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HI > Set 5 > Flashcards

Set 5 Flashcards

1
Q

Q1: John has just started working at a Health Insurer and is learning about healthcare in Singapore. John asked his manager as to how primary healthcare services are provided in the public sector. John should be told that these are provided through a network of…
(A) health insurers.
(B) private doctors.
(C) inpatient hospitals.
(D) outpatient polyclinics.

A

(D) outpatient polyclinics.

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2
Q

Q2: The government has introduced universal healthcare insurance for…
(A) lifelong protection.
(B) expatriates as a benefit.
(C) the most comprehensive coverage.
(D) exclusive coverage for the wealthy.

A

(A) lifelong protection.

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3
Q

Q3: Joan is seeking reimbursement of hospital miscellaneous expenses under a typical Medical Expense Insurance policy but is not sure which charges she can claim for. In respect of hospital miscellaneous expenses, Joan MOST likely can claim for…
(A) her costs of a short-stay ward.
(B) the charges of the operating room.
(C) her costs of being in an intensive care unit.
(D) the costs of surgical implant and prosthesis.

A

(B) the charges of the operating room.

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4
Q

Q4: Certain events will result in the termination of coverage of an employee under a group Medical Expense insurance policy. This may occur when the employee…
(A) goes on maternity leave.
(B) has ceased to be an employee.
(C) submits 10 or more declined claims in a year.
(D) contracts a critical illness after 5 years in the company.

A

(B) has ceased to be an employee.

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5
Q

Q5: Alice has purchased a Medical Expenses insurance policy. Alice notes that certain items under Hospital Miscellaneous Expenses are covered including…
(A) radiosurgery.
(B) anesthetist’s fees.
(C) ambulance services.
(D) congenital anomalies

A

(C) ambulance services.

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6
Q

Q6: Berty has a Medical Expenses insurance policy which includes Specific Disease Insurance. The specific disease which Berty is covered for is cancer. If Berty is diagnosed to be suffering from cancer, the insurance policy will pay Berty…
(A) a fixed lump sum.
(B) his funeral expenses when he dies
(C) his usual monthly salary until he dies.
(D) the cost of medical treatment to cure him.

A

(A) a fixed lump sum.

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7
Q

Q7: Mr Goh bought a family coverage plan of his Medical Expense Insurance policy. The application was submitted at the same time. A family discount of 5% was given by the insurer.

The premiums payable were as follows:
(i) Mr Goh: S$150
(ii) Mr Goh’s spouse: S$170
(iii) Mr Goh’s son: S$120
(iv) Mr Goh’s daughter: S$140

Calculate the total premium payable by Mr Goh.
(A) S$150
(B) S$304
(C) S$551
(D) S$580

A

(C) S$551

Total gross premium = S$150 + S$170 + S$120 +S$140 = S$580
Premium payable (include 5% discount) = 95% X $580 = S$551

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8
Q

Q8: Under which scheme do the employers, instead of providing their employees with Group Medical Insurance coverage, make additional monthly contributions to the employees’ respective Medisave accounts and the employees can then use the Medisave contributions to purchase MediShield Life or any one of the private insurers’ Integrated Shield Plans, to cover their inpatient or hospitalization needs?
(A) Community Health Assist.
(B) Portable Medical Benefits.
(C) Transferable Medical Insurance.
(D) Pioneer Generation Disability Assistance.

A

(B) Portable Medical Benefits.

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9
Q

Q9: A Group Insurance has been issued to ABC Ltd. This policy is MOST likely to be issued under a single contract called…
(A) Plan contract.
(B) Master contract.
(C) Employer contract.
(D) Employee contract.

A

(B) Master contract.

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10
Q

Q10: Under a Disability Income Insurance policy, a benefit offered by insurers as a hedge against inflation is known as…
(A) escalation benefit.
(B) waiver of premium.
(C) rehabilitation expense.
(D) partial disability benefit.

A

(A) escalation benefit.

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11
Q

Q11: Under a typical Disability Income Insurance policy, where Total Disability is defined as ‘‘the insured’s inability to perform any gainful occupation or a similar occupation for which the insured is reasonably suited by reason of education, training or experience’’, this refers to the type of disability called…
(A) severity.
(B) any occupation.
(C) own occupation.
(D) modified own occupation.

A

(D) modified own occupation.

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12
Q

Q12: Jane is covered under a CareShield Life. A feature of her policy is…
(A) it can only be issued as a rider to ElderShield.
(B) Jane shares in the divisible surplus of the insurer.
(C) its pay-out duration is for the entire duration of disability.
(D) even if Jane recovers from her disability, premium payment must continue until Jane reaches the age of retirement, or dies.

A

(C) its pay-out duration is for the entire duration of disability.

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13
Q

Q13: Mike is an underwriter working for a Health Insurer. Mike is reviewing policy wordings of Long-Term Care insurers and notes that it is usual for Long-Term Care insurers to usually pay benefits monthly or…
(A) daily.
(B) weekly.
(C) quarterly.
(D) annually.

A

(A) daily.

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14
Q

Q14: Cynthia is reading her Critical Illness policy and notes with interest that she is covered for Major Cancer. However, Cynthia’s Critical Illness policy will not cover if…
(A) the policy is in force.
(B) the diagnosis meets the insurer’s conditions.
(C) the diagnosis is made within the waiting period.
(D) the diagnosis meets the definition of critical illness.

A

(C) the diagnosis is made within the waiting period.

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15
Q

Q15: Mrs Ang bought a Whole Life insurance policy for a sum assured of S$300,000 when she was 28 years old. She added a 30% accelerated critical illness rider to the insurance policy.

10 years later, she successfully claimed for the critcal illness benefit. Owing to the illness, she passed away 15 years later.

Assuming that there are no bonuses in the insurance policy, calculate the amount payable upon Mrs Ang’s demise.
(A) S$90,000
(B) S$150,000
(C) S$210,000
(D) S$300,000

A

(C) S$210,000

CI claim = 30% X S$300,000
= S$90,000
Remaining payout upon Mrs Ang’s demise = S$300,000 - S$90,000 = S$210,000

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16
Q

Q16: The waiting period of a Critical Illness insurance policy for severe stage of major cancer is usually…
(A) 14 days.
(B) 30 days.
(C) 90 days.
(D) 120 days.

A

(C) 90 days.

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17
Q

Q17: Jane wishes to purchase Critical Illness insurance covering pregnancy related complications and congenital illness. In Singapore, it is possible for Jane to purchase such term insurance which is usually valid for…
(A) 3-6 months.
(B) 6-12 months.
(C) 2-3 years.
(D) 3-6 years.

A

(D) 3-6 years.

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18
Q

Q18: A Group Dental Care Insurance policy usually…
(A) includes a Schedule of Allowances.
(B) excludes pre-existing dental conditions.
(C) covers replacement of broken dentures.
(D) includes the cost of cosmetic treatment.

A

(A) includes a Schedule of Allowances.

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19
Q

Q19: Brian is an expert in Health Insurance. When asked about a Group Dental Insurance policy, Brian should advise that…
(A) it covers cosmetic dental treatment.
(B) it is usually issued on a contributory basis.
(C) its initial period of insurance is usually two years.
(D) its coverage is usually restricted to Singapore only.

A

(C) its initial period of insurance is usually two years.

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20
Q

Q20: Which type of Health Maintenance Organization Model has the greatest cost control although its members have lowest choice of providers?
(A) Staff.
(B) Group.
(C) Network
(D) Independent Practitioners Association.

A

(A) Staff.

21
Q

Q21: Under a Managed Healthcare Scheme, a Health Maintenance Organization (HMO) contracts with a relatively large number of group practices, some of which may have a single specialty, and the HMO also arranges for the provision of hospital services to its members. This HMO’s model is known as the…
(A) Staff Model HMO
(B) Mixed Model HMO
(C) Network Model HMO
(D) Independent Practitioners Association HMO.

A

(C) Network Model HMO

22
Q

Q22: Ms Ang is a 50-year-old Singaporean who is under the ElderShield scheme and became disabled resulting solely from an accident in the first 60 days of coverage. Ms Ang claims against the ElderShield scheme. How is the insurer most likely to deal with this claim?
(A) The insurer will pay the benefits in full, as the waiting period does not apply.
(B) The insurer will not pay the benefits, will terminate the policy and refund all premium paid.
(C) The insurer will pay half of the benefits because the accident occurred during the waiting period.
(D) The insurer will not pay the benefits, as…waiting period but the policy will remain in…

A

(A) The insurer will pay the benefits in full, as the waiting period does not apply.

The waiting period does not apply if the disablement is due solely to an accident.

23
Q

Q23: *All preliminary calculations should be correct to 2 d.p, and the final answer correct to the nearest unit (with rounding).

Jerry has purchased an ElderShield Supplement Plan from an approved insurer. The annual premium for this Plan is S$1,300.

The annual withdrawal limit for Jerry is S$600.

Calculate the amount of premium that Jerry has to pay by cash.
(A) S$400
(B) S$600
(C) S$700
(D) S$1,300

A

(C) S$700

Medisave Withdrawal Limit = S$600
Cash = S$1,300 - S$600
= S$700

24
Q

Q25: Darren met with an accident and was sent to a hospital by an ambulance. He underwent a minor surgery and stayed in a Class C ward. He was attended by a team of doctors and nurses. He did not understand why he was required to pay cash for a portion of his hospital bill, as his understanding was that MediShield Life covers the hospital bill in full.

The relevant charges and fees were within the policy limits. Darren asked his financial consultant who mentioned that one of the items was not covered under MediShield Life, hence resulting in Darren having to pay cash for the item.

The item that MOST likely resulted in Darren paying cash is the…
(A) surgery fees.
(B) ambulance fees.
(C) Class C ward charges.
(D) doctors’ and nurses’ fees.

A

(B) ambulance fees.

25
Q

Q26: The eligibility for higher subsidies at a Specialist Outpatient Clinic of a public hospital is based on the patient’s…
(A) age.
(B) gender.
(C) marital status.
(D) household monthly income.

A

(D) household monthly income.

26
Q

Q27: Jane is a Central Provident Fund member. She can use his MediSave for mammograms screening at approved medical centres if she is aged over…
(A) 45
(B) 50
(C) 35
(D) 40

A

(B) 50

27
Q

Q28: Mr Lee, aged 45 years, purchased a Medical Insurance policy with the following breakdown in the policy premium:
(i) MediShield Life component: S$1,000
(ii) Additional Private Insurance coverage = S$700

The annual withdrawal limit for Mr Lee is S$600.

Calculate the amount of premium payable by cash
(A) S$100
(B) S$700
(C) S$1,000
(D) S$1,700

A

(A) S$100

MediShield Life component = Fully paid by Medisave

AWL for 45 on IP = S$600 (ANB 41 to 70 years: S$600)
Premium payable by cash = S$700 - S$600
= S$100

28
Q

Q29: Mr Osman is a 35-year-old Singaporean. He was admitted to a public hospital on 1 December 2021 for a duration of three days during which he underwent an appendix surgery. The total claimable amount under Medishield Life for Mr Osman’s surgery was S$3,000, with a deductible of S$1,500.

The amount payable under Medishield Life is…
(A) less of deductible only.
(B) less of co-insurance only.
(C) less of deductible and co-insurance.
(D) the full sum as the bill is below S$3,000

A

(C) less of deductible and co-insurance.

29
Q

Q30: The Singapore Government worked with Integrated Shield Plan(IP) insurers to develop a Standard IP which is targeted at covering large hospital bills for Class ___ ward.
(A) A
(B) B1
(C) B2
(D) C

A

(B) B1

30
Q

Q31: MediShield Life covers all Singapore Citizens up till they…
(A) pass away.
(B) reach 99 years.
(C) become permanently disabled.
(D) decide to seek treatment at a private hospital.

A

(A) pass away.

31
Q

Q32: *All preliminary calculations should be correct to two decimal places (with rounding) and the final answer correct to the nearest unit (with rounding).

Veronica, a 55-year-old professional, has been quoted the following for her MediShield Life, CareShield scheme and CareShield Life Supplement:

(1) MediShield Life component = S$600
(2) Risk Loading = S$180
(3) CareShield Life = S$550
(4) CareShield Life Supplement = S$850

The annual withdrawal limit for Veronica is S$600.

Calculate the amount that Veronica will have to pay in cash for the CareShield Life Supplement.
(A) S$180
(B) S$250
(C) S$600

A

(B) S$250

Withdrawal limit for CareShield Life supplement = S$600

Cash payment = S$850 -
S$600
= S$250

32
Q

Q33: *All preliminary calculations should be corrected to 2 d.p(with rounding) and the final answer correct to the nearest unit (with rounding).

Jane purchased an ElderShield 400 policy from one of the approved insurers. She subsequently needed long-term care, but recovered after 75 months. Calculate the total payout that Jane received from her ElderShield 400 policy.
(A) S$3,200
(B) S$4,800
(C) S$28,800
(D) S$30,000

A

(C) S$28,800

ElderShield 400 = S$400 for maximum of 72 months
Total payout = S$400 X 72
= S$28,800

33
Q

Q34: To make a claim under a CareShield Life policy, the insured needs to submit a claim application to the…
(A) Ministry of Health Holdings.
(B) Agency of Integrated Care (AIC).
(C) Pioneer Generation Department.
(D) Monetary Authority of Singapore.

A

(B) Agency of Integrated Care (AIC).

34
Q

Q35: Any CareShield Life policyholder who wishes to obtain higher long-term care insurance coverage can also purchase…
(A) Exclusions.
(B) ElderShield.
(C) Deductibles.
(D) Supplements.

A

(D) Supplements.

35
Q

Q36: For Singapore Citizens and Singapore Permanent Residents(SPR) born in 1979 or before, how could they join CareShield Life?
(A) They can choose to apply to join CareShield Life from 6 November 2021 onwards.
(B) There is a yearly enrolment of Singapore Citizens and SPRs born in 1979 or before.
(C) CareShield Life is compulsory for them and hence they would be automatically enrolled.
(D) They cannot join CareShield Life as it is only open to Singapore Citizens and SPRs born after 1980.

A

(A) They can choose to apply to join CareShield Life from 6 November 2021 onwards.

36
Q

Q37: A policy owner who has just bought Critical Illness insurance policy, with built-in death benefits payable, wishes to make a nomination of beneficiaries, such that he still retains the policy ownership and is free to charge, add or remove them without their consent. Which nominations should he make?
(A) Trust Nomination.
(B) Revocable Nomination.
(C) Irrevocable Nomination.
(D) Recoverable Nomination.

A

(B) Revocable Nomination.

37
Q

Q38: Devesh works for a health insurer in the underwriting department. Devesh issues policies to policyholders. Devesh notices that the health insurance policies contain a clause outlining the period of time after delivery of the policy document during which the policy owner may review the policy and return it for a refund of the premium paid to the insurer, less any medical fees incurred. Devesh notes that this wording is contained within the ____ Clause.
(A) Signature
(B) Operative
(C) Entire Contract
(D) Free Look Period

A

(D) Free Look Period

38
Q

Q39: Alex has purchased a medical expenses policy and notes that this contains a waiting period. Alex reads that the waiting period is the period of time…
(A) starting from the date that a claim occurs, where the insured person’s medical expenses are not covered by the policy.
(B) starting from the date that a claim is made, where the insured person’s medical expenses are not covered by the policy.
(C) starting from the date that the premium is paid, where the insured person’s medical expenses are not covered by the policy.
(D) starting from the date of policy issue or reinstatement date, where the insured person’s medical expenses are not covered by the policy.

A

(D) starting from the date of policy issue or reinstatement date, where the insured person’s medical expenses are not covered by the policy.

39
Q

Q40: What will likely help to reduce the amount of premium that insurers charge for their Health Insurance policies if the insurer expects market conditions to be favourable?
Increase in…
(A) medical inflation.
(B) investment income.
(C) operating expenses.
(D) mortality experience.

A

(B) investment income.

40
Q

Q41: In the context of additional underwriting considerations for Health Insurance, the regular engagement in hazardous sports is considered to be a ______ risk.
(A) lifestyle
(B) financial
(C) speculative
(D) fundamental

A

(A) lifestyle

41
Q

Q42: Derry is a disability income insurance underwriter. Derry knows that financial information is important in underwriting individual disability income insurance. This is because Derry must ensure that the benefit amount applied for is reasonable and not higher than ___ of the policyholder’s current income.
(A) 10%
(B) 25%
(C) 50%
(D) 75%

A

(D) 75%

42
Q

Q43: One of the key factors in underwriting Long-Term Care Insurance is the…
(A) level of education
(B) status of citizenship.
(C) size and stability of the proposer’s earnings.
(D) detection of any early cognitive impairment.

A

(D) detection of any early cognitive impairment.

43
Q

Q44: A proposer with a pre-existing condition when buying Medical Expense Insurance will usually have the condition…
(A) covered in full from policy inception.
(B) excluded from coverage by the insurer.
(C) covered in full after 90 days of policy inception.
(D) covered after 90 days of policy inception subject to 50% co-insurance with the policyholder.

A

(B) excluded from coverage by the insurer.

44
Q

Q45: Notice No.: MAS 120 comprises both mandatory requirements and best practice standards on the disclosure of information and provision of advice to policy owners for…
(A) life policies only.
(B) accident and health(A&H) policies only.
(C) A&H policies and life policies that provide A&H benefits.
(D) A&H policies, Investment-Linked policies and Universal Life policies

A

(C) A&H policies and life policies that provide A&H benefits.

45
Q

Q46: Under the “Notice No.: MAS 120 - Disclosure and Advisory Process Requirements for Accident and Health Insurance Products’’, at least how many days in advance must the direct insurer write to the policy owner before it amends or varies policy terms?
(A) 15 days.
(B) 30 days.
(C) 45 days.
(D) 60 days.

A

(B) 30 days.

46
Q

Q47: Under Notice No.: MAS 120, the A&H insurance intermediary must perform a proper needs analysis, before recommending any product to the insured. This is because…
(A) the insured cannot opt out of any product advice from the A&H insurance intermediary.
(B) the A&H insurance intermediary shall ensure suitability of the product to the insured based on the information provided.
(C) if the A&H insurance intermediary is unable to identify a suitable policy, it will not need to inform the insured accordingly.
(D) the basis on which the A&H insurance intermediary is providing the advice to the insured shall only be verbally communicated to the insured.

A

(B) the A&H insurance intermediary shall ensure suitability of the product to the insured based on the information provided.

47
Q

Q48: One of the best practice standards in which an A&H insurance intermediary is expected to meet concerning disclosure of product information (including marketing materials) given to the policy owner as required under Notice No.: MAS 120 is…
(A) documents given to the policy owner need not be up-to-date.
(B) any jargon or technical term should not be explained to the policy owner.
(C) expressing an opinion is not allowed to be made in any marketing material.
(D) information disclosed should not be limited to seeking compliance with the requirements of this Notice.

A

(D) information disclosed should not be limited to seeking compliance with the requirements of this Notice.

48
Q

Q49: For the purpose of Notice No.: MAS 120, the definition of an accident and health insurance intermediary includes a…
(A) captive insurer.
(B) direct reinsurer.
(C) direct insurance broker.
(D) direct reinsurance broker.

A

(C) direct insurance broker.

49
Q

Q50: Needs selling is more desirable than product selling because it is:
(A) sales driven.
(B) pressure-selling.
(C) service-oriented.
(D) guaranteed to achieve the correct result.

A

(C) service-oriented.

HI (5 decks)

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