Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IF7 > IF7 > Flashcards

IF7 Flashcards

1
Q 
. An organisation which provides insurance to healthcare insurers against large losses is known as
A. an employee healthcare trust.
B. a healthcare reinsurer.
C. a health cash fund.
D. a third party administrator
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
2. The proportion of non-emergency surgery carried out in the UK by private hospitals compared to
National Health Service hospitals is
A. 5%
B. 15%
C. 20%
D. 25%
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. Emergency surgery is mainly carried out by what type of establishment
    A. private hospital.
    B. National Health Service hospital.
    C. National Health Service walk-in centre.
    D. General Practitioner surgery.
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
4. What type of dividends, if any, are payable by provident insurers?
A. None.
B. Debenture-based payments.
C. Equity-based distributions.
D. UK-share dividends
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. When a healthcare trust is set up to provide healthcare for a group of employees, what is
    the main purpose of arranging stop loss insurance?
    A. To avoid the need for a policy excess.
    B. To minimise the duration of the waiting period.
    C. To protect the trustees if the trust fails.
    D. To protect the trust fund from higher than expected claims costs.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. What restriction does an employee healthcare trust usually place on claim payments?
    A. Benefits are not absolutely guaranteed.
    B. A ceiling is placed on the number of claims that may be made per annum.
    C. Claims must not exceed £10,000 per annum.
    D. Each claim must not exceed £10,000
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. Two small healthcare insurance broking firms belong to the same network. What common
    relationship do they have?
    A. They are deemed to act on behalf of the same clients.
    B. They are owned by the same parent company.
    C. They are regulated through the same umbrella organisation.
    D. They are tied to the same product provider.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Worksite marketing of healthcare cover is primarily aimed at promoting
    A. company paid health cash plans.
    B. Employee Assistance Programmes.
    C. dental capitation plans.
    D. voluntary group private medical insurance.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. A firm employing 2,000 employees wishes to set up a company-paid private medical insurance
    scheme and requires advice on how to obtain the best possible deal. Which distribution channel is
    likely to be best for such an arrangement?
    A. A direct insurer.
    B. The internet.
    C. A specialist independent intermediary.
    D. A specialist tied intermediary.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q 
10. A potential disadvantage for an insurer using a direct sales force to distribute private medical
insurance is
A. greater control over sales processes.
B. greater cross-selling opportunities.
C. increased infrastructure costs.
D. paying commissions.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. General Practitioners are involved in the provision of services through which organisation?
    A. The British Medical Association.
    B. The local Clinical Commissioning Group.
    C. The National Institute for Health and Care Excellence.
    D. The General Medical Council.
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
12. What specific condition automatically entitles patients to free National Health Service (NHS) dental
treatment?
A. Alzheimer’s.
B. Diabetes.
C. Haemophilia.
D. Pregnancy.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Which body is responsible for recommending the treatments the National Health Service (NHS)
    should provide?
    A. The British Medical Association.
    B. The Department of Health.
    C. NHS Improvement.
    D. National Institute for Health and Care Excellence.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. What development in the American healthcare market has significantly increased competition for
    market share?
    A. The emergence of managed care.
    B. The fall in the cost of critical illness insurance.
    C. The new underwriting approach to long-term care.
    D. The rise in the coverage of dental insurance.
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q 
15. In Germany, what type of healthcare insurance, in addition to private medical insurance, is provided
under the State health insurance scheme?
A. Critical illness insurance.
B. Income protection insurance.
C. Long-term care insurance.
D. Personal accident insurance.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. The benefit provided under an income protection insurance policy as a percentage of the insured’s
    income is usually limited to a maximum of around
    A. 25%.
    B. 60%.
    C. 100%.
    D. 150%
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. A policy that assists with the day-to-day cost of dental and optical bills as well as therapy such as
    physiotherapy is known as a
    A. flexible benefit scheme.
    B. health cash plan.
    C. personal accident and sickness plan.
    D. small and medium enterprise private medical insurance
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  1. What service is usually excluded under a comprehensive private medical insurance policy?
    A. Hospital accommodation.
    B. Inpatient diagnostic tests.
    C. Private consultations with a general practitioner (GP).
    D. Surgery as a day patient.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. Alice runs a company employing 50 people. She wants to ensure that all staff have access to
    prompt medical treatment. The most appropriate product for this is
    A. a capitation plan.
    B. a health cash plan.
    C. occupational health services.
    D. a private medical insurance policy.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  1. Medical history disregarded is a term most likely to be found in a
    A. a corporate private medical insurance policy.
    B. an individual critical illness policy.
    C. an individual private medical insurance policy.
    D. voluntary private medical insurance policy.
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  1. A health cash plan offers a cash payment when a patient stays at which type(s) of hospital?
    A. A National Health Service (NHS) hospital only.
    B. A private ward of a National Health Service (NHS) hospital only.
    C. A private hospital only.
    D. A private hospital or a National Health Service (NHS) hospital.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  1. When a personal accident insurance policy includes a hospitalisation benefit, the benefit is usually
    expressed as a
    A. fixed daily amount.
    B. percentage of salary.
    C. sliding scale according to disability.
    D. fixed lump sum according to hospital band
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. Which type of insurance product provides for regular eye tests and any glasses or contact lenses
    required to protect vision?
    A. A health cash plan.
    B. An income protection insurance policy.
    C. A personal accident insurance policy.
    D. A private medical insurance policy.
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
  1. Kevin is concerned by the high one-off charges for his dental treatment, so he is looking for a way
    to spread the payments and budget for the overall cost. What type of healthcare product
    is likely to best suit his needs?
    A. A dental capitation plan.
    B. A health cash plan.
    C. A major medical expenses insurance policy.
    D. A standard private medical insurance policy.
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
  1. William has worked all of his life in England and chooses to retire in Spain. He needs to purchase
    insurance to cover potential hospital bills. The most appropriate insurance policy for him is
    A. an annual travel insurance policy.
    B. a health cash plan.
    C. an international medical insurance policy.
    D. a UK private medical insurance policy.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q 
26. A fitness for work assessment is a feature of
A. a health cash plan.
B. an immediate needs care annuity.
C. an occupational health service.
D. a private medical insurance policy.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
  1. Daniel goes on holiday to America where he becomes unwell. What medical benefit is unlikely to
    be recoverable under his travel insurance policy?
    A. Diagnostic tests.
    B. Inpatient costs.
    C. Outpatient costs.
    D. Over-the-counter medication
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
  1. Graham and Paula are both 60 years old and do NOT want to use any of their substantial
    investments to pay for nursing home care should they need it. What type of insurance product
    would be most suitable in these circumstances?
    A. A critical illness insurance policy.
    B. A health cash plan.
    C. A long-term care insurance policy.
    D. A private medical insurance policy
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
  1. Sheila is a self-employed interior designer. What would be the main benefit to her of taking out
    private medical insurance?
    A. She could elect to get treatment at a time when it was convenient for her business.
    B. She would get earlier emergency treatment than under the National Health Service (NHS).
    C. She would receive a lump sum if she were to be hospitalised.
    D. She would receive an income for the time she was unable to work
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
  1. The benefit under a critical illness insurance policy is normally paid in the form of
    A. a deferred annuity.
    B. an immediate annuity.
    C. a one-off lump-sum payment.
    D. a series of regular payments until retirement age.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  1. Ben wishes to take out a low-cost insurance policy which will cover the more expensive types of
    private inpatient treatment. What type of medical insurance policy is he most likely to buy?
    A. A comprehensive private medical insurance policy.
    B. A health cash plan.
    C. An income protection insurance policy.
    D. A major medical expenses policy.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q
  1. Jane has an in-patient only private medical insurance policy with no excess. She recently started
    suffering from abdominal pain, so her GP referred her to a private specialist. After an initial
    consultation, her specialist referred her for a day case procedure the following week. Two days
    later she received a follow-up consultation with her specialist. Which of the treatments, if any, are
    covered by her policy?
    A. None of the treatments.
    B. The day case procedure only.
    C. The day case procedure and the follow up consultation only.
    D. The day case procedure and both consultations.
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  1. When is primary care covered under a travel insurance policy, if at all?
    A. Never.
    B. In an emergency.
    C. Always, subject to a maximum financial limit.
    D. Only when required as routine treatment for an ongoing medical condition.
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q 
34. What cover will a health cash plan usually provide that is NOT normally covered under a private
medical insurance policy?
A. Nursing care.
B. Outpatient treatment.
C. Routine dental treatment.
D. Surgical procedures.
A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q 
35. The main function of an income protection insurance policy is to provide an income on
A. death.
B. illness.
C. redundancy.
D. retirement.
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q
  1. Under a ‘member get member’ loyalty scheme, when is a cash bonus normally paid to the existing
    member?
    A. On submission of a quotation request by the new member.
    B. On payment of the new member’s first premium.
    C. On completion of the new member’s first year.
    D. On completion of a specified claim-free period by the new member
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q 
37. Who is responsible for assessing the risk when transacting healthcare insurance?
A. The claims manager
B. The intermediary.
C. The policyholder.
D. The underwriter.
A

d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q
  1. When obtaining a medically underwritten budget private medical insurance policy for a client, an
    intermediary should typically ask
    A. details of hospital admissions only over the last five years.
    B. details of all previous and existing medical conditions over the last five years.
    C. whether the client is on a waiting list of more than six weeks for surgery.
    D. no medical questions.
A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q
  1. Who, if anyone, is primarily responsible for providing customers who have taken out a healthcare
    policy via an intermediary with information on mid-term changes to the policy?
    A. The insurer only.
    B. The insurance intermediary only.
    C. Both the insurer and the intermediary.
    D. Neither the insurer nor the intermediary
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q
  1. When is a fact-find usually undertaken?
    A. Prior to an application form being completed.
    B. Once an application form has been completed but before the policy is accepted by the insurer.
    C. Once the policy is accepted by the insurer.
    D. On receipt of a completed claim form.
A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q
  1. An employer has a private medical insurance scheme where the number of employees has
    increased year on year. The scheme is subject to a three-year premium agreement. How often, if
    at all, is the intermediary most likely to carry out a client review?
    A. At least annually.
    B. At the end of the three-year period.
    C. Only if requested to do so by the client.
    D. Never.
A

a

42
Q
  1. When calculating premiums for an individual private medical insurance policy using a sliding scale,
    the discounted premium is usually arrived at by applying
    A. a discretionary bonus.
    B. an introductory bonus.
    C. a loyalty bonus.
    D. a no claims bonus.
A

d

43
Q 
43. When an employee leaves employment of a company, who is responsible for informing his
healthcare insurer?
A. The employee.
B. The group secretary.
C. The intermediary.
D. The third party administrator
A

b

44
Q
  1. An intermediary has arranged to transfer a small and medium enterprise group private medical
    insurance policy from one insurer to another on continued personal medical exclusions (CPME)
    terms. In addition to the completed proposal form and schedule of employees to be covered, what
    other key piece of information will the new insurer require to complete the transfer?
    A. A copy of the previous insurer’s benefit schedule.
    B. A copy of the previous insurer’s employee membership certificates confirming original
    underwriting terms.
    C. A detailed health questionnaire completed by each employee.
    D. A general practitioner (GP) medical report for each employee, detailing pre-existing medical
    conditions
A

b

45
Q 
45. Which party is responsible for accepting the risk in respect of a healthcare policy?
A. The insurer.
B. The intermediary.
C. The policyholder.
D. The reinsurer.
A

a

46
Q
  1. A healthcare insurance company offers its policyholders a discount at a gym which operates
    nationally. This is an example of
    A. a core healthcare product.
    B. a customer loyalty mechanism.
    C. a flexible benefit scheme.
    D. an intermediated sales method.
A

b

47
Q
  1. What significance does a client’s postcode have when calculating premiums for an individual private
    medical insurance policy?
    A. It indicates the likely incidence of many chronic conditions.
    B. It indicates the availability of treatment for most standard covered conditions.
    C. It provides socio-economic data for the purposes of imposing a policy excess.
    D. It provides an indication of the likely cost of treatment.
A

d

48
Q
  1. Why do individual healthcare policies mainly exclude pre-existing medical conditions?
    A. So that members can be given different levels of cover.
    B. So that members are treated equally and claims costs are contained.
    C. So that underwriters can charge different levels of premium.
    D. So that underwriters can avoid accessing members’ medical records
A

b

49
Q
  1. The use of general exclusions of medical conditions under a private medical insurance policy has
    what overall effect on the risk to an insurer?
    A. The risk is reduced as uninsured conditions cannot be claimed for.
    B. The risk is increased as some clients may disguise the condition for which they are claiming.
    C. The risk is reduced as there is less need to assess each individual claim.
    D. The risk is increased as each claim must be scrutinised at a higher level.
A

a

50
Q
  1. A restricted hospital network consists mainly of hospitals which
    A. are owner-operated only.
    B. have single private rooms only.
    C. are selected by the insurer based on specially negotiated or agreed prices.
    D. are selected by the insurer based on their particular medical specialisms.
A

c

51
Q
  1. An applicant whose proposal is subjected to full medical underwriting will ultimately benefit
    because
    A. his cover will be less expensive.
    B. his cover will continue for longer.
    C. his policy will contain fewer exclusions.
    D. he will know what conditions will be covered.
A

d

52
Q
  1. A client has a private medical insurance policy which operates on a moratorium underwriting basis
    in respect of a five-year period prior to inception. If he develops a recurrence of a three-year-old
    medical problem two weeks after the policy starts, how will the insurer treat a claim?
    A. It will be rejected.
    B. A reduced maximum level of benefit will apply.
    C. A waiting period will apply.
    D. It will be settled in full in the normal way.
A

a

53
Q
  1. When applying for a private medical insurance policy, Shivani discloses that she recently received
    treatment for a shoulder dislocated two years ago. Her policy is subject to full medical
    underwriting. What is the underwriter’s decision likely to be regarding Shivani’s condition?
    A. Allow immediate cover for the condition at standard premium rates.
    B. Allow immediate cover for the condition subject to an additional premium.
    C. Exclude the condition.
    D. Apply a two-year moratorium for the condition.
A

c

54
Q
  1. With regard to a client’s medical history under a private healthcare insurance policy, full medical
    underwriting is likely to result in
    A. a general exclusion applying to all pre-existing medical conditions.
    B. a general exclusion applying to certain pre-existing medical conditions only.
    C. most pre-existing medical conditions being automatically excluded from cover.
    D. personal exclusions being applied to selected pre-existing medical conditions.
A

d

55
Q 
55. What is the usual maximum number of employee members required to qualify for age rated small
private medical insurance group schemes?
A. 10 members.
B. 25 members.
C. 100 members.
D. 250 members.
A

c

56
Q
  1. When a private medical insurance policy is set up, what is usually the maximum permitted increase
    in the premium, if any, after the renewal date?
    A. There is no maximum permitted increase.
    B. The increase in the relevant medical inflation index.
    C. The increase in the Retail Prices Index.
    D. 7.5% or the increase in the Average Weekly Earnings index if less
A

a

57
Q
  1. What is the primary underwriting concern for an insurer offering private medical insurance to
    employees under a voluntary scheme?
    A. The benefit limits.
    B. The geographical location of the employer.
    C. The hospital band chosen.
    D. Selection against the insurer
A

d

58
Q
  1. When calculating a renewal premium for a small to medium-sized private medical insurance
    scheme, on which aspect of claims statistics would the insurer usually focus?
    A. Each member’s claims experience.
    B. Market accepted claims statistics.
    C. The loss ratio of the scheme.
    D. The number of high value claims.
A

c

59
Q
  1. Why would some health insurers actively encourage private medical insurance policyholders to
    undertake regular exercise?
    A. As a long-term measure to control claims costs.
    B. As a marketing tool to attract new policyholders.
    C. To enable policyholders to claim for physiotherapy treatments.
    D. To monitor policyholders in accordance with their Body Mass Index
A

a

60
Q
  1. What aspect of a company paid private medical insurance policy is most likely to be affected by the
    location of the employer?
    A. The amount of payment for treatment carried out free by the National Health Service (NHS).
    B. The choice of specialist.
    C. The cost of cover.
    D. The size of the excess.
A

c

61
Q
  1. Colin’s private medical insurance cover is being transferred from one insurer to another on a
    medical history disregarded basis. What policy types are most likely to be involved in this transfer?
    A. An individual policy to an individual policy.
    B. An individual policy to a group policy.
    C. A group policy to an individual policy.
    D. A group policy to a group policy.
A

d

62
Q
  1. In order for a healthcare insurance underwriter to assess a risk, he is most likely to require the
    potential policyholder to
    A. complete a proposal form.
    B. identify her nearest healthcare trust.
    C. obtain alternative quotations.
    D. undertake a medical examination.
A

a

63
Q 
63. Private medical insurance underwriters control individual risk primarily by use of
A. cover limits.
B. excesses.
C. exclusions.
D. hospital bands
A

c

64
Q
  1. When rating an individual private medical insurance policy, what is usually the most significant
    factor when determining an individual’s premium?
    A. Age.
    B. Gender.
    C. Occupation.
    D. Previous medical history
A

a

65
Q
  1. To whom does a private medical insurer usually send claim payments?
    A. The policyholder.
    B. The policyholder’s general practitioner (GP).
    C. The policyholder’s employer.
    D. The provider of the policyholder’s treatment.
A

d

66
Q
  1. Under a private medical insurance policy with a pre-authorisation claims process, the policyholder
    does NOT normally require the insurer’s consent when
    A. emergency treatment is required.
    B. non-emergency treatment is required.
    C. there is more than one claim during the policy year.
    D. using a hospital on the insurer’s approved list.
A

a

67
Q 
67. What type of qualifications are case managers working for the claims department of private
medical insurers most likely to possess?
A. Accounting.
B. Hospital management.
C. Medical.
D. Underwriting.
A

c

68
Q
  1. A private medical insurance policyholder recently received treatment, however the cost of the
    treatment exceeded the policy limit. Who, if anyone, is normally responsible for paying the excess?
    A. The insurer.
    B. No one.
    C. The policyholder.
    D. The policyholder’s local Clinical Commissioning Group
A

c

69
Q
  1. The main reason a private medical insurer requires the original bills for treatment before settling a
    claim is to
    A. code claims accurately.
    B. comply with the Financial Conduct Authority’s regulations.
    C. determine the claim amount.
    D. prevent claims being fraudulently duplicated.
A

d

70
Q
  1. Treatment for chronic conditions is usually excluded from private medical insurance because
    A. chronic conditions are subject to a moratorium on pre-existing conditions.
    B. the risk of treatment recurring would add to claims costs.
    C. treatment is available free of charge at National Health Service hospitals.
    D. treatment is usually provided by general practitioners.
A

b

71
Q
  1. A provider of which type of healthcare insurance product might need to make provision in its claims
    reserves for potential payments on death?
    A. An income protection insurance policy.
    B. A mortgage payment protection insurance policy.
    C. A personal accident insurance policy.
    D. A private medical insurance policy.
A

c

72
Q
  1. Why is the potential duration of an illness less significant under a payment protection insurance
    policy than under an income protection insurance policy?
    A. The benefit payment progressively reduces each month.
    B. The maximum benefit payment period is much shorter.
    C. The payment is likely to be in the form of a lump sum.
    D. The underwriting criteria are more stringent.
A

b

73
Q
  1. In addition to covering the costs of dental treatment, a fixed lump sum is often payable under a
    dental insurance policy in the event of
    A. an accidental injury.
    B. a claims-free period.
    C. a complication arising during treatment.
    D. a diagnosis of mouth cancer.
A

d

74
Q
  1. The main reason why medical inflation has generally risen faster than the Retail Prices Index is
    because of
    A. clinical advances.
    B. constraints on National Health Service (NHS) funding.
    C. managed care initiatives.
    D. rising National Health Service (NHS) costs.
A

a

75
Q
  1. As a cost containment measure, a healthcare insurer has employed some medical specialists on a
    session basis. Each session is usually treated as lasting for what notional period?
    A. An hour.
    B. A half day.
    C. A full day.
    D. A working week.
A

b

76
Q
  1. What is potentially the key disadvantage to a policyholder of a private medical insurer adopting a
    managed care approach?
    A. An increase in premium level.
    B. An increase in underwriting.
    C. A reduction in the choice of healthcare provider.
    D. A reduction in medical confidentiality.
A

c

77
Q
  1. A private medical insurer can manage the cost of a valid claim that has already been notified under
    a comprehensive policy by
    A. comparing the cost of treatment against clinical norms.
    B. imposing an increased excess.
    C. introducing the concept of coinsurance.
    D. referring the claimant to a low-cost overseas treatment facility.
A

a

78
Q
  1. In relation to private medical insurance, to what does the term pre-authorisation refer?
    A. The insurer’s requirement to review the case prior to treatment going ahead.
    B. The insurer’s threshold before assessing potentially less expensive methods of treatment.
    C. The limit up to which case management workers can process claims on behalf of the insurer.
    D. The maximum claim payment before which assessment is required
A

a

79
Q
  1. What main factor normally dictates the frequency with which a private medical insurer settles
    payments direct with the healthcare provider?
    A. The age of the claimant.
    B. The size of the individual claim.
    C. The type of illness involved.
    D. The volume of insured care provided
A

d

80
Q
  1. How are claims payments in respect of hospital fees usually settled by a healthcare insurer?
    A. By cheque when each claim is made.
    B. By cheque on a monthly basis.
    C. By direct credit transfer when each claim is made.
    D. By direct credit transfer on a monthly basis
A

d

81
Q
  1. In the last two years, Martin has received treatment three times using his healthcare product
    without the need to contact the product provider. What type of product is he most likely to hold?
    A. A dental capitation plan.
    B. A health cash plan.
    C. An overseas medical expenses insurance policy.
    D. A travel insurance policy.
A

a

82
Q
  1. Judy wishes to claim under her private medical insurance policy for a MRI scan and on contacting
    her healthcare insurer is directed to one particular hospital in her area for the scan. Which claims
    cost control measure is the insurer most likely to be using?
    A. Care Pathway.
    B. Clinical guideline.
    C. Network facility.
    D. Procedure code.
A

c

83
Q
  1. Dan and Claire have taken out a joint stand-alone critical illness insurance policy with a sum assured
    of £100,000. Dan suffers a heart attack and dies seven days later. How much will Claire receive, if
    anything, under the policy?
    A. Nothing.
    B. A refund of premiums paid.
    C. £50,000
    D. £100,000
A

a

84
Q
  1. Jack has a private medical insurance policy and has submitted a claim to the insurer for an
    operation at a private hospital. The insurer has informed Jack that the chosen hospital does NOT
    adhere to its scale of approved fees. How will this usually affect the claim?
    A. The insurer will not pay the claim.
    B. The insurer will pay 50% of the claim.
    C. The insurer will pay the claim in full.
    D. The hospital fees are more than the insurer will pay and Jack will have to pay the extra cost.
A

d

85
Q
  1. Which statutory complaint resolution service resolves disputes between consumers and providers
    of healthcare insurance?
    A. The Claims and Underwriting Exchange.
    B. The Financial Ombudsman Service.
    C. The Financial Conduct Authority.
    D. The Financial Services Compensation Scheme.
A

b

86
Q 
86. A consumer has the statutory right to cancel a private medical insurance contract, without penalty,
within
A. 7 days.
B. 14 days.
C. 28 days.
D. 30 days.
A

b

87
Q
  1. Bob’s private medical insurance is an annual contract. He paid the full annual premium at the start
    of the policy. However, he decided to cancel his policy after 6 months. He did not make any claims.
    How much of the premium, if any, is his insurer obliged to refund?
    A. None.
    B. 6 months’ premium.
    C. 6 months’ premium less the premium for the cooling off period .
    D. All the premium.
A

b

88
Q
  1. What is the maximum award that the Financial Ombudsman Service can make to an individual who
    has a dispute with his private medical insurer?
    A. £75,000
    B. £125,000
    C. £150,000
    D. £250,000
A

c

89
Q
  1. Jeff attempts to make a legitimate claim on his critical illness insurance policy, but discovers that his
    insurer is unable to meet its financial obligations. To which body can Jeff apply to seek redress?
    A. Association of British Insurers.
    B. Financial Conduct Authority.
    C. Financial Ombudsman Service.
    D. Financial Services Compensation Scheme.
A

d

90
Q 
90. Which organisation publishes the Statement of Best Practice for Sales of Individual and Group
Private Medical Insurance
A. Association of British Insurers.
B. British Medical Association.
C. Consumer’s Association.
D. Financial Conduct Authority
A

a

91
Q
  1. What effect does the Data Protection Act 2018 have with regard to the rights of a proposer to view
    her medical records before the records are passed to the insurer?
    A. The insurer is required to automatically pass details of any medical report directly to a proposer.
    B. The maximum period for which a proposer can view her own medical records has been increased
    to 12 months after its issue.
    C. A proposer can ask to see any medical records requested by the insurer.
    D. A proposer no longer has the right to change any part of the record she believes is inaccurate.
A

c

92
Q
  1. How does the Equality Act 2010 affect the ability of a healthcare insurer to exclude any pre-existing
    medical conditions, if at all?
    A. The Act does not apply to insurance contracts and insurers.
    B. Exclusions can be made, but only if the condition can be shown to carry a higher risk for the
    insurer.
    C. Exclusions can be made, but only if the condition is expected to last more than 12 months.
    D. Exclusions can be made, but only if the proposer is registered disabled.
A

b

93
Q
  1. Which Act enables a healthcare insurer to obtain the medical history of a deceased policyholder?
    A. The Access to Health Records Act 1990.
    B. The Data Protection Act 2018.
    C. The Equality Act 2010.
    D. The Mental Capacity Act 2005
A

a

94
Q 
94. What tax is payable, if any, by an employee who receives healthcare insurance paid for by her
employer?
A. No tax is payable.
B. Income Tax.
C. Insurance Premium Tax.
D. Value Added Tax.
A

b

95
Q
  1. Andrew suffered a serious injury some months ago and is in receipt of benefit from his individual
    income protection insurance policy. How, if at all, will the benefit be taxed?
    A. It will be liable to Income Tax and National Insurance.
    B. It will be liable to Income Tax, but not National Insurance.
    C. It will be liable to National Insurance, but not Income Tax.
    D. It will not be liable to Income Tax or National Insurance.
A

d

96
Q 
96. A corporation purchasing healthcare insurance for its staff has resulting financial liabilities in the
form of
A. claims.
B. Corporation Tax.
C. National Insurance contributions.
D. occupational health services.
A

c

97
Q
  1. An insurer has requested a medical report for a policyholder. Under the Access to Medical Reports
    Act 1988, what is the minimum period, if any, for which the medical practitioner must retain the
    report?
    A. There is no minimum period.
    B. 3 months.
    C. 6 months.
    D. 12 months.
A

c

98
Q
  1. A healthcare insurer has requested a medical report from Margaret’s general practitioner (GP).
    Under the terms of the Access to Medical Reports Act 1988, how long does Margaret have to view
    the medical report before it is released by her GP to the insurer?
    A. 14 days.
    B. 21 days.
    C. 28 days.
    D. 30 days
A

b

99
Q
  1. Providers of healthcare insurance in the UK accept a higher degree of regulation, in addition to
    statutory regulation, by subscribing to
    A. the Association of British Insurers’ and other industry codes of practice.
    B. the British Medical Association.
    C. employee healthcare trusts.
    D. the General Medical Council.
A

a

100
Q
  1. A healthcare insurer has breached the guidelines of the Association of British Insurers with
    regard to the opening of submitted medical reports. What has it failed to do?
    A. Ensure that all reports are opened by the Chief Medical Officer only.
    B. Ask all underwriting staff to sign a confidentiality agreement.
    C. Ensure that all opened reports are passed immediately to the Chief Medical Officer.
    D. Ensure that those who open the reports are authorised to do so on behalf of the Chief Medical
    Officer.
A

d

IF7 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions