Health Insurance (5th Edition) Mock Paper

1. Which one of the following is NOT a fundamental objective under the Singapore
Governments healthcare philosophy?

A. To nurture a healthy nation.

B. To transfer risks of high medical costs to insurers.
C. To provide good and affordable basic medical services.
D. To promote healthy competition among healthcare providers.

2. A Medical Expense Insurance is designed to:

A. reimburse the cost of medical treatment

B. provide a lump sum upon disability or a major illness
C. provide a periodic income upon disability or hospitalisation
D. improve the health condition of the insured through a science-backed wellness
programme

3. ____________ and ____________ are common expense participation methods used by

insurance companies.

A. Deductible; Risk pooling

B. Deductible; Co-insurance
C. Upfront costs; Risk pooling
D. Upfront costs; Co-insurance

4. Amy holds a Medical Expense Insurance policy with Apex Insurance Company (AIC)
covering the period of insurance from 1 April 2012 to 31 March 2013. This policy
specified a per annum deductible amount of S$1,000. On 1 March 2013, Amy tripped
and fell into a drain. She was hospitalised for a day and incurred S$650 in hospital
expenses. However, on 15 March 2013, she was stung by bees and was hospitalised for
two days in which she incurred S$850 in hospital expenses. How much would AIC have
reimbursed Amy for her two hospitalisation claims during the period of insurance?

A. S$0
B. S$500
C. S$1,000
D. S$1,500

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Health Insurance (5th Edition) Mock Paper

5. In the event of a claim under a Medical Expense Insurance policy, which one of the
following is a standard document that will be accepted by the insurer for the
assessment of the claim?

A. The agents statement.

B. Photocopy of the medical bills.
C. Completed claim form by the insured.
D. Medical report generated by the nursing director.

6. Insurance companies in Singapore apply the citizenship factor on hospitalisation claims

to:

A. reflect the privileges of citizenship

B. sharpen the distinction between citizens and permanent residents
C. lower the increasing claims costs from permanent residents and foreigners
D. account for differences in the healthcare subsidy level for citizens, permanent
residents and foreigners

7. Donald is a 40-year-old Singaporean self-employed tutor, who lives in a 3-room HDB flat
located at Tampines. Recently, he was hospitalised for five days in a C Class Ward of
the Changi General Hospital (CGH) for dengue fever. The total hospital bill of S$2,000 as
charged by CGH is fully reimbursed by the insurer. The cover that he has bought is
MOST LIKELY a __________ Insurance policy.

A. Critical Illness
B. Long-Term Care
C. Medical Expense
D. Hospital Cash (Income)

8. Which one of the following is NOT one of the reasons why exclusions and limitations are
imposed on Medical Expense Insurance policies?

A. To avoid the insured selecting against the insurer.

B. To allow the insurer to avoid paying too many claims.
C. To avoid the insured making a profit from his insurance.
D. To more clearly define necessary medical care and treatment.

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Health Insurance (5th Edition) Mock Paper

9. How is a group Medical Expense Insurance (MEI) plan different from an individual plan?

A. Cost of coverage per person is higher in a group MEI plan.

B. Underwriting is usually done on an individual basis in a group MEI plan.
C. Under a group MEI plan, a members coverage stops when he leaves the group.
D. Under a group MEI plan, each insured member will be issued with a policy
document to confirm his participation.

10. Which one of the following is a qualifying criterion for the Transferable Medical
Insurance Scheme (TMIS)?

A. Group size of at least five or more employees.

B. At least 25% of its local employees are covered.
C. Employers pay 100% of the premiums for the group plan.
D. The option to allow employees to opt out of the group plan.

11. As part of its employee benefit package, Able Best Company (ABC) has approached
Dynamic Insurance Broker (DIB) to provide a quotation on a Group Health Insurance
plan to cover its 50 employees. After careful review of the completed Group Insurance
Fact-Find (GIFF) Form submitted by ABC, DIB recommends that ABC should effect a
compulsory Group Insurance plan, as one of its advantages is that ABC:

A. pays only half of the benefit cost

B. has to monitor regular payroll deduction
C. has greater control on the benefit structure
D. incurs higher cost owing to more administrative work involved

12. Which one of the following is one of the features of the Portable Medical Benefits
Scheme (PMBS)?

A. Participating employers can enjoy automatic tax deductions.

B. An employee can continue to be medically insured even though he is in-between

jobs.

C. Participating employees can purchase more than one of the approved policies in
order to maximise the benefits.

D. The employee has to make voluntary monthly contributions to his Medisave

account to participate in the PMBS.

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13. Which one of the following statements about Disability Income Insurance is FALSE?

A. It can be purchased as a stand-alone policy or as a rider.

B. It is usually bought by working adults with earned income.
C. Its main purpose is to provide death coverage to the insured person.
D. It pegs benefits to a specified percentage of the salary of the insured.

14. Limitation of disability benefit clause means that the:

A. insured will not profit from the policy

B. insured can claim only from one policy
C. insured can claim only for benefits after the waiting period
D. premiums will be waived during the disability benefit payout period

15. Daniel, an engineer, who used to earn S$6,000 a month suffered spinal injuries in a
workplace accident. Subsequently, he found a replacement job working as an office
clerk earning S$1,500 per month. Daniel is covered under a Disability Income Insurance
that replaces 75% of his lost income in the event of total disability.

Calculate the partial disability benefit that Daniel will receive.

A. S$2,250
B. S$3,375
C. S$4,500
D. S$5,000

16. Gary is a general medical practitioner (family practice) who owns a private clinic in
Woodlands. As a result of serious injuries sustained in a motor accident, he suffers
Total Disability as defined in his Disability Income (DI) Insurance policy, and he cannot
go to his clinic to examine, diagnose, and treat patients. The term Total Disability as
specified in his DI Insurance policy will MOST LIKELY take the form of _____________
disability.

A. severe
B. any occupation
C. own occupation
D. modified own occupation

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17. One should purchase Long-Term Care Insurance at an early age because:

A. it will cost less as premiums rise considerably with age

B. the buyer is guaranteed to be insured at the standard rate
C. younger applicants can be provided with enhanced coverage
D. it will be easier to claim for benefits since the premiums paid up in the later years
will be substantial

18. A ______________ Long-Term Care Insurance policy is designed to pay an insured if he

meets the benefit trigger, regardless of the service use.

A. fee-based
B. service-based
C. disability-based
D. monthly benefit

19. The insured is eligible for Long-Term Care Insurance benefit if he:

A. is suffering from diabetes

B. is claiming for pre-existing conditions
C. does not fulfil the deferred period requirement
D. cannot perform a minimum number of activities of daily living

20. Long-Term Care Insurance:

A. has no restrictions on entry age

B. can be surrendered for cash value
C. shares in the surplus of the insurer
D. is usually issued on a guaranteed renewable basis

21. Which one of the following is a common feature of a Critical Illness Insurance policy?

A. Cover starts from inception of the policy.

B. There is no restriction on the age of entry.
C. A policyholder can buy as much Critical Illness coverage as he wants.
D. There is no restriction on how the Critical Illness benefit payable is to be used.

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22. Danny is covered for S$400,000 under a Whole-Life Insurance policy attached with a
25% Acceleration Critical Illness rider. He has been recently diagnosed with cancer that
is covered and is able to successfully claim for benefits on his policy. Assuming that
there is no attaching bonus to the policy, what will be the remaining sum assured for
death and total and permanent disability?

A. S$100,000
B. S$200,000
C. S$300,000
D. S$400,000

23. A Hospital Cash Insurance policy from ABC Insurer had the following features:

Waiting Period: 30 Days

Minimum Hospital Confinement Period: 24 hours
Expiry Age: 90 years

Which one of the following individuals would be able to claim under this policy?

A. Jasmine was hospitalised owing to high fever 15 days after inception of the policy.

B. Marcus underwent chemotherapy for lung cancer. This was a pre-existing medical
condition.

C. Joe, aged 25 years, was confined in the hospital for 12 hours owing to an infection
in his right eye.

D. Jane fractured her ankle when she accidentally fell down the stairs three days after
inception of the policy, and was subsequently hospitalised for five days.

24. Which one of the following scenarios would allow a policyholder to claim for medical
expense benefits under a Travel Insurance policy when travelling outside of Singapore?

A. Death caused by riots in Cairo.

B. Routine health check-up in Bangkok.
C. Normal delivery of a baby in Kuala Lumpur.
D. Hospitalised for dengue fever two days after returning to Singapore from Cape
Town.

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25. Which of the following statement(s) about Dental Care Insurance is/are TRUE?

A. No underwriting is needed.
B. It is generally offered on a group basis.
C. It is usually on a non-contributory basis.
D. All of the above.

26. Oscar bought a 10-year Term Insurance policy for a sum assured of S$50,000 with an
Additional Benefit Critical Illness rider of S$100,000. Which one of the following
statements relating to the benefit payment in a covered event is TRUE?

A. In the event of Oscars accidental death, the insurer will pay S$150,000.

B. In the event of Oscars accidental total and permanent disability, the insurer will pay
S$50,000 plus bonuses.

C. In the event of the maturity of the policy at the end of 10 years, the insurer will pay
S$50,000 plus bonuses.

D. In the event of Oscar being first diagnosed with brain cancer and who subsequently
died three months later, the insurer will pay S$150,000.

27. Under Managed Healthcare (MHC) schemes, which of the following is NOT used to
contain and control healthcare expenditure?

A. Cost.
B. Accessibility.
C. Quality of care.
D. Quantity of patients.

28. _____________ Model Health Maintenance Organisation (HMO) contracts with a large
group medical practice to provide medical care services to its member.

A. Staff
B. Group
C. Network
D. Independent Practitioners Association

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29. Which one of the following is a characteristic of a Preferred Provider Organisation

(PPO)?

A. A PPO uses primary care physicians as gatekeepers.

B. PPO members require lesser "out-of-pocket" payments.
C. PPO members can consult specialists without getting referrals.
D. A PPO is more restrictive in the choice of healthcare providers.

30. ____________ provides the greatest cost control but the lowest degree of choice of
providers.

A. Point-of-Service Plan
B. Preferred Provider Organisation
C. Traditional Medical Expense Insurance
D. Staff Model Health Maintenance Organisation

31. Richard, 55 years old, wishes to use his CPF Medisave to finance his Integrated Shield
Plan with an annual premium of S$2,500; ElderShield with an annual premium of S$300;
and ElderShield Supplements with an annual premium of S$1,000.

Assuming the applicable withdrawal limits (per person per year) for the following
Medisave-Approved Medical Insurance plans are:

MediShield: No limit
Integrated Shield Plan: S$800 (aged 65 years and below)
ElderShield: No limit
ElderShield Supplements: S$600

Calculate the TOTAL amount that Richard will have to pay in cash after withdrawing the
maximum amount from his Medisave.

A. S$0
B. S$1,700
C. S$2,100
D. S$2,400

32. MediShield cover will NOT be renewed when the insured:

A. reaches the age of 85 years

B. renounces his Singapore citizenship
C. upgrades to an Integrated Shield Plan
D. uses his spouses Medisave to pay for his renewal premium

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33. How is a Private Integrated Shield Plan different from the CPF MediShield Scheme?

A. A Private Integrated Shield Plan has no expiry age limit.

B. A Private Integrated Shield Plan can only be paid in cash.

C. There is no cap on the annual limits under a Private Integrated Shield Plan.

D. A Private Integrated Shield Plan is designed for B2 and C class wards in public
hospital stay.

34. Which one of the following does NOT fall under the Activities of Daily Living (ADLs) as
specified in the ElderShield Scheme?

A. Talking.
B. Feeding.
C. Washing.
D. Dressing.

35. In an insurance policy, the insuring clause:

A. includes the effective date of cover

B. confirms that the policy is guaranteed renewable
C. states the annual premium payable by the policy owner
D. represents the insurers promise to pay under the conditions as specified in the
policy

36. Which one of the following documents will form the "Entire Contract" in a Health
Insurance policy?

A. Proposal form and Fact-Find form.

B. Policy document and Proposal form.
C. Product Summary and Fact-Find form.
D. Policy document and Benefit Illustration.

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37. John has two medical insurance plans, namely a Private Integrated Shield Plan and a
Group Health Benefits Plan sponsored by his employer. If John is hospitalised and he
claims from both policies, how will the reimbursements be settled?

A. Each plan will pay out benefits in equal proportions.

B. Each plan will pay out the claimed amount in full to John.

C. The Private Integrated Shield Plan will be the last payer in reimbursing the claim.

D. The Private Integrated Shield Plan will pay out first, subject to the benefit limits, and
the Group Health Benefits Plan will reimburse the remaining amount.

38. An endorsement attaching to an insurance policy:

A. has no legal effect

B. modifies the policy provision
C. is independent of the policy
D. provides additional benefits at no extra cost

39. When pricing Health Insurance products, insurance companies will charge females a
___________ rate than males because ______________.

A. lower; women statistically have a higher longevity rate than men

B. higher; women statistically have a lower longevity rate than men
C. lower; the medical claims costs for women are statistically lower than men
D. higher; the medical claims costs for women are statistically higher than men

40. The primary consideration in Health Insurance pricing is the ________ rate.

A. interest
B. inflation
C. mortality
D. morbidity

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41. The proposers income and his overall financial situation are the MOST important
factors in underwriting ______________ Insurance.

A. Critical Illness
B. Long-Term Care
C. Medical Expense
D. Disability Income

42. An insurance representative can help in the underwriting process by:

A. understanding the insurers underwriting guidelines

B. establishing the clients motivation and needs to purchase the policy
C. ensuring that the proposal form is duly completed and signed by the proposer
D. taking all of the above actions

43. When an insurance representative sells an Accident and Health Insurance policy, he
should disclose:

A. his name
B. any conflict of interest
C. the name of the insurer that he is representing
D. all of the above information

44. When selling an Accident and Health (A&H) Insurance policy, what should an insurance
representative do if the client rejects his recommendation and requests to purchase
another A&H Insurance policy?

The insurance representative should:

A. reject the request and file a report with his supervisor

B. ask the client to look for another insurance representative
C. proceed with the request but document the clients decision
D. get the client to sign a waiver of liability form before proceeding with the request

45. When marketing Accident and Health Insurance policies to clients or prospective clients,
the insurance representative should provide them with copies of the Fact-Find Form;:

A. Health Insurance and You, and Product Summary

B. Health Insurance and You, and Benefit illustration
C. Your Guide to Health Insurance, and Product Summary
D. Your Guide to Health Insurance, and Benefit illustration

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Health Insurance (5th Edition) Mock Paper

46. Which of the following is/are acceptable post-sales disclosure step(s) if an insurer
makes modifications to the key provisions of a policy?

A. Post a notice on its website indicating changes to the policy terms.

B. Obtain written acceptances of the modified terms from policyholders.

C. Advertise on the newspapers informing policyholders of the changes to the policy

terms.

D. Send a written notice to each policyholder only after the modifications have taken
effect.

47. Which one of the following is the MOST important factor to consider, when selecting an
insurance product to recommend to the prospective client?

A. Attitude of the client.

B. Lifestyle of the client.
C. Affordability of the client.
D. Financial knowledge of the client.

48. Rebecca, an insurance representative, is marketing a Health Insurance product to her

friend, Samuel. Which one of the following illustrates needs selling by Rebecca?

A. Rebecca offers a rebate of 50% of the commissions earned if Samuel buys the
product.

B. Rebecca explains how this product addresses the concerns of Samuel as stated in
his fact-find form.

C. Rebecca focuses on the features of the product, explaining how it will benefit
Samuel if he is hospitalised.

D. Rebecca tells Samuel to purchase now because the 10% discount for this product
will end in a weeks time.

49. An emergency fund is important for the client because it can:

A. act as a safeguard against retrenchment

B. be invested in speculative assets to generate higher returns
C. be used to purchase big ticket items such as down payment for a house
D. help him to buy more expensive policies from the insurance representative

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Health Insurance (5th Edition) Mock Paper

50. Given the following information and assumptions in Simons fact-find form:

Familys monthly average living expenses = S$5,000

Inflation rate = 3%
Rate of return = 7%
Number of years income is needed = 25 years
Existing insurance coverage = S$46,000

Calculate the additional amount of total and permanent disability benefit required by Simon.

A. S$882,820
B. S$928,820
C. S$974,820
D. S$1,500,000

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Health Insurance (5th Edition) Mock Paper

Answers to Mock Paper

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

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