1. A 26. B
2. A 27. D
3. B 28. B
4. A 29. C
5. B 30. D
6. C 31. B
7. D 32. C
8. A 33. B
9. D 34. D
10. A 35. A
11. A 36. A
12. B 37. A
13. D 38. B
14. D 39. A
15. A 40 B
16. C 41. B
17. B 42. A
18. B 43. A
19. D 44. C
20. C 45. B
21. A 46. A
22. A 47. C
23. B 48. C
24. C 49. B
25. C 50. C

Workings

Qn 18
Deferred period 6 months from 30/6/08, hence payable on 1/1/09.
Payments = $8000 x 75% = $6000

Qn19
Escalation will be effective on the 2nd year ie 1.1.2010 at $6180 ( $6000 + $6000 x3%)

Qn 20
$8000 - $2000 x $6180 = $4635
$8000

Qn 33
Total expenses = $6300
Less deductible = ($1500)
Less co-insurance = *($860)
Claimable = $3940

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Health Insurance Mock Exam 2

* Computation of Co insurance
$1000 - $3000 : $300 (15% x $2000)
$3001- $6000 : $560 (20% x $2800)
Total : $860

Qn 36
$2500 x 12 = $30,000
$30,000 x 14.3238 (A2 Table: (3% (6%-3%); 19 years) = $429,714
$429,714 X 1.03 = $442,605.42

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