REVIEW OF THE INDIVIDUAL RISK ASPECTS MODULE OF THE

PERSONAL INSURANCE: (RISP) LIFE, ACCIDENT AND SICKNESS

(PERSONAL ACCIDENT, MEDICAL EXPENSES AND HEALTH)

NAME: QUALIFICATION:
COMPANY:
DATE: TOTAL TIME OF
ANSWER:

Instructions: Check the answer you think is correct.

1. Where can the statistical records of deaths occurring each year within an initial group of
persons of a given age be observed?
a) INEGI records.
b) The Deaths Occurred Tables.
c) In the Mortality Tables.

2. What is the most important element of the Mortality Table and what is taken as the basis
for determining the cost of insurance?
a) Mortality rate.
b) Mortality rate.
c) Group average.

3. What do we mean when we say that it is the payment of each of the insured to
compensate the economic losses resulting from the group of deaths in which they are
stratified?
a) Economic investment.
b) Average Insurance Payment.
c) Cost of Insurance.

4. These are some of the types of premiums handled in insurance.

a) Level premium, partial investment premium, pure premium .
b) Net level premium, tariff premium, pure risk premium.
c) Decreasing premium, ascending economic leveling premium.

5. What is the pure risk premium based on?

a) In mortality tables.
b) In the average actuarial tables.
c) In the ascending risk rate.

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 6. Relate the "Premiums" columns to the "Characteristics" column.

( a ) Pure Premium A) Onlyfor the pure risk of death.

( e ) Natural
Premium B) It is the additional cost applied to the premium and is
Ascending calculated based on some factors that make the mortality risk
higher.
( g ) Decreasing C) Containsthe premium rate expenses and incorporates
premium surcharges, taxes and the policy fee, and VAT, although in life
this tax is not charged.
D) Is the one that is charged in a single exhibition.
( i ) Rate Premium
( c ) Total premium E) It is calculated year by year at the age reached by the
insured.
( h ) Accrued F) It is the premium that the insured decides to pay in two or more
premium installments.
( f ) Fractional G) It is the one that has a decrease in its amount as time goes
premium by.

( j ) Level premium H) Is that which is charged for the risk being run in a given period.
( b ) Extra Premium I) Premiums that also take into account the operating expenses
incurred by an insurance company.
J) This does not increase or decrease as long as the policy
( d ) Single premium remains in force.

7. What is the waiting period to claim the disability benefit for Organic Loss in Life
insurance, when the Insured has lost both eyes?
a) As determined by IMSS
b) 90 days.
c) 360 days
d) No waiting period.

8. What are the two types of premiums that a policyholder can pay under the
Life?
a) Pure risk premium. 1. a, b
b) Gross Premium. 2, b, c
c) Premium plus VAT 3. a, d
d) Level premium. 4. b, d

9. What do we call the premium that remains constant throughout the term of the
insurance?
a) Premium released.
b) Level premium.
c) Constant investment premium.

11. What do you call the company's overhead expenses derived from its operation: rent,
telephone, staff salaries, stationery, etc.?

a) Acquisition costs.

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 b) Administrative expenses.
c) Investment expenses.

12. What is the name given to the surplus paid during the first years of the policy through
the Level Premium?
a) Average premium.
b) Contingency reserve.
c) Mathematical reserve.

13. What factors influence an insurance proposal for the company to determine that it is
extra-premium insurance?
a) Medical and non-medical factors.
b) Occupational factors and occupational risk factors.
c) Determining factors, apparent to the eye and those stated by the
proposer as known and to be known by the proposer.

14. The following Life Insurance Plans offer investment options and guaranteed securities,
except:
a) Dotales c) Ordinary Life.
b) Temporary d) Life Limited Payments.

15. What is the name given to the rights that the policyholder can exercise to dispose of the
mathematical reserve?
a) Guaranteed values.
b) Reserve values.
c) Secured loan.

16. What type of loan operates when the insured receives part of his reserves in the form
of a loan with the interest rate equivalent to that which the company would obtain?
a) Automatic loan.
b) Loan extended.
c) Ordinary loan.

17. What type of loan does the insurance company grant to the insured to cover the
payment of some subsequent premiums that the insured has failed to cover?
a) Automatic Loan
b) Ordinary Loan.
c) Balanced Loan.

18. What type of insurance does the insured use to pay a single premium coverage for the
same term as originally contracted, but with a lower sum insured?
a) Insurance Extended.
b) Insurance Paid in full.
c) Ordinary Life Insurance.

19. What type of insurance does the insured use to keep the same sum insured but with a
shorter term than originally contracted?

a) Insurance Paid in full.

b) Insurance Extended.
c) Automatic Insurance.

20. What do you call the surplus that companies usually share with their policyholders?

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 a) Dividends.
b) Interest.
c) Rescue.

21. What type of insurance is the one that ensures that the family has the necessary
elements to maintain itself in a similar way despite the death or disability of the insured
person?
a) Major Medical Insurance.
b) Disability Accident Insurance.
c) Life Insurance.

22. How many days does the insured have to make the modifications to his contracted
policy?
a) 30 working days.
b) 15 calendar days.
c) 30 calendar days.

23. How long does an insurance policy have to be in force without interruption before it can
no longer be disputed?
a) 2 years of uninterrupted validity.
b) 1 year term
c) After 2 years

24. In what type of insurance does the lack of restrictions apply?

a) Medical expenses.
b) Damage.
c) Life.

25. From what age does the insurance take effect in the event of death when the insurance
is for minors?
a) From 18 years of age.
b) From 12 years of age.
c) From 25 years of age.

26. What is the Company obligated to do if the insured is under 12 years of age at the time
of death?
a) The Company shall pay the sum insured contracted in the death
coverage.
b) The Company will refund the premiums paid at the time of loss.
c) The Company shall pay the mathematical reserve reached at the
time of loss.

27. What type of insurance do we mean when the insured pays only for a certain number of
years and remains insured for life?

a) Life Limited Payments.

b) Ordinary Life.
c) Temporary.

28. What types of additional benefits are considered for life insurance?
a) Accident and Disability Benefits.
b) Benefits for medical expenses, organic losses and double
indemnity.

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 c) Group accident benefits, ultimate expenses and organic losses.

29. At what age is the accidental death benefit terminated?

a) 65 years.
b) 70 years.
c) 55 years.

30. In Life Insurance, what happens when the contract is terminated due to an inaccurate
declaration of the insured's age?
a) Dividends are returned.
b) The existing mathematical reserve is recovered.
c) The premiums are adjusted to the actual age.

31. What benefit do we refer to when an accident or illness prevents the insured from
performing all the activities of his normal job for at least 6 months?
a) Total and Permanent Disability.
b) Partial Disability
c) Premium Waiver Benefit.

32. In which cases is the waiting period not necessary to declare Total and Permanent
Disability?
a) When declared by the Insurance Company.
b) Upon declaration of absolute loss of sight, both hands or both feet
or their combination.
c) When declared by a physician.

33. What does the term "amount to be applied when favorable circumstances exist for the
appraisal of an insurance proposal" refer to?
a) Surcharge.
b) Discounts.
c) Extra Prima.
d) Benefits.

34. Under what clause will the insurance company pay the beneficiaries an advance on the
sum insured of the basic plan?
a) Death benefit advance.
b) Funeral Expenses
c) Death.

35. What are the two ways to manage the Sum Insured in Life Insurance?

a) Payment in a single exhibition. 1. a,b 2. b,c

b) Through an Individual Investment Fund. 3. a, d 4. b, d
c) Only the interest on the indemnity is paid.
d) Through a Trust.

36. These are the conditions for the operation of the Funeral Expenses benefit in the Life
Insurance, Except:
a) Advance of a percentage of the sum insured of the basic plan.
b) Payment of the sum insured contracted for this coverage.
c) It does not have guaranteed values.
d) By simply presenting the Death Certificate.

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37. The following are features of the Life insurance benefits, except:
a) Its term may be less than the basic coverage.
b) You can choose the sum insured, even if it is higher
c) Coverage that refers to risks that threaten the individual, without necessarily
implying death, are optional for the insured.
d) They are always disputable.

38. The following are Life Insurance benefits, except:

a) Accident Compensation.
b) Compensation for partial temporary disability.
c) Monthly income for total permanent disability.
d) Exemption from payment of premiums for total permanent disability.

39. These are the conditions to make use of the Guaranteed Securities, except:
a) To have three annuities paid.
b) The contracted plan must be for at least 10 years.
c) Cancel additional benefits.
d) Pay with a level premium.

40. Who will receive the sum insured if the beneficiaries die at the same time?
a) The legal succession of the insured.
b) Anyone who proves a relationship with a beneficiary.
c) Succession of beneficiaries.
d) The Insurer retains it in reserves pending fulfillment.

41. How will the Sum Insured be divided when there is no designated beneficiary?
a) 50% for the spouse and 50% for the descendants.
b) 100% for their children.
c) 50% for the wife and 50% for the parents.
d) 100% for their parents.

42. What is the name given to an event arising from an external, sudden, fortuitous and
violent cause that results in bodily injury or death of the insured?
a) Accident.
b) Sudden Event.
c) Incident.

43. In the Personal Accident Insurance, we will not accept ages over ?
a) 60 years.
b) 65 years.
c) 70 years.

44. What are the types of indemnity scales used by the insurance company to compensate
a personal accident insurance loss?

a) Table of special payments for losses.

b) Scale A and B.
c) Organic Loss Recovery Scale.

45. How does the company indemnify in the personal accident insurance, if the insured
suffers an accident in which he loses an arm and a hand, while traveling in a private airplane
What coverage would affect the indemnity?

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 a) On the benefit of Organic or Member Losses.
b) Under the daily partial disability indemnity benefit.
c) Under the additional benefits contracted.
d) In a risk by express agreement that has not been contracted.

46. All coverages can be contracted in the Personal Accident Insurance, except:
a) Reimbursement of Medical Expenses.
b) Partial or total disability due to accident.
c) Life Annuity for Disability.
d) Organic Losses.

47. When is the disability benefit paid to an insured under Personal Accident insurance?

a) When he demonstrates that he is unable to perform the work he

was performing during the term of the contract.
b) When determined by the company.
c)When the insured presents the IMSS diagnosis.

48. What is the minimum age of acceptance for daily disability indemnity coverage under
personal accident insurance?
a) 12 years
b) 16 years old
c) 18 years old

49. What is the maximum time for which reimbursement of medical expenses incurred as a
result of an accident covered by an A P Policy will be paid?

a) 300 days after the accident.

b) 1460 days.
c) 365 days from the date of the accident.

50. What expenses are not covered by a Personal Accident Policy?

a) Expenses for extra bed for the insured's companion.
b) Hospital expenses generated by the disabled person.
c) Expenses incurred by the insured without the consent of the
company.

51. By what percentage is an insured indemnified under a Personal Accident policy when
he/she suffers the loss of both feet or the loss of sight in both eyes?
a) 50% of the total
b) In 100% of
c) In 30% of

52. What is the basic coverage of Personal Accident insurance?

a) Accidental Death
b) Organic Losses.
c) Total and Partial Disability

53. What are the most important factors involved in risk assessment for Personal Accident
insurance?
a) Occupation.
b) Sports and hobbies.

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 c) Medical history and family
d) Maximum sum insured and sub-normal risks.

1. a, b, d
2. b, c, d
3. a, b, c
4. a, c, d

54. How long does it take to pay the first medical expenses under the Personal Accident
insurance policy for the Accident Medical Expense Reimbursement coverage to be
effective?

a) Ambulance expenses exceeding 20% of the Sum Insured.

b) Those carried out in the first 10 days after the accident.
c) Those disbursed one year after the accident.
d) Within the first two years, prior to the statute of limitations.

55. Compare the column on the left with the column on the right and choose the correct
answer.
A) Ambulance transfer of the Insured Party.
( d ) ( c ) Organic losses.
B) Inability to perform his or her occupation.

( b ) Daily Incapacity
C) Separation of the hand from the side of the
( a ) Medical Expenses hand. wrist.
upper
D) Separation of a phalanx of the index finger.

56. From the following list, choose two perils that are excluded from the Personal Accident
policy.
a) Poisoning. c) Loss of the hand from the wrist
b) Diving injuries. d) Self-injury due to mental illness

1. a, c 3. b, d
2. a, b 4. a, d

57. What do we mean when we mention that it is the "alteration of health resulting from the
action of morbid agents of internal or external origin in relation to the organism"?
a) Organic loss.
b) Accident.
c) Disease.
d) Disability.

58. Indicate what are the characteristics of a pre-existing disease:

a) One that at the date of initiation was diagnosed by a physician.
b) That disease that the insured already had, but without symptomatology.
c) Apparent to the eye.
d) Disease that, due to its symptoms or manifestations, could not go unnoticed.

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 1. b,c,d
2. a,c,d
3. a,b,c

59. It is one of the features of the benefit period for Medical Expense insurance.

a) The insured has 30 days to pay the insurance premium.

b) Upon exhaustion of the maximum limit of liability or medical discharge.
c) This is the time the insured has to include his or her beneficiaries.

60. What is the amount payable by the insured for each accident or illness covered by the
Medical Expenses insurance and which is generally determined by a percentage?
a) Deductible.
b) Coinsurance.
c) Co-payment.

61. How many deductibles does an insured have to pay when several insureds of the same
policy are affected?
a) According to the number of insured.
b) One time only.

c) At least three times.

62. The following are treatments that in no case are covered by the Medical Expenses
policy, except:
a) Obesity. c) Physical therapy for rehabilitation
b) Birth Control d) Psychiatric.

63. What is the name given to a condition whose symptoms or signs manifest themselves
over a long period of time?
a) Pre-existing. c) Epidemiological.
b) Covered d) Chronic.

64. What are the types of payments made by the insurance company to the policyholders
of a Medical Expenses policy?
a) Sick Pay and Accident Pay.
b) Payment by Reimbursement of Expenses and Direct Payment.
c) Agreed payment and tacit payment.

65. What documents does the insurance company request in order to pay a Medical
Expenses claim?
a) Notice of accident or illness.
b) Medical report.
c) Original receipts.
d) Pre-existing diagnoses.

1. a,c,d,
2. a,b,c,
3. b,c,d,
66. Is this expense not covered by a Medical Expense policy?
a) Expenses incurred after the accident.
b) Pre-existing condition expenses.

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 c) Hospitalization expenses.

67. What expenses are not covered by a medical expense policy?

a) Psychiatric treatments.
b) Expenses prescribed by an authorized physician.
c) alcoholism treatment.
d) circumcision.

1. a,c,d,
2. a,b,c,
3. b,c,d,
4. a,b,d,

68. For what type of care are Specialized Health Care Institutions considered?
a) The promotion, prevention and rehabilitation of people suffering from diseases.
b) Care of serious terminal illnesses, with psychological support.
c) Health promotion, prevention, diagnosis, treatment and rehabilitation.

69. The following are objectives of Health Insurance, Except:

a) Maternity care. c) Restore health.
b) Health prevention measures. d) Compensation for disability.

70. What is the role of the Ministry of Health with respect to Specialized Health Insurance
Institutions?
a) To be arbitrator in lawsuits between the insured and the physician.
b) Issuing Health Insurance policies.
c) Act as conciliator between the insured and the physician.
d) To issue medical advice opinions.

71. What is the procedure to be followed in the event that an agreement is not reached in
the Conciliation Board promoted by CONAMED due to a disagreement in the Health
Insurance?
a) A commercial lawsuit is filed.
b) An arbitration lawsuit is filed
c) A civil lawsuit is filed.
d) A criminal lawsuit is filed.

72. All of the following risks can be covered by Health Insurance, except:
a) Accident.
b) Disease.
c) Death.
d) Maternity.

73. Of the following services choose those provided by Health Insurance.

a) b) Vaccination. c) Application of fluoride
Minor surgery. d) Diagnosis of gastritis.

1. a, b 3. a, d
2. b, c 4. c, d

74. What types of expenses are covered by health insurance?

a) Major and minor medical expenses.
b) Accident medical expenses

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 c) Minor medical expenses

75. Health insurance has the following characteristics:

a) Rehabilitation
b) Diversification.
c) Prevention.
d) Diagnosis and Treatment.

1. a,c,d
2. b,c,d
3. a,b,c,

76. What are ISES?

a) Medical Insurance Institutions.
b) Specialized Health Insurance Institutions.
c) Social Security Institutions.

77. What is the name given to the financial participation charged to the insured when using
health services?
a) Deductible.
b) Coinsurance.
c) Co-payment.

78. Which table indicates the probability that a person of a given age will suffer illness or
disability?

a) Mortality Table.
b) Sickness Compensation Table.
c) Morbidity Table.

79. Where is the conciliation and arbitration procedure followed for the dispute resulting
from a health insurance?
a) CONDUSEF.
b) CONSAR.
c) CONAMED

80. To which agency other than the CNSF should the ISES be subject to?
a) To the Secretary of Health.
b) Social Security
c) To ISSTE

81. Choose the example that best describes the concept of scheduled surgery.
a) The insured and the physician agree on the timing of the operation.
b) The insured files the claim immediately after the operation.
c) The physician notifies the insurance company that he will perform an operation.
d) The insurer authorizes the surgery before it is performed.

82. They are considered first contact services in the health insurance:
a) General medicine.
b) Pediatrics.
c) Gynecology.
d) Thanatology.

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 1. a,c,d
2. b.c.d
3. a,b,c

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 TABLE OF QUALIFICATIONS
Hits Rating % Rating
82 100
81 98.78
80 97.56
79 96.34
78 85.12
77 93.90
76 92.68
75 91.46
74 90.24
73 89.02
72 87.80
71 68.58
70 85.36
69 84.14
68 82.92
67 81.70
66 80.48

Participant's Name and Signature:

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